The Care Act 2014 and occupational therapy: a handy summary

CQC assessments focus on how well councils are carrying out their statutory duties under The Care Act 2014, in line with their powers set out in Health and Care Act 2022 regulations. It’s very likely that some frontline occupational therapists (OTs) will be involved in discussion groups with CQC Inspectors. Following discussions with Principal Occupational Therapists (POTs) from the national and ADASS regional POT networks, we developed this short resource to support the occupational therapy workforce as part of council preparations for Care Quality Commission (CQC) assessment. We hope it will increase their confidence in speaking positively and confidently about their work.

This resource summarises the key principles of the Care Act 2014 and the universal and specific duties placed on councils as they relate to occupational therapy, with particular focus on prevention, wellbeing, and promoting independence. Where helpful, we’ve included some tips to encourage thinking in preparation for CQC Assessment. 

We have developed a separate resource for Principal Occupational Therapists (POTs) and lead OTs which sets out in more detail how they can prepare for assessment and interview by the CQC. As part of our support offer to POTs, we ran CQC assessment preparation workshops in each ADASS region from January to March 2025. POTs can get a copy of the workshop slides, along with ‘train the trainer’ notes which they can use to run their own workshops with frontline OTs by emailing [email protected]

Nothing in this resource seeks to amend or replace statutory guidance. Whilst every attempt has been made to ensure accuracy and promote best practice, this resource does not represent a formal statement of the law or government policy. Directors should obtain further information or legal advice, as necessary.

This resource is designed to support frontline occupational therapists in councils to prepare for CQC assessment, with a focus on wellbeing and prevention duties under The Care Act. Where appropriate, we have incorporated some suggestions which will aid preparation for CQC assessment

CQC assessment aim to provide assurance to local people about how well their council is discharging its duties under The Care Act 2014 using a single assessment framework structured around four themes:

Each of theme is underpinned by nine quality statements and councils are asked to provide CQC with a self-assessment of how well they are doing against each of these statements. Most councils use the self-assessment tool developed by the LGA and ADASS. Although designed for use by the whole council, the self-assessment includes some questions which are very relevant to occupational therapy and which OTs could potentially build into their preparation for assessment.

It's important to be aware that there may be no-one in a CQC assessment team who is familiar with the significant contribution occupational therapy can make to councils meeting their duties under The Care Act. Occupational therapy is about so much more than aids and adaptations. This means there may be an element of educating CQC about the essential role OT plays in supporting wellbeing, reducing or delaying the development of care needs, and promoting independence. We know that CQC-and government-are very concerned about waiting lists for assessment and services, and how risks associated with waiting are managed and mitigated so it’s very likely there will be questions about this. CQC frequently ask questions about support for unpaid carers so thinking about how you prevent, reduce and delay the burden of caring on unpaid carers will also be important. CQC are also keen to hear how councils are proactive in engaging with people least likely to access care and support and who experience the poorest outcomes, and about any action a council has taken to reduce barriers to taking up much- needed support.

The Royal College of Occupational Therapists (RCOT) have published Care Act 2014 Guidance for Occupational Therapists which includes some good practical examples of how OT can support wellbeing and prevention and Care Act 2014 Guidance for Occupational Therapists-Prevention

The Act was hailed as the most significant reform of care and support in more than 60 years. There is a clear focus on promoting wellbeing and preventing, reducing or delaying the development of needs for care and support and promoting independence.The Act introduced a single, national set of eligibility criteria to be applied equally across the board based on the wellbeing impacts an illness or disability has on the lives of individuals affected. The Act is supported by statutory guidance (the guidance) which sets out in detail how the legislation must be implemented by councils. This guidance (6.84) sees social workers and occupational therapists as central to the delivery of the personalised care and support envisaged by the Care Act:

The principles of The Care Act

The wellbeing principle

The Care Act places “wellbeing at the heart of care and support”. Councils are directed to apply this wellbeing principle to everyone who falls within scope of the Care Act. They are also required to promote wellbeing when carrying out any of their care and support functions.

