Step 2 - Getting a community care assessment

It is essential for a bureau to obtain as much information as possible about a local authority's community care policies, assessment procedure and criteria for service provision. This will enable an adviser to identify whether a client has been assessed and supported according to the local authority's own policies and procedures.

How to get an assessment

If a person 65 or over wishes to apply for free personal care at home, s/he must have an assessment of her/his care needs. Someone who is acting as her/his carer can also request an assessment of their own needs. This should include an assessment of any housing support needs that the client has.

 In law, it is not necessary for a client to ask a local authority to make an assessment unless the person is 65 or over and wishes to apply for free personal care. The local authority should carry out an assessment as soon as it becomes aware of an apparent need. However, in practice it may be advisable that s/he or her/his representative requests an assessment in writing, giving full details and enclosing any relevant letters or reports.

When a local authority carries out a community care assessment of someone and it appears that s/he is disabled, it must assess her/his needs for services under the Chronically Sick and Disabled Persons Act (CSDPA) 1970, and inform her/him that it is doing so. The advantage of this to a disabled person is that the local authority may be under a stronger duty to provide services under the CSDPA. If the local authority has not satisfied its duties under the CSDPA, the adviser should challenge the authority, and may need specialist advice.

An assessment is a way of determining whether an individual is in need of community care services. Under Section 12A of the Social Work (Scotland) Act 1968, local authorities have a duty to assess any person aged 18 or over who may need community care services (which can include Supporting People Services). The Community Care and Health (Scotland) Act extends the right to an assessment to carers. There is Scottish Government guidance on how assessments should be carried out. However, local authorities have discretion on the details of arrangements for assessments in their area. All local authorities are required to use single shared assessments.

What happens during an assessment

The assessment is carried out by someone from the council social work department. This might be an occupational therapist (OT).

29There are different types of assessment depending on what the client appears to need. These can range from self-assessment to comprehensive assessment. Where the client's ability to remain in her/his own home is in question the local authority must carry out a comprehensive assessment.

30An assessment may involve the client filling in a form or some other written procedure, but this will not necessarily be the case. The assessor will often have a standard form that s/he completes.

31The procedure for carrying out an assessment may vary from one local authority to another. Because of this local variation, it is essential that an adviser be aware of what the local authority policy is about how it will conduct assessments.

32Scottish Government guidance states that assessment will normally include an initial screening process, which could involve the client only being asked a few simple questions. This may be carried out by a receptionist in some authorities, or by a trained person. In some authorities this screening process may be used to control the demand for services and the client may not receive a further, comprehensive assessment. If the client's needs are not complex, this very simple type of assessment may be sufficient. If, however, s/he feels that her/his needs have not been adequately addressed, s/he could complain about the assessment.

33A person being assessed should give as much background information about her/his situation as possible in this initial screening process, which may take place, for example, on the telephone or in social work reception. Not giving sufficient detail may result in the client being given a low priority and the assessment being delayed.  A client can also request an assessment for housing support services.

The needs of the person requiring care will be assessed by someone from, or acting on behalf of, the local authority social work department. In carrying out the assessment, local authorities must consult a medical practitioner if the individual may require nursing care, and consult the NHS or housing authority if the person may need support with her/his health or housing related issues. Some voluntary organisations who provide community care services may do community care assessments.

More than one person could be involved in carrying out an assessment, and you may want to inform a client who is waiting for an assessment that s/he may be visited at home by different people, including a social worker, a physiotherapist and an occupational therapist. All local authorities are required to use single shared assessments. A person carrying out an assessment should be asked to identify her/himself.

In a single shared assessment, a person is assessed by the most appropriate lead professional. This may be a social worker, housing worker, medical practitioner or other care professional. Information is then shared between the departments or agencies to ensure that the person receives the appropriate package of support services. Once the assessor has decided upon the support requirements, the other agencies involved must accept the results.

In a single shared assessment the assessor must seek the consent of the person being assessed to the sharing of information with other agencies. The person or the person's representative (for example, a legal representative, carer or advocate) must give her/his consent before the information can be shared.

If a client feels that an individual who carried out an assessment was not equipped to carry out the assessment, was not the most appropriate person to carry out the assessment or did not request her/his consent to information sharing, then s/he may wish to challenge the decision.

A person who is being assessed can have a relative, friend or other person present to support her/him or to speak on her/his behalf during the assessment. This could be an independent advocate.

If the person being assessed has a carer, s/he may want her/his assessment to be carried out without the carer being present. The local authority would normally ask the client whether this is the case, but if it does not s/he can request it.

A carer can also ask that if s/he is having an assessment, this is carried out without the person being cared for being present.

What the assessor will take into account

The kinds of factors an assessor will take into account when making an assessment may include:-

• whether the person needing care has any particular physical difficulties, for example, whether s/he has difficulty walking and finds stairs too difficult to manage, and whether those difficulties could be resolved within the home by, for example, providing aids or adaptations
• whether, with appropriate support services, (such as nursing, home help, day and personal care, meals on wheels), the person needing care could continue to live in her/his own home; or whether s/he would need to move into a care home/other supported accommodation
• whether the person being assessed has any particular health or housing needs, including housing support needs
• what sources of help the person needing care already has access to, such as carers, family, or nearby friends, and their willingness to continue providing care
• what need may exist for social contact, stimulation, activities or recreation
• what needs the carer(s), if any, may have for support or respite
• the wishes of the person being assessed
• whether the circumstances of the person needing care may change, which means her/his needs may change, (for example, if s/he has a progressive illness)
• the views of both the carer and the cared for person on the care needs.

