Prevent, Reduce, Delay: Are Councils Meeting their New Duties to Support Unpaid Carers?

Transcription

1 Prevent, Reduce, Delay: Are Councils Meeting their New Duties to Support Unpaid Carers? Carers Trust

2 About Carers Trust Carers Trust is a major new charity for, with and about carers. We work to improve support, services and recognition for anyone living with the challenges of caring, unpaid, for a family member or friend who is ill, frail, disabled or has mental health or addiction problems. We do this with a UK wide network of quality assured independent partners, through our unique online services and through the provision of grants to help carers get the extra help they need to live their own lives. With locally based Network Partners we are able to support carers in their homes through the provision of replacement care, and in the community with information, advice, emotional support, hands on practical help and access to much needed breaks. We offer specialist services for carers of people of all ages and conditions and a range of individual tailored support and group activities. Our vision is of a world where the role and contribution of unpaid carers is recognised and they have access to the trusted quality support and services they need to live their own lives. Authors: Matt Hawkins, Policy and Campaigns Officer, Dr Moira Fraser, Director of Policy and Research, and Rachel Harris, Policy and Research Administrator, Carers Trust. Published by Carers Trust Loman Street London SE1 0EH Tel: Fax: info@carers.org Carers.org matter.carers.org babble.carers.org Carers Trust 2015 Carers Trust is a registered charity in England and Wales ( ) and in Scotland (SC042870). Registered as a company limited by guarantee in England and Wales No Registered office: Loman Street, London SE1 0EH. Carers Trust 2

3 Contents Executive summary... 4 Key findings... 4 Our recommendations... 5 Full report... 6 Introduction... 6 Methodology... 7 Our findings... 8 Our recommendations Conclusion Support available from Carers Trust Network Partners for councils commissioning prevention services References Appendix 1: Freedom of information request sent to all councils in England with responsibility for social care Carers Trust 3

4 Executive summary Under the new Care Act (Department of Health, 2014a) local authorities now have a duty to provide services to carers that prevent, reduce, or delay them developing a need for support. Carers Trust set out to analyse what councils are doing, and plan to do, to meet these new duties to carers. We sent a freedom of information request (FOI) to councils in England (see Appendix 1) with responsibility for social care asking them what they are doing to meet their new prevention duties. Key findings Quality of responses received from local authorities Variation in the quality and length of responses to our request meant in some cases it was difficult to gain a full picture of what is happening on the ground. Quantity and quality of prevention strategies Just 27 (20% of total responses received) councils mentioned a Prevention Strategy, Approach, or Plan. 11 of the 27 (41%) made no reference to carers in discussing their prevention strategies. Types of prevention services offered by councils Only 9 responses (7%) referred to a Carers Strategy. Just 13% of councils stated that they are working to identify carers. 24 councils (18%) discussed their emergency or crisis support policies in giving examples of preventative services. Diversity of services offered by councils The most commonly mentioned type of service, referenced by 50 councils, was information and advice. The focus of councils prevention policies is on providing support to older people. Organisations providing care and support Councils commissioning strategies are leaving third sector providers to deliver a wide range of services with insufficient funding. Extent of consultation on prevention plans Many councils undertook internal consultation in developing their prevention plans but far fewer consulted with carers. Carers Trust 4

5 Our recommendations Councils should ensure that they are providing up to date, quality, detailed information to carers on the support available to them and that this information is communicated through a range of channels. All councils should consider adopting a new prevention strategy which takes into account the new duties and requirements created by the Care Act to prevent, reduce, and delay carers from developing a need for support. Councils that are still developing their prevention strategies should ensure they consult widely across their own departments, with public, voluntary and third sector organisations, and with carers themselves. The requirement on councils to develop a Market Position Statement as part of their new Care Act duties offers an opportunity for councils to deploy such an approach. Councils should make identifying carers at their local GP practices a priority in their prevention strategies. As councils continue to develop their prevention plans, those plans should include activities and strategies specifically designed around the needs and aspirations of carers. In commissioning prevention services, councils must ensure that their local market of support is sustainable and offers choice to carers, reflecting the fact that carers of different ages and backgrounds will have different needs for support. They should ensure the local voluntary sector is funded sufficiently to provide the services required by their local community. Councils should ensure that they provide their local community with support packages, for example counselling, training, and one-to-one advice, tailored to individual needs. Councils should provide training to staff on the new prevention agenda and what it means for the services they commission. Central government should establish an online resource for councils to share best practice on how to deliver prevention strategies. Carers Trust 5

