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The Legal Bit – Care Assessments

Nicole Ridgwell Solicitor Ridouts

Care Assessments – why must they be person-centred and what does that mean?

The requirement for a multi-disciplinary care and support package to meet any service user’s assessed needs is the focal point of all provider-service user interactions within the health and social care sector.

It was the introduction of the Care Act 2014, and its ‘no decision about me without me’ principles, which focused the sector on the expectation that all service users must fully engage with and contribute to their care assessments through early and continued engagement. Where unable to, the Act places an obligation on local authorities to source independent advocates to assist service user engagement.

CQC rates against this expectation through Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Mirroring the Care Act language, the intention of the regulation is to ensure that service users enjoy personalised care and treatment, setting out the actions providers must take to ensure each person receives individualised care assessments based on their needs and preferences.

The watchwords of ‘person-centred care’ are key to CQC’s analysis of a provider’s ability to assess, plan and maintain service user wellbeing, and this commitment was emphasised again in July 2017, when CQC launched Quality Matters: its new vision on how to ensure person-centred care must become the norm for all.

The importance of being able to evidence compliance was reiterated in CQC’s October 2017 publication ‘The state of health care and adult social care in England 2016/17’. It makes interesting reading, not only in terms of the examples of best practice it offers but also in its acknowledgement that the ‘complexity of demand for health care and adult social care services in England continues to rise’.

The document is littered with references to the importance of local collaboration and joined-up care as the only route to ensuring a service-user’s needs are individually catered for. In assessing the best practice examples, the following themes emerge:

  • Acknowledge the multiple or complex needs of each service user;
  • Ensure that staff engage with local health and care leaders to identify the challenges raised within each care assessment;
  • Demonstrate the characteristics of an outstanding service by showing willingness to be innovative, to be creative in offering person-centred solutions to care needs, instead of simply seeing the risks or barriers.
  • Model strong and inclusive leadership within the provider’s management teams, encouraging leaders to show their teams the opportunities of collaboration in care planning, to achieve meaningful and realistic goals;
  • Translate the words of the care assessment to a frontline person-centred care focus, ensuring that all staff are supported to get to know their service users, understanding their interests, likes and dislikes.

Of course, the reality of implementing best practice care assessments is more complicated than following a checklist. CQC’s October 2017 publication acknowledges that many instances of providers failing to implement best practice are less unwillingness on the part of providers, more a result of a lack of resources. They point to the fact that the tendency to implement blanket policies, for example, may be caused in part by low staffing levels. It is up to the provider, therefore, to mitigate against this tendency.

In a sector in which providers are continuing to struggle with a lack of resources and competition for staff, providers must, as above, take every opportunity to make life easier for themselves by consulting the very guidance and best practice documents that CQC themselves refer to when making their judgments.

Mock inspections, external consultants and regular internal monitoring are all resources that providers should use to step back from and analyse their services at a distance. The emphasis on care assessments being person-centred is written into the legislation, the guidance and the inspectors’ checklists. Any provider that chooses not to take steps to enhance and demonstrate compliance with this offering is letting down their service users and losing out on easy ways to score points with their regulator.

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