External Review of the National Carer Organisations (NCOs)

Section 5: Conclusions and recommendations

5.1 It has been stated throughout this report that there is no question about the value of the NCO Network and the significant impact it appears to have had upon raising the profile of issues for carers. The review found a virtual consensus about the need for national work on carer issues to be carried out by NCOs in some configuration. The prevalent view of the Network's work to date was found to be largely positive, with a number of achievements cited, including a step-change in the profile and visibility of carer issues. A range of strengths and benefits have been highlighted (for carers, organisations working with carers and other organisations) and the Network's knowledge and expertise is well-recognised.

5.2 Although the individual NCOs represent a diverse group and vary considerably in size and structure, it is clear that there is a commonality of purpose. While specific purposes, aims and objectives vary by function, these are consistent with the national strategies and the overall aims of the NCO Network.

5.3 There are obvious benefits in providing a national voice for carers and carer organisations, and a joined-up approach. There are also a number of specific areas of work in which the Network is seen to have been effective, and it is clear that there remains virtually universal support for the national strategy for carers and young carers. The adoption by the NCO Network of the outcomes for carers and young carers in the strategy was viewed as highly positive.

5.4 A range of types of work were highlighted as being carried out best at a national level. Cross-cutting issues were seen to benefit from a coherent, co-ordinated voice, while some work was seen to be carried out more efficiently at this level (e.g. gathering and disseminating information; interfacing with the Scottish Government, NHS and CoSLA; distributing and administering grant funding etc.).

5.5 Many review participants talked of the carers' "movement" and the strength provided by national work to support and complement local resources (while recognising that much of the carer support work was best carried out a local level).

5.6 Against this positive background there are clearly some concerns, and scope for development of the NCO body, relating to aspects of its work and structure, as well as to the interface between national and local organisations.

5.7 This is a challenging time for the NCOs. Recent years have seen a significant expansion in the profile of carer issues and the funding to support carers at a national level, but it is by no means clear that this will continue. Allied to this, the local picture is one of pressurised budgets and the increasing use of competitive tendering by public sector partners. More generally, a range of non-carer organisations are increasingly providing support and services directly to carers, with strategic and pragmatic alliances being created. Individual carers themselves face a range of challenges, from welfare reform and from changing local authority priorities.

5.8 The NCOs will play a part, as a strategic partner, in the development of the next carer and young carer strategies. They will also have to respond to emerging legislation and policy developments. At the same time, the NCO members will face the challenges of ensuring the longer term sustainability of their own organisations, and the need to meet ongoing obligations.

5.9 The "network" of Carer Centres is fragmenting and re-forming, which also has implications for the NCOs. The level of affiliation to the Carers Trust has dropped, and a number of larger Carer Centres have chosen to go forward without seeking Carers Trust affiliation. A new "Scotland Network" (formed of Carer Centre managers and trustees), was recently established, and while there is no suggestion that Carer Centres are not operating to the highest standards, the fragmentation of national support frameworks is likely to make it more difficult to promote and monitor national standards and good practice. The current Carer Centres themselves face significant challenges from changing local circumstances (and it is worth bearing in mind that, as freestanding organisations, some Carer Centres are significantly larger in terms income and staffing than most NCOs).

5.10 For a variety of reasons, therefore, the NCOs face significant challenges in going forward. There is a need for a strong national grouping, with a clear direction and focus. Given the role that the Network has developed in providing a voice for carers, there is also a need for a professional, well-resourced national body and an overall national framework for taking carer issues forward, with clear roles, responsibilities and accountability. The conclusions and recommendations detailed below focus on developing the NCO body to meet these challenges.

The work and direction of an NCO Body

5.11 The Network lacks an overall strategy and action plan to guide its work in relation to achieving the national carer outcomes. It also lacks a strategic approach to particular aspects of its work (e.g. representation of carers; links to carers and other organisations). This, in turn, makes the work less transparent and accountable. As the work of the Network has developed and expanded, the need to ensure an appropriate approach to these issues has become more evident. The first recommendation is:

Recommendation 1: The NCOs should develop a clear strategy and action plan for the NCO body. This should include:

• ­ Its overall purpose and vision.
• ­ Aims and objectives.
• ­ Key principles.
• ­ Areas of work and overall responsibilities.
• ­ Key priorities, tasks and responsibilities.
• ­ Links to carers and organisations.
• ­ The planning cycle and timescales.
• ­ Mechanisms for monitoring and reporting.

5.12 There is a shared view of what the key purposes and aims of the NCO body should be. Central to this is the provision of a voice for carers, identified repeatedly in all strands of the review. The stated purposes of the NCO body (from the original Terms of Reference) remain relevant, but may require some updating to reflect the views of stakeholders identified in the review. The key aims should include to:

• Provide a voice for carers.
• Improve services.
• Improve outcomes for carers.
• Promote carers' rights.

