Assessment of needs under the Care Act 2014

An assessment under the Care Act is an assessment of needs for care and support (including transition assessments), or an assessment of a carer’s needs for support.

The nature of the assessment will vary depending on the person and their circumstances. The assessment process should be appropriate and proportionate to the individual and their needs.

You may need to do a re-assessment under the Care Act following a review of a care and support plan, when it has been identified that there has been a change in needs.

The purpose of an assessment is to explore the presenting needs (identified at the referral point) and identify the individual’s needs (assessed needs). The assessment considers the viewpoint of all those involved in the assessment process (i.e. assessor, individual, professionals, carer, etc.) and what outcomes an individual wishes to achieve in day-to-day life, for example:

• to see friends
• to go to work
• to learn a new skill.

To do this in a way that will support the determination of eligibility – once the assessment is completed ¬– you should get a full understanding of the individual’s priorities and desired outcomes in relation to the nine areas of wellbeing. You and the individual must identify, during the assessment, their own strengths, skills and capabilities; and whether these can be utilised or developed to enable them to achieve their desired personal outcomes. This will enable you to provide a full picture of the individual’s needs from the points of view of all those involved in the assessment process (i.e. assessor, individual, professionals, carer, etc.) and the individual personal outcomes in relation to the nine areas of wellbeing.

An assessment under the Care Act is a critical intervention in its own right. It gives you an opportunity to support an individual with an appearance of need, to understand their needs and how they may be affecting their ability to achieve their personal outcomes. It is also an opportunity to help them understand their strengths and those of the community around them, and how those strengths can help achieve their personal outcomes.

An assessment entails a semi-structured conversation between the assessor and the individual, based on a meaningful relationship which seeks to support the individual to achieve the outcomes that matter to them.

It can be a therapeutic process as you support an individual to understand their situation and the needs they appear to have, to work together to reduce or delay the onset of greater needs and to enable the individual to access the right support when they require it.

A local authority has a duty to carry out the Care Act assessment. The function of the assessment can be delegated but the accountability always remains with the local authority.

Whomever undertakes the assessment under the Care Act has to ensure that they understand the purpose, aims and outcomes of the intervention and that the assessment under the Care Act is defined by the Care Act duties and principles.

If a local authority does delegate the function of the assessment, it will need to assure itself that the information gathered is in line with the expectations of this intervention and is an accurate and complete reflection of the individual’s needs.

An assessment under the Care Act can be undertaken with:

• An adult over the age of 18 with an appearance of needs for care and support
• A young person under the age of 18 who is likely to have needs for adult care and support after turning 18 (regardless of whether they are in receipt of services as a child and the potential eligibility for care and support after 18)
• An adult over the age of 18 who is providing unpaid, necessary care and support
• A young person under the age of 18 who is providing unpaid, necessary care and support to an adult with an appearance of needs

As a social care practitioner, you need to do an assessment of needs for a self-funder.

An individual has the right to refuse an assessment. Whilst discussing with the individual their reasons, you will have an opportunity to explore the circumstances of the individual’s situation which gave rise to the third-party referral. This will enable you to listen and offer appropriate information and advice, undertaking your duty to prevent, reduce or delay the needs which have been perceived by the third party. Nonetheless, should the individual not wish to proceed, you would not ordinarily be required to undertake the assessment under the Care Act. The only times which you would be permitted to deviate from their individual right to make decisions for themselves is if you had reason to believe the individual:

• lacks capacity to refuse an assessment – it will be necessary for you to subsequently undertake a Mental Capacity Act assessment and follow the best interest process
• is at an identified level of risk to themselves or others

The Care Act does not specify the timeframes within which an assessment should be undertaken. However, an assessment under the Care Act should take place upon request in a timely manner if it is identified that there is an appearance of need for care and support. ‘Timely’ here refers to the individual and their circumstances, not to the local authorities’ priorities.

The speed with which the assessment takes place should be considered on a case-by-case basis. It should consider important factors such as potential risk and the impact of not prioritising the assessment.

There will be situations where the local authority will need to provide care and support without undertaking an assessment under the Care Act. The Care Act provides local authorities with the powers to meet needs for care and support and they may do so regardless of the individual’s ordinary residence.

If we look at the below examples, which of these statements do you think indicate that there is an appearance of need for care and support?

