Key Care Act principles for assessment and determination of eligibility

An individual’s capacity to consent to an assessment should be established on reception of referral and subsequent screening process.

The local authority must assume a person has capacity unless it is established that they lack capacity. It must satisfy itself that the individual has the 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.

As a social care practitioner, if you have concerns regarding an individual’s capacity to consent to the assessment, you must pause the assessment process and follow the procedures as outlined in the Mental Capacity Act 2005 and associated code of practice.

Appropriate and proportionate means that the assessment must be:

• Person-centred and suitable for the individual’s capacity, capabilities, circumstances and communication preferences.
• Carried out over an appropriate and reasonable timescale, taking into account the urgency of needs and with consideration of any fluctuation of those needs.
• 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; proportionality is related to the depth of the information gathered, not to the breadth of it, so you should not assume that certain areas or topics are not relevant to an individual. Your assessment style should therefore not be one size fits all, but adapted to the individual’s circumstances, needs (communication needs, levels of complexity etc) and preferences, and underpinned by the eight principles of the Care Act.

You will need to adhere to the duties of the Care Act, such as Preventing needs for care and support, Promoting integration of care and support with health services etc and Providing information and advice. However, the extent of this will be determined by the individual whom you are assessing.

To promote an appropriate and proportionate assessment you should be

• person-centred
• strengths-based
• collaborative
• clear and transparent
• flexible

In order to ensure that the assessment is proportionate, you should:

• Ensure the assessment is only as intrusive as it needs to be to establish an accurate picture of the person’s needs, personal wishes and preferences, desired outcomes and the severity and overall extent of their needs.
• Work with partners (e.g. housing, the voluntary sector, adult mental health professionals, relevant professionals in the criminal justice system) to join up around the individual and avoid multiple assessments taking place at different times.
• Use a format of assessment proportionate to the level of presenting needs, for example a telephone assessment may be the best approach in some cases.
• Actively listen to the individual to understand the initial presenting needs and explore as necessary to ensure any underlying needs are also explored and understood.
• Support the individual to explore all nine areas of wellbeing if they have not identified them initially, but accept there are some they may not wish to discuss.
• Recognise and seek to draw out the individual’s own knowledge, strengths and capacities in line with strength-based practice.

You must consider the impact of the individual’s needs being assessed on anyone who cares for the individual and their wider family. Where a young carer is identified, you must arrange a young carer’s assessment under Part 3 of the Children Act 1989.

These considerations will enable you to ensure the extent of the assessment is proportionate and not overly burdensome.

The local authority must consider the needs of an individual over an appropriate period of time to understand the full impact of their needs on their wellbeing.

The point at which the individual’s needs are assessed 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 process of assessment provides one of the most important elements of care and support, and you will take a holistic approach to enable understanding of the assessed needs so that the local authority can ensure ongoing care needs are met – not just those presenting on the day of the assessment meeting.

To consider fluctuating needs you must ensure that the assessment is not simply a ‘snapshot’ of a person’s care and support needs but considers those care and support needs over a suitable period of time to gain a complete picture and full understanding of the implications of their condition and circumstances.

An individual may not fully recognise the impact of these fluctuations on their wellbeing, thinking of them as something they just cope with. Therefore, supporting the individual to explore how their needs can fluctuate over time could be achieved through a reflective conversation. The following questions can support this:

• How do their needs present themselves on the given day?
• If their needs change over time, are those presenting during the conversation a true reflection of their condition over time?
• Do they have good days and bad days, what is the frequency and degree of variation and what may contribute towards it?
• How much of an issue have the fluctuations been in the past, and in what way?
• How are their needs likely to develop in the future? Are the fluctuations likely to persist?
• How might the fluctuations impact on the outcomes they want to achieve in their life, and in what ways?

Working with individuals around fluctuating needs will enable you to support them to consider contingency plans that may be needed to mitigate the impact of the fluctuations, preventing or delaying as far as possible, the development or escalation of further needs in the future.

If appropriate, you may want to consider using your previous experience of working with individuals with similar illnesses or disabilities which fluctuate, to know what type of questions to ask and what information to share with the individual. However, you must remember that each person will experience similar situations differently. It is important that you do not make assumptions based on your knowledge of the answers to the questions or the outcomes; instead you should clarify the individual’s experience in line with person-centred, strengths-based approaches.

It may be appropriate and proportionate to explore the wider causes of fluctuating need as needs may fluctuate not just because of a condition but also because of changing circumstances such as changes in employment or education, changes in a relationship or home environment.

Taking a whole family approach to an assessment of needs you must consider the impact of the fluctuations in the person’s needs on anyone who cares for them and their wider family.

It may be necessary for you to consider if any fluctuation of needs could mean that other care and support may be needed when needs increase. This includes safeguarding, independent advocacy or the assessment of mental capacity.

It may be appropriate and proportionate for you to access expert opinion to support any assessment of what can be reasonably expected of a person with a similar fluctuating condition and circumstances. However, it is vital to recognise that this is only indicative and cannot be used as an absolute measure.

See also: Fluctuating needs in assessment and eligibility for the Care Act 2014 – SCIE Guide

As a social care practitioner, when undertaking an assessment or determining eligibility, you will need to consider any risks that an individual’s assessed needs and desired outcomes may present to themselves and others.

If the individual has capacity, your main role is to inform them of the risks to themselves and ensure they take responsibility for the consequences, managing the risk. If they do not have capacity or the risks are to others, you may need to intervene to reduce or eliminate the risk.

