Carrying Out an Assessment

1. At what Stage of the Care and Support Process Should an Assessment be Carried Out

The statutory guidance defines the start of the process of assessment as being when the Local Authority begins to gather information about a person or carer. From the first point of contact, the Local Authority should give the person or carer as much information as possible about how the information it is gathering will be used and about the assessment process itself.

The assessment process is not complete until the Local Authority is satisfied that it has an accurate and complete reflection of the person’s (or carer’s) needs, outcomes and the impact of needs on Individual Wellbeing.

2. Who Should Carry Out the Assessment?

General Requirements of the Care Act

When making a decision about who should carry out a particular assessment under the Care Act the Local Authority must:

1. . Ensure that any assessor is appropriately trained and has the skills, knowledge and competence required to carry out an assessment on behalf of the Local Authority (including knowledge of Local Authority processes and the assessment requirements and duties of the Act);
2. Ensure that any assessor has the skills, knowledge and competence to carry out an assessment with the particular person or carer in question (this may include specialist knowledge or skills, for example that they are able to adapt communication to engage with a person who has a severe learning disability or are able to work confidently alongside other professionals if required or have a good understanding of the complexities and difficulties associated with particular health conditions);
3. Give regard to the views and wishes of the person or carer themselves and if they have a preference about who the assessor should be and any particular skills they will require.

It is possible for an assessor to be competent but still lack some of the skills and knowledge required to carry out an assessment with a particular carer or person, perhaps through a lack of experience working with a particular condition. In this case the Local Authority must consider whether the support of an expert is required to ensure that the person’s needs are fully understood and captured in the assessment.  Alternatively the Care Act makes provision for assessments to be carried out jointly if required.

Assessing People with Autism

Under the Care Act, anyone carrying out any care and support process with a person with Autism should have an understanding of the condition. Where this is not the case, they must involve or consult someone who does.

In addition to the above, the Health and Care Act 2022 requires all health and social care service providers registered with the Care Quality Commission to provide employees with training on autism and learning disabilities appropriate to their role (called Oliver McGowan Training). This applies to Local Authority/ICB registered provision as well as to commissioned services.

Assessing People who are Deafblind

The Care Act sets out specific requirements in relation to the assessment of a person who is deafblind. These requirements also apply:

1. To carers assessments when the person being cared for is deafblind;
2. Regardless of the nature or format of the assessment (for example whether it is a face to face assessment, telephone assessment, online assessment or supported self-assessment).

Under Care Act Regulations, deafblind is defined as having a combined sight and hearing impairment (including progressive sight and hearing loss) which causes the person difficulties with communication, access to information and mobility.

Assessments for people who are deafblind (or carers who provide care to a deafblind person) must be carried out by an assessor who has specific training and expertise relating to people who are deafblind. Whilst the assessor does not have to be a qualified Social Worker or Occupational Therapist they must have a minimum training level of at least QCF or OCN Level 3 to carry out an assessment for someone who is deafblind.

Where an assessment is delegated to an external specialist the Local Authority must provide them with:

1. In the case of a needs assessment any relevant information which it may have about the person; and
2. In the case of a carer's assessment any relevant information about the carer and also the person needing care.

If a person who is deafblind has other health needs, the assessor who is skilled in working with people who are deafblind may not be suitably skilled and knowledgeable about other areas of need. In this case the Care Act makes provision for consultation with relevant experts or for joint assessments to be completed (either with another Local Authority assessor or an assessor from another organisation e.g. health).

3. Methods of Assessment

The Statutory guidance provides the following examples of different methods of assessment, although the Act does require the Local Authority to be flexible in its approach to assessment and able to adapt the assessment process to maximise the involvement of each person or carer. Whichever method is adopted, the Local Authority must ensure it fulfils all statutory duties, including those relating to safeguarding, advocacy and mental capacity.

A Face to Face Assessment

Normally carried out in the person or carer's home this involves the assessor meeting face to face with the person being assessed.

A Telephone Assessment

Normally used for reassessments following a change in circumstances, where people have no communication difficulties and where needs appear to be less complex this involves one or more telephone conversations between the person or carer and the assessor.

An Online Assessment

Online assessments are often used where the person has non-complex needs, is not able to communicate their views verbally but is able to do so electronically.