• I need meals on wheels
• I need help having a shower
• My mobility has reduced, and I am finding it very difficult to manage around the home
• My microwave has broken, and I am not really able to cook any more
• My son has learning disabilities and has just lost his job due to an unfair dismissal

All these statements could indicate an appearance of need for care and support, but let’s focus on meals on wheels to explore how you can identify if there are appearance of need for care and support. It is possible for you to assume that the individual is requesting meals on wheels because they have reduced mobility or that they are unable to follow the necessary sequence for food preparation. The individual, however, may feel that they need meals on wheels because they smell the wonderful aroma from their neighbour’s kitchen when they microwave their meals on wheels. This indicates a desire, a preference, or a want but not a need as implied by the Care Act or even an appearance of need. It is therefore important for you to ask questions to gain an understanding of why the individual considers that they need meals on wheels, to explore what is happening in their life now which impacts the ability to have a hot meal on a daily basis. If the conversation indicates that there is a need that impacts on their ability to prepare a meal (and not merely a wish to have meals on wheels or a broken microwave or oven), this will trigger the duty under Section 9 of the Care Act 2014 to undertake an assessment under the Care Act. If it does not, then a conversation around the duties relating to provision of information, and advice and prevention, may be appropriate; however, it would not lead to an assessment under the Care Act.

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.

• Strengths-based approach
• Transparency
• Whole family holistic approach
• Appropriate
• Maximise person’s involvement
• Proportionate
• Individual’s choice and control
• Recognise fluctuating needs

It means that your practice will take into account at all times:

• mental capacity
• safeguarding
• risk enablement.

As a social care practitioner, you should prepare the individual for the assessment conversation(s) before you meet with them. To support the individual and to maximise their involvement you should:

• Make initial contact, to establish preferred times and methods for the assessment conversation(s) to take place. While the assessment must comply with the aim and purpose established in the Care Act, the process is flexible and should be adapted to best fit with the person’s needs and circumstances.
• Establish how they would like information to be provided to them:
  • consider their communication needs
  • is an Independent Advocate necessary?
  • explore the appropriate number of meetings, and their duration
• Provide an overview as to what the assessment conversation will entail, offering some prompts for them to consider in advance:
  • Any background information that they consider useful for you to know
  • What is important to them
  • What is working well, what’s not and what is preventing them from living the way they would like
  • What they may want to change, how and what help they may need to make this happen
  • What support they are already receiving.
• Share this useful article: Which?: preparing for the assessment under the Care Act
• Inform the individual that if they want, they can have other people present; ensure to record and invite the people they want there.

Before you undertake an assessment under the Care Act, you should prepare yourself for a conversation to establish the full extent of the individual’s needs:

• Read previous information about the individual and their circumstances.
• Think about what you need to know about the individual to fully understand them, their life, their priorities, etc.
• Think about any additional issues or obstacles you can foresee and how you can address them (i.e. risks).
• Ensure that during the assessment process (before, during or after the meeting) you get input from any professionals involved in the individual’s life as appropriate.
• Ensure you don’t have an answer/solution in your head until you have concluded the assessment process.

A local authority should offer an individual the opportunity to undertake a supported self-assessment which places the individual fully in control of the assessment, to a point where they themselves complete their assessment.

If an individual wants to do a self-assessment the local authority has to provide the necessary information, advice, and support.

The supported self-assessment should use the same assessment materials as used in other assessments of needs and the local authority must assure itself that it is an accurate reflection of the individual’s needs.

• Encourage and enable the individual to take a lead in the assessment under the Care Act as this intervention is about their lives and they are the experts.
• Have a conversation, using strengths-based open questions.
• Actively listen to the replies so that you are able to find out what is important to an individual and why and what it is they want to achieve.
• Understand from the individual’s perspective how their presenting needs prevent them from achieving their desired and/or personal outcomes.
• Gain a full picture of the individual’s needs, priorities, and personal outcomes.
• Support the individual to understand how their current set of strengths and networks of support can be utilised or developed to enable them to achieve or work towards the desired and/or personal outcomes.
• Gather enough information about existing needs, desired and/or personal outcomes and the individual, from the individual’s perspective and your own observations, so that you are able to use it as evidence through the determination of eligibility.
• Ask, with relevant consent, carers and people involved in the individual’s life.

