Carers

The Department of Health report Commitment to Carers 2014 states that – ‘a carer is anybody who looks after a family member, partner or friend who needs help because of their illness, frailty or disability. All the care they give is unpaid’

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 £87 billion nationally (Carers UK & University of Leeds, 2011).  For Redcar & Cleveland this would be around £268 million.

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Last updated: 2015-12-11 16:46:27
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1. What are the key issues?

Priority areas were identified by adult, young and parent carers during consultation in 2013-14 and are identified below. These have informed the development of the R&CBC Joint Carers Strategy 2014-19 and the actions that partners are going to take to address these issues.

Comments from Adult Carers

Information & advice
Carers have told us that they value face-to-face contact and emotional support more than anything else. Carers would like support in emergencies and out of hours. Carers have identified that the main area for improvement is for Local Authority and NHS staff to “know the system 100%” and carers want to be treated as partners in care. Carers feel they should be involved more fully in the hospital discharge process.

Active & supportive communities
Carers want more appropriate support and the freedom to tailor that support to their own needs. This includes the need to have flexible support, available on evenings and at weekends; time for group activities and 1:1 activities. Many carers reported how helpful they found the Breaks for Carers Fund in 2012/13 because it was very flexible.
Carers expressed a need to understand clearly how the cared for person’s personal budget is allocated and in particular how this is used to pay for care at home services.

Personal budgets & self-funding
Carers would like more involvement in and influence over the planning of the cared for person’s support plan within their personal budget / direct payment, so that they can ensure value for money with regards to local activities and more choice in how they receive support to help manage direct payments.

Flexible & integrated care & support
Carers value very highly the need for good communication both between organisations and across borough boundaries, so that those who are “living out of borough” are not disadvantaged in any way.

Carers indicated that the kind of support they want is through a named, non-judgemental social worker or a “champion” who will know their story, so that it will not have to be repeated over and over; and someone who can support both “the person and the family in all areas”.

Workforce
Carers feel that professionals do not value their expertise and knowledge as carers.
Carers need to feel confident that any complaint they make will not have a negative impact on the person they care for.

Risk enablement
Carers rate very highly the opportunity to work with staff who have good listening skills because they feel that they get the desired outcome quickly and efficiently, and this reduces the likelihood of a breakdown in care.

It is important to carers that staff are available to listen and respond quickly to carers’ needs.

Carers' views on health services.
Carers want improved communication with themselves by all professionals; and a more holistic view of the family situation so that staff who are involved with the family have up to date information about the family circumstances.

Carers use GP services primarily and they asked that appointment systems should be easier to use and understand; GPs should be more willing to visit patients at home and that there should be greater continuity of care with the same GP.

Carers and families should be given more information about the patient’s condition and how to manage it and staff should check that carers have fully understood the information they are given. They also need help to understand what to do if the person’s condition worsens.

They would like to see more respite care provided.

Carers want to see better information for carers and people who have dementia with a wider range of support services in place.

They thought it was very important that professionals listened to what carers knew about the cared for person and carerws and professionals should work together to keep each other informed about changes in the cared for persons health and how to manage this.

Carers for people with alcohol and drugs problems
Problematic drug use affects many people besides the person using the drugs. Family members and close friends, for example, can experience significant stress and health problems as a result of being close to and concerned about the person with the drug problem. The impact can also spread more widely, for example affecting family members’ employment, their social lives and relationships, and family finances.

Comments from young carers

Young carers and family support
Young carers said that they need resources and support for themselves and their families including one to one support, counselling, therapeutic group work, activities and whole family support, to reduce the negative impacts of their caring responsibilities on themselves and to maintain early intervention and prevention of break down in their home situation.

Young carers increase in self confidence
Young carers said that they want help to increase their skills and to develop their self-confidence and wanted help to make positive plans for their future.

Increased awareness of young carers' needs by schools
Young carers have said that they want to work with all local secondary schools to increase the awareness of staff and teachers about the needs of young carers so that they can provide more support to young carers throughout their school careers.

