Joint Redbridge Strategic Plan for Carers 2017-2020
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Joint Redbridge
Strategic Plan for Carers
2017-2020
9
Joint Redbridge Strategy for Carers
Lead Service Area Date:
Adult Social care Public health & Wellbeing Informal consultation December 2014
Hub Formal November 2015-November
2016Engagement extended to June 2017
Cabinet Portfolio Stage draft
Adult Social Services, Health & Wellbeing
Author: Version 4
Julie Fanning : Integrated Strategic
Commissioner Health & Care
Contents Page
Foreword 3
1. Introduction 4
2. Vision, Outcomes and Guiding principles 5
3. Involving carers and achieving our Vision 6
4. Local Context 9
5. What we know about the impact of caring 12
6. The Strategic context 16
7. More about carers 18
8. Services to support carers 24
9. Action plan 29
Appendix 1- Young carers pathway
Appendix 2 - Feedback form
Appendix 3 - Equality monitoring form
9
Foreword
As Chair and Vice Chair of the Redbridge Health and Wellbeing Board we welcome
the development of a new Joint Redbridge Carers Strategic Plan which has been
developed through consultation and involvement of carers, people who use, plan,
commission and provide health and social care services and is based on what we
know about local demographics and the growing needs of the population in
Redbridge.
This document presents what we know about carers in Redbridge and describes in
the Action Plan what changes we would like to make leading up to 2020 to improve
outcomes for carers. We are aware that more people are living with long term
conditions, leading not only to a steep rise in the number of carers of all ages
including young carers, but also an increase in the intensity of their caring role as
they care for more hours for family or friends with complex health and care needs. It
is estimated that one in three of us will take on a caring role at some point and this
can have a practical and emotional impact on our lives. This includes making it hard
to do well in school, finding or holding on to a job, managing finances and having a
life alongside caring, all of which can affect our health and wellbeing.
The Joint Carers Strategic Plan sets out the shared aspirations of the Council,
Redbridge Clinical Commissioning Group and our Partners, to improve outcomes for
Carers in Redbridge. It also acknowledges that the health and social care system
nationally and locally is under increasing pressure due to Government austerity
measures, legislative change, increasing demand for services and higher
expectations from the public. In order to keep pace with the transformation of public
services, local health and social care agencies are already making fundamental
changes to ways of working and at the planning stages, are engaging with carers in
recognition of the important role they have in supporting people who use services in
the health and social care system.
As in previous years the new Carers Strategic Plan 2017-2020 continues to move
towards greater integration across health and social care to achieve good outcomes
for carers of all ages.
Mark Santos Dr Anil Mehta
Chair Health and Wellbeing Board Vice Chair Health and Wellbeing Board
Cabinet Member for Health & Social Care Redbridge Clinical Commissioning Group
31. Introduction
The Government updated their Carers Strategy and the Second National Action Plan
2014-16 highlighted that most of us will have caring responsibilities at one or more
stages in our lives. The most recent Census data showed an increase in the number
of carers in England and Wales, with many older people devoting their retirement to
caring for their partners or their own ageing parents.
The greatest rise has been among those providing over 20 hours of care, being the
point at which caring starts to significantly impact on the health and wellbeing of the
carer and their ability to hold down paid employment alongside their caring role. The
Census also found that there were over 166,000 young carers aged between 5-17
years in England, however this is considered to be an underestimate.
Families and friends with caring responsibilities can encounter significant challenges
in their lives, for example, juggling caring roles with education or paid employment;
trying to provide care from a distance; or managing more than one caring role,
including multi-generational caring and mutual caring. They also face challenges in
looking after their own health while caring for someone else.
In response to the national guidance and in recognition of the important role they
have in supporting people who use services in the health and care system, the Joint
Redbridge Carers Strategic Plan 2017-20 has been co-produced with carers, people
who use, plan, commission and provide services and is based on what we know
about the needs of the population in Redbridge. The Strategy recognises that the
health and social care system nationally and locally is under increasing pressure due
to Government austerity measures, changes to health and social care law,
increasing demand for services and higher expectations from the public.
This Strategic Plan reflects our intention to achieve good outcomes for carers of all
ages. The idea is to help carers stay physically and mentally well so that they can
have a good life alongside their caring role.
42. Our Vision
Our Vision for improving the lives of carers over the next three years is that:
‘Carers will feel supported in their caring role, feel valued in their
communities and have their important role recognised and respected by
professionals. Support will be tailored to meet the individual’s needs
enabling Carers to maintain a balance between their caring responsibilities
and a life outside caring’.
The Outcomes we aim to achieve are:-
Priority 1. Identification and Recognition: So that those with caring
responsibilities are supported to identify themselves as carers at an early
stage, recognising the value of their contribution and involving them from the
outset, both in designing local care provision and in planning individual care
packages.
Priority Area 2. Realising and releasing potential: So that people with caring
responsibilities are supported to fulfil their educational and employment
potential.
Priority Area 3. A life alongside caring: So that support for both carers and
those they care for is personalised, enabling them to have a family and
community life.
Priority Area 4. Supporting carers to stay healthy: So that carers are supported
to remain mentally and physically well.
Priority 5. Supporting Young Carers: So that children and young people are
protected from inappropriate caring roles and have the support they need to
learn, develop and experience positive childhoods.
