Carers Legislation - Analysis of Consultation Responses

9 Identification

In summary,

Register of carers

• There was majority support for legislative provision for GPs or local authorities to maintain a Carers' Register in order to support the identification of carers; primarily from carer/ user support organisations. However, a number of respondents perceived the wording of this question to be confusing and the results of this question should be treated with caution.
• Some respondents felt that GPs are often in the position to be able to identify a carer or that this would be an effective way of identifying carers.
• That said, there were comments that if a Carers' Register is to be introduced, it needs to be meaningful; there were also some suggestions of a need for guidelines on how to use the Register.
• There were also some calls for guidance or awareness training on how to identify carers.
• There were concerns that this could result in multiple registers and duplication of information. Furthermore, there are also felt to be some issues in relation to data protection and who would have access to the Register.
• Some respondents felt there is less value in imposing such a duty on local authorities as not all carers will be accessing social work services.

Proactive use of Registers of Carers

• Almost all respondents were supportive of the Scottish Government ensuing that good practice is widely spread amongst Health Boards about the proactive use of Registers of Carers within GP practices.
• A key advantage is that this would promote equity and consistency across Scotland and offer a joined-up approach towards the provision of services to carers. Some respondents called for partnership working across all agencies involved in identifying or providing support to carers. That said, there were some concerns that the Register will simply be a data collection point and that regular monitoring will be needed to ensure carer needs are being met.
• Some respondents noted that GP practices already maintain a register of carers and that there should be more emphasis on sharing good practice between and across local authorities.
• There were some calls for additional training for GPs and other agencies to help them in the identification of carers, with some suggestions that there could be a named person within each GP practice to lead on carer support.

Monitoring compliance

• Almost all those responding to this question were supportive of the Scottish Government asking Health Boards to monitor compliance with the core contractual elements of the GP contract.
• Key advantages were that this would help to ensure consistency across Scotland, promote accountability or be beneficial for carers.
• There were some suggestions that GPs should be required to report annually or that Health Boards should have to report to the Scottish Government on an annual basis.
• There were a small number of requests for monitoring to be in place, and for this monitoring to link to outcomes.

9.1 The consultation paper noted that it is necessary to identify carers and young carers so they can have access to a carer's assessment and to the support they need. However, identification of carers can be a challenge.

9.2 There are a number of avenues through which a carer or a young carer can be identified and these include social work departments, health and other professionals. Additionally, there are a number of existing local and national initiatives to help professionals identify carers.

REGISTERS OF CARERS

9.3 One of the ways in which carers can be identified is through the requirement for a GP to hold a Register of Carers, and this is included in the core element of the GP contract; and, as such, is a contractual agreement. The aim of this is that carers are identified in the GP practice so they can then be referred on for a carer's assessment and the support they need. However, there appear to be inconsistencies across GP practices in terms of how this is applied.

9.4 Another option is for local authorities to have a Carers Register, although this could lead to multiple Registers being held. Furthermore, there is also an issue with data protection legislation and issues in relation to consent and confidentiality.

9.5 Having given consideration to a statutory requirement for GPs and local authorities to identify carers through the use of a Register of Carers, the Scottish Government have ruled this out as an option. The Scottish Government is not convinced that more carers would be identified by the introduction of this legislation. Question 22 asked:

Question 22: Should there be no legislative provision for GPs or local authorities to maintain a Carers Register in order to support the identification of carers?

Table 9.1: Question 22

Respondent group	Yes	No	Other	Nil response
Individuals (32)	8	16	-	8
Carer/ User support (81)	9	46	-	26
Local authority (24)	14	7	1	2
Health (13)	7	3	-	3
CHCP (6)	4	1	-	1
Public body (3)	-	-	-	3
Professional body (3)	1	-	-	2
Representative body (3)	1	1	-	1
TOTAL (165)	44	74	1	46

9.6 As can be seen in the table above, more said no (74) than said yes (44) while a respondents from the carer/ user support group said yes and no.