Domains of wellbeing

Although ‘wellbeing’ is not defined in the Care Act, Care Act Eligibility regulations describe the outcomes to be considered when deciding if a person is eligible for support :

• managing and maintaining nutrition
• maintaining personal hygiene
• managing toilet needs
• being appropriately clothed
• being able to make use of the adult’s home safely
• maintaining a habitable home environment
• developing and maintaining family or other personal relationships
• accessing and engaging in work, training, education or volunteering
• making use of necessary facilities or services in the local community including public transport, and recreational facilities or service
• carrying out any caring responsibilities the adult has for a child.

Care Act Statutory Guidance (1.5) directs councils to consider the following domains of a person’s wellbeing:

• personal dignity (including treatment 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 well-being
• suitability of living accommodation
• the individual’s contribution to society

Independent living is highlighted as core to wellbeing and supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The wellbeing outcomes described in the Care Act are intended to focus on what truly matter to people.

Councils must not apply any hierarchy to these domains of wellbeing. Each element of wellbeing has the same weight as the others. This means that the psychological and emotional impacts of an illness or disability are weighed equally with those which have physical or practical impacts.

Equity and the wellbeing principle

As part of the ‘Working with people’ people theme, CQC are keen to hear about whether local people experience equity in their engagement and outcomes from care and support. You can find some useful pointers about how you might provide evidence for this in the section on ‘Working with people – equity in experiences and outcomes’ in the LGA and ADASS self-assessment tool.

Other principles councils must follow include:

• a starting assumption that the person drawing on care and support is best placed to judge their own wellbeing, and support is not based on professional preconceptions about needs or how they should be met
• a person’s views, wishes, feelings and beliefs are central to person-centred care and support planning
• preventing or delaying a person’s needs for support, or reducing needs that already exist
• enabling people to fully participate in decisions about their support, and providing the information necessary, including advocacy if required, to achieve this
• considering the impacts that a caring role has, not just on unpaid carers, but on their wider social, family and community networks.

Universal services are those which councils have a duty to provide to all people in their local population, not just to those who may be eligible for assessment or support from them. This includes people who pay for their own support, or who get NHS-funded support through Continuing Health Care (CHC), for example.

Universal duty: Promoting wellbeing

This means…

• Applying the wellbeing principle every time a council carries out any aspect of its statutory care and support functions.
• Taking a proactive approach to promoting wellbeing (not just offering crisis support).
• Recognising that people are best placed to judge their own wellbeing and decisions about support recognise all individual circumstances
• Maintaining a focus on the wellbeing outcomes which are set out in Care Act and eligibility regulations.

Universal duty: Preventing, reducing or delaying needs

This means…

• Setting out how councils will prevent, reduce or delay the development of carers needs based on analysis of current and future demand, and highlighting any gaps in support.
• Being clear that some preventative support such as equipment, adaptations and reablement can normally be provided regardless of eligibility for services
• Describing how future demand and gaps will be both met and resourced, encouraging innovation and flexibility on the part of commissioned providers.
• Taking a co-produced approach to prevention that involves local people in the design, commissioning and provision of preventative wellbeing support
• Actively identifying and targeting people who may benefit from early information about looking after their health and wellbeing.

Universal duty-: Establishing and maintaining an information and advice service which is distinct from the duty to meet eligible needs

• The guidance (3.2) is clear that councils must “establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system.”
• Information and advice is a vital component of preventing or delaying people’s need for care and support so information should include advice to people about what can be done to prevent, delay, or reduce the development of their need for support.
• The guidance is clear that while eligible needs may be met by the provision of information and advice, this will be an individual response following assessment and that information and advice is not always an appropriate way of meeting eligible needs.
• Guidance (3.29) is also clear that “The [information and advice] duty in the Care Act will not be met through the use of digital channels alone.”

Universal duty: Market shaping and commissioning

This means…

• Keeping the wellbeing principle and a focus on outcomes central to market-shaping and commissioning strategies for care and support
• Collaborating with partners, including people with care and support needs, carers and families, to encourage and facilitate the whole market in its area
• Stimulating a diverse range of high-quality services (both in terms of the types of services and the types of provider)
• Commissioning which focuses on outcomes, promotes wellbeing, quality, choice, diversity and sustainability in local markets, and is co-produced with local people
• Encouraging flexible support to enable people to participate in work, education, training or volunteering, and which is appropriate to the local population’s culture, beliefs and demography
• Regularly updating Market Position Statements, including evidence and analysis underpinning council commissioning intentions for people who draw on care and support and services

This section sets out the specific duties and expectations of councils as they relate to people, including unpaid carers, who are eligible for assessment, and for care and support.