Local authorities have specific guidance on how an assessment should be undertaken and Scottish Government guidance has required local authorities to use single shared assessment since April 2004. An English court case has found that local authorities must take guidance into account when carrying out an assessment. This does not mean that they must necessarily follow the guidance, but, if they do not, they should give reasons. Important points in the guidance include:-

• assessment should examine the needs of the individual for any form of care or support - not be influenced by particular services which may happen to be available
• assessment should deal with the overall physical, mental, and social functioning of the person in need
• procedures should be flexible enough to cope with all types and levels of need. This normally means there should be a screening procedure to see if someone does not require a formal assessment or to identify that her/his needs are urgent
• the client and any carers, should be allowed to participate fully in the assessment process
• the client should be allowed to have a relative, friend or other person present to support her/him or to speak on her/his behalf
• the assessment process should be as simple, quick and informal as possible while still being sufficiently thorough
• the needs of carers should be fully recognised
• decisions about service provision should be non-discriminatory, and a local authority must comply with its public sector equality duty (see next paragraph). Assessment procedures should be readily accessible to all potential service users, and their carers. People with communication difficulties or other disabilities should be able to participate in the assessment process. Assessment should be accessible to people from minority ethnic backgrounds.

If you’re refused an assessment

A local authority could refuse to assess you because:

• you don't have an apparent need for a service
• you don't come into a priority group
• another reason.

If you've been refused an assessment you could challenge the decision. If s/he has been refused a housing support assessment, s/he can make a complaint.

                        More about challenging decisions

Under the Human Rights Act 1998, which incorporates many of the articles of the European Convention on Human Rights into UK law, there is a right not to suffer inhuman or degrading treatment. It may be argued that failure to undertake a necessary assessment of a client who may be in need of community care amounts to inhuman treatment. Similarly, if a local authority fails to deliver services that a client has been assessed as needing, or offers services of poor quality and neglectful of the client's needs, this too could be a breach of her/his human rights. The Scottish Government has produced guidance on the procurement of care and support services; one of its aims is to assist public bodies to make decisions that comply with all human rights obligations (endnote 5).

                         More about the right not to suffer inhuman and degrading treatment and the Human Rights Act

Client faces delay in receiving an assessment

A local authority is not required to carry out an assessment within a specific time limit. Assessments should be carried out within a reasonable time, and this will vary from case to case. There are no strict rules. If a client has urgent needs, you should argue that an assessment should be done immediately.

If a client feels there has been unreasonable delay, s/he should challenge this. The English local government ombudsman has recommended that English local authorities pay compensation for unreasonable delays in receiving an assessment.

 More about challenging decisions

At the end of the assessment

At the end of the assessment process, the local authority will produce a statement of what needs it has assessed the client as having. If it decides to provide support to meet those needs, it will produce a individual care plan which describes the support. It may carry out a financial assessment to see whether the client should pay charges for any service(s).

A local authority does not have to give assessment decisions in writing. However, guidance says that the client should be informed of the result of the assessment and, if a continuing service is to be provided, this must be in writing.

Even if the client is not given a written decision, s/he may have a right to see copies of her/his files, where the decision will be recorded.

 More about access to personal records

The assessment should explain to the client how the local authority has assessed need. It may be possible to challenge the local authority if it fails to give reasons for a decision. If the local authority has decided that evidence or arguments presented by the client have not demonstrated need, it should explain its decision. The local authority should also give information on how to have an assessment reviewed if someone is not happy with the reasons s/he is given.

After an assessment has been made, the local authority then has to decide whether or not to provide or arrange support to meet the needs identified in the assessment. These two stages should be separate. The assessment should identify a client's needs for specific support, irrespective of whether the local authority then proposes to provide those services. In practice, local authorities may be wary of identifying needs in the assessment process and then saying they will not provide services to meet them.

If you don't agree with the assessment

You might disagree with the assessment if it doesn't accurately represent your needs because, for example it:

• didn't take account of all the necessary information about you, your household and home
• took into account information it shouldn't have, like your ability to pay for services
• didn't consult all the relevant people, including you and any carers you have
• didn't fully take into account the practical consequences of any disabilities or health needs you have - for example, you have arthritis in your hands meaning you're increasingly unable to use walking sticks and so are becoming less mobile. 

You can ask for a review of your assessment. A review means that your most recent assessment of your needs or service provision is reconsidered. A review is different from a reassessment, which usually takes place after there's been a significant change your needs [link]. 

Asking for a review of your assessment

You should 

contact ask for it to be reviewed.

If the council don't If the local authority does not do this, or if s/he is not satisfied with the result of the review, s/he can challenge the decision.

An assessment or provision of services may be reviewed because:

• the local authority is conducting a regular review of the services a client is receiving; or
• there have been local policy changes on, for example, eligibility criteria and the local authority is examining the provision of particular services; or
• a client is not satisfied with the assessment and wants the local authority to reconsider its identification of her/his needs.

 regular intervals. The review should consider whether objectives set in the original care plan are being met, and whether services being provided should be increased, changed or withdrawn accordingly.

A local authority may be reluctant to conduct regular reviews of services being provided and give them a low priority because of the implications for the social work departments workload. If there has been a change in a client's circumstances and s/he wants new services or an extension of services already being provided, s/he should ask for a reassessment - see paragraphs below. If the local authority does not do this, or if there is a delay, the local authority can be challenged.

 More about challenging decisions

 Link to care plan.

If you’re worried about being made to leave your home or being told you’re not coping