What are the implications for practice? - Ensuring assessment is appropriate and proportionate
An assessment that is proportionate and appropriate will be as extensive as required to establish the extent of an individual or their carer’s needs. Needs may well differ in their severity – additional exploration of underlying needs may be required or an individual may have needs within some aspects of their lives. Local authorities may well find that there is a tension between ensuring that an assessment is completed efficiently (i.e. quickly) and ensuring that it is completed effectively (i.e. conscientiously).
In assuring an assessment has been thorough and has provided enough insight into someone’s needs, local authorities may consider it useful to seek the views of those who are in regular contact with the individual, such as their carer(s) or other appropriate people from their support network, and any professional involved in providing care such as a housing support officer, a GP, a treating clinician, a district nurse, a rehabilitation officer or relevant prison staff. This provides the opportunity for triangulation for the local authority and ensures that the assessment has captured the fullness of an adult with care and support needs or a carer with support needs. Of course in doing this, the local authority should first seek the individual’s consent.
In practice the following key elements are essential in ensuring appropriate and proportionate assessment takes place:
- the individual is listened to with the overall purpose of establishing their needs and no more
- appropriate pace and time are given to the process
- recognition is given to the individual’s strengths and weaknesses and the assets that exist in their immediate network and wider community
- clear and plain language is used in the assessment:
- avoiding the use of jargon/‘professional’ language
- listening and reflecting the discussion in plain language rather than putting words into someone’s mouth
- talking to the individual involved in the assessment in the first rather than third person
- reflective, accurate and appropriate recording – i.e. who said what.
Key features: communication, information and data-sharing
In principle it is of benefit to share information as widely as possible during the assessment process to get a full picture of the needs involved, however there are circumstances under which this is not always the case. It is important to be aware of the different levels of consent needed to share information related to adult and carer's assessments and in combining assessments.
- Since care and support functions are public functions, they must be carried out in a way that is compatible with all of the local authority’s legal obligations. For example, the local authority would be liable for any breach by the delegated party of its legal obligations under the Human Rights Act or the Data Protection Act.
- The exchange of data needed for the purposes of local authorities and NHS bodies carrying out their respective functions is allowed in accordance with the common laws of confidentiality and data protection legislation.
- It is the responsibility of the individual bodies to ensure they have robust data protection safeguards in place to ensure a person’s personal data is kept secure and only used for the purposes that it is required (i.e. seen by those it needs to be seen by on a need to know basis).
- The Data Protection Act (1998) provides the framework for decision-making on this.
- There is a duty to comply with data protection legislation without overusing it to prevent legitimate access to information by the adult requiring care and support of their carer. In this respect the Caldicott principles provide guidance on:
- sharing information unless there is a good reason not to
- sharing information proportionately in relation to what you need to know (when you are asking)
- what is needed to achieve sufficient understanding to be able to provide an appropriate intervention/eligibility determination.
The Six Caldicott Principles
- Justify the purpose(s) of using confidential information
- Only use it when absolutely necessary
- Use the minimum that is required
- Access should be on a strict need to know basis
- Everyone must understand his or her responsibilities
- Understand and comply with the law
Care Act context
- Before sharing any information, the local authority must ensure that the individual consents to that information being shared. If the adult with care and support needs or the carer with support needs lacks capacity, information must only be shared where the local authority is satisfied that doing so is in their best interests.
- In the case of a young carer, the local authority must also consider whether it is appropriate to share the information about the adult the young carer cares for.
- Carers and families often assist people in making decisions about their care and how they pay for it. Local authorities should, as appropriate, invite carers and/or families to participate in discussions, and should also provide them with all the information that would otherwise be given to the person they care for, subject (where required) to the consent of the person with care and support needs (if they have capacity) or someone else with appropriate authorisation. In doing this, they must ensure compliance with mental capacity and data protection legislation. (Not all information about a person’s care will necessarily be confidential – so local authorities will need to apply data protection legislation to consider where seeking consent is and is not required.)