Assessment

• Eligibility for an assessment is based solely on the ‘appearance of need’ and decisions about eligibility for support can only be made after an assessment has been undertaken
• The aim of an assessment is to understand what needs a person has and what wellbeing outcomes they are looking to achieve, maintain or improve
• The assessment can also identify needs that could be reduced, or where escalation could be delayed, and help people improve their wellbeing by providing specific preventive services, or information and advice on other universal services available locally
• Even where a person has needs that are not eligible, the council must consider providing information and advice or other preventative services.
• The outcome of the assessment will be full picture of the individual’s needs so that the council can provide an appropriate response; this could range from offering guidance and information to arranging for services to meet those needs
• The guidance says that to provide a comprehensive assessment, the assessor must be appropriately trained “Registered social workers and occupational therapists can provide important support and may be involved in complex assessments which indicate a wide range of needs, risks and strengths that may require a coordinated response from a variety of statutory and community services. Or they may be involved at the point of first contact to advise on whether preventative services would be more appropriate at that time.”

Eligibility for care and support

The Care and Support (Eligibility Criteria) Regulations 2014 are clear that someone is eligible for care and support where a) their needs arise from a “physical or mental impairment or illness” which (b) mean that they are unable to achieve two or more of the wellbeing outcomes specified; and there will be, or is likely to be, a significant impact on the adult’s well-being”. The wellbeing outcomes are set about above under ‘Domains of Wellbeing’. Guidance is clear that there should be no hierarchy applied to wellbeing outcomes, they are weighed of equal importance when deciding eligibility for support. Additional eligibility criteria beyond these wellbeing outcomes should not be introduced.

Note: eligibility for support for an unpaid carers means that they are unable to achieve one or more of the wellbeing outcomes specified

Provision of independent advocacy

Staff in councils who have ‘first contact’ with people who may need care and support should always establish whether someone would have ‘substantial difficulty’ in engaging with any assessment and support planning process. Where there is no-one else (such as a family member or friend) able to provide independent support, councils have a duty to arrange independent advocacy (Chapter 7 of the guidance).

Person-centred care and support planning

• The guiding principle in the development of the plan is that the process is person-centred and person-led
• It should enable people to remain in control of their own support, with the help they need to enhance their wellbeing and improve their connections to family, friends and community
• It should be built holistically around people’s wishes and feelings, their needs, values and aspirations
• The person must be genuinely involved and influential throughout the planning process, and should be given every opportunity to take joint ownership of the development of the plan with the council
• Plans should include a personal budget (PB) giving everyone clear information regarding the costs of their care and support and the amount that the council will make available to meet eligible needs
• The option of meeting needs by taking a direct payment must be clearly explained to people so that they can make an informed decision about the level of choice and control they wish to take over their care and support.

Entitlement to a personal budget

The Care Act places the right to a personal budget (PB) into law for the first time. Personal budgets and direct payments are often confused or conflated. A personal budget is a clear statement of the cost to the council of meeting all eligible needs. A direct payment (DP) is where a person chooses to take their personal budget as a direct payment (in full or in part) and they or a third party manages their own support arrangements.

Entitlement to the offer of a direct payment

Councils must provide information about direct payments, and ensure that people are offered the opportunity of a direct payment every time assessment, support planning or reviews take place.

Reviewing care and support plans

Guidance is that plans will be reviewed no later than every 12 months, with a light-touch review considered 6-8 weeks after the plan and personal budget have been signed off to check its working as intended.

Transition assessments

Councils have a duty to undertake transition assessments for children, young carers and parent-carers as they approach adulthood and transition between the children’s and adults social care system.

Safeguarding

Councils should consider protection from abuse and neglect in any assessment of adults or carers.

Support for unpaid carers

You can find a detailed briefing on The Care Act 2014 and Unpaid Carers on the LGA website.