During Frances McCabe’s long and varied career in health and social care, many things have changed, including attempts to improve assessment processes. She thinks that national assessment could provide many benefits, particularly to people with complex care needs, but that it may be difficult to deliver in practice.
Frances McCabe has worked in health and social care for over forty years. She first trained as a nurse in Coventry in the 1960s, before becoming a health visitor. She has also worked as a Social Services Inspector, a Senior Manager in Social Services, and as Chief Executive for Age Concern Camden and in a national team funded by the Department of health on care of older people. She is currently a trustee for Age Concern, Brighton, Hove and Portslade and lives in Brighton.
Integrating Assessments
Frances believes that assessment processes got better after the Community Care Act was introduced and saw joint assessment between health, housing and social care starting to happen in different local areas. She stresses how important this is for people who use services.
“The whole idea is for people to have a single system to relate to, so their needs could be orchestrated or at least kept within an integrated approach,” she says.
As well as talking about the need to provide better links between different types of assessment happening within an authority, Frances also describes how assessment varied between different areas, because of resources.
“Each local authority had to put in eligibility criteria,” she says. “150 local authorities all had something different. Not only that, they all approached it differently. Some tried to relate levels of need with the package of care you might get. Some tried to look at eligibility in relation to outcomes. Others had a mixture. Now, they’re already delivering very different services. So the starting point for a new system is already different.”
Towards National Assessment
For national assessment to work, Frances thinks it must be the same wherever you go and that building the link between national assessment and local delivery is the key challenge that must be faced. For Frances, the difficulty with this is that different areas have different needs, which must also be met.
“If their community have said ‘we’ve got our local community around us, we don’t need so much day care, for instance, we can achieve the same in a different way’ – that’s all right,” she says.
“But if you have a national criteria and it is open to too much local interpretation, you’ve already lost it. You haven’t got national assessment any more”.
She suggests that the solution may lie in building the structure for assessment that enables the same rules to be followed wherever it happens. This will mean that local people, who understand the local situation, are able to link this with national rules for assessment. She promotes a ‘passport’ assessment and care plan for people with very complex needs to ensure they get consistent support wherever they live.