THE SINGLE ASSESSMENT PROCESS
IN STAFFORDSHIRE
AND STOKE ON TRENT
Guidelines for staff working with older people
In Health and Social Care
Version 1, November 2003
Introduction
The purpose of this guide is to provide a brief outline of the new approach to the
assessment of health and social care needs. The Single Assessment Process is part of the
National Service Framework for Older People, and is being implemented nationally
according to Guidance from the Department of Health. It recognises that many older people
have health and social care needs so agencies should work together to ensure that
assessments and care planning are better co-ordinated, so people experience their
assessment as a seamless Single Process.
Full guidance on the Single Assessment Process and the key implications for various
professions can be found on the website: www.doh.gov.uk/scg/sap or the Circular HSC
2002/001: LAC (2002)1.
The paramount principle is Person Centred Care, which sets the tone for assessment and
subsequent planning, taking account of the user’s perspective throughout. This means that
in the course of the assessment:
 We listen to people’s views and recognise their strengths and abilities
 We respect their dignity and privacy
 We recognise individual differences and needs, including religious and cultural
needs
 We enable people to make informed choices, including informed consent
 We involve people in decisions about their needs and care, and the level of risk they
are prepared to take
 We provide co-ordinated and integrated services
 We involve and support carers where appropriate
 Key decisions and issues are copied appropriately to the assessed person
In particular, remember the requirements that
 The scale and depth of assessment is in proportion to the person’s needs
 There is a focus on outcomes, especially maintaining independence
 Agencies do not duplicate each other’s assessments and
 Professionals contribute to assessments in the most effective way.
Assessment information will be recorded on a series of forms initially, although in due
course it will be part of a shared electronic system so assessments can be shared or seen
instantly.
The documents only reflect this process; it is the professionals who make it work.
Levels of Assessment
There are 4 different levels within the Single Assessment Process, reinforcing the principle
that assessments should be proportionate to needs. These are Contact, Overview,
Specialist and Comprehensive Assesments.
1. Contact Assessment
This is to be used to gather or confirm common basic details. It should
replace the various Basic Details pages on files as new assessments or reviews are started.
It is
to be undertaken for every new contact ‘where significant difficulties are first described or
suspected’, in response to a change in circumstances. The purpose is to find out the
individual’s description of the problem and the impact on them, and to consider if any wider
health/social care needs assessment should be carried out. A contact assessment may also
be completed by a potential service user or their carer. It is to be used to record the
person’s agreement to share information with other professionals, and to make referrals
from one agency to another. However, it won’t be needed for every contact people make
with services. If information or advice is all that is required, this would not constitute a full
contact assessment although some record should be made to indicate any action taken.
Possible Outcomes:
 Referral / signposting
 Supply of simple equipment or short-term service
 Health promotion
 Overview Assessment - to see if specialist assessment needed
 Direct to Specialist or Comprehensive Assessment
 Adult Protection Procedures
SAP CONTACT ASSESSMENT FORM – Guidelines for completion
Preferred name – ask and record what the person likes to be called
Ethnicity – this is a common requirement for monitoring that the whole community has fair
access to public funded services. People should be asked to classify themselves according
to the census descriptions: White British, White Irish, White any other; Mixed White and
Black Caribbean, Mixed White and Black African, Mixed White and Asian, Any other; Asian
or British Asian Indian, Asian or British Asian Pakistani.
Faith – has implications for diet, invasive treatment and some rites; ask if people are
practising their faith, and give permission to say “None”.
Present address- where people may be staying as a temporary arrangement, eg. with a
relative or in residential care
Permanent address – ordinary residence
Interpretation/communication/sensory needs – indicate if someone needs an interpreter,
advocate, or any other aid or support to communicate, and how information should be given
to them (braille, other language, etc). This should ensure that everyone is aware of these
needs and take the appropriate measures in subsequent contacts, eg. sending letters in
large print or securing the help of an interpreter May trigger specialist assessment.
Occupation - can suggest health care needs, and interests for services provided. It is also
an essential part of the person-centred approach, recognising people’s personal histories.
Accommodation – for Type, specify house, bungalow, maisonette, flat, mobile, sheltered
or residential; for Tenure, specify owned, public rented, private rented, lives rent-free (eg.
with carer); for Suitability, identify any problems with access, heating, location, housing
support. May trigger specialist assessment.
Significant contacts – specify who is the main carer or next of kin for emergency contact
(and Nearest Relative under Mental Health Act if appropriate). It is helpful to say who is a
keyholder.
Professionals involved – this will be a developing box; as services join the list, they should
inform others already involved. If you stop providing a service, you should enter the end
date on the copy held by the service user, and inform others still involved.
