12.2 Promoting Wellbeing

1. Introduction

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. The  Care and Support Statutory Guidance sets out how the local authority should go about performing its care and support responsibilities and the importance of focusing on the needs and goals of the adult concerned.

Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of an adult. This is often called ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.

The wellbeing principle applies whenever a local authority is carrying out a care and support function, or making a decision. It applies equally to adults with care and support needs and their carers.

In some circumstances, it also applies to children, their carers and to young carers when they are subject to transition assessments (see Transition to Adult Care and Support).

2. Definition of Wellbeing

Wellbeing is a broad concept, and includes:

• personal dignity (including treating the adult with respect);
• physical and mental health and emotional wellbeing;
• protection from abuse and neglect;
• adults having control over their day to day life (including over care and support provided and the way it is provided);
• participation in work, education, training or recreation;
• social and economic wellbeing;
• domestic, family and personal relationships;
• suitability of living accommodation;
• making a contribution to society.

There is no hierarchy, and all these aspects should be considered of equal importance when considering ‘wellbeing’ in the round.

3. Promoting Wellbeing

Promoting wellbeing involves actively seeking to improve aspects of the adult’s wellbeing when carrying out care and support functions. It applies at every stage of the process, from the provision of information and advice to reviewing a care and support plan.

A local authority can promote wellbeing in many ways. The approach taken will depend on the adult’s own circumstances, including their needs, goals and wishes, and how these impact on their wellbeing. There is no set approach – a local authority should consider each case on its own merits, consider what the adult wants to achieve, and how their wellbeing could be promoted.

As everyone’s needs are different and personal to them, local authorities must consider how to meet each adult’s specific needs rather than simply considering what service they will fit into.

Whenever a local authority carries out any care and support functions relating to an adult, it must act to promote wellbeing – and it should consider all of the aspects of this when looking at how to meet the adult’s needs and support them to achieve their desired outcomes. However, in individual cases, it is likely that some aspects of wellbeing will be more relevant to the adult than others. For example, for some adults the ability to work or take part in education will be a more important outcome than for others, and in these cases ‘promoting their wellbeing’ is likely to involve a greater focus on these aspects. A flexible approach that allows for a focus on which aspects of wellbeing matter most to the adult concerned is important.

The principle of promoting wellbeing should be embedded through the local authority care and support system, but how it promotes wellbeing in practice will depend on the particular function being performed. For example, during the assessment process, the local authority should ask the adult what they feel are the most relevant aspects of wellbeing and then assess how their needs impact on them. Taking this approach will allow for the assessment to identify how care and support, or other services or resources in the local community, could help the adult to achieve their outcomes. During care and support planning, promoting wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family).

The wellbeing principle applies equally to those who do not have eligible needs but come into contact with the care and support system in some other way (for example, via an assessment that does not lead to ongoing care and support) as it does to those who go on to receive care and support and have an ongoing relationship with the local authority.

It should also inform delivery of universal services provided to all people in the local population. Although the wellbeing principle applies specifically when the local authority performs an activity or task or makes a decision in relation to an adult or carer the principle should also be considered by the local authority when it undertakes broader, strategic functions, such as planning.

Other key principles the local authority must have regard to when carrying out care and support functions include:

1. The importance of beginning with the assumption that the adult is best placed to judge their own wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the person is the ‘expert in their own lives’. They should be asked about their priorities and the outcomes they want to achieve. Local authorities must not make assumptions about what matters most to the adult.
2. The adult’s views, wishes, feelings and beliefs. Considering the adult’s views and wishes is key to providing person centred care and support. Where the adult has particular views, feelings or beliefs (including religious beliefs) which impact on the choices they may wish to make about their care, these should be taken into account. This is especially important where the adult has expressed views in the past, but no longer has mental capacity to make decisions their own decisions.
3. The importance of preventing or delaying the development of needs for care and support and reducing needs that already exist. At every interaction with an adult or carer, a local authority should consider whether or how the development of other needs could be delayed or prevented. Effective interventions at the right time can stop needs from escalating and help adults to maintain their independence for longer (see Preventing, Reducing or Delaying Needs for Care and Support).
4. The need to ensure that decisions are made having regard to all the adult’s circumstances. Decisions should not, for example, be based only on the adult’s age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the adult’s circumstances, but should in every case work to understand their individual needs and goals.
5. The importance of the adult participating as fully as possible in decisions about them and being provided with the information and support necessary to enable this. Adults should be at the centre of decisions about their care and support. If they need support to enable their participation, this should be provided (see Independent Advocacy).
6. The importance of achieving a balance between the adult’s wellbeing and that of any friends or relatives who are involved in caring for them. Adults should be considered in the context of their families and support networks. Local authorities should take into account the impact of the adult’s need on those who support them.
7. The need to protect adults from abuse and neglect. Ensuring adults are protected from abuse and neglect is a key part of promoting wellbeing.
8. The need to ensure that any restriction on the adult’s rights or freedom of action are kept to the minimum necessary. Where the local authority has to take actions which an adult’s restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary.

These principles should be considered in relation to every adult to ensure an approach which looks at their life holistically, considering their needs in the context of their skills, ambitions, and priorities – as well as the other people in their life and how they can support the adult in meeting the outcomes they want to achieve. The focus should be on supporting people to live as independently as possible for as long as possible.

As with promoting wellbeing, the principles above will vary in their relevance and application to individual adults. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. These principles should be applied on a case by case basis, reflecting the fact that every person is different and what matters to them most will vary.

4. Wellbeing throughout the Care Act

Wellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting adults to live as independently as possible for as long as possible.

Promoting wellbeing requires an assessment and planning process that is built around a genuine conversation about the adult’s needs for care and support and how meeting these can help them achieve the outcomes most important to them. Where someone is unable to fully participate in these conversations and has no one to help them, local authorities will arrange for an independent advocate.

The Care Act is designed to work in partnership with the Children and Families Act 2014, which applies to 0 to 25 year old children and young people with special educational needs and disabilities (SEND). In combination, the two Acts enable local authorities to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. See Transition to Adult Care and Support.

Promoting wellbeing is not always about local authorities meeting needs directly. Ensuring adults and their families and carers have the information they need to take control of their care and support and choose the options that are right for them is also important.

Control also means the ability to move from one area to another or from children’s services to the adult system without fear of suddenly losing care and support. The Care Act ensures that people will be able to move to a different area without suddenly losing their care and support and provides clarity about who will be responsible for care and support in different situations. It also includes measures to help young people move to the adult care and support system, ensuring that no one finds themselves suddenly without care on turning 18.

It is not possible to promote wellbeing without establishing a basic foundation where people are safe and their care and support is on a secure footing. The Care Act puts in place a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services.