CQC We and I Statements
Theme 1 – Working with People: Supporting people to live healthier lives
We support people to manage their health and wellbeing so they can maximise their independence, choice and control. We support them to live healthier lives and where possible, reduce future needs for care and support.
I can get information and advice about my health, care and support and how I can be as well as possible – physically, mentally and emotionally. I am supported to plan ahead for important changes in my life that I can anticipate.
MANCHESTER SPECIFIC INFORMATION
- 1. Introduction
- 2. Definition of Wellbeing
- 3. Promoting Wellbeing
- 4. Independent Living
- 5. Wellbeing throughout the Care Act
- 6. The Role of the Principal Social Worker in Care and Support
- 7. Further Reading
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 go about performing its care and support responsibilities. Underpinning all of these individual ‘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 person concerned.
Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may 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 a person. For this reason it is referred to throughout this chapter. It applies equally to adults with care and support needs and their carers.
2. Definition of Wellbeing
Wellbeing is a broad concept, and it is described as relating to the following areas in particular:
- personal dignity (including treatment of the individual with respect);
- physical and mental health and emotional wellbeing;
- protection from abuse and neglect;
- control by the individual over 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;
- the individual’s contribution to society.
The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering ‘wellbeing’ in the round.
3. Promoting Wellbeing
Promoting wellbeing involves actively seeking improvements in aspects of wellbeing set out above when carrying out a care and support function in relation to an individual at any stage of the process, from the provision of information and advice to reviewing a care and support plan. Wellbeing covers an intentionally broad range of the aspects of a person’s life and will encompass a wide variety of specific considerations depending on the individual.
A local authority can promote a person’s wellbeing in many ways. How this happens will depend on the circumstances, including the person’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, consider what the person wants to achieve, and how the action which the local authority is taking may affect the wellbeing of the individual.
The Act therefore signifies a shift from previous duties which required local authorities to provide particular services, to the concept of ‘meeting needs’. This is the core legal entitlement for adults to care and support, establishing one clear and consistent set of duties and power for all people who need care and support.
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. The concept of meeting needs also recognises that modern care and support can be provided in any number of ways, with different models emerging all the time, rather than the previous legislation which focuses primarily on traditional models of residential and domiciliary care.
Whenever a local authority carries out any care and support functions relating to an individual, it must act to promote wellbeing – and it should consider all of the aspects above in 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 person than others. For example, for some people the ability to engage in work or education will be a more important outcome than for others, and in these cases ‘promoting their 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 individual 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 individual 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 person to achieve their outcomes. During care and support planning, when agreeing how needs are to be met, promoting the person’s wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family). To give another example, the concept of wellbeing is very important when responding to someone who self-neglects, where it will be crucial to work alongside the person, understanding how their past experiences influence current behaviour. The duty to promote wellbeing applies equally to those who, for a variety of reasons, may be difficult to engage.
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, 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 by the local authority when it undertakes broader, strategic functions, such as planning, which are not in relation to one individual. Wellbeing should, therefore, be seen as the common theme around which care and support is built at both local and national levels.
In addition there are a number of other key principles and standards to which the local authority must have regard to when carrying out the same activities or functions:
- The importance of beginning with the assumption that the individual is best placed to judge the individual’s wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing. Local authorities should not make assumptions as to what matters most to the person; there should be an assumption that the individual is best placed to understand the impact of their condition/s on their outcomes and wellbeing.
- The individual’s views, wishes, feelings and beliefs. Considering the person’s views and wishes is critical to a person centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.
- The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer (see Preventing, Reducing or Delaying Needs chapter).
- The need to ensure that decisions are made having regard to all the individual’s circumstances (and are not based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the person’s circumstances, but should in every case work to understand their individual needs and goals.
- The importance of the individual participating as fully as possible in decisions about them and being provided with the information and support necessary to enable the individual to participate. Care and support should be personal, and local authorities should not make decisions from which the person is excluded.
- The importance of achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. People should be considered in the context of their families and support networks, not just as isolated individuals with needs. Local authorities should take into account the impact of an individual’s need on those who support them, and take steps to help others access information or support.
- The need to protect people from abuse and neglect. In any activity which a local authority undertakes, it should consider how to ensure that the person is and remains protected from abuse or neglect. This is not confined only to safeguarding issues, but should be a general principle applied in every case including with those who self-neglect.
