Scottish Government Response to 'Carers Legislation - Consultation on Proposals - January 2014'

Chapter 1: The carer's assessment (the carer's support plan)

Question 1 Should we change the name of the carer's assessment to the Carer's Support Plan?

What we heard

Most respondents supported the proposal to change the name of the carer's assessment to the 'carer's support plan'. Some local authorities told us that they already use this naming convention, or similar, for assessments.

The broad consensus is that removing the term 'assessment' is a positive step, as many carers consider the terminology to have negative or stigmatising connotations. Some respondents did however express the view that the end result and outcomes for carers are more important than a change of name.

Some respondents suggested that the term 'support' may lead to a presumption that support will automatically follow the completion of an assessment.

The Scottish Government response

We intend to introduce the adult carer support plan (ACSP) for all identified adult carers if they wish to have this Plan. The ACSP will, amongst other things, set out the adult carer's identified personal outcomes, his or her identified needs (if any) and the support (if any) to be provided to meet the needs. With regard to the adult carer's personal outcomes, these will include outcomes which would, if achieved, enable the carer to provide or continue to provide care for the cared-for person. There is likely to be a focus on outcomes that are linked to maintaining and improving the health and wellbeing of the carer.

The implementation of the ACSP will provide a consistent approach across all local authority areas. It is intended to remove the stigma that some carers feel exists with the term 'assessment.'

Question 2 Should we remove the substantial and regular test so that all carers will be eligible for the Carer's Support Plan?

What we heard

Most respondents welcomed the proposal to remove from the face of statute what is commonly termed 'the regular and substantial test.' This will extend what is now the ACSP to all adult carers, including those who only have low-level or temporary support needs.

Some respondents commented that current practice has created a barrier preventing some carers from accessing assessment and potential support. We have heard that this is especially the case for carers of people with unpredictable or episodic conditions and where a relapse or a change in the person's condition can result in support needed for the carer.

The Scottish Government response

We propose to remove 'the regular and substantial test' to create a more consistent approach across Scotland. The legal requirement for local authorities to make a decision about a carer's eligibility for an assessment i.e. whether the carer is indeed caring for a substantial amount of time on a regular basis will no longer exist.

The effect of extending the ACSP to all adult carers who want one will be positive and will raise awareness of caring and the potential support available. It will also enable adult carers who care for someone on an intermittent or irregular basis to have access to the ACSP that they may otherwise not have had.

Question 3 Should we remove that part of the existing carer assessment process whereby the cared-for person is a person for whom the local authority must or may provide community care services/children's services?

What we heard

A recurring theme that respondents highlighted is that currently some potential cared-for people have health needs only and are not in receipt of community care services or are resistant to accepting support services. Examples cited were people with mental illness, those who are affected by substance misuse, people living with HIV, older people, or people from black and minority ethnic (BME) communities. In BME communities, family members, in particular, are often not recognised as being carers and can, as a result, find themselves isolated with little or no support.

Some respondents commented that by removing 'the substantial and regular test' together with the removal of this criteria, there would be better identification (and self-identification) of carers. This could lead to better outcomes for carers and, in the longer term, result in less demand for costly services intended for cared-for people.

The Scottish Government response

We propose to remove the criteria that the cared-for person must be in receipt of community care services. We are persuaded that removal of this criteria will encourage better identification (and self-identification) of adult carers leading to an increased uptake in ACSPs.

Question 4 Should we introduce two routes through to the Carer's Support Plan - at the carer's request and by the local authority making an offer?

What we heard

A two-route option of the adult carer being offered a carer's assessment or the adult carer requesting a carer's assessment is already well-established as good practice in some areas. The majority of respondents feel that it would be helpful to have two routes through to the ACSP.

The Scottish Government response

In addition to the current pathway where a carer can request a carer's assessment, adult carers can be offered an ACSP. Providing two routes to the ACSP is expected to enhance accessibility of the ACSP, and facilitate a participatory and collaborative approach between the carer and the person or persons preparing the ACSP.

Question 5 Should we remove from statute the wording about the carer's ability to provide care?

What we heard

There was broad support for this proposal and in particular support for a move to an outcomes-based approach. It was suggested that the current wording creates negative connotations and acts as another barrier to carers accessing support. It was suggested that the concept of 'capacity' to care was more appropriate than 'ability.'

Some respondents suggested that in some cases it is important to consider or measure the 'ability' of someone as a carer.

The Scottish Government response

We have reflected on the use of the term 'ability.' It carries negative connotations. We do not propose however to use the term 'capacity' as it conveys mixed messages either about a carer's cognitive capacity or about his or her capacity in terms of their own health and wellbeing. On reflection, we do see merit in having in statute a requirement to take into account the extent to which the adult carer is 'able' to provide care for the cared-for person as opposed to making an assessment about the carer's 'ability' to provide care. If this is done then there will be discussions about whether the adult carer is able to care due to his or her availability, health and so on.

We will also make provision about an adult carer's willingness to provide care. In this respect, it is important that the carer is willing to provide care as well as being able to provide care.

Question 6 Should we introduce a duty for local authorities to inform the carer of the length of time it is likely to take to receive the Carer's Support Plan and if it exceeds this time, to be advised of the reasons?

What we heard

The majority of respondents supported this proposal. However, a significant number of local authority respondents suggested that introducing this duty would create additional bureaucracy and pressure on resources which would cause unwanted delays in the offering, undertaking and completion of ACSPs. Some local authorities stated the importance of retaining the ability to manage demand and resources within their own areas.

A number of respondents, especially carers and carers groups, disagreed with a duty to inform carers of the length of time it is likely to take to receive the ACSP. Instead, they sought provision in law that the 'waiting time' for being offered the ACSP and the undertaking of the ACSP should take no more than a specified number of weeks with a maximum 12 weeks being cited as a possibility.

