Care Act Factsheet 3 Assessing needs and determining eligibility

“…a move to outcome and needs based assessment would put the individual and their views, needs and wishes at the centre of the work, as the setting of outcomes is both a personal and subjective process.”

Joseph Rowntree Foundation

This factsheet describes how the Act and supporting regulations and guidance set out the process of assessing an adult’s needs for care and support, and deciding whether a person is eligible for publicly funded care and support.

What is the assessment process?

An assessment is how a local authority decides whether a person needs care and support to help them live their day-to-day life.

The assessment must be carried out by an appropriately trained assessor, for instance a social worker, who will consider a number of factors, such as:

  • the person’s needs and how they impact on their wellbeing – for instance, a need for help with getting dressed or support to get to work
  • the outcomes that matter to the person – for example, whether they are lonely and want to make new friends
  • the person’s other circumstances – for example, whether they live alone or whether someone supports them

The aim is to get a full picture of the person and what needs and goals they may have. After carrying out the assessment, the local authority will then consider whether any of the needs identified are eligible for support.

Because not all care needs are met by the State, the local authority uses an eligibility framework to decide which needs are eligible to be met by public care and support.

Why do we need to change the law?

As well as helping councils make decisions, the assessment allows people to express their own wishes and preferences. Talking with people to understand their needs, and how they can meet them, will support them to maintain their independence for longer and make better choices about their care. This is an important process in its own right.

Local authority responsibilities for assessments were previously set out in a number of different laws. These tended to focus on what service should be provided, rather than on what the person actually needs or wants. We want a care and support system built around the individual. We therefore changed, so that assessments focus on what the person wants to achieve. Each local authority previously set its own eligibility threshold based on guidance. This meant that the amount – and type – of care that was provided by the council varied depending on where a person lived.

What are the requirements for assessment?

The Act gives local authorities a duty to carry out a needs assessment in order to determine whether an adult has needs for care and support. The assessment:

  • must be provided to all people who appear to need care and support, regardless of their finances or whether the local authority thinks their needs will be eligible
  • must be of the adult’s needs and how they impact on their wellbeing, and the outcomes they want to achieve
  • must be carried out with involvement from the adult and their carer or someone else they nominate. The adult may need an independent advocate provided by the local authority to help them with the assessment process

As part of the process, the authority must consider other things besides services that can contribute to the desired outcomes, and whether any universal preventative services or other services available locally could help them stay well for longer. For example, the local authority may offer the person a period of reablement to reduce needs and regain skills, before completing the assessment.

The regulations which support the Act ensure that the assessment is appropriate and proportionate, so that people have as much contact with the authority as they need. In addition, they require the authority to consider the wider needs of the family of the person (for instance, if there is a young carer).

The regulations will also require that assessors have the appropriate training, and that experts carry out complex assessments such as for people who are deafblind.

If the person agrees and has capacity, they may also carry out a self-assessment, where the person takes the lead in identifying their needs and outcomes. The local authority will still be involved to help support the process, and to be satisfied that the person has identified all of their needs, but the person can take more control.

How does the authority determine who has eligible needs?

After the assessment, the local authority must determine whether the person is eligible for care and support. This is set out in regulations that set the national minimum threshold for eligibility, which will be consistent across England.

Determining eligible needs is important to work out, as the local authority must meet the adult’s eligible needs for care and support (see factsheet 2). The person will have eligible needs if they meet all of the following:

  • they have care and support needs as a result of a physical or a mental condition
  • because of those needs, they cannot achieve two or more of the outcomes specified
  • as a result, there is a significant impact on their wellbeing

The outcomes are specified in the regulations, and include people’s day-to-day outcomes such as dressing maintaining personal relationships, and working or going to school.

Where the person has eligible needs, and wants the local authority’s help to meet them, then the authority will discuss the person’s care and support plan with them (see factsheet 4). In all cases, the local authority must give people advice and information about what support is available in the community to help them.

The local authority must provide the adult with a copy of their assessment and their eligibility determination.

This factsheet relates only to adults who need care and support. Factsheet 8 explains the equivalent provisions for carers.”