Make life better for young adult carers
Young adult carers want the opportunity to access information and support to help them navigate through their options; re-assurance about managing the impact on the cared for person(s) and their family, and access to peer support networks.  This approach provides the confidence for Young Adult Carers to successfully move forward with their own lives and aspirations.

In other cases the young adult carers are the main carer, and they are starting to take on more responsibility which has an ongoing negative impact on their own lives. They want some help to focus on their own independence, aspirations, futures and career choices, and easy access to information and support. They identified the need, in some cases, to provide whole family support to minimise the ongoing and increasing negative impacts on themselves as young adult carers.

Comments from parent carers

Parent carers of children with autism
Parents of children with autism have highlighted the following priorities to support them in their caring roles:

  • Honest transparent information for parent /carers
  • Dedicated service for parent carers (as most parents think Carers Together is for carers of the elderly)
  • Support for the health and wellbeing of the parents and siblings
  • More support for specific areas of interest ie education personal budgets, transitions, housing, domestic violence, diagnosis
  • General local support ie where are disabled toilets, where do you get a radar key, how can you find local funding for holidays, availability of special schools.

 

Last updated: 11/12/15

2. What commissioning priorities are recommended?

The responses to the key issues identified above are set out in the R&CBC Joint Carers Strategy 2014-19.

Information & advice

  • Consideration will be given to increasing the opening hours of Carers Together so that carers can get face to face support for longer in the week.
  • The Carers Emergency Card and the Carers Emergency Card Plus scheme will be promoted.
  • The Carers Information and Support service at James Cook University Hospital will be retendered to support carers through the discharge process.
  • Easily accessible information about services and activities that are available in the Redcar & Cleveland area will  be developed for both for carers and the cared for person.
  • Carers Together will undertake all initial assessments with carers who approach the council for support and advice in addition to undertaking assessments with carers who approach CT themselves or are referred to CT by another professionals.  Carers Together will help carers identify existing services and activities that could form a useful part of their support plan.
  • Carers Together and The Junction will work with NHS and social care professionals to raise their awareness of the needs of carers.

Active & supportive communities

  • Carers Together will work with carers to complete their self-assessment and support plans so that services can be designed to meet their particular needs.
  • The carers breaks project will be reinstated and widely promoted to encourage new carers to come forward. It is funded from the Better Care Fund.

Personal budgets & self-funding

  • RCBC will review the help that is available to people who take direct payments to help them manage their arrangements.
  • RCBC will work with social workers to ensure that the support plans for cared for people are clear, and are shared with the carer with the cared for person’s consent.

Flexible & integrated care & support

  • All partners will continue to improve the ways in which they communicate with carers and between organisations.
  • The Local Authority & CCG will continue to support the Carers Partnership meetings and Carers Together to ensure that the views of carers are heard by statutory organisations.
  • Adult Social Care will continue to involve carers in the development of carers services and the process of assessment and support planning.
  • All partners will explore the benefits of the key worker / champion role for carers.

Workforce

  • Carers Together will continue to work with health and social care professionals through ongoing training and contact, to encourage them to seek out the views of carers.
  • Adult Social Care will work with care at home providers to maintain and improve the quality of care provided to the cared for person.
  • NHS Partners will build on the commitments given by NHS England to promote and work towards parity of esteem for carers so that mental health and wellbeing is considered and supported alongside physical health needs (Commitments 20 – 23).

Risk enablement

  • Carers Together & the Junction will work with training providers eg Universities of Teesside and Durham at Stockton to promote the needs of carers and the importance of treating them as equal partners in caring for the cared for person.
  • RCBC will maintain the advocacy service so that carers and cared for people can have independent support to explain their needs.

