Getting a needs assessment

What is a needs assessment?

If you need help to remain living independently in your own home or would like to move into supported accommodation to help maintain your quality of life, the first step is to get a care needs assessment from the social services department of your local authority.

You must meet certain eligibility criteria to qualify for local authority care, which can only be decided on through a needs assessment.

You have a right to this assessment and it’s free of charge. The assessment will look at all aspects of your life – including physical and mental health, and general wellbeing – to identify your needs. 

Following a needs assessment, the local authority might recommend you need services such as:

• practical support at home: help with meals, shopping or laundry, or reminders to take medication
• information and advice on community support
• disability equipment or mobility aids
• home adaptations such as stairlifts or grab rails
• assistive technology such as personal alarms or telecare sensors
• care at home: help with personal care, such as washing and dressing or supervision
• sheltered housing or extra-sheltered housing
• residential care in a care home or nursing home
• respite care.

How to arrange a needs assessment

To apply for a needs assessment, contact your GP or local adult social care department. If you’re not able to do this yourself, a friend or relative can request it on your behalf (and, if relevant, they may want to arrange a carer’s assessment for themselves at the same time). 

In some areas you can apply directly through your local authority’s website (although this isn’t always possible). 

Use the gov.uk website to find your local council and social services.

Who carries out the needs assessment?

A needs assessment is usually carried out by a practitioner from the local authority, such as an occupational therapist, nurse or social worker. It will usually be a face-to-face interview in your home. In some cases, though, your assessment may happen in hospital, in your GP’s surgery or at your local council’s offices.

Sometimes needs assessments are carried out over the phone. But a telephone interview isn’t ideal, because it can be difficult for the assessor to get a full picture of your situation.

Many councils have also introduced the option of ‘self-assessment’ to allow people to assess their own care needs. A self-assessment may be available as a paper questionnaire or as an online form on the council’s website. In Wales, self-assessments are not currently used, except by a few councils who may carry out a carer’s assessment in this way. 

Don’t be fobbed off if the local authority seems reluctant to carry out an assessment. If you feel you’re being unreasonably refused an assessment, you may wish to make a formal complaint. 

Getting support during the assessment

It can help to have someone else familiar with your situation present at the assessment, such as a relative, friend or carer. They can help communicate your needs and get across all the necessary points. It’s particularly advisable to have someone else present if you have difficulty expressing yourself or don’t feel confident about explaining your situation. What is said in the needs assessment is vital, as it forms the basis of the care plan that follows.

If there isn’t someone suitable who can support you, you have a right to ask for an independent advocate to be appointed. An advocate will help to ensure that the relevant circumstances of your situation are taken into account and your views and preferences are listened to. Local authorities have a responsibility to ensure individuals have access to independent advocacy services if this would help them participate fully in the assessment process.

The needs assessment process 

The practitioner assessing you should agree with you how to describe your situation. They then work out the various needs, which should have the following elements:

• What are the issues?
• What are the difficulties you face on a daily basis?
• What difference would it make to your life if these issues or difficulties were tackled?
• What is the desired ‘outcome’?
• What services or support could bring these outcomes about?

Through asking these questions, the practitioner can assess your level of care needs and the possible ‘risk’ if you’re not provided with support.

The assessor may contact other health or care professionals who are involved with your care. With your permission, they may also talk to any relatives also involved with your care.

For a more detailed list of questions you may be asked, see our advice on preparing for the needs assessment.

Needs assessment eligibility

Following the assessment, the local authority will decide whether your assessed needs meet their criteria for adult social care. In England, the eligibility criteria are based on three tests:

1. Do your needs arise from or are they related to a physical or mental impairment or illness?
2. As a result of these needs, are you unable to achieve two or more of the specified ‘care outcomes’ (see below)?
3. As a consequence, is there likely to be a significant impact on your wellbeing?

The local authority will consider the following ‘care outcomes’: 

• managing and maintaining nutrition
• maintaining personal hygiene
• managing toilet needs
• being appropriately clothed
• being able to make use of the home safely
• maintaining a habitable home environment
• developing and maintaining family or other personal relationships
• accessing and engaging in work, training, education or volunteering
• making use of necessary facilities or services in the local community, including public transport and recreational facilities or services
• carrying out any caring responsibilities the adult has for a child.

