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It protects individuals from being discriminated based on their disability, age, gender, and other protected characteristics.

How it impacts OT work: Occupational therapists must promote equality and inclusion when recommending adaptations or supporting access to employment, housing, and education. The Act reinforces the OT role in advocating for reasonable adjustments in homes, workplaces, and public environments.

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The Care Act 2014 has a significant impact on occupational therapy practice because it places a legal duty on local authorities to promote individual wellbeing and independence. This aligns closely with the core values of occupational therapy, which focus on enabling people to engage in meaningful daily activities.

The Act emphasises prevention, early intervention, and person centred assessment, guiding occupational therapists to identify functional needs and provide adaptive solutions that help individuals remain independent at home. It also promotes integration between health and social care, encouraging occupational therapists to work collaboratively within multidisciplinary teams.

Additionally, the Act recognises the rights of carers and strengthens safeguarding responsibilities, both of which influence how occupational therapists assess, plan, and deliver care. Overall, the Care Act 2014 shapes the scope and priorities of occupational therapy within adult social care by embedding wellbeing, independence, and collaboration into everyday practice.

Reference

Department of Health and Social Care. (2014). Care Act 2014. https://www.legislation.gov.uk/ukpga/2014/23/contents/enacted

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The Disability Discrimination Act 1995 defines disability as physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. The Disability Discrimination Act 1995 protects disabled people against various forms of discrimination. The act provides protection against discrimination in a number of areas, such as employment, education, provision of goods, and exercise of public functions, among others. This act was the first of its kind to protect disabled people from multiple kinds of discrimination including direct direct discrimination where a disabled person is treated less favourably than others due to their disability, failure to make adjustments in the workplace premises to accommodate the individual which puts them at a disadvantage. The act guides ethical practice, giving OTs a legal framework to work within, ensuring clients are protected and not discriminated against. OTs act as advocates inunsuring that disabled people are treated fairly. OTs must be aware of current legislation and reflect it in documentation, goal-setting, and service design.

https://lordslibrary.parliament.uk/disability-discrimination-act-1995-and-now/

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Impact in OT work:

-Section 21(5) states that OT interventions which focus on developing skills, must be treated as "special educational provision" even if they are provided by health/social care services. Meaning that OTs are recognized as part of a child's education.

-Section 42 states "Duty to secure special educational provision and health care provision in accordance with EHC Plan", meaning that OT service will be legally delivered regardless of the service provider.

How is this related to OT process:

-The assessments of OTs recognize the child's needs, and that is how the EHC plan is developed.

-OTs help with other professions as well as the children's' families, to set SMART goals.

-OTs create strategies that focus on needs, development and independence (holistic approach).

EHS= Education, Health and Care plan

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An Act to make provision about children, families, and people with special educational needs or disabilities; to make provision about the right to request flexible working; and for connected purposes.

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The Equality Act 2010 and its impact on occupational therapy

For occupational therapy professionals:

Professional standards: The Health and Care Professions Council (HCPC) mandates that occupational therapists understand and apply equality legislation to their practice. This includes challenging barriers to inclusion and recognizing how their personal biases might affect their work.

Client advocacy: Occupational therapists use their expertise to identify the specific needs of disabled clients and propose practical, individualized solutions to overcome workplace barriers. This can range from recommending specialist equipment to advising on modified work tasks.

Applying the duty to make adjustments: A core function of occupational therapy is enabling people to participate in the occupations that are meaningful to them. This aligns directly with the Equality Act, which requires employers and service providers to make reasonable adjustments to prevent discrimination.

Holistic assessments: Occupational therapists consider the relationship between a person's abilities, their environment, and the activities they need or want to do. This holistic approach is crucial for identifying what constitutes a "substantial disadvantage" and what adjustments are needed.

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The Care Act 2014 (England)

This is arguably the most significant piece of legislation for adult social care and occupational therapy. It reformed and consolidated decades of previous law.

Impact on OT:

Well-being Principle: It introduces a statutory duty for local authorities to promote an individual's "well-being." OTs are central to this, as their interventions (e.g., adaptations, equipment, reablement) directly relate to multiple well-being domains, such as personal dignity, social participation, and control over daily life.

Prevention and Reablement: The Act places a strong emphasis on preventing, reducing, or delaying the need for care. Occupational therapy is a key profession in delivering preventative services and short-term reablement programs, helping people regain skills and confidence after an illness or hospital stay.

National Eligibility Criteria: The Act establishes a national minimum threshold for eligibility for care and support. OTs are often the professionals who conduct the strengths-based assessments to determine how a person's condition impacts their ability to achieve "outcomes" (like maintaining personal hygiene, managing nutrition, or accessing the community). They assess if the person meets the criteria and how their needs can be met.

