1 Carers strategy: second national action plan November 2014 Christine Heron LGiU associate Summary This update to the national carers strategy provides an overview of achievements since the last update in 2010 and sets out key action for the next two years. Major progress in identifying and supporting carers is being brought about by the Care Act and the Children and Families Act. The update encourages local areas to refresh their local carer strategies to ensure all partners are signed up to the latest developments. This briefing will be of interest to councillors and officers in councils with adult social care responsibilities. Briefing in full Overall progress The update describes a major shift in national strategy and policy in which carers issues are now mainstreamed across government departments, with the Departments for Health, Education, and Business, Innovation and Skills working together to support carers in education and employment. The Care Act and Children and Families Act both present major opportunities to improve local support for carers. The Care Act gives a duty to local authorities to identify carers unmet needs as part of their preventative responsibilities, and a duty to NHS bodies to cooperate with local authorities on its functions. The Children and Families Act requires local authorities to take steps to identify the extent to which there are young carers with unmet needs. Both Acts strengthen the entitlement to carers assessments for adults this involves removing the requirement to provide substantial and regular care.
2 There will be a range of guidance and tools to support implementation of these Acts, and government departments will work with stakeholders, including the range of carers organisations, networks, and alliances, to produce these. New data on carers The update describes new information about carers which continues to emerge. The 2011 census found the same proportion of carers as in 2001 (5.4 million) but an increase of five percent in people caring for 20 or more hours a week, and an increase of 26,000 young carers. There was also a shift towards more men than women providing care in people over 65. While around half of carers reported that they are economically active, only around 12 percent of women and nine percent of men were working full time. Carers UK s State of Caring survey found that around a fifth of carers who had given up work were 10-15k a year worse off, and another fifth 15-20k worse off. Those aged were most likely to suffer financially. A Children s Society survey showed that around one in 20 young carers miss school because of caring responsibilities and many have lower educational achievements equivalent to nine grades lower overall than their peers. The personal social services survey of adult carers in England found that the highest level of carers needs were reported amongst carers who have mental health problems, those from Asian/British Asian communities, carers under age 64 and those caring for years. The update indicates that the government and partners will continue to refine data to support the development of national strategy and local joint strategic needs assessments. Also, a number of research projects for carers have been commissioned, including projects on employment, personalisation and resource allocation systems. The Department for Education has invested in the first ever national research project on young carers, including those who are currently not known to local authorities and schools. Next steps in the strategic priority action areas Priority area 1 Identification and recognition This priority is about supporting people with caring responsibilities to identify themselves as carers so they can access information and support. Carers should feel their knowledge and experience are valued by health and social care professionals and be involved in planning individual care packages and developing local strategies. The update points out that while much progress has been made many carers, particularly young carers, remain under the radar. Also, the caring population is not static. It is estimated that of the 5.4 million carer population, up to two million stop
3 caring responsibilities and two million start each year. The effort to identify and involve carers must be ongoing. Work with local authorities and other partners to help them prepare for implementation of the Care Act and Children and Families Act. Health and wellbeing boards are encouraged to involve carers in planning for this. Work with the health and care voluntary sector on the Strategic Partner Programme to improve the identification and involvement of carers. Provide funding for the final year of the DH programme to test approaches to improving how healthcare professionals identify carers. Fund the Next Steps programme supporting whole-family local services for young carers, such as reaching out to young carers in ethnic minority communities, and families affected by substance misuse or mental health problems. Encourage local partners to develop or refresh local strategies that show how different organisations can work together to identify and support carers, and disseminate information about the local offer to carers. With NHS England the government will: Encourage the identification of carers as part of the work to implement the vision of Transforming Primary Care, which includes a named GP for all people over 75. Deliver plans to improve the identification and recognition of carers through NHS England s Commitment to Carers e.g. training packages for healthcare professionals, a NICE best practice guide, a young carers festival, increased involvement in local health planning, and considering the potential for carers to access the medical records of the person they care for, with consent. Priority area 2 Realising and releasing potential This priority aims to support young carers, young adult carers and carers of working age to fulfil their educational and employment potential. Flexible working is a huge issue for adult carers. The government extended the right for all employees to request flexible working, from 30 June The Equality Act also offers protection against direct discrimination because of caring responsibilities. However a survey by Carers UK suggests a difference of view between employers and staff as to whether or not flexible working is on offer. Fund the Children s Society and Carers Trust to deliver Next Steps Programme including workshops for local workers to deliver a whole family approach to assessment and support for young carers. Update e-learning for schools in identifying young carers. Train 150 more school nurses to be young carer champions.