Findings about carers' views on health services from the IMProVE survey

  • GPs and all practice staff will be encouraged to set up carers registers and to recognise the special needs of carers as well as the cared for person.
  • Social prescribing is being introduced so that GPs can refer carers to other relevant services.
  • Information and training about the needs of carers will be available to all GP practice staff.
  • Consideration will be given to providing information for carers about the condition / diagnosis that the cared for person has been given.
  • The availability of respite care will be increased.
  • The Dementia Adviser service will be re-tendered to include provision of advice about dementia for carers of those who have been newly diagnosed.
  • The CCG will implement guidance from NHS England on how to ensure GP contracts are more responsive to the needs of carers (Commitments 24-26)

Young carers and family support

  • Young carers will be involved in identifying their own personal outcomes and goals.
  • Whole family assessments will be undertaken leading to action plans and support for the family
  • Additional resources will be available to support families, in addition to the work the Junction is already doing with families affected by mental health problems.

Young carers increase in self confidence

  • Young carers will be provided with access to information about illnesses; disabilities & addictions.
  • Young carers will have access to First Aid courses; financial skills and confidence building courses.

Increased awareness of young carers needs by schools

  • Young carers will be supported to provide awareness training in secondary schools
  • All schools will be encouraged & supported to appoint a Young Carers champion who can promote awareness of their needs, and increase understanding and support in schools.

Make life better for young adult carers

  • Young adult carers will be identified early through work with colleges; training establishments and  employment  organisations to help to identify hidden young carers
  • Whole family support will be provided by the Junction to reduce the negative impacts of caring, and to provide help with some practical issues eg Benefits checks, Housing, Advice and information, advocacy,& building sustainable emotional support networks.
  • One-to-one outreach will be provided to set up a support plan, and signpost to relevant services.
  • Access to social/peer support networks for young adult carers will be maintained.
  • Access to training for personal development  eg Volunteering, Mentoring, etc.will be available
  • Carers Together and The Junction will work together to provide support during transition to adult carers services.

Parent carers of children with autism

  • The Local Offer website intends to provide clear transparent information for parents and carers of children and young people with Special Educational Needs and Disabilities, through advice and information pages, as well as a searchable directory of services.
  • Carers Together has been commissioned to provide an Independent Parent Support Service via the National Children’s Bureau funding, for those going through the process of receiving an Education, Health and Care plan. This will be delivered in partnership with the Special Educational Needs and Disabilities Support Service (formerly known as the Parent Partnership Service). This will raise the profile of Carers Together with parents of children with disabilities and will ensure that they develop a focus on the special needs of these parents.
  • Information about the support available should be publicised through the local offer website and Carers Together.
  • The local offer should outline what is available and who is eligible for support. The broader People’s Information Network website (PIN) will include info on issues such as Domestic Violence.
  • The Local Offer area of the People’s Information Network will be developed to include information on accessible toilets/changing places and radar keys, and already contains information about grant schemes such as the Family Fund.

Carers for people with alcohol and drugs problems

  • Carers Together will undertake carers assessments and help to embed a process to ensure family members and carers receive an assessment of their personal, social and mental health needs.
  • Additional peer support groups may be delivered from South Bank and Loftus as well as from the base in Redcar to increase accessibility to support.

 

 

 

Previously identified commissioning priorities

2012/01
Promote the role of carers by comprehensive communication which will increase recognition and awareness of carers, resulting in an increase in the registration of carers with Carers Together and on registers of carers in general practices.

2012/02
Promote carer involvement and participation by consulting and involving them in policy and other developments which may affect them.

2012/03
Increase the numbers of carer assessments which offer carers personal support to achieve choice and control.

2012/04
Support carers to identify their own needs so that more carers can decide upon their own support through a personal budget.

2012/05
Increase and extend the range of breaks for carers to include opportunities for carers to have a break to pursue their own interests.

2012/06
Develop an adequate range of planned respite care opportunities for carers.

2012/07
Educate and support GPs and health and social care professionals to ensure that they involve and support carers appropriately.

2012/08
Ensure carers can access educational opportunities.

2012/09
Ensure local employers have carer-friendly policies, in line with the equalities agenda.

2012/10
Identify carers’ information and support services that are available outside of working hours (for example, evenings and weekends).

 

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?