6 Full report Introduction The Care Act 2014 and prevention policy Under the new Care Act (Department of Health, 2014a), which came into force in April 2015, local authorities now have a duty to provide services to carers that prevent, reduce, or delay them developing a need for support. This is in recognition both of the vital role that carers play in helping those in need and therefore the risks associated with them becoming too unwell to care and also of the need to ensure people feel healthy and empowered, rather than only having care and support available when they reach crisis. The Statutory Guidance issued to accompany the Care Act (Department of Health, 2014b), Section 2.16 Carers and prevention, outlines the type of services local authorities are expected to use in order to prevent carers developing a need for support. These include: Training that helps carers feel confident undertaking care tasks. Support developing coping mechanisms. IT equipment and assistive technology. Help finding paid employment. Information and advice on the welfare support available. Section 2.23 of the Statutory Guidance, Developing a local approach to preventative support, also highlights a number of other key requirements that local authorities must meet in their approach to prevention. They must: provide or arrange for services, facilities or resources which would prevent, delay or reduce the needs for support of carers. Local authorities should develop a clear, local approach to prevention which sets out how they plan to fulfil this responsibility, taking into account the different types and focus of preventative support as described above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support. From this, we can conclude that local authorities are required to meet a number of new duties. Carers Trust 6

7 Firstly, that they must have a proactive strategy or plan in place to prevent, delay or reduce carers developing a need for support. Such an approach will require the authority to deliver services that can meet the different types of support individuals require. Secondly, these services must be part of a local approach. Services should be developed following consultation (Department of Health, 2014b) with community care providers and should be designed so they respond to the needs of the local population. Finally, echoing the stipulation placed on local authorities by the Care Act (Department of Health, 2014a) to provide a market of care support, prevention plans are expected to offer a wide range of services that can meet different carers needs. Carers Trust wanted to ensure that these new duties are being met by local councils. In particular, we wished to establish whether or not councils were taking their new requirements to provide carer-specific support seriously and to find out if this was being reflected in their commissioning strategies. We were also concerned about the impact that year-on-year cuts to council funding might be having on the capacity of councils to deliver their new duties to carers. Our research and report aimed at providing answers to these questions. It begins with an analysis of the councils that already have or are developing a prevention strategy or plan and assessing their compliance with the new legislation. It then conducts a broader analysis of the support services being provided by all councils to assess the extent to which these services are working to prevent, reduce, or delay carers developing a need for support. Methodology Carers Trust set out to analyse the extent to which local authorities are complying with their new duty, introduced by the Care Act 2014, to provide services which prevent, reduce, or delay carers from developing a need for support. In order to establish our evidence base, on 2 July 2015 Carers Trust submitted an FOI request to the local authorities in England with Adult Social Services Responsibilities asking them to provide us with details of their prevention policies. A full transcript of that FOI request can be found in Appendix 1 at the end of this report. Of the 152 councils, five were omitted from our FOI request. This was on request from Carers Trust Network Partners based in those five areas who stated that they would prefer to find out the information we were seeking using their own contacts. The five councils omitted were: Hertfordshire County Council, Surrey County Council, Bexley Borough Council, Sunderland City Council and Devon County Council. Carers Trust 7

8 In total, we received 132 responses from local authorities to our request. Of those, one, Essex County Council, declined to send the information we requested on the grounds that it is exempt from disclosure under Section 21 of the Freedom of Information Act Information available elsewhere by visiting Commissioning Strategies. Using the information we received back from local authorities, Carers Trust then contacted local Carers Trust Network Partners to ensure that the answers provided reflected their understanding of their local authorities prevention policies and practices. The findings from our analysis and our correspondence with Network Partners are presented in the following pages of this report. Our findings Quality of responses received from local authorities There was variation in the quality of the responses to our FOI request that we received from local councils. Responses varied in length and detail on their prevention services and in whether they gave specific answers to our questions or signposted to external sources of information. As a consequence, some Carers Trust Network Partners reported to us that, in their opinion, their local council did not give a full response and in some cases omitted to mention work that is taking place locally to support carers, or alternatively, may have described services which currently have an uncertain future. Carers Support Centre Bristol and South Gloucestershire, for example, noted that both Bristol City Council and South Gloucestershire County Council did not capture in their responses the full breadth of preventative services they are providing specifically for carers, focusing instead on the work they are doing to support the wellbeing of the general population. This in their opinion was a missed opportunity by both authorities, as there are a broad range of services that they as an organisation are commissioned to provide, supporting carers of all ages in both geographical areas. Similarly, the Carers Trust Network Partner in Herefordshire noted that the county council did not provide any details in its response on the information and advice service that it commissions for carers through Herefordshire Carers Support. Sheffield Carers Centre observed that the response from Sheffield City Council only referred to the support it is giving to adult carers, omitting the services it commissions for young carers. Carers Trust 8

