Behind the headlines

Our regular panel comments on a topic in the

A single assessment process for the care of older people would,
it was hoped, ensure efficient assessments of their health and
social care needs without the disorganised intervention of a range
of agencies.

But since the SAP was announced more than two years ago as part
of the National Service Framework for Older People, many of the
health and social care agencies involved have made slow progress
towards the April 2004 implementation deadline.

Cash shortages and bureaucracy accompanying the government’s
implementation guidelines have been cited by some localities as
contributing to the problem. The government may impose a solution
if the deadline is not met.

A spokesperson for Age Concern England said: “People who are not
at immediate risk often find they have to wait weeks for an
assessment or even an indication of when to expect one.” Guidance
on SAP implementation, issued by the Department of Health, outlines
how local councils and health authorities should work together to
ensure assessment of older people is “kept in proportion to their
needs”. Bob Hudson, principal research fellow, Nuffield Institute
for Health, University of Leeds

“The idea of a single assessment is good, but like many ostensibly
sensible ideas, it can be difficult to bring to fruition. Time,
money and cultural change obviously are important and complex
considerations, but there is another factor that might easily be
forgotten – the narratives of older people themselves. Standard
information-gathering systems can too easily marginalise the
thoughts and insights of service users themselves. It has
traditionally been the task of social work to use the assessment as
an intervention in its own right, not merely as a means to a
bureaucratic end.”

Felicity Collier, chief executive, Baaf Adoption and

“Implementation which is partial, ill thought out, and
under-resourced would not safeguard the interests of older people
at all – lessons must be learned from the areas where good progress
has been made rather than taking a prescriptive, bureaucratic
approach which could never facilitate the cultural changes needed.
The indications are that the government is beginning to listen to
the difficulties many public services are experiencing in meeting
targets – a realistic time scale and carefully planned resource
allocation across the country is essential if the single assessment
process is to work.”

Julia Ross, executive director for health and social care,
London Borough of Barking and Dagenham

“We need to stick with the significance of single assessments as
the major driver for access to services. So much lies behind it,
let alone inequalities. We’re on target locally using the Cambridge
model. We may not achieve perfection from 1 April next year, but I
certainly don’t think it’s something we should give up on – it’s
too important.”

Bill Badham, development officer, National Youth

“Why is it often so hard to put people first? Having a grand vision
such as the National Service Framework for Older People is one
thing; having guidance, deadlines and threats of imposed solutions
another. But it can be done, as with the care programme approach
within mental health. It’s not only about structures and systems
but requires a deep structural shift with partnerships being more
than a temporary cessation of hostilities for the pursuit of

Martin Green, chief executive, Counsel and Care for the

“There needs to be far higher priority within these providers given
to making sure the single assessment is working. I would not want
to see the government giving agencies any flexibility on the
deadline. They should find out what is blocking implementation of
the single assessment process and there should be a real effort put
in on ways to turn a negative into a positive. There is still too
much reluctance among people to get out of their silos and provide
seamless services.”

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