Assessment and eligibility process map

Published: January 2015

This flowchart shows the processes involved in assessment and eligibility. Please click on the boxes to reveal more detailed description of each stage of the process.



Assessment and Eligibility Process Map Mental capacity Advocacy & participation support Impact on the family and carers (whole family approach) Safeguarding Strengths-based approach Ensuring assessment is proportionate and appropriate Initial information gathering Urgent need? Meet urgent care need Individual with care and support needs or carer with support needs? Signposting and prevention Carer's assessment Face-to-face assessment Supported self-assessment Joint assessment Online or phone assessment Combined assessment Needs and carers assessment Needs, outcomes and impact on wellbeing Consider if needs are likely to fluctuate National minimum threshold for eligibility met? If needs are ineligible If needs are eligible

Mental capacity – Assessment and eligibility process map

Introduction

This step covers the need for a local authority to ensure that individuals who may lack capacity to ask for, or engage with, a needs assessment are fully supported and that the process is person-centred and compliant with the Mental Capacity Act.

Core duties

The local authority must:

  • assume a person has capacity unless it is established that they lack capacity. A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success
  • ensure that the person’s wellbeing is considered including that their wishes and feelings are identified and listened to.
  • give the person, from their very first contact with the local authority, as much information as possible about the assessment process and about the many different ways of being engaged
  • seek to establish the total extent of the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve through the assessment, before considering the person’s eligibility for care and support.

Process description

From the start of the process the local authority must give the person as much information as possible about the steps involved in assessment – and about the different ways they can engage that might be relevant for the person.

The local authority must ensure the individual has the mental capacity to fully understand and be involved with the assessment by checking that they:

  • understand the questions they are being asked
  • are capable of providing answers to the questions
  • understand the implications on their personal circumstances of the overall process
  • have the capacity to express their wishes and feelings.

The local authority must conduct a capacity assessment at any point during the assessment process if they have reason to think the individual involved may lack capacity.

Link to Act

Link to Guidance

Links to other Resources

Next step

Consideration of the person’s capacity is an ongoing responsibility throughout the process, to which the local authority must pay attention.

Advocacy & participation support – Assessment and eligibility process map

Introduction

This step covers what the authority must consider to ensure that a person can be fully involved in the needs and carer’s assessment and when appropriate, facilitate that person’s involvement.

In this context ‘advocacy’ means supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need. The requirement to provide independent advocacy applies equally to individuals requiring care or support and to carers with support needs.

Core duties

The local authority must:

  • ensure that the person is able to be involved as far as possible/support the person to be involved
  • where appropriate, consider reasonable adjustments under the Equality Act 2010
  • consider whether the person would have ‘substantial difficulty’ in being involved in the assessment
  • provide access to independent advocacy for those who have substantial difficulty and have no appropriate individual who can support their involvement
  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care or support.

Process description

The local authority must be confident at all times that the person involved in the assessment is fully supported – either the person requiring support or care and/or their carer – to be at the centre of the process. From the point of first contact the local authority will need to consider whether the person requiring care or support or their carers have ‘substantial difficulty’ in being involved in the assessment. This consideration should be based on four areas:

  • understanding relevant information
  • retaining information
  • using or weighing the information as part of engaging
  • communicating wishes and feelings.

Where an individual has substantial difficulty in any of the above areas they require assistance.

If it is thought that the individual does have substantial difficultly, and if there is no appropriate individual who can support and represent them to facilitate their involvement, then the local authority must arrange for an independent advocate to support and represent the person.

Examples of an appropriate person may include:

  • any carer (who is not professionally engaged or remunerated);
  • a family member
  • an interpreter to address language or other communications issues
  • a friend.

If the local authority determines there is no one available or capable of representing the individual who is judged to have ‘substantial difficulty’ it must appoint an independent advocate to provide this support and representation. It must also consider any needs for independent advocacy that the person’s carer may have and ensure these needs are met.

In determining an appropriate individual to support and represent the person and to facilitate their involvement in the assessment process, the local authority should consider that it is not sufficient to know the person well or even to love them deeply. The appropriate individual must be able to support the person’s active involvement with the local authority processes. Some examples when people may not easily be able to fulfil this role include:

  • a family member who lives at a distance and who only has occasional contact with the person
  • a spouse who also finds it difficult to understand the local authority processes
  • a friend who expresses strong opinions of their own prior to finding out those of the individual concerned
  • a housebound parent.

A person will never be considered appropriate where they are implicated in any enquiry of abuse or neglect, or have been judged by a safeguarding adults review (SAR) to have failed to prevent abuse or neglect.

The role of the independent advocate is to support and represent the person and to facilitate their involvement in the key processes and interactions with the local authority and other organisations as required. The advocate must support and represent the person:

  • in accessing information and guidance about the assessment process
  • in the assessment
  • in the care and support planning
  • in the review.

Section 7 of the Care and Support Statutory Guidance provides detailed advice on this issue.

Link to Act

Link to Guidance

Links to other Resources

Link to SCIE resources

Next step

This is an ongoing requirement in the assessment process, through care and support planning and review processes and therefore must be continuously monitored.

Impact on the family and carers (whole family approach) – Assessment and eligibility process map

Introduction

This step considers the requirement for the local authority to take a holistic view of the impact on the whole family and any potential need for a carer’s assessment.

