Assessment - Statutory assessment of need

Assessments of need often define needs in terms of services. i.e. someone 'needs' day care or residential care. The Care Act articulates needs in terms of health and wellbeing outcomes that have to be achieved, and which focus on the assets or strengths of the person


'Asset-based' assessments or 'strength-based approaches' offer a new way of doing holistic person-centered assessments. They are based on the notion that needs can be met in a variety of creative ways. This is relevant because under the Care Act it is no longer acceptable to define needs as an absence of service.



What are the outcomes we want to achieve?

  • Individual care or support needs are identified by reference to difficulties, not services
  • The person identifies the outcomes they want to achieve in order to improve or maintain their well-being
  • The person understands how much money is likely to be needed to meet their outcomes
  • The person and family are fully involved in the process and the person takes control of as much of the process as they can and want
  • The person and family are fully informed and have clear, realistic expectations of what's available locally
  • The person has received a range of information and advice that can help maintain their independence and resilience: improved personal skills knowledge and abilities, better circle of support and greater involvement in the local community
  • The person and their family or carer are given sufficient time to consider their options
  • The process considers the person as a whole and focuses on individuals' capabilities and strengths as well as their needs
  • The person understands their own needs and how they impact on their own life and that of their family or carer
  • The process feels appropriate, proportionate and tailored to the individual needs and what the person wants
  • The Mental Capacity Act is properly applied where the individual may lack mental capacity to make some or all decisions for themselves
  • The assessment takes place at a time and in a way that all parties are happy with


What tools and resources do we need to do a good job? What are the steps we have to go through?

  • Assessment document which:
    • Focusses on an asset-based (strength-based) approach
    • Includes prompts to consider the person's mental capacity, with formal capacity assessment as required
    • Clearly identifies all needs for care and support
    • Clearly identifies eligible need and hence non-eligible need
    • Clearly identifies eligible unmet need if being scored for a realistic RAS as well
    • Enables agreement on:
      • Personal skills, knowledge and abilities that can be developed
      • Circle of support that can be enhanced e.g. by using peer support networks
      • Steps that will improve use of and access to local community resources
      • Social care needs
      • Eligible needs
      • Eligible unmet needs for RAS purposes (i.e. after carer conversation if not a carer's assessment)
      • Risks
      • Risk enablement plans
    • If eligible:
      • Preferred deployment route and money management options
      • Circle of support agreement
      • Care and support planning approach
      • Outcomes to be achieved
      • Resources that are available to meet outcomes
      • Timescale for confirmation
  • Online portal for self-assessment
  • Supported self-assessment
  • Resources and information in preferred format
  • Lead contact for the individual
  • Independent advocacy and interpreter where relevant
  • Information about money management options and support services available for each option
  • Skilled and motivated staff
  • Choice of time, location and medium for the assessment, within reason
  • Potential recognition for fluctuating needs taken into account
  • Mobile equipment/ technology
  • Integrated care record/ system
  • Information sharing protocol


What are the products we will have at the end of this process?

  • Agreement on how to develop personal skills, knowledge and abilities
  • Agreement on how to involve and develop an informal circle of support particularly making use of peer support networks
  • Agreement on what local community opportunities can be taken advantage of
  • Agreement on social care needs
  • Agreement on eligible needs
  • Agreement on eligible unmet needs
  • Agreement on risks
  • Agreement on risk enablement plan
  • If eligible, agreement on:
    • Money management
    • Outcomes to be achieved
    • Resources to achieve outcomes
    • Timescales for confirmation
  • Clarity about the person's mental capacity to take decisions about their own care and support -plans to develop mental capacity where possible
  • Referral to brokerage or third party support as required
  • Referral for preventative services as required
  • Referral to finance and DP support scheme where relevant
  • Permission to fund a close relative to deliver direct payment administration


When does this process start and end and within what timescales should this process be completed?

  • At point of referral for full assessment
  • Led by the level of urgency as well as the time that the person requires
  • Linked with local minimum standards for service delivery


Who needs to be involved and what is their role? Who is taking the lead?

  • Person
  • Family, carer or other who the person chooses to be involved
  • Independent advocate or chosen representative
  • Interpreter
  • Care coordinator
  • Relevant professionals with specialist knowledge e.g. Occupational Therapists (OT), nurse, housing staff
  • Staff from another organisation with delegated authority


Assessments that generate a service solution are formally unlawful under the Care Act. Similarly age-related assumptions are illegal. For example, council staff who speed up assessment or carer and support planning by assigning 'residential care' or '24 hour care' for an older person if it would not be appropriate were the person to be younger, will be likely to be challenged under the Care Act.

More time will be needed under the Care Act for staff to complete holistic needs led person-centered assessments. This has to be done without creating processes that are burdensome to the customer, costly for councils and inefficient for the work force.


Councils have to undertake an assessment based on the appearance of need. Assessments can be proportionate, but they must address the wellbeing principle of the Care Act, as well as clearly concluding on issues of capacity and unmet eligible need.

A good assessment process will further articulate:

  • the outcomes that need to be achieved
  • how the person's own skills, knowledge and abilities can be developed
  • how relationships with family, friends, the local community can support the individual in an informal way
  • how universal services can be used to support the individual's health and wellbeing


Posted on by Old Site User

Solution(s)? The problem is succinctly described, but I would suggest that there are ways of improving the situation, at least in terms of ensuring that sufficient time is allowed for a person-centred assessment to take place (e.g recent Age UK project involving trained volunteer support to older people taking up personal budgets).

Posted on by Old Site User


Thanks for the comment. We will be posting a case study on approaches to assessment shortly. SCIE is also producing some practice guidance which should be available in the near future.

Posted on by Peter Feldon

I don't think it is helpful to refer to unmet needs. The assessment is supposed to determine all of a person's needs for care and support, and disregard any needs that might or might not be being met by a carer. The statutory guidance carefully makes no reference to unmet needs for individuals. The outputs are identifying the eligible needs and non-eligible needs. After the assessment has been completed and eligibility determined the local authority must apply its duty to meet all of a person's eligible needs, except where there is a carer who is willing and able to meet some or all of the person's needs (or when the person chooses not to have their needs met by the local authority). Once an eligible need has been determined that is not being met by a carer, the local authority has a duty to offer to meet this need.

Posted on by Karen Robinson

I completely agree with Peter. A truly person centred assessment is supposed to be holistic. It should be completed in partnership with the individual and identify all areas of need, irrespective of what may be funded or what a specific service can meet.

I am also disappointed at the lack of reference to on-going assessment, and the role of others in something that may start as a statutory requirement, but should continue as 'best practice'. Even once a person is placed with a service, that service should continue the assessment process as part of the reviews.

Posted on by Tim Gollins

Peter, your assertion that it is unhelpful to refer to unmet needs in the assessment is valid. I will review where we have done this and make amends.

Karen, I also agree that a person-centred assessment is a holistic assessment, and should be carried out in partnership with the individual.

You are right on-going assessment isn't something we refer to much. I would be happy to learn more about what such a process would be like in practice?

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