Carrying Out an Assessment
1. At what Stage of the Care and Support Process Should an Assessment be Carried Out
The statutory guidance is clear that the process of assessment begins at first point of contact with a person or carer, when the Local Authority begins to gather information about them. More comprehensive information gathering process may be required for those with the most complex needs but the Act makes clear that this be done as a continuation of the assessment started at the first point of contact and not a whole new assessment process.
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:
- Ensure that any assessor has the general 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);
- Ensure that any assessor has the specific skills, knowledge and competence to carry out an assessment with the particular person or carer in question (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);
- 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 deemed 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 make sure they are supported by or able to consult with someone who has the necessary skills, knowledge and experience. Alternatively the Care Act makes provision for assessments to be carried out jointly if required.
Assessing People with Autism
The Care Act does not set out specific responsibilities for the assessment of people with Autism other than the general requirement for the assessor to be skilled, knowledgeable and competent. However, the statutory guidance does recognise people with Autism as a group of people with specific needs when carrying out an assessment. It refers directly to Think Autism 2014 guidance published by the Department of Health and makes clear that this has implications for the assessment of people with Autism under the Care Act that local authorities should consider.
Think Autism set out that local authorities should:
- Make basic Autism training available to all staff working in health and social care;
- Develop or provide specialist training for those roles that have a direct impact on access to services for those people with Autism; and
- Include quality Autism awareness training within general equality and diversity training programmes.
Assessing People who are Deafblind
The Care Act does set out specific requirements in relation to the assessment of a person who is deafblind. These requirements also apply:
- To carers assessments when the person being cared for is deafblind;
- 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 with 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 with someone who is deafblind.
Where an assessment is delegated to an external specialist the Local Authority must provide them with:
- In the case of a needs assessment any relevant information which it may have about the person; and
- 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. In all methods the Local Authority must ensure it fulfils statutory duties around 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 under the Act can 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 deem 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 with these bodies may be beneficial, as it will provide a holistic approach and 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 makes provision for the Local Authority to carry out a joint assessment with any other organisation, including but not limited to:
- Other areas of Adult Care and Support (e.g. Social Work or Occupational Therapy);
- Children's services;
- Health professionals;
- Mental Health professionals;
- Experts in the voluntary sector; and
A joint assessment does not necessarily mean that just 1 of the various bodies' assessment tools will be used or that only 1 assessment report will be written. It can mean that 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:
- Develop and agree a co-ordinated assessment process based on the needs and wishes of the particular person being assessed;
- Share information with each other to ensure that the support and services being provided are aligned and complimenting each other;
- Link together Care and Support plans wherever possible so there is a single, shared care pathway for the person.
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) without the direct involvement of the Local Authority.
Some people will be able to complete a full self-assessment of their own needs with very little or no support from the Local Authority, while others may be able to complete some aspects independently but require 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:
- In the case of a needs assessment provide the person with any relevant information it may have about them; and
- 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 must be provided in a format accessible to the person 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 as it 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 needs. This should be done proportionately and not by seemingly repeating the whole assessment process again. Depending on the level of assurance required the Local Authority could consult with the person, anyone else who has been involved in the supported self-assessment (so long as the person 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 a best interests determination).
A Delegated Assessment
Under the Act the Local Authority is able to delegate many Care and Support functions, including assessment. This can only occur when the body or person the function is being delegated to is in agreement.
Delegation often occurs when the needs of the person are specialist (for example those people who are deafblind).
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 it cannot delegate statutory responsibilities and 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.Other bodies are also able to delegate functions to the Local Authority so long as the Local Authority agrees to this. For example, where a person has needs that are to be met by more than one body, under the Care Act the Local Authority may agree to carry out the assessment on behalf of all the bodies.
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 an initial contact or triage 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:
- Is appropriate and proportionate to the needs and circumstances of the person or carer to whom it relates; and
- 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:
- The wishes and preferences of the person or carer;
- The outcome the person or carer seeks from the assessment; and
- 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:
- 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;
- 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);
- The specific communication needs of the person or carer (specifically 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);
- The potential fluctuation of the person or carers needs or situation; and
- 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:
- What can be expected during the assessment process;
- The format that the assessment will take (e.g. telephone assessment, face-to-face assessment);
- The indicative timeframe for assessment;
- The complaints process; and
- Information about possible access to independent advocacy.
The Local Authority must 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 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 must 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 make independent advocacy applies and, if so make the necessary arrangements.
For further detail see The Duty to Provide an Independent Advocate section of this guide.
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 they must establish this to be the case by carrying out a mental capacity assessment so that the appropriate and necessary support can be arranged.
Appropriate support could be through the duty to provide an Independent Advocate under the Care Act but, depending on the circumstances be to provide an Independent Mental Capacity Advocate under the Mental Capacity Act 2005.
For further detail see The Duty to Provide an Independent Advocate section of this guide.