It is estimated that there are currently 131 people aged over 85 who are providing care in Redcar & Cleveland (POPPI, 2012); one-quarter of these very elderly people are in poor health and two-thirds of them are providing over 50 hours care per week.

It is unsustainable to rely on people in their 70s and 80s to be the sole carer of people in need because if these arrangements break down then the cared for person has no other arrangements in place to provide cover.

Only a small proportion of the people who considered themselves to be carers in the 2001 census are known to Adult Social Care or are in receipt of services or are known to Carers Together (the local third sector user-led organisation for carers).  The 2001 census showed that there were 16,107 informal carers in Redcar and Cleveland. Compared to carers in the North East region and England, carers locally undertook more hours per week of caring than carers elsewhere.

Carers by time spent providing care, 2001. (Source: ONS)

R&C

North East

England

 

No.

%

%

%

All people providing unpaid care

16,107

100

-

-

People providing 1- 19 hours per week

9,837

61.07

62.10

68.64

People providing 20 – 49 hours per week

2,140

13.29

12.92

10.88

People providing 50+ hours per week

4,130

25.64

24.98

20.48

 

It is estimated that there are 561 carers aged 65 and over in Redcar & Cleveland receiving services in 2012 compared to the estimated 3,178 unpaid carers in that age group in 2012 (Projecting Older People Population Information, 2012). Only 17% of informal carers are receiving any support from Adult Social Care.

In February 2012 there were 2,629 carers in Redcar & Cleveland registered with Carers Together.

Carers receive information and advice as well as more tangible services from Adult Social Care. In Redcar & Cleveland a higher proportion of carers than nationally are getting information only, rather than services from the local authority.  Carers Together development workers dealt with 2,431 enquiries in 2010/11.

Redcar & Cleveland undertake fewer assessments of carers (26% compared to 33%) and offer significantly fewer services (26% compared to 44%) than either the comparator group of similar local authorities or the England average.

Carer services, Redcar & Cleveland and comparator areas, 2010/11 (Source: NASCIS ASC National Indicators)

R&C

Comparator group

England

NI 135 Carers receiving needs assessment or review and a specific carers service, advice or information

26.2%

33.3%

28.5%

Carers of people aged over 65 receiving information

74%

56%

52%

Carers of people aged over 65 receiving services

26%

44%

48%

 

 

Last updated: 27/09/12

5. What services are currently provided?

Assessment and review
679 carers were assessed in 2014.

The number of carers receiving support or information equated to 25% of the number of service users who received support packages in 2013-14. The ratio for Redcar & Cleveland appears to be consistently lower than the national (33%) and comparator local authority (31%) figures. However many carers are referred from Adult Social Care to Carers Together for an assessment of their needs and support planning so these figures may under reflect the number of carers who are receiving support. Where there is an identified social care need then carers are referred back to Adult Social Care for support.

394 of the carers assessed by Redcar & Cleveland adult social care received services, as opposed to information only. This is a higher percentage (58%) than the figure for England (46%) and comparator Local Authorities (35%).

Some carers receive a respite sitting service for 4 hours per week from a care at home provider of their choice.

Nearly 1,450 carers were assessed in 2010/11 (compared to 5,504 individuals in need).
This comprised 460 carers receiving services and 980 receiving information.

Self-directed support
156 of the 463 carers who received a service also took a personal budget and self-directed support.

Respite care breaks for carers
On average, 50 carers had a respite sitting service from Allied of 4 hours respite per week.

Cared for people may be assessed as needing respite care for themselves and to support their carers. The number of people using respite residential care has risen from an average of 39 per month in 2008 to 48 per month in 2011 and 56 per month in 2014. More recent figures may underestimate usage because people with personal budgets may be accessing respite with direct payments. The numbers of people using respite care in a nursing home has remained stable over 3-years.

Carers Together has received non-recurring funding from NHS Tees to provide respite services for carers. In 2010/11, 530 sessions of complementary therapy were offered. These personalised breaks enable all adult carers to access opportunities outside of their caring role and to lead a fulfilling life.