Carers' Rights: For the first time, carers are given the same legal rights to assessment and support as the people they care for. OTs often assess the carer's needs, looking at the sustainability of the caring role and providing support (e.g., equipment, moving and handling training) to make their role safer and more manageable.

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The Mental Health Act 1983 (amended 2007) is the key piece of UK legislation that governs the assessment, treatment, and rights of individuals with mental health disorders who may need compulsory care or detention in hospital or the community.

It provides the legal framework for:

·       Detaining people for assessment or treatment of mental disorder (commonly called being “sectioned”).

·       Protecting the rights of individuals during compulsory treatment.

·       Balancing autonomy and safety — ensuring that restrictions on liberty occur only whe absolutely necessary and under strict safeguards.

MHA Influence on Contemporary Occupational Therapy Practice:

Legal and Ethical Accountability

OTs working in mental health must practise within the MHA and uphold human rights.

They need to understand the legal status of each service user (e.g., informal vs detained) to provide appropriate care and document accurately.

Awareness of the MHA protects patients’ autonomy and practitioner accountability.

Advocacy and Empowerment

The MHA emphasises patient rights and advocacy — values that align with the core OT principles of empowerment, collaboration, and enabling participation.

OTs advocate for service users’ rights during ward rounds, discharge planning, or when reviewing community treatment conditions.

Least Restrictive Practice

The Act requires that interventions use the least restrictive option necessary.

OTs play a vital role in facilitating recovery-oriented interventions, promoting independence and community reintegration — alternatives to prolonged hospitalisation.

Example: designing graded community access plans, developing daily living skills, and addressing risk through occupation rather than control.

References:

Department of Health and Social Care (2007). Mental Health Act 2007. London: HMSO.

Department of Health (2015). Code of Practice: Mental Health Act 1983. London: TSO.

Creek, J. & Lougher, L. (2011). Occupational Therapy and Mental Health. Elsevier.

Duncan, E. (2021). Foundations for Practice in Occupational Therapy (6th ed.). Elsevier.

College of Occupational Therapists (2015). Code of Ethics and Professional Conduct. RCOT.

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This act was written for individuals in England and Wales over age 16 who cannot make decisions for themselves. The act protects the individuals and empowers them by prompting them to make decisions whenever they are available, and to plan for a future where someone may lose their ability to make choices.

The act impacts ~2 million people across England and Wales that cannot make their own choices, and the ~6 million people who care for them, including OTs.

The principles:

1. assumption that adults have the capacity to make choices for themselves

2. every effort should be made to support anyone in making a choice for theirself

3. those making a choice for theirself that is unwise does not mean it should be assumed they cannot make their own decisions

4. any choice made on behalf of someone must be done in their best interest

5. anyone acting on someone's behalf should do so that limits their interference with that person's rights and personal freedom

Reference: https://www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance/#:~:text=The%20Mental%20Capacity%20Act%20(MCA)%202005%20applies%20to%20everyone%20involved,guidance%20for%20less%20formal%20carers.

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SCIE At a glance 5

First published: June 2009
Last updated: July 2020; October 2022

This at a glance summary presents an overview of the Mental Capacity Act (MCA) 2005, which is important to health and social care practice.

The MCA has been in force since 2007 and applies to England and Wales. The primary purpose of the MCA is to promote and safeguard decision-making within a legal framework. It does this in two ways:

By empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process

By allowing people to plan ahead for a time in the future when they might lack the capacity.

Key messages

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

The MCA is designed to protect and restore power to those vulnerable people who lack capacity.

The MCA also supports those who have capacity and choose to plan for their future - this is everyone in the general population who is over the age of 18.

All professionals have a duty to comply with the Code of Practice. It also provides support and guidance for less formal carers.

The Act's five statutory principles are the benchmark and must underpin all acts carried out and decisions taken in relation to the Act.

Anyone caring for or supporting a person who may lack capacity could be involved in assessing capacity - follow the two-stage test.

The MCA is designed to empower those in health and social care to assess capacity themselves, rather than rely on expert testing - good professional training is key

Understanding and using the MCA supports practice - for example, application of the Deprivation of Liberty Safeguards

Reach

About two million people in England and Wales are thought to lack capacity to make decisions for themselves. They are cared for by around six million people, including a broad range of health and social care staff, plus unpaid carers. Those working in health and social care include: doctors, nurses, dentists, psychologists, occupational therapy, speech and language therapists, social workers, residential and care home managers, care staff (including domiciliary care workers), and support workers (including people who work in supported housing).

