Unified Assessment is the name given to the assessment process which involves health and social care professionals working together to assess and manage care and share information. Please note that the following guideline may need reviewing in light of recent legislative changes such as the Social Service & Well Being Act but principles remain similar.
Assessments underpin any funding decisions that are taken so it is essential that you prepare for and participate in this process. If you do not agree with decisions you have the right to appeal against a decision and free advice and assistance is available. Please contact us for information if in any doubt.
There are three main stages in the process:
Stage 1 Assessment
This is the process of collecting information from the individual, the carers and others about the individual's needs and wishes. Assessment should be carried out according to the following:
- Local authorities have a duty to assess individuals if they have the 'appearance of need', including people with higher-functioning autism and Asperger's syndrome.
- They aim to empower people, by enabling them to make informed choices and maximise their independence according to their individual circumstances.
- The main purpose of an assessment is to identify needs and how to meet them.
- Assessments should be carried out without reference to financial resources, availability of local services or locally preferred options.
- Authorities have a duty to provide users and carers with a full range of information about all services and the rights of users and carers.
- Information gained during assessment is confidential and shared only if the law says it should be. Users or their agents have a right to access the information under certain conditions.
- A care co-ordinator will carry out the assessments, who would usually be the most appropriate professional.
- Assessments should be carried out in a timely manner, in informal settings such as the home, and be proportionate to the level of need.
- There are specific types of need included in government guidance. All needs should be assessed in the light of their impact on independence, daily functioning and quality of life. The focus should always be on outcomes for service users and their carers.
- A person-centred approach should be taken during assessment and care planning. Person-centred planning and reviews also take place in addition to an assessment, if appropriate.
- Carers have a right to have their views acknowledged in the assessment process both in helping to identify the individual's needs and wishes and also to express their own views of the individual's needs and wishes as well as their own needs. The role of carers continues once the individual has left the family home.
Carers may request an assessment both of their own ability to care for an individual and of their own need for services for themselves. Carer's must be informed of their right to an assessment.
Stage 2 Making the Service Provision Decision
The service provision decision for social services makes clear which needs are eligible for support. The needs identified as a result of the assessment will be considered with the service user/carer and agreement sought on the most appropriate way of meeting them. This may involve support provided within the family network, by accessing voluntary sector services, statutory services or signposting to other sources of help and support.
The procedures to be applied are as follows:
- All risks are balanced against the independence of the individual in the light of the four key factors of independence, i.e. the individual's autonomy and freedom to make choices, health and safety, management of daily routine and involvement in other activities. This is based on the what would happen if no help were to be provided.
- There are four categories of eligibility (critical, substantial, moderate and low) laid down in the local authority's Eligibility Criteria. Once the risks are assessed, professionals should determine the position of the individual's needs within these bands. If the needs are above a threshold determined by the authority they become eligible needs and must be met. A holistic approach is taken, according to the four key factors of independence, even though the needs are identified separately.
- At this stage there should be no reference to financial resources, locally preferred options or the local availability of services.
Stage 3 Care Planning
This is the process of arranging provision of services:
- Care planning should address the eligible needs of the individual, the views of the individual and of the carer(s) and cost considerations. Services should be needs led with full information on a range of services.
- Care planning should be responsive to the age, living circumstances, location, disability, gender, culture, faith, personal relationships and lifestyle choices of users.
- Care planning should be flexible and adaptable to desired outcomes and expectations.
- Care planning should identify outcomes, i.e. the desired changes aimed at improving independence and quality of life. A recordmust be made, with timescales for achievement.
- Care planning should involve service users, carers and professionals in reaching an agreed care plan and identify the most appropriate aervices to acheive the desired outcome.
- Care planning services should be provided as holistically as possible to suit individual needs and maximise their potential for independence.
Where there is a genuine choice of services, the authority may choose a service based on quality and cost, taking the user's and carer's preferences into account. Cost ceilings may be used as a guide only and if lack of finance is a reason for making a choice, it must be shown by evidence. The authority should not impose its own preferred models of care.
Reviews or re-assessments must take place regularly and have a review date. They should focus on the needs of users and their carers and be evaluated according to a list of factors laid down in guidance.
Services may only be withdrawn if certain conditions are followed, i.e. if a full re-assessment has taken place to show that the individual no longer has eligible needs or if they can be met some other way. There can be no assumption of alternative support from carers. The withdrawal of services may go against the user's natural rights.
Users and carers may play an important role in monitoring services and may request support in doing so. Should a service break down, the original need for the service still applies and it is the authority's duty to provide for it.
There is no charge for an assessment or for giving advice and information. A person may have to pay for community care services depending on how much service they get and how much money they have. See the section on financial matters for more information. If eligible, they will receive free nursing care in their home or in a care home, although there may have to be a contribution towards other aspects of care such as personal care, food and accommodation costs.
Person Centred Approaches to Assessments and Care Planning
The Service Principles and Unified Assessment Guidance state clearly that social services and health should always take a person centred approach to assessment and care planning. (It should be noted that a person centred approach is not the same as person centred planning.)
Also see Carers' assessment