How to conduct an assessment that is appropriate and proportionate - Ensuring assessment is appropriate and proportionate

In practical terms this means using a person-centred approach to talk with the individual, within the formats deemed most appropriate, to understand together the outcomes the individual wishes to achieve in their day-to-day life.

A person-centred approach starts from the principle that the individual is at the centre of the assessment process as the expert in their own life. The objective is to take account of the person’s wishes, preferences and desired outcomes, to promote their wellbeing and to identify, together with the person and their family, how best to use care and support to achieve their desired outcomes.

The Care Act guidance includes the following examples of different ways in which an assessment can be conducted. Each of these formats of assessment may be appropriate to the individual’s circumstances. Assessment can be conducted through any one, or a mix, of these approaches as required.

All assessments must be carried out proportionately. An effective appropriate and proportionate approach to assessment will ensure it is person-centred and collaborative within the format.

Where the individual may experience substantial difficulty in independently engaging in the process, the local authority must involve someone who can help as early as possible. This can be a family member or friend. Where neither is available, the local authority must appoint an independent advocate. There are four areas of ‘substantial difficulty’ defined in the Act:

  1. Understanding relevant information
  2. Retaining information
  3. Using or weighing the information as part of engaging
  4. Communicating views, wishes and feelings.

Where there are concerns over the mental capacity of the person requiring care and support or their carers, the local authority should ensure the Mental Capacity Act Code of Practice is followed. See links:

The local authority must consider what preventative services, what information and advice (Care Act Sections 2 and 4) and what else besides care and support services might benefit the individual (e.g. debt advice, benefits, including attendance allowance or DLA). In addition the local authority should:

Specific and severe communication needs

Effective assessment establishes maximum possible communication between assessor and the adult with care and support needs or their carer, to ensure the person is as fully engaged as possible and has the opportunity to express their wishes and desired outcomes. When the person has a condition that affects communication, it is likely that additional expertise and training of the assessor will be necessary to ensure the person’s needs are fully understood and considered. Such conditions include autism, blindness or deafness (or deafblindness), learning disabilities, mental health needs and dementia. 

There is specific guidance relating to assessment for people who are deafblind (see Guidance 6.91–6.97). This includes ensuring that an expert is involved in the assessment of adults who are deafblind, including where a deafblind person is carrying out a supported self-assessment jointly with the authority. This specialist assessment must be carried out by an assessor or team that has training of at least QCF or OCN Level 3 – or above, where the person has higher or more complex needs.

View additional information in relation to the government’s autism strategy (April 2014)

What is appropriate?

This applies to the entire assessment process: which should be flexible enough to be adapted to the individual’s needs and circumstances to ensure their maximum participation.

Proportionate

  • Considers all needs and eligibility outcomes, but does not explore in depth those deemed irrelevant or inappropriate for the case.

Communication needs

  • Is an interpreter needed? Is information needed in a different format?
  • What means of communication are suitable for the individual?

Means

  • Is the phone suitable?
  • Is a face-to-face assessment required?
  • Is a supported self-assessment feasible?
  • Could be a single assessment method or a combination of them

Location and timings

  • Where should the assessment take place?
  • What time of the day?
  • Is more than one visit or phone call needed?

Capacity and level of understanding

  • Is an independent advocate needed?
  • Should an MCA be carried out?
  • Is there anybody with Deputyship, Power of Attorney, etc?

Holistic

  • Who should be involved in the assessment?
  • Are there other assessments that can be combined/joined up with?
  • Is the practitioner the best placed person to carry out the assessment, or there is another organisation who can do it on their behalf?

Process

  • Would it be of benefit to send the assessment material in advance?
  • Should the practitioner talk the individual through the assessment material in advance?

What is proportionate?

This applies to the entire assessment process: which should be flexible enough to be adapted to the individual’s needs and circumstances to ensure their maximum participation.

Severity and extent of the needs

  • Someone with more complex needs will require a more detailed assessment, potentially involving a number of professionals.
  • A person with fewer, or less complex, needs may require a less intensive response.
  • Individuals with more strengths and knowledge may require a less intensive assessment.

Person’s wishes, preferences and desired outcomes

  • Individuals who are aware of their needs – and how they want to live their lives – and those who have been involved in the assessment process previously may need less involvement/interaction with the local authority.

Potential fluctuation of person’s needs

  • Individuals with fluctuating needs may require a more in depth assessment and greater interaction with the authority (i.e. at different times)

Other information and assessments

  • The amount and reliability of existing information on the individual and their circumstances will influence the level of interaction in the assessment process. For example, previous assessment, a previous contact, a housing assessment, a district nurse assessment.

Relevancy of questions/areas for the case

  • If there is an area/question/heading which is not relevant, the practitioner should make a professional judgement and state ‘not appropriate’. This will ensure that the intervention is proportionate to the individual’s circumstances yet professional, holistic and comprehensive