Guiding Principles:
The Council, NHS and other statutory and voluntary sector partners responsible for
implementing the carers strategic plan agreed to the following underlying principles,
which are to:
• recognise the vital contribution that carers make to the lives of people who are
vulnerable, ill, disabled or misusing alcohol or substances and the impact it
can have on their lives;
• work in an integrated way, using a whole family approach, to ensure carers
are at the heart of decision making about their care and support and service
planning
5• respecting carers as expert care partners, involving and listening to them,
especially around hospital care and a whole system approach to hospital
discharge
• developing systems across health and social care so people only have to
give information once;
• collecting and sharing information efficiently, enabling the council, NHS and
community groups to find ways of reaching out to isolated and excluded
carers to help them get the support they need
3. Involving Carers and achieving our vision
What did Redbridge Carers say would help achieve the Redbridge Vision?
A number of workshops, surveys and focus groups took place involving carers with a
wide range of caring responsibilities including young carers, parent carers and older
carers. They told us that they want to be listened to and have their voices heard
when the person they care for uses health and social care services. During the
workshops, carers shared their experiences of using health and care services and
said how things could be improved to help them in their caring role.
We continued to work with carers to co-produce the Action Plan by checking with
them that they felt their comments had been listened to and that the Actions
described will address the issues they raised and improve their experience of using
health, social care and mainstream services.
The Action Plan detailed in Chapter 9 shows which Agency is responsible for each
action and when it will be achieved. It includes the need for earlier intervention
across the health and social care system
We have set ourselves a challenging agenda and we plan to achieve our goals by:-
• working in partnership across statutory, voluntary and community sectors to
identify and support Carers in their caring roles through a whole family
approach, seamlessly across the health and social care system;
• promoting self-care and the management of long term conditions through
earlier intervention and re-ablement to support and promote independence
and wellbeing;
• providing accurate, accessible and timely information
• encouraging front line professionals in the statutory and voluntary sectors to
identify carers including young carers, who would benefit from preventative
activities;
• promoting the use of equipment and assistive technologies to help carers and
enable people with support needs to remain in their own homes longer and
ensure the carers and cared for know how to use equipment safely;
6• promoting open and accessible services for all carers by finding ways through
commissioned services to proactively engage with a diverse range of carers
from different ethnic communities, disability groups or those who are
disadvantaged or isolated because of their caring role disability or
communication needs;
• working to promote physical, mental, emotional and economic wellbeing,
enabling carers to have a social and community life outside their caring role;
• highlighting the role of GPs in recognising and supporting carers.
making links between the Quality Assurance Teams across Adult and
Children’s Services and the NHS to embed good practice and learn from
comments and complaints received;
building stronger links with providers of education, training and employment
support services to help develop new skills; and
providing learning and development opportunities for staff, to ensure they
have the skills to deliver the outcomes set out in this plan.
During 2014-16 we asked carers about their views in the following ways;
asking how they are affected by their caring roles and what we could do to
improve their experiences and support:-
• Conducted surveys to measure how well the adult social services are
performing in respect of top level outcomes set by the Department of Health
and the Personal Social Services Survey. The survey findings relating to
carers showed an improvement over last year and a higher level of
satisfaction compared to London in relation to the proportion of people who
use services and carers who find it easy to find information and support
• Engagement on the ‘Redbridge Dementia Plan: Don’t you forget about me’
• A consultation event took place to consider the content of the Green paper
‘No voice unheard, no right ignored’ to feed back the views of local people
including carers, service users, providers and commissioners to the
Department of Health on the issues raised during the discussion in Redbridge
• subsequently a Workshop was held on the development of the Transforming
Care Programme in relation to implementation of Building the right support the
national plan to develop community support for adults and children with a
learning disability and/or autism who display behaviours that challenge the
service, including those with a mental health condition;
• Adult abuse awareness day providing an opportunity for people to find out
how to keep themselves and the people they care for safe
• Focus group discussion with service users and carers who had experience of
the intermediate care and stroke service to inform the service review
• Promoted end of life discussions at various public information events such as
Dying Matters Week, Older Peoples Week and Carers Week
• Thinking Ahead conference for carers of people with a learning disability
7• Consultation with carers on the development of an Approved Provider List for
Home Care services
• Satisfaction survey conducted by RCSS with their member carers
• Strategic planning Workshop based on ‘Making it real for Carers, with
statutory voluntary Sectors and carers
• Focus Group discussion with carers using Jewish Care services
• Workshop to inform this strategic plan and development of a new model for
delivery of health and social services (HASS) in August 2015
• Focus group discussion with young carers to inform strategic plan and
development of a new model for delivery of health and social services
(HASS)
• Successful Workshop for front line social care staff delivered by young carers
to promote the Young Carers Protocol.
We went back to carers again with the first draft Summary of the Plan and the detail
of the Action Plan, to check that the actions reflected what had been said by carers
and that they would be effective and make a difference to their lives. A number of
new actions and clarifications were added and overall people felt that the Action Plan
would make a difference if implemented.
In addition to the feedback from carers, the Vision, and outcomes detailed in this
Strategic Plan reflect duties introduced under the Care Act 2014, the Children and
Families Act 2014, the NHS Five Year Forward View the NHSE Commitment to
Carers and other local strategic plans currently under development.
In the Care Act 2014, the Government said that health and social care services must
be able to show that they are working well together to make a difference to carers
and the people using services. Everyone will have to work differently to change the
way services are provided, making sure they are available close to where people live
and that you only have to give your information once. We have begun to do this by
joining services and teams such as social workers, physiotherapists, nurses
together. The development of the integrated Health and Adult Social Care Service
(HASS) brings together Redbridge support services provided by NELFT, NHS,
Public Health and Adult Social Services and aligns them with GP clusters.
