‘Person-Centred Process’: Why perceptions of fair process matter in social care

Despite their importance, we know surprisingly little about how needs assessments are carried out in practice. Local Authorities have a legal duty under the Care Act 2014 to assess need, but there is limited evidence on how they decide what an assessment should look like, how these approaches vary across the country, and what this means for people trying to access support. This gap is particularly striking given that needs assessments are the single largest source of complaints to the Local Government and Social Care Ombudsman.

Most existing research focuses on what comes out of a needs assessment—such as care or support plans—rather than how decisions are reached in the first place. Our research starts from the view that how assessments are designed and experienced matters (Leishman et al, 2025; Meers et al, 2026). This reflects our interests as researchers in the Administrative Fairness Lab. Our mission is to build an evidence based understanding of how law and administrative processes shape frontline public services, and to explore new ways of improving how those services are experienced and delivered.

In this project, we set out to address this gap with three aims:
•    to understand how and why Local Authorities decide on the format of needs assessments under the Care Act 2014
•    to explore what social care users and the wider public think counts as a fair assessment process
•    and, ultimately, to identify how needs assessments could be redesigned to make them fairer in practice.

What does a fair process for seeking social care support look like? This question is a pressing question for at least three reasons. First, the scale of demand. The number of people requesting support from adult social care in England is rising. In 23/24 just over two million people asked for support for the first time (The Kings Fund, 2025). From the moment someone realises they or a loved one may need support, they enter a complex administrative system involving phone calls, emails, waiting lists, screening processes, eligibility rules, and follow-ups. Although finding the way in can be challenging (one participant in our work characterised adult social care as a ‘maze’), many will join a waiting list for an adult social care needs assessment.

The second, is the variation in support. The design and delivery of this process varies dramatically between the local authorities obligated to provide it. Each of the 153 local authorities in England (with responsibility for social care) offer the same headline service but approach it in different ways. This means that how long you wait, who carries out the needs assessment and what form it takes differs from place to place. While in some local authorities you may be asked to complete an online self-assessment, others rely on a professional assessment over the phone, in the client’s own home or at a local authority or community venue. The people carrying out these assessments vary from qualified social workers to people whose sole role is to carry out needs assessments (often referred to in local authorities as ‘unqualified social workers’).

Third, our research in the Administrative Fairness Lab  - alongside a growing evidence base in the field of procedural justice more broadly (see Mashaw, 1983), - has begun to demonstrates that perceptions of fair process matter not only for overall satisfaction with a service, but also crucially for their engagement with a service (see Tomlinson et al, 2024). We break these processes down into their individual components: the ‘process qualities’ that those designing the systems can prioritise, or not, in their delivery of services. We detail these in Table One below (Haliday et al, 2024). With hundreds of thousands of needs assessments conducted each year (as many 609,000 people in 2024/25 according to the The Department of Health and Social Care (2026)) there is a significant opportunity to improve how the public perceive their interactions with the front line of the state.

Table One: A list of process qualities identified within the Administrative Fairness Lab

Our work examined perceptions of fair process for those accessing social care support (Leishman et al, 2025). We interviewed 21 people who had either experienced a needs assessment themselves (4), provided support during the process for one or more family members (13) or had experience of the process both personally and as a carer (4). Our analysis of this data – albeit from a limited sample - offers insight into the kinds of process qualities that matter to people. These fall into two camps, reflected in Figure One below: process qualities that support a sense of dignified treatment (personalisation, voice and empathy) and those that can be thought of as supporting a sense of proactivity (responsibility-taking, dependability, transparency, assistance and availably).

Figure One: The process qualities that mattered for our participants

The majority of our participants had largely positive experiences of dignified treatment but expressed negative experiences of proactivity. Participants often described their interactions with staff during the assessment in positive terms. They appreciated when assessors took time to listen and hear the lives of the person being assessed, particularly when approaches were adapted to meet the needs of the individual. Sometimes this meant the process being slower, needing time to warm up through conversations about the persons home décor or in finding ways to directly interact with people who required interpreters. Feeling listened to, taken seriously and treated as a human being really matters and assessors are often doing this well in the needs assessment itself.  

However, alongside these positive interactions was a widespread frustration with the processes and systems involved with needs assessment. We repeatedly heard stories about people being left to chase updates with little knowledge of what was happening behind the scenes. Assessments were often moved or assessors were late requiring the person to be at home all day with no or little communication of delays. Both people going through the assessment and family carers want a system that takes responsibility, follows through on promises and offers proactive help and explanation. What they found was a maze without a map for navigation. Poor communication, unanswered calls and emails, and a lack of transparency left many of the participants feeling the system was intentionally designed to make them give up.

Taken together these findings demonstrate an imbalanced system where people appreciate how they are treated in their interactions with staff, but find the system they engage with challenging, frustrating and burdensome. Our findings suggest that improving needs assessment experiences relies both on the kinds of qualities that have formed the focus of social work education and practice for decades – those tied to ‘dignified treatment’ – but also a greater focus on ‘proactive’ elements of system design that have sometimes been neglected by comparison, such as information being clear and accessible, regular updates (even when nothing has changed) and offers of help that do not rely on a person or their advocate being able to ask. More broadly, we suggest that procedural justice theory presents an opportunity to reshape thinking around creating fairer systems in the design and delivery of social care. You can read more about our findings in Leishman et al, (2025) and Meers et al, (2026).

References:

Halliday, S., Meers, J., and Tomlinson, J. (2024) ‘Procedural Legitimacy Logics within the Digital Welfare State’, Journal of Social Security Law, 31: 64–81.

Leishman, E., Meers, J., Haliday, S. and Tomlinson, J. (2025). Person-centred process?: Procedural fairness and Care Act 2014 needs assessments. British Journal of Social Work, 55: 2856–2874

Mashaw, J. L. (1985) Managing Social Security Disability Claims. New Haven: Yale University Press.

Meers, J., Leishman, E., Salter, I., Haliday, S. and Tomlinson, J. (2026). What do the public think about artificial intelligence note-taking tools in social care? European Social Work Research (online, early view). Available at https://doi.org/10.1332/27551768Y2025D000000067  

The Department of Health and Social Care (2026). Adult social care client level data, England: quarterly update to September 2025 (online). Gov.uk. Published 15 January 2026. Available at https://www.gov.uk/government/statistics/adult-social-care-client-level-data-england-quarterly-update-to-september-2025/adult-social-care-client-level-data-england-quarterly-update-to-september-2025 (accessed 03/02/2026).

The Kings Fund (2025). Key facts and figures about adult social care. The Kings Fund (online). Available at https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-adult-social-care#:~:text=In%202023/24%2C%20local%20authorities%20received%20over%20two%20million%20requests,%2C%20and%2031%25%20receive%20nothing (accessed 03/02/2026)

Tomlinson, J., Cichocka, A., Halliday, S., Meers, J., and Seyd, B. (2024). Bureaucratic Justice in Universal Credit, Nuffield Foundation (online). Available at https://www.nuffieldfoundation.org/wp-content/uploads/2022/09/Report-2-Bureaucratic-Justice-in-Universal-Credit.pdf (accessed 04/02/2026).