The local authority will judge that a person can’t achieve an outcome if they’re unable to achieve it without assistance; without significant pain, stress or anxiety; without endangering themselves or others; or if it would take significantly longer than would normally be expected.

The care outcomes should be recorded. Local authorities are required to ‘signpost’ you to other ways of meeting any of your presenting needs that fall outside the eligible needs.

Getting the most out of a needs assessment 

To give yourself the best chance of having your needs met, consider the following important points:

1. Ensure that all your relevant needs are assessed and recorded. Use our checklist to help you get the most out of the interview.
2. Make sure the council explains how it categorised each of your needs. 
3. For any needs that don’t meet the eligibility criteria for state support, the local authority should still give practical advice about how those needs could be met.

This information will put you in a stronger position should you choose to challenge the council’s decision (see challenging a local authority decision). 

The care plan

Following your assessment, you will receive a written care plan (sometimes called a ‘care and support plan’). This should outline your assessed needs and suggest suitable solutions to address those needs. It will also explain which needs will be met by the local authority. 

Here are some examples of what a care plan could cover: 

Issue: Mr S is unable to work in the kitchen and cook.

• Possible outcomes: ensure Mr S has regular meals that meet his nutritional needs.
• Possible services/support: learn how to cook/prepare meals, or to have all meals provided. 

Issue: Mrs P lives alone and regularly wanders out of the house, putting her in an unsafe situation.

• Possible outcomes: to keep Mrs P safe.
• Possible services/support: arrange a carer to supervise at home, provide a personal alarm, or move to a care home.

Issue: Miss A is unable to get up the stairs and so has to sleep downstairs and use a commode.

• Possible outcomes: enable Miss A to use the stairs again so that she can sleep in her bedroom and use the upstairs toilet/bathroom.
• Possible services/support: provide a stairlift or other equipment to help her get upstairs, plus rehabilitation services to re-learn skills and confidence.

If you don’t receive a care plan following a needs assessment, then request a copy of it. This is an important document, as you will only be eligible to receive support for needs that have been recognised in the care plan.

It’s important to check the documentation to make sure that the recorded assessment captures all your needs, not just the ones the local authority regard as ‘eligible’. Written details of the assessment should be checked, agreed and signed by both you and the local authority.

Financing care after a needs assessment

If you’ve been found to need extra support, you will have a separate financial assessment (or means test) to see if the council will contribute to your care costs.

Local authority financial assessments differ depending on whether you are remaining in your own home or moving to a care home. We explain how these work in our guides on care home finance and home care finance.

Needs assessments in Northern Ireland, Scotland and Wales

Social care needs assessments are used in a similar way across the whole of the UK, but there are some regional differences. 

In Northern Ireland, the needs assessment is called a health and social care assessment and it will be arranged by the social services department of the local Health and Social Care (HSC) Trust. You will normally only undergo a financial assessment if you are moving into a care home.

In Scotland, people who are assessed as needing personal care or nursing care should not be charged for these services. The amount an individual contributes towards the remainder of their care costs, including accommodation, utilities, meals and so on, will be determined following a financial assessment of their income and assets. More information on this is available on the Scottish Government’s website.

Care Information Scotland has more information about what to expect from a care needs assessment in Scotland. 

In the Scottish Highlands, NHS Highland is responsible for arranging the needs assessment, rather than the local authority.

In Wales, regardless of your savings you will never have to pay more than £100 a week towards the cost of personal care support at home, if you have been assessed as needing it. Support services that are not classed as personal care (meals and laundry, for example) may take total charges above £100 per week.

Re-assessment of care needs

Local authorities should review care and support plans at least every 12 months, and a basic review should happen six to eight weeks after a new or revised care plan. You can ask for an earlier review if your situation changes before that time. Following a review, your care plan might be updated to reflect any changing needs.

If you think your care needs have changed substantially since the last review (for example, care at home is no longer working well for you and you think a care home would be a more appropriate place to live), you should ask the local authority to carry out a full re-assessment.