Health Conditions – it is important to distinguish between diagnosed conditions, and
personal opinions, and to check out what the person is aware of. Care must be taken to
pass on relevant information which the person is not aware of, but which will impact on care
planning, and this needs to be handled sensitively. May trigger specialist assessment.
Reason for contact – Keep it person centred. This is the client’s/patient’s views; there are
seven key issues to be addressed:







The nature of the presenting need;
the significance for the person;
how long it has been experienced;
potential soloutions identified by the person;
any other needs;
recent life events or changes;
views of family and carers
If an initial request is being made on behalf of someone, check if they are
aware of the referral, and agree to it. If the enquiry is from another professional,
check how far their assessment has progressed and how information can be
pooled.
Presenting problem – views of the referrer or assessor, which may differ from the above
views of the person being referred.
Known risks – this covers environmental hazards, moving and handling risks and any risks
to staff.. If neglect/abuse reported, start Vulnerable Adult process. May trigger specialist
assessment.
Action – details of referral on to other agencies, initial problem solving or service provided.
DRT and OTs can respond more quickly to referrals for equipment such as commodes if
you can give the person’s height and weight.
Comments – dates of hospital admissions are important as useful assessment information
may be held in hospital records. They can also help to build up a picture of potential risks.
Consent –Many referrals will be via a third party, so written consent should be obtained at
the earliest opportunity when the assessor meets the client. Verbal consent to a
referral/assessment should be accepted and recorded. N.B. This is only consent to sharing
information gathered in this episode of assessment. Subsequent episodes need fresh
consent. It is not a consent to treatment, care or charges. People have the right to give
restricted consent, but need to understand why information would be shared, with who, and
the disadvantage of not sharing it.
“If a patient wants information withheld from someone who might otherwise
have received it in connection with his or her care or treatment, the patient
should be informed of any health or social care implications …The reason for
not passing on information must be noted…. As the law stands, no-one can give
consent for an adult. However, if someone is unconscious or unable to give
informed consent, decisions to pass on information will in practice usually be
taken by the health professionals involved, taking into account the patient’s best
interests, and as necessary the views of relatives or carers… An earlier refusal
to particular information being passed on, given while a patient had the capacity
to decide, should, unless there are overriding considerations to the contrary, be
regarded as decisive in circumstances similar to those envisaged by the
patient… The patient’s ultimate decision should be respected unless there are
overriding considerations to the contrary; for example in some cases involving a
history of violence, or when an elderly frail person shows signs of nonaccidental injury, it may be justifiable to pass information to another agency
without his or her agreement.”
(The Protection and Use of Patient Information: Guidance from the Department
of Health, last updated 5 April 2001)
2. Overview Assessment
Tthis is a collation of standardised assessment information giving a more rounded picture of
a range of possible health and social care needs. It should be used to clarify key areas
where needs identified in the Contact Assessment are not clear cut. The areas for Overview
Assessments are set out in the Department of Health Guidance and includes main Domains
and Sub-domains. Professionals will exercise their judgement as to which domains should
be explored, remembering that assessments should be in proportion to needs, so they
should consider each area to decide if it is appropriate to the individual.
Responses may identify levels of risk and the need for further, specialist, assessment. N.B. It is
very important that people understand clearly that they are only being offered a referral for
assessment, and there is no implicit promise of a service. No agency/professional should
ever commit the resources of another agency/professional, or suggest that they will provide
a service. All we can offer is to make a referral for assessment.
The need for an Overview Assessment may be recognised when someone is having a
review of relatively low level care they have been receiving for some time, eg. home care
reviews. In some cases, it will be immediately apparent that someone is in need of
Specialist Assessment and help, and that would be the first course of action, with the
Overview Assessment coming at a later stage.
It is intended that Overview Assessments will be completed by single suitably trained - not
necessarily qualified - members of staff, who should have access to any other previous
assessments in order to reduce duplication.
OVERVIEW/SUMMARY ASSESSMENT FORM – Guidelines For Completion.
The form includes a checklist and space for free text. This tool may be used either as a
cover summary sheet for existing broader assessments to indicate which domains have
been assessed, by whom, and dates of any scores, or as an assessment tool in itself using
the text boxes to give more detail on identified needs. If needs are identified in an overview
assessment, they should either be explained in the comments text box, or if the document is
used as a summary sheet, the explanation should be in your own assessment document.
Scores from any validated scales (eg. Waterlow, BARTHEL, BASSOLL) and the dates can
be put in the text box, and if a series of scores obtained during a period of assessment are
recorded together in this way, it can provide a useful summary of any changes.