84. Local Context
This new Redbridge Joint Strategic Plan for Carers takes account of new legislation
and is also linked to other key Redbridge strategies and plans including the Children
and Young Person’s Plan, Redbridge Joint Health and Well Being Strategy, the
Better Care Plan for health and social care and the End of Life Plan and Dementia
Plan ‘Don’t you forget about me’. It also highlights why it is important for health and
social care commissioners and providers to support carers in their role.
Carers are routinely engaged in discussions to inform planning and delivery of
services as described in Chapter 3 and these have been used to inform the
development of the Action Plan detailed in Chapter 9.
The Joint Carers Strategy takes account of the Council’s Corporate Strategy which is
an overarching document that unifies all of the Council’s activities. It sets out the
shared vision for the Council, Ambitious for Redbridge, and outlines four Corporate
Priorities to help achieve this vision:
Increase FAIRNESS and respond to the aspirations of the Borough
EMPOWER communities to help shape our Borough and the services we deliver
IMPROVE quality of life and civic pride amongst our communities
TRANSFORM our Council in tough times to be dynamic and responsive to the challenges of
the future
It also takes account of recent significant national policy changes including the NHS
5 year Forward Plan, Children and Families Act 2014, the SEND Reforms and the
Care Act 2014 which brings onto statute comprehensive changes in social care law
and significant financial, cultural and attitudinal challenges for health and social care
staff.
As part of the process to move towards greater integration plans, are underway to
extend joint working arrangements across Barking & Dagenham, Havering and
Redbridge (BHR) Clinical Commissioning groups and Councils to create an
Integrated Care Partnership and more widely across North East London in the
development of Sustainable Transformation Plans (STP).
In developing the Carers Strategic Plan we have also considered the priorities
outlined in existing strategies and plans and those under development, which aim to
9improve the health and wellbeing of the community and reduce inequalities, in
recognition of the impact on carers. This includes the refresh of the Redbridge
Dementia and Autism Plans, the End of Life Strategic Plan and the Transforming
Care Programme which operates across Barking & Dagenham, Havering &
Redbridge and relates to plans to improve community based support for adults and
children with a learning disability, autism and behaviours that challenge the system.
Evidence has shown that a key element of commissioning plans would be to improve
preventative and early intervention services. They need to be targeted towards
people with care and support needs, including carers that would benefit most from
interventions which help them live well and independently for as long as possible,
empowering and supporting them to self-care and, in doing so improve their
wellbeing and prevent, reduce or delay the need for high cost care services.
By working in a more integrated way efficiencies may be found and outcomes for
people using services can be improved by streamlining access to advice, information
and support at the front line
Since the production of the last Joint Strategy for Carers in Redbridge there have
been significant national policy changes which will affect the lives of people who care
for family members or friends, in particular the Care Act 2014, which relates to adults
over 18 and the Children and Families Act 2014 relating to children and young
people up to age 25 years. This together with an increasingly ageing population,
the rise in the number of people with caring responsibilities involving people with
long term complex care needs and the shift towards greater independence self-
management and care at home, will continue to require support from carers.
Despite operating in an increasingly challenging financial climate, Adult Social Care
and the Children’s Service allocate significant resources to provide support to carers
at a practical level through the provision of a variety of direct and contracted services
such as carer assessments, direct payments, home care services and respite care,
information and advice and community based day activities.
In addition the council has a good track record of engaging carers at an operational
and strategic level through commissioned services including a contract with the
Redbridge Carers Support Service, to provide direct services to carers to improve
their wellbeing and ensure that the views of carers are considered as part of the
development of policies and service delivery.
The previous Joint Carers Strategy was reviewed and this new Strategy for 2017-20
sets out how carers in Redbridge will be supported to maintain their health and
wellbeing and will be considered as part of the priority areas of work of the Health
and Well Being Board to ensure a continued partnership approach. Both adult and
children’s services, the NHS and voluntary and community sector are committed to
improve the level of partnership working as exemplified by the recent development of
10a Transitions Team focusing on the needs of young people aged 14-25 as they
prepare for adulthood and the development of a Young Carers protocol and a care
pathway attached as Appendix 1.
In addition the council is responsible for delivering their duties under the Care Act
2014, which brings about the biggest change to adult social care law in over 50
years. The Care Act sets out a range of additional statutory duties for local
authorities including a number relating to carers.
It is critical to the Vision in the Care Act that the care and support system works
proactively to promote wellbeing and independence, rather than waiting until people
reach crisis point. The Care Act places a duty on all local authorities to provide, or
arrange for the provision of services, facilities or resources, or take other steps which
it considers will contribute towards preventing, delaying or reducing the development
of needs for care and support by adults and or their carers in the area.
As part of the process for developing this Strategic Plan we have spoken to a wide
range of carers to secure their views about the care and support they receive for
themselves to help them in their caring role and also about other plans for health
and social care service developments enabling them to have a voice in service
planning.
The Personal Social Services Survey (PSS) of Adult Carers in England 2012-2013
has gathered extensive information from adults caring for someone aged over 18, in
receipt of support wholly or partially funded by social services, to find out more about
their experience of support from social services and about their quality of life. This is
a valuable source of data for all local councils in terms of informing Joint Strategic
Needs Assessments, the development of local Carers Strategies and Better Care
fund plans. It is now mandatory for councils to undertake this survey every two
years. The findings of the 2017 survey are not yet available.
The earlier survey showed the highest level of carers’ needs were reported among
carers with mental health problems of their own, among carers from Asian/British
Asian Communities, carers under age 64 and among those caring for 15 -20 years.