Core duties

The local authority must:

  • have regard to the needs of the family of the adult to whom the assessment relates
  • consider the impact of the person’s needs for care and support on family members or other people the authority may feel appropriate – this will require the authority to identify anyone who may be part of the person’s wider network of care and support
  • consider, in terms of the impact of the person’s needs on those around them, whether or not the provision of any information and advice would be beneficial to those people they have identified – for example, this may include signposting to any support services in the local community.

Process description

The local authority must at all times throughout the assessment process take into account the impact of the adult’s needs on the whole family and on those with caring responsibilities. This includes identification of any adults or children who are providing care.

This means the local authority must identify who the family and support network are.

The local authority must also identify any other adults in need of care and support during the process. For example:

  • If the assessor finds that an adult has a carer, who in turn has parenting responsibilities and caring responsibilities for an elderly relative in addition to the adult with care needs. This situation would constitute an ‘appearance of need’ and the assessor should then offer both a carer’s assessment and an assessment for the elderly relative in addition to the assessment of the adult with care and support needs.

The local authority must consider the impact on the wellbeing of carers and others in the adult’s support network and how they can help:

  • Where the local authority identifies carers or others in the adult’s support network who are affected by their caring role, it must consider whether the provision of information and advice will be beneficial to them. The authority should also consider a carer’s assessment.
  • If it is viewed as being of benefit to the individual, the local authority must advise the person on how to access appropriate advice and information. This may include actions such as signposting to support services where they are available in the local community.
  • Where the local authority identifies a child or children as being involved in the provision of care it must:
    • consider the impact of the needs of the individual concerned on the child’s wellbeing, welfare, education and development and
    • identify whether any of the tasks which the child is performing for the individual are inappropriate for the child to perform, having regard to all circumstances.
  • If the person is eligible, care and support should be provided in a way that is sufficient to alleviate any (young) carer’s inappropriate caring responsibilities. In practical terms this means:
    • The local authority must consider the need to refer the child or young person for a young carer’s assessment under the Children Act 1989. This will also require ensuring adult and children’s care and support services work together to ensure the process is smooth.
    • The local authority must consider the extent to which the caring responsibilities affect the young person’s physical or emotional wellbeing. Caring might for instance prevent the child from ‘normal’ activity, such as building friendship networks or having other social contact, or prevent them from undertaking regular exercise if they wish to.
    • The local authority must consider the impact on the young person’s wellbeing, education and development. An impact could for instance manifest itself in regular absence from school or college or other impacts such as an inability to concentrate in class.
    • The local authority must also consider whether the caring responsibilities of the young person are inappropriate having regard to all circumstances. Examples of inappropriate care tasks may include:
      • strenuous physical exercise, lifting and handling
      • personal care (for instance, bathing and managing toilet needs)
      • routinely handling cash transactions and looking after the family budget
      • providing emotional support.

This is not an exhaustive list and when making any assessment of caring responsibilities the local authority should take the young person’s views on their own capabilities into account.

  • The local authority must also take into account the parenting responsibilities of the adult requiring care or support, alongside the impact their needs may have on the young carer.

Link to Act

Link to Guidance

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Safeguarding – Assessment and eligibility process map

Introduction

This step considers the duty of the local authority to act upon any identified safeguarding issues as they occur. Where necessary the safeguarding process should run parallel to the assessment process and is not subject to any eligibility considerations.

The local authority should recognise that it should make a similar response where it considers that a carer is at risk of harm or abuse.

Core duties

The local authority must:

  • start an enquiry if it believes an adult is experiencing or is at risk of abuse and neglect
  • ensure that the person is able to be involved as far as possible, for example by providing an interpreter where a person has a particular condition affecting communication – such as autism or deafblindness
  • appoint an independent advocate if the person has substantial difficulty in being involved in the safeguarding enquiry or safeguarding adult review, and if there is no appropriate individual to support them – this should be done at the earliest opportunity in the process.

Process description

The safeguarding duties apply to an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs)
  • is experiencing, or at risk of, abuse or neglect; and
  • as a result of those care and support needs is unable to protect themselves from either the risk, or the experience, of abuse and neglect.

If at any point the local authority suspects or receives information from another person or agency that an adult is experiencing, or is at risk of, abuse or neglect, it must make enquiries, or cause others to do so.

An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place. An enquiry may be a conversation with the adult, or, if the adult lacks capacity or has substantial difficulty in understanding the enquiry, a conversation with their representative or advocate, prior to initiating a formal enquiry under Section 42, right through to a much more formal multi-agency plan or course of action. The objectives of an enquiry into abuse or neglect are to:

  • establish facts
  • ascertain the adult’s views and wishes
  • assess the needs of the adult for protection, support and redress, and how they might be met
  • protect the adult from the abuse and neglect in accordance with their wishes
  • make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect
  • enable the adult to achieve resolution and recovery.

If the local authority decides that another organisation should make the enquiry, for example a care provider, then it should be clear about timescales, the need to know the outcome of the enquiry and what action will follow if the enquiry is not completed.

The nature and timing of the intervention and who is best placed to lead it will be, in part, determined by the circumstances. However, the primary focus must still be what immediate steps need to be taken to protect the adult and whether there is a wider risk to other adults. It may need to be referred to the police to consider whether a criminal investigation is required or appropriate.

Local authorities must cooperate with each of their relevant partners, as described in Section 6(7) of the Care Act, and those partners must cooperate with the local authority in the exercise of their functions relevant to care and support, including those to protect adults. Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk through timely information-sharing and targeted multi-agency intervention.