Someone's Mental Capacity, or ability to make a certain decision, may be impacted by:

a stroke or brain injury

a mental health problem

dementia

a learning disability

confusion, drowsiness or unconsciousness because of an illness of the treatment for it

substance misuse.

Five key principles

The Act is underpinned by five key principles (Section 1, MCA). It is useful to consider the principles chronologically: principles 1 to 3 will support the process before or at the point of determining whether someone lacks capacity. Once you've decided that capacity is lacking, use principles 4 and 5 to support the decision-making process.

Assessment of capacity and best interests decision-making (Sections 2-4, MCA)

What is mental capacity and when might you need to assess capacity?

Having mental capacity means that a person is able to make their own decisions. You should always start from the assumption that the person has the capacity to make the decision in question (principle 1). You should also be able to show that you have made every effort to encourage and support the person to make the decision themselves (principle 2). You must also remember that if a person makes a decision which you consider eccentric or unwise, this does not necessarily mean that the person lacks the capacity to make the decision (principle 3). Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment - the more serious the decision, the more formal the assessment of capacity needs to be.

When should capacity be assessed?

You might need to assess capacity where a person is unable to make a particular decision at a particular time because their mind or brain is affected by illness of disability. People's situations may change and the capacity determination may need to be reviewed. You cannot decide that someone lacks capacity based upon age, appearance, condition or behaviour alone.

The test to assess capacity

Two-stage functional test of capacity

The Supreme Court in the case of A Local Authority v JB [2021] UKSC 52 supported the following approach to undertaking and an assessment and making a determination of someone's capacity to make a specific decision (this was also included in the Draft Codes of Practice):

1. Is the person able to make the decision (with support if required)?

2. If they cannot, is there an impairment or disturbance in the functioning of their mind or brain?

3. Is the person's inability to make the decision because of the impairment or disturbance?

The person is determined as unable to make the relevant decision if they are unable to:

1. understand information given to them

2. retain that information long enough to be able to make the decision

3. weigh up the information available to make the decision

4. communicate their decision - this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

The determination of a person's capacity is made on the balance of probabilities - is it more likely than not that the person lacks capacity? You should be able to show in your records why you have come to your conclusion that capacity is lacking for the particular decision.

Best interests decision-making

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in their best interests (principle 4). The person who has to make the decision is known as the 'decision-maker' and normally will be the carer responsible for the day-to-day care, or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation need to be made.

What is 'best interests'?

The Act provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person's best interests. A person can put their wishes and feelings into a written statement if they so wish, which the person determining capacity must consider. In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person's best interests.

For more detailed information you should refer to the Code of Practice.

If a person has been assessed as lacking capacity then any action taken, or any decision made for or on behalf of that person, must be made in their best interests.

Case example: Assessing capacity

Anna Southcott (the patient's name has been changed), 76, has dementia and lives in a care home. She has asthma. Her capacity fluctuates. The district nurse attends to administer flu vaccinations. Ms Southcott is able to communicate.

Principle

The decision relates to administering a flu vaccination. The district nurse should start from the position of assuming that Ms Southcott has the capacity to decide whether to receive a flu vaccination, unless there is evidence to show that she lacks the capacity to do so (principle 1). Even if the nurse has to help Ms Southcott to make the decision, this does not mean she lacks the capacity to make it.

The nurse should not treat Ms Southcott as being unable to make the decision herself until all practicable steps to help and support her to make it have been taken, without success (principle 2). Only if this is the case should the nurse assess Ms Southcott's capacity to make the decision using the two-stage test.

As Ms Southcott's capacity fluctuates, the nurse should consider whether the decision can be postponed until she may have capacity to make the decision. The nurse will speak to Ms Southcott's carers about this, as well as asking about her condition and whether there are any contraindications for a flu vaccination - the following assumes this not to be the case.

Practice

The nurse must disregard Ms Southcott's ability to make decisions in general. The impairment or disturbance must affect her ability to make a specific decision at a specific time. The nurse will give her some simple information about why she needs a flu vaccine (her age and asthma), then will ask her to repeat that information. It may be that Ms Southcott has previously expressed preferences about having a flu vaccination, and this might provide a useful steer for the nurse.

In relation to the decision that needs to be made, the district nurse should decide on the balance of probabilities (more likely than not) whether Ms Southcott is able to:

understand relevant information about the decision

retain that information in her mind long enough to make the decision herself

use or weigh up (evaluate) that information as part of the decision-making process.

If Ms Southcott cannot do any of these three things, she is treated as being unable to make the decision.

