Wellbeing and quality of life

Kind Minds with KM promotes wellbeing in line with the Care Act and, through assessment and intervention, supports quality of life in ways recognised by established frameworks such as WHOQOL and the ONS (2025) wellbeing measures. This ensures that support is meaningful, person‑centred, and grounded in well‑established, evidence‑based standards.

Wellbeing and quality of life measures

Wellbeing

Understanding Wellbeing under the Care Act 2014

WHO QoL

Understanding the World Health Organization’s definition of Quality of Life

UK ONS QoL

The UK Office for National Statistics (ONS) definition of Quality of Life.

Wellbeing and the Care Act 2014

Understanding Wellbeing and Unmet Needs Under the Care Act 2014

Under the Care Act 2014, unmet needs—whether they meet eligibility criteria or not—can have a significant impact on one or more aspects of a person’s wellbeing. This is especially relevant for individuals with Autism Spectrum Disorder (ASD), neurodivergence, and mental health needs, whose support requirements are often misunderstood, minimised, or under‑assessed.

Unmet social care needs (both eligible and non‑eligible) may affect any or all of the wellbeing domains described in the Care Act 2014. These include areas such as emotional wellbeing, personal dignity, physical and mental health, relationships, safety, control over daily life, and participation in work, education, or community life.

Local authorities have a legal duty to promote a person’s wellbeing whenever they carry out any care and support function. This is often referred to as the wellbeing principle because it places the person’s overall wellbeing at the centre of all decisions, actions, and assessments.

Wellbeing is a broad, holistic concept. Under the Care Act, it includes (but is not limited to):

Personal dignity and respectful treatment
Physical and mental health, and emotional wellbeing
Protection from abuse and neglect
Control over day‑to‑day life, including how care is provided
Participation in work, education, training, or recreation
Social and economic wellbeing
Domestic, family, and personal relationships
Suitable living accommodation
Contribution to society

These areas reflect the full spectrum of what matters in a person’s life. There is no hierarchy within the wellbeing domains, and each aspect must be considered with equal importance when understanding a person’s needs and circumstances.

All Wellbeing Domains Matter Equally. There is no hierarchy within the wellbeing domains. Every area counts. Every area must be considered. Even an impact on one single domain can meet the criteria for support.

Understanding wellbeing and identifying unmet social care needs is essential not only for adults with care and support needs, but also for carers, and—crucially—for children and young people who are eligible for a transition assessment as part of Preparing for Adulthood (PfA).

This includes children and young people with SEND, young carers, and Looked After Children, whose needs may be complex, evolving, or easily overlooked. A clear understanding of wellbeing as wll impact of unmet needs ensures that support is proactive, strengths‑based, and responsive to the barriers these young people face as they move towards adulthood.

Under the Care Act 2014, an adult’s needs meet the eligibility criteria when three conditions are met:

1. Their needs arise from, or are related to, a physical or mental impairment or illness.

2. Because of those needs, they are unable to achieve two or more specified daily outcomes.

3. As a result, there is — or is likely to be — a significant impact on their wellbeing.

The final third condition of the eligibility test requires local authorities to look beyond tasks and checklists and consider the real‑life impact of a person’s needs. Even if someone has needs linked to an impairment (Condition 1) and struggles to achieve key daily outcomes (Condition 2), the local authority must still determine whether these difficulties:

cause, or
risk causing

a significant impact on the person’s wellbeing.

A “significant impact” does not mean a crisis or severe harm. It simply means that the person’s needs are having a genuine, noticeable effect on their day‑to‑day life, independence, safety, stability, or ability to pursue what matters to them.

In practice, this part of the assessment focuses on the person’s lived experience — how their needs shape their routines, relationships, choices, and overall quality of life — ensuring that support is based on what truly affects their wellbeing. This means the assessment should go beyond tasks and checklists, focusing instead on the real‑life impact of the person’s needs as described by wellbeing principles.

Examples:

Anxiety or sensory overwhelm stops someone leaving the house
Executive dysfunction makes it difficult to manage daily routines
Burnout or depression affects personal care or home management
Trauma responses impact relationships or safety
Difficulties with planning or organisation affect work or education
Sensory sensitivities make cooking or shopping overwhelming
Fatigue or cognitive overload reduces independence

The law requires local authorities to take these impacts seriously — even when they are invisible or fluctuate day to day.

Why This Matters

For autistic adults, ADHDers, and people with mental health conditions, the third condition is especially important because it recognises:

Invisible disabilities
Fluctuating needs
Masking and “pushing through”
Emotional and sensory barriers
Executive functioning challenges
The cumulative impact of unmet needs

The Care Act requires local authorities to look at real‑life functioning, not assumptions, appearances, or how someone presents on a “good day.”

