The Care Act and Social Care Assessments

How to request an assessment under the Care Act

If you have a service user who you feel needs an assessment for a social care service provided by the local authority, you should:

• Support them to contact their local Adult Social Care department for an assessment – you could also ask for an assessment on their behalf.
• Offer support to complete any forms – make sure they provide detailed descriptions of their care and support needs and what the consequences will be if they don’t receive help.
• If your client will receive a visit from professionals as part of their assessment, try to be present during the meeting to support them to articulate their needs – if your service is supporting the individual, be clear about the limitations of the service you can provide e.g., providing ‘personal care’ is not within your remit, time-limitations to support etc.

What will the assessment look like?

The local authority must carry out an assessment for all the referrals it receives. There are no defined formats or ways of carrying out an assessment, but the following conditions must be met:

• The assessment must be person-centered, involving the individual and any person they might want involved.
• Establish the total extent of the needs. This means going beyond the presenting need and assessing the impact on wellbeing.
• Where individuals struggle to express their needs, the local authority must use supported decision making, involving the individual as much as possible in the process, as well as an advocate. They must carry out a mental capacity assessment where there is doubt about the individual’s understanding of the need to make a particular decision, the likely consequences of making/not making a decision, the ability to understand, retain, or use relevant information, and the ability to communicate a decision.
• Eligibility can only be decided after an assessment.
• Financial assessments which may run in tandem to the needs assessment must not influence the eligibility for a care service.

The Care Act requires local authorities to consider the full range of needs, including any fluctuation in needs. This ensures that assessments are not simply a ‘snapshot’ of the individual’s care and support needs on the day of assessment. Local authorities must consider needs over a suitable period of time, including reasonably foreseeable future needs, to gain a complete picture.

To carry out an assessment, the local authority can use a variety of methods which include:

• A face-to-face assessment.
• A supported self-assessment – the same materials as a face-to-face assessment are used but the person completes the assessment themselves and the local authority assures itself of the accuracy of the information by consulting with third parties.
• An online or phone assessment, which could be a proportionate response for less complex assessments, or where the individual is already known to the local authority.
• A joint assessment with other agencies including the deliverers of housing related support.
• A combined assessment, where an adult’s assessment is combined with a carer or child’s assessment.

How is eligibility determined?

The Care Act removes reference to ‘eligible’ and ‘ineligible’ groups so that potentially any adult with any level of need will be entitled to an assessment. In reality, to qualify for a service, individuals’ needs will have to be significant.

For a successful referral, resulting in an eligible need being identified, 3 conditions need to be met:

1. Establish a need – arising from a physical or mental impairment or illness. A formal diagnosis is not required, and a mental impairment could cover learning or cognitive disabilities, drug and alcohol use, and brain damage.
2. Identify at least 2 outcomes that the person is unable to achieve.
3. Show a significant impact on a person’s wellbeing.

The Care Act specifies outcomes as:

• managing and maintaining nutrition
• maintaining personal hygiene
• managing toilet needs
• being appropriately clothed
• being able to make use of the adult’s home safely
• maintaining a habitable home environment
• developing and maintaining family or other personal relationships
• accessing and engaging in work, training, education or volunteering
• making use of necessary facilities or services in the local community including public transport, and recreational facilities or service; and
• carrying out any caring responsibilities the adult has for a child.

An adult is to be regarded as being unable to achieve an outcome if the adult:

• is unable to achieve it without assistance;
• is able to achieve it without assistance but doing so causes the adult significant pain, distress or anxiety;
• is able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the adult, or of others; or
• is able to achieve it without assistance but takes significantly longer than would normally be expected.

Wellbeing is described as relating to the following areas:

• 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 their day-to-day life (including over care and support provided and the way they are provided)
• Participation in work, education, training or recreation
• Social and economic wellbeing
• Domestic, family and personal domains
• Suitability of the individual’s living accommodation
• The individual’s contribution to society.

There is no hierarchy in the list – all are equally important. It is important to know that there is no single definition of wellbeing, as how this is interpreted will depend on the individual, their circumstances and their priorities. The meaning of ‘significant’ impact is not defined in regulations; a given situation could have a ‘significant impact’ on one individual but not on another. Therefore, information gathering and professional judgement are crucial to establishing whether there is a ‘significant impact’ to an individual’s wellbeing.

What happens once a decision is made?

Making a determination or decision is not easy. The decision-maker must take account of the assessment, the wishes of the adult, what risks are present and what risks can be reasonably taken. All decisions must be accompanied by appropriate evidence.

Where no eligible needs are identified or not all an individual’s needs are eligible, the local authority must provide information and advice on:

• what can be done to meet or reduce the needs that are not eligible
• what services are available in the community that can support the individual in meeting those needs
• what can be done to prevent or delay the development of needs in the future.

If the individual has eligible needs, the local authority must:

• produce a written plan on how they propose to meet these needs - the local authority can offer to meet these needs by using its own or contracted services, but all individuals are entitled to a direct payment and can make direct arrangements within the rules of the personal payments regimes.
• carry out a financial assessment where it proposes to make a charge for meeting the needs.

If your client is offered a direct payment, they do not have to accept it. They may prefer to have their care services arranged by the local authority and should make this clear. If your client is happy to receive a direct payment, they will have to arrange their own care services. The direct payment should cover all costs involved. Local support agencies may be able to help make arrangements. A list of these agencies can be obtained from Disability Rights UK by calling their personal budgets helpline: 0330 995 0404 (open Tuesday and Thursday 9.30am-1.30pm) or emailing: personalbudgets@disabilityrightsuk.org

If your client is told that they must pay for their adult social care services and they think that the charges are unreasonable or can't afford to pay them, they should ask for the charges to be reviewed. You may want to support your client in challenging the charges they have been asked to pay.

What types of social care are there?

Social care services may include:

• A place in a care home
• Home care services
• Adaptations to the home
• Meals
• Recreational or occupational activities
• Help to access and maintain employment, training, learning or voluntary activity.

Individuals living within staffed hostels or supported accommodation may still be eligible for social care services as they may need social care services as well as housing related support.

All adults with an agreed care or support need are eligible for direct payments. This means that individuals can make personal arrangements to have their needs met. In theory, this is with anyone they choose, including friends, individuals that they create an agreement with directly or through an agency, or agreeing an arrangement with a provider of housing related support.

How can I make a complaint?

If you, or the person you are supporting are unhappy with either the assessment procedure, the determination, or proposed plan, they are entitled to make a complaint.

In the first instance, support the person to contact their Adult Social Care department to ask about the complaints procedure. Your client may require help in making their complaint.

There are several possible stages involved in making a complaint and it may be necessary to refer your client to the local government and social care ombudsman if they are not happy with the result of the local authority review.

Further resources

The toolkit below, produced by Voices of Stoke, is a tool to assist with the collection and submission of information to social services. It’s intention is to help people with multiple needs and their support networks to articulate their circumstances in the context of the Care Act.

Listen to Series 5, Episode 1 of our Going Beyond podcast, to hear about how to overcome barriers in accessing Adult Social Care.