Fair access to care services (FACS): prioritising eligibility for care and support
Assessment - Impact of the outcomes approach
Councils should work with individuals to explore their presenting needs and identify what outcomes they would like to be able to achieve. In this way they can evaluate how the individual’s presenting needs might pose risk to their independence and/or wellbeing, both in the immediate and longer term.(‘Eligibility for social care’, DH, 2010, para 59)
Brian’s story – good assessment contributes to positive outcomes
Brian, aged 79, has multiple sclerosis and his wife, Beverley, is finding it increasingly difficult to cope with his bladder infections and unsteadiness. His symptoms are worse when he worries about his daughter who lives in France. Beverley now has high blood pressure that is proving difficult to control. The couple want to be together at the end of their lives, to have a better quality of life and more contact with their daughter. The care workers raised charitable funds to get the couple on Skype and email. The GP secured equipment so that Brian could bathe safely, and suggested Beverley make contact with the local Carers’ Centre. There she could be offered information and advice; receive friendship and peer support; and have the opportunity to learn relaxation techniques and other ways of managing stress and depression.
In applying the individual outcomes approach in practice, staff should be able to:
- help individuals and carers to explore their presenting needs, personal strengths, skills and circumstances to identify and agree outcomes they want to achieve and plan how this can be done; where individuals do not have mental capacity, formal Best Interests decisions will be required
- inform individuals and their carers about the options of personal budgets, direct payments or managed personal budgets, the support available within each to implement the plan, and sources of independent advice, such as Centres for Independent Living and Carers’ Centres, offering practical support to manage a personal budget or direct payment
- adopt an integrated approach to pursuing social care, NHS and public health outcomes with individuals and their carers, and ascertain whether there are other factors, such as housing or income, which should be considered in an outcomes approach
- review progress, barriers and any changes required to the agreed outcomes
- identify any unmet needs that may prevent the realisation of agreed outcomes
- identify external and environmental factors that may cause, or have caused, or exacerbate, the difficulties the individual is experiencing
- consider health professionals and NHS bodies that may have relevant information to contribute, or whose expertise and services may enable the person to achieve the agreed outcomes
- look beyond social services to identify resources and services, including local community groups and support the person and carer may be able to access to achieve the agreed outcomes
- explain that the review process may identify outcomes that have been achieved, or needs or risks that have reduced as a result of reablement or other reasons, and that if so, a reduction or variation in support may be justified.
The emphasis on individual outcomes in the ‘Eligibility for social care’ section of the FACS guidance is echoed at the local authority population level in the DH’s Adult Social Care Outcomes Framework (ASCOF) for 2013/14.  This sets out four overarching domains of adult social care performance, and some outcome measures for each. The domains are:
- enhancing quality of life for people with care and support needs
- delaying and reducing the need for care and support
- ensuring that people have a positive experience of care and support
- safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm.
Under the Care Bill, assessments will remain an integral part of the system, as they are now. However, rather than acting primarily as a gateway to the individual either receiving care and support or not, the future system will place more emphasis on the role of the assessment process in supporting people to identify their needs, reduce needs or delay them increasing where possible, understand the options available to them, and plan for meeting current and future care needs and caring responsibilities.
The assessment process in the Bill provides for joint assessments between local authorities and other bodies such as the NHS. Improved integration will help to ensure that the person does not have to undergo multiple separate assessments, and will support better care planning to meet the individual’s overall health and care needs. It will also join up whole-family assessments which look at an individual needing care alongside those who care for them.