Carers

A carer is someone who helps another person, usually a relative or friend, in their day-to-day life. This is not the same as someone who provides care professionally, or through a voluntary organisation. (Department of Health, 2014).

Recognising carers and the contribution they make to society is important for raising their profile and identifying better ways of helping them to help others. Historically the needs of carers have been overlooked. Whilst this situation is improving, many carers remain socially excluded, suffer from caring-related ill-health and, once they have ceased caring, find themselves in a difficult economic position, often with little or no pension provision.  This can lead to the carers needing to access health and social care services for themselves and may impair their ability to continue providing care to the cared for person.

The economic value of unpaid care is estimated to be £132 billion nationally (Carers UK, 2015).  For Middlesbrough this would be around £328 million.

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Last updated: 2015-12-11 15:04:03
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1. What are the key issues?

During 2014, a strategic planning process was undertaken to develop key outcomes for carers in Middlesbrough.   This resulted in the Middlesbrough Strategy for supporting carers 2015–2019 (MVDA, 2015). This planning process took into account the new person and family-centred duties outlined in the Care Act 2014, which contains a new, broader definition of what it means to be a carer and includes the provision of practical and emotional support for carers: "an adult who provides or intends to provide care for another adult (adult needing care)"  - Clause 10 (3) of the Care Act 2014.

The key issues identified through the development of the Middlesbrough Strategy to support and value carers 2015-2019 are that, carers in Middlesbrough:

  • are maintaining their own health and wellbeing;
  • have worse health and lower wellbeing rates than people who do not provide care;
  • experience more social and financial isolation than people who do not provide care;
  • do not have access to appropriate services and support to ensure their needs are met; and
  • lack the support needed to be involved in commissioning decisions that shape services for carers.

 

Last updated: 11/12/15

2. What commissioning priorities are recommended?

The following are the considered commissioning priorities for carers in Middlesbrough for 2015-19.

2015/01
Ensure carers health and wellbeing is improved
by:

  • Providing a range of high quality carers services that enable choice;
  • Improving the support infrastructure for carers;
  • Changing and improving health and social care pathways so that carers are identified, their roles recognised and choice is supported throughout their caring experience;
  • Encouraging carers to register as a carer with their general practice and Adult Social Care services at Middlesbrough Council.

2015/02
Encourage social and financial inclusion
by:

  • Providing access to education and training for carers;
  • Improving understanding of carers' needs in mainstream services;
  • Increasing the range of high quality accessible information, advice and advocacy especially in relation to accessing welfare benefits;
  • Ensuring all carers have access to a range of support and services which enable choice as well as tackling loneliness and isolation.

2015/03
Provide carers with the right support at the right time
by:

  • Improving the understanding of carers' needs in health, social care and community sector organisations;
  • Enabling early identification of support needs;
  • Increase collaboration between carers, providers and commissioners to shape service planning.

 

Last updated: 11/12/15

3. Who is at risk and why?

The National Carers Strategy (DH, 2010a) identified the needs of carers in five main areas:

  • Carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role.
  • Carers will be able to have a life of their own alongside their caring role.
  • Carers will be supported so that they are not forced into financial hardship by their caring role.
  • Carers will be supported to stay mentally and physically well and treated with dignity.
  • Children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive and to enjoy positive childhoods.

All carers are at risk of poor health and well-being due to their caring role.  Carers of different client groups (i.e. different types of illness of the cared for person) face different challenges but these challenges can put them all at risk of poor health and well-being. However, some have an increased risk of poor physical and mental health.

Age
The 2011 Census shows that the peak age for caring is 50-64 (In 2001, the Census showed it was 50 to 59). More than 10% of people aged 50-64 (5 million across the UK) provide some unpaid care.

Young carers
There are 400,000 young carers in the UK, of whom 90,000 care between 0-19 hours a week (2011 Census). Some carers can be as young as 5 years old. Younger carers encounter specific problems, for example 68% of young carers report that they are bullied at school.  Young carers, many of whom are providing inappropriate levels of care, are at risk of not only poor health and well-being, but their caring role can also impact on their emotional and social development and on their education.