The District nurse must then decide: does Ms Southcott have an impairment of, or a disturbance in, mind or brain function? There must be an impairment of her mind or some disturbance that affects the way her brain works. She has dementia, so this part of the test is fulfilled to the balance of probabilities (more likely than not).

Does the impairment or disturbance mean that she is unable to make a specific decision, at the specific time she needs to?

The decision about Ms Southcott's capacity must not be based merely on her age, appearance, assumptions about her condition or any aspect of her behaviour.

The nurse decides that Ms Southcott lacks capacity to make a decision about receiving a flu vaccination and clearly records her assessment with reasons. Using best interests decisionmaking (principle 4) the decision is taken that in view of her age and asthma, it would be in her best interests to receive the vaccination.

Thanks to Andrew Alonzi of Nottingham Law School for his contribution to this case study (updated by Claire Webster to reflect the Supreme Court ruling in A Local Authority v JB [2021] UKSC 52).

The new roles, bodies and powers supporting the MCA

Attorneys appointed under Lasting Powers of Attorney (LPAs) - the Act introduces a new form of Power of Attorney which allows people over the age of 18 to formally appoint one or more people to look after their health, welfare and/or financial decisions, if at some time in the future they lack capacity to make those decisions for themselves.

Court of Protection and Deputies - the MCA created a new court and a new public official to protect people who lack capacity and to supervise those making decisions on their behalf. The Court is able to appoint a Deputy, for example, because a person has an ongoing lack of capacity. The Court will tailor the powers of the deputy according to the circumstances of the individual.

The Public Guardian - the role of the Public Guardian is to protect people who lack capacity from abuse. The Public Guardian is supported by the Office of the Public Guardian (OPG). The OPG maintains a register of LPAs and EPAs. It also maintains a register of the Court-appointed Deputies and is responsible for supervising them.

Independent Mental Capacity Advocate (IMCA) - IMCAs are a statutory safeguard for people who lack capacity to make some important decisions. This includes decisions about where the person lives and serious medical treatment when the person does not have family of friends who can represent them. IMCAs can also represent individuals who are the focus of adult protection proceedings. The Deprivation of Liberty Safeguards introduced further roles for IMCAs.

Advance decisions to refuse treatment - the Act creates statutory rules with clear safeguards so that people may make a decision in advance to refuse treatment if they should lack capacity in the future.

A criminal offence - the Act introduces a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity.

Code of Practice

The Code explains how the MCA works on a day-to-day basis and provides guidance to those working with people who may lack capacity. The Code explains the key features of the MCA in more detail, as well as some of the practical steps that people using and interpreting the law need to take into consideration. If you work with people who lack capacity and you are a professional and/or you are paid for the work you do then you have a legal duty to have regard to the Code. It is also relevant to unpaid carers who will be helped and guided by it. The current code of practice requires updating, as case law continues to provide updated guidance for practice. The new Mental Capacity Amendment Act, and Liberty Protection Safeguards will also be followed by an updated Code of Practice to include updated case studies and findings from case law.

Interface with the MHA

It will be important for health and social care staff who support some client groups (for example, those with mental health problems, particularly those with severe and enduring mental ill health, or older people) to have an understanding of the interface issues between the MCA and the Mental Health Act 1983 (as amended by the 2007 Act). This will also include the need to have an awareness of the Deprivation of Liberty Safeguards. Health and social care staff who support people should have an understanding that there are still requirements to follow the MCA even when a person is detained under the Mental Health Act, and an understanding which legal framework should be used at the relevant time, to deprive a person of their liberty.

Liberty Protection Safeguards

In July 2018, the government published a Mental Capacity (Amendment) Bill which will see DoLS replaced by the Liberty Protection Safeguards (LPS). This passed into law in May 2019. Under LPS, there will be a streamlined process to authorise deprivations of liberty. Read more here: Liberty Protection Safeguards.

Keep up to date

We hope this at a glance about MCA has been helpful. Some aspects of the MCA are complex, and it is important that they are fully understood. SCIE offers e-learning, bespoke training, and consultancy support, to make sure that you and your organisation are aware of good practice and legal duties in this area. Or if you would like to talk to our team about how we can help, please complete our enquiry form.

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Mental Capacity Act 2005 at a glance - SCIE

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Skip to content SCIE At a glance 5 First published: June 2009Last updated: July 2020; October 2022 This at a glance summary presents an overview of the Mental Capacity Act (MCA) 2005, which is important to health and social care practice. The MCA has been in force since 2007 and applies to England and Wales.