As part of the process, local authorities are asked to identify qualifying carers and to
survey a sample. In Redbridge the eligible number was 1629 and the sample size
was 900, with 366 completed survey forms returned. A short summary of the
outcome is as follows:
Table 1
Redbridge London England
Carer quality of life 8.8 7.6 7.9
(maximum score of 12)
Overall satisfaction of 54.4% 35.2% 41.2%
11carers with social services
The proportion of carers 51.4% 35.5% 38.5%
who reported that they
had as much social contact
as they would like
The proportion of carers 73.7% 65.1% 72.3%
who report they have
been included or
consulted in discussions
about the person they care
for
The proportion of carers 78.5% 62.1% 65.5%
who find it easy to find
information about services
Overall including service
users 82.6% 72.5% 74.5%
Survey of Adult Carers in England - SACE (Autumn 2014)
5. What we know about the impact of caring
The Carers Strategy: Second National Action Plan 2014-16 reminds us all that most
of us will have caring responsibilities at one or more stages in our lives. Much has
been published in the last few years about demographic changes and the impact
they are having and will have on all our lives. People are living longer both with
lifelong disabilities and long term health conditions which they develop as they grow
older.
Over the next 20 years the number of people aged over 85 is expected to double.
There is also a continuing shift away from institutional care to care provided at home
and in the community. The majority of people with dementia, for example, are now
cared for at home by a relative or friend. While this shift is welcome, it is important to
recognise that the pressure on families to care in their own homes, particularly for
spouses and partners, is growing significantly and is predicted to double over the
next 30 years.
Who are the carers?
It is important to understand that within the definition of a carer - there are three
types of carers:
1. Adult carers - adults caring for adults over the age of 18, this includes parents
caring for their adult children.
2. Parent carers/lifelong carers - parents caring for a child or young person
under the age of 18 who has a disability.
123. Young carer – children or young people under the age of 18 who are caring
for either another child, young person or an adult, who is sick, disabled or has
mental health problems, or is misusing drugs or alcohol.
It is recognised that these three types of carer are broad groups and that all carers
are individuals and as such have differing and diverse needs.
For the purposes of this Strategy we will use the following definition of a carer:
‘A carer is someone of any age who provides unpaid support to family or
friends who could not manage without this help. This could mean caring for a
relative partner, a child or friend who is ill, frail, disabled or has a mental
health or substance misuse problem’
Caring responsibilities can have a significant impact on the wellbeing of carers with
regard to physical, emotional and social wellbeing and affect educational
achievement and employment prospects.
Anyone can become a carer; carers come from all walks of life, all cultures and can
be of any age. Caring may be sudden and unexpected or could be developed over a
period of time. Many feel they are doing what anyone else would do in the same
situation. A caring role may last a few months or years and for some it will last for
the rest of their lives. Many people with caring responsibilities do not identify
themselves as carers and see themselves as spouse, parent, sibling, friend or
neighbour and so could be missing out on valuable support. These are known as
hidden carers. Access to information at the right time in the right way is therefore a
very important part of that support.
Families and friends want to provide good care but we know that they can encounter
significant challenges in their lives in doing so – for example, juggling caring roles
with education or paid employment; endeavouring to provide care at a distance;
managing a multiplicity of caring roles, including multi-generational caring and
mutual caring. They also face challenges in looking after their own health while
caring for someone else and having a life of their own alongside caring.
The National Strategy produced by the Government was informed by research
undertaken by a range of organisations to establish the impact of caring on
individuals, many of whom did not expect to step into a caring role. This includes
young carers, adult carers, who may be caring for their children and also their
parents and older carers.
13Findings from the research have found that caring affects carers in the following
ways:-
Health and wellbeing
Forty-three percent of people caring for an older person are themselves aged
over 65.
Nearly half of older carers reported high blood pressure or hypertension,
cholesterol and arthritis.
Around 20% of older carers experienced self-care difficulties themselves, for
example, as many as 13% reported difficulty dressing. (Independent Age ‘The
Bigger Picture: Understanding disability and care in England’s Older
Population’ Dec. 2014).
58% of carers said that their mental health had been adversely affected by
being a carer (Carers Trust survey).
27% said that caring had a negative impact on their physical and mental
health.
Substantial numbers of young carers report stress, anxiety, low self-esteem
and depression.
Personal emotional challenges
Carers Trust research suggests that:
• One of the most difficult challenges carers have to cope with is the impact on
their relationships, with two thirds (66%) saying their relationships had
suffered as a result of their caring responsibilities.
• The same percentage said they felt a loss of identity as a direct result of their
caring role.
• Three-quarters had not had a regular break from caring in the past 12 months
and 38% had not had a single day off.
• Many young carers report feeling isolated from their peers. They also feel that
they lack the time and opportunity to socialise and can also be reluctant to do
so.
Financial difficulties
• 59% of carers said that being a carer had a negative impact on their working
life; with 17% having to stop work; 15% having to reduce their paid working
hours; 15% having to use holidays for caring duties (Carers Trust survey).
• A survey of 3,000 carers found that 44 per cent had been in debt as a result of
caring (Carers UK 2013).
• More than two thirds (67%) reported they were financially worse off as a result
of caring (Carers Trust survey).
Educational attainment
• 27% of all young carers of secondary school-age experience some
educational problems, while 40% of children caring for someone who misuses
drugs or alcohol have educational difficulties.
• Many miss school and fail to attain any educational qualifications. This,
combined with on-going caring responsibilities, serves to exclude some young
carers from the labour market.
14Hidden carers
• Identifying young people with caring responsibilities for a relative at home is
difficult – they may not have the language, confidence or self-awareness to
relay the physical and/or emotional impact of living with a relative who
requires care. Many experience traumatic life changes such as bereavement,
family break-up, losing income and housing, or seeing the effects of an illness
or addiction on their loved one.
