Devon County Council

Index of questions

• What is the difference between a presenting need and an eligible need?
• What if an individual is assessed as moderate but I believe they are at risk without service?
• How does FACS impact on assessment practice?
• How do we assess risks to independence and where do we record this?
• Is an individual only eligible for community care services if they have lots of needs and services?
• Should the eligibility criteria checklist be shared with the individual?
• Is emotional well being covered in FACS?
• Can you explain what is meant by work and family responsibilities?
• How does FACS interface with Direct Payments?

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What is the difference between a presenting need and an eligible need?

• The term presenting need defines all the needs that a person has, as described both at the first point of contact and throughout the assessment / review.

Eligible needs are those that are:

• above the 'threshold for services' line based on the assessment information
  and
• the individual is unable / does not wish to arrange the care and support for themselves
  and
• assistance is not available from, or appropriately arranged by, others such as family, wider community or other agencies.

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What if an individual is assessed as moderate but I believe they are at risk without service?

• As well as addressing an individual's immediate risks and needs, practitioners will also assess for future risks. This analysis should be based on information provided by the service user, carers / family, other representatives of the service user, key providers of any services and other agency staff involved - with the agreement of the individual.
  
  Practitioners will then need to make decisions about whether the provision of help to an individual will prevent her / him from deteriorating to a point whereby s/he would become eligible for services in the future due to independence / safety and / or role being undermined.
  
  This may mean that an individual who, based on the snap shot of the here and now appears to be moderate, may in fact be in substantial due to prediction about what is likely to occur if needs are not met and services are not provided.
  
  This is a critical part of our assessment skills - to interpret assessment information in terms of predicting the likely consequences / risks to an individual or their carer's independence, safety or sustainability of role if needs are not supported.
  
  This is also a key part of ensuring we work within a preventive framework.

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How does FACS impact on assessment practice?

• Assessment practice should follow the principles of person centred approaches as set out in the FACS policy and practice guidance.
  
  The assessment should be holistic whilst not being overly intrusive, addressing relevant issues concerning the person's difficulties, strengths, hopes, attitudes to risk, abilities, environmental factors, carers role and autonomy .

It will also include:

• The range of appropriate solutions and options to meet needs and address difficulties. These include: how the individual might manage her / his own situation (for example by buying the care / item themselves); through family support; via a referral to another agency; via further assessment such as intermediate care or sensory assessment.
  
• An understanding of the individual's preferences about how needs could be met having considered the relevant options
  
• Clear explanation of the FACS eligibility criteria for any support from social services
  
• Assessment of risks (see next question).
  
• Other assessment information, for example from health, housing and provider colleagues - with the individual's agreement.

This should be clearly recorded on the assessment documentation.

• Note: Assumptions should not be made about the capacity of either the individual to meet their own needs or about family members or close friends to offer support or assist in other ways. However, if the individual or family members wish to pursue this approach, and it is an appropriate response, then the discussions about options and preferences and decision making about how to manage the situation should take account of this. The quality and timing of information giving is extremely important.

• FACS decision making should flow from the assessment information.

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How do we assess risks to independence and where do we record this?

• The FACS Practice Guidance provides a framework for assessment of risk to safety / independence / sustainability of role which is repeated here.

Assessment of risk explores the interaction between an individual's needs and risks as follows:

• Instability and /or unpredictability of needs
• The intensity of needs and level of distress they cause the individual
• The complexity of the person's needs, in particular the number of different needs, how they interact and how the individual reacts to the difficulties facing them
• The impact of external and environmental factors
• The sustainability of support from family, wider community and other agencies

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Is an individual only eligible for community care services if they have lots of needs and need lots of services?

• No this is not the case. The numbers of services an individual may need does not form part of the eligibility decision making process.

The critical category in the Eligibility Criteria Checklist refers to vital needs. This means there may only be one need but it is vital to an individual's independence and / or safety to have that need met. An example might be someone who is able to get to the toilet but cannot use it without equipment.

In the substantial / moderate / low categories, risks are determined by the interaction between the number of needs and the seriousness of the risks in terms of safety and impact on independence and /or sustainability of role if those needs are not met.

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Should the eligibility criteria checklist be shared with the individual?

• The individual should be asked if they want a copy and if so, a copy should be sent or given to them together with a copy of the assessment / summary and / or care plan where relevant.
  
  Where individual's do not want a copy this should be recorded on the assessment form.

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Is emotional well being covered in FACS?

• The issue of an individual's emotional well being should be addressed at each stage of the assessment / review. This should then inform a practitioners decision making concerning the level of risks to independence and safety at the Eligibility Criteria Checklist stage.

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Can you explain what is meant by work and family responsibilities?

• As with all areas of our work, social services involvement is underpinned by the law (ref - The Law in relation to Assessment and the Provision of Community Care Services), and the details about the individuals situation as gathered at the assessment / review. For example, for some people problems they are experiencing with personal care will be paramount whilst for others difficulties in sustaining the parenting role will be equally as important.

The following provides some guidance only on this issue and is not an exhaustive list.

Critical:

• The disabled person experiences major barriers to accessing / maintaining paid employment essential to her / his financial independence or education with recognised vocational qualifications
• The disabled person is unable to provide vital personal care or domestic care needs and / or safe supervision of a child or young person (under 17 years)
• There is a major risk to the carer's employment due to the caring role

Substantial

• The disabled person experiences significant barriers to accessing employment or recognised educational vocational training which is essential to his / her healthy psychological functioning and / or involvement in these activities provides significant support to the carer to enable them to continue caring
• The disabled person requires support / training with basic personal living skills in order to achieve independent social functioning.
• The disabled person needs assistance to carry our many aspects of their parenting role

Note: Where equipment is needed for employment and education these are normally provided by other agencies / sources. Some examples of such support services include: Access to Work schemes which can fund both equipment and personal assistance. The Employment Service has a Disability Services Team - telephone 01752 615 700. This team can provide advice on what may be available to an individual including equipment and transport costs. The Disabled Persons Employment Advisor can also be contacted at the local Job Centres. Other sources are from manufacturers, REMAP, statutory services such as the NHS who will sometimes 'share' the cost.

Where the individual is in Education, the normal principal we follow is that the education establishment is responsible for either the equipment itself or they support a student in obtaining the disabled students grant (currently about £10,000 per year).

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How does FACS interface with Direct Payments?

• FACS is used to determine whether an individual has eligible needs for services or not. How councils decide to deliver services to meet eligible needs is a separate issue.
  
  However the provision of Direct Payments is an important way of empowering individuals with eligible needs so that they can choose the most appropriate services and support for them.
  
  The government has decided that every council must offer older people access to direct payments. This means that every older person assessed as being eligible for services / support must be given the choice of receiving the service or, instead, receiving a cash payment to purchase care for themselves that better suits their individual needs.