Foundations for self-directed support in Scotland
Foundations for self-directed support in Scotland

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Foundations for self-directed support in Scotland

3.4 Assessments based on needs or outcomes-based assessments?

Local authorities have a duty to carry out ‘an assessment of need’ under the NHS and Community Care Act 1990. They also have duties to assess the needs of children who are 'in need' under the Children (Scotland) Act 1995. Jennifer Harris, an academic who has studied outcomes-based approaches, has argued that the way that assessments are organised and carried out reflects the extent to which professionals retain control in the provision of care services so that service users come to be regarded as dependent recipients of care:

The outcome-focused approach is consistent with the spirit of these Acts but challenges the notions of expert power bound up in the framework of assessment in favour of one in which service users utilise the skills and experience of professionals in the identification and achievement of their desired outcomes.

(Harris, 2004, p. 116)

Activity 3.2 explores the notion of ‘expert power’ in the assessment of need.

Activity 3.2: The power gap

Timing: (Allow about 10 minutes)

Watch this short video [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] which explores the concept of power and how it works in society. Make notes in your learning log about the impact of the ‘power gap’ on the assessment of people’s entitlement to health and social care services.


Assessment has been described as an ‘exercise in power’ (Gillman, 2004, p. 254) that privileges the ‘objective’ perspective of the professional above the ‘subjective’ experience or opinions of the service user.

This imbalance of power between the professional who acts as the gatekeeper to services and other resources and the ‘recipient’ service user perpetuates notions of dependency. It also undermines the capacity of people to make appropriate decisions for themselves or for their children. The culture within which professionals practice, including the understandings that the professionals themselves bring to the process, impacts on the way in which practice develops and is perpetuated. Hay suggests it is ‘almost inevitable that professionals bring this “model” to bear on the person and family we are working with. We can override [the service user's] perceptions of the world, and, indeed, are often trained to do precisely that’ (Hay, 2002, p. 13 cited in Gillman, 2004, p. 254).


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