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Comprehensive assessment of older people with complex care needs: the multi-disciplinarity of the Single Assessment Process in England

Published online by Cambridge University Press:  20 July 2010

DAVID CHALLIS ,
MICHELE ABENDSTERN ,
PAUL CLARKSON ,
JANE HUGHES  and
CAROLINE SUTCLIFFE
DAVID CHALLIS*
Affiliation:
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
MICHELE ABENDSTERN
Affiliation:
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
PAUL CLARKSON
Affiliation:
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
JANE HUGHES
Affiliation:
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
CAROLINE SUTCLIFFE
Affiliation:
Personal Social Services Research Unit, University of Manchester, Manchester, UK.
*
Address for correspondence: David Challis, Personal Social Services Research Unit, Dover Street Building, University of Manchester, Oxford Road, ManchesterM13 9PL, UK. E-mail: D.J.Challis@manchester.ac.uk
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Abstract

The quality of assessment of older people with health and social care needs has for some time been a concern of policy makers, practitioners, older people and carers in the United Kingdom and internationally. This article seeks to address a key aspect of these concerns, namely whether sufficient expertise is deployed when, as a basis for a care plan and service allocation, an older person's eligibility for local authority adult social-care services requires a comprehensive needs assessment of their usually complex and multiple problems. Is an adequate range of professionals engaged, and is a multi-disciplinary approach applied? The Single Assessment Process (SAP) was introduced in England in 2004 to promote a multi-disciplinary model of service delivery. After its introduction, a survey in 2005–06 was conducted to establish the prevalence and patterns of comprehensive assessment practice across England. The reported arrangements for multi-disciplinary working among local authority areas in England were categorised and reviewed. The findings suggest, first, that the provision of comprehensive assessments of older people that require the expertise of multiple professionals is limited, except where the possibility arose of placement in a care-home-with-nursing, and second that by and large a systematic multi-disciplinary approach was absent. Policy initiatives to address the difficulties in assessment need to be more prescriptive if they are to produce the intended outcomes.

Keywords

comprehensive assessmentmulti-disciplinary assessmentolder peopleSingle Assessment Processlocal authority adult services
Type
Research Article
Information
Ageing & Society , Volume 30 , Issue 7 , October 2010 , pp. 1115 - 1134
Copyright
Copyright © Cambridge University Press 2010

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References

Abendstern, M., Hughes, J., Clarkson, P., Sutcliffe, C., Wilson, K. and Challis, D. 2010. ‘We need to talk’: communication between primary care trust and other health and social care agencies following the introduction of the Single Assessment Process for older people in England. Primary Health Care Research and Development, 11, 1, 61–71.CrossRefGoogle Scholar
Applegate, W. B., Miller, S. T., Graney, M., Elam, J., Burns, R. and Akins, D. 1990. A randomised controlled trial of a geriatric assessment unit in a community rehabilitation hospital. New England Journal of Medicine, 322, 22, 1207–14.CrossRefGoogle Scholar
Audit Commission 1997. The Coming of Age. Stationery Office, London.Google Scholar
Audit Commission 2002. Integrated Services for Older People: Building a Whole System Approach in England. Public Sector Briefing Document, Audit Commission, London.Google Scholar
Australia, Department of Community Services 1986. Nursing Homes and Hostels Review. Australian Government Publishing Service, Canberra.Google Scholar
Australia, Department of Health and Ageing 2007. The Australian Community Care Needs Assessment (ACCNA): Synopsis of Field Test Report and Eligibility and Assessment Working Group Response. Australian Government Department of Health and Ageing, Canberra.Google Scholar
