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‘Well-being’ is at the heart of The Social Services and Well-being (Wales) Act, (2014) – but what does it mean in practice?
‘Fitness’, ‘wellness’, ‘health’, ‘well-being’...so what IS in a name? The new Welsh Government Social Services and Wellbeing Act (SSWA) adopts the term ‘Wellbeing’ within its title and throughout all facets of the legislation. Let’s consider the significance and implications...
Although the current English and Welsh legislation governing health and social care are largely similar in outline, purpose and function, they differ in their adoption of terminology. Whilst England has opted for the term ‘Care’ in the title of its Act, in Wales we have gone for the term ‘Well-being.’ Why? Is it just a question of following a fashion (“Care” is simply passé, dear!), or are there substantive reasons for the distinction. Well, some practitioners have long bridled against the term ‘care’. In their minds, ‘care’ is a flawed term given its association with dependency, disempowerment and – by extension – with failures in care (community and residential), and even egregious abuse. ‘Well-being’ by contrast has no such baggage.
Herein lies the fork-in-the-road between the English and Welsh legislation. Whilst ‘Care’ is retained within the English Act, it is abandoned in favour of the ‘cleaner’ concept of 'well-being' in Wales. So what is the origin and utility of the term, and what are we to make of its adoption? More importantly what are the consequences for practice?
Three approaches of well-being
An analysis of the concept indicates that there appear to be three main linguistic strands influencing the term. Let us call these strands “Original”, “Umbrella” and “Volitional.” Each strand contributes to the contemporary meaning of well-being.
Firstly the “original” term ‘health and well-being’ has been part of the vernacular for many decades. To be concerned about someone was/is to be concerned for their general 'well-being'. ‘Well-being’ in this usage is the state arising from gaining and maintaining positive health and social status. Some models of psychology and nursing speak of this state as being “self-actualisation,” “balance” or “homeostasis.” Perhaps we should therefore consider this definition as being the one which should guide us in providing a service.
Secondly, as an “umbrella” term, ‘well-being’ has emerged both within the research-literature and applied usage in government surveys, over the past decade or so, as a term to cover multiple facets of experience relating to physical and psychological health and social status (e.g. housing, employment, income). In this context ´well-being has become a “packed” umbrella term to capture these multiple facets. The use of well-being as a ‘catch-all’ helps to draw these items together collectively. Again, this has implications for service-providers, as from April next year we are to be measured by the apparent wellbeing of the people we support.
Thirdly, the “volitional” term has extended into areas of motivation, active decision-making and the ability to act and influence one's situation. In this context, the term has diversified to include mindfulness, self- awareness, self-determination, goal-attainment, adaptation and optimal interpersonal functioning. We can therefore expect to be judged by the extent to which we promote the independence of the people we support.
Elements of these three etymological strands can be seen in the 2014 Act. Within the Act (Part 1; 2) where the term is defined) well-being is tightly prescribed within eight items (original, umbrella and volitional) with two supplementary (mostly) volitional domains – see Table 1.
The Eight Items of Wellbeing (a-e) and the Further Two Volitional Domains (i-j) In The 2014 SSWA (Part 1, section 2)
|a)||Physical and mental health and emotional wellbeing|
|b)||Protection from abuse and neglect|
|c)||Education, training and recreation|
|d)||Domestic, family, and personal relationships|
|e)||Contribution made to society|
|f)||Securing rights and entitlements|
|g)||Social and economic wellbeing|
|h)||Suitability of living accommodation|
|i)||Control over day to day life|
|j)||Participation in work|
These then (a-j) are the areas that have to be covered within an assessment under the act.
SSWA concept of well-being
The three strands are all, therefore, to be found within the well-being concept enacted in the SSWA.
- Firstly, the Act is concerned with the “original” state of being arising-from positive health and social status.
- Secondly, well-being as an “umbrella” term, links together multiple facets of health and social experience, which are prescribed in the Act as domains which have to be included within assessment. Our assessment and practice will need to reflect the prescribed domains in order to fulfil the umbrella and holistic sense of well-being.
- Thirdly the “volitional” notion of well-being involving active-participation towards person-centred, goal-driven interventions is redolent within the Act and behoves professionals and services to put individuals ‘actively’ at the heart of their plan. We may have heard the term ‘person-centred’ before...but it has never been embedded in legislation like this!
Passivity, professional control, and unfocussed care plans with an absence of defined outcomes are defunct. 'Volitional' person-centredness rules! In previous blogs on this site we have looked at some of the mechanics of person-centred care planning (or should that be ‘person-centred well-being planning? Which will be further reinforced by the SSWA (see our previous blogs “No care without me” and “ Mental health care planning ”). Henceforth inspections are likely to audit many of the key features of well-being, so proactive services will need to implement their new well-being practice as soon as possible.
In practice, “well-being” is the positive term-of-choice now and sets a challenging agenda for professionals and services to meet. It’s going to be an interesting twelve months.
Paul Rees – QCS Expert Welsh Care Contributor