Carers (Scotland) Act 2016: implementation plan 2021-2023 (March 2021)

Priorities for 2021-23

Priority 1 Strategy and Leadership

Outcome

There is visible, long term commitment at national and local level to ensuring the Carers Act makes a real difference to all carers, with and without one or more protected characteristics, and those they look after, including by:

• recognising and supporting carers
• fostering connected and collaborative approaches to achieve the necessary cultural shift to deliver real change for carers across Scotland
• building strategic understanding of how wider areas of policy can support carers.

Challenges

Ongoing response and recovery from COVID-19 pandemic, alongside other competing priorities

Complex system with lots of local variation

Wider pressure on health and social care

Links to other areas/initiatives

The Carers Act forms part of a wider agenda of reform of adult social care; personalisation of support; and a shift towards prevention.

The need for change in social care was highlighted by the COVID-19 pandemic. This led to the Independent Review of Adult Social Care, which engaged with carers and made wide ranging recommendations which affect carer support.

There are multiple links to other areas which affect carers (including social security, children's services, education, fair work and employment, loneliness and social isolation, reform of primary care, and support for people with particular needs or conditions including mental ill health, dementia, autism, palliative care, neurological conditions).

These broader national policies and approaches to support unpaid carers in Scotland have been considered whilst developing the outcomes contained in the draft Carers Strategic Policy Statement (CSPS). The CSPS was intended to assist local and national strategic planning and policy development by detailing the shared ambitions for carers to maximise benefit from policies by connecting them and building a better understanding of the system as a whole. Work on the CSPS is currently paused in response to the COVID-19 pandemic.

Actions

1. Continued communications and involvement, including supporting consistent, on-going reinforcement by local (and national leaders) of their commitment to supporting carers (all ISG members) [See also priority 4, action 1.]

2. Commitment to ongoing work of ISG (all ISG members)

3. Promote and understand use of the Carers Strategic Policy Statement, when published, to inform and guide strategic planning at local and national level

4. Review and revise local carer strategies under section 33 of the Carers Act (Integration Joint Boards/Local Authorities/Health Boards with involvement of local carers, carer organisations and carer representatives, in line with national guidance and equality requirements)

5. Take a systematic approach to collecting, sharing and embedding good practice across the system by:

• Delivering a National Learning and Sharing event
• Young Carer Working Group to facilitate development, sharing and embedding practice in relation to young carers, recognising the need to connect young carers policy with services across education and wider children's services. The group will provide updates to the ISG. The ISG will also feedback anything they feel would be appropriate for the Young Carer Working Group to discuss.

Priority 2 Legislation and Guidance

Outcome

Carers, practitioners and organisations can draw on clear guidance and legislation relevant to carers, to develop local standards, processes and procedures, including on terminal illness and waiving of charges.

Challenges

Ongoing response and recovery from COVID-19 pandemic

Local variation.

Links to other areas/initiatives

COSLA homecare charging guidance.

Self-directed support options – as applied to provision of carer support which includes a break from caring.

Supporting disabled children, young people and their families

Development of updated Getting it Right for Every Child guidance.

Evolving Covid restrictions, response & recovery guidance which affects carers

Work in response to the Independent Review of Adult Social Care is also likely to be closely connected to the actions below in relation to the Carers Act.

Actions

1. Develop terminal illness regulations (including drafting and laying regulations). (SG)

2. Review and update statutory guidance to:

• incorporate local eligibility criteria guidance into main guidance;
• reflect terminal illness regulations; and
• incorporate material on waiving charges examples. (SG with consultation/co-production)

3. Review, consult on and update Carers' charter to:

• account for terminal illness regulations (SG)
• supplement the Carers' charter with additional rights (SG, NCOs, COSLA, SWS)

4. Maintain guidance in relation to Covid-19 and sections 16 and 17 of the Coronavirus Act as these affect carers (SG) and cross-reference other relevant guidance e.g. SDS.

