Investors in Carers Annual Report 2015/16 1
Contents Foreword by Dr Gareth Morgan...3 GP Surgeries...4 Community Pharmacies...5 Hospital Settings...6 Secondary Schools...7 Carers Leads...9 Carers Feedback/Stories...9 The Way Forward/Further results...10 Tables and graphs...12-18 The team...19 2
Foreword As newly appointed Health Board lead for Carers, I am delighted to write this foreword to the Investors in Carers (IiC) annual report. From my previous portfolio, I d followed the work of the IiC team with great interest and it is with great enthusiasm that the few words below are offered by way of introduction. Carers play a huge and sometime silent role in supporting health and social care services. As per the report last year, the IiC continues to be an essential element of the Hywel Dda contribution to delivering the Carers Strategies Measure (Wales) 2010. The continued engagement with General Practitioners is particularly important and in some settings, this has further expanded to a more advanced standard. In addition, efforts to build further links with Community Pharmacy and secondary care settings are especially encouraging. Beyond the healthcare setting, work is also in progress with other partners such as secondary schools, which is invaluable as we endeavour to support the Young Carers across the region. Other greatly valued partnership links include our colleagues in the third sector organisations, who along with Local Authority Champions and colleagues, who have attended county events for Carer s leads. In delivering all this, I d like to pay tribute to the work of the IiC team of Pennie, Matt, Julie and Tracey. They have driven this agenda tirelessly but as suggested by the logos on the front cover, this is all underpinned by the partnerships with a range of organisations. Further, it is clear that more work is needed and the number of Carers registered is one matter to be developed. It is important to properly acknowledge the delivery of this work was underpinned by collaboration. Whilst Hywel Dda University Health Board led on this and held the money received from the Welsh Government, how the money was spent had to be agreed by ALL partners, which it was. This included agreement from third sector organisations and local authorities within our footprint. This foreword would not be complete if that was not acknowledged fully and our sincere thanks expressed to our partners for their help, support and encouragement. In looking to the future, we are now working up a new action plan to deliver the duties under the Social Services and Wellbeing Act (Wales) 2014. Critical thought will need to be given about the best way IiC can contribute to this work but the opportunities available to us are considerable. I am therefore pleased to offer my support to this report and commend it to your attention. Dr Gareth P. Morgan. FRSPH. Hywel Dda University Health Board Carers lead. 3
IiC and GP surgeries. The IiC Scheme continues to be applied by all GP surgeries within the Hywel Dda University Health Board region. The IiC team have been supporting surgeries to meet their objectives on the Carer agenda with the great majority of surgeries (98%) having gained the Bronze level standard. Whilst there is one remaining surgery yet to achieve the standard there is clear evidence all are supporting Carers in a number of different ways. The IiC s Bronze award accreditation is only valid for two years, so the Team are now supporting surgeries that are in the process of re-validation. We have also updated this level to ensure that it was still fit for purpose ten years after its introduction. This exercise has eliminated duplication of areas and made the process easier to manage for the GP Surgery in an ever increasing busy environment. Silver Level A number of surgeries are now working on the Silver level - a more advanced level that demonstrates new (or more in-depth) ways of working to support Carers. This level is about what differences surgeries can make to a Carer s life and concentrates on outcomes and results. The IiC team are helping surgeries and Carer Leads to work closer with some of the voluntary sector organisations including Marie Curie, British Red Cross and the Alzheimer s Society. A guide and toolkit has also been produced to help surgeries with ideas on how they can help Carers further and achieve this level. This includes offering annual health checks and measuring the differences these make to Carers; working closer with District Nurses to help identify hidden Carers and again measuring the impact of this exercise Two further surgeries have achieved their Silver accreditation during 2015/16, Teifi and Llynyfran surgery both in Llandysul. Silver Level Presentation Matt Sims IiC Ceredigion Officer, Lucy Williams, Holly Adams & Ann Johnson from Llynyfran surgery, Pennie Muir, IiC Regional Manager Bernie Rees OBE from HDUHB Dr Darren Chant & Kay Birkett from Teifi Surgery. Ann Johnson, Practice Manager for Llynyfran Surgery commented: Llynyfran Surgery are proud to accept the silver award in recognition of our commitment in supporting Carers of all ages. We have attended many local events to gain knowledge of services available for our registered Carers. 4