- The need to ensure that any restriction on the individual’s rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary for achieving the purpose for which the function is being exercised. Where the local authority has to take actions which restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary. Concerns about self-neglect do not override this principle.
All of the matters listed above must be considered in relation to every individual, when a local authority carries out a function as described in this guidance. Considering these matters should lead to an approach that looks at a person’s 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 person 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 factors above will vary in their relevance and application to individuals. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. Local authorities should consider how to apply these further principles on a case by case basis. This reflects the fact that every person is different and the matters of most importance to them will accordingly vary widely.
Neither these principles nor the requirement to promote wellbeing require the local authority to undertake any particular action; the steps it takes should depend entirely on the individual’s’ circumstances. The principles as a whole are not intended to specify the activities which should take placed. Instead, their purpose is to set common expectations for how the local authority should approach and engage with people.
4. Independent Living
Although not mentioned specifically in the way that wellbeing is defined, the concept of ‘independent living’ is a core part of the wellbeing principle. Section 1 of the Care Act includes matters such as individual’s control of their day to day life, suitability of living accommodation, contribution to society – and crucially, requires local authorities to consider each person’s views, wishes, feelings and beliefs.
The wellbeing principle is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention). Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The language used in the Act is clear, and focus on the outcomes that truly matter to people, rather than using the relatively abstract term ‘independent living’.
5. 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 people to live as independently as possible for as long as possible (see Preventing, Reducing or Delaying Needs chapter).
Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the system for providing care and support is an assessment and planning process that is a genuine conversation about people’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.
In order to ensure these conversations look at people holistically, local authorities and their partners must focus on joining up around an individual, making the person the starting point for planning, rather than what services are provided by what particular agency. The chapter on Integration and Cooperation sets this out in more detail.
In particular, 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 SEN and Disabilities. In combination, the 2 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 the Transition to Adult Care and Support chapter.
Promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them. People have the opportunity to request support from their local authority in the form of a direct payment that they can then use to buy their own care and support using this information. The chapters on Information and Advice and Direct Payments explain this in more detail.
Help & Support Manchester (HSM) is Manchester City Council’s online all services directory of local and national services, activities and opportunities for the citizens of Manchester; including adults, older people, families, children and young people and the practitioners and workers supporting them.
Manchester is an age friendly city. The Manchester City Council website contains information for older people, and provides information about what’s going on, local contacts and services, plus useful help and advice. People can also find out what the Council is doing behind the scenes to improve life for older people.
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 created a 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.
6. The Role of the Principal Social Worker in Care and Support
The purpose of this section of the guidance is to further clarify arrangements to have in place a designated principal social worker in adult care and support. Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:
- lead and oversee excellent social work practice;
- support and develop arrangements for excellent practice;
- lead the development of excellent social workers;
- support effective social work supervision and decision making;
- oversee quality assurance and improvement of social work practice;
- advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice;
- function at the strategic level of the Professional Capabilities Framework (British Association of Social Workers).
All local authorities should ensure principal social workers are given the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level and are given sufficient time to carry out their role. The principal social worker should also be visible across the organisation, from elected members and senior management, through to frontline social workers, people who use services and carers. Local authorities should therefore ensure that the role is located where it can have the most impact and profile.
Whatever arrangements are agreed locally, the principal social worker should maintain close contact with the DASS and frontline practitioners and engage in some direct practice. This can take several different forms, including direct casework, co-working, undertaking practice development sessions, mentoring, etc.
The integration of health and care and support will increasingly require social workers to lead, both in their teams and across professional boundaries, particularly in the context of safeguarding, mental health and mental capacity. Organisational models of social work have traditionally focused on managerial, as opposed to professional leadership – through their direct link to practice, principal social workers can ‘bridge the gap’ between professional and managerial responsibility, to influence the delivery and development of social work practice.
Chapter 14 of the Care and Support Statutory Guidance endorses the: ‘Making Safeguarding Personal’ approach (see Adult Safeguarding chapter). This represents a fundamental shift in social work practice in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers should have a broad knowledge base on safeguarding and Making Safeguarding Personal and be confident in its application in their own and others’ work. Local authorities should, therefore, ensure that principal social workers lead on ensuring the quality and consistency of social work practice in fulfilling its safeguarding responsibilities. In particular they should have extensive knowledge of the legal and social work response options to specific cases and in general.