ASSESSMENT OF NEEDS AND ELIGIBILITY

Anyone with a disability or long term condition is entitled to an assessment of needs for services. Whether you are then eligible for a service or support from them depends on whether you meet their eligibility criteria and then they look at how the person’s needs are met in the support plan. The process is:-

1. Identify the person’s needs (all needs!). You can do this yourself. It’s a good idea to think about it before an assessor or Social Worker visits.
2. The assessor will identify what they think the person’s ‘eligible needs’ are (see below).
3. The Local Authority Social Worker or assessor will assess what they think are the person’s ‘unmet eligible needs’ under the Fair Access to Care Criteria.
4. Finally, once an assessment has been carried out and the ‘unmet eligible needs’ have been identified are, a care and support plan will be drawn up which sets out how these ‘unmet needs’ should be met.

The Local Authority has a statutory duty to provide services to a person if they meet the Fair Access To Care Criteria.

THE CRITERIA FOR CRITICAL NEEDS ARE:

If services are not provided:
• Life is or will be threatened
• Significant health problems have developed or will develop
• There is or will be little or no choice over vital aspects of the immediate environment
• Serious abuse or neglect has occurred or will occur
• There is or will be an inability to carry out vital personal care and domestic routines
• Vital involvement in work, education or learning cannot or will not be sustained
• Vital family or other social roles and responsibilities will not or cannot be maintained

Example: Peter has a mild learning disability and Type 2 Diabetes. He lives independently and undertakes voluntary and paid work during most weekdays.

He is able to attend to all his personal care needs and carry out daily living skills including making basic meals, however, he struggles to read at times and does not have a good understanding of his diabetes.

He needs support to help him plan meals, go shopping, read food labels and monitor his sugar levels to keep himself physically alive and to ensure his diabetes is well managed and the risk of significant health problems is reduced.

THE CRITERIA FOR SUBSTANTIAL NEEDS ARE:

If services are not provided
•There is or will be only a partial choice and control over the immediate environment
•Abuse or neglect has occurred or will occur
•There is or will be an inability to carry out the majority or personal care routines or domestic tasks
•Involvement in many aspects of work, education or learning cannot or will not be sustained
•The majority of social support systems and relationships cannot or will not be maintained
•The majority of family and other social roles and responsibilities will not or cannot be maintained

If you meet any of these criteria, you are entitled to receive a service or support from the Local Authority to meet your eligible unmet needs.

If the support is withdrawn for any reason, it becomes an unmet need and you should be reassessed.

There is a difference between need and want and therefore, the Local Authority can decide what they consider to be a need and or a want. Evidence as to why it is a need and how a person would be affected if the need wasn’t met may be required. BUT you may have to pay for some or all of your support, depending on the amount of income and capital you have.

THE ASSESSMENT

Make sure you get a good assessment of needs –
Make sure it is a face to face assessment, not by phone, even if it is a review
Really think about the person’s needs – if you were not around could they do it alone? What might they need?

Always try to have a neutral person at the assessment with you, a friend or advocate for example.

Ask to talk privately if you feel that some of the information you need to give would upset the person you care for, for example, how much help they really need – not just what they think they need.

The assessment is only carried out once the person’s needs have been identified, and these have satisfied the eligibility criteria above (critical or substantial).

A care plan must be put in place to advise how these needs will be met appropriately (and without infringing Human Rights or dignity).

Ask for a copy the assessment in writing to make sure it records:

A note of the eligible needs identified in the assessment
The agreed outcomes and how support will meet these outcomes (not specific services)
Any risk assessments done to manage any risks
A contingency plan to manage any emergency changes
The financial contribution the person is asked to pay
Any support Family Carers or others are willing to provide voluntarily
Any other support provided to address any needs identified through a the Carers Assessment
A review date

Consider your own needs as a Family Carer. If you offer to provide support to your relative, it will be unpaid and delivered in all but the direst of circumstances. If you want or have a life outside of your caring role this has to be considered as part of the assessment – there is no legal requirement that you provide more care than you are prepared to give.

GOOD SUPPORT PLANNING IS THE KEY

Make sure the person, their family and friends, support workers, other professionals and any advocates are involved.
Find out what is on offer and where, speak to friends, family, voluntary services and use as many resources as you can.
Do not just consider specialist services – lots of support in the community can and should be accessible to everyone.
Be creative in finding ways to achieve outcomes which meet assessed needs – the only limit is your imagination.

Using a voluntary organisation or other support planning service can often be more creative than using a social worker. In Suffolk there are a number of agencies who will do this and can be paid for doing it by the Local Authority. Ask your Social Worker to refer you to the external support planning service.

A GOOD STRONG SUPPORT PLAN WILL:

Make sure the personal budget allocated will meet your relative’s assessed needs and works towards all of his or her outcomes
Be very clear and say who will do what, when, why and how much it costs. The support plan needs to cover 24 hours a day, 365 days a year. Think about what happens if a person is not at college or if the day service is unavailable
Consider what happens if the person or the Carer is ill or what procedure is followed in adverse weather etc.
Be realistic, for example, if you, if you live in a rural area, how easy would is it to get an hour’s support first thing in the morning or last thing at night. How much would this service cost?
Involve all the people important in the person’s life
Be regularly reviewed (at least annually by social care and perhaps more often by the support team)

MORE DETAIL ON MEETING ASSESSED NEEDS

Assessed needs can be legitimately met through the voluntary sector or by friends and family. The local authority can signpost you to voluntary services that are able to meet your assessed needs and can take into account what your friends and family do (until they stop doing it and then your assessed need is unmet), however, by simply signposting you to a service they are not fulfilling their duty – You must check if the voluntary sector can meet your needs rather than just assuming.

A person’s eligible assessed unmet need MUST be met regardless of the cost and the assessment is crucial to ensuring this is the case, however, it is only eligible assessed unmet needs that must be met. Further, the Local Authority can meet these needs in the most cost effective way possible as long as it does not infringe your human rights or dignity.

The Resource Allocation System (RAS) will be used to calculate how much money you are entitled to through the Local Authority. The figure the RAS gives is only an estimate and can be adjusted.

Blanket policies such as ‘we don’t fund travel arrangements’ are illegal. If your assessed need is, for example, to need support to travel they must meet it. In this example they can take into account your DLA mobility component as it is there to pay for additional costs of travel due to your disability so your ‘need’ may already be met. This need may still exist, however, if DLA mobility does not meet the need in full.

If funding for an assessed eligible unmet need is refused, ask for the reasons to be set out in writing.

If the funding allocated is insufficient, ask the Local Authority to explain why this amount has been allocated. If you cannot get Carers for the hourly rate suggested, ask the Local Authority to review their decision and provide evidence to show why you cannot meet the need with the funds available. If the review is refused ask for reasons in writing, and if you still disagree, you can appeal the decision by complaining or by utilising the appeals process.

Gently remind the Social Worker that it is their duty, under the General Social Care Council Code, to support the rights of the person they are working with and not to be concerned with cost, that’s a manager’s responsibility.

If there is no suitable service locally to meet your need, do not just accept an out of County placement. Ask the local authority how they are planning to arrange or commission a service locally to meet the person’s needs.