9.7 However, it should be borne in mind that a number of respondents commented on the wording of this question which they saw as confusing because it is asked in the negative (should there be no legislative provision). Wherever possible, the yes/ no answer has been checked against any further comments. However, as this has not been possible in every case the results from this question should be interpreted with a degree of caution.

9.8 One hundred and forty-one respondents commented on this question. A large number of those answering 'no' at this question provided comments such as:

• There should be legislative provision to identify carers.
• There should be a Carers' Register in GP practices and this should be mandatory.
• It should be a requirement of GPs to hold a Carers' Register.
• This is an effective way to identify carers.
• GPs are often in the position to identify a carer who would otherwise remain hidden.
• Some GPs are reactive and do little to actively identify carers at present.
• A GP practice is often the first port of call for a carer.

9.9 There were also a small number of comments that very few GPs currently identify carers or that this practice is inconsistent across Scotland, and legislation would rectify this position.

9.10 While there was majority support for legislation, some respondents noted a number of provisos in order to make this more effective. A significant number, primarily carer/ user support organisations, noted that if a Carers' Register is to be kept, it needs to be meaningful i.e. a carer's name should do more than simply appear on a register; once registered, there should be referrals to resources and support or that it should be linked to actions to support the carer.

9.11 Some respondents also felt that guidance or awareness training needs to be provided to highlight how to identify carers, with some reference to young carers in particular; or requested guidelines on how the Register should be used. A small number of carer/ user support organisations suggested that each GP practice should have a named lead individual who can focus on carer identification and support.

9.12 A small number of respondents referred to there being less value in placing this requirement on local authorities as some carers might not be using social work services; whereas most individuals will be contacting their GP at some point in time. Some respondents only commented on GP practices maintaining a register and made no reference to local authorities doing the same.

9.13 There were some concerns that this could result in multiple carers' registers and a small number of organisations, mainly carer/ user support organisations noted the need to ensure that under integration, all registers should be combined to ensure there is no duplication. Allied to this, a small number of respondents noted concerns over who would have access to this register and cited data protection as an issue. For example, a professional body commented that the sharing of information would not be allowed; a health organisation that there would need to be clarity over who would have access to such information and how this information would be used. There was a suggestion from one carer/ user support organisation for the inclusion of third sector organisations as they are involved in joint working practices.

9.14 There were a small number of references from carer/ user support organisations for the need to ensure inclusion of all carers, including those in more hard-to-reach groups and young carers.

9.15 Respondents answering 'yes' to this question noted a number of issues, each one cited by relatively small numbers of respondents and these included:

• A register in itself might not actually identify more carers or help to identify hard-to-reach carers.
• There is no need for legislation although GPs and local authorities should be encouraged to maintain a register.
• GP contracts already stipulate that carers must be identified and signposted, thus negating the need for further legislation.
• Requests for further discussion on the purposes of the register; this was cited primarily by local authorities who felt that the purpose and practical value of a register needs to be demonstrated.
• Concerns over the resources that would be needed to maintain a Carers' Register; again, cited by local authorities.
• It would be essential for any registers to be kept up to date.

9.16 A number of respondents also noted the need for different organisations to work in partnership with each other, to allow for consistency.

PROACTIVE USE OF REGISTERS OF CARERS

9.17 While the Scottish Government has ruled out the option to introduce legislation for GPs or local authorities to maintain a Carers Register in order to support the identification of carers, there is an acknowledgment of the need to continue with further policy and practice developments. Question 23 asked,

Question 23: Should the Scottish Government ensure that good practice is widely spread amongst Health Boards about the proactive use of Registers of Carers within GP practices?