Working age carers
There is limited information about working age carers although we do know most carers fall into this age group.  Nationally, about one in eight (13%) adults aged 16 to 64 in full-time employment care for a sick, disabled or elderly person. However, the prevalence of caring is highest of all among the economically inactive, just over one in five of whom (21%) were spending time caring for someone.  About half of carers spending the most time (between 20 and 49 hours) caring per week were in employment in 2001. The challenges of combining paid work and informal care seems to particularly affect those undertaking substantial hours of caring per week (DWP, 2009).

Older carers
This group of carers is at higher risk of poor health as they have the additional problems associated with ageing.  A survey of experiences of older carers showed that 65% had long-term conditions or disabilities themselves, and 69% said their caring role had an adverse effect on their mental health (Princess Royal Trust for Carers, 2011).

Gender
In the UK, more women than men have a caring role; 58% of carers are women and 42% are men (Carers UK, 2012).

Socioeconomic status
Over one in five (21%) economically inactive people are carers, a rate that is more than 50% higher than for people in full-time employment (Department of Work and Pensions, 2009).

For carers who give up work there will be an impact on pension contributions and an increased risk of poverty in later life.  Amongst carers:

  • 45% are depressed about their financial position,
  • 62% have no savings,
  • 15% have turned to drink or drugs to cope with their financial situation (Princess Royal Trust for Carers, 2010).

The skills of carers are lost to the workforce and economy.

Ethnicity
Carers in black and minority ethnic (BME) communities can be reluctant to seek help, are often unaware of the support available and can become isolated in their role.  Bangladeshi and Pakistani men and women are three times more likely to provide care compared with their white British counterparts (Carers UK, 2012).

Time spent providing care
Increased time spent caring can increase the risk of poor health as the stress involved may increase and the carer has less time to consider their own health. This is particularly relevant to older carers whose health is at risk due to the normal ageing process.

 

Last updated: 11/12/15

4. What is the level of need in the population?

People with impairments
There were 15,000 adults in Middlesbrough who reported they had a limiting long-term illness (Census, 2011). There were also 15,000 adults who had a disability which limited them a lot and 14,000 adults with a disability which limited them a little.  Just over 4,800 adults accessed NHS specialist mental health services.

According to the Personal Social Services Survey of Adult Carers in England 2014-15, the majority of people cared in Middlesbrough have a physical disability (48.1%), followed by age related problems (43%) and long standing illnesses (41.2%) (Health and Social Care Information Centre, 2015).


Carers
There were a total of 14,160 adults in Middlesbrough who provide unpaid care which is over 10% of the population (2011 census).  This is a similar proportion to that seen throughout England but lower than the North East average.

Carers by time spent providing care, 2011

 

Middlesbrough

North East

England

Number

%

%

%

People providing 1-19 hours per week

7,516

5.4

6.3

6.5

People providing 20–49 hours per week

2,301

1.6

4.3

1.3

People providing 50+ hours per week

4,343

3.1

1.6

2.4

All people providing unpaid care

14,160

10.2

11.2

10.3

Source: ONS

 

Carers receive information and advice as well as more tangible services from Adult Social Care.   In Middlesbrough a higher proportion of carers than nationally are getting information and support from carers’ groups / someone to talk to in confidence.

Support services received in the previous 12 months, Middlesbrough, 2014-15

 

M’bro

North East

England

Q6a. Used information & advice services

65.7%

48.1%

53.9%

Q6b. Used support from carers groups or someone to talk to in confidence

38.7%

25.3%

30.8%

Q6c. Received training for carers

3.8%

3.5%

5.5%

Q6d. Received support to keep in employment

3.3%

2.7%

3.4%

Source: Personal Social Services Survey of Adult Carers in England, 2014-15

 

Assessment and review
Analysis was completed on a sample of carer assessments completed from the 1st January 2014 to 31st July 2014 (data extracted from Social Care Database (LAS) on 1st August 2014).   This analysis captured carers who had an individual assessment, but did not include carers who were supported by receiving “joint” services.