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 thoughts, wishes and preferences of the person at all times and to this end should consider this in respect to the timing of assessment, the method and the location of any meeting.
The Local Authority should inform the person or carer that a financial assessment will take place 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 guide.Under the Care Act the financial assessment does not normally take place until after the determination of eligibility. This is because the outcome of the financial assessment has no bearing upon the outcome of the needs or carers assessment or the eligibility determination. In some circumstances a financial assessment can be instigated during the assessment process but in no circumstances can it have a bearing on the assessment process or outcome.
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 maximise the involvement of the person or carer in their assessment and the process of assessment must be flexible to support 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.
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 accurately their level of needs. Judgements should not be made about the level of need based on either a 'worse case' or 'best case' scenario.
Pausing the Assessment ProcessSometimes it will become clear that a particular easily accessible Care or Support service may be highly beneficial to the person or carer; one that if provided may have a significant impact on the outcome of the assessment being carried out and prevent, reduce or delay the need for Care and Support/Support. For example, this could be to access information or advice given, to allow equipment or Telecare to be provided or for a period of reablement to take place. In these situations the Care Act makes provision for an assessment process to be 'paused' to allow for the intervention to take place before continuing to review its impact.
7. The Assessment Conversation
Supporting the Person/Carer to Understand their Situation
The Act is clear that the person should be fully involved in their assessment process (able to express their wishes and feelings, weigh up options and make decisions). In order to support and maximise 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:
- Be as informed as possible;
- Be able to explore possible options;
- Be able to make the best decisions about how to meet any Care and Support/Support needs they may have; and
- 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 a gateway to support from the Local Authority. 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:
- Taking a holistic view of the person or carers needs in the context of their wider support network;
- Helping the person or carer to understand their strengths and capabilities within the context of their situation;
- Helping the person or carer to understand and explore the support available to them in the community;
- 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
- 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.
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.Likewise, where people have more complex needs the assessment tool may need to be adapted, enhanced or substituted for other tools specific to a particular condition (for example a specialist tool to support people who have a brain injury, mental health issue or Autism). The statutory guidance credits several organisations as having developed specialist tools that the Local Authority may wish to consider using in specialist situations.
9. Involving others in the Assessment
Consulting with Others
Under the Care Act an assessor must also consult with any person who has expertise in relation to any health condition or other circumstance of the person or carer whose needs are being assessed 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 (or any non family members the Local Authority feels may need to be included in this). This will enable to Local Authority to discuss from a strengths based approach how the person or carers current support network is helping, how sustainable this is and their 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.
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:
- Consider whether the child should be referred for a young carer's assessment or a needs assessment under the Care Act 1989;
- 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);
- Consider the impact of the needs of the person on the child's well-being, welfare, education and development; and
- 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 HealthcareUnder the Care Act the Local Authority has a duty to meet eligible needs but it is not permitted to arrange services when a person is found to have a primary need for healthcare. If, during an assessment process the Local Authority feels that the person's needs may make them eligible for NHS Continuing Healthcare they must refer the person to the relevant health body following the national framework for NHS Continuing Healthcare as soon as possible.
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. This will give 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 expressed a view about) some areas of the assessment process this should also be clearly recorded.Where a person has fluctuating needs the assessment record should be clear about how information about the level of need was gathered (e.g. over what timeframe, what the level of fluctuation was and how the decision about level of need was reached). When assessing fluctuating needs the statutory guidance states that the Local Authority may take into account what can reasonably be expected in the future based on knowledge of others with similar needs. This approach is seen as beneficial as it allows for measures to be put into place to prevent, reduce or delay the onset of further associated needs.
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:
- 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
- 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. They 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 subject to further refusal).
Refusal of Assessment by the Carer
Where a carer refuses a carer's assessment, the Local Authority concerned is not required under the Care Act to carry out the assessment. There are no circumstances when this is not the case.
Where, having refused a carer's assessment previously, the carer then requests an assessment the Local Authority must complete the assessment.Where a carer has refused a carer's assessment previously and the Local Authority thinks that the needs or circumstances of either the carer or the person needing care have changed, a further carer's assessment must be offered (but subject to further refusal).
12. Assessment and Safeguarding
If an assessor becomes aware that a person they are assessing is at risk of, or experiencing abuse or neglect safeguarding procedures apply in all cases. Depending on the situation and level of risk this could mean:
- The assessment is paused to allow for a safeguarding enquiry to take place; and/or
- Urgent Care and Support/Support is arranged to manage risk while a safeguarding enquiry takes place; or
- 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 when deemed 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 this can only be done with the person or carer's consent (unless they lack capacity and the Local Authority deems it 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.If an advocate is already involved they should be informed when the assessment has been provided to the person so that they can support them to understand it. If the assessment has been provided in a format that the Local Authority knows or suspects the person or carer will not be able to understand the duty to make an Independent Advocate available may still apply.