A Combined Assessment

The Local Authority may combine the assessment of a person with the assessment of a carer where both parties agree to this. The statutory guidance recognises the benefits of doing so in that it avoids duplication (especially for the carer) and saves time for the authority.

Where either the person or the carer does not want a combined assessment, the Local Authority must complete separate assessments. The Local Authority must also complete separate assessments when it does not consider a combined assessment to be appropriate.

A Joint or Integrated Assessment

Some people will have needs that are being met or will be met by various bodies. In these situations, a joint assessment between the Local Authority and these bodies may be beneficial, as it will provide a holistic approach and can lead to a better understanding of the persons various needs. It will also avoid the person having to undergo several assessment processes and repeating information multiple times.

So long as the person consents (or if they lack capacity it is deemed in their best interests) the Care Act permits the Local Authority to carry out a joint assessment with any other organisation, including but not limited to:

1. Other areas of Adult Care and Support (e.g. Social Work or Occupational Therapy);
2. Children's services;
3. Health professionals;
4. Mental Health professionals;
5. Experts in the voluntary sector; and
6. Housing;

A joint assessment does not necessarily mean that just one of the various bodies' assessment tools will be used or that a joint assessment report will be written. It can mean that the different bodies involved co-ordinate their approach to assessment by arranging to meet with the person at the same time in order to gather information about needs, make decisions and understand the role that the other bodies are taking in meeting needs.

The statutory guidance does place special emphasis on the need for health and social care to deliver a co-ordinated assessment when it is known that a person has both health and social care needs. To achieve this the guidance sets out that health and social care should:

1. Develop and agree a co-ordinated assessment process based on the needs and wishes of the particular person being assessed;
2. Share information with each other to ensure that the support and services being provided are aligned and complimenting each other;
3. Link together Care and Support / Care plans wherever possible so there is a single, shared care pathway for the person.

Supported Self-Assessment

A supported self-assessment is so called because it is a process of assessment where the Local Authority supports the person or carer to complete as much of the assessment as they are able to (or want to) themself.

Some people will be able to complete a full self-assessment of their own needs with very little support from the Local Authority, while others may be able to complete some aspects independently but require much more Local Authority support to assess others.

The person or carer can choose who they want to support them during self-assessment (although the Local Authority still has a duty to make Independent Advocacy available if they feel the person or carer has substantial difficulties). They can also decide who to consult with.

To facilitate the carrying out of a supported self-assessment the Local Authority must:

1. In the case of a needs assessment provide the person with any relevant information it may have about them; and
2. In the case of a carers self-assessment provide any relevant information to the carer it has about them, and also about the person needing care (so long as the person has consented for this to be provided or, if they lack capacity to consent a decision is made by the Local Authority that sharing information is in their best interests).

Any information provided to facilitate the carrying out of a supported self-assessment should, wherever possible be provided in a format accessible to the person or carer it is being given to.

The process of a supported self-assessment should be similar to the process of any other needs or carer's assessment, in terms of the information gathered from the person or carer. The information will be used in the same way, to determine eligible needs and gain an understanding about the best ways to support those needs.

A supported self-assessment is not completed until the Local Authority has assured itself that the information within it is a true representation of the person's (or carer’s) needs. This should be done proportionately and not by seemingly repeating the whole assessment process again. Depending on the circumstances, the Local Authority could consult with the person or carer, anyone else who has been involved in the supported self-assessment (so long as the person or carer consents or it is deemed in their best interests to do so) or anyone else that the Local Authority feels should be consulted (again only with the consent of the person or carer or after a best interests determination).

A Delegated Assessment

Under the Care Act, the Local Authority is able to delegate many Care and Support functions, including assessment.

Examples of circumstances when delegation can occur include when the needs of the person are specialist (for example those people who are deafblind), or where the person lives in the area of a different Local Authority. Some Local Authorities will delegate carers assessments to a local Carers Service.

In all cases, the body to whom the assessment is delegated must be in agreement.

When the Local Authority delegates a function it must provide all necessary resources and information required to ensure that delegated function can be completed.

Although the Local Authority can delegate the function, that does not relieve it of statutory responsibilities. It must ensure that the functions being carried out by others on its behalf fulfil all relevant duties (for example the provision of an Independent Advocate for people who have substantial difficulties being involved in assessment). In the eyes of the law all delegated functions are seen as having been carried out by the Local Authority.

