22/10 Adult social care needs assessment and care planning
As the UK population gets older and with more people surviving into adulthood with long-term disability or illness, requests for support to meet a person’s social care needs are increasing. In England, 1.9 million requests for support from new clients were received by English local authorities in 2019-20 (NHS Digital Adult Social Care Activity and Finance Report, 2020) of which 71% requests were from people over 65. The most recent data shows that 83% of adults (aged =65 years) in Northern Ireland (NI), 82% in Scotland and 75% in Wales received state support (Institute for Government, 2020). Support sought might include help with activities of daily life such as personal care, washing and getting out of bed, equipment, and adaptations to enable greater independence, eating and drinking. Such support may be provided by a range of sources including friends and family, home care agencies, the NHS, local authorities, or private and voluntary organisations. Support may also cover helping people to engage with and be active in their community or if they are not able to remain at home help can be provided to fund placement in a care home. The latter also has a key role in providing information and advice and counselling from social workers.
The national eligibility criteria for the Care Act 2014 has a minimum threshold for adult care and support and all local authorities must, at a minimum, meet needs at this level. The threshold is based on identifying how an individual’s needs affect their ability to achieve relevant desired outcomes, and consequently has a significant impact on their wellbeing. To determine how to meet a person’s eligibility for social care support, each local authority (health and social care trust in NI) is responsible for conducting a ‘care needs assessment’ in England and Wales or ‘community care assessment’ in Scotland and Northern Ireland (Carers UK, Needs Assessment Factsheets, 2021 (.PDF)). This may be carried out by a qualified social worker but may also be undertaken by staff who are not professionally qualified under the supervision of a qualified social worker. Anyone who believes they need help, due to ill health, disability or old age, to live as independently as possible, is entitled to an assessment, regardless of the perceived level of care required or their financial circumstances (DHSC, The Care Act 2014). Each local authority has its own assessment procedures, but they follow a minimum eligibility threshold. In England this is set out by The Care Act 2014 (DHSC, The Care Act 2014) and each of the devolved administrations have separate legislation relating to those in need of care or with caring responsibilities (The Social Care Act 2013, Scotland; Social Services and Wellbeing (Wales) Act 2014 (.PDF); Carers and Direct Payments Act 2002, NI (.PDF)). These include principles of wellbeing, prevention of needs developing, appropriateness and personalised care support according to individual context, capacity, needs and support networks. If a person is identified as having eligible needs for social care support and it is determined that the local authority has a duty to meet these needs, a care and support plan will be devised. As part of this plan, the local authority must decide how eligible needs will be met, including establishing a personal budget setting out how the plan is to be funded and taking into account the individual’s financial means. The recent survey from Association of Directors of Adults Social Services in England highlights that nearly 55,000 disabled or older people, or carers are awaiting a Care Act assessment, support, or safeguard and 12% of these have been waiting for more than six months (ADASS, Spring Survey 2021)
The Local Government and Social Care Ombudsman, Review of Adult Social Care Complaints, 2019 has reported that social care assessment and care planning is one of the biggest areas of complaints in England’s social care system, many relating to funding decisions but some concerns have also been raised over the assessment process itself. The decision making process involves both professional judgements by social workers about eligibility and what is required to meet need, and resource-related factors that budget managers must consider, however, this distinction is currently blurred. Not only individuals with social care needs but workers have expressed a need to develop a clearer specification of professional judgement within the overall local authority decision-making process, about how and to what extent individual social care needs are going to be met from public funds, how assessments are explained and undertaken, as well as issues of inequalities in accessing assessments amongst different groups of people (Parliamentary Health & Social Care Committee Social care: funding and workforce Inquiry, 2020).
The four UK nations (England, Wales, Scotland, and Northern Ireland) operate a means test and a needs test to determine access to social care support from the local authority or health and social care trust, however, there is considerable variation in the levels of care across them. Spending in all four nations has not risen in line with demand and very few social care outcomes are collected.Those that are collected are difficult to compare, therefore, hindering the learning from each other’s experiences to improve services (Institute for Government, 2020).
Strengths-based approaches focus on people’s goals rather than their problems, seeking to build on their existing skills, resources, and relationships. These approaches are being adopted by social workers, but their application is variable. An HSDR systematic review (Price 2020) on the effectiveness and the implementation of different strengths-based approaches (focusing on people’s life goals rather than problems) within adult social work in the UK highlighted lack of good quality research on these approaches, including for assessment and eligibility processes. An on-going NIHR study funded by the School for Social Care Research is looking at understanding the impact of the implementation of 3 Conversations (3Cs), a strengths-based approach to providing services that works collaboratively with people seeking support, including carers.
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