Draft Self-directed Support Statutory Guidance on care and support

Section 4: Eligibility and Assessment

This section deals with assessment. It covers the concept of assessment, its basis in social care legislation, its purpose in day to day practice and its place in the supported person's pathway.

The legal basis for assessment

16. Section 12A of the Social Work (Scotland) Act 1968 provides the legal basis for community care assessment for adults. The equivalent assessment duties for children, carers of adults and carers of children are:

• Section 23 of the 1995 Act (children);
• Section 12AA of the 1968 Act (carers of adults)
• Section 24 of the 1995 Act (carers of children).

17. Please see Annex A in this document for a copy of the relevant legal provisions.

The purpose of assessment

18. A good quality assessment helps to ensure better outcomes for individuals and it helps to ensure greater consistency and transparency in how decisions are reached. This section provides guidance on two distinct aspects of assessment:

• the initial steps in order to determine the person's eligibility for support, and;
• the detailed exploration or "further assessment" of the person's needs, moving on to their desired outcomes.

a) Determining a person's eligibility for support

19. The first purpose of assessment is to identify the person's needs with a view to determining whether the relevant authority has an obligation to meet those needs. In other words, it is to determine the person's "eligibility" for support.

20. The duties contained in Sections 12 and 12A relate to the provision of services to a "person in need". In order to qualify as a person in need the person must be in need of support arising out of infirmity, youth or age or require support arising from illness, mental disorder or disability (also included are persons subject to immigration control and those in need of care and attention arising out of drug or alcohol dependence or release from prison or other forms of detention). The professional must therefore undertake an assessment of the person's needs and then, having regard to the results of that assessment, a further consideration of whether the needs call for the provision of services.

Eligibility criteria

21. Local authorities apply local eligibility criteria in order to determine whether the person's needs call for the provision of services (i.e. to determine if the person's needs are eligible needs). Where the person is over 65 and eligible for personal care, or where the person is eligible for nursing care, the local authority must follow the relevant joint Scottish Government and COSLA guidance on eligibility criteria.

22. The eligibility framework for access to social care for adults prioritises risks into 4 bands: critical, substantial, medium and low:

• Critical Risk: Indicates that there are major risks to an individual's independent living or health and wellbeing likely to call for the immediate or imminent provision of social care services (high priority).
• Substantial Risk: Indicates that there are significant risks to an individual's independence or health and wellbeing likely to call for the immediate or imminent provision of social care services (high priority).
• Moderate Risk: Indicates that there are some risks to an individual's independence or health and wellbeing. These may call for the provision of some social care services managed and prioritised on an on-going basis or they may simply be manageable over the foreseeable future without service provision, with appropriate arrangements for review.
• Low Risk: Indicates that there may be some quality of life issues, but a low risk to an individual's independence or health and wellbeing with very limited, if any, requirement for the provision of social care services. There may be some need for alternative support or advice and appropriate arrangements for review over the foreseeable future or longer term.

Application of eligibility criteria via the assessment

The professional's role

23. In determining a person's eligibility, the professional should take full account of how the person's needs and risks might change over time. The professional should consider the impact of failure to intervene and whether this would lead to escalation of need in future. They should take a well-rounded approach, recognising that risks to participation in society (living an ordinary life, engaging with others) are valid alongside risks to dignity (personal care, "life and limb" support). They should be alive to potential "hidden" needs which may not be obvious or highlighted in generic guidance documents. Both parties - the professional and the individual - should be able to access information and advice about alternative sources of support out-with formal or "funded" social services.

The local authority's role

24. A local authority can take into account its overall resources when determining eligibility criteria. However, once it has decided that the individual's needs are such that they call for the provision of services (i.e. are 'eligible needs') they cannot then refuse to meet those needs because of budgetary constraints. The local authority should take a strategic approach to the application of eligibility criteria and it should do this in partnership with wider partners including the health board, providers, user groups and carer groups. The authority should develop its criteria within the context of its wider commissioning strategy. The authority's strategy or policy on eligibility criteria should consider the application of that criteria within a broader framework of prevention, early intervention, support to carers and universal services. If a person does not meet a particular eligibility threshold, the authority should take steps to ensure that the appropriate arrangements are in place, providing an environment where the professional can direct that person to suitable alternative sources of support. The authority should consider their strategy for investing in preventative and universal services - interventions which prevent or delay the need for formal social care and support.

