National carers strategy

1. Living with COVID-19

Strategic outcomes

• Carers feel confident and supported to protect themselves from COVID-19.
• Carers and the people they care for feel supported and confident to re-engage with their communities.
• Carers are supported to recover from the negative impacts of COVID-19.

Why this is important

We know the COVID-19 pandemic had and continues to have a significant effect on unpaid carers. At the start of the COVID-19 pandemic, we created carer-specific information to help carers and carer organisations find the most up-to-date information relevant for them. We worked closely with carers and carer organisations to ensure that the information met carers needs and was also circulated through channels they were likely to use. We worked with NHS 24 to develop tailored information on NHS inform for people with ongoing symptoms following COVID-19, which includes signposting to guidance and support for unpaid carers. Unpaid carers were prioritised for vaccination in line with advice from the Joint Committee of Vaccination and Immunisation (JCVI).

The pandemic enforced lockdowns and associated restrictions which presented a series of unfolding challenges for carers. Each caring situation is unique so everyone faced different situations, but we know that carers faced particular issues in caring safely and sustaining caring roles.

Many carers were supporting people who were advised to shield because they were considered to be at highest risk of becoming severely ill if they caught COVID-19. Supporting people on the Highest Risk List involved asking this group and those around them to take many extra precautions to limit the chance of catching and transmitting COVID-19. For many carers, this increased the existing stress, fear and isolation of living under lockdown and ongoing restrictions.

The majority of pandemic-related precautions have been lifted, but we have heard from some carers that they have felt vulnerable, left behind and ignored as communities, workplaces and wider society open up again. We will continue to work with carers to address their concerns and ensure they are supported to keep safe while they re-engage in their wider communities.

We recognise that some carers will be providing support to friends and family members living with long-term effects following contracting COVID-19, known as long COVID. These effects vary in their presentation and nature from person to person, and can have a significant impact for those adults and children most severely affected.

The impacts of the COVID-19 pandemic disproportionately affected different equality groups. The majority of carers are women and were at greater risk of these disproportionate effects. Some minority ethnic groups were particularly vulnerable to COVID-19 and often less connected to support services. The pandemic increased the risk of trauma for many people across Scotland, particularly for those already affected by inequality, trauma and adversity. Research shows that experience of trauma can impact on people's mental and physical health outcomes if left unsupported.

As we move into the new phase of living with COVID-19, some carers need support to rebuild confidence and feel safe to re-engage with wider communities and services. Communication with carers is a key element of that, but there are also practical measures to share the latest guidance and expertise.

We remain committed to recognising the immense contribution carers make, increasing public awareness of caring and involving carers to ensure that our policies are informed by their lived and living experience. The following chapters set out actions to support this commitment.

How we will achieve this

Keeping people safe

In February 2022, our COVID-19 Strategic Framework Update refreshed our strategic intent: to manage COVID-19 effectively, primarily through adaptations and health measures that strengthen our resilience and recovery, as we rebuild for a better future.

For individuals and families, including carers, this will include continued hygiene measures, improving ventilation and wearing face coverings when and where appropriate.

For organisations, becoming more resilient to COVID-19 may include adapting premises to make them safer and enabling hybrid working where that makes sense and supports businesses and carers.

Carers for people who were on the Highest Risk List.

We know a lot more about the virus and its impact on different groups now. Combined with our successful vaccination programme and the availability of effective medicines for eligible people, this means the majority of people who were on the Highest Risk (formerly Shielding) List and the wider population are now far less likely to become seriously ill from COVID-19.

We recognise how challenging and frightening the COVID-19 pandemic has been for many people who were on the Highest Risk List and their carers. We know that people may need to make a significant change in how they assess their own level of risk, moving from being in the highest risk group to having a level of risk similar to the rest of the population. This shift may take more time and be more difficult for some people than others.

There remains a group of people who may not get the same level of protection from the vaccination as the majority of the population. This is because they have a medical condition, or are undergoing treatment, which means their immune system is weakened. It is likely that many people in this group will be supported by unpaid carers. This group of people remain at a higher risk from COVID-19, and we have developed guidance for them which is on the Scottish Government website.^[10]

The COVID-19 vaccination programme in Scotland is working well. The evidence now tells us that most of the people who were considered to be at highest risk from COVID-19 at the start of the pandemic are now at a much lower risk, and even people with a weakened immune system are getting protection from vaccination. It is important that everyone in this category gets all of the vaccines they are eligible for – including additional booster vaccinations - and follows any condition-specific advice from their clinician. They should also take the same steps to protect themselves from COVID-19 as they would from any other infectious disease.