Number of Carers Assessed, Middlesbrough, January-July 2014

Total number of carers assessed   

221

Number of carers receiving more than one assessment during this period

9

Total number of carer assessments completed

230

 

 

Team Recording Carers Assessed, Middlesbrough, January-July 2014

Access- SSL

93

Care Management

47

Hospital

28

CMHT Older People

26

Access General

9

Physical Disabilities

7

Affective Disorder

<5

Early Intervention

<5

Learning Disabilities

<5

Psychosis

<5

Transitions

<5

Total

221

 

Age and Gender Breakdown, Middlesbrough, January-July 2014

 

18-64

65-74

75-84

85+

Total

Female

107

31

16

5

159 (72%)

Male

30

14

12

6

62 (28%)

Total

137

45

28

11

221

 

Ethnicity, Middlesbrough, January-July 2014

Ethnicity

Carers

Middlesbrough Population

White

187 (89.5%)

88.3%

Asian / Asian British

19 (9.1%)

7.3%

Other

3 (1.4%)

4.4%

Not obtained

12

 

Total

221

 

 

Outcome of Carer Assessment by Age, Middlesbrough, January-July 2014

 

18-64

65-74

75-84

85+

Total

Carer Specific Services

61(65%)

24(26%)

<5

<5

94

Carer Emergency Card

50

20

10

<5

82

Community Care Services to give carer a break

19(65%)

<5

<5

<5

29

Signposting and/or advice given to carer

16

5

<5

<5

25 (9%)

Sanctuary Supported Living Carers Outreach Service

9

<5

6

<5

18

Professional Support

7

0

<5

<5

12(4%)

Other – not specified   

7

2

2

1

12

No change to existing services

7

sup

sup

sup

8

MIND MH carers support service     

<5

0

0

0

<5

No further action

<5

0

<5

0

<5

No services offered     

<5

<5

0

0

<5

Services removed/increased/reduced

<5

0

<5

0

<5

Referred to another agency

0

<5

0

0

<5

Service User Emergency Card

0

<5

0

0

<5

Total

 

 

 

 

292

 

 

Last updated: 11/12/15

5. What services are currently provided?

Commissioned services specific to Middlesbrough include:

  • Adult Services Carers Centre Resources
  • Carers Assessments
  • Carer Respite: Additional Services for the Service User
  • Carer Service Resources for Carers with Specific Needs
  • GP Carer Workers
  • Hospital Carer Workers 
  • Information, Advice and Advocacy
  • Moving and Handling Training for Carers
  • Resources for Young Carers and Child Carers
  • Supporting Carers to Cope with Caring 

 

Implementation of national priorities include:

  • Care Act 2014
  • Carer Engagement
  • Developing Local Authority Carer Assessments
  • Embedding Carer Support in Social Care All Work Streams
  • Embedding Carer Support in Public Health All Work Streams
  • Embedding Carer Support in All Health Work Streams
  • Joint Commissioning, Better Care Fund
  • Links to Strategies for Child Carers and Young Carers
  • Support Carer Awareness Training for Health Staff 

 

Last updated: 11/12/15

6. What is the projected level of need?

In Middlesbrough the population aged over 65 (the most likely to need care) unable to manage at least one self-care activity on their own is projected to increase from 7,500 in 2015 to 9,100 in 2025.

Forecast number of people aged over 65 unable to managed at least one self-care activity, Middlesbrough, 2015-2025

 

2015

2020

2025

Age 65-74

2,583

2,880

3,045

Aged 75-84

2,985

3,008

3,381

Aged 85 and over

1,916

2,291

2,666

Total population over 65 unable to manage at least one self-care activity

7,484

8,179

9,092

Source: www.poppi.org.uk

 

In terms of people with a long-term illness (again the most likely to need care) a total of 12,500 people in 2015 have an illness which limits their day-to-day activities and this is projected to rise to 13,700 in 2020 and 15,300 in 2025.

Forecast number of people aged over 65 with a long-term condition which limits their day-to-day activities, Middlesbrough, 2015-2025

 

2015

2020

2025

Age 65-74

5,651

6,221

6,601

Aged 75-84

4,945

5,075

5,856

Aged 85 and over

1,945

2,363

2,848

Total population over 65 whose daily activities are limited

12,541

13,659

15,305

Source: www.poppi.org.uk

 

It is estimated that there were 14,200 carers in Middlesbrough receiving services in 2011.  This compares to the estimates of the numbers of unpaid carers aged over 65 of 3,000 in 2015 and rising to 3,200 by 2020 and 3,500 by 2025 (Projecting Older People Population Information, 2014).