Banwell, H. 1959. The new relations between central and local government. Public Administration, 37, 3, 201–12.CrossRefGoogle Scholar
Barrett, S. and Fudge, C. 1981. Examining the policy–action relationship. In Barrett, S. and Fudge, C. (eds), Policy and Action: Essays on the Implementation of Public Policy. Methuen, London, 3–32.Google Scholar
Beech, R. 2005. Evidence on the effectiveness of Intermediate Care. In Roe, B. and Beech, R. (eds), Intermediate and Continuing Care: Policy and Practice. Blackwell, Oxford, 106–18.CrossRefGoogle Scholar
Beswick, A., Rees, K., Dieppe, P., Ayis, S., Gooberman-Hill, R., Harwood, J. and Ebrahim, S. 2008. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta analysis. The Lancet, 371, 9614, 725–35.CrossRefGoogle ScholarPubMed
Booth, T. A. 1981. Collaboration between the health and social services: Part I, a case study of joint care planning. Policy and Politics, 9, 1, 23–49.CrossRefGoogle Scholar
Bouman, A., Rossum, E., Ambergen, T., Kempen, G. and Knipschild, P. 2007. Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in the Netherlands. Journal of the American Geriatrics Society, 56, 3, 397–404.CrossRefGoogle ScholarPubMed
Bouman, A., Rossum, E., Nelemans, P., Kempen, G. and Knipschild, P. 2008. Effects of intensive home visiting programs for older people with poor health status: a systematic review. BMC Health Services Research, 8, 74, 1–11. Available online at http://www.biomedcentral.com/1472-6963/8/74 [Accessed 23 June 2009].CrossRefGoogle ScholarPubMed
Byles, J. E. 2000. A thorough going over: evidence for health assessments for older persons. Australian and New Zealand Journal of Public Health, 24, 2, 117–23.CrossRefGoogle ScholarPubMed
Cameron, A. and Lart, R. 2003. Factors promoting and obstacles hindering joint working: a systematic review of the research evidence. Journal of Integrated Care, 11, 2, 9–17.CrossRefGoogle Scholar
Carpenter, I. 1998. Standardised assessment in the community. In Challis, D., Darton, R. and Stewart, K. (eds), Community Care, Secondary Health Care and Care Management. PSSRU, University of Kent and Ashgate, Aldershot, UK, 89–116.Google Scholar
Challis, D., Darton, R., Johnson, L., Stone, M. and Traske, K. 1995. Care Management and Health Care of Older People. Ashgate, Aldershot, UK.Google Scholar
Challis, D., Weiner, K., Darton, R., Hughes, J. and Stewart, K. 2001. Emerging patterns of care management: arrangements for older people in England. Social Policy and Administration, 35, 6, 672–87.CrossRefGoogle Scholar
Challis, D., von Abendorff, R., Brown, P., Chesterman, J. and Hughes, J. 2002. Care management, dementia care, and specialist mental health services: an evaluation. International Journal of Geriatric Psychiatry, 17, 4, 315–25.CrossRefGoogle ScholarPubMed
Challis, D., Clarkson, P., Williamson, J., Hughes, J., Venables, D., Burns, A. and Weinberg, A. 2004. The value of specialist clinical assessment of older people prior to entry to care homes. Age and Ageing, 33, 1, 25–34.CrossRefGoogle ScholarPubMed
Charters, W. and Pellegrin, R. 1973. Barriers to the innovation process: four case studies of differentiated staffing. Educational Administration Quarterly, 9, 1, 3–14.CrossRefGoogle Scholar
Chevannes, M. 2002. Social construction of the managerialism of needs assessment by health and social care professionals. Health and Social Care in the Community, 10, 3, 168–78.CrossRefGoogle ScholarPubMed
Clifford, P. I. 1997. Structuring the Clinical Record: The FACE Assessment and Outcome System. Main report to the Department of Health, Centre for Outcomes, Research and Effectiveness, University College London, London.Google Scholar
Cm 4818-1 2000. The NHS Plan. A Plan for Investment, A Plan for Reform. Stationery Office, London.Google Scholar
Cm 6737 2006. Our Health, Our Care, Our Say: A New Direction for Community Services. Stationery Office, London.Google Scholar