We now have antiviral and monoclonal antibody treatments available which can help prevent serious illness in those who are eligible due to a weakened immune system.

We will continue to prioritise unpaid carers when offering COVID-19 vaccination in line with JCVI advice.

Anyone who may still be at higher risk of serious illness from COVID-19 due to a health condition or ongoing medical treatment can still access extra support and treatments to help protect them from becoming seriously ill from COVID-19. Access is via either a clinical trial (being publically referred to as a national study called PANORAMIC) or a limited deployment of neutralising Monoclonal Antibodies (nMABs) and antivirals to an extremely vulnerable cohort of patients, managed centrally by health boards. More detail is available on NHS Inform.

Involving carers

We will continue to involve carers and carer organisations in our work in living with COVID-19, including making sure they have the most current advice, and that the advice takes account of the particular needs of unpaid carers. We will listen and respond to issues as they arise and we will learn from our experience of how we could do it better.

Actions about keeping people safe

Ministers and officials will continue to engage with carers to ensure their voices are heard, including ongoing support for those whose risk may still be higher.

We will continue to ensure that carers receive accurate and up-to-date information about living with COVID-19.

We will continue to closely monitor all emerging evidence on COVID-19 treatments and their clinical effectiveness.

Unpaid carers will continue to be able access free PPE until March 2023. The provision of PPE beyond this is under review.

Support to rebuild confidence and reconnect with communities

Public buildings, workplaces and businesses

It is important that carers feel confident in entering our public buildings, returning to physical workplaces and engaging with public services.

We are taking measures to ensure our public buildings, workplaces and businesses are as safe as they can be. This includes taking forward the recommendations of our Ventilation Short Life Working Group. We are reviewing building regulations to explore how buildings can have infection resilience built into their design from the outset and providing information and guidance on adaptations that employers can make to support staff and customers to return and access services, including Coronavirus (COVID-19): safer workplaces and public settings.

A new suite of ventilation guidance, developed in cooperation with Public Health Scotland, has been publish which includes guidance for ventilation: in the workplace, for individual households and advice on the use of air cleaning technologies. This guidance has been shared with relevant sectors. We have developed a signage scheme that allows organisations to display by way of signage the protective measures, including ventilation, that they have in place within their buildings. The scheme will soon be relaunched as the 'Stay Well This Winter' Signage.

Engaging with health and social care services

Some carers have told us that they are nervous about engaging with or accepting support from health or social care staff for fear of catching COVID-19.

The Scottish Social Services Council (SSSC), in collaboration with national carer organisations and NHS Education Scotland (NES), has developed COVID-19 guides for carer support staff to specifically support staff working with unpaid carers. This is to provide staff with information and tools to support their own emotional wellbeing and encourage them to look after themselves while supporting others.

Community Link Workers (CLW) proved invaluable during the COVID-19 pandemic by helping to assist people, including those who were shielding or caring for others. The long-term social and economic and health and wellbeing impacts of COVID-19 mean that CLWs are key to recovery plans.

Distance Aware scheme

The Distance Aware scheme is designed to help those worried about mixing with others as we adapt to living with COVID-19. People can wear Distance Aware badges and lanyards to show others that they need more space.

We developed this scheme as a result of feedback from those on the Highest Risk List themselves (July 2021). The majority felt uncomfortable about restrictions being lifted and all said this was because of the behaviour of others. Almost three-quarters said they would welcome an initiative such as this to provide extra reassurance and help them feel more confident and comfortable in public places.

This voluntary scheme is open to anyone who wants to signal to others that they would like additional care and space when out in public.

Emergency and future care planning

We appreciate that carers are concerned about the impact on their ability to care if they were to become ill from COVID-19 or long COVID. Carers already have rights to help with putting in place emergency and future care plans for how care would be managed in these situations.

Reconnecting with activities and friends

We have heard from many carers that they now feel very isolated. For some people this has been exacerbated by a combination of intensive caring, lack of available breaks and limiting social contact and activities to reduce the risk of infection. Evidence suggests this is further heightened for those carers who live in rural and island communities.

Our longer term commitments to tackle loneliness and social isolation are set out in Chapter 4.