Kay Birkett, Practice Manager on behalf of Teifi Surgery added: We are delighted to have received the silver level award we hope this reflects the importance we place upon identifying and supporting Carers. Further surgeries are now engaging with this level and want to ensure that their Carers are supported to carry on with their caring role. A number of workshops have been held in Pembrokeshire and Carmarthenshire for surgeries who want to make a start. These sessions covered the Silver level framework and encouraged attending surgeries to look at what they can feasibly do in preparation for working towards this level. Feedback from the Carmarthenshire event said that participants on the day were more positive, with each practice now having a better understanding of how to move towards achieving their Silver level. Gold level. The IiC team had a meeting in January 2016 to a draft a Gold level framework based on experiences of working with the GP surgeries and a working knowledge of the bronze and silver levels. The team also took into consideration some of the best practice work that has been carried out across the region. The draft framework was then sent to a number of different people/groups for consideration and to gain valuable feedback. These included GP surgeries, Carers, Carers Development officers, members of the Strategy group and Carers Services in the third sector. Given this valuable feedback it has been agreed by the Carers Programme Board that the IiC team should concentrate on supporting more surgeries to achieve the Silver level for 2016-17. However, it is still planned that the Gold level will be launched in the future and feasibility will be considered in the next year. IiC and Community Pharmacies. Nine Community Pharmacies have gained their Bronze level in total with a further 10 engaging with the Scheme. Boots Haverfordwest Claire Billingsley, Pembrokeshire Young Carer Worker; Julie Campbell, IiC Officer; Sian-Marie James, Vice Chair Hywel Dda UHB; Claire Setford, Carers Lead for Boots Haverfordwest; Cllr Mike James Pembs County Council Carer Champion; Stephanie James, Store Manager, and Rebecca Thomas, Store Manager. 5
Boots, Haverfordwest Carer Lead, Claire Setford, said: Taking part in the Investors in Carers Scheme has definitely helped us to support carers. We have found out about the extra support that we didn t realise was there. Working in a community pharmacy gives you direct contact with people enabling you to have a conversation and reach out to people who aren t looking for help but it becomes apparent that they could do with it. I can help people find out about the kind of support there is out there, it is important for people not to be nervous of it they can often be worried about asking. IiC and Hospital Settings. Currently there is one hospital setting who have achieved the bronze level which is South Pembrokeshire Hospital. Other areas working on the scheme are Cardigan Hospital Out- Patients and Tregaron Hospital. In Older Adult Mental Health area both Enlli Ward in Bronglais, Aberystwyth and Bryngolau ward in Prince Philip hospital, Llanelli obtained their Bronze in 2014/15. One of the region s Community Mental Health Teams (CMHT) has also achieved the Bronze, with other teams now working on theirs. Heddfan Presentation Andrea Phillips CMHT Manager, Emma Reynolds Community Support worker, Donna Pritchard Older Adult Mental Health Services, Robert Adams OT, Ffion Jones Community Support worker, Libby Ryan Davies Director of Mental Health and Learning Disabilities, and Tracey Roberts Jones IiC Carmarthenshire Development Officer Specialist Child and Adolescent Mental Health (S-CAMHS) areas in all three counties are also working on their Bronze level. The Mental Health directorate supports a Carers champion forum in which the IiC Scheme is a standing agenda item which has helped drive the messages out to the wider areas of the Health Board and create culture changes that are now embracing the Carers roles in the patient/carer journeys. Further areas are coming on board in the Mental Health and Learning Disabilities area as achieving the Bronze level IiC standard will be underpinning the Triangle of Care pilot programme planned for October 2016. These areas will be supported by staff from West Wales Action for Mental Health (WWAMH) 6