9 In contrast, Crossroads Care Slough informed us that although the response we received from Slough Borough Council did provide an accurate brief on the services currently commissioned by the council, many of them, including for example the companion bus pass, are likely to be withdrawn soon due to funding pressures. There is therefore a variation in the quality of information being communicated by local councils about the support they are commissioning for carers. In some cases it may be that the necessary information was not accessible to the official responding to our request, but is available locally. It could also indicate a wider problem, however, with the council s approach to communicating the strategies and support it has in place to support carers. We therefore recommend that councils review their strategies for communicating information about the support they offer to carers, making sure that that information is detailed and up to date and easily accessible to carers in their local area. Quantity and quality of councils prevention strategies Out of the 132 responses we received from councils to our FOI request, just 23 (17%) specifically mentioned a Prevention Strategy and four referred to a Prevention Approach *. Of these, eleven stated that they currently have strategies or approaches in place; nine have draft strategies or are currently developing strategies; four will be developing strategies in the lead up to autumn 2015; and two are in the process of updating existing strategies. 1 * We also analysed responses to see if they mentioned a Prevention Plan but none did. Carers Trust 9

10 Percentage of council responses 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Status of council's prevention strategies or prevention approaches according to our FOI responses 80% Did not mention "Prevention Strategy", "Prevention Plan", or "Prevention Approach" 8% 7% Prevention Strategy or Approach in place Drafted strategies or currently developing strategies 3% 2% Will be developing strategies Updating existing strategies Status of prevention strategies Graph 1: Status of council s prevention strategies according to our FOI responses Councils are still developing their prevention agenda Only 8% of councils stated that they have a prevention strategy in place that responds to the new duties laid down by the Care Act. The remaining councils that did mention a prevention strategy have either drafted one, are currently developing one, or will be creating one in the future. This does not mean that other councils are not providing services which act in a preventative way. However, the requirement of the Care Act Statutory Guidance to develop a clear, local approach to prevention (Department of Health, 2014b) indicates to us that councils are required to develop a specific plan. We were therefore disappointed to see the low number of councils who stated in their FOI responses that they have or will be developing a prevention strategy. From the answers that we did receive it is apparent that many councils are still working out what the requirement to prevent, reduce, and delay carers developing a need for support will mean for them in practice. Peterborough Council s Care Act Framework document, for example, lays out how the council intends to comply with their new prevention and wellbeing duties. Sections of the report are dedicated to explaining what the terms prevention and wellbeing mean and the impact they will have on council policies. It is clear that, although the Care Act came into force in April 2015, councils are still understanding what impact it will have on their health and wellbeing policies. Carers Trust 10

11 Prevention strategies are not carer-specific Among the 27 councils that made reference to a Prevention Strategy or Prevention Approach there was little evidence that these strategies are being developed to provide targeted, carer-specific support. 11 out of the 27 councils (41% of those with a strategy, 87% of total respondents) made no reference at all to carers in their responses. Where carers were mentioned, many councils failed to provide details on the support being provided to them. References were made by one council to carer support services, to services for carers and carers services by others, and carers advice by another. No details were provided on what these services look like and whether they are carer-specific. Part of the reason for this is a tendency by councils to view carers as supporters of someone with care needs rather than as individuals with specific needs themselves. Middlesbrough Council, for example, aims to have greater dialogue with people in receipt of services and their carers to access enablement, reablement, and/or access to self-help support. An approach that sees carers solely as supporters to someone with care needs, however, fails to fully acknowledge the individual needs of carers. In addition, where councils have developed preventative approaches priority is largely given to the most vulnerable or to those already in need of support. In their response to our FOI request, for example, East Sussex Council stated: We have a range of services in place that help prevent, reduce or delay the need for care and support, including access to joint community reablement and rehabilitation support, integrated community equipment services and adaptations, home from hospital services, take home and settle services and access to employment support commissioned from the voluntary sector, and supported living services agreed in partnership with local Councils responsible for housing services and funded through our Supporting People programme. While this approach to prevention will benefit someone who already has care needs and is already being supported by their local health service, it does not help those people such as carers who do not have any current needs for support but are at risk of developing needs in the future. East Sussex Council can therefore be said to be meeting their duty to provide secondary ( Early Intervention ) and tertiary ( Delay ) prevention services, but they did not detail any primary prevention services that they are providing that can intervene before someone develops a need for support. There were however, examples which were more explicit in how they intend to address carers needs. Slough Borough, Windsor and Maidenhead, and Dudley Carers Trust 11

