Debate on single assessment process for older people

We asked people whether they think the single assessment
process for older people can work, and if it can be in place in
time for the deadline of April next year.

These are the comments we received:


As far as the government coming in and enforcing a system it
shows how much the department of health understands the full
implication of SAP (single assessment process), that it’s more than
a just a system. Then again should we all sit back and let them
provide us with a system that they will need to resource which at
present they do not seem to have the resources for.

As project manager for the single assessment process I, like
many others, feel frustrated that to move the process forward
requires far more than purchasing a system and applying it.
Importantly joint training to establish a cultural change not just
in attitude but in practice is a strong requirement for success.
The assessment document that most people get ‘hung up’ on is just a
minor step. What goes with it is like walking on the moon
achievable but over time and at a cost.

Some consolation is that rumour has it that if a single
assessment approach has been adopted we will have a further year –
2 years for full implementation.

SAP does what it says it presently SAPs your

Sue Shaw
Project Manager for the Single Assessment Process
Intermediate Care Team
Islington Medical Centre

I am the part-time SAP co-ordinator for Bath
and North East Somerset, working with all agencies. In my view, the
April 2004 timetable is not achievable…and not for want of
trying! Here are my thoughts (random order) :
Single assessment is a principle we all uphold but the guidance and
evidence base has been poorly thought out. There is:

• little acknowledgement of good existing assessment
practice (e.g. community care assessments are already person
centred, involve carers, include consent, etc) – staff have found
the government’s approach patronising – “teaching
grandmothers to suck eggs” – also very prescriptive
dismissing existing systems which have local ownership
“throwing the baby out with the bath water”

• a lot more work needs to be done on inter professional
sharing before SAP can work; with the slowing up of care trusts /
pooling / the integration agenda, there is much less opportunity or
willingness for this

• too much emphasis on the overview stage of the process
(e.g. the Easycare tool) which is more suitable to health screening
of a medically stable population /case finding – not for getting
detailed information with which to plan care in response to complex
and/or fluctuating needs

• a paper based system is time consuming, hard to share
and impossible to update with accuracy across professionals
involved in an older person’s care, yet the IT intrastructure
does not seem to be a priority

• many professionals consider their assessments to be
specialist assessments – about which there’s been little
guidance; specialist assessments should complement each other, not
converge… The issue of a care coordinator to pull together
care on behalf of the older person is central to a single
assessment process, but this issue has not been addressed properly
(e.g. whose job is it, who manages resouces, commissions etc?)

• what do you do about raising expectations / finding
unmet need? – health has waiting times, and social services has
explicit eligibility criteria; the overview tools seem to exist in
a vacuum.. no fit with performance monitoring, budgeting, etc.

• If we look at the introduction of the Iintegrated care
programme approach in mental health, it has taken 5-10 years to bed
in since its inception. Over ambitious timetable for such a major
cultural change across such a bit client group. Hospitals, GPs and
mental health are having the most difficulty. 

• This is not on the priorities of chief execs and there
seem to be few people at the doh willing to champion it (even the
website isn’t updated in light of these debates or reviewed
in light of developments; accreditation has been stalled, etc).
It’s a process change and our pilots don’t demonstrate
added value enough to convince many people to take on what they
perceive as additional work.

I hope the doh is listening to the feedback on the ground…
This undertaking needs some serious review of its scope, timing,
funding, objectives and approach.

Bo Novak

SAP Project Manager

Bath and North East Somerset

The single assessment process will work
because Mrs Georgiou on the 329 bus to Enfield Town wants it to
work.  She needs her health and social care to be connected, the
right hand knowing what the left hand is doing, and she wants to
know who is doing what.  And we want it for oursleves too.

We might not have the training or IT resources, or even the
tools sorted out yet, but we do know what will make it work.  In
Enfield we’re working on some of these:

* bringing staff together across professional and borough
boundaries within the strategic health authority sector,
re-visiting assessment skills and sharing perspectives to build
informed, confident practice

* establishing networks across London through the London older
people’s service development programme and other NHS
collaboratives, trying changes in bite sized pieces, measuring it
and checking it back with service users

* building case finding and prevention initiatives, delivering
health promotion advice, information and practical services,
establishing voluntary agencies as valued partners

* hearing older people’s views and contributions, understanding
needs and building confidence across health and social care and
beyond, that community care can work

These things are person centred and they’re practical.  They’re
about looking at things differently, and giving us all, older
people and practitioners, an opportunity not to be

Charlie Clerke
Project Manager – Older People
Enfield PCT

I do agree that the new single assessment
process will only make a positive impact if it is embraced as a
whole cultural approach.

The older person has to be at the centre with information
sharing ensuring a quality needs led assessment, seamless care
planning and services in place to meet the need.

In Lincolnshire we have a county project team with local
implementation teams feeding in the results of paper based
pilots. The most positive result has been even closer multi
disciplinary working and this has included housing colleagues. It
is the process that is important and working together through the

At the end of the day, SAP will only work with the IT back up
– information available 24/7 and this is the area for
investment that we struggle with.

We have benefited from much enthusiasm and hard work ensuring
that we are meeting the timescales, but more importantly providing
quality needs led assessment for older people. This has only been
possible through the dedication and commitment of users and
colleagues from the health and social care community in

Lilian Crawford
Single Assessment Project Manager
Lincolnshire Social Services

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