5. Any further changes following the Independent Review of Adult Social Care.

Priority 3 Workforce and Systems Support and Development

Outcome

People who work in health and social care and education have the skills, knowledge and confidence to identify, support and involve carers as equal partners and understand the implications of the Carers (Scotland) Act 2016 for their practice, culture and ways of working.^[4]

Third sector provider organisations have the capacity to deliver flexible, personalised support to carers.^[5]

Local authorities, HSCPs and social care providers have proportionate, person-centred systems and participatory processes which enable carers to achieve the outcomes that matter to them.^[6]

Local authorities, HSCPs, Health Boards and third sector social care providers empower and promote partnership working, collaboration and innovation, including recognising the role of community assets and building resilient communities.

Challenges

Ongoing response to and recovery from COVID-19 pandemic

EU Exit

Issues associated with social care workforce are well articulated in the Health and Social Care Workforce plan part 2.^[7] The actions in this plan relate to specific activity connected to introduction of the Carers Act.

Pressure on health and social care – particularly due to Covid-19

Recruitment for early learning and childcare impacting on resources

Complexity of systems and workforce – with multiple individuals and organisations interacting with and playing roles in identifying, involving and supporting carers

Links to other areas/initiatives

Embedding Self-directed Support as the mainstream approach to social care.

Ensuring people get the right care at the right time in the right place (through health and social care integration)

National Health and Social Care Workforce Plan

Support for the mental health and wellbeing of health and social staff

Recognising and supporting the important role of community infrastructure.

Support and flexibility for carers as employees, including health and social care staff who have unpaid caring roles

Connections to wider reform of adult social care

• Actions to develop the capacity of staff working with carers complements the wider work on workforce conditions and skills, including embedding Fair Work principles.
• The skills we are targeting on outcomes-focused conversations, carer identification and on treating carers as equal partners will complement development of a national framework and standards for self-directed support.
• Work in response to the Independent Review of Adult Social Care will also be closely connected to the actions below in relation to the Carers Act.

Actions

1. Legislation and Guidance – see priority 2

2. Facilitate collaboration and conversation through ISG, carers leads and Young Carer Working Group (SG chair).

3. Develop and disseminate training resources and share good practice:

a. to support social care workforce, including unregulated carers centre workforce in identifying, supporting and involving carers? (SSSC)

b. to support health workforce in identifying, supporting and involving carers, including young carers, including promotion of EPIC, building on learning from s28 projects and exploring a quality improvement approach to involving carers in discharge decision making (NES, HIS and third sector with SG funding)

c. to support teachers and other education staff in identifying, supporting and involving young carers (Carers Trust and statutory partners, co-ordinated through YCWG)

d. to support health and social care workers, including carer centre staff with their own mental health and wellbeing (NCOs, SSSC, NES)

e. to support health and social care workers, including carer centre staff, in providing accessible information and building cultural competency in supporting minority ethnic carers (NCOs – MECOPP & COCIS)

f. to support health and social care workers, including carer centre staff to develop person centred solutions for short breaks and promote variety in the breaks available ( NCOs – Shared Care Scotland & HIS).

4. Provide support for third sector to build capacity including through

a. single carers centre managers network (NCOs with SG funding)

b. Scottish Young Carers Services Alliance (SYCSA) (Carers Trust with SG funding)

c. remote working transition fund and tailored support in 2020 to respond to Covid-19 pandemic (SG)

d. Short breaks fund – including additional short-term funding for carer support announced in January 2021 (SG)

e. any emerging priorities for support which may be identified in conjunction with centre managers and young carers services

5. Promote collaboration and statutory/third sector partnership:

a. Support joint meeting between statutory carers leads and carers centre managers to share practice and discuss shared challenges (SG, NCOs, statutory partners)

b. Third sector funding to NCOs with focus on promoting collaboration (COCIS post, funded by SG)

c. support carers centre managers network and SYCSA as above (NCOs)

d. explore further opportunities to promote collaboration (all members)]

e. Adopt collaborative approach to identify key gaps and target efforts to address these:

i. Short life working group on hospital discharge to be reconvened and remit/membership to be reviewed.

ii. Young Carer Working Group

6. Improvement support for cultural and systems change necessary to ensure unpaid carers are identified and supported at all points across the health and social care system (HIS/NES/ potentially Care Inspectorate).