In recognition of the important role that carers have in supporting people with health
and social care needs, the Care Act 2014 included new rights for Carers, including
young carers, which includes parity of care and support to carers as for the cared for
person. If a carer appears to have a need for support they will be offered an
assessment regardless of the amount of care they provide their financial situation or
whether the person they care for has an eligible need.
People with care and support needs and their carers will be able to access advice
and information and have access to universal services available in the community
regardless of whether they pay for their own care or receive funded support from the
council. This is to help people maximise their wellbeing and independence and help
them make informed decisions about their care and support. The assessment will
take a ‘whole family approach’ and look at how caring affects the life of the carer
including their wellbeing, physical, mental and emotional needs. If a carer is
assessed as being eligible for publicly funded support they will also receive a
financial assessment to determine their ability to pay for their own care, in the same
way that service users are financially assessed.
We have also used as a point of reference the recommendations arising from
findings from a range of local Scrutiny Committee reviews, strategic planning
sessions involving carers of all ages, Safeguarding Boards and wider inspections of
specific services across England such as the Francis and Winterbourne Reviews,
which have looked in detail at the needs of Carers, children with disabilities, people
with learning disabilities and challenging behaviour, older people and those with
dementia and people approaching end of life. The actions included in the
improvement plans for these areas are reflected in the attached action plan.
156. The strategic context
National context
The Government published the National Strategy for Carers, ‘Carers at the heart of
21st century families and communities’, (2008) with 5 intended outcomes. These
stated that by 2018 every carer should be:
• Recognised and supported as an expert care partner
• Enjoying life outside of caring
• Not financially disadvantaged
• Mentally and physically well; treated with dignity
• Children will be thriving and protected from inappropriate caring roles
An updated national strategy ‘Recognised, valued and supported: Next steps for
the Carers Strategy’ was published in 2010. Although, the targets set in both
strategies are the same, the Government outlined the importance of carers to
families and communities and set out the Government’s intention to provide support
to carers particularly through:
• extending the roll-out of personal budgets to give people and their carers
more control and purchasing power;
• using direct payments to carers and better community based provision to
improve access to respite care;
• extending the right to request flexible working to all employees, consulting
with business on how best to do so; and
• establishing a commission for long-term care which was to consider how to
ensure responsible and sustainable funding for long-term care.
However, until the Care Act 2014 was introduced, even though the national
strategies were in place, carers did not have a legal right to receive support, it
remained at the discretion of local authorities, with some carers being treated
differently from the people they care for and making the system difficult for carers to
understand in some boroughs. Redbridge Adult Social Services have been proactive
for many years in supporting carers by promoting carers assessments and investing
in contracts which provide community based support for carers.
The Care Act 2014 is the biggest change to social care law since 1948 and brings a
framework for important new rights for carers by giving them for the first time the
same rights to assessments and care services from local authorities as those they
care for, regardless of their level of caring.
The Care Act 2014 relates mostly to adult carers who are caring for another adult.
This is because young carers aged under 18 and adults who care for disabled
children can be assessed and supported under the new Children’s and Families Act
2014. However there are many places where the two Acts overlap creating
16opportunities for local authority and NHS commissioners to consider ways of making
more effective use of resources when implementing the reforms. The Care Act
proposes a whole family approach meaning assessments must take into account the
needs of the whole family when assessing the needs of the person in need of
support. This must include ensuring that any child within the family is not undertaking
inappropriate levels of care
This could include new systems and processes such as pooled budgets across adult
and children’s services, as well as across education, health and social care. The
Better Care Fund is the vehicle for progressing joined up working across health,
housing and social care.
The introduction of the Better Care Fund (BCF) which is a £3.8 billion national fund
formed by bringing together existing NHS and social care funding streams and aims
to promote further integration through local plans which demonstrate how local
authorities with NHS partners, intend to meet the projected increase in demand for
health and social care services in the future in an integrated way, in the context of
finite resources and the changing NHS and social care landscape.
Both Acts and the Better Care Fund are outcome focussed and promote person
centred practice as part of assessment, planning and commissioning.
Through the introduction of the Care Act 2014 the Government was able to put in
place rules about looking at whole family circumstances when assessing an adult’s
need for care which means for example that the position of a young carer within a
family would not be overlooked.
This ensured a clear and consistent approach and parity for carers, including an
assessment of the carer ability to pay for any services they receive as a result of a
carers assessment.
From April 2015 the Care Act 2014 introduced the following changes for carers
• Carers have the same rights as those they care for.
• Local authorities have a duty to assess carers who appear to have eligible needs.
• Local authorities must consider a carer’s overall wellbeing, which includes
physical, mental and emotional wellbeing, participation in work, education and
training, and social and economic wellbeing.
• Carers who meet eligibility criteria will have a right to support to meet their eligible
needs.
• Carers should be supported to retain and gain employment.
• Carers will have new rights to be consulted on the cared for person.
• Local authorities have a duty to provide information and advice.
17The Children and Families Act 2014, in conjunction with the above, adults-focused
Care Act, seeks to make sure young carers and parent carers get the support they
need. Under this Act, local authorities are expected to try to identify young carers so
they can be offered support and both adult and children’s social services will need to
work together to help young carers.
Young people over 18 and their carers may also become entitled to adult social care
services and so there is a crossover between the two acts in respect of the provision
of support to young people between 18 and 25. The needs of carers should also be
considered as part of transition planning.