As mentioned above, the Care Act sets out a number of wellbeing domains that must be considered during any assessment and actively promoted. These domains reflect the full picture of a person’s life — their health, safety, independence, relationships, daily routines, sense of control, and ability to participate in their community.

Unmet social care needs (eligible and/or non-eligible) -

Examples of Impact Across Wellbeing Domains.

Impact of unmet needs can include the risk or deterioration of physical and mental health, a decline in emotional well-being, gaps in support or missed chances for intervention, and an increased risk of hospital admission.

Personal Dignity - Feeling disrespected or dismissed due to communication differences or lack of understanding

Physical & Mental Health - Increased anxiety, depression, or physical health deterioration due to lack of support

Protection from Abuse - Greater vulnerability to exploitation or harm, especially in unsupported environments

Control Over Life - Impulsivity, loss of autonomy, rigid routines imposed, or decisions made without consent or capacity.

Participation in Activities - Isolation, lack of purpose, or missed opportunities for growth and inclusion

Social & Economic Wellbeing - Financial hardship, social exclusion, or inability to access benefits or services

Relationships - Breakdown of family or personal relationships due to stress or lack of support

Living Accommodation - Unsafe, unsuitable, or unstable housing that worsens mental health or sensory needs, an unsuitable setting without sensory adaptations, leading to distress and withdrawal.

Contribution to Society - Talents and strengths go unrecognised, leading to low self-esteem and disengagement

Examples of wellbeing being supported and encouraged, in line with the wellbeing domains set out in the Care Act 2014.

Personal Dignity - Respectful treatment and recognition of the individual’s worth

Being spoken to respectfully and not dismissed due to communication differences
Having privacy during assessments or care tasks
Being involved in decisions about own care and support
Being able to use preferred communication styles (e.g., visual aids, written formats, quiet environments).
Being involved in all decisions
Respected and supported sensory needs

Physical, Mental Health and Emotional Wellbeing - Support for both physical and psychological needs

Access to sensory-friendly environments
Support for managing anxiety, depression, or trauma and any other co-morbid needs.
Help with routines that support sleep, nutrition, and emotional regulation.
Trauma-informed support— having recognised past experiences, include neurodivrgent trauma and avoiding re-traumatisation. and/or stigmatisation.
Support self-regulation strategies (e.g., stimming, quiet time, sensory tools)
Substance misuse prevention and recovery.

Protection from Abuse and Neglect - Safeguarding from harm, exploitation, or mistreatment include self-neglect

Safeguarding from bullying, rejection, stigmatisation or exploitation, especially in unfamiliar settings
Support to understand and assert personal boundaries
Help recognising unsafe situations or relationships
Understanding rights and boundaries.
Awareness of triggers and risk factors.

Control Over Day-to-Day Life - Choice and autonomy in how care and support are delivered

Choosing who supports and how
Having input into the daily schedule and routines
Having access to communication tools (e.g., visual aids, apps) to express preferences

Participation in Work, Education, Training or Recreation - Opportunities to engage in meaningful activities

Access to neurodivergent friendly volunteering or training opportunities
Adjustments in the workplace or classroom (e.g., quiet spaces, flexible hours)
Support to explore interests and build confidence
Link with neurodivergent friendly employers
Support in disclosure and self-advocacy
Support with transport and mobility.

Social and Economic Wellbeing - Inclusion, financial stability, and access to community resources

Help managing finances or benefits
Support accessing community resources or social groups
Assistance with budgeting or planning for independence
Support access to community resources (e.g., libraries, social groups).
Recognise the impact of poverty and social exclusion
Support with transport and mobility.

Domestic, Family and Personal Relationships - Support to maintain and develop important connections

Support to maintain contact with family or trusted others.
Help navigate social situations or resolve misunderstandings
Encouragement to build new relationships in safe, supported ways
Facilitate safe spaces for connection (e.g., peer support, family mediation).

Suitability of Living Accommodation - Safe, appropriate, and accessible housing

Housing that meets sensory and accessibility needs
Support with tenancy, bills, or household tasks
Help finding safe, stable accommodation
Support tenancy sustainment (e.g., help with bills, routines, landlord and services communication).

