The single assessment process An introduction to the principles and process the single assessment process training resource

National Service Framework (NSF) for Older People Standard 2 Person-centred care Covers: Single assessment process Integrated equipment Continence services The single assessment process was first introduced as part of the NHS Plan in 2000. It is part of Standard 2 of the National Service Framework (NSF) for Older People which focuses on person-centred care. Standard 2 links to all the other standards: Standard 1 Rooting out age discrimination Standard 2 Person-centred care Standard 3 Intermediate care Standard 4 General hospital care Standard 5 Stroke Standard 6 Falls Standard 7 Mental health in older people Standard 8 Promotion of health and active life in old age More details at www.doh.gov.uk/scg/sap the single assessment process training resource

The single assessment process What is it? Why do it? How? When? What is it? An assessment process which will ensure that: the scale and depth of assessment is kept in proportion to older people’s needs agencies do not duplicate each other’s assessments professionals contribute to assessments in the most effective way older people are at the centre of the process it provides information to support the determination of the Registered Nursing Care Contribution (RNCC) – free nursing care a validated tool is used. Why? Older people said that they were having to give the same information many times. ‘Local implementation of the single assessment process by health and social care systems will promote better care services and better outcomes for older people, and more effective use of professional resources’ (DoH guidance). How? The implementation process is laid down and includes twelve steps which guide authorities through the process to ensure that all agencies are fully engaged. See Handout 4. When? By April 2004 local partnerships must meet the criteria laid down or be implementing agreed action to ensure compliance by April 2005 – if not DoH will impose a tool. the single assessment process training resource

Who? service users/patients/ older people/their carers Who? staff/organisations Who? Older people (service users) and their carers Exactly who will qualify needs to be determined locally. Some people are defined by the guidance. For example older people with mental health issues which pre-date old age would continue to be dealt with under the Care Programme Approach (CPA) system, whereas older people who develop mental health conditions in old age would follow the single assessment process. Slide SAP 5 shows a stakeholder map of people who may become involved with service users and their carers during the single assessment process. Who? Staff Those likely to be involved include district nurses, care managers social workers, occupational therapists, GPs, ward staff in acute trusts, staff from mental health trusts, housing staff etc. Slide SAP 6 shows a stakeholder map for organisations. the single assessment process training resource

Stakeholders Individuals Community psychiatric nurses (CPNs) Housing officers GPs Therapists Service users and their carers Health visitors Ward staff District nurses Volunteers Occupational therapists Intermediate care staff A stakeholder map showing service users and their carers surrounded by the various people who could become involved with them during the single assessment process. Care managers Home carers Residential staff the single assessment process training resource

Stakeholders Organisations Housing Primary care trusts Social services Single assessment process Voluntary sector Acute trusts A stakeholder map showing the key organisations working together to implement the single assessment process. Mental health trusts the single assessment process training resource

Why is the single assessment process important? Fundamental to the delivery of the NSF for Older People: Falls prevention Management of medications Long-term care (RNCC, free nursing care) Delayed transfers of care Intermediate care Maintaining independence Falls prevention (Standard 6 of the NSF) Standard 6 recognises that a single assessment of an older person can identify those at risk of falls. Management of medications The use of medicines is a fundamental component of each of the NSF standards, and there is a common link to every standard in the NSF. Achieving greater partnership in medicine-taking between patients and health professionals, improving choice and addressing the needs of older people and their carers can help to meet these standards. Long-term free nursing care The need for free nursing care is assessed at the stage where someone’s health needs are quite high and likely to be longstanding. Health needs requiring a registered nurse may originally have been identified as areas for further assessment as a result of an overview assessment. Intermediate care (Standard 3 of the NSF) An early single assessment can assist in the discharge planning process and help to avoid premature discharge and premature or avoidable admissions to long-term residential care. More details on the National Service Framework (NSF) for Older People at www.doh.gov.uk/nsf/olderpeople/index.htm the single assessment process training resource

Why is the single assessment process important? Registered nursing care contribution (RNCC) – free nursing care Maintaining independence Reviews of medication Single assessment process Delayed transfers of care Fair access to care services (FACS) Falls Continence the single assessment process training resource

Reasons for introducing the single assessment process Raymond Warburton Local variations in depth and quality of assessment Information about assessment may be limited Older people are not at the centre of assessment and care planning Treatable health conditions are missed or misdiagnosed Raymond Warburton is the lead for the single assessment process at the DoH and the issues outlined here are those he identified at a conference held in Bristol in November 2002. (Slides SAP 9 and SAP 10) continues the single assessment process training resource

Insensitivity to race and culture Scales are adapted for local use continued Raymond Warburton Insensitivity to race and culture Scales are adapted for local use Assessment is not in proportion to older people’s needs Assessments are duplicated and information is not shared Professionals may not accept each other’s assessments the single assessment process training resource

Single assessment process Key benefits Facilitation of joint working Shared information Reduced duplication Improved discharge planning Improved prevention Fewer avoidable hospital admissions Case finding Key benefits The single assessment process can assist in the facilitation of joint working across all agencies. Information can be shared thereby reducing the number of times older people have to go through the process of giving information about their situation. As mentioned previously, it will improve discharge planning, improve prevention and reduce unnecessary hospital admissions. Case finding Case finding can make an an important contribution to preventative strategies and health promotion. However given that all agencies are working to limited budgets and have limited resources this optional element of the guidance may take time to introduce fully. See Joint working jargon buster for definition of case finding. the single assessment process training resource