In recognition of the growing number of young carers being identified, a Young
Carers Task and Finish Group was established by the multi-agency Carers Strategy
Steering Group to develop a Young Carers Protocol to ensure Adult and Children’s
services work together to support young carers, including through transition to adult
services. An Agreement was developed and signed by the Directors of Children’s
and Adult Social Services and a pathway was put in place and piloted by adult and
children’s services social work teams to test out the effectiveness of the model.
During the pilot period, training was arranged by the Adult Social Services Care Act
Implementation Group to ensure the workforce had sufficient understanding of the
agreed pathway which ensures Care Act compliance. Subsequently a further
workshop, led by young carers was held in September 2015 to consolidate learning
for health and social care staff. Recommendations arising from this workshop are
included in the Carers Action Plan.
7. More about carers
The census data released in December 2012 by the Government showed that the
number of carers increased from 5.2 million to 5.8 million in England and Wales
between 2001 and 2011. Almost 1.3 million (1,277,693) older people are devoting
their retirement to caring for their partners or their own ageing parents. Census
figures show that this is an increase of 35% in the last ten years in this age group.
The greatest rise has been among those providing over 20 hours care – the point at
which caring starts to significantly impact on the health and wellbeing of the carer,
and their ability to hold down paid employment alongside their caring responsibilities.
Across England and Wales there are now 2.1 million people providing over 20 hours
a week, a rise of almost half a million people in the last 10 years. Those providing
the most number of hours of care i.e. over 50 hours a week and very often caring
round-the-clock, has increased by 270,000 and is up from 1,088,000 to 1,360,000.
The Census also found that there were over 166,000 young carers aged 5-17 in
England – an increase of over 26,000 since 2001. The majority were providing 1 to
19 hours care but over 8% were providing 50 or more hours of care. However these
figures are considered to be a gross underestimate. Research carried out by the
18BBC in 2010 indicated that there may be as many as 700,000 young carers. The
BBC survey of 4000 UK schools pupils found that 1 in 12 had moderate or high
levels of caring responsibilities four times the official estimates.,
Also significantly, more women than men in the age group 50-64 were providing
care. But there has been a shift in the age group of 65 and above; more men were
providing care than women in 2011.
It is clear from the 2011 Census that the general health of carers deteriorates
incrementally with the increasing hours of care provided. 5.2% of carers reported
their own health as ‘not good’ and this rose to almost 16% among those caring for
more than 50 hours a week.
While 55% of female adult carers and 44.9% of male adult carers reported they were
economically active, only 12.1% of women and 9.3% of men were working full-time
alongside caring responsibilities and only 1.2% of women and 1% of men reported
they were in full-time employment while providing 50 hours or more care a week.
National voluntary sector surveys
The voluntary sector has continued to publish surveys which provide valuable
insights into the experience and personal circumstances of carers of all ages. These
include, for example,
• The Children Society’s report about young carers Hidden from View: the
experience of young carers in England,
• the Carers Trust’s Report A Road Less Rocky – Supporting Carers of
People with Dementia, and
• Carers UK annual reports on The State of Caring and its Caring & Family
Finances Inquiry
The Children’s Society report shows that around 1 in 20 of young carers miss school
because of caring responsibilities and many have significantly lower educational
attainment at GCSE level, the equivalent to nine grades lower overall (i.e. the
difference between nine Bs and nine Cs) than their peers. Many young carers
between the age of 16 and 19 are neither in education, employment or training.
It is evident from Carers UK’s The State of Caring surveys and the Caring & Family
Finances Inquiry that many carers of working age feel forced to give up work to care
and after a period of absence many find it difficult to return to the labour market. The
State of Caring survey in 2011 found that of carers who had given up work or
reduced their working hours to care, a fifth were £10-15k a year worse off and a
further fifth were losing £15-20k. Many older working carers aged 55-64 are likely to
lose at least £30k a year.
How many carers are there in Redbridge?
According to the census the total number of carers in 2011 was 27,291 (in 2001=
23,848), an increase of 3,443. Out of this:
• 17,182 carers provide 1 to 19 hours unpaid care a week
• 4,405 carers provide 20 to 49 hours unpaid care a week
• 5,704 carers provide 50 or more hours unpaid care a week
19It is recognised that some individual service users may have more than one carer.
Health and social care professionals need to acknowledge and support all the carers
involved. It is also recognised that many people do not see themselves as carers
because, first and foremost, they may be husbands, wives, partners, siblings and
friends and are often unaware of the support available.
Young Carers
What do we know about young carers locally?
We do not know how many children and young people provide care within
Redbridge. The new Young Carers Protocol and Think Family approach will improve
our understanding of the local picture.
Redbridge Young Carers Project (Indigo) estimates that there may be 650 young
carers resident in Redbridge. In January 2012 there were 66 young carers aged 8-
18 years being supported by Indigo.
As the national and local data suggests, it is likely that only a small proportion of
children and young people who provide care are known to services or receive
assessment for support.
Table 2
Percentage of young carers working with Indigo and type of care provided:
Care for parents 60%
Primary carers (no other adult lives at 48%
home)
Sibling carers 33%
Source: Redbridge Indigo Young Carers Project, 2011
Indigo figures showed that there were more females than males who provided care
and that service users came from a wide range of cultural and economic groups
reflecting the makeup of our local community.
Reaching Hidden Carers
Research suggests that key groups likely to suffer inequalities include:
• Carers providing 20+ hours of care a week
• Carers from diverse backgrounds
• Older carers providing high levels of care
• Young carers
• Young adult carers
In order to achieve better outreach to all carers including Black and ethnic minority
and socially excluded populations, as well as working carers, service commissioners
and providers within statutory and independent sectors need their own approaches
to identify hidden carers.
