1. National Service Framework for Older People Single Assessment Process Milestone : April 2004

2. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS PERSON-CENTRED CARE : STANDARD TWO, NSF FOR OLDER PEOPLE Managers & Professionals should: Listen to older people Respect their dignity and privacy Recognise individual differences and specific needs including cultural and religious differences Enable older people to make informed choices, involving them in all decisions about their needs and care Provide co-ordinated and integrated service responses Involve and support carers wherever necessary

3. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS REASONS Local variations in depth and quality of assessment Information about assessment may be limited Older people not at the centre of assessment and care planning Treatable health conditions are missed or mis- diagnosed i.e. dementia, depression, incontinence, etc. Scales adapted for local use Assessment not in proportion to older people’s needs Assessments duplicated and information may not be shared… Professionals may not accept each other’s assessments

4. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS Key Aspects: Person Centred Information given once Views and wishes are central Holistic picture of needs Assessment proportionate to need Consent to sharing Written details to older person

5. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS PURPOSE The process should not: displace existing good practice replace clinical judgement be thought of as separate to the NSF, but inherent within The Single Assessment Process should: encourage raising of standards within the care of older people be a continuous process for an older person, but a joint process for professionals Be outcome centred for the older person

6. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS PROFESSIONALS / AGENCIES INVOLVED GP surgeries Community Health Services Social Services Housing Ambulance Hospitals (A & E, Outpatients. Medical Assessment Units, Old age psychiatry units, Wards, Other locations caring for older people, Dentists and podiatrists) Other NHS facilities

7. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS STAGES OF ASSESSMENT AND CARE MANAGEMENT Publishing information about services / case finding Completing assessment  Contact  Overview  Specialist  Comprehensive Evaluating assessment information Deciding what help to offer Care planning Monitoring Review

8. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS DOMAINS OF THE SINGLE ASSESSMENT PROCESS User’s perspective Clinical background Disease prevention Personal care & physical well-being Senses Mental health Relationships Safety Immediate environment and resources

9. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS TYPES OF ASSESSMENT Contact assessment nature of the presenting problem; significance for the older person; duration of the problem; potential solutions identified by the older person; other problems experienced; recent relevant life events; perception of family and carers

10. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS TYPES OF ASSESSMENT Overview assessment all, or most of the domains are explored; may be sufficient to fully describe person’s needs; may trigger areas where further assessment is required; may occur as soon as basic personal information has been collected

11. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS TYPES OF ASSESSMENT Specialist assessment exploration of specific domains as indicated by either contact or overview assessment; requires the involvement and judgement of appropriately qualified and experienced professionals; may require the use of specific tools and scales i.e. Geriatric Depression scale; O.T. assessments; etc.

12. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS TYPES OF ASSESSMENT Comprehensive assessment maybe necessary following initial contact if needs are perceived by the professional to be complex and multiple; may follow on from an overview assessment will be required for all older people where the level of support and treatment likely to be offered is intensive and complex (including permanent admission to a care home, intermediate care facilities, or intensive packages of care at home)

13. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS COUNTY PROGRESS TO DATE Cumbria and Lancashire Partnership Group [senior management in older people services across Lancashire and Cumbria’s Health & Social Services] Local steering groups Local project leads Developed joint training strategy Information sharing agreements Initial roll out of Single Assessment started in all localities

14. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS LOCAL PROGRESS TO DATE Multi-professional and multi-agency working groups have: Agreed purposes; outcomes & shared values Agreed terminology Mapping care processes Agreed link between medical diagnosis and assessment Piloted strategies for joint staff development SSharing of demographic information, imminent AAwareness raising high on agenda

15. Designed by Kate Bebe SOME OF THE WORK DONE SO FAR IN SINGLE ASSESSMENT Eleven shared values have been agreed across Cumbria and Lancashire: 1. Respect and promote the autonomy of the individual 2. All service provision to be seen by the user as a single package of care 3. Informed consent is needed for every element of the care package 4. Age (of itself) should not determine how services are accessed or provided 5. If an individual lacks capacity to make decisions, agencies to have procedures for maximum participation and safeguarding the older persons interests.

16. Designed by Kate Bebe SOME OF THE WORK DONE SO FAR IN SINGLE ASSESSMENT Eleven shared values have been agreed across Cumbria and Lancashire (continued) 6. SAP should promote health and well being and optimise independence 7. Service information should be understandable and accessible 8. Professionals should be competent to work with older people and should be active in Continuing Professional Development. 9. Care workers will promote and maintain good practice and adhere to legal requirements and relevant standards of practice. 10. Communication will be open and straightforward 11. A holistic approach to assessment will incorporate the whole picture of individual needs

17. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS CASE STUDIES Example 1: Mrs Brown presents at the surgery with a sore throat. She has no other health or social problems Mrs Brown does not enter into the Single Assessment Process

18. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS CASE STUDIES Example 2: Mrs Brown presents herself at the GP surgery. She is complaining of weight loss over the last 6 months and is finding it increasingly difficulty to get in and out of her bath safely.  In contact assessments, professionals need to explore health and social care problems where the: Presenting problems are not clear Other potential problems maybe identified

19. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS CASE STUDIES Example 3: Following the death of her husband, Mrs Brown has been living on her own, without support, for the last 6 years. Recently, she has found it difficult to bend down which has affected her ability to manage her own personal care. She experiences dizziness and becomes tired if she exerts herself physically. Mrs Brown also admits to feeling “quite low at times”. Mrs Brown requires an holistic overview assessment. Key factors include: Personal care; medical and mental health issues

20. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS CASE STUDIES Example 4: Mrs Brown has had several admissions to hospital, instigated by her GP. She has complex health conditions, which result in reduced mobility. Considerable support is necessary to maintain her personal care. Social Services provide home care four times per day. Mrs Brown also has a private cleaner. On her last admission to hospital, Mrs Brown discussed, with her named nurse, the fact that she is “tired of managing on her own” and wants “to live somewhere she feels safe”. Mrs Brown requires a comprehensive assessment including several specialist assessments

21. Designed by Kate Bebe SINGLE ASSESSMENT PROCESS Local Contacts: Name: Tel: Name: Tel:

22. Designed by Kate Bebe FURTHER INFORMATION General: http://www.dh.gov.uk/scg/sap/index.htm Tools and Scales: http://www.dh.gov.uk/scg/sap/toolsandscales/index.htm Guide to implementation: http://www.dh.gov.uk/scg/sap/locimp.htm