Cowpe, J. 2005. Intermediate care: policy and context. In Roe, B. and Beech, R. (eds), Intermediate and Continuing Care: Policy and Practice. Blackwell, Oxford, 3–18.CrossRefGoogle Scholar
Department of Health 1990. Caring for People: Community Care in the Next Decade and Beyond. Stationery Office, London.Google Scholar
Department of Health 1992. Implementing Caring for People: Community Care Packages for Older People. EL (92) 13, CI (92) 10, 11 March. Department of Health, London.Google Scholar
Department of Health 1993 a. Monitoring and Development: Assessment Special Study. Department of Health, London.Google Scholar
Department of Health 1993 b. Inspection of Assessment and Care Management Arrangements in Social Services Departments. Interim Overview Report, Department of Health, London.Google Scholar
Department of Health 1996. Caring for People at Home: An Overview of the National Inspection of Social Services Department Arrangements for the Assessment and Delivery of Home Care Services. Department of Health, London.Google Scholar
Department of Health 1997. At Home with Dementia: Inspection of Services for Older People with Dementia in the Community. Department of Health, London.Google Scholar
Department of Health 2001 a. National Service Framework for Older People. Department of Health, London.Google Scholar
Department of Health 2001 b. Intermediate Care. HSC2001/01: LAC (2001) 1, Department of Health, London.Google Scholar
Department of Health 2002. Guidance on the Single Assessment Process for Older People. HSC 2002/001: LAC (2002) 1, Department of Health, London.Google Scholar
Department of Health 2008. Health and Care Services for Older People: Overview Report on Research to Support the National Service Framework for Older People. Department of Health, London.Google Scholar
Ellis, G. and Langhorne, P. 2005. Comprehensive geriatric assessment for older hospital patients. British Medical Bulletin, 71, 1, 45–59.CrossRefGoogle ScholarPubMed
Everitt, B. 1992. The Analysis of Contingency Tables. Chapman and Hall, London.CrossRefGoogle Scholar
Gill, T. M., Baker, D. I., Gottschalk, M., Peduzzi, P. N., Allore, H. and Byers, A. 2002. A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine, 347, 14, 1068–74.CrossRefGoogle ScholarPubMed
Glasby, J. 2003. Hospital Discharge: Integrating Health and Social Care. Radcliffe Medical, Abingdon, UK.Google Scholar
Glasby, J. 2004. Social services and the single assessment process: early warning signs? Journal of Interprofessional Care, 18, 2, 129–39.CrossRefGoogle ScholarPubMed
Gostick, C., Davies, B., Lawson, R. and Salter, C. 1997. From Vision to Reality in Community Care: Changing Direction at the Local Level. Ashgate, Aldershot, UK.Google Scholar
Gray, A. and Hunter, D. 1983. Priorities and resource allocation in the Scottish health service: some problems in planning and implementation. Policy and Politics, 11, 4, 417–37.CrossRefGoogle Scholar
Hardy, B., Leedham, I. and Wistow, G. 1996. Care management co-location in GP practices: effects upon assessment and care management arrangements for older people. In Bland, R. (ed.), Developing Services for Older People and Their Families. Research Highlights in Social Work 29, Jessica Kingsley, London, 161–78.Google Scholar
Hill, M. and Hupe, P. 2002. Implementing Public Policy. Sage, London.Google Scholar
House of Commons Health Select Committee 1998. The Relationship Between Health and Social Services. First Report Volume 1, Session 1998–99, Report and Proceedings of the Committee. HC 74-I, Stationery Office, London.Google Scholar
Howe, A. L. and Kung, F. 2003. Does assessment make a difference for people with dementia? The effectiveness of the aged care assessment teams in Australia. International Journal of Geriatric Psychiatry, 18, 3, 205–10.CrossRefGoogle ScholarPubMed
Hudson, B., Lewis, H., Waddington, E. and Wistow, G. 1998. Pathways to Partnership: The Interface Between Social Care and Primary Health Care: National Mapping Exercise. Nuffield Institute for Health, Leeds, UK.Google Scholar
Hunter, D. and Wistow, G. 1987. Community Care in Britain: Variations on a Theme. King Edward's Hospital Fund for London, London.Google Scholar
