Assessments and eligibility

In adult services, the support offered to you will be decided through a ‘needs assessment’, carried out by your local authority.

What you need in terms of care and support, healthcare and housing should all be considered as part of this assessment.

How to get an assessment

If you believe you need support, the first thing you should do is contact your local authority and request a needs assessment. Your local authority will be the local council in your area with a social services department. This could be a city council, county council or borough council. Find your local authority.

Your local authority has a legal duty to carry out an assessment if it appears you may need social care services. It is a low threshold to trigger the duty to carry out an assessment – the local authority should just look at whether there is any realistic prospect that you may need services, and if so you should be given an assessment.

How does an assessment work?

Your assessment should then involve a face-to-face meeting with a social worker or someone else who works for the local authority. This person is the assessor. The assessor will ask you to tell them what things you need support with day-to-day. These could be things in your home like washing, dressing or cooking, or things outside your home like using public transport and making friends. It is important you tell them everything you need support with – big and small – so they can identify all of your needs.

All of your needs should be recorded clearly in your assessment. If you get support from your family, the assessment should record all of the things that you would need help with if you did not get any support from your family.

When carrying out your assessment, the local authority will need to think the ‘wellbeing principle’ as set out in the Care Act. This means that the local authority will need to promote your wellbeing when carrying out the assessment and planning services to meet your needs. The social worker will also need to consider things like your dignity, your health, your ability to participate in work or training, and your social or family relationships.

At the point of assessment, your finances or the potential cost of services are irrelevant. This means the local authority should only look at what you need, not how much money you have or how much your services may end up costing.

Once the local authority has carried out your assessment, it will need to determine which of your needs are “eligible” for support. In order to do this, the local authority will refer to its “eligibility criteria”.

What are eligibility criteria?

The Care Act has introduced national minimum eligibility criteria. This means there is now a national minimum threshold at which people are entitled to support.

To have eligible needs, your needs must be caused by or related to a physical or mental impairment or illness. Whilst this is not the sort of language we would use, a learning disability is considered a mental impairment.

As a result of your needs, you must be unable to do two or more of the following things:

• manage and maintain nutrition
• maintain personal hygiene
• manage toilet needs
• be appropriately clothed
• be able to make use of your home safely
• maintain a habitable home environment
• develop and maintain family or other personal relationships
• access and engage in work, training, education or volunteering
• make use of necessary facilities in your local community, including public transport and recreational facilities
• carry out any caring responsibilities you have for a child
• because of the above there is, or is likely to be, a significant impact on your wellbeing.

The definition of the word “unable” in above is important. The Care Act states that “unable” to do something actually means that without help, you would be in “significant pain, distress or anxiety”, or it would take you significantly longer.

If your needs are “eligible” for support under the criteria above, the local authority must meet those needs.

To find out about how they should meet your needs, see our section on How to plan your care and support.

Support through the assessment process

Your assessment should be person-centred and start from the assumption that you understand your needs best. The person conducting the assessment – often a social worker – should involve you in every aspect of your assessment, so far as this is possible. If you have substantial difficulty in understanding the assessment process, someone close to you such as a family member should be involved to help you understand it. If there is no suitable person who can help you understand it, you are entitled to support from an independent advocate.

An advocate can support you to:

• understand what is happening
• tell others what you want and about your views and feelings
• make sure you get your rights
• make sure that documents say what you need them to say.

The Care Act brings in new rights to advocacy in certain circumstances. Local authorities must provide independent advocacy to people who would have “substantial difficulty” in being involved in the assessment process, and who have no-one suitable (e.g. a family member or friend) who can support them to be involved.

Substantial difficulty being involved means that they would have substantial difficulty in one or more of these areas:

• understanding information
• retaining information
• weighing up information
• communicating their views.

More information about rights to Advocacy under the Care Act.

Useful resources

We've created the following factsheets to help you with the benefits application, Care Act assessment and follow-up process:

Delays in receiving benefits (PDF, 52 KB) - this factsheet explains the options that may be available to you whilst you're waiting for your first payment.

Mandatory reconsiderations (PDF, 48 KB)  - this factsheet explains what to do if you wish to challenge a benefit decision.

Reasonable adjustments (PDF, 425 KB) - this factsheet explains what changes should be made by the Job Centre and DWP for people with a learning disability who are looking to claim benefits.

What happens next (PDF, 367 KB) - this factsheet sets out what should happen after your Care Act assessment.

Reviews and new assessments (PDF, 219 KB) - this factsheet is for people who already receive care and support through a package of social care and what they can expect from the review and assessment process.

Direct payments (PDF, 72 KB) - this factsheet explains how people with a learning disability and their families can receive direct payments to arrange their social care support themselves.