Under the Care Act, an outcome describes something that follows as a result of, or as a consequence of, an intervention such as an assessment of needs for care and support or the provision of care and support. Within the assessment, the outcomes that you explore will relate to the things that matter to the individual in their life. It is important that you explore the individual outcomes around the nine areas of wellbeing to ensure you comply with the legal duty of promoting individual wellbeing. There is a difference between the desired outcomes that the individual has, and the outcome of the intervention. An outcome of the assessment under the Care Act may be the provision of information and advice, the individual gaining further insight of their needs or a progression towards a determination of eligibility.

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Example

Evie has been involved in a road traffic accident which has reduced her mobility. She is finding it difficult to walk for more than a few minutes at a time. Evie used to meet her friends at the park on a Saturday morning but now feels that she is not able to do this as getting there leaves her so tired that she can’t then enjoy the time with her friends. The personal outcome for Evie at the start of the conversation was to meet with her friends at the park on a Saturday morning. An outcome of the assessment under the Care Act could be that you have:

• supported Evie to see how being unable to achieve this is impacting on her ability to maintain friendships that are important to her
• provided information regarding a local taxi company that has wheelchair accessible transport, and that you have supported her to contact Citizens Advice for support with applying for disability related benefits.
• supported Evie to amend her outcome to one which could be more achievable for her, such as to meet with friends on a weekly basis but not necessarily on a Saturday morning.

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When discussing outcomes with the person, it may be helpful to think of the nine areas of wellbeing simply as usual areas in a person’s life. The individual would phrase their desired outcomes in their own terms, not in terms which reflect the terminology of the Eligibility outcomes such as ‘developing and maintaining family or other personal relationships’, but instead say that they quite enjoy watching a game of football in a pub. It is up to you to think through the person’s life and check what needs are present which prevent them from achieving this outcome. For example, is there difficulty in accessing a social space, which could mean they cannot access the community or other resources to maintain their social relationships? In the above example of the game in the pub, it may not be the game itself that is important but the social interaction. But on the other hand, that single activity could fulfil wellbeing in several areas.

The record of an assessment under the Care Act should:

• be a full picture of the individual’s needs, their views and the assessor views on those needs, and the individual personal outcomes in relation to the nine areas of wellbeing and how their needs affect them in achieving those outcomes.
• reflect the conversations that have taken place, and the consideration of the individual’s current set of strengths and networks of support
• outline the information and advice which has been offered
• contain your professional analysis based on the information gathered from the individual and other appropriate sources of information, and on your own factual observations or evidence
• demonstrate the impact of the current circumstances on the individual and others
• identify any risks and assess their impact and likelihood

Procedurally, the record of the assessment under the Care Act is an important document which you will use to enable you to undertake an eligibility determination. It is therefore important that it is an accurate reflection of:

• desired and/or personal outcomes
• presenting needs
• impact on individual wellbeing.

However, it is a unique document as it reflects an individual’s life, and you will need to write it in a way that both identifies the perceived needs and highlights the strengths that the individual has in their life, for example:

I reflected that her friendships were clearly important to her and that she was important to her friends. We explored how her reduced mobility makes it difficult for her to meet her friends without support. Together we thought about different ways A, B and C in which Evie could still have weekly contact with her friends. Evie informed me that she liked the idea of A and would be able to follow this up by herself.

Assessments have to be written factually, objectively and with evidence to support the information that is recorded. See our resource on social work recording.

The Care Act says that determination of eligibility happens ‘upon completion of assessment’. Therefore, as a social care practitioner, you need to determine when your assessment is completed to move to the next stage.

An assessment under the Care Act is completed, even if not recorded, when you have a clear understanding of the individual’s needs and circumstances and their personal outcomes in relation to the nine areas of wellbeing, both from your point of view and theirs.

If you do not have this clear understanding, the assessment process should continue, and you should gather further information.

Once the assessment under the Care Act is completed you should determine eligibility.

Once the assessment under the Care Act has been recorded, you should share it with the individual so that they can assure themselves that it is an accurate account.

Your professional opinion – based on evidence – may differ from the individual’s opinion, but if both are recorded accurately in the assessment form and the individual has been informed of that difference, the individual should agree that the assessment is an accurate reflection of the process.

Once the individual agrees that the assessment record is accurate, you should provide the individual and anybody else that the individual requests with a copy of the assessment document, unless this will place the individual or anybody else in danger (if you think this is the case, discuss with your manager and record why).