Risk is:

• the probability that an event will occur with beneficial or harmful outcomes for an individual or others with whom they come into contact. For example, an individual you are assessing may express a desire to live independently of the family home. While there may be harmful outcomes initially, with a period of enablement support, the individual may be able to develop independent living skills and so the initial risk will have beneficial outcomes. When making a determination of eligibility you will need to consider risks which may apply in the event that the individual is not supported to achieve the specified outcome.
• A product of the likelihood that an event will happen and the impact that event will have if it does occur.

You should try to gather as much information as possible about the individual’s circumstances before and during an intervention to ensure any risks are looked at properly.

Find out more: Risk identification and virtual interventions for social workers

A strengths-based approach to an assessment sees the process as a collaborative one, working “together to determine an outcome that draws on the person’s strengths and assets.”

“Let’s look first at what people can do with their skills and their resources and what can the people around do in their relationships and communities. People need to be seen as more than just their care needs.”

Alex Fox, Chief Executive of Shared Lives Plus, Vice Chair of Think Local Act Personal and a SCIE trustee

To take a strengths-based approach to assessment, you as a social care practitioner should see your role in the assessment process as a facilitator of change, working to develop a high-quality relationship between you and the individual which you are supporting to identify needs, personal outcomes and maintaining or improving wellbeing. You will get to know the individual, not just their needs.

You will need to work in collaboration with the individual, supporting them to do things for themselves, with the aim that they become more than passive recipients of care and support. In order to do this, it is fundamental that you establish and acknowledge the capacity, skills, knowledge, network and potential of both the individual and the local community.

In taking a strengths-based approach to assessment, it may be possible for you to collectively identify what opportunities already exist which the individual can access independently thus increasing independence and developing personal resilience.

Your practice should not be one size fits all but the format, methods and approaches to the relationship should be led by the individual, or their representative, to promote them as experts in their own life. Begin with the assumption that they know what is best for their wellbeing.

A strengths-based assessment will include the individual’s:

• personal resources, abilities, skills, knowledge, potential etc.
• network and its resources, abilities, skills etc.
• community resources, also known as ‘social capital’ and/or ‘universal resources’.

You will work with the individual to explore, through a semi-structured conversation using strengths-based open questions, how their current set of strengths and networks of support can be utilised or developed. This will enable them to achieve, or work towards, the desired and/or personal outcomes and maintain or improve their individual wellbeing.

Being person-centred means that you as a social care practitioner work with the individual during an assessment and when determining their eligibility, to keep them at the heart of the intervention and any decision made about their life.

Person-centred practice means that the assessment and determination of eligibility is based around the individual, their needs, preferences and priorities and that no decision is made without the individual, or the person representing them. Your intervention with the individual will be appropriate, and proportionate to the individual and their circumstances.

The relationship you develop and approaches you use will be fundamental to enabling the objective of the assessment as an intervention to be achieved. This will signal that you are interested in the individual’s life and not just the difficulties that they are facing. Find out more about building rapport and establishing meaningful relationships using technology in social work.

To be person-centred, your practice is based on the core values of health and social care which are care, commitment, compassion, courage, competence and communication, promoting an individual’s human rights and having positive conversations where risk has been identified.

You involve the individual or their representative as much as they wish to be and as is practicable, engaging with them using a format and method of assessment deemed most appropriate to aid their understanding and ability to work with you to explore the outcomes they wish to achieve in their day-to-day life.

If you do not consider you have the necessary knowledge of a particular condition or circumstance, you must consult someone who has relevant expertise, such as a health professional or expert within the local authority.

You are flexible and perceptive of the individual’s situation and needs around the assessment process. For example:

• allow for a break in the assessment if needed so that the person doesn’t become overwhelmed
• demonstrate an understanding of the person’s condition
• repeat facts, to confirm they are accurate and that you have noted them down correctly.

Being person-centred means you are professional, honest, open and approachable. For example:

• Make sure you listen.
• Let people speak, even if their assessment is taking place with an advocate present.
• Be clear that you can’t fix everything in one session and that this is an ongoing process.
• Build trust with people.
• Be conversational, without too much direct questioning – people will open up more and provide more detailed answers.
• Be friendly but be aware of the difference between ‘friend’ and ‘friendly’.
• Be clear about who is making any given decision. If you need to take your findings to your manager, then be clear about this from the start.
• Let the individual know that they have a right to appeal against the outcome of the assessment.
• Explain the possible outcomes.
• Don’t use jargon.
• Perform your assessment as an intervention, so that the individual will benefit from the process itself no matter what the outcome is.

As a social care practitioner, when you are undertaking an assessment or determining their eligibility, you will ‘look at the person’s life holistically, considering their needs and agreed outcomes in the context of their skills, ambitions and priorities’. This means that you will see more than the difficulties that they are facing, and offer the opportunity to have a conversation about their whole life and not just their assessed needs. You need to look at the individual as a person and their relationships, interactions and role in them and in their community.

You will see the individual as a whole person and consider all of their needs as appropriate and proportionate, in line with the nine areas of wellbeing. For example, having a conversation about important relationships, hobbies, previous life experiences. These things may seem small to you but mean the world to the individual, and could support you and the individual to identify assets and strengths which could be utilised in supporting them to achieve the outcomes that matter to them without the necessity for state intervention.

The Care Act recognises that an individual’s needs do not just impact on them but can also on other people in their lives. When having an assessment conversation with an individual, it will be important for you to give them the opportunity to explore this and to consider your duties in relation to carers assessments.

You will consider the individual in the context of their whole community, in terms of their desire to contribute to it and hence be better integrated in the wider society around them. The community the individual has access to should also be considered as a potential network of support, that could enable the individual to achieve their desired outcomes and prevent needs from escalating.