4. Appropriate and Proportionate Assessment

The Care Act is clear that the nature of assessment will not be the same for every person or carer and, depending on the circumstances it could range from a brief process which helps a person with lower needs to access support in their community, to a more intensive, sustained process which requires the input of a number of professionals.

Under the Care and Support (Assessment) Regulations 2014 the Local Authority must be flexible in its approach to assessment and carry out any assessment in a manner which:

1. Is appropriate and proportionate to the needs and circumstances of the person or carer to whom it relates; and
2. Ensures that the person is able to participate in the process as effectively as possible.

In seeking to ensure that an assessment is carried out in an appropriate and proportionate manner, a Local Authority must have regard to:

1. The wishes and preferences of the person or carer;
2. The outcome the person or carer seeks from the assessment; and
3. The severity and overall extent of the person and/or carers needs.

Some of the other factors that should be considered when deciding in a proportionate and appropriate method of assessment include:

1. Whether there is a concern about the person capacity in relation to a particular decision to be made. In this situation the Care Act requires the Local Authority to carry out a face to face assessment;
2. Whether the method of assessment chosen by the Local Authority poses any challenges or risks for the person (or persons in general if the Local Authority intends to have a preferred method of Assessment);
3. The specific communication needs of the person or carer (the Local Authority has a duty of care to carry out an assessment in a way that enables them to recognise the needs of those who may not be able to put these into words);
4. The potential fluctuation of the person or carers needs or situation; and
5. Any need for multidisciplinary working or assessment.

5. Preparing the Person or Carer for the Assessment

Provision of Information about the Assessment

The Local Authority must give information about the assessment process to the person or carer whose needs are being assessed at the earliest opportunity. This should include:

1. What can be expected during the assessment process;
2. The format that the assessment will take (e.g. telephone assessment, face-to-face assessment);
3. The indicative timeframe for assessment;
4. The complaints process; and
5. Information about possible access to independent advocacy.

The Local Authority should also provide a list of questions that will be asked of them during the assessment. This will help the person or carer to prepare for the assessment and to think about their Wellbeing, the impact of their needs on this and what outcomes they want to achieve.

If the person lacks capacity, the above information must be given to their carer or the person who will be supporting them during the assessment (this could be an Independent Advocate).

The information should be provided prior to the assessment wherever practicable, and in a format which is accessible to the person to whom it is given.

Establishing Substantial Difficulty and the Need for Independent Advocacy

In providing information about the assessment it should become clear whether the person or carer is likely to have substantial difficulty being involved in the assessment process. As soon as this is established the Local Authority must consider whether the duty to arrange independent advocacy applies and, if so make the necessary arrangements.

For further detail see The Duty to Provide an Independent Advocate section of this resource.

The Local Authority must also consider any specialist communication or engagement support the person may need and make arrangements for this. This could include an Interpreter or support from a Speech and Language Therapist.

Assessing Mental Capacity

If the Local Authority feels that the person to be assessed may lack capacity to be involved in the process, it must carry out a mental capacity assessment so that appropriate support can be arranged if necessary.

Depending on the circumstances, appropriate support could be appointment of either an Independent Advocate under the Care Act or an Independent Mental Capacity Advocate (IMCA) under the Mental Capacity Act.

For further detail see The Duty to Provide an Independent Advocate section of this resource.

Where the person lacks capacity information about the assessment must be given to their carer or the person who will be supporting them during the assessment (this could be an Independent Advocate).

Other Factors to Consider

Regardless of whether the person or carer has substantial difficulties or lacks capacity, the Local Authority should consider the impact of the assessment process itself on their condition(s) or situation. Some people find the whole process very worrying and this can cause considerable anxiety. Others may find the physical process of assessment strenuous. Local authorities have a duty under the Care Act to give regard to the wishes and preferences of the person or carer and should consider this in respect to the timing of assessment, the method and the location of any meeting.

Financial Assessment

The Local Authority should inform the person or carer that a financial assessment will take place in due course and that the outcome of this will determine whether they will need to make a financial contribution to the cost of any support, services or equipment arranged by the Local Authority.

For further detail about specific information about financial assessment that must be given under the Care Act see the Providing Information and Advice section of this resource.