It should be treated as a record of your assessment, not as a script; issues should be
discussed in the person-centred assessment process according to the priority the older
person gives them, not by some pre-determined order. The structure is there as an aidememoire to ensure that all relevant issues are considered, without the need for any
specialist knowledge. Remember to keep the depth of assessment proportionate to the
person’s needs; you don’t have to fill in the domains that do not apply to an individual, but
you do need to show that this was a judgement decision, not just an oversight by indicating
no assessment needed in that domain. If a domain is assessed, you should consider all its
sub-domains.
 User’s perspective; their views, wishes, strengths, abilities and what they want to
happen. This area should always be explored, to establish what outcomes the
person desires, what their existing abilities are, what they have already tried to do to
help themselves. These details may already be on the Contact Assessment; is so,
don’t repeat it here, but if not they must be included. This is an essential part of the
person-centred approach, and as such it isn’t optional.

Health background: diagnoses, history of falls. Refers to diagnosed conditions, to
be distinguished from any self-reported conditions. Anyone who has suffered more
than one fall in the past 6 months should be referred for a falls assessment.
 Medication: This section is important for discovering medication-related issues,
which too commonly lead to falls or hospital admissions. These trigger questions
have been developed from national trials on medication monitoring. If someone
seems confused about their medicines, or their answers indicate problems, they may
need a medication review.
 Disease Prevention: regular checks or screenings, diet, exercise. There is no
need to track down or record results, as long as they are held elsewhere, but the
important aspect of this is to assess how someone’s attitude to their health may
affect their vulnerability and risk. Make a note in the Comments box of any food or
other allergies. In considering eating/drinking, remember to consider any special
dietary needs, swallowing as well as chewing, recent weight loss, and also alcohol
consumption. Refer for nursing assessment of continence if people have difficulty
passing urine or opening their bowels, if they leak urine or faeces, or if they have
concerns about frequency or retention.
 Personal care: ability to maintain personal hygiene, mobility, sleeping, etc.
Assessors need to be alert to the potential for the individual to regain skills lost
through illness, or help needed to maintain levels of functioning through Intermediate
Care and Reablement. Identify any equipment that has been supplied, and whether
it is useful. If equipment isn’t helping this person, it may be returned to the joint
equipment store for someone else’s benefit.
 Mobility: use of equipment or reliance on other people should be clearly recorded,
and use of inappropriate support (eg. using the towel rail or radiator to get up from
the toilet) should trigger a risk assessment and OT/DRT referral
 Senses: try to establish the impact that sight, hearing, communication difficulties
may have on the person’s independence. If sensory impairment causes difficulty in
everyday communication, this should be noted on the front page of the Contact
sheet to alert others that they have to accommodate those needs.
 Emotional well-being: emotional issues and low mood are often linked to
bereavement, loss and isolation which tend to accumulate with increasing age. Be
alert to what you observe as well as the feelings expressed; poor sleep patterns, low
mood and loss of a partner or friend should alert the assessor to the possibility of
depression which is common and treatable. Any signs of confusion or memory loss
should prompt evaluation of other issues such as management of medication and
finances, and questions as to whether this person is still driving a car.
 Safety: any areas of risk to self or others, including signs of abuse or neglect. This
does not constitute a full risk assessment, but may indicate that one is needed.
People have the right to take informed risks, and to choose a lifestyle that may be
detrimental to them, and such choices should be respected and recorded.
Distinguish between risks caused knowingly by people’s behaviour, and those
beyond their control. The main issues for care planning are risks relating to health
and safety, moving and handling, environmental hazards and any sort of risks to
people going into the home. We have a duty of care to each other and this is an
occasion when the duty of confidentiality takes second place.
Many people living at home are heavily dependent on a network of support in which
the critical factor is informal unpaid care by family. Assessors should discuss the
need for contingency plans and arrangements for emergencies, so people can think
about what they would like to happen before the pressure of a crisis hits. Eg. What
would I do if my husband/wife/daughter/son were taken ill and unable to care for
me? This contingency plan should be written down as part of the care plan and a
copy kept accessible in the person’s home. Where used, this should be
incorporated into “fridge notes”.
 Environment and resources: housing, care of the home, managing finances are all
factors that can have a positive or a negative impact on a person’s needs, and their
difficulties should be considered in this context. Does their accommodation or
transport availability make their problems worse or better? Can they use public
transport, if it is there? If they can use a car, but have severe difficulty walking,
might a blue car badge improve their independence? Assessors must be mindful
that when needs are identified which may be dealt with by another agency, all they
can offer is referral for assessment ; it is important that you don’t suggest any
promise of service delivery from other agencies, as every service will be working to
priorities that may change from time to time.
