1. Background

The Single Assessment Process forms part of the Government's agenda for modernisation of Health and Social Care Services. Specifically, it is introduced through the National Service Framework for Older People (NSFOP) Standard Two. This standard is concerned with Person Centred Care, it aims to “Ensure that older people are treated as individuals and they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries.” (National Service Framework for Older People 2001).

The implementation of the Single Assessment Process in Sandwell like all other areas is guided by Department of Health guidance, but takes account of the way that local systems already operate. Importantly the Single Assessment Process builds on existing good practice in Sandwell for example, partnership working.

The need to introduce a Single Assessment Process is based on several national trends such as:

• An aging population, for example, in Sandwell there has been a 29% increase in the number of people over the age of 85 years between 1991-2001
• A recognition that despite contact with services there is a high level of undiagnosed depression in older age.
• Increased number of people with early onset dementia.
• People from diverse cultural backgrounds do not always have their needs properly assessed. One in five people in Sandwell classified themselves as being from a minority group in the 2001 census.
• The experience of many people who come into contact with health and social care agencies is that there is frequently a duplication of assessments.
• Department of Health have recently reconfirmed through a circular “The Community Care Assessment Directions 2004” that good practice requires full involvement of individuals and their carers in assessment and care planning.

The Single Assessment Process in Sandwell aims to ensure that where people have health and social care needs that assessments and care planning is well co-ordinated across the agencies.

The process will be implemented in Sandwell for people 60 and over from 31 October 2004.

Whilst the implementation of the Single Assessment Process in will initially be for older people aged 60 and over, the intention will be to extend the process to other age groups.

2. What does the Single Assessment Process aim to do?

• To ensure that older people have their needs assessed in a similar way regardless of the discipline of the worker involved.
• To ensure that person centred care is at the heart of the process
• To avoid the potential for administrative and service inefficiency caused by the number of different assessment processes.
• To further develop joint working between health and Adult Services,and Health (formerly Social services) and housing
• To make the process of registering with Health (e.g. community based nursing services) or Adult Services and Health more convenient for the individual using the service, in that they should be required to give their basic details once.
• To ensure no older person's needs are overlooked by Health or Adult Services and Health
• To provide quicker access to appropriate services that will result from the changes aimed for above.

3. What are the Advantages of the Single Assessment Process. The Advantages for Individuals and their Carers

• A person centred approach is taken, so that the person is kept at the centre of discussions, they are recognised as experts in their situation, their needs and aspirations are taken into account.
• Carers' needs are recognised.
• Assessments are not duplicated.
• Individuals have a record of their assessment and care plans.
• Information concerning an individual is shared with the permission of the individual
• Subsequent care arrangements are well co-ordinated.

The Advantages for Staff

• There will be a common format for assessments.
• Information will be accessible to those who need it, subject to the agreement of the person concerned. For example, where a more detailed exploration of particular issues are needed i.e. specialist assessment, this can be started from the information already available.
• Multi agency working will be further improved.
• Services will be better co-ordinated.

4. What Changes will there be with the Single Assessment Process?

Change	In practice this will mean
Introduce Person Centred Care	This builds on best practice by placing the person at the centre of any of the processes. The person should be an active participant. The person's expertise in themselves will be recognized, with professionals taking a partnership approach to the management of the person's care.
An information sharing protocol will be implemented.	Service users will give written consent for information to be shared between agencies. This builds on best practice of obtaining verbal consent to share information. Information will always be protected by current legislation and policy such as Data Protection Act 1998. (In certain circumstances information maybe shared without the explicit permission of the service user, i.e. "under the professionals' Duty of Care")
Assessments will be carried out in a common format, for most staff this will be a paper based record, whilst a computer based approach is adopted. Adult Services will continue to use "Swift"	There will be four levels of assessment.The contact, overview and specialist assessments will be on common paper work. A comprehensive assessment will be made up of an overview and specialist assessments. These new formats replace several of the "AC" forms
Registration of patients	The SAP forms, the contact form SAP1 will be used as basic registration forms for community health staff such as district nurses.
Person Held Records	People will routinely be given a copy of their overview assessment, care plan or statement of service delivery. This builds on existing good practice.
The process will introduce "Single Assessment Care Coordinators"	The SAP care coordinator will be a professional involved with the care of that person who will act as the first point of contact for the individual.

5. The Principles of Assessment - Ensuring Best Practice

Complete, holistic, inclusive and focused and based on service user's perspectives

A Person Centred Approach

Outcome focused, and takes account of users strengths, goals and aspiration

What is it that the person wants to change or achieve?

Non intrusive and appropriate to level of need

Finding out only what's relevant

User centred and encourage the active participation of users

Consider appropriate ways of communicating

Enabling and emphasize what people can do and their capacity for self care i.e., promote and support the users independence and autonomy

Develop care packages that encourage service users

Timely and completed without undue delay in order to determine needs, risks, priority and nature of response and eligibility

Accurate information is essential for multi agency working

Sensitive and respectful of the differing cultures and faiths of local communities and individuals

Discuss how these can be supported

Non discriminatory

promote equality of access to assessment

Proportionate to the service users needs.