4 Set up a national Task and Finish group to consider what more needs to be done for young adult carers. Set up a pilot scheme to explore ways in which local authorities and other partners can support carers to maintain paid employment. Promote the new carer specific pledge in the public health responsibility deal to increase uptake in organisations. Priority area 3 A life alongside caring This priority is about personalising support for carers, based on an approach that recognises carers as individuals with specific needs, and improving the availability of good quality information, advice and support. The update points to a range of measures in the Care Act and the Children and Families Act, and the Better Care Fund which will benefit carers. For instance, the duty on local authorities to promote wellbeing when exercising care and support functions, the requirement to establish the outcomes carers wish to achieve in their everyday lives and to consider whether support could contribute to this, the offer of a personal budget for families and young people with an Education, Health and Care plan. Explore the available evidence to assess the impact of caring roles on people s lives. Work with integration pioneer sites to consider how integrated health and social care can improve outcomes for carers. Support local partners to use the Better Care Fund to promote shared approaches to supporting carers. Help local authorities prepare for implementation of the Care Act through practice guidance and practical tools. Priority area 4 Supporting carers to remain mentally and physically well This priority area is focused on the impact of caring on health and wellbeing and how this can be improved by early intervention, and supporting carers to look after their own health. While caring can be rewarding there are clear links between the amount of time spent caring and ill health, with young carers and people providing more than 50 hours a week support particularly vulnerable. The update reports to government investment in breaks for carers (now in the Better Care Fund) and for disabled children. Also to the NHS England Commitment to Carers. Support local partners to maintain a focus on breaks from caring through delivery of the Better Care Fund. NHS England will: Include an offer of a health check for carers in a revised GP enhanced service for dementia.
5 Repeat the survey of bereaved people to measure quality of care provided to people at end of life and their relatives and carers. Comment Were it not for the severe pressure on funding which is impacting on services in health and social care, this would be an auspicious time in developments for carers both nationally and locally. Carers have benefitted from successive governments commitments to making improvements on a cross-government basis. Genuine sign-up by the NHS is also a huge step forward. The NHS Five year forward view sets out a clear commitment for the NHS to do more to identify carers, provide more help in crisis situations, and to support NHS employees with caring responsibilities. The local NHS response to carers now needs to progress much more quickly, particularly in primary care. Implementing the Care Act will mean that councils will disentangle the sometimes torturous approaches to carers assessment that have built up in care management, and replace these with a (hopefully) simpler, person centred approach. Where possible, integrated assessment with the NHS should provide a more streamlined experience for carers and the people they care for, while the Children and Families Act paves the way for improved transition arrangements. Health and wellbeing boards, supporting local carer strategies, have an important role in ensuring these developments are knitted together at the strategic level, and that all partners, including employment and education bodies, are involved. In the final statutory guidance on the Care Act, thresholds for access to adult social care have been tightened, with adults entitled to care and support if their needs are related to a physical or mental impairment, and their wellbeing is significantly affected by not being able to achieve two or more outcomes from a list of ten. For example, managing and maintaining nutrition, developing and maintaining family or other personal relationships. This has proved disappointing to carers groups. However in the current funding regime, tighter eligibility is, unfortunately, realistic. Related policy briefings NHS Five year forward view
6 For more information about this, or any other LGiU member briefing, please contact Janet Sillett, Briefings Manager, on