IiC and Secondary Schools. Three schools in the Hywel Dda region have achieved their Bronze level: Greenhill School in Tenby being awarded first with Milford Haven School and St John Lloyd in Llanelli following on shortly afterwards. A further 5 schools are currently working towards their accreditation with Pembrokeshire College and Coleg Ceredigion also working on the college versions. Greenhill School Peter Llewellyn HDUHB, Jan Kingston Head teacher, Kate Evans-Hughes, Director of Education and Cllr Mike James, Carers Champion for Pembrokeshire County Council. Milford Haven School Rod Francis, Head teacher Peter Llewellyn HDUHB, Gemma Baker Carer Lead, Kate Evans-Hughes, Director of Education and Cllr Mike James, Carers Champion for Pembrokeshire County Council. St John Lloyd Secondary School Kelly Shearer Young Carer Project Worker, Mags Williams YC Manager, Graziella Fiorillo, Deputy Head &YC lead, Tracey Roberts-Jones IiC Carmarthenshire Rob Sully, Director of Education for Carmarthenshire County Council, Anthony Jones, Governor, Ashley Howells, Head teacher Pennie Muir, IiC Regional Project Support Manager Paul Martin, Young Carer worker 7
The Scheme for Secondary Schools is helping identify and support Young Carers who may be struggling with their caring role and their education. A board game called I care, do you...? has been produced (by Carers Trust Swansea Bay worked with Barnardos and Action for Children) for use in schools. Its aim is to help pupils and teachers understand the role of a Young Carer and how this differs from that of a young person. The games have been purchased by Marie Curie as a part of their Caring for Cares project and have been played on a number of occasions with those secondary schools participating in the IiC Scheme. Pupils playing the game at Greenhill School, Tenby. Pupils from Greenhill School, Marie Curie staff and Jane Hutt AM at the Marie Curie Great Daffodil Launch at the Senedd in February 2016. A big Thank You goes to Marie Curie for their help and support in all of the IiC Schemes. 8
Carer Leads Most GP surgeries (and Community Pharmacies and other settings) have now identified someone to be a Carer Lead. This person s role is to be a point of contact with the IiC Team, receive Carers information and cascade this to the rest of the staff. Other duties include keeping their Carer notice board up to date, supporting national and local events as well as speaking with Carers about their circumstances and signposting them as appropriate. Carer Lead events now take place on an annual basis in each of the three Counties. The workshops provide learning and development for attendees in a range of Carer related topics, encourage best practice and ensure Carers are supported to best effect at the Surgery/Pharmacy. Topics covered at events over the last 12 months have included: Dementia Friendly sessions, Young Carers, Carers Week, Registration and referral process Carer Stories. The events have proved to be very popular in terms of encouraging networking across a range of health care providers as well as having contributions from other Carer Professionals and the Third Sector organisations that support Carers. Some comments made on what they gained from some recent events include: I now have more understanding of my role (as a Carer s Lead) within the Surgery ; Ideas generated (at the Workshop) were inspiring ; Good to hear (about) Carers issues from a health professional s perspective Discussing about Carers of different people in the workshop Carer s feedback/stores. The IiC team have also been gathering Carers stories over the past two years. These have provided some key learning areas for the Carers Partnerships which suggests that the IiC is having an impact on Carers lives. Whilst this is difficult to quantify the Carers stories are indications that without the IiC Scheme things may have been more difficult for some Carers, in that the information and support they now have may have been delayed or not received at all. An analysis of the Carer stories took place and a report was produced with a number of emerging themes: Theme 1 Circumstances and Impact of being a Carer; Theme 2 Knowledge and Understanding of Services and Support Available; Theme 3 Perceived Need for Carer-centred Support; Theme 4 Role of Health Care Professionals in Recognising Health and Social Care Needs of Carers; Theme 5 Quality of Services Currently Experienced by Carers; Theme 6 The Carer-Cared For-Professional Interface. 9
