Circular SWSG7/94 5458 - Community Care - The Housing Dimention

SECTION 4 - INDIVIDUAL ASSESSMENTS

Introduction

4.1 Section 3 (Planning) discussed aggregate assessments of need. This section discusses the involvement of housing in community care assessments of individuals. It should be noted that the information assimilated from individual needs assessments will aid the aggregate planning process.

4.2 Before arranging for community care services to be provided for an individual, social work authorities are required to carry out an assessment of the needs requirement. There will be exceptions in cases of urgency. 12A(3)(b) of the Social Work (Scotland) Act 1968 (inserted by section 55 of the NHS and Community Care Act 1990) states clearly that Social Work Authorities are required to invite the local housing authority to assist in the assessment. General guidance on individual community care assessments was set out in the 17 June 1991 circular "Community Care in Scotland: Assessment and Care Management" (SW11/1991 and HHD/DGM(1991)40) which was copied to Directors of Housing; this section considers further the involvement of housing in such assessments.

General Principles

4.3 The 1991 circular includes the following general principles for individual needs assessments which are still valid:

4.3.1 While statutory responsibility for ensuring that assessments are conducted lies with social work authorities, they should be carried out on an interagency basis.

4.3.2 Assessments should be needs-led, not service led.

4.3.3 There should be an initial screening process to confirm that community care services may be required, and if so whether the case is urgent and what general range of services are required. In addition there should be a flexible response system so that the time and resources devoted to each assessment, and the number of bodies involved (including housing bodies), should be no more than is essential in each case.

4.3.4 Users and carers should participate in assessments, and assessment procedures should be easily accessible and non-discriminatory.

4.3.5 Assessments should cover physical, mental and social functioning, the intention being to preserve or restore normal living as far as possible. The physical nature of the housing or other accommodation provided, and any in-house support services, may have a substantial effect on the functioning of the person being assessed.

4.3.6 Since the general aim is that those receiving community care should if possible remain in their own home, or at least in a homely setting, assessors should consider whether the provision of appropriate health, social care or housing management services will avoid the necessity to move users from their existing home.

4.3.7 The results of the assessment should be recorded and made known to users, and be subject to review.

4.4 Housing may be an issue for the individual whose needs are being assessed. In preparation for this, housing bodies should therefore be closely involved in:

- Determining the housing content of the assessment form.

- Identifying what constitutes a housing need.

- Determining the process for referral to a housing body, where a housing need is identified; and vice versa where a housing body identifies a possible need for social care or health services.

- Determining the arrangements for 'fast-track' assessments and emergency admissions to housing, or to social work or health accommodation.

- Determining when housing should take part, what housing body should be involved under what circumstances in individual assessments and reviews, and in the preparation of individual care plans.

4.5 During the assessment process, housing must be involved in discussion with users, carers and the other assessors, on the implications of the assessment and the options or alternatives that may exist. It may be that the need is for a specialist type of housing, but that provision might not be possible. Therefore, alternatives must be discussed if a realistic package is to be compiled for the individual.

4.6 A person's current accommodation (or lack of it) may have a significant effect on their physical, and perhaps social, functioning; and therefore housing bodies may need to be consulted at the initial stage on this, and how the person's functioning could be affected by alternative housing. Rehousing in another location may affect informal support networks of family and friends. On the other hand, it is accepted that it can be confusing for the person being assessed if many assessors are involved in her or his assessment, particularly if many of them visit him or her. One possible solution is to design an assessment form which the main assessor, usually a social worker, can use to obtain relevant housing and other information and distribute for comment to specialist housing and other assessors. Some training in the use of such forms may be required. This approach may also save time.

4.7 Community care assessments represent a significant change in the responsibilities of local authorities, in the practice of professionals and in inter-relationships between bodies and individual professionals. The new arrangements are still in the process of settling down. To aid the process, social work, health, and housing bodies should pay particular attention to:

- Being clear about which body has responsibility, particularly for making the placement and the funding of care and/or accommodation.

- Exchange of information between bodies about the people responsible and procedures for assessment within each body. There should be named contacts wherever possible.

- Good communication and acceptance of referrals between bodies, in order to identify problems at an early stage and avoid unnecessary delays.

- Recognising changing needs by reviewing decisions timeously.

- Ensuring recommendations for the provision of housing take account of the policies, procedures and criteria of housing bodies.

- Ensuring that assessments and related placements do not undermine the financial viability of providers, for example by causing voids or late payments because of slow assessments.

See also comments on allocations in paragraphs 5.2-5.6.

Direct Access and Short Stay Accommodation

4.8 The Scottish Office is aware that particular problems have arisen in relation to placements in emergency/direct access accommodation. In these cases an initial decision whether or not to admit has to be made on the spot, and often the resident will stay for only a short time before moving on elsewhere. Community care procedures have therefore to recognise that the assessment process for this type of urgent need requires an immediate response.

4.9 However, at local level, housing and social work bodies have been working hard and successfully to overcome these problems, within the national guidelines, by adopting the following approaches:

4.9.1 Social Work Departments delegating authority to decide on immediate admissions to voluntary and other bodies running emergency accommodation.

4.9.2 Carrying out assessments (needs and financial) as soon as possible, using the fast track assessment process as appropriate.

4.9.3 Ensuring that those making assessments are clear when a complex as opposed to a more simple assessment is required. The assessment process should of course begin with an initial screening to determine the person's needs and appropriate further action. It may be possible to delegate simple assessments at least to staff based in, or linked to, the accommodation who will often have specialist knowledge and expertise in the client groups they serve; or to third parties.

4.9.4 Where the normal expectation is that residents in accommodation will receive support from the social work authority, a system of block payments, adjusted in the light of individual financial assessments, may prevent cash flow problems for providers.

Naturally, the use of the delegated powers should be subject to quality audit procedures.

4.10 It should be noted that individuals seeking housing, including housing for community care client groups, may have no additional needs other than more appropriate housing. Therefore such housing can be accessed by individuals who have not had, and do not require, a formal needs assessment.