Table 9.2: Question 23

Respondent group	Yes	No	Other	Nil response
Individuals (32)	26	1	-	5
Carer/ User support (81)	52	-	-	29
Local authority (24)	20	1	-	3
Health (13)	11	-	-	2
CHCP (6)	4	2	-	-
Public body (3)	1	-	-	2
Professional body (3)	1	-	-	2
Representative body (3)	2	-	-	1
TOTAL (165)	117	4	-	44

9.18 Almost all of those who replied said yes (117) while only four said no. Eighty-four respondents commented on this question. A number of reasons were offered in support of this, each mentioned by small numbers of respondents. These included:

• The importance of ensuring effective and proactive use of GP Carers' Registers.
• This will promote equity and consistency across Scotland in the sharing and use of good practice, and the provision of support to carers, with a joined up approach to providing the necessary services to carers.
• GPs are in a good position to identify carers and respond to their needs.
• This encourages GPs to become involved in good practice.
• This will help to ensure the Register has some purpose.
• That this is better than a legislative requirement.

9.19 Some respondents also provided examples of current practice in their area or commented that health boards already share good practice and learning. A small number of respondents noted that GP practices already maintain a register of carers and that there should be more emphasis on sharing best practice between and across local authorities.

9.20 While almost all respondents were positive about this suggestion, a significant number of respondents qualified their comments at this question. Some of these respondents noted that the Register should not simply be a data collection point but that there is also a need to ensure good practice is being implemented or that supporting mechanisms exist to ensure carers are supported fully. There were also some comments that this needs to be regularly updated and that regular monitoring should be undertaken to ensure that carer needs are being met.

9.21 A few respondents also noted the need for partnership working across all agencies that are involved in identifying or providing support to carers. Indeed, there were some comments that this should not solely be the responsibility of GPs but that the wider NHS service and social work departments also need to be responsible for ensuring that good practice is widely maintained.

9.22 There were some calls for additional training for GPs and other agencies to help them in the identification of carers. A small number of respondents felt there should be a named person in each GP practice to lead on carer support.

9.23 There were a small number of comments from carer/ user support organisations that this will only be effective if it is combined with a duty on health boards.

MONITORING COMPLIANCE

9.24 The consultation paper then went onto ask respondents whether Health Boards should monitor compliance with the core contractual elements of the GP contract. Question 24 asked,

Question 24: Should the Scottish Government ask Health Boards to monitor compliance with the core contractual elements of the GP contract?

Table 9.3: Question 24

Respondent group	Yes	No	Other	Nil response
Individuals (32)	25	1	-	6
Carer/ User support (81)	54	1	-	26
Local authority (24)	19	1	-	4
Health (13)	7	2	-	4
CHCP (6)	3	3	-	-
Public body (3)	1	-	-	2
Professional body (3)	1	1	-	1
Representative body (3)	2	-	-	1
TOTAL (165)	112	9	-	44

9.25 The table above shows that 112 respondents said yes and only nine, including three from the CHCP group and two from the health group, said no. Many of those who said 'yes' to this question, did not provide further commentary, and a small number referred to their answer to the previous one or two questions. That said, 67 respondents commented on this question.

9.26 A few respondents noted advantages to this approach in that this would help to identify areas of non-compliance, ensure consistency across different areas, promote accountability or simply that it would be beneficial for carers.

9.27 Some respondents, mainly carer/ user support organisations, commented that GPs should be required to report annually and/ or that health boards should have to report to the Scottish Government annually. These respondents also asked for information such as the number of carers identified and the number of referrals made each year. Some of these organisations also suggested there should be a lead individual within the GP practice with responsibility for support of carers.

9.28 A small number of other respondents referred to the need for monitoring, with one carer/ user support organisation suggesting that carer organisations should be involved in the monitoring process. There were also a small number of comments that the Register should be updated regularly. Two respondents - a local authority and a carer/ user support organisation commented there should be legislation to make NHS Boards monitor compliance with the core contractual elements of the GP contract.

9.29 As with Question 23, there were some calls for the monitoring to link to outcomes or to have some form of reporting which allows for the measurement of progress. There were also a small number of requests for awareness training for GPs or other practice staff.

9.30 The small number of respondents opposed to this concept were primarily from health organisations and commented that contract monitoring and payment verifications systems are already embedded within health boards.