NHS Tees is providing a further allocation of funding in 2012/13 which will be administered by Carers Together to provide short breaks for carers.

Emergency card scheme and emergency card plus
There are 965 people on the emergency card scheme and 685 for emergency card plus (November 2014). This is an increase of 62% and 176% respectively since March 2011. The distinction between the 2 schemes is that for those on the emergency card plus scheme, care at home services will be provided for 48 hours in an emergency, whereas people on the emergency card scheme can be reassured that a neighbour or other family member will be contacted if the main carer is suddenly unavailable to carry out their caring responsibilities.

Dementia Adviser service provided by Carers Together
There were 868 carers and people with dementia registered with the Dementia Adviser service (October 2014). This service is joint-funded by South Tees CCG and Redcar & Cleveland Borough Council.

In March 2015 the service will be re-tendered for the coming 3 years.

Transition service for carers aged 18-30
Better Care funding has been made available from South Tees CCG to commission the development of a transition service for carers aged 18 to 25 years, to improve the health and well-being outcomes for this age group.

Young carers
In 2014 the Junction Foundation based in Redcar supported 697 children, young people and family members with 6501 face to face and person to person contacts delivered through 3 complementary programmes to support children & young people’s emotional health and wellbeing; support for young carers, young adult carers and their families and helping young people through transitions to adulthood.

Services already in place for carers (as at 2014)
The Local Authority provides and commissions services specifically for carers:

  • The opportunity for carers needs to be assessed primarily through completing a self assessment questionnaire. Support is provided by Carers Together and Social Workers to complete the assessments.
  • Personal budgets and direct payments to carers who meet the Fair Access to Care (FACs) criteria so that they can commission services that will support them in their caring role.
  • Access to respite sitting services for the carer and respite stays in a care home for the cared for person.
  • Funding for the carers emergency card and emergency card plus schemes to provide support in the event of an emergency.
  • *Financial contributions to the revenue costs of Carers Together to provide support to carers.
  • Commissions services from other agencies for carers
  • * Telecare & assistive technology
  • A peer support group for those affected by substance misuse (FACES) accessed via the commissioned substance misuse recovery service provider
  • * Funding for short breaks for carers

South Tees CCG provides funding to the Local Authority, via the Better Care Fund, to support the commissioning of carers services identified above with *.

Carers Together provides:

  • Friendly and confidential services that aim to ease the pressure of caring, including information and support with benefits and finances, health problems, housing, training, employment, taking a break from caring or concerns about the person being cared for.
  • Flexible support that can change as carers’ needs change.
  • Individual or group support at home, in local community venues, by telephone or email
  • Carers assessments and support plans
  • A Welfare Rights service
  • A Counselling service
  • A Dementia Advisory service
  • Information and support for working carers and employers
  • Activities and events
  • A carers’ newsletter
  • Carers Emergency card
  • Training for carers and professionals
  • Involvement opportunities eg in a Carers Partnership and local carers groups
  • Volunteering roles with Friends of Carers Together

The Junction
The Junction’s mission is to make a difference to the lives of children, young people and their families.  It strives towards achieving 3 Life Changing Objectives:

  • Accessible, specialist, child and young person centred services which are confidential, age appropriate, friendly and welcoming for children and young people aged up to 25 with the specific aim of making life better for young carers, young adult carers and their families.
  • The work focus is on promoting the positive impacts of their caring responsibilities, removing barriers which might prevent them achieving their potential and supporting them to lead healthy and fulfilling lives. The Junction aims to reduce the negative impact of their caring role and reduce the risk of harm.
  • Services include: support and information services for young carers, young adult carers and their families.
  • Safe space and Whole family working – 2 pilot schemes funded by the CCG in 14-15.

