The quality of assessment of older people with health and social care needs has for some time been a concern of policy makers, practitioners, older people and carers in the United Kingdom and internationally. This article seeks to address a key aspect of these concerns, namely whether sufficient expertise is deployed when, as a basis for a care plan and service allocation, an older person's eligibility for local authority adult social-care services requires a comprehensive needs assessment of their usually complex and multiple problems. Is an adequate range of professionals engaged, and is a multi-disciplinary approach applied? The Single Assessment Process (SAP) was introduced in England in 2004 to promote a multi-disciplinary model of service delivery. After its introduction, a survey in 2005–06 was conducted to establish the prevalence and patterns of comprehensive assessment practice across England. The reported arrangements for multi-disciplinary working among local authority areas in England were categorised and reviewed. The findings suggest, first, that the provision of comprehensive assessments of older people that require the expertise of multiple professionals is limited, except where the possibility arose of placement in a care-home-with-nursing, and second that by and large a systematic multi-disciplinary approach was absent. Policy initiatives to address the difficulties in assessment need to be more prescriptive if they are to produce the intended outcomes.

The implementation of single assessment for vulnerable older people by 2004 was introduced in the National Health Services (NHS) Plan and the National Service Framework for Older People. The evaluation reported and discussed here is of a single assessment and integrated care process (SAP, ICP) piloted and subsequently introduced into a NorthWest of England Primary Care Trust. The initiative introduced enabled district nurses to undertake social assessments and fulfil the role of care manager for people already on their caseloads whose social needs increased.

The objectives of the evaluation were to explore the impact of the initiative on service users and on district nurses and social workers professional roles compared to the previous system of separate assessments and to examine any barriers to the implementation of single assessment and integrated care.

The perceptions of health and social care professionals and service users were collected via telephone and face-to-face semi-structured interviews (n = 21).

All professionals could identify both actual and potential benefits and disadvantages to service users of single assessment and integrated care planning. The areas important to respondents included a SAP that is, more efficient, without duplication; familiarity with assessor; timeliness of assessment; increased co-ordination and the quality of assessments. Many of these are also discussed in terms of a change in professional roles, mainly that of district nurses. The introduction of the ICP was not as successful as had been anticipated; a number of reasons for this were identified. The requirement to assess clients’ financial circumstances was the main conflict reported for district nurses compared to their traditional role. Issues relating to their lack of knowledge and familiarity of the social care sector were also highlighted. The discussion focuses on how these issues could be addressed namely through education and training, and facilitating integrated working.