Key messages of assessing fluctuating needs under the Care Act 2014

  • The Care Act 2014 requires local authorities to take into account the full range of needs of adults with care and support needs and their carers with support needs (due to their own circumstances and/or their caring responsibilities). This must take into account any fluctuation in the needs of the person. The process of assessment provides one of the most important elements of adult care and support, and this holistic understanding of need is vital to ensuring ongoing care needs are met – not just those presenting on the day of an assessment.
  • Consideration of fluctuating need ensures that assessment is not simply a ‘snapshot’ of a person’s care and support needs. Local authorities must consider the person’s care and support needs over a suitable period of time to gain a complete picture of those needs.
  • People should be asked during a needs or carer’s assessment how their needs change over time. They should be encouraged to consider how their needs present themselves on the given day, how much of an issue they have been in the past, how they are likely to develop in the future, and the impact these changes have on the outcomes they want to achieve in life.
  • Establishing an accurate picture of needs that fluctuate over time will also require supporting the person to provide an assessment of their own circumstances. It may also be useful for the practitioner to draw upon others’ experience of similar needs and reasonable expectation of outcome when the same condition and like circumstances exist. However, the use of previous experience should not override the person-centred approach and will provide a guide, not a definitive answer, which will vary from person to person.
  • Consideration must be given to the wider causes of fluctuating need. This requires taking into account the condition itself, changing circumstances and the environment.

Fluctuating need?

In the context of a needs or carer’s assessment ‘Fluctuating need’ refers to needs which:

  • may not be apparent at the time of the assessment; but
  • have been an issue in the past; and
  • are likely to arise again in the future.

In other words, when practitioners assess a person’s needs, those presenting at initial contact may not be a true reflection of their condition over time; they may be coping with circumstances where they:

  • experience good and bad days, or parts of a day; or
  • are well for weeks or months at a time.

Needs may not fluctuate just because of a condition but also because of changing circumstances, such as changes in employment or education, or the transition to adult services which may be the case for young carers entering adulthood.

An accurate assessment of any fluctuation requires practitioners to give consideration to the needs of a person and their carer over an appropriate period of time to understand the full implications of their condition and circumstances.