Actions about rebuilding confidence

We will continue to meet carers and carer organisations regularly to hear current concerns so we can provide up-to-date information. This includes funding and engaging with MECOPP (Minority Ethnic Carers of People Project) to ensure information meets the needs of carers with one or more protected characteristic.

We will encourage employers to be more supportive and flexible to support unpaid carers, through our Carer Positive scheme, which may include ensuring that sick pay and staffing practices support public health aims, adapting premises to make them safer for customers and staff, and enabling hybrid working where that makes sense.

We will take measures to ensure our public buildings and businesses are as safe as they can be.

We will encourage shops and other public spaces to display Distance Aware signage about personal distance.

We will work with partners to raise awareness and increase the uptake of emergency and future care plans.

Supporting carers to recover from the impacts of COVID-19 and improve wellbeing

Wider social care support services

The COVID-19 pandemic placed huge pressure on the health and social care system which has been unable to meet the level of demand for social care support. This in turn increased pressure on carers who stepped into the gap. Supporting the recovery of social care services is therefore a vital part of alleviating caring roles.

In December 2021, the Pandemic Response in Adult Social Care Group (PRASCG) developed the Adult social care - winter preparedness plan. Carers' needs are explicitly addressed in the winter plan and statement. Carers on PRASCG had the opportunity to feed into the plan and helped secure the additional £4 million to support unpaid carers noted above.

Our ongoing commitments to improve wider social care are also set out in Chapter 3.

Self-directed support (SDS) and flexibility

During the COVID-19 pandemic, existing flexibilities available in SDS implementation have been highlighted. This includes, the power to provide or arrange for the provision of support without the need for a full assessment where the local authority considers that the need is a matter of urgency; and the ability, with local authority agreement, to employ family members as Personal Assistants.^[11]

Mental health support

We have worked to support carers' mental health and wellbeing throughout the pandemic. This included the launch of the National Wellbeing Hub which aims to enhance personal resilience and self-care. This remains a valuable source of advice as we continue to recover from the pandemic. The Hub provides a range of digital wellbeing resources for all staff working in health and social care, with a dedicated page for unpaid carers.

We provide support and services for children and young people who have been on the Highest Risk List, including a series of blogs on Aye Feel - Mental Health & Emotional Wellbeing Information to provide information on mental health and emotional wellbeing to support young people. Access to mental health counsellors is also now available through secondary schools across Scotland.

We will continue to work with carers to understand their concerns as the country gets used to living with COVID-19.

Coronavirus Carer's Allowance Supplement

Carers who receive Carer's Allowance tend to be those with the most intensive caring roles and who are likely to be on lower incomes. In Scotland, this group of carers already get more than those south of the border through the Carer's Allowance Supplement introduced in 2018. In recognition of the additional pressure on carers during the pandemic, we acted quickly to make a double payment of the Carer's Allowance Supplement in June 2020 and again in December 2021. This additional £40 million investment came entirely from the Scottish Government budget.

We have worked closely with the Department for Work and Pensions (who deliver Carer's Allowance in Scotland on behalf of Scottish Ministers) to protect carers' benefits by relaxing the breaks in care rules and allowing for remote caring to count towards the 35 hours a week of care required for Carer's Allowance. Working closely with stakeholders in Scotland, we helped to provide the Department of Work and Pensions with evidence of the ongoing need for these relaxations to ensure that both Governments took the necessary steps to continue the relaxations throughout the height of the pandemic. We will continue to reflect the specific needs of carers in our engagement with the Department of Work and Pensions.

The COVID-19 pandemic has identified a need for greater flexibility in how we support carers when society faces significant changing circumstances. We are considering the need to support carers to recover from the pandemic and future-proof our benefits system to provide greater flexibility to respond to changing circumstances as we develop our proposals for Scottish Carer's Assistance, which will replace Carer's Allowance in Scotland.

Actions about supporting recovery

We will work to improve carer recognition, health and social care support, and financial and social inclusion for carers, through the actions set out in the following chapters.

We provided £21 million funding in 2021-22 and have committed £15 million funding in 2022-23 for community-based initiatives to promote good health and wellbeing and tackle the mental health issues made worse by the COVID-19 pandemic and the cost of living crisis (the Communities Mental Health and Wellbeing Fund).

As we develop Scottish Carer's Assistance, we are considering the best way to support carers to recover from the COVID-19 pandemic and future proof our benefits system to ensure there is flexibility to respond to changing circumstances.