Single Assessment Process

Why was this example implemented?

Older people are often in frequent contact with various health and social care providers and assessments are duplicated. Such a fragmented system can lead to ineffective care packages which do not address needs holistically. Thus the Single Assessment Process (SAP) was announced in 2001 in the Department of Health’s National Service Framework for Older People to address these issues. It came into effect in 2002 with all areas having it implemented from 2004. The aim of the SAP is to create a more person-centred approach to care delivery by improving the communication of common assessment information between services and providers therefore reducing the burden of assessment on the user. Information could be shared between both health and social care services.

Description

SAP was initiated and pushed forward by the Department of Health for use by social and healthcare professionals nationally. Guidance for the SAP states that a core set of information should be shared across settings to reduce duplication of work. The SAP includes four levels of assessment:

1. Contact: basic/screening information collected at the first assessment
2. Overview: a more rounded assessment of mental, physical and social well-being
3. Specialist: if there are specific needs to be addressed by a specialist
4. Comprehensive: where specialist assessments from different areas or additional support is required.

No one tool is mandated for use and ‘home grown’ tools are encouraged as long as they meet the broad guidelines. The Centre for Policy on Ageing has been commissioned by the Department of Health to host an online resource for health and social care providers. There are more than 40 examples of SAP implementations listed on their website. It recommends a number of tools on its website which can be purchased from private providers. The following are examples of assessment tools that have been used in different regions: MDS-HC (overview, comprehensive) (Miller et al, 2005), EASY-Care (contact, overview) (Abley et al, 2006), Sherbrooke postal questionnaire (contact) (Roberts et al, 2006), and FACE (contact, overview). SAP is used by a range of professionals, such as: social workers, occupational therapists, nurses, doctors and community care workers.

A good example of the SAP spanning both health and social care settings can be found in the county of Essex. In Essex Primary Care Trusts, Acute Trusts, Care Trusts, Mental Health NHS Trusts and County Councils pooled their resources to establish a group to develop the Essex Single Assessment Protocol and the Essex Shared Assessment Tool. The project group also had representation from housing and the ambulance trust.

What are/were the effects?

Though SAP is meant to have a systemic impact by changing the way assessments are conducted, its real world impact has been less substantial due to variations in implementation. Where SAP has been implemented successfully streamlined patient records with less paperwork have been reported (Abley et al, 2006; Miller et al, 2005). Increases in the number of multidisciplinary assessments since the introduction of SAP have also been reported, though it is unclear whether this increase is justified by patient need or simply the result of new policy initiatives (Sutcliffe et al, 2008). Sharing information can reduce the risk of crises occurring in the community (Miller and Cameron).

Where SAP has not been fully implemented or implemented but not successfully utilised, common reasons have been cited: difficulties in crossing professional boundaries, professional resistance to change, lack of professional ownership over the process, and insufficient IT solutions to support information sharing (Dickinson, 2006; Tucker et al, 2007). Engaged professionals tend to come from social and community care professions, rather than acute and medical professions (Miller and Cameron), thus increasing the likelihood of assessment duplication.

It appears that the SAP is being subsumed by the Common Assessment Framework (CAF) for adults which is currently being piloted. The CAF will retain the core principles of the SAP but will remove age as a boundary and therefore will be used for all adults, not just older people. It is possible that SAP in name will no longer be used in the coming years, but the concept of shared information will remain in the CAF.

What are the strengths and limitations?

Strengths

• SAP has potential to reduce paperwork burden and streamline the assessment process for the user. Where used well it can increase multidisciplinary working.
• SAP has also been shown to increase the probability of detecting needs, though accuracy remains low, particularly with regards to identifying depression (Clarkson et al, 2009).
• The concept of having a common assessment used across services could easily be replicated in other countries or in other care fields.

Weaknesses

• Services have different assessments and thus agreeing to a core set of data to be shared is difficult.
• Professionals are reluctant to give up their own assessment practices and worry about losing their professional identity.
• Devolved control over health and social care means that agreement by services on a single assessment process is unlikely as catchment areas may not be coterminous.
• Even in areas with successful implementations, not having shared electronic assessment systems is a major hindrance.
• The cost benefit and cost effectiveness of implementing SAP has not been thoroughly evaluated (Turning Point, 2010).

Opportunities

• Agreement on having a single electronic assessment system at a regional or preferably national level (such as MDS-HC, or e-SAP) could make the SAP more widely successful.

Threats

• Lack of integrated IT systems threatens successful implementations. Though it has been recognized that IT solutions are needed to improve implementations of SAP, the government has recently decided to cut funding to the NHS IT scheme which could see the development of the electronic patient record system scrapped.
• Professional tribalism which hinders multidisciplinary working threatens the SAP.
• As stated above, regions in which the catchment areas of services are not aligned may hamper the utility of SAP.

Credits

External Links and References

• Abley C, Clegg A, Fraser A, Tindle N, Waddell B. (2006) 'Ask the experts: Single assessment process' in: Nursing Older People, 18(2):14-15.
• Clarkson P, Abendstern M, Sutcliffe C, Hughes J, Challis D. (2009) 'Reliability of needs assessments in the community care of older people: impact of the single assessment process in England' in: Journal of Public Health, 31(4):521-529.
• Dickinson A. (2006) 'Implementing the single assessment process: opportunities and challenges' in: Journal of Interprofessional Care¸ 20(4):365-379.
• DH – SCLG&CP (2009) Common Assessment Framework for Adults: A consultation on proposals to improve information sharing around multi-disciplinary assessment and care planning. London: DH.
• Miller E, Cameron K. (2001) 'Challenges and benefits in implementing shared inter-agency assessment across the UK: A literature review' in: Journal of Interprofessional Care, 25(1):39-45.
• Miller J, Birnie S, Douglas C, Dutton K, Elliott P. (2005) 'Implementing the single assessment process using the Minimum Data Set-Home Care (MDS-HC): an observational study' in: Nursing Older People, 17(6):18-22.
• Roberts HC, Hemsley ZM, Thomas G, Meakins P, Powell J, Robison J et al. (2006) 'Nurse-led implementation of the single assessment process in primary care: a descriptive feasibility study' in: Age and Ageing, 35:394-398.
• Sutcliffe C, Hughes J, Abendstern M, Clarkson P, Challis D. (2008) 'Developing multidisciplinary assessment – exploring the evidence from a social care perspective' in: International Journal of Geriatric Psychiatry, 23:1297-1305.
• The Single Assessment Process for Older People, FAQs 
• Tucker S, Baldwin R, Hughes J, Benbow S, Barker A, Burns A et al. (2007) 'Old age mental health services in England: implementing the National Service Framework for Older People' in: International Journal of Geriatric Psychiatry, 22:211-217.
• Turning Point (2010) Benefits realisation: Assessing the evidence for the cost benefit and cost effectiveness of integrated health and social care. London: Turning Point.
• Centre for Policy on Aging - Single Assessment Process - Moving towards a Common Assessment Framework 
• Tameside - The Single Assessment Process 
• Department of Health - The Common Assessment Framework
• Department of Health - Single Assessment Process