Forecast number of unpaid carers aged over 65, by age group, Middlesbrough, 2015-2025

 

2015

2020

2025

Age 65-74

1,802

1,975

2,099

Aged 75-84

955

978

1,134

Aged 85 and over

207

251

302

Population aged 65 and over providing unpaid care to a partner, family member or other person

2,964

3,204

3,535

Source: www.poppi.org.uk

 

To consider whether other activities may be sought by carers the following table show the hours that carers are estimated to spend on caring duties.

Forecast number of carers aged over 65 by age and hours of care provided, Middlesbrough

 

Hours of care provided

2015

2020

2025

Aged 65-74

Not providing any care

9,953

11,560

11,801

Between 1 and 19 hours per week

793

862

919

Between 20 to 49 hours per week

373

249

265

50 or more hours per week

781

429

915

Aged 75-84

Not providing any care

6,591

6,822

7,866

Between 1 and 19 hours per week

286

293

341

Between 20 to 49 hours per week

132

135

156

50 or more hours per week

591

550

637

Aged 85+

Not providing any care

2,793

4,249

3,698

Between 1 and 19 hours per week

40

48

58

Between 20 to 49 hours per week

29

35

42

50 or more hours per week

38

168

202

 

Source: www.poppi.org.uk

 

 

Last updated: 11/12/15

7. What needs might be unmet?

Only a small proportion of the people who considered themselves to be carers in the 2011 census is known to Adult Social Care or is in receipt of services. There is little information about the needs of carers from BME backgrounds; carers in work or seeking to return to work; and carers of people who have drug and alcohol problems.

 

Last updated: 11/12/15

8. What evidence is there for effective intervention?

National Guidance

Care Act 2014
A significant piece of legislation for carers, the responsibility for implementation rests with Local Authorities.  For the first time carers are recognised in law and this Act sets out legal rights for carers to receive assessments and support and for local authorities to promote carers health and wellbeing.

Children and families Act 2014
This Act gives young carers rights similar to those of adults in the Care Act 2014.

Our health, our care, our say (Department of Health, 2006)
Sets out the government’s commitment to put people more in control and make services more responsive to the needs of individuals. Innovation is encouraged to allow greater service user choice and there is an emphasis on prevention and earlier intervention and more support to maintain mental health and emotional well-being.

Recognised, valued and supported (Department of Health, 2010a)
Sets out the support needed by carers to maintain / improve their health and well-being and to carry out their caring role in four main areas:

  • Supporting carers to identify themselves as carers at an early stage
  • Enabling carers to fulfil their educational and employment potential
  • Provision of personalised support for carers and those they support
  • Supporting carers to remain mentally and physically well.

Carers and Personalisation: improving outcomes (Department of Health, 2010b)
A guide on emerging evidence, including examples to illustrate how the principles of personalisation have been applied, emphasising the value of finding ways forward that make sense and work best locally.  Includes:

  • Carers as expert care partners & whole family approaches
  • Early intervention and prevention
  • Making self-directed support processes work for carers.

New Approaches to Supporting Carers’ Health & Wellbeing (Centre for International Research on Care, Labour & Equalities & University of Leeds 2011)
This programme was developed by the Department of Health as part of its commitments made in the National Carers Strategy in 2008. The commitments included new measures to improve carers’ health and well-being. The programme focused on breaks, health checks and better NHS support for carers. Sites looked at new and innovative ways to engage with carers and deliver services.

The programme was delivered over 18 months and supported over 18,500 carers. Analysis of the programme produced evidence-based conclusions and recommendations for improving carer support services:

  • Breaks from the caring role 
  • Health checks for carers
  • Creative and innovative approaches
  • Establishing carers’ champions in GP practices
  • Services need to be accessible from a variety of venues
  • Local authorities, NHS organisations and voluntary organisations working together
  • Involving a diverse range of carers in service development
  • Local partnerships should work flexibly and sometimes on an ad hoc basis to engage carers
  • Effective carer support to include a varied portfolio of carer support services
  • Locally agreement of portfolios of care between local authorities, NHS organisations, voluntary sector organisations and other agencies

A review of research on interventions to support carers (Parker et al, 2010) found that:
"The strongest evidence of effectiveness of any sort from our meta-review is in relation to education, training and information for carers."  However, they noted that, overall, the evidence base is poor.