Once enquiries are completed, the outcome should be notified to the local authority which should then determine with the adult what, if any, further action is necessary and acceptable. One outcome of the enquiry may be the formulation of agreed actions for the adult which should be recorded on their care plan. This will be the responsibility of the relevant agencies to implement. In relation to the adult this should set out:

  • what steps are to be taken to assure their safety in future
  • the provision of any support, treatment or therapy including ongoing independent advocacy
  • any modifications needed in the way services are provided (e.g. same gender care or placement; appointment of an Office of the Public Guardian [OPG] deputy)
  • how best to support the adult through any action they take to seek justice or redress
  • any ongoing risk management strategy as appropriate
  • any action to be taken in relation to the person or organisation that has caused the concern.

Conducting a safeguarding enquiry, and any action which needs to be taken as a result, is entirely independent of the person’s eligibility. It is of paramount importance that establishing the impact of the concerns is dealt with in parallel with the assessment process. This ensures the local authority can address safeguarding concerns effectively without disrupting the assessment process and meet its duty to meet eligible needs.

The adult who has care and support needs must be involved in addressing the safeguarding concerns or have a family member, friend or advocate able to support them.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Strengths-based approach – Assessment and eligibility process map

Introduction

This step considers the individual person’s strengths and capability as well as any support which may be available from their wider network and in their community. When looking at this potential support, local authorities should consider whether such networks have the capacity to continue to meet the adult’s needs on a regular basis.

This helps to ensure the assessment is person-centred and focuses on both their individual and wider network’s strengths rather than on their condition.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and establish the impact of this on the adult’s desired outcomes
  • consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve.

Process description

In conducting an appropriate and proportionate assessment the local authority should at all times ensure that the process takes into account not only the individual’s needs for care and support but also the strengths they themselves have which could be mobilised to help the adult achieve their outcomes. A strengths-based approach values the capacity, skills and knowledge of an individual and their immediate family/carer network, as well as the existing connections to the person’s community. It is important to note that this is not about imposing more on carers.

The local authority must, throughout the process, consider the person’s own strengths and capabilities and work together to identify what support in the community may be accessed independently.

This will ensure that the needs and desired outcomes the person wishes to achieve are at the heart of the process along with consideration of the extent to which the person can provide solutions to their situation and assist the local authority in ensuring their care and support needs are met.

In some cases, a person’s eligible needs may be met through support from their own networks or the wider community, and the local authority retains responsibility for ensuring that eligible needs are met and should review the situation should the person’s circumstances change.

In order to achieve the benefits of the strengths-based approach, a full picture of the person’s current and past situation will need to be built up. This will focus both on the problems the person is experiencing (a deficit-based approach) and on their history (e.g. their likes and dislikes, hobbies, occupation, social network etc.) to get a picture of their skills and abilities (a strengths-based approach). In the subsequent discussion it is possible that the assessor and the person may together identify potential sources of support not previously considered.

It also makes long-term strategic sense to invest in such support for adults with care and support needs and their carers in terms of confidence-building, independence, ‘up-skilling’ etc. for the individual and the overall contribution this makes to their wellbeing.

Link to Act

Link to Guidance

Next step

This is an ongoing requirement in the assessment process and therefore must be continuously monitored.

Ensuring assessment is proportionate and appropriate – Assessment and eligibility process map

Introduction

This step details the requirements on the local authority to ensure that the form of assessment is appropriate to support the individual’s involvement. This means it will be as extensive as is required to establish the extent of a person’s needs, will always be person-centred and will be based on their individual circumstances.

‘Proportionate’ and ‘appropriate’ are concepts that must be applied to all assessments and are not in themselves a form of care assessment.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and must establish the impact of this on the adult’s desired outcomes
  • carry out an assessment in a manner which is appropriate and proportionate to the needs and circumstances of the individual to whom it relates and ensure it has regard to the:
    • wishes and preferences of the individual to whom it relates
    • outcome the individual seeks from the assessment
    • severity and overall extent of the individual’s needs.

Process description

The assessment process must have the needs of the person at its centre. That means the process must be suitable to the individual’s capacity and capabilities, and any difficulties they may face in communication. The process must be proportionate to the extent and severity of the person’s needs, which will have been identified at the stage of initial information gathering and subsequent contact.

Needs and carer’s assessments must be carried out appropriately and proportionately – this may be applied in a range of ways. To ensure the method of assessment is appropriate local authorities must take into account the ability and situation of the individual being assessed; establish how much they want to be involved in the assessment and meet that wish as far as is possible. Formats of assessment include but are not limited to:

  • face-to-face assessment between the person and an assessor;
  • supported self-assessment, where the person leads on the completion of the assessment material and the local authority assures itself that it is an accurate reflection of the person’s needs;
  • online or phone assessment;
  • Joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments;
  • Combined assessment, where an adult’s assessment is combined with a carer’s assessment and/or an assessment relating to a child. It is, of course, important to recognise that where there is a young carer, their assessment will be conducted by children’s services by an appropriately qualified assessor.
    • If both the adult with support needs and the carer have substantial difficulty in being involved in the assessment process, and do not have an appropriate individual to support them, an independent advocate must be arranged.
    • The local authority may be carrying out assessments of two people in the same household. If both people agree to have the same advocate, and if the local authority consider there is no conflict of interest between the individuals or either of the individuals and the advocate, then the same advocate may support and represent the two people.

For the assessment to be proportionate this will involve:

  • Both hearing and understanding the initial presenting problem;
  • Not taking this at ‘face value’; and
  • Ensuring any underlying needs are also explored and understood.

