Why does assessment quality make such a big difference

1
National Framework for NHS Continuing Healthcare
and NHS funded Nursing care Thoughts for the
Week - Monday 30 July 2007
Welcome! This is the third of our little weekly
notes. Theme for this week Assessments Again,
this issue has a much wider significance than
just Continuing Care. Assessments were one of the
things that people have told us really need to be
improved to enable NHS Continuing Healthcare
decisions to be more efficient and consistent,
and this is true for many other areas of health
and social care too. This note just draws your
attention to some of the things to think about
and some resources that are there to help you.
You might want to refer back to the points made
last week about involving people and their carers
too.
Why does assessment quality make such a big
difference? Everyone, from the NHS, local
government and the Ombudsmans office, expresses
concerns about assessment quality. Why? Not
having the right level of detail or accuracy can
lead to delays, wasting everyones time and in
the worst case leads to wrong decisions being
made about funding or care provision. Accurate,
comprehensive assessments completed in a timely
manner allow people to achieve better outcomes
more quickly, minimise complaints and optimise
the use of resources.
Assessments in Policy There are many models of
assessment process out there, e.g. the Single
Assessment Process and the Care Programme
approach. The White Paper, Our Health Our Care
Our Say, made a commitment to a Common Assessment
Framework that would build on and help integrate
existing processes. That work is ongoing and
youll see some news about that later in the
year. But these are ultimately frameworks, within
which assessors work, and dont take away the
responsibility of the assessors themselves to do
a good job and the people managing or
commissioning from them to keep an eye on the
quality and standards.

• What are the key characteristics of any good
  assessment?
• DH and CSIP ran workshops earlier this year and
  one of the focuses was on what makes a good
  assessment. Heres a reminder of some of the
  things we talked about the list is not
  exhaustive.
• Person-centred this is the key - culturally
  sensitive, user-friendly, equitable and with
  appropriate involvement from all relevant
  parties.
• Holistic looking at all the evidence and
  circumstances - and looking at peoples values,
  abilities and aspirations, not just things that
  are negative or difficult
• Objective
• Transparent everyone should know what the
  process is and when the next stage will happen
• The right place at the right time obviously,
  assessments go on all the time in all sorts of
  settings, but if the information is to be used to
  make a decision about long term care options,
  careful thought about time and location allows a
  better understanding of how a persons needs
  might develop
• Integrated all the relevant agencies and
  professionals should be involved appropriately,
  not losing sight of the principles of good data
  sharing.
• Documented accurate and thorough documentation,
  which is legible, traceable and with the dates
  and signatures of those involved, helps avoid
  duplication and mistakes, ensures accountability,
  and speeds up review processes
• Inclusion of risk assessment we all live with a
  certain degree of risk and risks need to be taken
  account of along with benefits when making an
  assessment and planning care
• Within a reasonable timescale
• But its not the principles that are the
  problem. - We were regularly told that the
  theory isnt a problem you all know how an
  assessment might look in an ideal world where you
  all have plenty of time and staff, but that isnt
  reality see over for a thinking exercise about
  this.

2
National Framework for NHS Continuing Healthcare
and NHS funded Nursing care Thoughts for the
Week - 23 July 2007

• So this weeks little exercise is to map out
  for yourself
• What role you have to play in assessments even
  if youre not directly involved in assessments
  yourself, but youre using other peoples
  assessment information and find it
  unsatisfactory, it is in your interests as a
  commissioner of those assessments to find a
  solution rather than having to re-do assessments.
  
• Could assessments in your organisation be
  improved?
• Why do problems occur? What are the key barriers,
  what gets in the way?
• Discuss with your colleagues how you could tackle
  some of the issues. To start you off, here are a
  few thoughts.

Clear roles and responsibilities Is it always
entirely clear to you, who has ownership of a
particular individuals case as it progresses
through an assessment and care planning process?
You may have defined the role of key worker or
care coordinator, depending on the process thats
being followed it might not necessarily be just
one person, but its important that
responsibilities within a team are made clear
from the outset and that there are clear contacts
and communication channels for linking between
professionals and keeping the individual (and
carer or family) up to date
Time for training Do you and your colleagues have
adequate time to allow you to continue to develop
your skills? If not, what gets in the way?
Identify the person in your organisation who is
responsible for this and make time for a
conversation about how you can make things easier.
Auditing Keeping track locally of quality of
assessments will be the quickest way for you to
identify problem areas and reinforce good
practice. There isnt currently a national
auditing tool for all assessments, but you may
already have a template you could adapt. There
are several things that might be important -
activity, timescales, outcome, completeness of
documentation, any challenges, whether any part
of the assessment had to be redone and why.......
What next? You may find some of these links
helpful White paper http//www.dh.gov.uk/en/Pol
icyandguidance/Organisationpolicy/Modernisation/Ou
rhealthourcareoursay/index.htm Single Assessment
process http//www.dh.gov.uk/en/Policyandguidance
/Healthandsocialcaretopics/Socialcare/Singleassess
mentprocess/index.htm Care Programme Approach
(currently under review) http//www.dh.gov.uk/en/
Consultations/Closedconsultations/DH_063354 Person
centred planning http//www.dh.gov.uk/en/Publica
tionsandstatistics/Publications/PublicationsPolicy
AndGuidance/Browsable/DH_4098013 Risk http//www.
dh.gov.uk/en/Publicationsandstatistics/Publication
s/PublicationsPolicyAndGuidance/DH_074773 If you
have any queries, comments or contributions, drop
a line to national.continuing.care_at_dh.gsi.gov.uk,
but please note that this inbox will close from 1
October.

• PS The occasional gremlin creeps into these
  notes last week we jumped ahead and promised
  care planning heres a reminder of what really
  comes next
• Care planning
• Discharge process
• Screening tools including fast track process
• Decision Support Tool
• Nursing care - decision making, and the single
  band
• Writing decision letters
• Commissioning
• Reviews and dispute resolution