Single assessment process Main challenges Joint working: cultural changes and organisational barriers Building trust Pressures on workforce of other targets and requirements Difficulties releasing staff from training Information management and technology (IM&T) Joint working involves organisations and individuals in accepting and trusting each others’ assessment. There are other external pressures that will challenge the single assessment process: Pressure on the workforce to meet targets Releasing staff from their area of work for training Information management and technology Computers currently not talking to each other Not all areas of work have access to a computer Training Funding the single assessment process training resource

Single assessment process Key issues Person centred Information is gathered once Professionals work together in the best interests of older people Older people’s views and wishes are central to the assessment process The depth of the assessment is appropriate to their needs What does person-centred care mean? That the single assessment process will aim to gather the information once. That the information will enable professionals to work together in the best interest of the older person. That the view of the older person will be central to the assessment and that the depth of the assessment is appropriate to the need. the single assessment process training resource

Single assessment process Key issues Standardised Evidence based Enables professionals to access each other’s assessment Facilitates sharing of information between professionals and agencies Evidence based The tools used to gather the information for assessment are evidence based. EASY-Care is one assessment tool. Others are being and will continue to be developed or agreed, e.g. specialist (in-depth) assessments. If the tools are standardised, health and social care professionals will be able to access each others assessments. This naturally leads to the assessment being shared between professionals. The issue of giving information about key decisions and issues in writing (or other appropriate format) is an important one. It needs to be picked up again when discussing specific tools and local methods later in the training. the single assessment process training resource

Single assessment process Key issues Outcome centred Promotes health, independence and quality of life for older people Helps fulfil potential for rehabilitation Outcome centred Single assessment promotes health, independence and quality of life for older people and will help to fulfil their potential for rehabilitation. the single assessment process training resource

Single assessment process Key issues Older person’s contribution This starts at the beginning of the contact assessment. There needs to be a statement of the person’s needs, expectations, strengths and abilities in their own words Their contribution continues throughout Key decisions and issues should be given to the person in writing or in another appropriate format. the single assessment process training resource

Carer’s assessment The overview assessment should give sufficient information to establish whether there is a carer involved who provides ‘substantial’ care. If there is, they should be advised about their right to an assessment of their own needs. the single assessment process training resource

Stages in the single assessment process Publishing information about services Assessment Evaluating assessment information Deciding what help should be offered (includes eligibility decisions) Care planning Monitoring Review • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

The assessment process Contact assessment Overview assessment Specialist (in-depth) assessment Comprehensive assessment It is important to realize assessment is not a linear process. A contact assessment should come first, but following this a decision will need to be made about the level and breadth of any further assessment. An overview assessment may be sufficient further action, but it may identify other needs which lead to a specialist assessment. Specialist assessments are also known as in-depth assessments. For example, It may be that on admission to hospital a number of specialist assessments are undertaken around mobility issues. This may identify the need for a broader but less specialised assessment in other areas. Then an overview assessment could be undertaken. Alternatively the specialist assessment may indicate several areas of difficulty which need other specialist assessments, in which case these should be pulled together as a comprehensive assessment. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Contact assessment What is it? Not all contacts! Done when significant needs are first described or suspected What is it? Collection of basic personal information Establishes the nature of the presenting problem Explores the potential presence of wider health and social care needs To assess, or not to assess? Some examples: Older person comes in for pre-holiday injections, no other issues – no assessment needed. Flu injection, no other issues – no assessment needed. Older person comes in to have stitches removed. Need further information to make decision. How did injury occur? Fall? Has it happened before? May need to undertake overview assessment to establish full background and needs with the person. If on the other hand it is the first time and they tripped over the dog then not likely to need full overview assessment (remember the rule that assessment should be in proportion to the needs). • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Overview assessment Likely to be undertaken by one assessor Local organisations need to agree who can do these Covers the full range of ‘domains’ Judgement will be needed about which areas to pursue At this point trainers should check that everyone understands domains and sub-domains (see Joint working jargon buster). Domains: User perspective Clinical background Disease prevention, e.g. nutrition, diet and liquids, vaccination Personal care and physical wellbeing Senses Mental health Relationships Safety, e.g. abuse and neglect, public safety Immediate environment and resources • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Specialist (in-depth) assessment Examines specific needs in detail Undertaken by specialists e.g. nurses, social workers, geriatricians, therapists, housing officers, community psychiatric nurses Needs to be carried out by the most appropriate specialist Key point in the guidance is that agencies should note the specialist contribution therapists can make to the assessment of: mobility transfers, speech, language, eating, drinking and functional capacity the impact of the home and wider environment on needs. In particular therapists are skilled in the assessment of the potential for rehabilitation and independence. However, these assessments should be based on the needs of the person not the specialism of the assessor! • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Comprehensive assessment Involves (in-depth) assessment of all the domains May be obvious from the beginning that this is needed and therefore overview may not be needed Must be done for people where level of support is likely to be intensive and/or prolonged A Registered Nursing Care Contribution (RNCC) determination should draw upon information gathered during the single assessment process. ‘When making an RNCC determination nurses should look to the full extent of an older person’s needs not just those for which a nursing response is immediately obvious.’ Annex H, National Service Framework (NSF) for Older People. (Slides SAP 23 and SAP 24) continues • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Comprehensive assessment continued Will provide information for the Registered Nursing Care Contribution (RNCC) determination (free nursing care) Will include assessments from a range of professionals and agencies Will need coordination by a case coordinator • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource

Case coordinator role Required where needs are complex Coordinates assessment Coordinates care planning Has an ongoing role acting as the focus for communications Details need to be defined and agreed locally This should have been developed locally and you can add local notes for it. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • the single assessment process training resource