Contribution to Society - Recognition and support for the individual’s role and value in their community

Opportunities to volunteer, share lived experience, or mentor others
Recognition of strengths and talents
Support to engage in community projects or peer networks
Recognise and celebrate strengths
Encourage civic participation (e.g., voting, community projects)

WHO Definition of Quality of Life

The World Health Organisation defines Quality of Life as:

“an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”

This definition emphasises that quality of life is subjective, multidimensional, and shaped by cultural context, personal values, and individual expectations.

The World Health Organisation says that quality of life is about how a person feels about their life — their health, their relationships, their environment, and their ability to do what matters to them.

It’s shaped by:

the culture and community they live in,
their personal goals and hopes,
their expectations for the future,
and the things they worry or care about.

In short, Quality of life is how people see and experience their own life, in their own context.

The WHOQOL Framework

The World Health Organisation Quality of Life (WHOQOL) assessment was developed by the WHOQOL Group in collaboration with 15 international field centres. Its purpose is to provide a cross‑culturally valid way of understanding how people experience their quality of life. The most recent revision of the WHOQOL instruments was released in 2012 by the WHO’s Health Promotion (HPR) division.

WHOQOL measures quality of life across six key domains, each containing multiple facets that reflect different aspects of a person’s lived experience.

Domain 1 — Physical Health

Pain and discomfort
Energy and fatigue
Sleep and rest

Domain 2 — Psychological

Positive feelings
Thinking, learning, memory, and concentration
Self‑esteem
Body image
Negative feelings

Domain 3 — Level of Independence

Mobility
Activities of daily living
Dependence on medication or treatments
Work capacity

Domain 4 — Social Relationships

Personal relationships
Social support
Sexual activity

Domain 5 — Environment

Financial resources
Safety and security
Access to health and social care
Home environment
Opportunities for information
Recreation and leisure
Physical environment
Transport

Domain 6 — Spirituality / Religion / Personal Beliefs

Meaning in life
Spirituality
Personal beliefs

A Holistic Model of Wellbeing

Together, these domains reflect the holistic nature of the WHOQOL model. It looks beyond medical symptoms to capture the broader lived experience of individuals across different cultures, environments, and value systems. This makes WHOQOL a widely recognised and respected framework for understanding wellbeing in a person‑centred, culturally sensitive way.

A Care Act– and SEND‑Aligned Interpretation of the WHOQOL Framework

The WHOQOL model aligns closely with the Care Act 2014 and the SEND Code of Practice (0–25) because all three frameworks emphasise wellbeing, participation, independence, and the lived experience of the individual.

Below is an interpretation of each WHOQOL domain through a Care Act and SEND lens.

Note: Please also read the Care Act 2014 eligibility criteria page.

- Understanding Fluctuating Needs

- What “Being Unable to Achieve an Outcome” Really Means

1. Physical Health

This domain reflects how physical health, as well as energy and fatigue, sleep, and rest, may affect daily life, independence, and participation. Under the Care Act and SEND Code, practitioners consider how health conditions influence functioning, access to education, and the ability to engage in meaningful activities. Support focuses on reducing barriers, promoting safety, and enabling individuals to live as independently as possible.

WHOQOL focus: pain and discomfort, energy and fatigue, sleep and rest. It considers how physical symptoms influence a person’s ability to function, participate, and maintain wellbeing.

Care Act link: physical and mental health; protection from abuse and neglect; and t

Pain and discomfort, energy and fatigue, sleep and lack of rest, and other physical symptoms directly affect a person’s ability to meet Care Act outcomes safely, consistently, and without distress.

SEND link: health needs within EHC plans; impact on learning and participation

The WHOQOL's focus on pain, fatigue, and sleep closely aligns with SEND's consideration of how health needs affect learning, participation, and day‑to‑day functioning. Physical health difficulties mentioned by WHOQOL will likley affectstamina and

stamina and energy for learning
attendance and engagement
sensory regulation
sleep and concentration
participation in school routines and social activities

2. Psychological Wellbeing

WHOQOL focus: emotions, thinking, self‑esteem, body image
Care Act link: emotional wellbeing; control over day‑to‑day life
SEND link: social, emotional, and mental health (SEMH) needs

Interpretation:
Psychological wellbeing is central to both Care Act and SEND assessments. This includes emotional regulation, confidence, resilience, and the impact of trauma or neurodivergence. Support aims to strengthen coping strategies, promote positive identity, and ensure that interventions are sensitive to the person’s developmental stage and lived experience.

3. Level of Independence

WHOQOL focus: mobility, daily living, reliance on treatment, work capacity
Care Act link: independence; ability to carry out daily living activities
SEND link: preparation for adulthood; independence skills

Interpretation:
This domain aligns directly with the Care Act’s emphasis on enabling people to maintain or regain independence. For children and young people, it links to SEND outcomes around developing life skills, autonomy, and confidence. Support focuses on strengths, reasonable adjustments, and reducing barriers to participation.

