Summary of Chapters 1-7
Chapter 1: Introduction
The strategy proposes to test a new pan-government definition of carers:
“A carer spends a significant proportion of their life providing unpaid support to family or potentially friends. This could be caring for a relative, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems.” (p20) This will not immediately affect thresholds for benefits or services and there are variations in understanding of the term for different communities and condition groups (p24).
Some key facts and figures, including demographic changes, are outlined on p31 onwards, including graphs showing that older carers are more likely to be heavy end carers and geographical, gender and BME stats.
Chapter 2: Integrated and personalised services
“We should not see the needs of carers in isolation from those of the people for whom they care.” (p43) This section begins by outlining the areas in which services can join up, stressing the need to work with the third sector. “Key to achieving greater integration of services is the use of more effective holistic assessment” (p46), alongside development of the Common Assessment Framework (CAF) for adults, whilst retaining the option for a separate Carers’ Assessment. The CAF will include a note of caring roles.
Plans for the third sector are on pp51-52:
- “many carers prefer to deal with third sector organisations than with the statutory services for a variety of reasons”
- “We recognise the vital role that these organisations play in ensuring that carers have the greatest possible flexibility in receiving and accessing support and services”
- “third sector organisations play a valuable advocacy role in supporting carers to influence the design and delivery of mainstream services and support”
- “We will continue to work with local government and the third sector to ensure that the services it provides have far greater reach”
The discussion of personalisation and personal budgets (see Putting People First reproduced in the Appendices) notes the potential benefits for carers of increased personal budget take up. “Parliament is currently considering legislation to extend the availability of direct payments to people who lack capacity under the Mental Capacity Act 2005” (p61), which will allow more carers to receive payments on behalf of relatives, including parents of severely disabled children who currently lose their entitlements when they turn 18. “It is also important that councils consider appropriate solutions to managing risk with individuals, carers and their families” (p61). The strategy appears to reign back on hints of a rapid move towards making it easier for family carers to be paid via Direct Payments (p62).
“Easy access to comprehensive and up-to-date information at the right time continues to be fundamental in supporting carers, and was highlighted during the consultation, ” but “at present, unfortunately, fragmented information is disseminated by a number of agencies, often leaving the carer wondering where to begin.” (p63-4) This will be addressed through the national helpline and website, alongside new funding “to help ensure the provision of information is comprehensive, easy to access (by being available in a variety of languages, for example) and up to date about services available in each carer’s local area.” (p65). This is likely to mean significant funding for local carers’ services. In the longer term, the government will “explore possibilities around enabling all carers, no matter where they live, to access specialist carers’ services” (p67) and offer carers a lead professional.
Chapter 3: A life of their own
There will be “a greater emphasis on the provision of planned breaks, which will provide carers with the time to take up the same work, education, leisure and training opportunities as anyone else.” (p70). The £150m over two years will be “allocated to PCTs, who will be required to work with their local authority partners to publish joint plans – as part of the Joint Strategic needs assessment process…for the provision of breaks. These plans will be published following a local consultation with relevant parties, including the third sector and carers themselves. Setting out a strategy for improving quality and choice, the plans will take account of both the new money and the existing money provided to local authorities for planned breaks through the Carers Grant.” (p73) It is notable that this money will be the first time PCTs have had a major carers’ funding stream, which could help alter NHS culture.
There will also be pilots to test innovations in breaks such as the use of personal budgets. Every carer will be offered a personal budget in the “next few years” (p75).
Partnership approaches with housing and leisure services are set out on p79 onwards.
Chapter 4: Income and employment
This Chapter steers away from raising benefit levels: “While the benefits system can provide a safety net, the most reliable and sustainable means of ensuring that carers can enjoy a reasonable level of income is if they, where possible, combine paid employment with their caring role” (p84). This will be achieved “through the provision of better services for the person being supported, increased break provision, easier access to training and skills and encouraging more flexible working opportunities” (p85). Extending rights to make flexible working requests to the 20% carers who are not co-resident and/or relatives will be considered.