25. The authority should develop its policy in relation to eligibility criteria in line with the general principles within this guidance. In particular, it should consider the principles of involvement (of service users/carers), informed choice and collaboration. It should take steps to involve people who use support, carers and partner organisations in the development of its policies and it should do so from the outset. It should publish the eligibility criteria/framework and it should do so in a clear and transparent way. Finally, the authority's response to need - in other words, their application of eligibility criteria - should be informed by the continuing review of each individual's needs, including consideration of how urgently service provision is called for and what interim measures may be appropriate pending any long-term support. High quality and thorough professional judgement is needed in order to discharge this task.

Further guidance and hyperlinks:

For further guidance on the application of eligibility criteria see the Scottish Government and COSLA's National Standard Eligibility Criteria and Waiting Times for the Personal and Nursing Care of Older People: http://www.scotland.gov.uk/Topics/Health/Support-Social-Care/Support/Older-People/Free-Personal-Nursing-Care/Guidance

b) Further exploration of the person's needs and outcomes

26. A further purpose of assessment is to provide the basis for future support interventions. This is where the professional and the individual fully explore the nature of the person's needs and seek to translate needs into personal outcomes. Throughout this process, the supported person and the professional should work together in order to consider creative means by which to meet the person's eligible needs. Crucially, the process should rest on a conversation between the professional and the supported person.

The importance of assessment

27. Assessment is important because it helps to set the tone for what is to come. If the assessment is conducted in the wrong way, for example as a tick-box and form-filling exercise, then the supported person can be left with the impression that social care is something that they receive rather than something they help to shape. If it is conducted in the right way - based around the person's assets and personal outcomes - then it can be an important and valuable intervention in its own right.

A "good" assessment

28. Assessment may act as the starting point for development and improvement in an individual's life. Alternatively, it may support a person to maintain the "status quo", to slow the rate of deterioration or to ensure that any decline in a person's situation is well managed. Individuals' needs can change over time, even over relatively short timescales. The assessment should respond to changing circumstances, changes to a supported person's needs and changes during the course of the person's life.

29. A good assessment rests on critical thinking and constructive challenge. It rests on the professional's ability to be open and honest with the person. It requires good judgement, awareness and significant "people" skills. The professional should be skilled in conversation and able to strike the right balance between advising the individual and supporting them to play an active part in the assessment process.

30. Some assessments will be conducted in quite challenging environments. For instance, they may take place after a fall or in a hospital environment. Crisis situations are rarely conducive to an effective assessment. However, the professional should ensure that the initial support to address any crisis situation does not become the de facto long-term arrangement for the individual. After the initial crisis has stabilised, and as soon as the supported person is ready to do so, the professional should seek to develop a comprehensive assessment.

The general principles that must inform the assessment

31. Section 12 of the 1968 Act requires the relevant authorities to "promote social welfare by making available advice, guidance and assistance on such a scale as may be appropriate for their area". Assessment is an important means by which to deliver this duty. Promoting social welfare means taking any steps that are necessary to improve the quality of life for individuals and the wider population. The equivalent duty in relation to children is the duty in Section 22 of the 1995 Act to "safeguard and promote the welfare of children who are in need". Sections 12 and 22 provide the relevant professional with a fairly wide discretion to use their judgement and to provide any type of support or service provided that the intervention or level of support will help to meet the relevant needs. The professional should utilise this discretion in order to work with the supported person and to design flexible solutions based not just on the assessed needs but on the positive outcomes for the person.

32. The general principles in Section 1 and 2 of the 2013 Act provide a further guide in interpreting and discharging the various assessment duties found in the 1968 Act and 1995 Act.

Table 4: The general principles of assessment (provided by Section 1 of the 2013 Act)

Collaboration The professional must collaborate with a supported person in relation to the assessment. They should work with the person and towards a shared goal, in this case the identification, development and subsequent delivery of the supported person's outcomes. They should facilitate the active contribution of the person as a partner in working towards a shared goal.

Involvement The supported person (adult, child or carer) must have as much involvement as they wish to have in the assessment.

Informed Choice The supported person must be provided with any assistance that is reasonably required to enable them to express their views about the assessment.

Further guidance and hyperlinks:

For further guidance on the general principles on assessment and support planning see section 3 in this document.