4. Social Relationships

WHOQOL focus: personal relationships, social support, sexual relationships
Care Act link: family and personal relationships; social participation
SEND link: friendships, peer relationships, and social inclusion

Interpretation:
Healthy relationships are a core component of wellbeing. Both the Care Act and SEND Code emphasise the importance of supportive networks, belonging, and reducing isolation. Interventions may focus on communication skills, social confidence, safeguarding, and strengthening natural support systems.

5. Environment

WHOQOL focus: safety, finances, home environment, access to services, leisure, transport
Care Act link: suitability of living accommodation; participation in work, education, training, recreation
SEND link: access to education, reasonable adjustments, inclusive environments

Interpretation:
Environmental factors shape a person’s ability to thrive. This includes safe housing, accessible services, financial stability, and opportunities for meaningful activity. Care Act and SEND assessments consider how the environment supports or restricts wellbeing, and what adjustments or services are needed to promote inclusion and independence.

6. Spirituality / Religion / Personal Beliefs

WHOQOL focus: meaning, purpose, beliefs
Care Act link: personal dignity; individual views, wishes, feelings, and beliefs
SEND link: person‑centred planning; respecting identity and culture

Interpretation:
This domain reflects the importance of identity, values, and meaning. Care Act and SEND frameworks both require practitioners to respect the individual’s beliefs, culture, and preferences. Support is shaped around what matters most to the person, ensuring dignity, respect, and culturally sensitive practice.

Why This Matters for Kind Minds with KM

Intergrating WHOQOL approach alongside the Care Act and SEND Code ensures that assessments and interventions are:

holistic — looking at the whole person, not just symptoms
strengths‑based — focusing on abilities, not deficits
person‑centred — shaped by the individual’s goals and values
developmentally appropriate — aligned with SEND principles
evidence‑based — grounded in internationally recognised frameworks

This approach supports meaningful, personalised outcomes and ensures that wellbeing is understood in the context of the person’s life, culture, environment, and aspirations.

Example of Intergrating WHOQOL approach alongside the Care Act and SEND Code: Impact of Transport Without Appropriate Assistance

A young person with SEND expressed significant distress during transport to school when travelling without personal assistance. This distress directly affects several areas of functioning that are recognised within the SEND Code of Practice and wellbeing frameworks:

Stamina and energy for learning - Distress before school reduces capacity to engage, concentrate, and retain information.
Attendance and engagement - Anticipatory anxiety about transport can lead to refusal, lateness, or reduced participation.
Sensory regulation - Without support, sensory overload during transport can escalate into dysregulation that continues into the school day.
Sleep and concentration - Stress around transport can disrupt sleep patterns, which then impacts attention, memory, and emotional regulation.
Participation in school routines and social activities - Arriving dysregulated or exhausted reduces the young person’s ability to join lessons, interact with peers, and benefit from the school environment.

These impacts are predictable, preventable, and directly linked to the absence of appropriate support.

Failure to Hear the Child and Parent’s Views

If the local authority refuses to consider the child’s and parents’ views, wishes, and feelings, this is likely to:

worsen the young person’s distress,
increase barriers to learning and participation,
undermine wellbeing,
and contravene statutory duties under the SEND Code of Practice, which requires decisions to be person‑centred, co‑produced, and based on the lived experience of the child and family.

Ignoring these views is not only poor practice — it is likley legally non‑compliant.

Legal Rationale

1. Essex County Council Transport Policy (page 13)

The policy states that children with an EHCP must be transported in a way that prepares them for learning upon arrival, and

ensures their comfort and safety. If a child arrives distressed, dysregulated, exhausted, or unable to learn, the transport arrangement fails to meet the policy requirement.

2. Case Law: R v Hereford and Worcester County Council, ex parte P [1992] 2 FCR 732

This case established that home‑to‑school transport must enable a child: “to reach school without undue stress, strain or difficulty such as would prevent him from benefitting from the education the school has to offer.”

This principle is still relied upon in SEND law today.

If a child arrives:

distressed,
dysregulated,
exhausted,
or unable to engage in learning,

Then the transport arrangement arranged by the local authority likely fails to meet this legal standard.

Conclusion

When a young person with SEND experiences distress during transport, and the local authority refuses to consider the child’s and parents’ views, this:

undermines the child’s ability to learn,
contradicts the SEND Code of Practice,
breaches the Essex County Council’s own transport policy, and
conflicts with established case law requiring transport to be safe, suitable, and free from undue stress.