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The Health and Social Care Act 2012 significantly reformed the structure of the NHS and social care in England, which has direct implications for occupational therapists.

1. Integrated care systems: The Act promoted integration between health and social care services. This means OTs increasingly work across traditional boundaries between NHS and local authority services, requiring them to navigate different organisational structures and collaborate across sectors to provide seamless care.

2. Clinical Commissioning Groups (CCGs): The Act transferred commissioning responsibilities to CCGs (now integrated care boards), changing how OT services are commissioned and funded. OTs need to demonstrate the value and outcomes of their interventions to commissioners who decide which services to fund.

3. Health and Wellbeing Boards: The Act established Health and Wellbeing Boards in local authorities to improve integration and joint working. OTs contribute to joint strategic needs assessments and health and wellbeing strategies that these boards develop.

4. Focus on outcomes: The Act emphasised measuring outcomes and quality of care rather than just activity. This has shifted OT practice toward demonstrating measurable improvements in function, independence, and quality of life, influencing how OTs collect data and evaluate their interventions.

5. Any qualified provider: The Act introduced greater competition in service provision, meaning OTs may work for a wider range of organizations including private and voluntary sector providers delivering NHS-funded services.

This legislation fundamentally changed the organisational landscape within which OTs practice, affecting employment settings, service models, and how care is coordinated.

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Section 21(5): States that "any health-care or social-care provision which educates/trains a child/young person is to be treated as special educational provision."

Importance: OT interventions that teach/train skills must be recognized under the education-side (EHS) of the child’s support plan.

How it affects OT process: assessments and reports must clarify if the work is training/education, so it can be included in the support plan.

Section 42: States that "the local authority must secure the specified special educational provision and health-care provision set out in a child’s EHC plan".

Importance: If OT intervention is listed in the EHC plan, the local authority has a legal duty to ensure it is provided, making OT support mandatory.

How it affects OT process:

OTs must ensure their interventions are clearly written in the EHC plan, and collaborate with education and health professionals to ensure the support is delivered, and reviewed.

Sections 22-30: State that the act introduces a birth-to-25 framework for children and young people (with SEND), extending support beyond school age and requiring joined-up work across education, health, and social care.

Importance: This recognizes that children’s needs continue into adulthood, so services must plan for continuity and smooth transitions.

How it affects OT process: OTs must coordinate across agencies and plan for transitions, ensuring consistent support and shared outcomes throughout the 0–25 journey.

In conclusion:

1)it supports person-centred planning, involving children/young people, families and other professionals in SMART goal-setting.

2)it provides guidance on documenting and reviewing OT interventions in EHC plans.

3)it aligns OT practice with statutory duties, ensuring interventions are legally recognized and coordinated across services.

EHS= Education, Health and Care Plan

SEND= Special Educational Needs and Disabilities

https://www.legislation.gov.uk/ukpga/2014/6/contents

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An Act to make provision about children, families, and people with special educational needs or disabilities; to make provision about the right to request flexible working; and for connected purposes.

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Protect decisions making for people who lack capability to make decisions.

Promote authnomy, states that, all adults has the capacity unless they are proven otherwise.

Impact on Occupational therapy. OT's assess decision-making capacity and support individuals to express preferences about their care and daily activities.

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The Children and Families Act (2014) is an important piece of legislation that focuses on improving support for children, young people, and their families. A key part of the Act introduced the Education, Health and Care (EHC) plans, which replaced the old system of special educational needs (SEN) statements. These plans aim to bring together services across education, health, and social care to provide more coordinated, person-centred support. The Act also highlights the importance of involving children and their families in decision-making about the care and services they receive.

For occupational therapists, this Act is very influential because it supports collaborative, holistic approaches to helping children reach their full potential. OTs often contribute to EHC assessments, identifying how a child’s physical, sensory, or cognitive needs impact their participation in school and daily life. The legislation reinforces the OT’s role in promoting inclusion, adapting environments, and supporting children’s engagement in meaningful occupations both at home and in education. It ensures that OTs work as part of a multidisciplinary team, focusing on what matters most to the child and family.

Reference:
HM Government. (2014). Children and Families Act 2014. London: The Stationery Office. Available at: https://www.legislation.gov.uk/ukpga/2014/6/contents/enacted

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The Health and Care Act 2022 (Department of Health and Social Care, 2022) strengthens integration between health and social care services, directly impacting occupational therapy (OT) by formalizing collaboration, accountability, and person-centred care across systems.

Impact on OT practice:

1. Integrated Care Systems (ICSs) are now statutory bodies, meaning OTs are expected to work more closely with professionals across health, housing, and social care to deliver joined-up support.