5.13 The key principles should include:

• Engagement with carers.
• Equality and rights.
• Co-production.

5.14 There are a number of broad areas of work where there is a national role, with a range of options for work within them. These are not radically different from the current four "pillars", but the review can help define and refine them. For example, "engagement" is perhaps better conceived as a principle underpinning all areas of work, while "services" can be more defined. Some additional broad areas should also perhaps be identified among the core functions of the NCO body.

5.15 There are also aspects of specific types of work which could be developed. For example, there is a lack of single point of contact for policy work, and a relatively weak "brand" both of which impact on the level of awareness of, and involvement in its work with others. There is a need for a more strategic and proactive approach to links and communication with carers and other relevant organisations, as well as a need for a clearer local, regional and national engagement structure and framework. It is recognised that developments to NCO body's work will depend on capacity and availability of resources which, in turn, will depend on the structure adopted, and provision by other organisations, particularly the Scottish Government.

5.16 The findings suggest that key areas of work for the NCO body should include:

• Policy development, to include:
  • ­ Strategic development.
  • ­ Input to national policy.
  • ­ Consultation and representation.
• Oversight, monitoring and research, to include:
  • ­ Evidence gathering.
  • ­ Use of research to support other functions.
  • ­ Oversight and scrutiny.
• Developing capacity and practice, to include:
  • ­ Training.
  • ­ Development of standards.
  • ­ Equalities work.
  • ­ Supporting work by other stakeholders.
• Communication, to include:
  • ­ Public awareness raising
  • ­ Publications
  • ­ Knowledge transfer and good practice dissemination
• National level services, to include:
  • ­ Provision of information to carers and workers.
  • ­ Existing services.
  • ­ New pilot work.

5.17 There is a strong view that the NCO body should have a role in campaigning and lobbying, but a lack of clarity about the extent to which this can take place without impacting on funding. In developing the strategy, the NCO body should seek clarity about the nature of work allowed or prohibited as a condition of funding. The NCOs could source specific funding for campaigning, ring-fencing this area of work.

The development of the NCO body

5.18 The current structure of the NCO Network has evolved informally and has, in the past, been adequate for the work. Some weaknesses have, however, been identified, given the changing role and expansion of work.

5.19 There are some current concerns about the mix of participants and the criteria for participation. Some concerns were also expressed about the number of NCOs and potential duplication, although the review found little evidence of overlaps (with the possible exception of dissemination of information about carer issues). The number of participants was not found to be a barrier to effective working, and, arguably, the participation of seven NCOs has added value to the work undertaken. These concerns may reflect a lack of clarity of the Network's role, rather than its composition per se.

5.20 The review has, however, identified constraints relating to the suitability of the current informal structure of the Network, which is vulnerable to organisational change and lacks clear mechanisms for representation of carer views and engagement with other relevant organisations. There is also a lack of transparency; channels of reporting and communication; and accountability, as well as a lack of strategic direction and co-ordination, making the Network's agenda often reactive.

5.21 The work of the Network is currently constrained by a lack of resources (including individuals' time and funding), and there are concerns about the inability of the Network to apply for funding in its own right, as well as the current means of funding national work. There are many areas in which the work could develop further, but this would be unlikely to be possible within the current structures, with resources as presently distributed. Changes to the overall context within which the Network is operating (e.g. the volume of work; expectations of carers and organisations; and future developments) suggest a need to develop capacity and develop a firmer foundation for the work.

5.22 There now appears to be a need to revisit the structure of the Network. Key considerations in helping determine the nature of the way forward include a need to ensure:

• A focus on national level issues.
• A focus on addressing concerns and effective use of resources.
• The capacity to deal with diverse issues coherently.
• An inclusive approach to involvement.
• Transparency and accountability.
• A focus on equality.
• Appropriate resources for the work required.
• Cost effectiveness, and the identification of any opportunities for efficiency savings, alongside the identification of opportunities for redeployment of any resources freed up.

5.23 Whilst it is for the NCOs and the Scottish Government to consider the most appropriate structure to address the issues raised, the review identified a number of suggested structures, which are set out in more detail in Annex 3. These provide a starting point for further consideration and discussion of the way forward.

5.24 Although it would be inappropriate to make a definitive recommendation, it is likely that the operation of the NCO body as a partnership (whether formal or informal) would be the most feasible at this stage. Although the development of a single, or small number of national organisations would, in many respects be optimal, there may be difficulties in bringing this about in the short term (given the complexity of the organisations involved, the current funding structures and the expressed reluctance of the NCOs to move to this, at least at present).

5.25 Within the partnership options, however, consideration should be given to greater formalisation to address some of the emergent concerns. (This could include considering the employment of shared staff, and incremental development of a stronger national entity.) The main benefits of this approach would be:

• The opportunity to develop the work to meet current and new challenges, while preserving existing strengths.
• The opportunity to apply for funding to enhance capacity (particularly from sources other than the Scottish Government).
• The development of a more transparent and accountable approach.
• The potential for some efficiency savings.

