1. The single assessment process
An introduction to the principles
and process
the single assessment process training resource

2. National Service Framework (NSF) for Older People
Standard 2 Person-centred care
Covers:
Single assessment process
Integrated equipment
Continence services
The single assessment process was first introduced as part of the NHS Plan in It is part of Standard 2 of the National Service Framework (NSF) for Older People which focuses on person-centred care. Standard 2 links to all the other standards:
Standard 1 Rooting out age discrimination
Standard 2 Person-centred care
Standard 3 Intermediate care
Standard 4 General hospital care
Standard 5 Stroke
Standard 6 Falls
Standard 7 Mental health in older people
Standard 8 Promotion of health and active life in old age
More details at
the single assessment process training resource

3. The single assessment process
What is it?
Why do it?
How?
When?
What is it? An assessment process which will ensure that:
the scale and depth of assessment is kept in proportion to older people’s needs
agencies do not duplicate each other’s assessments
professionals contribute to assessments in the most effective way
older people are at the centre of the process
it provides information to support the determination of the Registered Nursing Care Contribution (RNCC) – free nursing care
a validated tool is used.
Why? Older people said that they were having to give the same information many times. ‘Local implementation of the single assessment process by health and social care systems will promote better care services and better outcomes for older people, and more effective use of professional resources’ (DoH guidance).
How? The implementation process is laid down and includes twelve steps which guide authorities through the process to ensure that all agencies are fully engaged. See Handout 4.
When? By April 2004 local partnerships must meet the criteria laid down or be implementing agreed action to ensure compliance by April 2005 – if not DoH will impose a tool.
the single assessment process training resource

4. Who? service users/patients/ older people/their carers
Who? staff/organisations
Who? Older people (service users) and their carers Exactly who will qualify needs to be determined locally. Some people are defined by the guidance. For example older people with mental health issues which pre-date old age would continue to be dealt with under the Care Programme Approach (CPA) system, whereas older people who develop mental health conditions in old age would follow the single assessment process.
Slide SAP 5 shows a stakeholder map of people who may become involved with service users and their carers during the single assessment process.
Who? Staff Those likely to be involved include district nurses, care managers social workers, occupational therapists, GPs, ward staff in acute trusts, staff from mental health trusts, housing staff etc.
Slide SAP 6 shows a stakeholder map for organisations.
the single assessment process training resource

5. Stakeholders Individuals
Community
psychiatric nurses
(CPNs)
Housing officers
GPs
Therapists
Service users and
their carers
Health visitors
Ward staff
District nurses
Volunteers
Occupational therapists
Intermediate care staff
A stakeholder map showing service users and their carers surrounded by the various people who could become involved with them during the single assessment process.
Care managers
Home carers
Residential staff
the single assessment process training resource

6. Stakeholders Organisations
Housing
Primary care
trusts
Social
services
Single
assessment
process
Voluntary
sector
Acute trusts
A stakeholder map showing the key organisations working together to implement the single assessment process.
Mental health
trusts
the single assessment process training resource

7. Why is the single assessment process important?
Fundamental to the delivery of the NSF for Older People:
Falls prevention
Management of medications
Long-term care (RNCC, free nursing care)
Delayed transfers of care
Intermediate care
Maintaining independence
Falls prevention (Standard 6 of the NSF) Standard 6 recognises that a single assessment of an older person can identify those at risk of falls.
Management of medications The use of medicines is a fundamental component of each of the NSF standards, and there is a common link to every standard in the NSF. Achieving greater partnership in medicine-taking between patients and health professionals, improving choice and addressing the needs of older people and their carers can help to meet these standards.
Long-term free nursing care The need for free nursing care is assessed at the stage where someone’s health needs are quite high and likely to be longstanding. Health needs requiring a registered nurse may originally have been identified as areas for further assessment as a result of an overview assessment.
Intermediate care (Standard 3 of the NSF) An early single assessment can assist in the discharge planning process and help to avoid premature discharge and premature or avoidable admissions to long-term residential care.
More details on the National Service Framework (NSF) for Older People at
the single assessment process training resource