12 Borough Council all stated in their responses that their current or forthcoming prevention strategies will contain carer-specific support services including advice lines, emergency card schemes, funding for carer breaks, carer training, projects to identify carers, and counselling. Each of the councils stated that their prevention strategies contain unique activities focused solely on providing support to carers. They also exhibited knowledge of the number of carers in their locality and how their services respond to those needs demonstrating that these councils are taking a proactive approach to managing carers needs rather than waiting for carers to come into contact with one of their services when they reach crisis. Councils are updating existing prevention approaches The lack of evidence of carer-specific support services being provided by councils is partly a symptom of the fact that, rather than developing new prevention strategies in the light of the Care Act, many authorities are choosing to update their existing health and wellbeing policies. This is the case in Manchester, Oldham, and North Tyneside. Similarly Kirklees Council, Cornwall County Council, South Gloucestershire Council and Durham County Council all refer to the social care support they provided before the introduction of the Care Act, stating that these will continue in the future. However, because these strategies were developed prior to the introduction of the Care Act, Carers Trust is concerned that they fall short of the new requirements on councils to provide carer-specific, preventative support. Although the responses from Manchester, Kirklees, and Cornwall Councils all stated that their existing strategies contain support services commissioned for carers, Oldham, North Tyneside, and South Gloucestershire councils answers made no reference to any carer-specific support. Types of prevention services offered Looking at all the responses we received from councils - not just those that mentioned a prevention strategy authorities detailed a range of services they are offering as preventative services to people living in their locality: Carers Trust 12

13 Number of councils who mention service Types of support services offered by councils Graph 2: Types of prevention services offered by councils Lack of evidence of carer-specific services Type of prevention service offered by councils Although Carers Trust is pleased to see that a range of services is being provided to support people s health and wellbeing, as with the prevention strategies we analysed above we are concerned by the lack of evidence of preventative services being delivered by councils to support carers. Only nine councils (7%) who responded to our FOI request stated that they are developing a Carers Strategy specifically designed to support carers. 2 The responses from Rochdale and Wigan Borough Councils and Gloucestershire and North Yorkshire County Councils, for example, focused almost entirely on the packages these councils are providing to prevent the person with care needs from developing a need for support. Wigan s response stated: The council provides an Early Intervention and Prevention service to everyone who appears to have a need. This involves the provision of information and advice, equipment, adaptations, assistive technology and Reablement service. This service is at the first step in the social care journey for most people. The aim is to improve independence and wellbeing and reduce dependency on long term services. Carers Trust 13

14 Carers Trust does welcome the fact that councils are providing preventative support for people with care needs. We recognise that effective support given to a person with needs is likely to have a beneficial impact on their carer. However, in light of the fact that the Care Act calls upon councils to provide support specifically targeted at carers, it was disappointing to see that so many councils failed to detail what carer-specific support, if any, they are providing under the banner of preventative support. We therefore strongly recommend that as councils continue to develop their prevention plans, those plans include activities and strategies designed specifically around the needs and aspirations of carers as well as people with care needs. Council s prevention policies lack a strategic approach From the minimal references made to prevention strategies, it was difficult to discern from councils responses how the policies they deliver come together to form a strategic approach to prevention. As an illustration, only ten responses 3 (7%) we received referred explicitly to how councils will prevent, reduce, and delay needs for support developing and of those only one, Harrow Council, indicated that this approach was being taken with carers specifically in mind. However, more positively, a range of methods of support was described by some councils. Good practice was reported on in a number of cases. Barnet Borough Council, Haringey Borough Council and Cambridgeshire County Council stated in their responses that they offer tiered support depending on a person s level of need. Cambridgeshire Council, for instance, splits its services into the following stages: Tier 1 of the model represents the need to raise awareness of the role of carers within the wider community and ensure that relevant information and signposting is easily accessible when people begin to recognise this role in themselves or in others Tier 2 of the model represents more focused carer activities e.g. carers groups for peer support including specialist groups for people caring for someone with particular conditions, where carers draw on each other for support. Responsive support for individual carers who require short term input to manage a particular situation would help to delay/avoid long term expensive input. By providing intensive targeted support in partnership with health, housing, voluntary organisations and the wider community this will ensure that the carer is appropriately supported through the particular situation with the intention of delaying expensive social care services in the long term. Carers Trust 14

