Caring Together: The Carers Strategy for Scotland 2010 - 2015

EXECUTIVE SUMMARY

Headline Message

Carers are equal partners in the planning and delivery of care and support. There is a strong case based on human rights, economic, efficiency and quality of care grounds for supporting carers. Without the valuable contribution of Scotland's carers, the health and social care system would not be sustained. Activity should focus on identifying, assessing and supporting carers in a personalised and outcome-focused way and on a consistent and uniform basis.

The Government's Headline Actions

The following are the headline actions in this strategy to help improve outcomes for carers:

1. We acknowledge the immense contribution carers make to society and the need for appropriate support. We will develop a Carers Rights Charter, consolidating existing legal rights and setting out key principles for carer support both now and in the future.

2. We will put in place measures to help professionals in the health and social care workforce identify carers. Carer identification opens the door to a carer's assessment and to the provision of support. There will be a strong emphasis on workforce training as members of the workforce who are 'carer-aware' have a big role to play.

3. We will take steps to improve the uptake and quality of carers assessments/carer support plans. This will be achieved through workforce training and widely-disseminated guidance as well as by inclusion of the role of assessments in the forthcoming NHSinform carers information zone. Carers centres will continue their vital work in supporting this process.

4. We will improve the provision of information and advice to carers through various means including workforce training and our support for NHSinform.

5. We will ensure carer representation on Community Health Partnerships. Carers will be central to the planning, shaping and delivery of services for the people with care needs and in relation to support for themselves.

6. As carers can suffer poor health directly as a result of caring, carer health and well-being is vitally important. We will produce a bespoke resource on issues relating to stress and caring to complement the successful Steps for Stress. We will continue to work with the Royal College of General Practitioners Scotland and the national carer organisations on carer identification and support, including promoting good health. We will ensure that carers aged 40-64 have access to health checks under plans to target groups of people, including carers, who may not live in the most deprived areas - those eligible people in the most deprived areas will already have access to health checks under the Keep Well initiative.

7. Carer training promotes carer confidence and enables carers to care for longer. We will invest £281,000 in carer (and workforce) training this year through a grant to the national carer organisations. We will work with NHS Boards to ensure a 'training offer' may be made to carers in greatest need, contingent on the outcome of the next Spending Review.

The provision of short breaks or respite is hugely important to carers. We will work with a range of partners to promote the further development of flexible, personalised short breaks. Local authorities will continue to provide, and support access to, short breaks. We will invest a further £1 million in 2010-11 to provide more innovative short breaks provision in Scotland to be delivered by the voluntary sector.

9. It is important for carers to be able to remain in employment, when they want to, or to take up employment, learning or training opportunities. We will encourage and promote carer-friendly employment practices. Skills Development Scotland will be working with the national carer organisations to help promote learning and other career opportunities.

10. There is a clear need for better strategic planning and collaborative working between health and social care services to ensure the delivery of co-ordinated services and supports. We will work to ensure this happens so that carers do not have to negotiate the boundaries of different health and care services.

Appendix 1 sets out the membership of the Carers Strategy Steering Group which helped inform strategy development. Appendix 2 sets out the membership of the Carers Reference Group, comprising carers from different parts of Scotland and with different caring experiences, which also helped inform strategy development.

Chapter 1: Action Points and Implementation

Chapter 1 sets out the arrangements for implementation of this strategy. The consolidated list of Action Points is at Appendix 3.

Chapter 2: Introduction

Chapter 2 sets out the shared vision for unpaid carers (carers) in Scotland where carers are recognised and valued as equal partners in care; supported to manage their caring responsibilities; fully engaged in the planning and development of services; and not disadvantaged or discriminated against by virtue of caring. We set out a number of key outcomes linked to the vision.

Carers play a crucial role in the delivery of the health and social care system in Scotland. This role will become more important as a result of demographic and social changes. Carers need to be at the heart of a reformed health and social care system with a shift from residential, institutional and crisis care to community care, early intervention and preventative care. We make clear that in making radical changes to the health and social care system, carers should not be burdened, but supported and sustained in their caring role.

We set out the economic and efficiency arguments for supporting carers, whilst recognising the fundamental human rights and equalities perspective. We make clear that much more needs to be done to achieve practical support on a consistent and uniform basis and in a way which enables carers to have a quality life of their own outside of their caring responsibilities.

Appendix 4 sets out resources committed by the Scottish Government to date for support to carers. There is a focus on the challenging economic climate. There is also a clear statement that despite the extreme pressures on public finances, local authorities and Health Boards will commit to delivering incremental improvements to support for carers. This recognises that the demand on current statutory health and social care provision is unsustainable without changes in the pattern of service delivery.

This chapter sets out the role of the Scottish Government, COSLA, local authorities, Health Boards, the national carer organisations and other partners in delivering the strategy.

We make clear that there will be a baseline position against which to measure progress over the next 5 years.

We outline our commitment to publish, at the same time as this strategy, good practice to show the innovation of local authorities, Health Boards, the Third Sector and private sector. We are also publishing a selection of 'carer stories' to show the wide range of caring experiences, both positive and negative.

