Key Care Act duties for assessment and determination of eligibility

Promoting individual wellbeing involves actively seeking improvements in the aspects of wellbeing when carrying out a care and support function. This duty applies to any stage of the process from the provision of information and advice to reviewing a care and support plan.

Local authorities must promote individual wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’, because it is a guiding principle that puts wellbeing at the heart of care and support.

Preventing needs for care and support is critical to the vision, expressed in the Care Act, of creating a care and support system that works to actively promote wellbeing and independence and does not just wait to respond when people reach a crisis point. Prevention and early intervention enable the local authority to support individuals, help people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible.

For people to receive high-quality health care and support, local organisations need to work in a joined-up way, to eliminate the disjointed care that is a source of frustration to people and staff, and which often results in poor care, with a negative impact on health and wellbeing. The vision is for integrated care and support that is person-centred, holistic, tailored to the needs and preferences of those needing care and support, carers and their families.

The Care Act 2014 had intended to build upon the creation of Health and Wellbeing Boards which were established in the Health and Social Care Act 2012 to promote the integration of health and social care. However, The Health & Social Care Bill White Paper acknowledges that the spirit of the Care Act is not being fully realised in the objectives of promoting individual wellbeing, and in supporting people with care and support needs to live their lives in the way that they want. There is still work to be done to ensure the provision of seamless and more integrated support, both strategically and operationally. This resource addresses how to move forward in an operational way.

Information and advice are fundamental to enabling people, carers and families to take control of, and/or make well-informed choices about, their care and support. Not only does information and advice help to promote people’s wellbeing by increasing their ability to exercise choice and control, it is also a vital component of preventing or delaying people’s need for care and support.

The duty to provide information and advice underpins any contact or intervention that the local authority has with the individual. It should be provided in accessible ways: not just on a website or via leaflets in a GP’s office but tailored to the needs of local people.

Local authorities must facilitate a diverse, vibrant and sustainable market for care and support services that benefit the whole population. Good commissioning, as outlined in the Care Act and its guidance, should follow some key principles. It should focus on individual wellbeing, workforce development, pay and appropriate pricing of services. It should support sustainability and ensure choice. This should be done through strategic planning, supporting providers and good contracting mechanisms co-produced with local people who have experience of social care.

The Act requires local authorities to promote integration, cooperation and partnership with the NHS and other key partners to enable a care and support system which is person-centred. This means that joint working protocols should be in place to achieve the common goal of promoting individual wellbeing; combining methods, processes and models of practice to bring about a co-ordinated approach to care and support.

Despite the duty placed on the sector to co-ordinate care and support, The Health & Social Care Bill White Paper acknowledges that the spirit of the Care Act is not being fully realised with regard to the objective of promoting individual wellbeing, and supporting people with care and support needs to live their lives in the way that they want.

Local authorities must make enquiries if they believe an adult is, or is at risk of, being abused or neglected. They must also set up a Safeguarding Adults Board that includes key stakeholders. This board will carry out safeguarding adults’ reviews when a vulnerable adult dies or is seriously injured, and abuse and/or neglect is known or suspected to be a factor.

An assessment of needs is a crucial intervention that starts when we commence gathering information about the individual, therefore the screening of the referral is an important part of the assessment from the law point of view.

1. What? An assessment identifies the individuals existing needs for care and support, regardless of eligibility, from the points of view of all those involved in the assessment process (i.e., assessor, individual, professionals, carer, etc.)
2. Who? An assessment should be carried out by an appropriately trained assessor and is led by the individual
3. How? An assessment can be done using different methods/means

Determination of eligibility is an intervention undertaken upon completion of the assessment of needs, to establish if the assessed needs meet the national eligibility threshold.

1. What? A determination of eligibility identifies which of the assessed needs are eligible needs and which ones are non-eligible needs
2. Who? It is the local authority who must carry out the determination of eligibility
3. How? The determination of eligibility should be in line with the eligibility regulations

Many of a local authority’s care and support responsibilities relate to the entire local population (for instance, in relation to promoting individual wellbeing, information and advice or preventive services) as they are general responsibilities. However, establishing responsibility for the provision of care and support for carers requires the local authority to consider the ordinary residence of the individual with needs for care and support.

The Care Act 2014 provides direction on Ordinary Residence.

Some people can have real difficulty being involved in social care processes and don’t have someone appropriate to support them to maximise their participation in the process. If this is the case, then the local authority must arrange an independent advocate to support their involvement in assessment, planning, appeals or safeguarding enquiries.

The Care and Support (Discharge of Hospital Patients) Regulations 2014 set out:

• the details of what the NHS body responsible for a relevant patient must include in the assessment notice that it issues, so that the local authority can comply with its requirements to undertake assessments, and put in place any arrangements necessary for meeting any of the patient’s care and support needs or, where applicable, the carer’s needs
• the minimum period that the local authority has to undertake the assessment
• the details of what must be included in the discharge notice
• the minimum period of notice that the NHS must give the local authority in terms of a relevant patient’s discharge
• the circumstances when an assessment notice and a discharge notice must be withdrawn
• the period and amount of any reimbursement liability which a local authority may be required to pay the NHS for any delayed discharge.

Under Section 117 of the Mental Health Act 1983 (the 1983 Act), local authorities together with Clinical Commissioning Groups (CCGs) have a joint duty to arrange the provision of mental health after-care services for people who have been detained in hospital for treatment under certain sections of the 1983 Act.

