9. CGA in Primary Care Settings: Involving Social Services

A comprehensive assessment needs to consider the impact of social factors on the health and wellbeing of individuals and vice versa. The connections between their social circumstances, improved health outcomes and a sense of wellbeing may not be visible to the individual, nor to the professionals unless there is a full picture and joint development of the care and support needs, considering all the interdependencies and the wishes of the individual. 

Closer integrated working with Health and Social Care would enable information sharing - saving time and reducing the consequences of poor communication. Putting the patients and their informal carers at the centre of this assessment and allowing sharing of the information with any health and social care professional with whom they come into contact should be supported. This would create a truly patient-centred resource and stop the repetition of information-giving that is a frequent source of discontent amongst patients and their carers.

Readers need to be mindful of the differences in the legislative frameworks supporting health and social care delivery across the 4 countries of the UK when reading this page. These have similar aims but key differences. Their application and levels of integration can influence the ease with which the delivery of a single assessment can be achieved. More information can be found about these frameworks below.

Regardless of the legislative framework there is a general consensus of what good practice in supporting people with frailty should look like. 

With new duties being placed on health and social care, the development of integrated working with shared information systems and processes is essential. This may also require that professionals not only share information but trust colleagues' information and undertake some of each other's parts of the assessment where this makes sense. 

The health and social care legislation differs in the four nations of the UK:

Wales

The Social Services and Well-being (Wales) Act 2014 contains some distinct differences in duties around assessment and information. 

Northern Ireland

Northern Ireland are making changes to their health and social care system under a programme called Transforming your care.

Scotland

Public Bodies (Joint Working) (Scotland) Act 2014

• Nationally agreed outcomes, which will apply across health and social care, and for which NHS Boards and Local Authorities will be held jointly accountable
• A requirement on NHS Boards and Local Authorities to integrate health and social care budgets
• A requirement on Partnerships to strengthen the role of clinicians and care professionals, along with the third and independent sectors, in the planning and delivery of services
• Partnerships will be jointly accountable to Ministers, Local Authorities, NHS Board Chairs and the public for delivering the nationally agreed outcomes.

England

The Care Act 2014 (England) places a statutory duty on local authorities to:

• Carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care.
• Focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve.
• Involve the person in the assessment and, where appropriate, their carer or someone else they nominate.
• Provide access to an independent advocate to support the person’s involvement in the assessment if required
• Consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support).

Use the new national minimum threshold to judge eligibility for publicly funded care and support. 

Further Reading

See NICE guidance regarding social care needs for older people with one or more long term conditions.