Priority 4 Raising Awareness/Communications

Outcome

Carers are more aware of the choices available to them under the Carers Act, and are empowered to make genuine outcome-focused choices which support them^[8]

Carers can obtain relevant, understandable and usable advice and information about their rights under the Act and support available to them^[9]

Practitioners, managers, national organisations and the wider public are more aware of carers, the rationale for supporting carers, and carers rights under the Carers Act

These outcomes are achieved equally for carers with and without one or more protected characteristics, including minority ethnic carers.

Challenges

Ongoing response to and recovery from COVID-19 pandemic

Carer identification – "hidden carers", removing stigma and improving self-identification

Achieving early intervention

Resources

Risks of exclusion through eligibility criteria

Variation in levels of awareness across healthcare professions which play a key role in identifying carers

Variation in level or effectiveness of local promotion of carers rights to support

Lack of accessible information due to language and literacy barriers

Digital exclusion limiting access to information

Links to other areas/initiatives

Promoting Self-directed Support as the mainstream approach to social care.

Ensuring people get the right care at the right time in the right place (through health and social care integration).

Support and flexibility for carers as employees, including health and social care staff who have unpaid caring roles

Connecting Scotland – support to get online

Actions

1. Maintain a strategic focus and visible commitment to carers at national and local level - through articles, communication materials, engagements, social media, quotes and speeches, (SG and ISG members) including through

• development and delivery of a national marketing campaign (see Priority 1)
• Young Scot awareness campaign (Young Scot, funded by SG)
• materials and activity in response to COVID-19
• highlighting carers and their rights across other plans and strategies (e.g. Social Care Winter Plan, neurological conditions, MH, dementia (SG and other ISG members)

2. Local authority development and delivery of information and advice services and associated leaflets, including tailoring for young carers and equality groups (IJBs/Local Authorities, working with third sector)

3. Continue to work with the statutory sector and carer centre manager network to ensure that relevant information and advice is being delivered, including

• supporting sector about how to meet statutory requirements regarding carers with one or more protected characteristics (MECOPP, COCIS)
• understanding and building on lessons learned from adapting information and advisory services to COVID-19 (SG, NCOs, statutory partners, through carers leads and carer centre managers)

4. Review and update short breaks services statements, drawing on lessons learned about the first SBSSs and the challenges of COVID-19 (IJBs with scope to draw on template developed by SBSS think tank co-ordinated by SCS)

5. Review and revising of local carer strategies (IJBs, with carer involvement and consultation as per section 33 of the Carers Act and with guidance & support from national partners as necessary).

6. Third sector information and awareness raising:

• supporting carers and carers centres through carers centre managers network, SYCSA and other networks (NCOs)
• supporting Young Scot in developing and publishing posts on the young carer platform to ensure young carers have access to up to date and easy to digest information (Young Scot with SG funding)
• support condition-specific organisations to raise awareness and share materials (NCOs)

7. Raise awareness of young carers and their rights under the Act through schools and other channels, including promoting links between child and adult services at:

• national level - building on work of Young Carer Working group (SG/NCOs/Young Scot/ Education Scotland/ADES/GTC/SSSC/CAMHS/ SDS) - see priority 3); and
• local level – (Local Authorities – non delegated children's services and education)

8. Raise awareness of carers of all ages, including young carers, at national and local level in the context of the duty to involve carers in hospital discharge – see also priority 3 (Health Boards, NES and other members of short life working group)

9. Support engagement with health teams, including primary care who have a key role in identifying carers, to raise awareness of carers and building on existing work in this area, including work with health staff highlighted under priority 3 including in relation to EPIC

See also Priority 3 action on raising awareness of carers' rights among care providers.

Priority 5 Carer involvement and choice

Outcome

Carer's views in relation to the cared-for person are taken into account,^[10] including in relation to hospital discharge

Carer is involved in personal health and social care decisions^[11]

Caring responsibilities reflect carer's needs and wishes^[12]

Carers have a range of choices and a strong role as equal partners in care and in commissioning their own support.

