Lack of national guidance blamed for delays to single assessments

There is growing concern that many areas in England will fail to
meet the government’s deadline for introducing the single
assessment process (SAP) for older people from April.

Some SAP projects report that they are unlikely to be ready until
the autumn despite assurances last week from older people’s tsar
Ian Philp that it would be implemented across most of England on
time (news, page 16, 11 March).

There is also evidence to suggest some of the delays may be caused
by the government’s decision to allow local authorities to develop
their own SAP systems rather than insist on an overall national
standard. Many of those involved in SAP also believe a lack of
guidance from the government on what the new systems need to do is
largely to blame for the problems and delays.

Recent figures quoted in Help the Aged’s January policy update
showed that 60 per cent of the 131 councils that responded to a
survey would not meet the April deadline for implementing
SAP.

“There is considerable local variation about the method and
progress of implementation,” said Kathryn Willmington, Help the
Aged’s former policy officer for community health and social
care.

Areas unlikely to implement by April include Worcestershire, Bath
and North East Somerset, and Liverpool SAP projects. Lack of
resources is one major issue but there appears to be much
uncertainty over the details of how the assessment process will
work in practice and whether that will tally with the paper-based
or electronic management systems being developed.

“Although there are some areas that are further ahead, there are
still a lot of areas that are struggling with it,” explains Frankie
Dearling, chairperson of the Community Practitioners and Health
Visitors’ Association’s special interest group on older
people.

Some believe the government’s paper-based system is too
complicated, while the off-the-shelf computer systems are too
expensive and not always suitable. As a result, areas have decided
to develop their own solutions, which has delayed progress
further.

But there are concerns about the quality of some of these
locally-developed systems. Experts assessing the programme’s
development are concerned that local systems could be found wanting
and be unable to deliver the potential of SAP.

Dr Iain Carpenter, associate director of the Centre for Health
Service Studies at the University of Kent, is worried that local
projects are putting systems together that are not refined enough
to produce the necessary data. “The quality of the questions it
asks and the quality of the data produced are not very high. If
that happens, you find that people don’t complete the assessment
and you get poor quality information that is not reliable or
valid.

“If you put rubbish information into a system you get rubbish out
when trying to make decisions for managing a service,” says
Carpenter.

Carpenter also believes that many of the local systems, while
effective at establishing the needs of the individual client, could
not be used for wider service development and clinical governance
because they have been shaped by front-line staff “who lack
scientific and technical ability”.

He also believes local systems will try and fit the assessment
process around the needs of the different professionals feeding
into it. “You have to make sure everyone records in the same way.
Systems will only examine the meeting between client and
interviewer, and not the planning of services, monitoring outcomes
of care and whether they are efficient. It will meet their local
needs but it’s not what the information should be used for. It’s a
big mess.”

He is also scathing about the single assessment summary, which he
says does not separate out what a person’s disability is and what
their needs might be.

All those that looked like failing to meet the April deadline were
to be required to implement one of the three government-accredited
systems. But the Department of Health has now shied away from this,
instead saying they should only consider using an accredited
assessment tool.

This may mean that many who are struggling to be ready for April
will use the paper-based system, whereas it had been hoped most
would develop part-electronic ones.

However, Carpenter says: “If lots of people use the summary, SAP
will be classed as a failure. If you get the assessment right then
you can do astounding things with the information. But if not,
everyone else will be affected and there will be deficiencies in
the service clients receive further down the road.”

Carpenter believes that if SAP doesn’t work it could follow the
path of continuing care, where clients resort to legal action
because they are being deprived of services they believe they
should get.

Sophy Tayler, business development manager for health and social
care at The Stationery Office, which provides assessment tools and
training materials to one of the accredited systems, believes that
a variation in practice locally could result in different levels of
service.

“People are more aware of what’s going on in other areas and are
able to make comparisons. It’s an issue that is likely to be taken
up if it is perceived an older person is not getting the same level
of service as others elsewhere,” she says.

However, Tayler argues that many areas will do the bare minimum
when developing their SAP systems and “sit on their hands” because
of a lack of clarity over what the long-term requirements of
systems are and how these are to be financed.

“The reality is that few people, if any, are going to have
something up and running as originally envisaged when the targets
were put in place. The top 10 per cent will go out and raise funds
and make it happen but others will say ultimately they will be
overtaken by events and the system they would have invested in
could be left on the sidelines.”

Despite the criticisms, most people support SAP and believe it will
help achieve the government’s 2004-5 target of carrying out all
assessments within 48-hours.

“If we streamline things so that information is readily available
about a person and accessible and professionals’ time is not taken
up with something somebody else has done, you actually release time
so that assessment reviews can be done on a more regular basis,”
says one SAP manager.

On the lack of guidance, the DoH says: “We’ve offered considerable
guidance and support but ultimately it is for councils themselves
to decide what SAP suits their local circumstances to communicate
with older people, whether it’s an off-the-shelf tool, a design of
their own, or even no tool at all.”

What is the single assessment process?

The SAP is part of the government’s wider vision of joined-up
public services where staff from different agencies work across
professional and organisational boundaries. Instead of social
workers, health visitors, housing officers, doctors and
physiotherapists duplicating elements of each other’s assessments,
under SAP one professional – generally from the first agency the
client meets – will carry out an overview assessment of a person’s
needs to see if it is appropriate to refer them to other
professionals for specialist assessments.

The benefits to the client are many. Their needs should be assessed
and services provided more quickly and it should eradicate the
stressful and annoying practice of clients having to provide the
same information to different professionals.

There are 12 main requirements for its implementation, including
placing older people at the heart of assessment, ensuring care
plans are produced and that clients receive a copy, and collating
and sharing information with all SAP stakeholders.

Other requirements are for information to be collected, stored and
shared as effectively as possible using the single assessment
summary, which is a paper-based system, or a local variant; for
professionals to be trained to undertake person-centred assessments
and care planning; and for local arrangements to be publicised.