PERSON CENTRED APPROACH TO CARE

THE CENTRE FOR POLICY ON AGEING (CPA) is working to support a person centred approach to care for older people and all adult groups requiring health and social care. Person centred approaches are ways of commissioning, providing and organising services rooted in listening to what people want, to help them live in their communities as they choose. These approaches work to use resources flexibly, designed around what is important to an individual from their own perspective and work to remove any cultural and organisational barriers. People are not simply placed in pre-existing services and expected to adjust, rather the service strives to adjust to the person.

THE SINGLE ASSESSMENT PROCESS (SAP) FOR OLDER PEOPLE

The Single Assessment Process (SAP) was introduced in the National Service Framework for Older People (2001), Standard 2: person centred care. This standard aims to ensure that the NHS and social care services treat older people as individuals and enable them to make choices about their own care. The requirement to develop a Single Assessment Process was based on the recognition that many older people have wide-ranging welfare needs and that agencies need to work together so that assessment and subsequent care planning are effective and coordinated. Care is holistic and centres on the whole person. The involvement of service users is fundamental to the implementation of this strategy.

The Single Assessment Process therefore provides a person centred health and social care framework, which includes entry into the system, holistic assessment, care planning, care delivery and review. SAP aims to make sure older people's needs are assessed thoroughly and accurately, but without procedures being needlessly duplicated by different agencies. SAP coordinates the assessment of the health and social care needs of an individual and shares that information appropriately between health and social care agencies.

SAP is not just stages of assessment (contact, overview, specialist and comprehensive). SAP is not just an assessment tool.

Training and workforce development is key to the effective delivery of SAP to ensure each practitioner has appropriate level of skills, knowledge and ability, relevant to their role within SAP. This requires the development of a common language; a shared value base; shared information systems, processes and protocols; multi agency learning opportunities; and collaborative working.

The means of sharing information between health and social care agencies is a vital element in joint working. There is a range of paces and approaches to implementing electronic SAP (e-SAP) across the country. NHS Connecting for Health and the Electronic Social Care Records Implementation Board jointly oversee a project which is tasked to develop a consistent national framework for e-SAP specifically and for information exchange generally.

THE COMMON ASSESSMENT FRAMEWORK (CAF)

The Single Assessment Process is increasingly being used for other adult groups as well as older people, such as those with learning disabilities. Many regions now apply the principles of SAP when delivering care to everyone over 18 years of age. National policy documents are promoting SAP as a model for a Comprehensive Assessment Framework (CAF) to deliver person centred care. The White Paper, 'Our Health, Our Care, Our Say' (January 2006) proposes a Common Assessment Framework for Adults to be developed primarily from the experience to date from implementing the Care Programme Approach for Mental Health, the Single Assessment Process for Older People, and Person Centred Planning for People with Learning Disabilities. It states in particular that 'SAP provides a generic framework that could be applied more widely'.

The Common Assessment Framework will retain the core features and properties of SAP:

• supporting seamless delivery of services across health and social care;
• avoiding duplication of information collection and procedures;
• a proportionate assessment according to an individual's level of need;
• a person-centred assessment of needs feeding into a personalised care plan to support people;
• and delivering greater transparency around the needs assessment process and agreed support.

POLICY IMPLEMENTATION

Audits and reviews of policy implementation focus specifically on the value of the Single Assessment Process for delivering better services. 'Living Well in Later Life: A Review of Progress Against the National Service Framework for Older People' - produced by the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspection (March 2006) stated that: 'NHS Trusts and social services need to work together to implement the single assessment process fully and to promote its benefits widely in all organisations that are in contact with older people.' The report concludes: 'A change in culture is required, moving away from services being service-led to being person centred, so that older people have a central role, not only in designing their care with the combination and type of service that most suits them, but also in planning the range of services that are available.'

SAP links with policy on long term conditions with its emphasis on supported self care/self management, personalised care plans and using case management to provide care for individuals with complex needs. The report 'A New Ambition for Old Age: Next Steps in Implementing the National Service Framework for Older People' by Professor Ian Philp confirms the need to build on the Single Assessment Process to deliver the benefits of a holistic needs assessment for all adults with long term conditions. The consultation document (June 2006) on the National Framework for NHS Continuing Healthcare notes that the decision-making process recognises that the Single Assessment Process, or other comprehensive assessment processes, is the key to professional assessments for NHS Continuing Healthcare. For more information on policy documents click here