The Scottish Government response

We do not intend to introduce a specific duty for local authorities to inform the carer of the length of time it is likely to take to receive the ACSP. Nor will we set a specified time in law for offer of the ACSP. To do so could result in an artificial and inflexible management system where all or most adult carers are offered the ACSP at the maximum time limit e.g. 12 weeks. Our view is that some adult carers (e.g. those with complex caring situations including caring for someone with a terminal illness or at end of life) would require to be offered the ACSP very quickly and for the ACSP to be prepared quickly whereas longer, but not unacceptable, timescales would be the way forward in other circumstances.

We intend to introduce a requirement in law that each local carer strategy (see Chapter 6) must set out the authority's intended timescales for preparing ACSPs and young carer statements (YCSs). (See later in this chapter for young carer statements). Since each local authority must publish its local carer strategy, information will be available on a Scotland-wide basis about intended timescales. This in itself will act as a driver for consistency of approach whilst maintaining local discretion as appropriate.

This provision in law will be underpinned by statutory guidance covering, for example, good practice and expectations around timescales in different situations. Indeed following carer identification, timescales relate to different parts of the ACSP process as follows:

• offer of an ACSP and acceptance of the offer by the adult carer or request for an ACSP by the adult carer
• preparation of an ACSP
• completion of an ACSP
• review of an ACSP

In some cases it will not be known whether there are circumstances requiring speedy completion of the ACSP until the preparation of the ACSP in underway. In other cases, this will be known through the initial contact with the adult carer. This means that it is not acceptable for carers to have to wait a long time for the offer of the ACSP. We fully expect that there will be many more ACSPs prepared than carer's assessments currently and they should be provided within reasonable timescales. Likewise, support to carers should be provided within reasonable timescales.

The guidance will also be clear that it is good practice to advise carers on an individual basis about the expected timescale for offering the ACSP or YCS, for preparation and completion of the ACSP or YCS and for keeping adult and young carers informed of any significant delays.

Question 7 How significant an issue is portability of assessment for service users and carers?

Question 8 Should the Scottish Government and COSLA with relevant interests work together to take forward improvements to the portability of assessment?

What we heard

Portability of assessment for both service users and carers was thought to be a significant issue. Many respondents commented on what they regard as a lack of consistency in assessment and support. A small number of local authorities supported a move towards greater consistency whilst a similar number pointed out that differences exist due to different needs in different areas.

All respondents bar one supported the idea of the Scottish Government and COSLA working together to improve portability of assessment. Comments included the need for the ACSP to be portable in order to minimise stress for carers.

The Scottish Government response

We agree that the Scottish Government and COSLA should work together to improve portability of assessment and will do so.

What else we are doing

• Young Carer Statement (YCS)

What we heard

Many respondents highlighted the experiences of young carers and young adult carers.

A concern raised by some respondents was that young carers should have a specific young carer plan or carer support plan in addition to, or instead of, the child's plan.^[3] Others commented that the needs of young carers should sit within the GIRFEC (Getting it Right for Every Child) approach, with consideration being given to the rights of young carers as they move into adulthood.

The Scottish Government response

After consideration of the views of young carers and bodies representing young carers, we will introduce a Young Carer's Statement (YCS).

The YCS will be very similar to the ACSP in terms of the identification of personal outcomes and identified needs (if any) and setting out the support (if any) to be provided to a young carer to meet those needs.

Moreover, because of a young carer's age, the YCS will contain information about the extent to which the 'responsible authority'^[4] considers that the nature and extent of the care provided by the young carer is appropriate. This will facilitate discussions about the appropriateness of the type of care provided and whether the caring is detrimental to the young carer's health and wellbeing.

In order to ensure continuity, if and when the young carer becomes an adult carer, the YCS will continue to have effect until the young carer who is now an adult carer is provided with an ACSP.

Young carers who are eligible for a child's plan under the Children and Young People (Scotland) Act 2014 (CYP Act) will be able to have a YCS too.

The ACSP will be available to young adult carers aged 18 and over. However, if a young carer has attained the age of 18 while a pupil at a school and is still at school he or she will be a young carer and will have the YCS. This is for consistency with the circumstances in which the named person service under the named person service under the CYP Act applies. We will ensure that guidance covers the particular circumstances of young adult carers.

• Review of ACSP and YCS

What we heard

Many respondents commented that the plan should be reviewed as and when necessary to ensure that it is kept up-to-date to reflect carers' changing circumstances.

The Scottish Government response

We will make provision for both the ACSP and YCS to contain information about the circumstances in which the plan or statement is to be reviewed. The Scottish Ministers will also have a regulation-making power about the review of the ACSP and YCS. Therefore, it may well be the case that the ACSP and YCS should be reviewed when a cared-for person is discharged from hospital.

• Other issues

We see merit in the ACSP and the YCS containing information about whether support should be provided in the form of a break from caring. This will be provided for in the Carers Bill.

Some respondents called for the ACSP to include provisions about emergency planning. We recognise this as a concern for adult carers and young carers too. Since not all adult and young carers will however require discussion of, and arrangements for, emergency planning, we propose to enable emergency planning to take place on an individual basis. Emergency planning will therefore be covered in regulations.

We do not want the ACSP and YCS to be overly onerous or time-consuming to complete as we understand that an overly complicated plan and statement could in itself act as a barrier to support. Some carers are supported now without a carer's assessment although they are asked a few questions to establish needs for support. The ACSP and YCS will provide a transparent means of establishing needs for support. The provisions will ensure the preparation of a person-centred plan or statement which can be light-touch or more thorough as necessary providing certain key elements are covered in the plan and statement. This means that it is appropriate for certain information to be provided for in regulations rather than in the Bill itself.