primary health care | Vol 12 No 1 | February 2002
wareness of the needs of olderpeople in the community stretchesback over decades (Iliffe
1964). Older people oftenhave a complex mix of health care needs,requiring comprehensive holistic assess-ment (Joseph Rowntree Foundation 1996).However, concern has been raised aboutthe quality of assessment for older peoplein the UK, both before and after movinginto a care home (Royal Commission 1999).Just below half a million predominantlyfrail older people live in care homes (RoyalCommission 1999), and an anticipatedshort term increase in the population agedover 80 (Morris and Bowman 1999) maylead to a further rise in the numbers ofpeople living in care homes. It has beensuggested that timely high quality assess-ment may impact on this rise, leading tomore effective rehabilitation and associatedincreased independence for older people(Audit Commission 1997).Against this background, The NationalService Framework for Older People (2001)highlights as a priority, a single compre-hensive assessment process of health andsocial care, and in 2001, consultationpapers for the single assessment processwere published (Department of Health(DoH) 2001). The implications of the singleassessment process, for implementationfrom April 2002, are relevant to all health,social and other services’ professionalsinvolved in the care of older people.In brief, the current consultation papersfor the single assessment process indicatethat different professionals could be in-volved in one or more of four types ofassessment. The first assessment type is
in which basicinformation is recorded, the nature of theproblem is established, and the potentialpresence of wider health and/or socialproblems is explored. The second type is an
in which all orsome of the recommended domains of thesingle assessment process are explored. Thethird type is an
where specific problems are explored indetail. Finally, a
comprehensive old ageassessment,
requiring exploration of all ormost of the recommended domains, is thefourth type of assessment. These four typesare not intended to be perceived orimplemented as a sequential progression;selecting the assessment type should beappropriate to the exploration of actual orpotential needs of each older person beingassessed and included within its process.
Single assessment process
In general, it is suggested that the singleassessment process is to be welcomed, forit has the potential to be a major mecha-nism for making the National ServiceFramework for Older People a living andworking document over the next decade(DoH 2001, Ford and Wild 2001). Further-more, it could prove to be the necessarycatalyst to pull together health, social andother related services (including housing)professionals towards the common aim of aperson centred approach that meets in full,the often complex health and social needsof older people. As additional bonuses, ithas the potential to prevent the waste ofvaluable resources by avoiding anunnecessary duplication of assessment timeand materials, contributing to theovercoming of ageism, and promotinggreater equality for older people in theiraccessing multi agency services.
Erosion of professional barriers
Making the single assessment processwork, however, could require a majorcultural change in health, social and otherrelated services through the erosion ofprofessional barriers that can inhibit sharedways of working towards common goalsfor older people. For example, adopting aperson-centred approach to care will needserious commitment and insight from alllevels of health and social organisations, asit often entails taking on a much moreconsumer orientated approach.One way of achieving cultural change isthrough a commitment to shared multi-disciplinary education and learning byhealth and other social services profes-sionals working with older people.Education and learning should address theinteraction of physical, psychological andsocial ageing processes, adopt a person-centred approach, and generate a sharedprofessional language. It can be arguedthat the time-scale for the introduction ofthe single assessment process may not haveallowed for adequate multi-professionaleducation to be in place or undertakenprior to implementation. Thus, until thishappens, there is the potential danger forprofessionals to undertake the singleassessment process with a professionallynarrow focus that could inhibit the benefits
The singleassessment process
examines whether the single assessment process could herald the beginning of betterways of working to meet the needs of older people