After-care services must have both the purposes of ‘meeting a need arising from or related to the person’s mental disorder’ and ‘reducing the risk of a deterioration of the person’s mental condition and, accordingly, reducing the risk of the person requiring admission to a hospital again for treatment for mental disorder.’

All adults in custody, as well as offenders and defendants in the community (i.e. custodial settings), should expect the same level of care and support as the rest of the population. This is crucial to ensuring that those in need of care and support achieve the outcomes that matter to them, which is a requirement of the Care Act 2014, and that will support them to live as independently as possible at the end of their detention. In addition to ensuring that individual needs are met, this will contribute to the effectiveness of rehabilitation and improve community safety.

Transition assessments should take place at the right time for the young person or carer, and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like after the young person turns 18. There is no set age when young people reach this point; every young person and their family are different, and as such, transition assessments should take place when it is most appropriate and of benefit to them.

Effective person-centred transition planning is essential, to help young people and their families prepare for adulthood. Transition to adult care and support comes at a time when a lot of change can take place in a young person’s life. It can also mean changes to the care and support they receive from education, health and care services, or involvement with new agencies such as those who provide support for housing, employment or further education and training.

To promote individual wellbeing as a social care practitioner, you should:

• Begin with the assumption that the person is best placed to judge their own wellbeing.
• Connect with the individual to have genuine conversations to identify and explicitly consider the most relevant aspects of their wellbeing.
• Avoid making assumptions about what is important to an individual’s wellbeing: every person will have a different idea of what wellbeing is.
• Remember that there is no hierarchy in terms of the wellbeing areas and that they all interconnect: the Care Act does not see one area of wellbeing as more or less important than another.
• Ensure conversations are not guided by eligible needs, as you won’t know these at the assessment stage.
• Acknowledge that a person’s sense of wellbeing can change over time; wellbeing relates to the things that the person sees as priorities in life at the moment in time that they are asked.
• Be holistic – have regard to all of the person’s circumstances.

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life to promote their individual wellbeing.

Wellbeing is a broad concept and if you google “what does wellbeing mean?” it brings up the definition that it is “a state of being comfortable, healthy, or happy”.

The Care Act describes it as being related to the following nine areas in particular:

• personal dignity (including treatment of the individual with respect)
• physical and mental health, and emotional wellbeing
• protection from abuse and neglect
• control by the individual over day-to-day life (including over care and support provided, and the way it is provided)
• participation in work, education, training or recreation
• social and economic wellbeing
• domestic, family and personal
• suitability of living accommodation
• the individual’s contribution to society.

Promoting the individual’s wellbeing during an assessment of needs means that you ensure the assessment conversation focuses on the needs and the goals of the individual concerned around the nine wellbeing areas.

The third condition of the eligibility criteria is that you must consider whether the adult’s assessed needs and their inability to achieve the specified outcomes cause, or risk causing, a significant impact to their wellbeing. You will be making an evidence-based professional judgement of the impact that not supporting the individual to achieve the eligibility outcomes they are unable to achieve will have on their wellbeing. The evidence which you will use to understand what is wellbeing for that individual will come from the assessment of needs. To promote individual wellbeing during a determination of eligibility therefore means that during the assessment of needs you ensure the assessment conversation focuses on the needs, the personal outcomes of the individual concerned and the impact on their wellbeing.

A key part of the Act is a focus on preventing or delaying needs and therefore the need for care and support. This means supporting an individual to prevent their needs escalating so that they can keep well and independent, or aiming to reduce needs and help individuals regain skills.

The objective of an assessment of needs is to:

• ensure the individual receives a personalised assessment with the provision of sufficient information, advice and guidance to explore the presenting needs (identified at referral point)
• identify the individual’s needs (assessed needs) from the points of view of all those involved in the assessment process (i.e. assessor, individual, professionals, carer, etc.)
• identify what outcomes an individual wishes to achieve in day-to-day life.

Your role will be to take into account the presenting needs and tailor any information, advice or guidance so that it is appropriate and proportionate to the individual’s circumstances and the needs which you are assessing. During the assessment conversation you will support the individual to consider how they can keep well and independent, reduce needs or regain and learn new skills.

As you gather information from the individual regarding their presenting needs you should consider other sources of care and support which may be beneficial to the individual in supporting them to achieve their outcomes. These could be:

• 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).

You would consider the local offer in relation to care and support services which could assist the individual to achieve their personal outcomes and you will provide information and advice to them on how to reduce or meet their needs and how to prevent, reduce or delay the development of future needs.

The assessment of needs conversation may not identify any needs, or the subsequent determination of eligibility may not identify that the assessed needs are eligible for care and support. However, prevention and early intervention are placed at the heart of the care and support system, and you can provide information and advice or other preventative services to prevent, reduce or delay future need for care and support.

During an assessment of needs under the Care Act, the following requirements apply:

• Provide information and advice to everyone in the area, not just people who have eligible needs.
• Ensure that information covers the rights and entitlements that people have under the Act and how they can access them in their local area. This should include financial advice.
• Provide information in accessible ways – not just on a website, or as leaflets in a GP’s office, but tailored to the needs of local people.

Provision of information and advice is useful for enabling the individual to take a lead in the assessment process, through understanding what the intervention entails to the knowledge of what potential options are available to address the presenting needs.

The information and advice which you will provide, prior to and during an assessment of needs will be unique to the individual to whom the assessment relates. All parties involved will guided by the information and advice which you provide during the conversation you have.

Through supporting the individual to explore their needs and how these impact on their ability to achieve the outcomes that matter to them, you will provide information and advice which may enable them to keep well and independent, to reduce needs or take steps to regain or learn new skills.