To address proportionality the assessor will be required to take into account that needs may differ in their breadth and depth, meaning it may be necessary to:

  • explore underlying needs
  • consider that an individual or carer may have needs only in relation to some aspects of their lives
  • consider that individuals with a clear understanding of their own needs may require less intensive assessment than someone who is approaching the local authority for the first time and does not know what care or support they require.

These considerations will ensure the extent of the assessment is proportionate, is not overly burdensome and recognises both the individual’s and their carer’s own knowledge and capacity.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

Information-gathering and signposting.

Initial information gathering – Assessment and eligibility process map

Introduction

This step provides an overview of the responsibilities of the local authority from first contact with a person who appears to have a need for care and support. The first contact sees the local authority providing as much information as possible on the assessment process and where possible taking action to prevent or delay the need for care and support.

First contact is important, particularly as it may be the only contact some people will have with their local authority.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support;
  • ensure that staff are appropriately trained to carry out an assessment, be able to identify a person who may lack capacity and be able to steer people seeking support to appropriate information and advice
    • undertake proportionate and appropriate assessments of any adult or carer with an appearance of need, irrespective of any presumptions of the eligibility of the person’s needs or financial situation
    • give the person, from their first contact with the local authority, as much information as possible about the assessment process, in a format that is accessible to the person.

Process description

This applies equally to adults with care and support needs and their carers.

Information gathered at first contact at this stage might usefully establish the basic facts about:

  • whether the person has the capacity to understand and articulate their own needs
  • whether the person has difficulty communicating their needs (e.g. due to autism or profound and multiple learning disabilities, mental health needs or dementia)
  • whether the person faces any safeguarding issues.
  • the person, their needs, expected outcomes in day-to-day life and the overall impact of the current circumstances on their wellbeing.

The local authority could also consider whether the person has an immediate network of support and how this network contributes to the individual achieving their desired outcomes.

It is important for the local authority to consider that many of the people who qualify for independent advocacy under the Care Act may also qualify for a mental capacity advocate (MCA). The same advocate can therefore provide support as an advocate under the Care Act and the Mental Capacity Act. This ensures that the person receives seamless advocacy support and also avoids them having to repeat their stories for support under different legislation to different advocates.

Link to Act

Link to Guidance

Next step

Urgent need?

Urgent need? – Assessment and eligibility process map

Introduction

This step provides a narrative on the identification of an urgent need faced by an adult in need of care and support. This recognises the local authority can act on such a need without the need for assessment or eligibility checks.

Core duties

The local authority must:

  • consider whether the individual’s needs impact upon their wellbeing and establish the impact of this on the adult’s desired outcomes.

Process description

The Care Act 2014 provides the local authority with the power to meet urgent need without undertaking an assessment or making a determination of eligibility, regardless of the person’s ordinary residence.

There will be instances where it is obvious that immediate action is required, and in such cases it is likely that the assessment will be paused to be resumed later so a fuller assessment can be conducted.

Circumstances under which needs could be classified as urgent include, for example”

  • people who are terminally ill
  • rapid deterioration in an adult’s condition
  • the occurrence of an accident
  • a specific issue such as a stroke
  • evidence of a safeguarding issue
  • unsafe living quarters.

This applies equally to adults with care and support needs and to carers with support needs.

Link to Act

Link to Guidance

Next step

Meet urgent care need – Assessment and eligibility process map

Introduction

This step provides a narrative on action following the identification of an urgent need faced by an adult in their care and support. This recognises that the local authority can act on such a need without the need for assessment or eligibility determination.

Core duties

The local authority must:

  • Consider whether the individual’s needs impact upon their wellbeing and must establish the impact of this on the adult’s desired outcomes.

Process description

Having established that the individual faces an urgent need, the local authority can and should choose to provide support without first conducting an assessment or eligibility determination.

Under these circumstances the local authority should meet the identified urgent care needs immediately. It should also inform the individual that a more detailed needs assessment, an eligibility determination, establishment of ordinary residence and a financial assessment will follow the intervention.

This applies equally to adults with care and support needs and to carers with support needs.

Link to Act

Link to Guidance

Next step

Signposting and prevention.

Signposting and prevention – Assessment and eligibility process map

Introduction

Following the provision of initial information to the individual on the assessment process, this step provides an overview of the requirements for the local authority to conduct initial information-gathering and assessing the appearance of needs. This builds on the provision of initial information provided at first contact (initial information-gathering and signposting) and may run concurrently, particularly in cases where there is no urgent need identified.

This also provides a narrative on the importance of the provision of information and advice to all who seek support from the local authority, irrespective of any existing care or determination of eligibility.

At this stage it may be possible to identify an early or targeted intervention, such as universal services, a period of reablement or provision of equipment or minor household adaptations which could prevent, reduce or delay the progression or development of an individual’s needs . In these circumstances the assessment process will be paused so that any benefit to the adult from the intervention may be determined. If such an opportunity to try a preventative service is not identified the assessment will continue without pause.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the individual’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and establish the impact of this on the adult’s desired outcomes
  • consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the individual wants to achieve
  • ensure that the individual is able to be involved as far as possible, for example by providing an interpreter where they have a particular condition affecting communication – such as autism or deafblindness
  • offer an assessment where an individual previously refused an assessment and the local authority establishes that the adult’s or carer’s needs or circumstances have changed, unless the person continues to refuse
  • ensure the assessor is appropriately trained and has the right skills, knowledge and competence to carry out the assessment in question, whichever method is used
  • ensure that support is available to the assessor where the assessment relates to a specific condition or circumstances requiring expert insight (e.g. autism, learning disabilities, mental health needs or dementia).