6. The Timeframe for Assessment

The statutory guidance states that an assessment should be carried out over an appropriate and reasonable timeframe taking into account the urgency of the needs or situation and consideration of any fluctuating needs. The Local Authority has a duty to facilitate and ensure the involvement of the person or carer in their assessment and the process of assessment must be flexible enough to enable this to happen.

The Local Authority should inform the person or carer of an indicative timescale for assessment and keep them informed as the assessment progresses.

Fluctuating Needs

Where the level of the person or carers needs fluctuate, the Local Authority should extend the process of assessment so that it covers such a period as the Local Authority considers necessary to establish their level of needs accurately. Judgements should not normally be made about the level of need based on either a 'worse case' or 'best case' scenario.

Pausing the Assessment Process

7. The Assessment Conversation

Supporting the Person/Carer to Understand their Situation

The Care Act is clear that the person should be as fully involved in their assessment process as possible. This includes being able to express their wishes and feelings, weigh up options and make decisions. In order to facilitate and support this involvement, the Local Authority must support the person to understand all their needs and all the areas of their Wellbeing, so that they can:

1. Be as informed as possible;
2. Be able to explore possible options;
3. Be able to make the best decisions about how to meet any Care and Support/Support needs they may have; and
4. Be able to make the best decisions about how to achieve their outcomes. 

Whilst the Care Act is clear that the person or carer is always best placed to judge their own Wellbeing and understand their own needs, there is recognition in the statutory guidance they may not always possess the necessary skills or insight to take a holistic view of their circumstances and the impact of their needs across all areas of their Wellbeing.

Where, even with support to do so the person is unable to understand their situation holistically the Local Authority must still consider their needs and Wellbeing in a holistic way. This can be challenging for the assessor and the person if there are different perspectives and it is therefore important that the person remains central to the process and involved in their assessment.

Strengths Based Approach

An assessment under the Care Act is not only a gateway to support from the Local Authority. As part of the assessment process, the Local Authority must consider how the person or carer, their support network and the wider community can contribute towards meeting the outcomes the person or carer wants to achieve.

The Local Authority should take a strengths based approach to assessment, which involves:

1. Taking a holistic view of the person or carers needs in the context of their wider support network;
2. Helping the person or carer to understand their strengths and capabilities within the context of their situation;
3. Helping the person or carer to understand and explore the support available to them in the community;
4. Helping the person or carer to understand and explore the support available to them through other networks or services (for example through health provision); and
5. Exploring some of the ways that the Local Authority may be able to help (such as through prevention services or signposting).

Preventing, Reducing and Delaying Needs

There is a clear duty under the Act to prevent, reduce and delay the need for Care and Support /Support. One of the ways this can be achieved is through the provision of good information and advice. The Local Authority must ensure that assessors are skilled and knowledgeable enough to make appropriate judgements and steer people towards information and advice or preventative services where appropriate.

For further detail see the Providing Information and Advice and Preventing Needs for Care and Support sections of this guide.

Risk

As part of the assessment, the Local Authority must have regard to the need to help protect people from harm, abuse or neglect. Using a strengths based approach to risk they should assist the person or carer to identify any risk in their situation and ways that these could be managed. They should also assist the person or carer to decide how much risk they can manage and what action they can take if this is exceeded.

Where a person lacks capacity to make their own decision about risk the Local Authority must ensure that any restrictions placed on their rights or freedoms are kept to a minimum, carefully considered and regularly reviewed.

8. The Use of an Assessment Tool

The statutory guidance describes how each Local Authority may decide to use a tool to support them in the collation of information about the person or carer during assessment.

Where needs are less complex the assessor should not however use areas of an assessment tool that are not relevant to the person or carer as this would be disproportionate.

9. Involving others in the Assessment

Consulting with Others

Under the Care Act, if an assessor does not have the relevant expertise themself in relation to any health condition or other circumstance of the person or carer whose needs are being assessed, they must consult with a suitable expert in order to gain a comprehensive understanding of the support that may be required. Such consultation may take place before or during the carrying out of the assessment.

Whole Family Approach

The statutory guidance states that the Local Authority must take a whole family approach to assessment. Put simply, this means that the Local Authority must consider the impact of the needs of the person or carer to whom the assessment relates on any other family members (either living in the household or who is part of their support network). This includes both other adults and children.