Ikegami, N. 1997. Public long-term care insurance in Japan. Journal of the American Medical Association, 278, 16, 1310–4.CrossRefGoogle ScholarPubMed
Jorg, F., Boeije, H. R., Huijsman, R., de Weert, G. H. and Schrijvers, A. J. P. 2002. Objectivity in needs assessment practice: admission to residential home. Health and Social Care in the Community, 10, 6, 445–56.CrossRefGoogle ScholarPubMed
Kane, R. L. and Kane, R. A. 2000. Assessing Older Persons: Measures, Meaning and Practical Applications. Oxford University Press, New York.Google Scholar
Kendig, H., McVicar, G., Reynolds, A. and O'Brien, A. 1992. Victorian Linkages Evaluation. Department of Health, Housing and Community Services, Canberra.Google Scholar
Lewis, J. 2001. Older people and the health-social care boundary in the UK: half a century of hidden policy conflict. Social Policy and Administration, 35, 4, 343–59.CrossRefGoogle Scholar
Lingard, J. and Milne, A. 2004. Integrating Older People's Mental Health Services: Community Mental Health Teams for Older People, a Commentary and Resource Document. Department of Health, London.Google Scholar
Lipsky, M. 1980. Street-level Bureaucracy: Dilemmas of the Individual in Public Services. Russell Sage Foundation, New York.Google Scholar
Lymbery, M. 2005. Social Work with Older People: Context, Policy and Practice. Sage, London.CrossRefGoogle Scholar
Marks, L. 1994. Seamless Care or Patchwork Quilt? Discharging Patients from Acute Hospital Care. King's Fund Institute, London.Google Scholar
Martin, S. and Webb, A. 2009. Citizen-centred public services: contestability without consumer-driven competition? Public Money and Management, 29, 2, 123–30.CrossRefGoogle Scholar
McIntosh, J. 1985. District nursing: a case of political marginality. In White, R. (ed.), Political Issues in Nursing: Past, Present and Future. Wiley, Chichester, UK, 45–66.Google Scholar
McNally, D., Cornes, M. and Clough, R. 2003. Implementing the Single Assessment Process: driving change or expecting the impossible? Journal of Integrated Care, 11, 2, 18–29.CrossRefGoogle Scholar
Moriarty, J. and Webb, S. 2000. Part of Their Lives. Community Care for Older People with Dementia. Policy Press, Bristol, UK.Google Scholar
Naylor, M. D., Brooten, D., Campbell, R., Jacobsen, B., Mezey, M. D., Pauly, M. V. and Schwartz, J. S. 1999. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. Journal of the American Medical Association, 281, 7, 613–20.CrossRefGoogle ScholarPubMed
O'Reilly, K. and Rose, D. 1997. Criterion validation of the interim revised social classification. In Rose, D. and O'Reilly, K. (eds), Constructing Classes: Towards a New Social Classification for the UK. Economic and Social Research Council and Office for National Statistics, Swindon, UK.Google Scholar
Otis, N. and Butler, A. (eds)1997. Assessment of Older People: A Review of Recent International Literature. Lincoln Gerontology Centre, La Trobe University, Melbourne.Google Scholar
Øvretveit, J. 1993. Co-ordinating Community Care: Multidisciplinary Teams and Care Management. Open University Press, Buckingham, UK.Google Scholar
Petch, A., Cheetham, J., Fuller, R., Macdonald, C. and Myers, F. with Hallam, A. and Knapp, M. 1996. Delivering Community Care: Initial Implementation of Care Management in Scotland. Stationery Office, Edinburgh.Google Scholar
Phelan, E. A., Williams, B., Pennix, B., LoGerfo, J. P. and Leveille, S. G. 2004. Activities of daily living function and disability in older adults in a randomised trial of the Health Enhancement Program. Journal of Gerontology: Medical Sciences, 59A, 8, 838–43.Google Scholar
Philp, I. 2000. Easy-Care: a systematic approach to the assessment of older people. Geriatric Medicine, 30, 5, 15–9.Google Scholar
Pressman, J. and Wildavsky, A. 1973. Implementation: How Great Expectations in Washington are Dashed in Oakland: Why it's Amazing that Federal Programs Work at all, this Being a Saga of the Economic Development Administration as Told by Two Sympathetic Observers Who Seek to Build Morals on a Foundation of Ruined Hope. University of California Press, Berkeley, California.Google Scholar
