Promoting Individual Wellbeing

In short, Wellbeing is how you feel about yourself and your life. 

The concept of Wellbeing is complex as it is entirely subjective to the person whose life it is, and often cannot be easily interpreted or understood by others. 

Wellbeing is influenced by a range of factors including physical, mental, emotional, and social factors. Researchers investigating happiness have found the following factors enhance a person's Wellbeing:

• Happy intimate relationship with a partner;
• Network of close friends;
• Enjoyable and fulfilling career;
• Enough money;
• Regular exercise;
• Nutritional diet;
• Enough sleep;
• Spiritual or religious beliefs;
• Fun hobbies and leisure pursuits;
• Healthy self-esteem;
• Optimistic outlook;
• Realistic and achievable goals;
• Sense of purpose and meaning;
• A sense of belonging;
• The ability to adapt to change;
• Living in a fair and democratic society.

Wellbeing is strongly linked to happiness and life satisfaction.

Until 2014 there was no legal description of Wellbeing. The Care Act changed this by introducing the Wellbeing principle.

The Wellbeing principle sets out 9 areas of life that should be considered when trying to establish a person’s sense of Wellbeing:

The Care Act is clear that there is no hierarchy, which means simply that no areas of life are more or less important - how the person feels about each area will determine how important it is to them. 

Another thing to note is that the Wellbeing principle applies equally to all people, regardless of their needs, mental capacity or ability/willingness to engage with services.

The local authority has a legal duty to promote individual Wellbeing.

The promotion of individual Wellbeing is described in the Care Act as 'actively seeking improvements in Wellbeing when carrying out any care and support function'. 

This can relate to any stage of the care and support process, from the provision of information and advice to reviewing a care and support plan or as part of a safeguarding concern / investigation.

If the service has been commissioned directly by the local authority, or if the person has arranged the service themselves after receiving information and advice from the local authority, you have a responsibility to promote individual Wellbeing when planning, reviewing, or providing care and support.

The local authority will want to know how you have promoted the person’s individual Wellbeing when they carry out a review of their care and support plan.

The following ‘rules’ reflect the requirements of the Care Act 2014 and should be remembered when promoting individual Wellbeing:

1. A sense of Wellbeing is extremely personal and will be different for every person;
2. Never make assumptions about what is important and what is not important to a person;
3. The person is the expert in relation to their own Wellbeing;
4. If a person tells you they have no worries in a particular area this does not mean the area is not important to them; and
5. Conversations about Wellbeing should be 'genuine' person centred conversations, not process led.

Any questions that are used to support a person to think about Wellbeing must:

1. Be proportionate to the level of information required;
2. Be appropriate, taking into account the person's specific needs around communication and their specific circumstances;
3. Be realistic in respect of the persons mental capacity and ability to be able to answer the question; and
4. Be asked in a manner that is accessible to the person.

Some people will lack capacity to have a conversation or communicate how they feel about their own Wellbeing at a particular moment in time (verbally or through another means). For example, they may be too unwell to do so or have a significant learning disability. 

Where this is the case the responsibility to promote individual Wellbeing still applies. It is up to you to be creative about the ways in which you can establish this.

The following are a few examples:

1. Establish and take into account any historical views and beliefs expressed by the person about what is important/not important to them;
2. Arrange for a carer, family member or independent advocate to support the person to engage and ensure that they are represented;
3. Spend time with the person; this can show you what they enjoy about life and what may be most important to them (this could be a person, a place or something they do with their time);
4. Consult with others who know the person well before reaching a judgement about Wellbeing. Speak to a family member, a health professional, a college tutor, or a day services manager; this will give a much better picture of what appears to matter most to the person;
5. Use other available evidence to support you to understand Wellbeing (for example ABC charts and other records that show behaviour changes clearly linked to an event, person, or place).

Note: Any information gathering or sharing should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

A person's wellbeing is always affected by what is happening in their life at that time. It changes as their situation changes, and sometimes the changes in Wellbeing that take place can be quite dramatic. It is therefore important to understand a person's Wellbeing in the context of their current situation, but to monitor and review Wellbeing as things change.

A person’s Wellbeing outcomes are:

1. The areas of life/things that they want to achieve;
2. The areas of life/things they want to change; and
3. The areas of life/things that they want to stay the same.

Supporting the person to meet their outcomes and achieve their goals is intrinsic to promoting their individual Wellbeing.

Depending on the situation and the communication ability of the person, powerful questions and appreciative enquiry can both be helpful approaches when talking about outcomes.

Powerful questions

A powerful question is a specific type of open question that:

1. Encourages a person to reflect;
2. Is thought-provoking;
3. Supports an exploration of options; and
4. Helps the person to gain a greater insight into their situation.

Powerful questions should be framed in a positive way to promote engagement of the person and promote a strengths based approach.

Appreciative Enquiry

An appreciative enquiry is a conversation that is led by the person and focuses on times of personal strength. It supports them to recognise that they do still have those strengths and abilities and to think about how they can apply them to their current situation.

The listener should invite the person to:

1. Talk about a time or times when something has been working well in their life;
2. Explore what it was that worked well and supported them at that time;
3. Think about how that experience could support them now in making a plan for the future.

Some key questions to support an appreciative enquiry approach include:

1. Tell me about a time when things were going well for you?
2. What did you learn about your strengths at that time?
3. If you had a magic wand what would the future look like?
4. What is it that you value most in your life now?
5. What small changes would make the most difference?

Promoting independence and strengths

People should be supported to think about how to remain as independent as possible for as long as possible, and within this how to utilise their own strengths and the strengths of their informal networks and communities. 

• Is there anything within their own power that they can do themselves?
• Is there anything within the power of their family, friends, or community that they can use?

Supporting the person to meet outcomes

Where the person is not able to take action themselves, or draw on the support of their informal networks the service should explore whether or not it can take any action to support the person to meet their Wellbeing outcome.

That said, the service is not expected to be able to meet all of the person’s Wellbeing outcomes regardless of what they are. For example, they may not have the resources or necessary skills at their disposal.

If the service is not able to meet the person’s Wellbeing outcomes they should support the person to access any help they may need - the responsibility to promote individual Wellbeing still remains. This could involve liaising with a carer, family member, advocate or other professional that is better placed to assist in meeting that particular outcome.

If the service is unable to (or no longer able to) support the person to meet their outcomes, a review should be requested to consider the ongoing suitability of the placement or any need to alter the level of care and support being provided.

Proportionate records should be kept about the person’s Wellbeing, specifically how this is being understood and promoted by the service. The local authority will want to know this, as will the Care Quality Commission (CQC) when they carry out any inspection.