 

Last updated: 11/12/15

9. What do people say?

According to the Personal Social Services Survey of Adult Carers in England 2014-15:

  • Majority of carers are satisfied with support or services in previous twelve months (68.1%)
  • Majority of carers had not received a break from caring role in past twelve months (67.8%)
  • Majority have used advice and information services in past twelve months (65.7%)
  • Majority have not used home care services in past twelve months (63.6%)
  • Majority have not used day care services in past twelve months (70.2%)
  • Majority have not used permanent residential services (82.6%)
  • A lower number of carers feel they have been involved in decision discussions about services (47.6%)

 

Last updated: 11/12/15

10. What additional needs assessment is required?

Carers UK estimate that although Middlesbrough has one of the highest claimant rates (1,500) there are still considerable numbers of carers are not claiming the Carers Allowance that they are entitled to.  A full picture of unclaimed allowances needs to be obtained.

Carers should also be made aware of the following:

Health tips

  • Eat properly and drink plenty of fluids
  • Get regular check-ups from the GP
  • Let your GP know you are a carer 
  • Have a medication check regularly
  • Have a flu jab (free for carers)
  • Access massages or holistic therapies
  • Know your local pharmacy
  • Get plenty of sleep and if you can’t sleep get help
  • Dress appropriately for the weather

Tips to tackle loneliness and isolation

  • Join a local carers group so you can connect with other carers
  • Take regular respite breaks
  • Keep in touch with family & friends
  • Talk to others
  • Use skype or take part in online blogs
  • Take up a hobby
  • Join the gym 
  • Visit your local library
  • Get to know what help is out there
  • Access all the welfare benefits
  • Take up volunteering
  • Have a carers assessment
  • Notify you employer that you are a carer
  • Access discount cards

Access to free flu jabs
The injected flu vaccine is offered free of charge on the NHS to people who are at risk.  Eligibility criteria:

  • People 65 years of age or over   
  • Women who are pregnant 
  • People who have certain medical conditions 
  • People who are very overweight
  • Those living in a long-stay residential care home or other long-stay care facility 
  • Those who receive a carer's allowance or the main carer
  • Front-line health and social care worker

 

Last updated: 11/12/15

Key Contact

Name: Craig Duerden
Job Title: Strategic Development Officer
E-mail: craig.duerden@mvdauk.org.uk
Phone: 01642 357855

Name: Richard Pink
Job Title: Commissioning Lead, Older People and Carers
E-mail: richard_pink@middlesbrough.gov.uk
Phone: 01642 729257

References

Local strategies and plans

Middlesbrough Voluntary Development Agency (MVDA, 2015). Middlesbrough Strategy for supporting carers 2015–2019

 

National strategies and plans

Department of Health (2010a) Recognised, valued and supported: next steps for the Carers Strategy.

Department of Health (2008). Carers at the heart of 21st century families and communities: a caring system on your side, a life of your own.

Department of Work and Pensions (2009) Employment support for carers

Department of Health (2014). Care Act 2014

Department for Education (2014). Children and families Act 2014

 

Other references

Carers UK (2015). Valuing carers 2015 – The rising value of carers’ support.

Centre for International Research on Care, Labour & Equalities & University of Leeds (2011). New Approaches to Supporting Carers’ Health & Wellbeing: Evidence from the National Carers’ Strategy Demonstrator Sites Programme.

Department of Health (2010b). Carers and Personalisation: improving outcomes.

Department of Health (2010). Our health, our care, our say.

Health and Social Care Information Centre (2015). Personal Social Services Survey of Adult Carers in England, 2014-15

Parker, G; Arksey, H; and Harden, M (2010). Meta-review of international evidence on interventions to support carers. Social Policy Research Unity, University of York

Princess Royal Trust for Carers (2010) Broke and Broken: Carers battle poverty and depression.

Princess Royal Trust for Carers (2011) Always on call always concerned: A Survey of the Experiences of Older Carers.

Projecting Adult Needs and Service Information (PANSI)

Projecting Older People Population Information (POPPI)