2. It reinforces prevention and early intervention, aligning with OT’s focus on enabling independence and reducing long-term care needs.

3. It introduces Care Quality Commission (CQC) oversight of local authority social care functions, including assessments and equipment provision in OT practice.

4. Mandatory training on learning disability and autism is now required for OTs.

Reference

Department of Health and Social Care. (2022) Health and Care Act 2022: combined impact assessments. GOV.UK. Available at: https://www.gov.uk/government/publications/health-and-care-act-2022-combined-impact-assessments

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What is the Care Act (2014)?

The Care Act (2014) sets out how adults who require care and support should be assessed and supported by local authorities. It places individual well-being at the centre of all care and support in order to promote independence, prevention, and person-centered care. Local authorities need to work collaboratively with health care services to provide coordinated care.

Why is this important for Occupational Therapists?

The Care Act (2014) reinforces the role of occupational therapists in enabling people to carry out meaningful occupations in order to live independently through functional assessments, home adaptations, and rehabilitation. The well-being and prevention aspects of the act align closely with the core values of occupational therapy, which focus on enhancing participation, autonomy, and quality of life. It also supports the holistic approach that occupational therapists adopt in their practice.

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The Care Act 2014. (Juliet Manufor)                                                        

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The Care Act 2014. (Juliet Manufor)                                                        

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The 2014 Care Act stands as the leading social care legislature that significantly defines how OT practitioners should carry out their duties. The Act emphasises on the principle of promoting well-being and preventing delay in the escalation of care needs.

Key impacts of the Care Art 2014

The Care Act emphasises on how important it is for Occupational therapy practitioners to assess people's needs holistically, considering the person's strengths, social connection, and the person's ability to participate in the activities of daily living.

The Act provides guidelines on how OT practitioners should transition people between settings, such as between hospital and home environment, and making sure that the right adaptation is put in place to aid daily occupation.

The Act requires OTs to apply a person-centred approach that put peoples' wishes and preferences at the forefront of their support plan.

Reference:

The Care Act 2014 and occupational therapy: a handy summary Available at: https://www.local.gov.uk/publications/care-act-2014-and-occupational-therapy-handy-summary (Accessed 27th October 2025)

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The Care Act 2014 and occupational therapy: a handy summary

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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.

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The Equality Act 2010 is a key piece of UK legislation that directly impacts occupational therapy (OT) in social care. It protects people from discrimination based on characteristics like disability, age, race, and gender, and requires services to make reasonable adjustments to ensure equal access and participation.

For OTs, this means:

Designing interventions that are inclusive and accessible

Advocating for environmental adaptations and assistive technology

Ensuring assessments and care plans respect individual rights and needs

Since we will be working with different communities and different needs, it is useful for OTs to be mindful of the legislation protecting these individuals, and how we can advocate for it. For example, recommending grab rails or voice-assisted devices for someone with a disability isn’t just good practice—it’s a legal duty under the Act to promote independence and prevent exclusion.

Reference: https://www.gov.uk/guidance/equality-act-2010-guidance

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Information and guidance on the Equality Act 2010, including age discrimination and the Public Sector Equality Duty.

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This act promotes inclusion and accessibility for all individuals creating a framework through which OTs can advocate for reasonable accommodations for their service users in a variety of settings including workplaces and educational settings.

This act also directly impacts occupational therapists in their work through prohibiting discriminatory hiring practices against those with health issues or disabilities, allowing for a more diverse field of OTs who are suited to meet the needs of the populations they serve through lived experience,

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NHS England Wheelchair quality Framework (2025)

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NHS England Wheelchair quality Framework (2025)

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This framework sets out the standars for how wheelchair services should operate. It covers assessment, prescription maintenance, and follow-up care. The focus is on ensuring that all wheelchair users receive consistent, high-quality, person-centred services, regardless of where they live.
It encourages OTs to use evidence-based assessments and involve clients in decisions about their equipment, promoting both comfort and function. It also supports monitoring outcomes and service improvement.
Relevance to OT: An OT using the framework to review service delivery times and gather user feedback helps ensure quality and accountability in wheelchair provision.

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One key piece of legislation that impacts occupational therapy practice is the Care Act 2014. This law outlines how local authorities in England must assess and meet the care and support needs of adults. It places emphasis on wellbeing, prevention, and personalised care, which aligns closely with the OT focus on enabling individuals to participate in meaningful daily activities. The Act also reinforces the importance of involving individuals in decision-making about their care, which supports client-centered practice and collaborative goal setting in OT.

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Why it impacts OT work:

The Care Act 2014 is one of the key pieces of legislation guiding adult social care in England.