This is a two stage process involving:

  • offer information and advice/refer to preventative services
  • proceed to the next step or pause the assessment process.

Process description

The objective is to ensure the individual receives a personalised approach to assessment. Staff must be appropriately trained to be able to carry out an assessment, and should have access to professional support to assist in the identification of more complex needs or underlying conditions.

If the initial information gathered suggests that the person would benefit from a targeted intervention or preventative service, the assessment may be paused while these are put in place and any benefits from them are realised. When the assessment is resumed it will focus on the remaining needs that have not been met by such interventions. If the local authority pauses the assessment, it should inform the person that they are doing so.

When the local authority provides information, it must be in an accessible format to support the individual’s involvement in the process. A further and important part of this and every subsequent stage of the assessment process is the prevention, delay or reduction in the escalation of care and support needs. This will involve the local authority providing or arranging services that either:

  • help keep people well and independent
  • aim to reduce needs and help people regain skills.

It is important to note that prevention may be considered at different levels and may be utilised at any appropriate point in the assessment process:

  • primary prevention/promoting wellbeing (e.g. by supporting access to universal services)
  • secondary prevention/early intervention (e.g. targeted support to provide a few hours of support to a carer, or adaptations at home to reduce the likelihood of falls)
  • tertiary prevention/intermediate care and reablement (e.g. support to regain specific skills or provide support to improve a carer’s life).

The local authority’s responsibilities for prevention apply to all adults, including:

  • people who have no current needs for care and support
  • adults with care and support needs, whether eligible and/or met by the local authority or not
  • carers, including those about to take on a caring role or who have no current support needs, and those with support needs not being met by the local authority or another organisation.

This is an important step in ensuring the assessment is centred on the needs of the person and is appropriate and proportionate to the individual’s circumstances. Establishing the correct initial information as well as enabling people to access preventative services will also save time and costs later.

Relevant protection is built into the process to ensure adults do not exit the assessment process too early, and suitable preventative interventions are put in place.

If the local authority decides not to proceed with assessment, alternatives to be considered are:

  • Pause: the local authority should consider if pausing the assessment process will be helpful in order to put in place and establish the benefit of any identified interventions, and the extent to which these prevent, reduce or delay the development of the adult’s needs. Making use of the opportunity to pause the assessment enables the appropriate point to be reached at which the assessment can be continued appropriately.
  • Prevention: if a full needs or carer’s assessment is not taken forward the local authority must ensure appropriate steps are taken to prevent, delay or reduce the escalation of care and support needs. Whatever level of prevention is implemented it is important that this is reviewed and the person returns to the assessment process if and when appropriate.
  • Signposting: the local authority must not let the person exit the assessment process without offering information and advice on coping with their condition or referring them to preventative services or to organisations in the community who can provide relevant support. The local authority must provide the person with information and advice on how to reduce or meet their needs and how to prevent, reduce or delay the development of needs. 

Link to Act

Link to Guidance

Next step

Individual with care and support needs or carer with support needs?

Individual with care and support needs or carer with support needs? – Assessment and eligibility process map

Introduction

Often the immediate focus might be on the adult who requires care and support, however, the needs of any carer the individual has may require a separate assessment.

This step describes the process of identifying the person’s needs and in particular whether it is just the individual who has care needs or if there are additional support needs for their carer caused by their responsibilities.

This requires the local authority to consider how these impact on the individual’s wellbeing and to explore who else might be affected by the person’s situation.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified and establish the impact of this on the adult’s desired outcomes;

Process description

The assessment must seek to establish a complete picture of the individual’s needs, what outcomes they want to achieve in their day-to-day life and what impact this has on their wellbeing. In the case of a needs assessment of an adult with care and support needs, the assessment must discount the care currently provided by any carer to ensure that a full picture of the overall needs is established. It is important to understand what impact the provision of care may have on any carer’s wellbeing.

If the information provided indicates that the carer might have needs for support due to their caring responsibilities, then the local authority must offer to undertake a carer’s assessment for that individual.

Refusal of assessment

There is no absolute requirement for an individual – either a person with care needs or a carer with support needs – to have a needs or carers assessment. If an individual refuses an assessment, the local authority is not required to undertake one. People may choose not to have an assessment if they do not feel they need care or do not want local authority support.

Local authorities must assess a person who previously refused an assessment but has changed their mind.

Link to Act

Link to Guidance

Next step

Carer’s assessment – Assessment and eligibility process map

Introduction

This step provides a narrative of the duty of the local authority to provide an assessment for any carer who appears to have any level of need for support.

Core duties

The local authority must:

  • offer an assessment to any carer with an appearance of need for support
  • ensure the carer is involved in their assessment along with anyone else they might want involved
  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for support
  • establish whether the carer is willing and able to continue to provide care
  • establish whether the carer has substantial difficulty in being involved in the assessment process and, if there is no appropriate person to support them, appoint an independent advocate.

Process description

The local authority must ensure that any carer who may have support needs is offered a carer’s assessment. This must happen irrespective of any future determination of eligibility and is important in establishing the fullest picture of the carer’s needs and, importantly, the sustainability of the current arrangements.

The carer’s assessment must seek to establish:

  • the carer’s needs for support
  • the practical and emotional sustainability of the caring role
  • the willingness and ability of the carer to continue to provide this support.