Statutory bodies work in partnership with third sector and carers in strategic development of carer support and in commissioning.

Commissioners have the skills, knowledge and confidence to commission for the personal outcomes desired by carers.^[13]

Carers have the skills, knowledge, opportunity and confidence to influence macro commissioning decisions and to make micro commissioning decisions for themselves in the context of Self-directed Support.^[14]

Challenges

Complex landscape and systems – particularly around commissioning – challenging for carers to navigate, challenging to change

Lack of understanding and knowledge of entitlement to Self-directed Support

Differences in local approaches to the implementation of SDS, including levels of flexibility in using it

Balancing the rights of carers and cared-for people, including in respect of sharing information

Links to other areas/initiatives

Promoting Self-directed Support as the mainstream approach to social care

Ensuring people get the right care at the right time in the right place (through health and social care integration)

Ensuring reform of adult social care promotes the rights of carers

Carer representative role on IJB boards

Connecting Scotland work

Work in this area connects with the reform of adult social care and integration of health and social care, in particular that people with care needs and unpaid carers are actively involved in decisions about their own support as well as local strategic planning. It also supports work to ensure planning and purchasing of social care support is focused on flexible and person-centred support.

Actions

1. Support and engage with Carers Collaborative – forum for carer representatives on IJBs (COCIS coordination, SG funding)

2. Involve carer organisations and carers in strategic planning, including review and revision of local carer strategies and short breaks services statements (IJBs/Local Authorities/Health Boards – as per Carers Act duties)

3. Commission third sector delivery of carer services under the Act where appropriate (IJBs, LAs, Health Boards)

4. Promote joined up working across teams involved in Carers Act/Self-directed Support/person-centred care and seek to promote greater flexibility in the use of SDS for carers (SG, IJBs, third sector)

5. Build on the collective work of the short breaks think tank to assist LAs/IAs with their responsibility on market sufficiency and provider choice in the provision of short breaks and to build more sustainable short break options in future (SG, Shared Care Scotland, HIS, LAs/IAs)

6. Share and build on learning and good practice from remote digital support to carers during the pandemic in order to

a. understand the potential of digital connectivity in identifying, communicating with, involving and supporting carers and

b. address digitally exclusion

Priority 6 Measuring Progress and Impact

Outcome

We understand how effectively the Act is implemented and understand its practical impact on carers' lives and in terms of prevention.

We can use this understanding to inform future decisions in relation to carers policy.

Challenges

Lack of baseline data

Inconsistent records of carers

Variations in how data is collected between LA's/Health Boards/ Third sector

Different opinions about estimated costs/demands

Evaluability of key wellbeing outcomes

Difficulties attributing change directly or solely to the implementation of Carers Act

General pressure on health and social care

Differing expectations of national/local accountability

Links to other areas/initiatives

Social care charging

Promoting Self-directed Support as the mainstream approach to social care

Health and Social Care Integration

Getting It Right For Every Child

Mental Health

Education

Improving data and evidence on carer support is an important aspect of wider work to improve data and evidence for adult social care support.

Actions

1. Carers Census

a. Collect and analyse post commencement data on an annual basis, following disruption to the collection process due to the pandemic (Integration authorities/third sector/ SG)

b. Continue to work with local authorities and Carers Centres to improve the quality of the data.

c. Link the Carers Census data to the National Records of Scotland's population spine, in order to improve the de-duplication process and obtain an accurate number of carers being supported by local services in Scotland.

2. Finance Advisory Group (reporting to ISG)

a. consider options to understand demand for and investment in carer support, in the light of challenges in establishing the census and collecting data during the pandemic

b. consider demand, future costs, approach to funding delivery and next steps once census data available

3. Monitoring and evaluation group (reporting to ISG)

a. Reconvene group

b. Build on work of previous group by considering:

i. completeness of logic model and whether it should also cover systems and workforce outcomes

ii. recommendations in evaluability assessment report for how best to assess progress with the identified outcomes (options include - formative process evaluation; analysis of administrative data; analysis of routine data sets; and opportunities for local evaluation)

c. explore scope to establish academic carers group/community