It places a duty on local authorities to promote individual wellbeing, prevent needs for care and support, and provide person-centred assessments.

For occupational therapists, this means OTs play a central role in assessing functional needs, supporting independence, and recommending interventions or adaptations that align with the Act’s focus on promoting wellbeing and autonomy.

It also emphasises multi-disciplinary working and empowerment, both of which are core OT principles.

The Act ensures that OTs must consider the person’s choices, environment, and social participation, not just their physical function.

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The Mental Capacity Act 2005, is deeply relevant to the OT process, especially during assessments and interventions involving individuals who may lack capacity. The Act ensures that:

Decisions are made in the person’s best interests, a principle that OTs uphold when planning care.

Capacity is assumed unless proven otherwise, which supports autonomy and aligns with OT’s strengths-based approach.

Least restrictive options are prioritized, echoing OT’s focus on enabling participation with minimal barriers.

Together, the Care Act and the Mental Capacity Act reinforce the OT process by embedding ethical, person-centred, and legally sound practices into everyday work.

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The Care Act 2014 and occupational therapy: a handy summary

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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.

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Social care policy and legislation have a big influence on occupational therapy (OT) because they set up frameworks that guarantee client rights, direct practice, and support person-centred care. For example, in the UK, regulations such as the Care Act 2014 require that clients receive interventions and assessments that are specifically customised to their needs and preferences. This guarantees that OTs concentrate on improving the independence and standard of living of their customers.

Furthermore, these laws frequently specify how funds and resources are to be distributed, which affects the accessibility of services. By following these guidelines, occupational therapists can better represent their clients' interests and make sure they get the help and resources they need. All things considered, laws influence the moral and practical aspects of occupational therapy practice, guaranteeing that it continues to be sensitive to the demands of its clients.

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The Care Act 2014 is a key piece of social care legislation in England that sets out the legal framework for providing adult social care, requiring local authorities to focus on the well-being of individuals, including their personal dignity and preventing their needs from escalating. It places a general duty on local authorities to promote the well-being of people who need care and support and to provide services that help prevent needs from becoming more serious.

Why it impacts OT work:

The Care Act 2014 legally embeds core OT values into the social care system, making our professional reasoning a statutory requirement. Its impact is multi-faceted:

1. Well-being Principle: The Act places a legal duty on local authorities to promote an individual’s well-being, which is defined in terms that are central to OT, including "participation in work, education, training or recreation," "social and economic well-being," and "personal dignity" (S1). This means our focus on meaningful occupation is no longer just best practice; it is the law's starting point.

2. Strengths-Based Approach: It mandates a strengths-based approach to assessments and care planning. This aligns perfectly with the OT philosophy of focusing on what a person can do, their assets, and their goals, rather than just their deficits. We are required to consider the individual's capabilities, their support network, and community resources.

3. Duty to Provide Information and Advice: The Act requires authorities to provide comprehensive information and advice to help people understand and access care and support. OTs are perfectly positioned to fulfil this by providing expert advice on adaptive equipment, home modifications, and community services that enable independence.

4. Carer's Assessments: It gave carers the right to an assessment on the same legal footing as the person they care for. OTs play a crucial role in assessing the impact of the caring role on the carer's own well-being and occupational balance.

In essence, the Care Act 2014 provides the legal mandate for the OT process, from the initial client-centred, strengths-based assessment through to the implementation of interventions that promote well-being and participation in occupation.

References:

1. Department of Health and Social Care. (2016). Care and support statutory guidance. Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance

2. Gopikumar, S., & Bowers, H. (2017). Personalisation and social care assessment – the Care Act 2014. BJPsych Bulletin, 41(3), 176–180. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5451654/

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Care Act 2014: supporting implementation

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Support for local authorities to carry out the implementation for part 1 of the Care Act 2014.

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The Act is both a reforming piece of legislation (it changes the law) and a consolidating piece of legislation (it repeals many previous laws relating to care and support and replaces them with this Act). The Health and Care Act 2022 does not replace the Care Act 2014, it amends and builds upon it. The Care Act 2014 replaced numerous previous laws, creating a single, modern legal framework for adult social care. It impacts OT-s, because it shifted the focus of care from simply reacting to crises to actively promoting independence and wellbeing.

The 6 safeguarding principles of the Care Act 2014:

1. Empowerment: People being supported and encouraged to make their own decisions and informed consent.

2. Prevention: It is better to take action before harm occurs.

3. Proportionality: The least intrusive response appropriate to the risk presented.

4. Protection: Support and representation for those in greatest need.

5. Partnership: Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.

6. Accountability: Accountability and transparency in safeguarding practice.

Why it Impacts Occupational Therapy?