A detailed assessment of carers in Redbridge was undertaken as part of the
development of the previous strategy for carers and to assist future commissioning
20approaches. This was based on an in depth analysis of the 2001 Census information
about the provision of unpaid care.
Older carers
In Redbridge it is estimated that in 2010 there were 3,953 people aged over 65 years
of age providing unpaid care for someone else. It is projected that this will increase
to 4,213 people by 2015 (Protecting Older People Population Information, 2011).
A report by the Department of Work and Pensions in 2011 ‘Developing a clearer
understanding of the Carer’s Allowance claimant group’, found that older people in
need of care seemed to be the least likely to accept the services available from local
authorities and/or private providers. Thus their carers often found themselves
providing most of the care alone, making seeking paid employment problematic.
Long-term caring had a particular impact on financial welfare.
Older carers in the study particularly emphasised their concerns about what would
happen when they reached State Pension age and were no longer entitled to receive
carer’s allowance. Many found this rule incomprehensible. Older carers were less
likely than younger carers to be seeking paid employment, probably because many
were already near retirement age and were also more likely to provide physical help
to the person they cared for and to do paperwork for them.
From the responses to the postal survey, older carers were most likely to be female,
White British, a carer for more than two years and provide 100+ hours of care per
week. Only 20% felt their financial situation was ok and most are not highly qualified.
The relationship between carers and those they provide care for is detailed in Table
3. For carers aged over 50 years, nearly a quarter (23%) was looking after a
parent/parent-in-law, 40% a partner/spouse and a quarter their child/grandchild. For
carers aged 60+, a quarter were also in poor health themselves, two to three were
looking after a spouse/partner, 89% had been a carer for more than two years and a
third had been a carer for more than 10 years.
Table 3
Relationship between carers and who they provide care for, by age:
Carers 16-49 Over 50 Total % 16-49 % Over % Total
50
Child/grandchild 113 34 147 44.0% 14.8% 30.2%
Spouse or partner 38 92 130 14.8% 40.2% 26.7%
Parent/parent-in- 65 53 118 25.3% 23.1% 24.3%
law
Adult child 13 28 41 5.1% 12.2% 8.4%
Other relative 15 16 31 5.8% 7.0% 6.4%
Friend/neighbour 8 5 13 3.1% 2.2% 2.7%
Grandparent 5 1 6 1.9% 0.4% 1.2%
All 257 229 486 100% 100%
Source: Developing a clearer understanding of the Carers Allowance claimant group, Department
for Work and Pensions, Research Report No 739, 2011
http://research.dwp.gov.uk/asd/asd5/rports2011-2012/rrep739.pdf
21Carers Allowance claimant numbers
The Department of Work and Pensions figures below in Table 4 show the numbers
of people claiming carer’s allowance in February 2013. It can be seen from this data
that most carers in Redbridge were female and over a quarter were aged over 55
years of age. For carers over 55 years of age, most had been a carer for more than
a year.
Table 4
Carers allowance claimants February 2013:
Duration of claiming
Age Male Female Total Up to 1 1-5 years 5+years
year
18-54 190 1050 1240 250 510 470
55-64 100 250 350 20 120 190
TOTAL 290 1300 1590 270 630 660
Source: ONS Crown Copyright Reserved [from Nomis, 2011]
Carers receiving services
The number of carers receiving a service in Redbridge in 2015 was projected to be
5.2%, which is higher than the London and England averages (see Table 5).
Table 5
Number of carers aged 65 and over receiving services.
Numbers Percentage of carers
known to authorities
Number of carers aged 2010/11 2014/5 2010/11 2014/5
65 and over receiving
services
England 79,830 138,385 46.3% 58.7%
London 7,455 13,065 41.9% 60.1%
Redbridge 1,060 1,175 85.5% 51.6%
22Table 6
Adult carers (18 and over) receiving social care through self-directed support as a proportion
of those adults receiving services 2014/2015
2014/2015 Redbridge London England
Number of carers receiving 802 15,830 106,605
self-directed support
Carers receiving services 929 18,710 137,760
including breaks for the carer
and / or other carers' specific
Carers services (excludes
(All Ages) information and advice)
Carers receiving social care 86.3% 84.6% 77.4%
through self-directed support
in the year to 31st March as a
% of all carers receiving carer
specific services
Carers receiving self-directed
support in the year to 31st 60.3% 73.8% 66.9%
March via a direct payment (560) (13,805) (92,155)
Number of carers 2,934 35,900 250,800
Carers Carers receiving services 1,494 23,145 154,580
(18-64) Percentage 50.9% 64.4% 61.6%
Number of carers 1,840 18,335 208,120
Carers Carers receiving services 1,056 11,710 111,900
(65 – 84) Percentage 57.4% 63.8% 53.8%
Number of carers 435 4,460 48,170
Carers
Carers receiving services 117 2,415 26,485
(85+)
Percentage 26.9% 54.1% 54.9%
Source: NHS Digital 2016
Direct payments are a way of enabling people to get the help and support they need
in a flexible way which can enhance their quality of life. More recent figures
highlighted in the Redbridge Local Account 2016 highlighted that in Redbridge the
proportion of people using social care who receive direct payments was 38% which
compared favourably to London at 27.6%. However the proportion of carers
receiving direct payments is 65.7% which has not kept pace with the London figure
which was 75.2%.
It is unclear whether this is a result of the introduction of the financial assessments of
carer’s ability to pay for services they receive, which came in to practice following the
Care Act 2014.
Carers with long term conditions
The numbers of older people who identified themselves as being in poor health as
well as having caring responsibilities increased slightly in 2010. These individuals
are likely to require extra support to maintain their independence and also fulfil their
caring role.