This is achieved through:

  • Comprehensive whole family assessment
  • Outcomes focused Action planning and pathways to relevant support
  • Whole family support where there is a significant negative impact on young carers and young adult carers
  • One to one support for young carers to develop positive coping strategies and achieve positive outcomes
  • * One to one support for young adult carers to enable positive transitions and achieve positive outcomes
  • Advocacy and voice
  • Specialist children and young person’s Counselling to address long term and deep rooted issues, providing confidential space to facilitate positive change
  • * Young carer and young adult carers led sustainable peer support networks
  • Focused and themed group work, e.g. emotional well being, confidence building,
  • Leisure and social activities and opportunities to have fun, build relationships and share experiences with other young carers and young adult carers
  • Learning and development opportunities, e.g. understanding issues, peer mentoring, First aid, safety etc.
  • Providing access to complementary young person centred services provided by The Junction and its partners. i.e. Mental health and emotional well being, information and support, education and employment support
  • Raising awareness of young carers and young adult carers

FACES provides

  • Specialist advice and support for family and carers of drug and alcohol users in the Redcar and Cleveland area.
  • FACES offers; one to one support; advice and information; home visits; crisis intervention; workshops; advocacy; respite; signposting; and a peer support group.

The workshops cover:

  • Alcohol Awareness,
  • Drug Awareness,
  • Kinship caring, legal and financial support,
  • Relationship Management,
  • Building recovery capital
  • Safety management
  • Health and Wellbeing
  • Sleep management
  • Stress management
  • Social functioning

Carers will be able to receive a package of support tailored to their individual needs. To receive this support the person they are caring for does not have to be in treatment.

Tees, Esk & Wear Valley Foundation Trust provides

  • The Foundation Trust has its own carers support strategy for 2014 -17 in place.  This strategy applies the Trust’s values and behaviours to their contact with carers and provides a framework for staff as part of the Quality and Assurance Strategy to improve, monitor and evaluate carer experience alongside patient experience measures. The strategy recognises carer expertise and outlines the priorities that the carers of users of trust services have identified are important to them, via feedback from consultations and previous surveys,
  • The Psychosis Team are implementing the CQUIN relating to Carer involvement.
  • The Trust is implementing the ‘Triangle of Care’ (TOC) guidance which was launched in 2010 by the Carers Trust as a guide to best practice in mental health care in England. A second edition was published in 2013 to extend the work into all areas of the mental health care pathway. The aim of the guidance is to ”provide a therapeutic alliance between service user, staff member and carer that promotes safety, support, recovery and sustains wellbeing.” It includes standards and resources to support Trusts to ensure carers are fully included and supported when the person they care for, has an acute mental health episode.

The Triangle of Care guidance has 6 key elements to achieving a better collaboration and partnership with carers in the service user and carer’s journey through mental health services as follows:

  • Carers and the essential role they play are identified at first contact or as soon as possible thereafter.
  • Staff are ‘carer aware’ and trained in carer engagement strategies
  • Policy and practice protocols re: confidentiality and sharing information, are in place
  • Defined post(s) responsible for carers are in place
  • A carer introduction to the service and staff is available, with a relevant range of information across the care pathway
  • A range of carer support services is available
  • The Older People’s Mental Health  / psychosis team is developing links with Carers’ Together and plans to provide, in conjunction with the Mental Health Carers’ Group, a number of ‘awareness’ sessions for carers, family members and service users to assist with understanding the symptoms of dementia. These sessions are being developed following feedback from the Mental Health Carers’ Group as to their specific requirements.
  • An information pack for carers is being compiled and will be made available in the reception at Foxrush House and as a resource for Care-Co-ordinators.
  • As an employer the Trust has carer friendly employment policies in place, to support staff who have caring responsibilities.
  • Carers Champions are in place for the whole Trust and for individual departments eg CAMHS and Older Peoples Mental Health services.

 

Last updated: 11/12/15

6. What is the projected level of need?

Information gained from the 2011 census shows that in Redcar & Cleveland there are:
16,000 carers - a reduction of 70 from the 2001 census (zero change over 10 years), though the overall population has reduced by about 4,000 or 3% over the same period.

Of the 16,000 carers, 1,200 are aged under 24 (8%); 5,300 are aged 25-49 (33%); 5,800 are aged 50-64 (36%) and 3,700 are aged over 65 (23%). Since 2001, there has been an increase of 18.7% in young carers (aged under 25) and of 73% in the number of carers aged over 65. The proportion of carers aged 25-49 has dropped by one sixth. This is consistent with many council areas in the North East.