We highlight the importance of the Care 21 Report: The Future of Unpaid Care in Scotland, which contained 22 recommendations in relation to carers and young carers. We set out progress since the publication of Care 21 in Appendix 5.

Chapter 3: Profile of Carers

Chapter 3 summarises a range of data on the characteristics of carers, including age, gender, hours spent caring each week, whether working or not, and socio-economic background. Appendix 6 sets out the number of identified carers by local authority area.

We discuss the difficulties of collecting data on Black and Minority Ethnic ( BME) carers and state the action in hand to make progress on this front. We discuss the diversity of both the carer and cared-for population. We make clear that support for carers needs to take account of the dynamics of the caring situation and to be tailored accordingly. We acknowledge that there are groups of carers we know little about, such as carers with disabilities, gypsy travellers and refugees and that we should address this lack of knowledge.

Chapter 4: Prioritising Support to Carers

Chapter 4 focuses on the need for statutory and Third Sector organisations to prioritise support to carers in greatest need, according to local partnerships' own definitions of need, based on needs assessment work. Some caring situations will be more challenging than others but where caring responsibilities are minimal, plans should be put in place to prepare for any escalation in the demands on the carer. An emphasis on preventative action and early intervention should be the default position rather than crises-led responses which happen after an escalation of the problems and issues. Small packages of cost-effective support delivered in a timely way are appropriate.

Chapter 5: Equalities
- Equality Groups
- Caring in remote and rural areas

In addition to the many references to equalities issues throughout the strategy, Chapter 5 focuses on the need to fully recognise and implement in a meaningful way, and to further mainstream, equalities issues. Carers should not be discriminated against on the grounds of age, ethnicity, gender, disability, sexual orientation or religion. Therefore, efforts need to be made to identify and support carers who can sometimes be 'hard-to-reach.'

This chapter builds on the references throughout the strategy to the particular needs of carers in remote and rural areas, including accessibility of services for the cared-for person, the lack of easy-to-reach respite provision, the additional costs of caring in remote and rural areas, difficulties in delivering carer training and so on. We set out in Appendix 7 the full range of Scottish Government policies designed to improve transportation in remote and rural areas. We will work with key partners to identify innovative solutions to help address some of the issues.

Chapter 6: Carers Rights

Chapter 6 makes clear our intention to develop a Carers Rights Charter which will consolidate in one place existing carers rights and set out key principles for the future. Subject to a Self-Directed Support Bill being introduced into Parliament, and receiving Royal Assent, there will be a further legal right for carers to receive direct payments if various criteria are met. We will promote the Equality Act 2010. We make clear that the delivery of all the Action Points in the strategy should drive forward support for carers over the next 5 years, and beyond.

Chapter 7: Carer Involvement in Planning, Shaping and Delivering Services and Support

Chapter 7 makes clear that services and support will only be planned and delivered effectively and efficiently if carer organisations and carers are fully involved at all stages. Since carers comprehensively outnumber the paid workforce, they should have a central role in planning, shaping and delivering services and support. The Scottish Government will ensure carer representation on Community Health Partnerships ( CHPs). The review of Public Partnership Forums will involve carer representatives. The Healthcare Quality Strategy for Scotland is also ensuring carer involvement in important issues regarding the quality of healthcare services. There should also be carer involvement in procurement processes.

Chapter 8: Identification of Carers

Chapter 8 sets out the most effective ways to identify carers and stresses the pivotal role of practitioners in the health and social care professions, who are trained in carers' issues. Carer self-identification is also important. Identification is the first step to having a carer's assessment and accessing support - enabling carers to be identified or to self-identify is therefore critical. To this end, we will continue to work with the Royal College of General Practitioners Scotland and the national carer organisations. NHS Boards need to continue to support carer identification beyond 2011, when current Carer Information Strategy funding comes to an end. We will work with Alcohol and Drugs Partnerships ( ADPs) and the new Scottish Drugs Recovery Consortium ( SDRC) to help identify and support carers of people with addictions and substance misuse problems. Appendix 8 sets out a carer pathway from identification through to support.

Chapter 9: Carers Assessments (Carer Support Plans)

Chapter 9 sets out the range of actions to help improve the uptake of carers assessments/carer support plans, to enhance the quality of the assessments being undertaken and to provide more and better support following an assessment. There will be further work to ensure that the Talking Points approach to the undertaking of assessments is pursued rigorously. There is an emphasis on the need for practitioners to be fully trained in the carrying out of assessments and to acquire knowledge about services and support available locally. With the right focus, the assessment should lead to carers being signposted to appropriate support. Assessments must be revisited and reviewed to take account of changing circumstances and must take account of the wider needs of carers.

Chapter 10: Types of Support

Chapter 10 is a link chapter to the following chapters, which set out action to improve the planning and delivery of different types of support.

Chapter 11: Information and Advice

Chapter 11 sets out the importance of carers having access to
up-to-date, good quality information and advice whenever they need it. The Carers Information Zone, to be launched later by NHSinform, will provide useful information and advice on-line. Information and advice will also continue to be provided by carers centres, Health Boards, GP practices, local authorities,
condition-specific organisations and by others. We will scope the potential for a Scotland-wide carers helpline, and the options for providing it.

