Assessment: identifying the barriers to good practice

Abstract

Although much has been written about the concept of assessment, there is still no clear consensus on the characteristics of good practice. Moreover, recent studies have highlighted the fact that frameworks for assessment are often heavily influenced by particular professional perspectives, and consequently the holistic assessment of need envisaged in the National Health Service (NHS) and Community Care Act 1990 has yet to emerge. This paper identifies some of the contradictions inherent in the practice guidance relating to assessment and discusses the results of early evaluations of the implementation of the new assessment process. A possible model to structure this process is outlined and suggestions made as to the benchmarks of good assessment practice.

Priorities, “street level bureaucracy” and the community mental health team

“…Concerns that community professionals have inadequate resources to 336 0 1997 Blackwell Science Ltd, Health and Social Care in the Community 5(5), [333][334][335][336][337][338][339][340][341][342] Street level bureaucracy and CMHTs ~~ ~~ implement the new measures reinforces the view that the legislation delineates the responsibilities of the keyworker without the means to fulfil them (Bluglass 1993b, Eastman 1994. In fact it is clear that practitioners in mental health often are the de facto rationers in relation to balancing demand against limited resources (Hogman 1996, Muijen 1996a, Nolan & Caldock 1996 and that policy guidance envisages a greater role in this respect (Department of Health 1996). Eastman (1994) states that, if people are to have their civil rights restricted, they should be compensated by the supply of adequate resources to facilitate compliance.…”

“…Such pressures have played a part in the slow implementation of the 'Care Programme Approach (Social Services Inspectorate 1995a). Securing practice change in this context is a well known policy and management concern (Nutting & Green 1994, Veeramah 1995,Nolan & Caldock 1996 and is likely to be complicated by the Mental Health (Patients in the Community) Act (1995) through the pressure its implementation may place on resources (MIND 1995). In this respect the tension between professional attitudes, clinical autonomy and practice with management and the priorities of government has a significance for wider policy imperatives.…”

Implementing the Single Assessment Process: Opportunities and challenges

“…HCP The above practitioner may also be demonstrating professional protectionism, which Nolan & Caldock (1996) suggest inhibits joint working practice.…”

“…However, assessment practice has been described as problematic (Audit Commission 1999;Social Services Inspectorate 2003;Nolan andCaldock 1996, Challis et al 2004), and previous policies that set out to improve assessment practice in community based services have proved to be unsuccessful in terms of addressing collaboration across health and social care and achieving seamless care or involving users or carers in the process. It is argued that assessment has continued to be driven by service availability rather than needs (Lewis & Glennerster 1996;Qureshi 2002).…”

The evidence base for individual patient and client assessment by community nurses

“…A key UK policy document stated that 'assessment' is the 'cornerstone of good quality care' (Department of Health, 1989). This complex process is required in order to achieve what Nolan and Caldock (1996) have argued are the three components of assessment namely analysing information, determining care or support needs and relating these to options for intervention or referral. This information and understanding must then be integrated with a recognition of patient and carer preferences and a knowledge of local policies and service provision.…”