15 Tier 3 of the model involves the formal statutory assessment of need against eligibility criteria. Currently there are approximately 3,500 carers known to the Council who receive regular and ongoing support including direct payments and other commissioned services. Adopting the strengths based assessment and making best use of services and activities available through Tier 1 and 2 will help to focus on maintaining the health and wellbeing of the carer while meeting their assessed needs. This seems to be one way in which a local authority has considered its approach to prevention. It lays out how a person can be supported prior to developing a need for support or as their needs change and provides specific support to carers. Carers Trust therefore recommends that all councils consider adopting a prevention strategy which takes into account the new duties and requirements created by the Care Act and which details the different kinds of support that will be provided to carers depending on their level of need and individual wishes. That way, an outcome-orientated approach can be taken which ensures that carers needs for support are managed and monitored. Councils expect local population to help themselves Carers Trust is concerned that many councils are choosing to deliver preventative support by relying on universal support services that people will only benefit from if they choose to proactively access them. Croydon Council, for example, has framed its prevention agenda as being about helping the community do more for itself. Oldham Council states it wishes to promote independent living. It is important to ensure communities are better equipped to care for themselves in order to reduce the demand on emergency, statutory health services. However, this approach ignores the fact that carers face external pressures caused by their caring role which they have only limited control over. They are already doing it for themselves and in many cases they cannot look after their wellbeing without external support. Carers who need a break from their caring role, for example, may only get that kind of support if a service is in place which means replacement care can be arranged if they need it. The need to offer a range of universal and targeted services has, however, been recognised by a number of councils. For example, Brent and Enfield Borough Councils stated that they provide breaks for carers, training in how to cope with caring, advocacy, counselling, and one-to-one tailored support packages. In addition, Enfield Council reported that it operates a Carers Register. We do caveat, however, that the council s response did not specify how this register is being used or whether it is regularly updated. While we would recommend that other councils adopt similar schemes, we would also add that, in order to be effective, registers must be Carers Trust 15

16 maintained and used strategically to monitor local carers needs and changing requirements. Overall, we urge councils to adopt the type of flexible approaches detailed in the responses from Brent and Enfield councils ensuring that support services are personalised and interventions can be made to support carers who are developing a need for support. Few councils say they proactively identify carers Out of the responses we received from local councils just 17 (13%) made mention of any work they are doing to identify carers who might have a need for support or could develop a need for support in the future. 4 Carers who do not identify themselves as carers or who are unaware of their rights therefore risk missing out on vital support. Nonetheless, some councils did describe how they identify carers. Slough and St. Helens councils both stated that they are working with GP surgeries to identify and register carers and direct them towards support services. We recommend this type of intervention is rolled out across all areas. As GP surgeries are one of the places that carers are most likely to visit in their local community, they are therefore the ideal location for ensuring that carers are identified and referred for support. Emergency services used to provide preventative support Carers Trust notes that 24 councils (18% of respondents) referenced emergency or crisis forms of support when discussing their prevention strategies. 5 Carers Trust recognises that certain forms of emergency support a Carers Emergency Card, for example can provide preventative support for a carer if they provide them with some peace of mind if they are going out to work, for instance. However, we are concerned that so many councils made reference to emergency support services when responding to a question about the strategies that they have in place to prevent carers developing a need for support. Carers Trust therefore argues that work must be done by councils to develop a prevention culture across their care and support work. West Berkshire Council, for example, stated in their response that, in response to the Care Act, it ensured that all relevant staff were provided with training on the new prevention agenda. This highlights the need for this new priority in health and social care to be instilled across council departments. At present, the tendency of councils to quote emergency forms of support as evidence of prevention planning indicates that health strategies, at least in delivery, are still focused on a crisis rather than prevention model. Carers Trust 16