In adopting a whole family approach, the Local Authority will identify anyone in the person or carer's wider family network of support who is impacted by their needs (or any non family members the Local Authority feels may need to be included in this). This will guide the Local Authority to consider how the current support network is helping, how sustainable this is and its potential role in the future.

Impact of Needs on other Adults in the Person's Family.

Where the Local Authority considers during an assessment process that any adult present would benefit from the provision of information and advice about any aspect of Care and Support and/or Support (even if this does not relate to the person being assessed) it has a duty under the Care Act to provide this.

Where the Local Authority feels that any adult present would benefit from a  preventative service in their own right it should take steps to support them to access that service.

For further detail see the Providing Information and Advice and Preventing Needs for Care and Support sections of this guide.

Impact of Needs on Children living in the Home (Young Carers)

Where the Local Authority identifies that a child is involved in providing care to a person (adult) the Local Authority must:

1. Consider whether the child should be referred for a young carer's assessment or a needs assessment under the Care Act 1989;
2. Consider whether the child should be assessed as a young carer under section 63 of the Care Act (transition from children's services to adults services);
3. Consider the impact of the needs of the person on the child's well-being, welfare, education and development; and
4. Identify whether any of the tasks being performed by the child are inappropriate having regard for all the circumstances and the child's view.

Where an assessor without the relevant skills, knowledge or experience has been tasked to carry out a young carer's assessment under the Care Act the statutory guidance states that they should work with children's services to ensure the assessment is effective.

NHS Continuing Healthcare

10. Agreeing the Level of Need

The Local Authority is responsible for making the judgement about level of need based on the information gathered in the assessment process. It must have regard to the views of the person or carer and those other people they have consented for the Local Authority to consult with (or where the Local Authority has deemed it in the person's best interests to do so).

Where there has been some disagreement about the level of need (for example where the person may have lacked insight into their needs in some areas) this should be clearly documented.

Where a person has not been involved in (and therefore has not expressed a view about) some areas of the assessment process, this should also be clearly recorded.

11. Refusal of Assessment

Refusal of Assessment by the Person

Where a person refuses a needs assessment, the Local Authority is not required under the Care Act to carry out the assessment unless:

1. The person lacks capacity to refuse the assessment and the Authority is satisfied that carrying out the assessment would be in their best interests; or
2. The person is experiencing, or is at risk of, abuse or neglect.

In either of the above situations, if the person declines to engage in the assessment process then the Local Authority should complete an assessment to the best of its ability and document this. It should also maintain regular contact with the person or carer and carry out an assessment if the person or carer changes their mind.

Where, having refused a needs assessment previously, the person then requests an assessment the Local Authority must complete the assessment.

Where a person has refused a needs assessment previously and the Local Authority thinks that their needs or circumstances have changed, a further assessment must be offered (but may be subject to further refusal).

Refusal of Assessment by the Carer

In all circumstances, where a carer refuses a carer's assessment, the Local Authority concerned is not required under the Care Act to carry out the assessment.

Where, having refused a carer's assessment previously, the carer then requests an assessment the Local Authority must complete the assessment.

12. Assessment and Safeguarding

If an assessor becomes aware that the person they are assessing is at risk of, or experiencing abuse or neglect, the safeguarding procedures apply in all cases. Depending on the situation and level of risk this could mean:

1. The assessment is paused to allow for a safeguarding enquiry to take place; and/or
2. Urgent Care and Support/Support is arranged to manage risk while a safeguarding enquiry takes place; or
3. The assessment continues in parallel with a safeguarding enquiry.

Decisions about safeguarding do not depend on the person having eligible needs, so any safeguarding response should not be delayed to first allow for an assessment to be completed and eligibility determined.  

When an assessment has been paused to allow for a safeguarding enquiry to take place it should be continued as soon as it is considered appropriate to do so, and eligibility determined regardless of the outcome of the safeguarding enquiry.

13. Action to take after the Assessment is completed

Following the assessment process the person or carer must be given a written record of their assessment. A copy must also be shared with anyone else that the person or carer requests the Local Authority share a copy with.

If the Local Authority wishes to share the assessment with anyone else, this can only be done with the person or carer's consent (unless they lack capacity and the Local Authority has determined that it is in their best interests to share the assessment).

It is important that the person or carer understands their assessment and the outcome of it. To this end it should be provided in a format that is accessible to them.