Remember that the assessment is person-led, and if they are reluctant to discuss
finances, this should be respected at this stage, which is more about the impact of
financial issues on needs. Social care services which are subject to charging
policies will involve a means test. There are different arrangements for managing
finances; if in doubt, seek advice;
an agent my be nominated to collect state benefits on behalf of a person who
does not want to give up control of their affairs;
an appointee may be approved by the Department of Work and Pensions to
take over the responsibility for collecting, claiming and managing someone’s
state benefits. This is frequently used by relatives to assist people who lack
mental capacity, or by the Local Authority for people in their residential homes;
it only applies to state benefits, not savings or bank accounts.
Power of Attorney is a legal status, giving authority to manage all finances.
 Relationships: social contacts, interests, family and carers, strengths and needs.
Consider how well the person is supported by others, and what impact this may
have on the carer or their relationship. How sustainable is it? People may feel
threatened or pressurised by those around them, which raise issues of adult
protection. Many relatives who are critical to enable very dependent people to stay
at home may not describe themselves as carers, but if they are offering regular and
substantial care to someone, they should be offered the chance to discuss the
impact of caregiving on their own lives. This simple opportunity to share the
stresses and feel valued may be enough, or carers may feel the need for a break of
some kind.
 Additional Information: Include significant information given by the person or their
carer, any assessments or information offered whether accepted or refused.
Feedback and research show that people want to have written information about
services and they must have written details of any charges they are liable to pay.
Assessors should offer relevant written information and record this.
 Evaluation: This section should reflect the professional’s judgement, based on the
whole of the information gathered. The assessor evaluates the significance of the
information gathered, together with their own professional observations, the older
person’s views and the main areas where help is needed.
All information gathered in the course of assessment needs to be evaluated in
terms of risk to the individual’s independence and well-being. The key task is to
identify factors that may suggest the person may suffer harm to their health or
safety, or their independence (autonomy and freedom to make choices) is at risk.
The assessor must consider how significant these risks are, and how immediate the
consequences would be if they were not addressed. The risk evaluation should
include both the severity and the likelihood of any harm. For Social Services, this
evaluation includes the FACS Banding level.
 Care Planning: This must embody a person centred approach; there is no simple
line between identified need and service response. Care plans should have
outcomes that reflect the individual’s long-term goals, what changes they want in
their lives and what would give them greatest relief – as well as difficulties they may
be prepared to live with, but which would be unacceptable to the next person. This
section should include decisions on which needs are eligible to be met; any referrals
for specialist assessments; provision of health or social services; input from informal
carers or voluntary sector; any private arrangements to supplement care provided.
 It is important to record the date of completion, as needs may change, and further
assessments done; it is important to know which is the latest version.
For people going into residential/nursing care, there are additional domains, which are
to be built into Comprehensive assessments. These are : Personal fulfilment and
Spiritual fulfilment; Personal Relationships; Lifestyle choices.
3. Specialist Assessment
These are done when a specific problem needs to be explored in more detail, as they are
currently by all agencies with a number of different tools and scales for recording the
information. Unlike Contact and Overview assessment, there is no plan in Staffordshire to
change existing tools and scales or standardise Specialist Assessments under SAP. They
will be appropriate in unstable or unpredictable situations, or where needs are complex.
From a Specialist Assessment, professionals should be able to confirm the extent and likely
development of health or social care needs, and establish links to other conditions and
needs. It is likely that the holistic approach of the overview will generate more referrals for
specialist assessments, where conditions may not have been recognised previously. This is
one of the stated intentions of the Department of Health, and would be a sign of the success
of improves screening assessments. All agencies need to know the extent of unmet needs,
and this will be important evidence for planning and commissioning.
4. Comprehensive Assessment
This level is intended for people with complex needs and includes contributions from the
older person themselves and a range of different professionals or specialist teams. It will
be co-ordinated by a named, appropriately skilled professional and will be the basis for
detailed care planning. The decision as to who should undertake the role of assessment
co-ordinator will be made on an individual basis, taking into account the older person’s
needs and wishes as well as professional suitability. When all the domains of an Overview
Assessment have been addressed and Specialist Assessments triggered in most or all of
them over a period of time, the result is also a Comprehensive Assessment.
Comprehensive Assessments must be completed where the level of support is likely to be
intensive or prolonged such as admission to residential care, intermediate care services or
substantial packages of care at home. This is broadly similar to the existing Community
Care Assessment process.
N.B. Although the descriptions present the four types of assessment separately, in practice
there will be overlaps and it is important that they should not be seen as a linear process,
like a string of beads. For example, Overview assessment should be carried out for all
users, but may be done at different stages of the process according to individual needs.
The process should be dynamic and respond to changing circumstances and nee ds.