23Table 7
People aged 65 and over in Redbridge providing unpaid care to a partner,
family member or other person, projected to 2030
Redbridge 2014 2015 2020 2025 2030
People aged 65-84 providing unpaid care 4533 4627 5048 5620 6313
People aged 85+ providing unpaid care 473 483 544 624 714
Total all older people 65+ 5006 5110 5592 6244 7027
Source: POPPI 2016
8. Services to support carers
A range of services are commissioned to provide support for carers in Redbridge
including:
• commissioned services provided in the community by voluntary and
community organisations
• public health commissioned preventative support including access to leisure
services
• help in the home
• community meals
• day care for the cared for person
• respite care
• short stay in residential or nursing home
• information on carers benefits
The Local Account December 2016 highlighted that in 2016 Adult Social Services:
6The Redbridge Local Account showed that
• Assisted 13,882 people who contacted the council Adult Social care service
by providing relevant information and advice about the care and support
available within Redbridge. The Information and advice internet pages were
accessed 125,946 times;
• 503 individuals who pay for their own services were supported to access
suitable care services including residential and nursing care homes;
• Supported 3,407 people to maintain their independent living arrangements
in their own home
24• Helped 555 vulnerable people who were harmed by others in some way or
at risk of being harmed
• Undertook 8,440 assessments and reviews
• Supported 2,463 people caring for relatives or friends
• Provided 6,845 people with various care services such as personal home
care, residential care, end of life care
*There are also a number of other local and national voluntary and statutory
organisations that provide information, advice and advocacy and a range of specific
voluntary sector services that are commissioned to support carers.
Redbridge Carers Support Service (RCSS) is commissioned by Adult Social
Services to provide a range of support services for carers, including the provision of
information, advice and informal advocacy and to have a strategic role enabling the
voice of carers to be heard in the development of policies and services. Currently,
RCSS has 3,119 registered carers on its database. Funding has been secured from
Redbridge council and a wide range of Trusts, Foundations and donors support
carers via services such as health and wellbeing activities; complementary therapies;
counselling; trips, events and outings; support groups; support to young adult carers,
older carers and carers from newly arrived, refugee and migrant communities. RCSS
also supports vulnerable, isolated carers in their own homes with the provision of
welfare visits and volunteer befriending.
Staff and volunteers play a vital role making a positive difference to carers’ lives
enabling them to cope with their caring role. Vulnerable carers are empowered to
break the cycle of isolation and loneliness by accessing services via help with
transport and respite.
Service provision to support young carers
Indigo are a partnership between Barnardo’s and Redbridge Children’s Service and
work with young people aged between 8–18 years and their families, living in
Redbridge, who have a substantial caring role that is impacting on their emotional,
social, physical, or educational development. Indigo aim to remove the negative impact
of caring from young carers lives by working with their families from a ‘think family’
agenda, to ensure they have access to positive activities and their families are
supported in a way that means their development is not negatively affected.
Indigo has an open referral system receiving referrals direct from families and from
sources such as the Children’s Trust, community care, NELFT, NHS and education,
drug and alcohol and HIV services. They offer a range of opportunities for young
carers, including; After school clubs: work with individuals: Recreational
Programme; Family support; Sibling carers workshops; and Sixteen plus; Once
young people reach the age of sixteen they are invited to be part of a monthly group
who organise their own activities and start to look at issues that are going to affect
them as they move into adulthood.
25Indigo also work with Redbridge Carers Support Service (RCSS) Young Adult Carers
Group to improve the experience of the transition from child to adulthood. The
Council works with Indigo and RCSS and other agencies to help younger and older
people build their CVs by supporting them to find job opportunities and work
experience
Redbridge Carers Emergency Alert Card
The card identifies the carer and stores information needs, the person you care for
and contact details of family and friends who can help.
This card helps give carers peace of mind in knowing that there will be alternative
support provided to the person they care for in the event of an unplanned emergency
such as a family crisis or accident.
NHS Choices: Your health your choices, provide an on-line Information Service to
improve the health and wellbeing of the population including service users and
carers. This includes the ‘5 steps to mental wellbeing’ as detailed below;-
5 things that, according to research, can really help to boost your mental wellbeing:
• Connect – connect with the people around you: your family, friends,
colleagues and neighbours. Spend time developing these relationships. Learn
more in Connect for mental wellbeing.
• Be active – you don't have to go to the gym. Take a walk, go cycling or play a
game of football. Find an activity that you enjoy and make it a part of your life.
Learn more in Get active for mental wellbeing.
• Keep learning – learning new skills can give you a sense of achievement and
a new confidence. So why not sign up for that cooking course, start learning
to play a musical instrument, or figure out how to fix your bike? Find out more
in Learn for mental wellbeing.
• Give to others – even the smallest act can count whether it's a smile, a thank
you or a kind word. Larger acts, such as volunteering at your local community
centre, can improve your mental wellbeing and help you build new social
networks. Learn more in Give for mental wellbeing.
• Be mindful – be more aware of the present moment, including your thoughts
and feelings, your body and the world around you. Some people call this
awareness "mindfulness". It can positively change the way you feel about life
and how you approach challenges. Learn more in Mindfulness for mental
wellbeing.
Source: http://www.nhs.uk/conditions/stress-anxiety-depression/pages/improve-mental-
wellbeing.aspx
In addition a service directory and a wide range of information and advice for carers
including advice on ‘moving and handling the person you care for’ can also be found
on the website or through links on Redbridge i / My Life.
Assistive technology can support the aspirations of many older or disabled people
by providing them with greater choice. As the average age of the population
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