The Act places a legal duty on local authorities to promote an individual's wellbeing. The Act legally requires councils to provide services that prevent, reduce, or delay the need for care and support.

The Act mandates a strengths-based approach to all assessments. This means OT-s must move away from a deficit model (focusing only on what a person can't do) and instead focus on the person's own strengths and goals.

The Act consolidates the duty to provide equipment and home adaptations (like grab rails, ramps, etc). OT-s are the primary professionals responsible for recommending this equipment, using their skills in activity and environmental analysis to find the right solution to enhance safety and independence.

The Care Act 2014

SCIE, 2024.

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  The Equality Act 2010

This act protects individuals from discrimination in the workplace and wider society, based on characteristics such as age, disability, gender, race, religion, and sexual orientation.

OTs advocate for reasonable adjustments and inclusive access. Legal duty to provide mobility aids in public services, education, and employment

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The Equality Act 2010 is not just a legal document, but a practical tool for occupational therapists in the UK. It ensures fair and inclusive access to services for all individuals, protecting them from discrimination based on disability, age, race, and gender. This aligns closely with the OT profession’s values of inclusion and empowerment. A key aspect of the Act is the duty to make reasonable adjustments, which directly relates to how occupational therapists assess environments and recommend adaptations to help individuals participate fully in daily life.

By understanding and applying the Equality Act, occupational therapists can advocate for their clients’ rights, challenge barriers to participation, and promote equitable opportunities across health, education, and community settings. This legal framework supports ethical practice and strengthens the profession’s commitment to social justice and inclusion, offering a hopeful vision of a more equitable future.

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This act introduced new legislative measures that aim to make it easier for healthcare organizations to deliver joined-up care for people who rely on multiple different services such as occupational therapy, physio, social work, etc. This act also includes targeted changes to public health, social care and the oversight of quality and safety. This act aims to integrate care systems and bring together different NHS bodies which occupational therapists are a part of. Occupational therapists contribute to multi-disciplinary teams that deliver client-centered care. This aligns with the Act’s goal to reduce bureaucracy and improve service coordination. The Royal College of Occupational Therapists (RCOT) advocates for health equity which goes hand in hand with the act's bigger goals of improving access to healthcare and improving healthcare outcomes.

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Physical Therapists and Occupational Therapists Act (1965)

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Physical Therapists and Occupational Therapists Act (1965)

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Is a law specific to Japan that has influenced other legislation. This act influenced other social welfare policies like Long Term Care Insurance Act (2000) and the Act on Comprehensieve Support for Persons with Disabilities.

"OT Work in Social Care

Funding and Service Delivery: The LTCI Act shifted the focus from hospital-based care to community-based and in-home services. OTs work across various settings funded by LTCI, such as day centers, group homes, and clients' own homes, providing interventions aimed at "meaningful occupations" and daily living activities.

Focus on Community-Based Care: Japanese social care policy strongly emphasizes integrated community care systems, allowing OTs to work in diverse settings (even farms or shopping malls) to help clients engage in meaningful activities within their local environment.

Preventative Care: There is an emphasis on preventative care and health promotion within the social care framework, encouraging OTs to help individuals maintain healthy lifestyle habits and manage chronic conditions.

Interdisciplinary Collaboration: OTs work alongside a variety of professionals, including care workers and physicians, within these systems. Their services require collaboration and adherence to standardized care plans developed under these legislative frameworks.

Cultural Context: Japanese OT practice often incorporates unique cultural values, such as valuing interdependence (rather than just independence) and considering the concepts of uchi (inside/familiar) and soto (outside/unfamiliar) when working with clients in their communities. "

What I find interesting about the Japanese approach to OT, is that they are not defining independence as the goal or standard to strive for like we are in western cultures, but rather they value interdependence and how the individual interweaves their activities and how society can facilitate a healthy mind, body and soul within their's live's flow.

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The Care Act 2014. This Act imposes a legal duty on local governments to promote individual well-being, which is consistent with the underlying philosophy of occupational therapy. The Act focuses on person-centred care, meeting needs, and enabling people to live independently for as long as possible. For occupational therapists, this means assessments and interventions must take into account not only immediate functional demands, but also broader factors such as emotional well-being, social participation, and living environment.

The Care Act also supports the OT's involvement in reablement services, home adaptations, and equipment provision, ensuring that our work directly contributes to minimising hospital admissions and promoting safe discharge. It enables OTs to advocate for their clients' rights and design solutions that maintain dignity and autonomy.