5.26 The second recommendation is, therefore, as follows:

Recommendation 2: The NCOs should give careful consideration to developing a more formal partnership in order to begin to address the issues raised in the review, increase effectiveness and provide a platform for further development in the future.

5.27 In the medium to long term, the NCOs should keep the structure under review, and consider the potential benefits of working towards the establishment of a single body, or a smaller number of national level organisations.

Key considerations about the development of a more formal partnership

5.28 Regardless of the structure adopted, there are a number of further considerations relevant to the development of a more formal partnership.

5.29 The NCO body could, for example, in the first instance, establish itself as a formal entity and apply for development funding to explore the options for a new structure and strategy in more detail. This could build on the review suggestions, taking advice from organisations with appropriate expertise in third sector development. The NCO body could consider employing a Development Officer to facilitate this (e.g. hosted by an individual NCO), or commission short-term support. This process could involve detailed consideration of the nature of the structure, the development priorities (with timescales) and the best means of funding the developments (including the implications for NCOs).

5.30 The NCO body should consider working towards the employment of some shared staff to develop its work within the new structure. In the first instance, this could involve the employment of a shared Co-ordinator to support the administration of the NCO body through the process of change, with subsequent employment of some additional shared staff to take forward key areas of work. (Given the view of the Scottish Government that it will not provide additional financial resources, funding for such developments would either have to come from other sources, or from the redeployment of current resources.)

5.31 The NCO body should also consider its current membership. Whilst this does not preclude retaining existing members, the rationale for membership should be considered, as well as any changes required to the roles of individual NCOs to reflect their role in the group (e.g. having Crossroads as "representing" direct service providers; or developing MECOPP's "national" functions). Clear membership criteria should be agreed and specified, as should procedures for management, co-option of relevant expertise and accountability. The partners should revisit the Terms of Reference as part of considering the overall structure.

5.32 The NCO body should have a single name, logo and consistent branding and communicate this widely. The current arrangement where the NCO Body does not have a fixed name, nor a manageable logo is unsustainable, and arguably counterproductive. Partnership communications should come from a domain attached to that name, rather than individual partners.

Specific issues in relation to equalities work and representation

5.33 While the particular issues faced by carers in some equality groups have been recognised, there are other equalities issues (e.g. disability; gender; other aspects of age etc.) and issues for other groups of carers (for example, those in rural areas) which are arguably not currently being adequately represented or addressed. There is also a lack of a coherent approach to effective representation of all carers. Regardless of the structure adopted by the NCO body, the third recommendation is:

Recommendation 3: The NCOs should consider further development of equalities work and comprehensive representation of carers, broadening the focus of specific work from BME and young carers to include other groups of carers facing particular issues as a result of their circumstances (including those in rural areas), and taking a more strategic approach to representation overall.

5.34 There is a need to ensure not only that the NCOs and NCO body focus on issues for particular groups of carers, but also that other key relevant policy areas (e.g. GIRFEC; rural policy; independent living etc.) take account of issues for carers.

The development of national level information for carers

5.35 There is a lack of a coherent approach to information provision by the NCOs, with no national level entry point for carer information, and no obvious single resource to signpost carers to support. There were concerns about the information available on NCO websites (e.g. as not necessarily comprehensive, impartial or Scotland-specific, and information relevant to young carers being presented within the Carers Trust UK website). The fourth recommendation is:

Recommendation 4: The NCO body should consider the development of consistent, high level national information and provision of this through a single point of access (e.g. shared website).

5.36 In order to facilitate the recommendations in this report (particularly Recommendation 4), it is suggested that a detailed mapping exercise of carer support organisations in Scotland should be carried out. The range of support provided to carers should be mapped, including provision by non-carer led organisations (e.g. condition-specific and independent living organisations, as well as free-standing projects funded by local authorities, the NHS and charitable trusts).

Funding issues

5.37 There are some issues with the current means of funding national work, relating to the fact that, at present, most NCO funding is provided by the Scottish Government through Section 10 funding for individual projects. The NCO Network itself receives no direct funding, and most pieces of work are the subject of individual bids, with a few exceptions. As a result, "national" activities have been funded in a piecemeal way, making it difficult to have an overall strategy underpinned by a budget matched to actions and outcomes. The fifth recommendation (to the Scottish Government and NCOs) is:

Recommendation 5: The current mechanism used by the Scottish Government to fund national level work with carers (unlimited separate bids to Section 10) should be reconsidered.

5.38 Additionally, the NCOs should perhaps consider working towards decreasing their reliance on Scottish Government funding (e.g. by identifying alternative funding sources) in order to reduce their future vulnerability.