Reilly, S., Challis, D., Burns, A. and Hughes, J. 2003. Does integration really make a difference? A comparison of old-age psychiatry services in England and Northern Ireland. International Journal of Geriatric Psychiatry, 18, 10, 887–93.CrossRefGoogle ScholarPubMed
Rhodes, R. A. W. 1988. Beyond Westminster and Whitehall. Hyman, London.Google Scholar
Rummery, K. and Glendinning, C. 2000. Primary Care and Social Services: Developing New Partnerships for Older People. Radcliffe Medical, Oxford.Google Scholar
Sabatier, P. 1986. What can we learn from implementation research? In Kaufmann, F., Majone, G. and Ostrom, V. (eds), Guidance, Control and Evaluation in the Public Sector. De Gruyter, Berlin, 313–25.Google Scholar
Sabatier, P. and Mazmanian, D. 1979. The conditions of effective implementation: a guide to accomplishing policy objectives. Policy Analysis, 5, 4, 481–504.Google ScholarPubMed
Seigel, S. and Castellan, N. 1988. Nonparametric Statistics for the Behavioural Sciences. McGraw-Hill, London.Google Scholar
Sheard, D. and Cox, S. 1998. Teams, Multi-disciplinary and Interprofessional Working and Dementia. Dementia Services Development Centre, University of Stirling, Stirling, UK.Google Scholar
Social Services Inspectorate 1997. The Cornerstone of Care: An Inspection of Care Planning for Older People. Department of Health, London.Google Scholar
Social Services, Inspectorate 2003. Improving Older People's Services: An Overview of Performance. Department of Health, London.Google Scholar
Steiner, A. 2001. Intermediate care: more than a ‘nursing thing’. Age and Ageing, 30, 6, 433–5.CrossRefGoogle ScholarPubMed
Stocking, B. 1985. Initiative and Inertia: Care Studies in the NHS. Nuffield Provincial Hospitals Trust, London.Google Scholar
Stuck, A. and Kane, R. L. 2008. Whom do preventive home visits help? Journal of the American Geriatrics Society, 56, 3, 561–3.CrossRefGoogle ScholarPubMed
Stuck, A. E., Siu, A. L., Wieland, G. D., Adams, J. and Rubenstein, L. 1993. Comprehensive geriatric assessment: a meta-analysis of controlled trials. The Lancet, 342, 8878, 1032–6.CrossRefGoogle ScholarPubMed
Tucker, S., Baldwin, R., Hughes, J., Benbow, S., Barker, A., Burns, A. and Challis, D. 2007. Old age mental health services in England: implementing the National Service Framework for Older People. International Journal of Geriatric Psychiatry, 22, 3, 211–7.CrossRefGoogle ScholarPubMed
Warren, M. 1946. Care of the chronic aged sick. The Lancet, 247, 6406, 841–3.CrossRefGoogle Scholar
Watt, S., Sword, W. and Krueger, P. 2005. Implementation of a health care policy: an analysis of barriers and facilitators to practice change. BMC Health Services Research, 5, 53. Available online at www.biomedcentral.com/1472-6936/5/53 [Accessed 1 July 2007].CrossRefGoogle ScholarPubMed
Webb, A. 1991. Coordination: a problem in public-sector management. Policy and Politics, 19, 4, 229–41.CrossRefGoogle Scholar
Webb, A. and Hobdell, M. 1978. Co-ordination between health and personal social services: a question of quality. In Carver, V. and Liddiard, P. (eds), An Ageing Population: A Reader and Sourcebook. Hodder and Stoughton and Open University Press, Sevenoaks, UK, 336–48.Google Scholar
Webb, A. and Wistow, G. 1986. Planning, Need and Scarcity: Essays on the Personal Social Services. Allen and Unwin, London.Google Scholar
Weiner, K., Stewart, K., Hughes, J., Challis, D. and Darton, R. 2002. Care management arrangements for older people in England: key areas of variation in a national study. Ageing & Society, 22, 4, 419–39.CrossRefGoogle Scholar
Williams, E. I. 1989. Caring for Elderly People in the Community. Stanley Thornes, Cheltenham, UK.Google Scholar
Williamson, J., Stokoe, I. M., Gray, S., Fisher, M. and Smith, A. 1964. Old people at home: their unreported needs. The Lancet, 283, 7343, 1117–20.CrossRefGoogle Scholar
Wilson, D. 1992. A Strategy of Change: Concepts and Controversies in the Management of Change. Routledge, London.Google Scholar