Challenging your social care needs assessment
This information applies to England and Wales.
Your social care needs assessment will decide if you are eligible for support. If you do not get the support you hoped for, this can be upsetting. If you believe you should be eligible for more support, you can:
- challenge the decision
- find other sources of help for things not covered by your care and support package
Getting a social care needs assessment
The support you can get and how long this might take can vary by area. The needs assessment is the first step when applying for social care support. After this comes the means assessment. This will look at how much money you have to pay for your own care.
Eligibility criteria
The Care Act 2014 defines specific eligibility criteria for social care. These are:
- Do the needs arise from physical or mental illness?
- Do these needs mean the adult is unable to achieve 2 or more of the listed outcomes?
- Is there a significant impact on wellbeing?
'Eligible' outcomes
Outcomes cover:
- using your home safely
- maintaining a habitable home
- developing and maintaining personal relationships
- accessing and engaging in work, training, educational volunteering
- carrying out caring responsibilities
By law, your local authority must provide care to meet the eligible needs in your assessment. But this care may not be what you want.
Carers meeting eligible needs
Social Services do not have to meet eligible needs which are already being met. For example, if your relative helps you.
But Social Services must check with that your relative is willing and able to continue meeting those needs.
Your carer can ask for their own Carer Assessment to help with this.
For example:
- You might want a carer to prepare meals for you. A meal delivery service could meet these needs too.
- You might want a 24-hour carer. Your local authority may offer a place in a residential care home.
If you are reassessed, your eligible outcomes might be different, and your care could change.
Support for 'ineligible' needs
Your local authority may not support all your needs but they should tell you about other organisations in your area that may be able to provide support and advice. You can also:
- search online for support in your area
- ask your doctor for information about local support
Challenging your needs assessment
If you are unhappy with an assessment, ask your local authority about their appeals process.
You have the right to take someone with you to an appeal or assessment. This could be someone who:
- helps you to say how things affect you and speak up for what you need
- provides emotional support
You could also ask for an advocate. Advocacy services are usually free.
Advocates for social care assessments and appeals
Find an advocate in your area (NHS)
Take copies of your:
- needs assessment
- care plan
- financial assessment
- complaint
Refer to social work legislation, guidance and local authority policies.
Care and support statutory guidance (GOV.UK)
It may be worth asking for a review if yours is over 1 year old or your circumstances have changed.
1. Have an informal conversation with your assessor
Ask your local authority for a written explanation of the assessment. If you are unhappy with this, tell the assessor what you are unhappy with, either in writing, face to face or over the phone.
For example, you might say: "When considering need x, you need to take y and z factors into account."
If you decide to do this face to face or over the phone, follow this up in writing so that you have a record.
The authority may take this information into account and revise the decision. Or they might explain in greater depth why you are not eligible. If you are still unsatisfied, take your complaint to the next level.
2. Make a formal complaint
All local authorities have a formal complaint procedure. Your assessor should be able to tell you about this.
You can also search online for the name of your local authority and ‘complaints procedure’. This will include:
- contact details
- what should happen and when
This will usually be a written complaint made online, either by email or using a form.
You should get an initial reply within 2 weeks. The local authority may decide to reassess your needs or they may not.
Writing a formal complaint about your social care needs assessment
Warning Complaints can take time
If the complaints process takes longer than 3 months, you cannot challenge the decision in court.
You may want to get legal advice to decide the best option for you and your situation before you complain. It could also help you understand your rights.
Disability Law Service is a national charity that gives free legal advice about community care to disabled people, their families and carers.
3. Ask for an independent review
Ask your local authority for an independent review if you are unhappy with how they respond to your complaint.
Write to them and explain why you are not happy.
For example, the assessor may have missed something or not considered important information relating to your condition or impairment.
The reviewer will usually be an independent social worker. They will look at the records of your assessment and consider your support needs.
4. Complain to the Local Government Ombudsman
The Local Government Ombudsman investigates complaints from the public about councils and public services in England. Make a complaint to the Ombudsman if you:
- have made a formal complaint and
- had an independent review
The Ombudsman:
- can ask your local authority to reconsider a decision or to provide an apology or compensation
- has the final say, except in rare cases that raise legal questions that need a judicial review
You can contact the Ombudsman once for each complaint. Make sure you give them all the information you feel that they need to know.
Legal action
You may be able to challenge the decision legally. You should get legal advice from a community care solicitor first. They can tell you if you can get legal support and what to do next.
The time limit for legally challenging a decision is 3 months minus a day from the date of the decision. Do not wait until the end of the 3 months as the process can take time.
Paying for your own care
If you are not eligible for care from your local authority and you can afford it, you can also pay for your own care.
Help at home from a paid carer (NHS)Advice on social care
- Contact gives advice, information and support for families of disabled children.
- Personal Budgets Helpline from Disability Rights UK provides information on social care funding, direct payments and personal budgets.
- The Learning Disability Helpline is a service run by the national charity Mencap.
- National Autistic Society has information about social care problems for people affected by autism.
Last reviewed by Scope on: 30/11/2023
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