8. Why is the single assessment process important?
Registered
nursing care
contribution (RNCC)
– free nursing
care
Maintaining
independence
Reviews of
medication
Single
assessment
process
Delayed
transfers
of care
Fair
access to care
services
(FACS)
Falls
Continence
the single assessment process training resource

9. Reasons for introducing the single assessment process
Raymond Warburton
Local variations in depth and quality of assessment
Information about assessment may be limited
Older people are not at the centre of assessment and care planning
Treatable health conditions are missed or misdiagnosed
Raymond Warburton is the lead for the single assessment process at the DoH and the issues outlined here are those he identified at a conference held in Bristol in November 2002.
(Slides SAP 9 and SAP 10)
continues
the single assessment process training resource

10. Insensitivity to race and culture Scales are adapted for local use
continued
Raymond Warburton
Insensitivity to race and culture
Scales are adapted for local use
Assessment is not in proportion to older people’s needs
Assessments are duplicated and information is not shared
Professionals may not accept each other’s assessments
the single assessment process training resource

11. Single assessment process Key benefits
Facilitation of joint working
Shared information
Reduced duplication
Improved discharge planning
Improved prevention
Fewer avoidable hospital admissions
Case finding
Key benefits
The single assessment process can assist in the facilitation of joint working across all agencies. Information can be shared thereby reducing the number of times older people have to go through the process of giving information about their situation.
As mentioned previously, it will improve discharge planning, improve prevention and reduce unnecessary hospital admissions.
Case finding
Case finding can make an an important contribution to preventative strategies and health promotion. However given that all agencies are working to limited budgets and have limited resources this optional element of the guidance may take time to introduce fully.
See Joint working jargon buster for definition of case finding.
the single assessment process training resource

12. Single assessment process Main challenges
Joint working: cultural changes and organisational barriers
Building trust
Pressures on workforce of other targets and requirements
Difficulties releasing staff from training
Information management and technology (IM&T)
Joint working involves organisations and individuals in accepting and trusting each others’ assessment.
There are other external pressures that will challenge the single assessment process:
Pressure on the workforce to meet targets
Releasing staff from their area of work for training
Information management and technology
Computers currently not talking to each other
Not all areas of work have access to a computer
Training
Funding
the single assessment process training resource

13. Single assessment process Key issues
Person centred
Information is gathered once
Professionals work together in the best interests of older people
Older people’s views and wishes are central to the assessment process
The depth of the assessment is appropriate to their needs
What does person-centred care mean?
That the single assessment process will aim to gather the information once.
That the information will enable professionals to work together in the best interest of the older person.
That the view of the older person will be central to the assessment and that the depth of the assessment is appropriate to the need.
the single assessment process training resource

14. Single assessment process Key issues
Standardised
Evidence based
Enables professionals to access each other’s assessment
Facilitates sharing of information between professionals and agencies
Evidence based
The tools used to gather the information for assessment are evidence based. EASY-Care is one assessment tool. Others are being and will continue to be developed or agreed, e.g. specialist (in-depth) assessments.
If the tools are standardised, health and social care professionals will be able to access each others assessments. This naturally leads to the assessment being shared between professionals.
The issue of giving information about key decisions and issues in writing (or other appropriate format) is an important one. It needs to be picked up again when discussing specific tools and local methods later in the training.
the single assessment process training resource

15. Single assessment process Key issues
Outcome centred
Promotes health, independence and quality of life for older people
Helps fulfil potential for rehabilitation
Outcome centred
Single assessment promotes health, independence and quality of life for older people and will help to fulfil their potential for rehabilitation.
the single assessment process training resource

16. Single assessment process Key issues
Older person’s contribution
This starts at the beginning of the contact assessment. There needs to be a statement of the person’s needs, expectations, strengths and abilities in their own words
Their contribution continues throughout
Key decisions and issues should be given to the person in writing or in another appropriate format.
the single assessment process training resource