The conversation: good assessment practice and personal outcomes

33. The detailed consideration of the nature of a person's eligible needs should be conducted on the basis of personal outcomes for the individual. This approach is in tune with the general principles within the 2013 Act. It also fits with the so-called "exchange model" of assessment. The exchange model emphasises the collaborative nature of assessment, showing how the views of the supported person, carer, assessor and agency are brought together to negotiate, agree and record outcomes. See Figure 1 for an illustration of the exchange model of assessment.

Figure 1. The Exchange Model of Assessment¹

34. An outcome is a result or effect of an action. Personal outcomes are the things that matter to the supported person such as:

• being as well as possible
• improving confidence
• having friendships and relationships
• social contact
• being safe
• living independently
• being included

35. Personal outcomes are identified through good conversations with people during assessment and support planning. Often the conversations will involve unpaid carers. The outcomes should reflect what is important to the person, and why they are important. Table 5 provides an example of the main differences between an assessment led by the need for a particular service and an assessment based on personal outcomes:

Table 5: Service led assessment vs. assessment based on personal outcomes

An assessment led by the service…	An assessment informed by personal outcomes…
- sees the ultimate destination as the delivery of the service	- sees the ultimate destination as the impact of the supported person's plan
- is based on pre-determined question and answer formats	- is based on a semi structured conversation with open questions
- obtains information in order that a form can be filled out	- involves active listening by the professional and reflecting back
- views the supported person as a client, service user or patient	- views the supported person as a supported person in their own right with skills, abilities and a role to play in determining and achieving their outcomes
- views the professional as an expert	- acknowledges the professional's expertise but views their role as an enabler and partner
- focuses on identifying problems and deficits and matching them to a list of services	- focuses on building on a supported person's capacities and strengths to develop creative, flexible solutions
- results in a tick box form	- builds a picture which helps to form a clear plan to achieve the supported person's outcomes

36. Implementing an outcomes approach is not straightforward. The demands placed on the professional may lead to a tick box approach to assessment. In contrast, skilled and flexible communication is required to fully engage individuals in defining what is important to them in life. Rather than matching problems to service solutions, the professional should work with the individual to identify their outcomes and then 'work backwards' to plan how everyone can contribute towards achieving those outcomes.

37. An approach based on outcomes also requires the wider organisations to take proactive steps to move away from service-led and standardised approaches. The relevant organisations should support its front line professionals and managers to think and act flexibly. It is essential that personal and collective outcomes are ingrained in the culture and approach of social care services, the health board and the local providers of support. Senior managers must believe in the merits of this approach and they must support their staff to do the same. The organisation must invest the necessary time and effort to support a culture based on outcomes. Outcomes must be the starting point not just for assessment, but for the commissioning, planning, monitoring and evaluation of services. The organisation should also seek to use the collated information on personal outcomes to make improvements to the way that services are commissioned, planned and delivered.

Self-assessment

38. Self-assessment describes a process whereby the supported person, often with support from a provider, undertakes an assessment of their own needs prior to a full assessment. Self-assessment can be used as a starting point, but it should not replace the further assessment involving the judgement and input from the social care or health professional.

The main products from the assessment

39. There should be three main products from the assessment process:

• the assessment itself - this should include a decision about whether the person is eligible for support.
• the support plan (where the person is eligible for support) - this should articulate the eligible needs, outcomes and plans for the individual.
• the actual support provided to the individual.

40. It is important that the supported person's outcomes are later reviewed, to ensure the continued relevance of support.

Further guidance and hyperlinks:

Institute for Research and Innovation in Social Services, Leading for Outcomes: A guide
http://www.iriss.org.uk/resources/leading-outcomes-guide

Institute for Research and Innovation in Social Services, Understanding and measuring outcomes
http://www.iriss.org.uk/resources/understanding-and-measuring-outcomes

Joint Improvement Team - Talking Points: Personal Outcomes Approach (includes Talking Points: A Practical Guide)
http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/

Scottish Community Development Centre - Co-production: useful resources
http://www.scdc.org.uk/co-production-scotland/co-production-useful-resources/

Further links (including a guide to professionals, user's guide and carer's guide) to follow.

Draft Statutory Guidance on Care and Support

Consultation Questions

Section 4: Eligibility and Assessment