Care partnership managers will be introduced at JobCentre Plus (JCP) branches (p94 onwards) alongside training for JCP staff, marking vacancies as “carer friendly”, funding replacement care for carers on approved training courses and investigating providing Sector return to work support via the Third Sector. A good practice guide for all employers on the benefits of employing carers will be produced. Flexible learning opportunities will be promoted. There are likely to be new opportunities for carers’ services to work with JCP and learning providers arising from these commitments.
Chapter 5: Health and well-being
This chapter states that “carers must be treated by professionals as partners in care” (p101). “Carers often find that their caring responsibilities prevent them from accessing health services both for their own needs and on behalf of the person they support. It is important, therefore, that both carers and the people they care for are given as much choice and control as possible when accessing NHS services.” (p106). The new care planning processes being introduced for people with long term conditions will be developed with carer involvement in mind.
Nationally, “projects offering emotional support to carers” will be considered as a “priority category” for DH core funding. (p108). The Strategy makes some useful statements on local health commissioning: “With the advent of initiatives such as LINks, World Class Commissioning and PBC, the NHS has now sent an unambiguous signal that it should take greater responsibility for supporting carers. Whether it be through third sector organisations or individual involvement there is a real opportunity here, one which cannot be overstated.” (p112)
GPs are covered on p114 onwards, with The Princess Royal Trust for Carers’ partnership with RCGP mentioned prominently, to be followed by a new DH pilot GP training programme. There is a focus on carers as “partners in care”: “Lord Darzi’s Next Stage Review of the NHS, which will publish its final report in summer 2008, will appropriately reflect the importance of carers being treated as expert partners in the NHS” (p118).
Chapter 6: Young carers
The vision for this chapter is that “children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive, to enjoy positive childhoods and to achieve against all the Every Child Matters outcomes” (p123). The strategy stresses preventative, whole family approaches alongside universal access to specialist support and better awareness amongst children’s professionals.
Schools will receive new resources such as The Trust’s schools pack (p126) and new young carers resources via the development of the National Healthy Schools programme and the SEAL and Personal, Social, Health and Economic education (PSHE) programmes. (p127-8). There will be new funding for “awareness-raising across schools and other children’s settings” and for GPs and hospital discharge teams (p128).
There is a focus on building the evidence base for young carers support and considering new support routes such as the Extended Schools and Targeted Youth Support programmes, so partnership development with these initiatives may be wise in anticipation of these developments. CSCI and Ofsted will be conducting a survey with disabled parents. Another £4m will add to the £3m already committed via the Family Pathfinder pilots for whole family young carers work (p137) and over the next two years, £1m will be targeted at projects “focused on lifting young carers out of excessive caring” and working “closely with local authority and PCT-funded services that are already supporting the family” (p137). Local and regional training on whole-family working for staff in local services, focusing on adult mental health and substance misuse services will be developed.
Chapter 7: Implementation
A programme board including senior representatives from across Government and key delivery partners will be established alongside the Standing Commission on Carers to monitor implementation. Over half of all Local Area Agreements (LAAs) already include National Indicator 135 on carers (p144), but NI135 “does not give a clear enough indication of carers’ experience of the way that services are provided, and it counts only those carers who have received an assessment and service of some sort from their local authority” (p145), so it will be reviewed as part of the general review of the local performance framework of the next spending round. CSCI has already given The Trust a commitment that we will be involved in that review. In the short term the DH will consider if carers’ experience can be included within the local authority survey programme already being developed for NI 127 (self reported service user experience) and a carer experience survey for local authorities to undertake on a voluntary basis in 2009–10 will be developed. This survey will give data on “whether carers are receiving the services they need and what they think of the quality” and “help to identify harder-to-reach groups who are currently not accessing services” (p144). National information on carers will be gathered via the 2011 Census and an Omnibus Survey in 2008–09.