Of the 16,000 carers, 9,000 provide up to 19 hours care per week (56%); 2,500 provide 20 to 49 hours of care per week (15%) and 4,600 provide over 50 hours of care per week (29%). Consistent with England and the North East, there has been an increase in the number of people providing over 20 and over 50 hours of care per week.

Of the 4,600 carers providing over 50 hours care per week, 700 (15%) say they are in bad or very bad health themselves. The figure for England is 13% and for the North East 15.5%.

Nearly half (45.8%) of carers are in employment (full time; part time & self employment). This compares to a rate of 50% in the North East and 53% in England.

Of the 16,000 carers, 15,900 are white British (99%); 50 are of mixed race; 80 Asian; 15 are black and 10 other ethnic race. In England 89% of carers are white British and in the North East 97% are white British.

 

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 are known to Adult Social Care or are in receipt of services.  A larger number are registered with Carers Together but this still only equates to 5,000 out of 16,000, less than one-third. It is hoped that initiatives like the Carers short breaks will encourage more carers to come forward for support.

The Care Act 2014 will give carers the right to an assessment of their needs and the provision of support from Adult Social Care services from April 2015. This opportunity will be advertised widely. Adult Social Care and Carers Together are trying to anticipate the likely additional demands. Carers Together has been commissioned to undertake carers assessments for all those carers who come forward and to help them develop a support plan to meet their needs.

There is little information about the needs of carers from BME backgrounds and carers in work or seeking to return to work.

 

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?

Consultation was undertaken with carers during 2013 – 14 in preparation for refreshing the joint Carers Strategy 2014- 19. The outputs from the consultation are summarised in the Key Issue section of this JSNA topic.

Feedback from adult carers
Feedback from users of the FACES service for carers of people with drug and alcohol problems.

The Department of Health undertook a National Carers survey in 2012. 1,300 questionaires were sent out by Redcar & Cleveland Council, with a  40.6% response rate from carers.

The key findings where the responses from carers in Redcar & Cleveland was different from the national average, were:

 

Redcar and Cleveland

England

Caring for someone with dementia

17%

26%

Describe level of support as ‘right’

86%

75%

Get a break of 1-24 hours per week

24%

34%

Treated with respect by GP

71%

65%

Getting support from GP

63%

54%

 

The general conclusions drawn from the survey were that there is a greater degree of satisfaction with carers services locally than in England; carers feel that they have a better quality of life in Redcar & Cleveland but, overall, carers in Redcar & Cleveland get fewer services than elsewhere in England.

Carers Together has undertaken focus groups with carers and report that there is great concern about the difficulties carers have in pre-booking planned respite care so that they can arrange their own holidays in advance.

Carers UK estimates that approximately 1,000 carers in Redcar & Cleveland are not claiming the Carers Allowance that they are entitled to. In November 2009, 1,900 people were claiming this benefit and by November 2010 this had risen to 1,960. Carers Together now employ a welfare benefits adviser to help carers claim the benefits they are entitled to.

 

Last updated: 11/12/15

10. What additional needs assessment is required?

Carers assessments are currently undertaken by Adult Social Care services and Carers Together. It is intended that in future all these assessments will be held on the central data system of the Local Authority, if carers agree to their data being shared. This will ensure that we have a comprehensive understanding of all carers and their needs which will assist in targeting further assessments and identifying hidden carers as well as understanding better the level of demand for services.

 

Last updated: 11/12/15

Key Contact

Name: Sue Renvoize

Job Title: Commissioning Lead, Older People and Carers

e-mail: susan_renvoize@redcar-cleveland.gov.uk

phone: 01642 771500

References


Local strategies and plans

 

Redcar & Cleveland Borough Council and NHS Redcar & Cleveland (2009). Redcar and Cleveland Carers’ Strategy 2009/14.

 


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)