The report was presented at the October 2015 Carers Programme Board which was received favourably. The IiC team have now used this feedback in the training and awareness sessions delivered across a range of health settings. We have also considered this feedback in the Silver level of the IiC Scheme along with our ongoing communications with Carer Leads and other professionals. Some quotes/stories have also emerged: I ve received several referrals from Bro Cerwyn following the IiC Officers talk explaining Carers Support services Carer Story North Pembrokeshire My husband has been diagnosed with early-onset Vascular Dementia and it took me quite a few visits to my GP surgery before I realised I was a Carer. I had read the information several times before I realised that it applied to me. I have registered with my surgery and have found the information pack I received very useful. I have met the Carer s Outreach Support worker who was very helpful and attended a support group which was the last thing I thought I wanted to do but in fact have found it very useful I realised that I was a Carer and could register with my GP after seeing the notices on the board in my Surgery. Carer s Outreach/ Investors in Carers/Young Carers/Co-delivery A Carer was referred to the Outreach service via the Investors in Carers scheme at Meddygfa Tywi. The Carer is divorced and has a teenage daughter and a teenage son with Autism. The Carer also has a 20 year old daughter who helps to care for the children as they both require significant care and support. The Carer was very concerned for the future as they hadn t been able to discuss transitional support for when the children finish school. The eldest daughter is also planning on going to university this year and she had concerns about how her parent would manage without her support. The Carer felt very anxious and stressed as there was no support in place other than Special Educational Needs provision at the children s school. The Carer completed the Carers Star (a measurement framework) with the Carers Outreach worker. They had to give up work two years ago as the younger daughter had a breakdown and needed more support. The Carer has been unable to work since. Although they have adjusted to the changes to their income, the Carer really misses the social aspect of working and has felt very isolated since giving up work. The Carer also felt that their caring responsibilities had a negative impact on their health & wellbeing and that this was at risk of deteriorating further if they couldn t access support. The Carer has attended a support meeting and coffee morning to meet with other Carers and has reported feeling less isolated. A referral was made in January to the Social Care team for a Carers Assessment for the Carer as they were interested in the Direct Payments scheme to access support for time out (they are still waiting for an assessment of needs). As the Carers daughter helps to care for the siblings, a referral has been made to access 1:1 support from the Young Adult Carers project. 10
The Way Forward The IiC scheme will continue to be developed within health; at both primary and secondary care and social services area as the Social Services and Well Being Act 2014 starts to make an impact. The Act also emphasis partnership working and this is evident within the workings of the IiC Scheme. The scheme is also funded through monies from Welsh Government which is not solely health and includes input from Pembrokeshire, Ceredigion and Carmarthenshire County Councils. The Scheme is included and regularly reported on in the Pembrokeshire Joint Carers Strategy, the Carmarthenshire Carers Action plan and the Ceredigion Single Integrated Plan (SIP) as well as the HDUHB Integrated Medium Term Plan (IMTP). The Act s guidance (Section 9) also says that we must include the Third Sector in the delivery of Carer services and this is again evidenced within the workings of the Scheme. For example, Outreach work with Red Cross and Crossroads carried out in GP surgeries, Alzheimer s Society working closer with surgeries for referrals. Other examples of partnership working are: Carer Lead events being supported by all three counties Social Services departments