It must also consider:

  • the impact of their support needs on their wellbeing
  • the outcomes the carer desires from daily life
  • the impact of their caring responsibilities on their ability to work, access education, training or recreation
  • whether support could help achieve these outcomes
  • whether the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve
  • whether the carer would benefit from preventative support or information and advice.

The outcome of the carer’s assessment will provide an understanding of the sustainability of the carer’s input in the short, medium and long term. The general principles of assessment still govern a carer’s assessment. For instance, the format of assessment must be appropriate to the carer’s circumstances.

Refusal of assessment

There is no absolute requirement for an individual – either a person with care needs or a carer with support needs – to have a needs or carers assessment. If an individual refuses an assessment, the local authority is not required to undertake one. People may choose not to have an assessment if they do not feel they need care or do not want local authority support.

Local authorities must assess a person who previously refused an assessment but has changed their mind.

Link to Guidance

Links to other Resources

  • Carers’ implementation support that Department of Health (DH) has commissioned from the ADASS carers network. Whole family guidance being ADASS Carers Network.

Next step

Needs and carers assessment.

Needs and carers assessment – Assessment and eligibility process map

Introduction

This step provides a narrative on the various approaches to conducting a needs or carer’s assessment.

It also considers the requirement for the local authority to ensure that any assessment is appropriate and proportionate to the needs and circumstances of the individual and remains so for the duration of the assessment process.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and must establish the impact of this on the adult’s desired outcomes
  • consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve
  • ensure that the person is able to be involved as far as possible, for example by providing an interpreter where a person has a particular condition affecting communication – such as autism or deafblindness, or an independent advocate in cases of substantial difficulty
  • ensure that where the assessor does not have the necessary knowledge of a particular condition or circumstance, they must consult someone who has relevant expertise
  • carry out an assessment in a manner which is appropriate and proportionate to the needs and the circumstances of the individual to whom it relates, and ensure that the individual is able to participate in the process as effectively as possible.

Process description

Having determined the type of assessment, the local authority must identify the person’s needs and how these impact on their wellbeing, and the outcomes that the person wishes to achieve in their day-to-day life.

The principle of proportionality means that an assessment goes as far as is necessary to establish a complete picture of the person’s needs. The principle of appropriateness means that an assessment must be carried out in a manner that has regard to the person’s wishes, preferences and outcomes, the complexity of the person’s needs and any potential fluctuations of those needs.

Additional support may need to be provided (e.g. understanding may be aided through the provision of accessible information or independent advocacy).
Assessments can be undertaken via telephone or online, provided that the local authority has made sure it has fulfilled its duties in relation to the assessment and the need for safeguarding, independent advocacy and assessing mental capacity.

The local authority must ensure the assessment is person-centred, which may include provision of support in circumstances where there are capacity issues or specific difficulties in communication.

What constitutes an appropriate and proportionate assessment needs to be kept under constant review throughout the assessment and eligibility process to ensure the process fits the person’s overall needs.

The SCIE Care Act hub provides practice examples of good practice in ensuring assessment is proportionate and appropriate, and can be found at: SCIE Care Act 2014.

In considering the specific assessment to be applied, the following checklist is a guide to choose which format to use:

  • Where can the assessment take place?
  • Who will conduct the assessment?
  • Are there any specific communication needs to be addressed?
  • When will the assessment take place?
  • What is the mental capacity of the adult with care needs?
  • Who has been consulted?
  • Who will be involved?

During assessment it is important to ensure the process remains person-centred, the impact of preventative services is considered in maintaining or improving the individual’s wellbeing and the outcomes that the person sets for themselves are considered at all times.

It is also important to establish the needs of any carers in the process as an ongoing part of the assessment of an individual’s needs and the impact these have on those around them.

Depending on the answers to these questions, any of the following forms of assessment may be deemed appropriate. They do not constitute an exhaustive list.

Link to Guidance

Links to other Resources

  • Whole family approach guidance being developed by Carers UK

Link to SCIE resources

Next step

Needs, outcomes and impact on wellbeing.

Face-to-face assessment

A face-to-face assessment is conducted between the person requiring care and support and an assessor, whose qualification and job title may vary depending on the circumstances, and who must always be appropriately trained, with the right skills and knowledge to conduct the relevant assessment. There may be other circumstances in which the local authority should ensure that the assessor has access to relevant expert knowledge.

Next step

Needs, outcomes and impact on wellbeing.

Supported self-assessment

A supported self-assessment is where the same assessment materials are used as in a face-to-face assessment, but the person requiring care and support completes the assessment on their own and leads the assessment process, with appropriate help from a carer or advocate. The local authority must assure itself that the assessment is an accurate reflection of the person’s needs (e.g. by consulting with other relevant professionals and people who know the person).

Next step

Needs, outcomes and impact on wellbeing.

Joint assessment

A joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments (including assessments in a prison, where local authorities may need to put particular emphasis on cross-agency cooperation and sharing of expertise) is a good way to fit around the needs of an individual. Doing joint assessments with more than one agency or local authority requires good practice in sharing information and working together to ensure needs are accounted for and provided for in a coordinated way.

Transition assessments require joint working between adult and children's services to ensure changes in circumstances and desired outcomes are captured. Transition assessments of young people with care and support needs and young carers alike should therefore be conducted as a joint assessment.

Next step

Needs, outcomes and impact on wellbeing.

Online or phone assessment

An online or telephone assessment may be an appropriate way of carrying out an assessment if, for example, the person who needs care and support has less complex needs, or is already known to the local authority and it is carrying out an assessment following a change in the person’s needs or circumstances.