A lawful and person‑centred response requires the local authority to review the transport arrangements, consider the child’s lived experience, and provide the necessary assistance to ensure the child arrives at school regulated, safe, and ready to learn.

The UK Office for National Statistics (ONS) measure Quality of life in the UK across 59 measures of well-being, grouped by 10 topic areas:

Personal well-being – which is the most direct representation of how people are doing. Measures in this topic area cover people’s opinions on aspects of their current well-being. Within this topic following measures are included:

Life satisfaction
Feeling things done in life are worthwhile
Happiness
Feeling anxious
Hope for the future
Fair treatment

Relationships - People's relationships can affect their well-being outcomes, including quality of life and happiness. Measures in this topic area cover the presence and quality of relationships people may have with family, friends, and the community around them. Within this topic following measures are included:

Unhappy partner relationships
Satisfaction with social relationships
People to rely on
Loneliness
Local community integration
Trust in others

Health - Physical and mental health are important parts of people’s personal well-being. Measures in this topic area cover both objective and subjective measures of health. They also cover satisfaction with the healthcare system to capture how the nation’s health is supported. Within this topic following measures are included:

Healthy life expectancy
Satisfaction with health
Physical health conditions
Depression or anxiety
Satisfaction with healthcare system

What we do - Participation in, satisfaction with, and balance between work and leisure activities represent people’s lifestyle choices. Measures in this topic area cover subjective and objective measures related to work, leisure and volunteering. Within this topic following measures are included:

Satisfaction with time use
Satisfaction with main job
Time spent on unpaid work
Volunteering
Engagement with arts and culture
Sports participation
Visits to nature

Where we live - Where people live, the quality of their local area and their community, and how they feel about it can affect personal well-being. Measures in this topic area cover housing, the local environment, access to facilities, and being part of a cohesive community. Within this topic following measures are included:

Satisfaction with accommodation
Satisfaction with local area
Belonging to neighbourhood
Digital exclusion
Crime
Feeling safe

Personal finance - How households and individuals are managing financially influences many aspects of their lives. Measures in this topic area cover household income and wealth, poverty and financial inequalities, and people’s opinions about their own financial situations. Within this topic following measures are included:

Median household income
Median household wealth
Relative low-income households
Household income inequality
Gender pay gap
Difficulty managing financially

Education and skills - Education and skills can determine individuals’ socioeconomic outcomes. Measures in this topic area cover human capital, as well as qualifications and skills. They also cover satisfaction with the education system to capture how people’s education is supported. Within this topic following measures are included:

Not in education, employment or training (NEET)
No qualifications
A-level or equivalent qualifications
Human capital
Satisfaction with own education and skills
Satisfaction with education system

Economy - The economy affects the financial welfare of individuals, communities and the UK as a whole. Measures in this topic area cover economic activity in the UK. They also cover consumer confidence to capture people's perceptions of the country's economic situation. Within this topic following measures are included:

Unemployment rate
Inflation rate
Public sector net debt
Consumer confidence

Governance - Good governance contributes to better social and economic outcomes. Measures in this topic area cover public trust and civic participation. They also cover satisfaction with the police and justice system to capture how public administration is supported. Within this topic following measures are included:

Voter turnout
Trust in UK government
Voice in government matters
Satisfaction with police
Satisfaction with courts and legal system

Environment - The natural environment is relevant to people’s quality of life because it makes human life and activity possible. Measures in this topic area cover aspects of climate change, the UK’s natural environment and natural capital, and the effects of human activity on the environment. Within this topic following measures are included:

Greenhouse gas emissions
Renewable energy use
Household recycling
Protected areas
Priority species
Air pollution
Surface water status
Pro-environmental lifestyle

Anyone can explore current trends in national and personal well-being across the UK, with this overview offering insights at individual, community, and national levels. It can help reveal which life factors are linked to Health and Social Care.

UK Measures of National Well-being Dashboard - Office for National Statistics

ONS data shows that quality of life in the UK is strongly shaped by:

Healthcare access
Difficulty contacting GPs and concerns about NHS performance directly affect well‑being.

Mental health and life satisfaction

Life satisfaction and anxiety levels are key indicators in ONS well‑being dashboards.

Social support and relationships

High levels of social support are linked to better outcomes in health and social care settings.

Community and environment

Where people live — safety, green spaces, pollution — influences both physical and mental health.

Financial stability

Inflation, debt, and personal finance pressures affect stress, health, and access to services

Wellbeing and quality of life