And

Service users should be fully supported to be active participants throughout assessment

Consider how and where assessments take place

Decisions should be transparent

Explain clearly how & why decisions are made

Needs identified through individual assessment should inform the future strategic direction of both local single agency and joint planning and service commissioning

6. What exactly is the Single Assessment Process?

The Single Assessment Process has four levels of assessment which have been defined by the Department of Health guidance.
A person will not enter the Single Assessment Process (SAP) if their needs are of a straight forward nature e.g. specific minor ailments, are short term or requiring only say the intervention of one agency. For example, someone requiring removal of sutures following minor surgery will not enter SAP if they have no other wider needs.

In Sandwell SAP will apply when:

The person is aged 60 years or over and their presenting needs are not clear cut, or other potential needs are identified, or requests for more intensive forms of support or treatment have been made.
The single assessment process will usually be started by the professional having first contact with the person. It may also be relavant for service users over 18 where there are complex needs.

7. The 4 Levels of Assessment

The four levels of assessment need not follow in this linear sequence, as for some people, it will be immediately apparent that their needs are of a complex nature.

SAP 1

This level of assessment refers to a contact between an older person and Health and Adult Services and Health where significant needs are first described or suspected. It does not refer to every contact between, say, a GP and an older person coming to their surgery. At contact assessment basic personal information is collected and the nature of the presenting problem is established and the potential presence of wider health and social care needs is explored.

SAP2

An overview assessment is a set of documentation that is completed by the professional staff assessing and treating the older person, a copy will be given to the person. It provides an indication that staff have recognised the person has a need for a more rounded multi-disciplinary assessment and it provides the documentation for all agencies to share information and to signpost where more in depth specialist assessments can be found or are required. The assessment should be kept in proportion to the person's needs and therefore not all domains or headings need to be completed.

Who is most likely to carry out this type of assessment?

• Professionals from a range of disciplines who currently undertake assessments
• Usually the professional to have first contact with the person
• Staff should refer onto the appropriate partner services for other health or social needs where they feel a more specialist assessment is required

SAP 3

Specialist assessments offer a way of exploring specific needs, in detail, and may be indicated by a contact or overview assessment. As a result of a specialist assessment or several specialist assessments, staff should be able to confirm the presence, extent, cause and likely development of a health condition or problem or social care need, and establish links to other conditions, problems and needs.
It will be following this assessment that consideration will be given to whether a person meets the eligibility criteria for service, for example Fairer Access to Care criteria in Social Care

Who is most likely to carry out this type of assessment?

• The most appropriate qualified professional.

SAP 4

Comprehensive Assessment
Consists of the overview assessment and one or more specialist assessments where long term care needs are identified.

For some individuals there will be a strong likelihood that they may need intensive support or prolonged support (for example a year or longer) including permanent admission to a care home, the receipt of intermediate care services or substantial care packages at home. In such cases, all the domain headings and many sub-domains should be explored, and specialist assessments carried out in a number of them. This equates to a comprehensive assessment.

Who is most likely to carry out this type of assessment?

• A range of different professionals or specialist teams, with the relevant skills and knowledge. Geriatricians and old age psychiatrists, and their teams, should usually play the leading or a prominent role.

8. Information Sharing as part of the Single Assessment Process Background

Person centred care means involving people throughout the process of assessment, planning and delivery of their care. Therefore they have a legal right to determine what information about themselves is shared and with whom.
Sandwell has a formal inter agency sharing protocol which demonstrates how individual's information will be shared and how it may be used.
Information is protected under Data Protection Act 1998.

It is important to also to remember that all professionals are also operating under the common law duty of confidentiality, this means:

• professionals and agencies should work to ensure that only those who actually need to see information should be able to see it;
• cases are only discussed with those responsible for providing care or checking the quality of care provided; and
• As far as practicable, patients and service users should be involved in decisions about sharing information and any objections raised should be respected.

9. Who Can Be SAP Care Coordinator?

The SAP care coordinator will usually be the person who deals with the person's predominant need.
So this includes all allied professionals and social workers.
Where a person enters residential care, then the best placed person will be a social worker or care manager, this is particularly relevant where the care is funded through the local authority.

10. What is the role of the SAP care coordinator?

To act as the first point of contact for the person concerning their care.

Refer the person onto other agencies as indicated in the overview assessment

"Signpost" the person to other services that they access themselves

To provide advice to the person and their carer about what to do if they are unhappy with service they have received. That is, advice about the complaints processes.

Oversee the package of care to ensure that it is progressing in a timely manner.

To consider whether the individual has needs that would benefit from a more structured review.