Next step

Needs, outcomes and impact on wellbeing.

Combined assessment

A combined assessment is when an adult’s assessment is combined with a carer’s assessment and/or an assessment relating to a child so that interrelated needs are properly captured and the process is as efficient as possible. If either of the individuals to be assessed disagrees with the proposal to combine assessments, the assessments must be carried out separately.

Next step

Needs, outcomes and impact on wellbeing.

Needs, outcomes and impact on wellbeing – Assessment and eligibility process map

Introduction

The step provides a summary of the individual’s care needs, their desired personal outcomes and the impact of their condition and circumstances on their wellbeing.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and establish the impact of this on the adult’s desired outcomes
  • consider how the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve.

Process description

The assessment must provide sufficient information for the assessor to be able to establish what the person’s needs are and how they impact on the person’s wellbeing, what outcomes they are seeking to achieve in their day-to-day life, and how care and support, or in the case of a carer, support, can contribute to the achievement of those outcomes. In order to make an eligibility determination, the assessor ought also to establish how the person’s desired outcomes fit with the specified outcomes in the eligibility criteria.

Following the assessment the individual must be given a written record of their needs or carer’s assessment. If the person asks the local authority to share the record with anyone, the local authority must do so. If an independent advocate has been involved in the process, the local authority should also inform them of the outcome of the assessment in order for the advocate to help the person understand the implications of the assessment.

As a minimum this must record:

  • the adult’s care needs – including any supporting information from any combined or joint assessment
  • the carer’s support needs – including any support information from any combined or joint assessment
  • the individual’s outcomes – which in this context refer to the outcomes set by the person for themselves and not those associated with the eligibility determination
  • the impact on the individual’s wellbeing of their care needs
  • any care being provided by a carer (this should still be recorded for the care planning process, if the person has eligible needs.

The SCIE Care Act hub provides practice examples of good practice in to How to assess for needs and outcomes and how these link to wellbeing which can be found at: SCIE Care Act 2014

Link to Act

Link to Guidance

Link to SCIE resources

Next step

Consider if needs are likely to fluctuate.

Consider if needs are likely to fluctuate – Assessment and eligibility process map

Introduction

This step considers the action required by the local authority to identify those needs of an adult with care and support needs which may not be apparent at the time of the assessment but which have been an issue in the past and which are likely to arise again in the future.

Core duties

The local authority must:

  • seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support
  • consider whether the individual’s needs impact upon their wellbeing in any way, including those areas of wellbeing that the person hasn’t identified, and establish the impact of this on the adult’s desired outcomes
  • consider whether the individual’s current level of need is likely to fluctuate and what their ongoing needs for care and support are likely to be.

Process description

The local authority must consider the needs of an individual over an appropriate period of time to understand the full implications of their condition.

The point at which the local authority assesses the individual’s needs may not be a true reflection of their condition over time. Where a condition is likely to present fluctuating need – which may mean that the individual is coping with a condition in which they have good and bad days, or parts of a day, or are well for weeks or months at a time – the local authority must assess the impact of this in order to reach the right eligibility decision and build a care and support plan that is suitable to the person’s real needs.

The local authority should also consider that needs may not fluctuate because of a condition but may fluctuate 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. Carers’ needs might fluctuate, for example because of school holidays or changes in employment.

This requires the local authority to consider the person’s care and support history over a period of time which captures the fluctuating need the person or their representative reports, in terms of frequency and degree of fluctuation. It is vital to ensure that the impact of these varying needs on any carer is also considered as part of a carer’s assessment.

If the individual’s needs are likely to fluctuate, the local authority must make an accurate record of fluctuating needs to ensure they are effectively factored into the person’s care plan, assuming their needs are eligible for support.

This could be done – for example – by the provision of flexible services resulting in a more responsive care plan that can save time if/when the person with care and support needs comes back into the system.

The local authority must also consider the impact the fluctuation in the adult’s needs may have on their carers.

The SCIE Care Act hub provides practice examples of good practice associated with fluctuating need.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

National minimum threshold for eligibility met?

National minimum threshold for eligibility met? – Assessment and eligibility process map

Introduction

This section considers the local authority’s duty to establish eligibility in relation to the minimum threshold set out in regulations for adults and carers. The use of the word ‘eligible’ here refers only to the needs of adults with care needs and carers with support needs, not to their financial resources or other circumstances

Core duties

The local authority must:

  • determine whether the individual has eligible needs as described in the national eligibility criteria
  • establish whether there are needs which the local authority must ensure are met – everyone will receive a written record of that decision, whether their needs are eligible or not
  • – in cases where the adult with care needs or their carer does have eligible needs – establish the adult’s ordinary residence and carry out a financial assessment, as well as considering what support, in whatever form, could be provided to meet those needs
  • meet the minimum level of needs as prescribed in the regulations, however, local authorities can also decide to arrange services to meet needs at a lower level.

Process description

The minimum threshold for eligibility has been set to ensure that all local authorities meet the same minimum level of needs. This does not mean that local authorities cannot choose to meet needs that fall below this threshold, but that they must provide for needs that meet the following three conditions:

  • The needs arise from or are related to a physical or mental impairment or illness.
  • As a result of those needs the adult is unable to achieve two or more of the specified outcomes:
    • managing and maintaining nutrition
    • maintaining personal hygiene
    • managing toilet needs
    • being appropriately clothed
    • being able to make use of the home safely
    • maintaining a habitable home environment
    • developing and maintaining family or other personal relationships
    • accessing and engaging in work, training, education or volunteering
    • making use of necessary facilities or services in the local community, including public transport and recreational facilities or services
    • carrying out any caring responsibilities the adult has for a child
    • As a consequence of being unable to achieve these outcomes there is, or there is likely to be, a significant impact on the adult’s wellbeing.