17. Carer’s assessment The overview assessment should give
sufficient information to establish whether
there is a carer involved who provides
‘substantial’ care.
If there is, they should be advised about
their right to an assessment of their own
needs.
the single assessment process training resource

18. Stages in the single assessment process
Publishing information about services
Assessment
Evaluating assessment information
Deciding what help should be offered (includes eligibility decisions)
Care planning
Monitoring
Review
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the single assessment process training resource

19. The assessment process
Contact
assessment
Overview
assessment
Specialist (in-depth)
assessment
Comprehensive
assessment
It is important to realize assessment is not a linear process.
A contact assessment should come first, but following this a decision will need to be made about the level and breadth of any further assessment.
An overview assessment may be sufficient further action, but it may identify other needs which lead to a specialist assessment. Specialist assessments are also known as in-depth assessments.
For example, It may be that on admission to hospital a number of specialist assessments are undertaken around mobility issues. This may identify the need for a broader but less specialised assessment in other areas. Then an overview assessment could be undertaken.
Alternatively the specialist assessment may indicate several areas of difficulty which need other specialist assessments, in which case these should be pulled together as a comprehensive assessment.
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the single assessment process training resource

20. Contact assessment What is it? Not all contacts!
Done when significant needs are first described or suspected
What is it?
Collection of basic personal information
Establishes the nature of the presenting problem
Explores the potential presence of wider health and social care needs
To assess, or not to assess?
Some examples:
Older person comes in for pre-holiday injections, no other issues – no assessment needed.
Flu injection, no other issues – no assessment needed.
Older person comes in to have stitches removed. Need further information to make decision. How did injury occur? Fall? Has it happened before? May need to undertake overview assessment to establish full background and needs with the person. If on the other hand it is the first time and they tripped over the dog then not likely to need full overview assessment (remember the rule that assessment should be in proportion to the needs).
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the single assessment process training resource

21. Overview assessment Likely to be undertaken by one assessor
Local organisations need to agree who can do these
Covers the full range of ‘domains’
Judgement will be needed about which areas to pursue
At this point trainers should check that everyone understands domains and sub-domains (see Joint working jargon buster).
Domains:
User perspective
Clinical background
Disease prevention, e.g. nutrition, diet and liquids, vaccination
Personal care and physical wellbeing
Senses
Mental health
Relationships
Safety, e.g. abuse and neglect, public safety
Immediate environment and resources
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the single assessment process training resource

22. Specialist (in-depth) assessment
Examines specific needs in detail
Undertaken by specialists e.g. nurses, social workers, geriatricians, therapists, housing officers, community psychiatric nurses
Needs to be carried out by the most appropriate specialist
Key point in the guidance is that agencies should note the specialist contribution therapists can make to the assessment of:
mobility transfers, speech, language, eating, drinking and functional capacity
the impact of the home and wider environment on needs.
In particular therapists are skilled in the assessment of the potential for rehabilitation and independence.
However, these assessments should be based on the needs of the person not the specialism of the assessor!
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the single assessment process training resource

23. Comprehensive assessment
Involves (in-depth) assessment of all the domains
May be obvious from the beginning that this is needed and therefore overview may not be needed
Must be done for people where level of support is likely to be intensive and/or prolonged
A Registered Nursing Care Contribution (RNCC) determination should draw upon information gathered during the single assessment process.
‘When making an RNCC determination nurses should look to the full extent of an older person’s needs not just those for which a nursing response is immediately obvious.’ Annex H, National Service Framework (NSF) for Older People.
(Slides SAP 23 and SAP 24)
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the single assessment process training resource

24. Comprehensive assessment continued
Will provide information for the Registered Nursing Care Contribution (RNCC) determination (free nursing care)
Will include assessments from a range of professionals and agencies
Will need coordination by a case coordinator
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the single assessment process training resource

25. Case coordinator role Required where needs are complex
Coordinates assessment
Coordinates care planning
Has an ongoing role acting as the focus for communications
Details need to be defined and agreed locally
This should have been developed locally and you can add local notes for it.
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the single assessment process training resource