Latest occupational therapy legislation – The Care Act

Care Act, Social Services, Housing and Promoting Wellbeing

The Care Act has been hailed as the biggest change in health and social care since its origins 60 years ago.  It will do this this by replacing numerous outdated pieces of social care legislation, Fair Access to Care (FAC’s), the Chronically Sick and Disabled Person Act 1970 are two such pieces of legislation which have been repealed for adults, which has been at the forefront of Occupational Therapy professiona within social care.  This article will look at,

• Key principles and legislative changes
• Housing – suitability of living accommodation
• The impact on Occupational Therapy practice

The Care Act is attempting to address the confusion and often-conflicting piecemeal Social Care legislation by empowering and trusting people to take responsibility for their own health and social care needs.  The Care Act is also making a bold statement by making well-being the focus of social care provision, yet does not give Occupational Therapists a clear definition on which to work with. Though the guidance does not define wellbeing as such, it does provide what commentators are calling the wellbeing principles as set out in Act under Clause 1(2) and the guidance states clearly that Local Authorities MUST promote wellbeing.

Independent living is not one of the key principles but is a crucial part of the Act and covers the key components expressed in the UN Convention on the Rights of People with Disabilities Article 19, supporting everyone to ‘live as independently as possible, for as long as possible’.  The Act also affirms the need for the outcomes to be focused on what truly matters to the end user. Suitable housing is key to independent living as is a client centred approach and a core part of a community OT’s practice.

Whilst some people have criticised the Care Act for not providing a definition of wellbeing, it could be argued that principles are more useful to professionals who implement it, as it allows us to put the client at the centre of the process and clearly defines the needs around one or more of the 9 principles. The guidance lists the nine wellbeing criteria and one the key ones for those working in housing is point ‘h’ Suitability of living accommodation.  The guidance is also clear that point ‘h’ is just as important as the other 8 principles

Housing is mentioned throughout the Act and its guidance. It is seen as a crucial health- related service. The key areas of note for any OT working in Social care are:

• The Act places a duty on a LA to carry out care and support functions that promote integration, including housing (4.88 in the guidance)
• LA must provide or arrange services which prevent delay or reduce individuals needs for care and gives as an example home adaptations (2.2.3 in the guidance)
• Home adaptations are an example of prevention as stated in 2.8 of the guidance.
• There is a legal duty to cooperate with external partners including housing providers (15.21 in the guidance)
• Clearly states that the Housing Grants, Construction and Regeneration Act 1996 still stands as a provider of housing grants to adapt service users homes via a disabled facilities grant.
• Funding up to £1,000 is still available for minor adaptions (and equipment) and is free of charge (8.14 in the guidance)
• Re-ablement and adaptations are seen as an effective route to prevention of deterioration of the clients condition or admission into hospital’ (15.62 in the guidance)

The World federation of Occupational Therapy defines OT as a ‘client-centered health profession concerned with promoting health and wellbeing through occupation,’ – wellbeing is at the heart of what we do and the Act supports our professional role.

The new Care Act will enable OT’s in Housing to

• Empower the service user to define their own housing needs and goals
• To promote independent living in a way that is focused on the client not the services or resources available.
• Look at more innovative ways to achieve the client’s goal.

The OT Profession needs to understand the legislation and be able to clinically reason occupation based assessment of need of the individual clients we are working with.

As a profession we need to embrace change and look at ways of promoting our services, which will put the client at the centre and promote true wellbeing as defined by our users. The Care Act should enable us to achieve this outcome.

Kate Sheehan

The OT Service