1.1 Promoting Wellbeing

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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. Throughout the Care and Support Statutory Guidance, the different chapters set out how a local authority should carry out its care and support responsibilities. Underpinning all of these ‘care and support functions’ (that is, any process, activity or broader responsibility that the local authority performs) is the need to ensure that doing so focuses 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 sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.

The wellbeing principle applies in all cases where a local authority is carrying out a care and support function, or making a decision, in relation to an adult. For this reason it is referred to throughout the guidance. It applies equally to adults with care and support needs and their carers.

In some specific circumstances, it also applies to children, their carers and to young carers (see Transition to Adult Care and Support).

2. Definition of Wellbeing

Wellbeing is a broad concept, and it 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 what care and support is 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 should be considered of equal importance when promoting the adult’s wellbeing.

3. Promoting Wellbeing

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

A local authority can promote an adult’s wellbeing in many ways. How this happens will depend on the circumstances, including the adult’s 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, identify what the person wants to achieve, and how the action which the local authority is taking may affect their individual wellbeing.

The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’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 the different aspects of this when looking at how to meet a person’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 engage in work or education will be a more important outcome than for others, and in these cases ‘promoting wellbeing’ effectively may mean taking particular consideration of this aspect. Local authorities should adopt a flexible approach that allows for a focus on which aspects of wellbeing matter most to the adult concerned.

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. During the assessment process, for instance, the local authority should explicitly consider the most relevant aspects of wellbeing to the adult concerned, and 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, when agreeing how needs are to be met, 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.

Wellbeing should inform delivery of universal services which are provided to all people in the local population, as well as being considered when meeting eligible needs. Although the wellbeing principle applies specifically when the local authority performs an activity or task or makes a decision in relation to a person, the principle should also be considered when broader, strategic functions, such as planning, are being carried out.

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

1. The importance of beginning with the assumption that the adult is best placed to judge the their own wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the adult is ‘the expert in their own life’. They should be asked about their priorities and the outcomes they want to achieve. Local authorities should not make assumptions as to 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) impact on the choices they may wish to make about their care, these should be taken into account. This is especially important where an adult has expressed views in the past, but no longer has mental capacity to make decisions themselves.
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, the local authority should consider whether or how the development of other needs could be prevented or delayed. Effective interventions at the right time can stop needs from escalating, and help adults maintain their independence for longer (see Preventing, Reducing or Delaying Needs).
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. The local authority should not make judgements based on preconceptions about the adult’s circumstances, but should in every case work to understand their individual needs and goals (see Assessment).
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 the adult’s needs 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 restrict an adult’s rights or freedoms, they should ensure that the course followed is the least restrictive necessary (see Deprivation of Liberty Safeguards).

These principles should be considered in relation to every adult; to ensure an approach that looks at a 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, these principles 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. The principles should be applied on a case-by-case basis, reflecting the fact that every adult is different and what matters most to them will vary widely.

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 a genuine conversation about 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 chapters on Assessment, Eligibility, Care and Support Planning and Independent Advocacy discuss this in more detail.

The Care Act is designed to work in partnership with the Children and Families Act 2014, which applies children and young people (aged 0-25 years) with special educational needs and disabilities (SEND). In combination, the two Acts enable areas to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. This is considered in more detail in 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. The chapters on Continuity of Care, Ordinary Residence and Transition to Adult Care and Support set this out in more detail.

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 introduced a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services. The chapters on Adult Safeguarding and Managing Provider Failure set this out in more detail.

5. Further Reading

5.1 Relevant chapters

Preventing, Reducing or Delaying Needs

Information and Advice

5.2 Relevant information

Chapter 1, Promoting Wellbeing, Care and Support Statutory Guidance (Department of Health and Social Care)

Prevention and wellbeing (SCIE)

ePractice