For an adult’s needs to be considered eligible for support by the local authority they must meet all three criteria.

An adult is to be regarded as being unable to achieve an outcome if they:

  • are unable to achieve it without assistance
  • are able to achieve it without assistance but doing so causes the adult significant pain, distress or anxiety
  • are able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the adult, or of others
  • are able to achieve it without assistance but take significantly longer than would normally be expected.

Similarly, a carer’s needs are eligible where they meet three conditions:

  • The needs arise as a consequence of providing necessary care for an adult
  • The effect of the needs is that any of the circumstances specified in the Care and Support (Eligibility) Regulations 2014 apply to the carer, namely:
    • the carer’s physical or mental health is, or is at risk of, deteriorating
    • the carer is unable to achieve any of the following outcomes:
      • carrying out any caring responsibilities the carer has for a child
      • providing care to other persons for whom the carer provides care
      • maintaining a habitable home environment in the carer’s home, whether or not this is also the home of the adult needing care
      • managing and maintaining nutrition
      • developing and maintaining family or other personal relationships
      • engaging in work, training, education or volunteering
      • making use of necessary facilities or services in the local community, including recreational facilities or services
      • engaging in recreational activities.
  • As a consequence of that fact there is, or there is likely to be, a significant impact on the carer’s wellbeing.

For a carer’s needs to be considered eligible for support by the local authority they must meet all three criteria.

A carer is to be regarded as being unable to achieve an outcome if they:

  • are unable to achieve the outcome without assistance even if assistance were provided
  • are able to achieve the outcome without assistance, but doing so causes or is likely to cause significant pain, distress or anxiety or endangers the health or safety of the carer or any adults or children for whom the carer provides care
  • are able to achieve the outcome without assistance but doing so is likely to endanger the health or safety of the carer or any adults or children for whom the carer provides care.

The Care Act guidance provides examples of how these outcomes could be interpreted or be relevant in a given situation of these eligibility criteria.

Following the outcome of the eligibility determination the local authority must provide the person to whom the determination refers with a copy of the decision. If the needs have been deemed not eligible, the local authority has to explain how they have reached this decision.

Link to Act

Link to Guidance

Link to SCIE resources

Next step

If needs are eligible or if needs are ineligible.

If needs are ineligible – Assessment and eligibility process map

Introduction

This step details the requirements on the local authority to provide information to adults who are determined as ineligible for support and care as well as providing preventative services.

Core duties

The local authority must:

  • establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers
  • ensure appropriate steps are taken to prevent, delay or reduce the escalation of care and support needs.

Process description

If, following completion of the assessment, the local authority deems that a person’s needs are not eligible, it must provide information and advice on:

  • Meeting or reducing the needs e.g.:
    • the choice of types of care and support, and the choice of providers available in the community for the adult or their carer
    • how to access the care and support that is available
    • planning for future care and support needs
    • how to access independent financial advice on matters relevant to the meeting of needs for care and support.
  • Any package of information provided to the adult or carer should be tailored to reflect the needs of the individual, to prevent future needs and delay deterioration. This will ensure people are helped to access local services, which may be provided by the local authority or by another organisation.

The local authority must also take action to prevent or delay the development of needs, considered at different levels:

  • primary prevention/promoting wellbeing (e.g. by supporting access to universal services)
  • secondary prevention/early intervention (e.g. targeted support to provide a few hours of support to a carer, or adaptations at home to reduce the likelihood of falls)
  • tertiary prevention/intermediate care and reablement (e.g. support to regain specific skills or provide support to improve a carer’s life).

Link to Act

Link to Guidance

Link to SCIE resources

Next step

  • The process of assessment ends for people with needs that have been deemed ineligible.
  • The local authority should maintain a record of the person’s need to be able to provide support in the future if their circumstances change.

If needs are eligible – Assessment and eligibility process map

Introduction

This step provides a narrative of the key points related to care and support planning relevant to the assessment and eligibility process.

Core duties

Things the local authority must do:

  • Establish whether there are needs that the local authority must meet. Everyone will receive a written record of that decision, whether their needs are eligible or not.
  • If the person or carer does have eligible needs, the local authority is required to establish the adult’s ordinary residence and carry out a financial assessment ... and consider the support (of whatever form) that could be provided to meet those needs.
  • The regulations prescribe the minimum level of needs which local authorities must meet. Local authorities can decide to arrange services to meet needs at a lower level.

 Process description

Following a determination that the adult in need of care and support, or the carer with support needs, is eligible for support, the local authority undertakes a detailed care and planning support process. This process is separate to the assessment and eligibility determination, and the local authority will need to satisfy the following before proceeding to plan to meet the agreed needs:

  • The local authority should discuss with the adult how their eligible needs will be met.
  • Establish the adult is ordinarily resident in the local authority’s area.
  • Conduct a financial assessment.
  • Proceed to care and support planning, considering:
    • information and advice
    • what needs may already be met by a carer
    • what preventative services may be relevant.

Please note this step outlines only the local authority’s core duties for care planning. For more detail on the process please refer to Delivering care and support planning from Think Local Act Personal.

Link to SCIE resources

Download

All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:

Available downloads:

  • Assessment and eligibility process map