Chapter 12: Carer Health and Well-Being

Chapter 12 focuses on the mental, emotional and physical health of carers. Early identification of carers and the provision of support is the key to carer health and well-being. Carers centres play a major role in improving carers' overall health and well-being, as do other organisations. We will commission a bespoke resource for carers, building on Carers Scotland's health guide for carers to complement Steps for Stress. We want NHS Boards, CHPs and local authorities to ensure carers have access to training on moving and handling. Health checks will be provided to eligible carers. We will promote to carers the health benefits of the seasonal flu vaccine.

Chapter 13: Short Breaks (Respite)

Chapter 13 emphasises the importance of providing flexible, personalised short breaks provision to carers. Innovative solutions are required to help meet demand. Such solutions can focus on, for example, the use of volunteers to give carers a break, building community capacity, ensuring more flexible use of and access to universal provision such as playschemes for children with disabilities, more beds being available in care homes for respite in suitable circumstances and increasing the use of direct payments to purchase personalised respite. We will invest £1 million in 2010-11 to provide carers with short breaks.

Chapter 14: Training
- Carer training
- Workforce training

Chapter 14 makes clear that carers who receive training, if they need it, feel better supported in their caring role, and more confident. Whilst there is a great deal of carer training being undertaken by Health Boards, national carer organisations, local authorities and others, this needs to be consolidated and carried forward. The grant the Scottish Government has given to the NCOs in 2010-11 of £281,000 will be used to expand carer (and workforce) training. The NCOs will build on the good practice in training pilots the Scottish Government also funded - in Lothian, with BME communities and in rural areas. NHS Boards should continue to deliver carer training. Subject to the outcome of the Spending Review, we will work with NHS Boards so that they may make an offer of training to carers in greatest need.

Workforce training in carer awareness and carer support is essential. A well-informed, knowledgeable, trained and skilled health and social care workforce can help improve the lives of carers. NHS Education for Scotland ( NES), with NHS Boards and the NCOs, will build on current work and identify training materials to be used within core induction, education and training curricula. NES will communicate to the relevant regulatory, professional and national bodies the crucial importance of workforce training. We will work with NHS Boards to ensure workforce training is carried forward. We will also work with the Scottish Social Services Council.

Chapter 15: Housing and Housing Support

Chapter 15 acknowledges that housing is an important element in enabling carers to support the person they care for to live independently, if possible, safely and with dignity in their own homes and communities. Housing must be suitable for changing needs. Under the Reshaping Care programme, five main outcomes have been identified for older people's housing. We need to develop more effective links between housing, social care and health policies, with carer involvement, and will work towards achieving this.

Chapter 16: Use of Assistive Technology
- Telecare
- Equipment and Adaptations

Chapter 16 covers both telecare and equipment and adaptations. Much has been achieved over the last few years to ensure the availability of telecare which benefits carers significantly, delivering good outcomes. We want to maximise the impact of telecare investment to ensure that the benefits and application of new technology for carers continues and develops.

We recognise the benefits of suitable equipment and the need for adaptations to be carried out efficiently and when required. There is a need to build on the existing work to ensure that carers have appropriate information on equipment and adaptations services and that they receive training on the use of equipment.

Chapter 17: Advocacy Support

Chapter 17 sets out the benefits of advocacy support to carers, especially those who are the most vulnerable. There are only three carer advocacy organisations in Scotland. Given this scarcity of provision, and the outcomes that can be achieved through advocacy, we urge local authorities, NHS Boards and other local partners to develop or expand carer advocacy services for those in greatest need.

Chapter 18: Employment and Skills

Chapter 18 is clear that people should not have to give up work to care and should not find difficulty accessing work. Carers should be supported in employment through carer-friendly policies and practices. Work provides carers with a sense of normality, a life outside of caring and is the key to addressing carer poverty, including maintaining pension rights. With changing demographics, many carers who want to work should be helped to do so, as there will be a shrinking working-age population. We will encourage and promote carer-friendly employment practices and Skills Development Scotland will help carers into training and employment. Carers should also be supported to enjoy lifelong learning opportunities to improve their own well-being.

Chapter 19: Tackling Poverty: Financial Inclusion

Chapter 19 focuses on the financial consequences of caring, the low take-up of benefits by carers and service users, fuel poverty and local authority charging policies for services and support. Appendix 9 sets out the fuel poverty energy assistance package.

Increasingly, Community Planning Partnerships are enhancing mainstream services which address income maximisation, debt advice and financial capability. Carers centres, national carers organisations and others provide advice on benefits and income maximisation. Where voluntary services are located in GP practices to advise and support carers, there has been a take-up in benefits by carers.

We will pursue with the new UK Government the level of the Carer's Allowance and a review of financial support to carers. COSLA also provides guidance to local authorities on charging policies and is developing a benchmarking facility to facilitate consistent approaches in this regard.