and the third sector agencies, Carers Week events led by the Local Authority, Mental Health Carers Champion meetings, HDUHB Regional Carers Programme Board and Strategy Implementation Group meetings, Carer Stories and Young Carer work stream. We are currently working with our Statutory and Third Sector partners in the sustainability of the IiC scheme in all areas during the transition from the Carers Measure to the SSAWB Act 2014. Further results. The following tables and graphs show present Carer related data gathered by the IiC Team over the last 12 months. The figures are collated quarterly and fed into the overall Performance figures that were required by Welsh Government under the Carers Measure during 2015/16. The figures are also analysed by the IiC team to understand trends in numbers of Carers registered at GP surgeries. For example, a marked increase in the numbers of Carers registered with some surgeries in Quarter 3 is often due to Carer awareness sessions being held during the flu jab campaign. It can also help the IiC Team, Carer Leads and surgeries to consider alternative ways of increasing the numbers of identification and registrations which may then lead onto an increase in referrals. For further information about the IiC Scheme please contact Pennie Muir, Regional Project Manager for the Scheme pennie.muir@wales.nhs.uk 11
Some results from GP Surgeries engagement with the IiC Scheme. Registrations As part of the IiC Scheme GP surgeries encourage Carers to come forward and register themselves as Carers. A Registration/consent/referral form is now in existence in each county for this purpose. The Carer has the choice of just registering themselves as a Carer at their surgery. This can lead to the surgery making some allowances because of their caring role, e.g. flexible appointments; however this will depend on the capacity of each surgery. Please note: The numbers of Carer Registrations are collected on a quarterly basis and have shown fluctuations over time. This can be down to an increase in activity to encourage more Carers to come forward for example the annual Flu Campaign. Some surgeries have also gone through a data cleansing exercise to ensure that their records are up to date and correct, this has also had an effect on the overall numbers. Table 1a; Carers Registered by GP Surgery Clusters in Carmarthenshire as at 31 st March 2015 and 31 st March 2016 GP Cluster area No. of GP Surgeries No. of Carers from 2011 census Actual no. of registered Carers in surgeries as at 31.3.15 Actual no. of registered Carers in surgeries as at 31.3.16 Amman/Gwendraeth 8 8405 1087 979 Llanelli 8 7724 793 903 Taf/Teifi/Tywi 8 7833 833 905 23,962 (13.2% of pop) 2713 2787 * *Some surgeries have cleansed their data and one surgery has closed. Graph 1b Carers Registered by GP Surgery Clusters in Carmarthenshire as at 31 st March 2015 and 31 st March 2016 1200 1000 800 600 400 200 0 Carmarthenshire GP Surgery Carer registrations Llanelli Cluster 2 T's Cluster Amman Gwendreath Cluster 12 Carers registered 31st March 2015 Carers registered 31st March 2016
Table 2a; Carers Registered by GP Surgery Clusters in Ceredigion as at 31 st March 2015 and 31 st March 2016 GP Cluster area No. of GP Surgeries No. of Carers from 2011 census Actual no. of registered Carers in surgeries as at 31.3.15 Actual no. of registered Carers in surgeries as at 31.3.16 North 8 4417 533 863 South 8 4078 673 740 *Some surgeries have carried out a data cleansing exercise. 8,495 (11.7% of pop) 1206 1603 * Graph 2b Carers Registered by GP Surgery clusters in Ceredigion as at 31 st March 2015 and 31 st March 2016 1000 Ceredigion GP Surgeries Carers registerations 800 600 400 Carers registered at 31st March 2015 Carers registered at 31st March 2016 200 0 North Cluster South Cluster 13
Table 3a; Carers Registered by GP Surgery Clusters in Pembrokeshire as at 31 st March 2015 and 31 st March 2016 GP Cluster area No. of GP Surgeries No. of Carers from 2011 census Actual no. of registered Carers in surgeries as at 31.3.15 Actual no. of registered Carers in surgeries as at 31.3.16 North 9 7936 969 703 South 6 7211 920 735 15,147 (12.6% of pop) 1672 1655 * *Some surgeries have carried out a data cleansing exercise. Graph 3b Carers Registered by GP Surgery clusters in Pembrokeshire as at 31 st March 2015 and 31 st March 2016 1200 1000 800 600 400 200 0 Pembrokeshire GP Surgery Carer registrations Carers registered 31st March 2015 Carers registered 31st March 2016 North Cluster South Cluster References. 2011 Census figures taken from an analysis of ONS figures. 14
