Carers strategic policy statement: consultation

1. Introduction

1.1 What does this document do?
The Carers Strategic Policy Statement sets out the Scottish Government's overall ambitions for unpaid carers and for carer support. Our priority is to make the most of two major commitments and reforms (the Carers (Scotland) Act 2016^[1] and ongoing reform of carer benefits) and to connect the many other reforms and initiatives which affect carers.

This document maps the main policies across the Scottish Government which will be particularly relevant to carers. It sets out the overall outcomes these policies contribute towards, as well as the principles underpinning our work.

1.2 Who is this document for?
The document is primarily intended to inform strategic planning and policy development for local and national organisations working with carers. It will also inform frontline workforce training, including for teachers, social workers, health professionals and carer support workers.

1.3 Carers in Scotland^[2]
Scotland's carers make a huge contribution to the people they care for and our communities. There are more people caring full time for relatives or friends than staff working either in the NHS or in social care^[3]. The actual number of carers is not known but is estimated to be around 700,000 to 800,000 people. The latest estimated number of carers is 680,000^[4].

1.3.1 Age and gender
Of the 680,000 carers in Scotland, 31,000 are under 18. Although people can become carers at any stage, they are most likely to be caring between the ages of 45-54. In this age group, over a quarter of all women and around a sixth of all men are carers.

There are over 170,000 carers aged 16+ caring for 35 hours a week or more. Over half of older carers (aged 65 and over) provide 35 hours of care a week or more compared with just over a fifth of carers under 24.

Overall, 59% of carers are women and 41% are men. Throughout the working years, women are more likely to be carers than men. With gender stereotypes surrounding caring still present in our society, there is a risk that women feel more pressured to undertake caring roles. This pressure can negatively impact on a woman's career path and be a key driver of the gender pay gap.

Diagram 2: Carers Strategic Policy Statement Policy Map

1.3.2 Demographic pressures
Scotland's population is ageing, with numbers of very old people predicted to continue growing and a proportionately smaller working age population. This is a success story in terms of improved health and wellbeing and longer life expectancy, but it has significant implications for the future of care and support in Scotland. With demand for health and social care services predicted to grow by 25% by 2031^[5], the role and contribution of carers will be even more critical in the future.

1.3.3 Intensive caring and deprivation
47% of carers in the most deprived areas care for 35 hours a week or more - almost double the level in the least deprived areas. Caring may therefore stem from lack of choice and may be exacerbated by existing inequalities of low incomes and poor health in these areas^[6].

1.3.4 Impacts of caring
Unpaid carers make a huge contribution to the people they care for and our communities. Unpaid care in Scotland is already estimated to be worth £10.8 billion a year^[7].

For many people, caring can be a positive experience. Those with the least intensive caring roles can experience better than average mental health and wellbeing^[8]. For many carers, the time spent with the person they are caring for can be a positive and rewarding experience, if supported appropriately.

However, people in more intensive and stressful caring roles often experience negative impacts on their health and wellbeing.

Carers can often go without time for themselves while they focus on providing care. Things like bringing the cared-for person to appointments, picking up prescriptions and preparing meals all take time, on top of other regular tasks such as cleaning, paying bills and shopping.

There can be additional costs associated and reduced earning capacity with a caring responsibility. Carers often have to find money for things such as specialist food and equipment or the cost of taxis where public or private transport is not appropriate or available.

Every caring situation is unique. Carers' individual needs and the impact of caring depend on all sorts of factors such as their age, health and ethnicity, and their support networks of family and friends.

The level and type of care they provide is also a major factor. There are very different physical and emotional pressures from supporting someone with addiction, a mental illness, a physical disability or learning disability, or a progressive condition or terminal illness.

Carers' age and wider circumstances will also play a big part in determining the impact of caring:

• Young carers have all the demands of school and growing up to contend with.
• Young adult carers can have the added pressures of moving from school into training, employment, college or university, while also making the transition from young carer support into adult carer support.
• Many adult carers try to balance their caring role with other responsibilities such as work and looking after their children.
• Older carers often have to contend with their own health problems, making some caring tasks increasingly difficult.

Where a carer's health and wellbeing suffers, there is also an impact on the cared-for person. In turn, this often results in greater need for health and care support, particularly for older people, such as admission to a care home or hospital or delays to hospital discharge^[9]. Where the caring role leads to a carer leaving employment, this will affect their financial situation, their employer and the wider economy.

1.4 Scottish Government policy and carers
Scottish Government policy works in a variety of ways to help protect carers' health and wellbeing and to sustain caring relationships. It is based on a human rights approach to supporting carers, in line with other government policies and legislation. The strategic framework below sets out the overall outcomes our policies contribute towards, as well as the principles underpinning our work.

1.4.1 Strategic Framework

Vision

Carers are recognised and valued as equal partners in care and involved in decision making relating to their caring role. Carers are supported on a consistent basis to allow them to continue caring, if that is their wish, in good health and wellbeing, allowing for a life of their own outside of caring.

Young carers are enabled to be children and young people first and foremost and relieved of any inappropriate caring roles, while being involved in decisions relating to their caring role.

We live in carer-friendly communities, where carers' needs are understood, and they are not excluded or discriminated against by virtue of their caring role.

Principles

We should:

• Prioritise preventative support to help prevent problems developing.
• Enable choice and control so that support can be personalised.

Strategic Outcomes

Our policies contribute to strategic outcomes across four broad areas.

Carer voice and engagement

• Carers voices are heard and their views and experiences are taken into account in decisions which affect them.

Health and social care support

• People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing (National Health and Wellbeing Outcome 6).

Social and financial inclusion

• Carers access the financial support and assistance they are entitled to.
• Carers are able to take up or maintain meaningful employment alongside caring.
• Carers can participate in and are valued by their community and wider society.

Young carers

• Young carers are supported; and protected from inappropriate caring and negative impacts on their education, social lives and future development.

National Outcomes

Our policies contribute to outcomes from our National Performance Framework^[10].

• We are healthy and active.

• We live in communities that are inclusive, empowered, resilient and safe.
• We respect, protect and fulfil human rights and live free from discrimination.
• We grow up loved, safe and respected so that we realise our full potential.
• We are well educated, skilled and able to contribute to society.
• We tackle poverty by sharing opportunities, wealth and power more equally.

1.4.2 Principles
The principles of prevention and personalisation are consistent with the Christie Commission on the future delivery of public services in Scotland^[11], which described the prize for reform as a "sustainable, person-centred system, achieving outcomes for every citizen and every community".

We aim to prioritise preventative measures across public services to reduce demand and lessen inequalities. We know that intervention at crisis point is not effective for the carer, the cared-for person or the economy. We understand that support at an early stage in a carer's journey can prevent caring situations deteriorating.

Focusing on personalisation recognises the huge diversity of caring situations. Much of our work is founded on an understanding that enabling personalisation and choice of support leads to much better outcomes for both the carer and the cared-for person.