Staff Training/briefings The IiC team also deliver staff briefing sessions for GP Surgeries which focus on a number of areas including; who are/are not Carers; understanding some of the day to day challenges faced by Carers; receiving an overview of the IiC Scheme and what benefits are likely to come to the surgery through engagement. The IiC team have delivered briefings to other groups who are likely to come in contact with Carers, e.g. Social Services teams, third sector organisations. GP Surgery Carer Lead events have also contributed to the number of staff having learning and development opportunities, see above. A total of 339 people have had briefings and the following table shows this across the Region between April 2015 and March 2016 Graph 4: Number of Healthcare, Community Pharmacy, Social Services and Voluntary sector staff receiving Carer/IiC related training/briefings from IiC Team by County for period April 2015 March 2016 80 Carer briefings and IiC interventions 2015/16 70 60 50 40 30 Carmarthenshire Ceredigion Pembrokeshire 20 10 0 Q1 Q2 Q3 Q4 15
Carer Aware E-learning Staff in GP surgeries and Community Pharmacies has been encouraged to participate in the Carer Aware and Young Carer E-learning programmes. In the Bronze level framework there is a Staff awareness section so the certificate that is produced when competing the E-learning programmes can be used for evidence in that section. Table 5: GP and Community Pharmacies have staff either registering and/or passing the Carer Aware and Young Carer E-learning module, by County County Carer Aware GP Surgeries Carers Aware Pharmacies Young Carer both Carmarthenshire 19 surgeries out of 24 have staff who have passed and some have registered and yet to complete the programme. 4 Pharmacy staff has passed. 6 surgery staff have passed with 1 registered. Ceredigion 8 out of 14 surgery staff have attained passed 4 Pharmacy staff has passed. 3 Surgery and 1 pharmacy staff have passed. Pembrokeshire 6 out of 15 surgery staff have attained passes 3 Pharmacy staff has passed No surgeries have yet registered to do this programme. Three GP s from two surgeries in Ceredigion have also passed the Carer Aware programme; these surgeries have also been awarded their Silver level accreditation. All Carer Lead s are now being encouraged to work through the Young Carer e-learning programme and again can use the certificate as evidence in the folders. 16
Referrals The Carers registration/consent/referral form used by all GP surgeries, participating Pharmacies and hospital wards presents the Carer with a number of options on what further help and support they might want/need. This includes a referral for an Information Pack, a Newsletter, and referral to Social Services for a Carers Needs Assessment/an appointment with an Outreach worker and in Ceredigion an Emergency Card Scheme. As part of the IiC Scheme surgeries, pharmacies and hospital wards are expected, where appropriate, to encourage Carers to complete the referral section on the form to gain additional help and support from the counties Carers Information Service. An analysis of referrals made through each surgery in each county for each quarter over the last 12 months has been undertaken. Tables 6a, 6b, 6c and 6d report on the total number of referrals for additional help and support per county. (Note figures are available for each surgery should the reader want to have a breakdown of figures). Table 6a: Total numbers of requests for further help and support for each county GP surgeries. Totals for Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total Carmarthenshire 26 93 131 71 321 Ceredigion 36 43 34 22 135 Pembrokeshire 22 57 50 49 178 Table 6b: Referrals for further help and support from Carmarthenshire surgeries. Carmarthenshire GP Sugery Carer referrals 2015/16 per cluster area Totals Q1 - Q4 173 82 66 Llanelli Cluster Amman Gwyndreath cluster 2 T's cluster 17
Table 6c: Referrals for further help and support from Ceredigion surgeries. Ceredigion GP Surgery Carer referrals 2015/16 per cluster area Totals Q1 - Q4 77 58 South Cluster North Cluster Table 6d: Referrals for further help and support from Pembrokeshire surgeries. Pembrokeshire GP Surgery Carer referrals 2015/16 per cluster area 107 Totals Q1 - Q4 71 North Cluster South Cluster 18
The Investors in Carers Team L-R Matt Sims - Ceredigion Development Officer, CAVO Pennie Muir - Regional Manager, HDUHB Tracey Roberts-Jones Carmarthenshire Development Officer, Crossroads Sir Gar Julie Campbell Pembrokeshire Development Officer, PAVS 19