17 Diversity of services Focus on providing information and advice Since the provision of information and advice is a statutory duty under the Care Act (Department of Health, 2014a) it is unsurprising that it was mentioned by around one third of councils in their responses. However, what is a concern is the extent to which many councils are relying on this as their primary means for preventing people developing a need for support. As an example, Buckinghamshire Council stated that it has focused its prevention efforts on creating a website carersadvicebucks.org that directs carers to locations of support. A similar model is being operated in Bury, a council which uses its newly created Carers Hub to signpost carers to support services available to them. Carers Trust would be concerned at any councils using solely information and advice as a preventative support service. The approach relies on carers identifying themselves as carers, recognising that they have a need for support, and deciding to access information about it. In addition, information and advice cannot provide the type of practical intervention such as a carers break, physical health check, or counselling for example that can provide relief and support for a carer. While information and advice does need to be a part of a council s prevention strategy, it cannot be a substitute for the provision of personalised services, provided or commissioned by local councils and tailored to the needs of the individual. Focus on older people Councils prevention policies are focused on providing support to older people with care needs. While 28 councils (20%) made reference in their answers to the care they provide for older people, just three (2%) mentioned young carers and none referenced younger people or young person support. Carers Trust is pleased to see that such a range of services are being provided to support older people. It reflects the fact that the population of England and Wales is continuing to age. As a result the number of people over 85 in the UK, the age group most likely to need care, is expected to increase by over 50% to 1.9 million by 2017 (Personal Social Services Research Unit, 2008). Councils are therefore, understandably, directing much of their energies to providing help for the largest demographic group in need of support. However, councils must be alive to the fact that people of any age and background can need support whether they have care needs themselves or are a carer. 16% of working age adults have a registered disability (Gov.uk, 2015) for example, while the 2011 Census revealed that the number of carers aged between five and seven had increased by 83% in the previous 11 years (UK Census, 2011). Carers Trust 17

18 Carers Trust therefore calls upon councils to ensure they are mindful of the new requirements, introduced by the Care Act 2014, to provide a diverse range of support services that give carers choice over the services they access and can meet the needs of carers and people with care needs of any age and background (Department of Health, 2014b). The organisations providing care and support Councils are predominantly commissioning third parties to deliver their prevention services. For example, Kirklees Council has invested heavily in the voluntary sector to provide social care support and Trafford Council is currently in the process of undertaking an open-market competitive tender to deliver its prevention services. Carers Trust welcomes this approach because it utilises the skills of those organisations, such as Carers Trust Network Partners, that have experience of supporting carers and people with care needs and working closely with their communities. We would therefore recommend that councils continue to seek out opportunities to commission organisations such as Carers Trust Network Partners to deliver their preventative support services. Nonetheless, the findings from our research does raise specific concerns about the way councils are currently commissioning their preventative support services: Central government funding cuts are affecting care providers We know from Carers Trust Network Partners that central government funding cuts are causing them concern. By 2020 a 4.3bn gap is expected to emerge in social care funding (Local Government Association, 2014). This is having a knock-on effect on the resources that councils are able to provide to their local care organisations. Carers Trust Network Partners for example, are very concerned that, without additional funds, they will not be able to pay the new National Living Wage that is due to be introduced in April 2016 without either scaling back the services they offer or having to close down entirely. In a recent survey of Network Partners, many raised concerns that their entire viability will be under threat if they are not provided with additional funding to help them pay the new National Living Wage. Central government must ensure that councils and care providers have the funds they need to continue to provide the services they deliver for carers. Councils are pushing more duties on to providers The declining levels of funding are particularly problematic in areas where individual third sector providers are being asked to take on an increasing number of responsibilities for supporting carers. According to the FOI response we received from Brent Borough Council, Brent Carers is providing information and advice, emergency support, money and benefits advice, caring support and training, access Carers Trust 18

19 to health and wellbeing services, whole family support, a carers forum, access to work and training and mental health support a vast range of activities which support carers. While Carers Trust welcomes the fact that Brent Carers Centre is being commissioned to provide these vital services, we would be concerned if these duties were falling upon the centre without an understanding of the impacts it is having on its current and future resource levels. We recommend that councils are aware of the duty placed upon them by the Care Act to ensure that the market of care support in their locality is sustainable (Department of Health, 2014b). This means engaging in regular dialogue with care providers to ensure that a balance is being maintained between the expectations placed upon them and the funding they provide to deliver those services. The requirement on local authorities to write a Market Position Statement should be seen as an opportunity for them to future proof their prevention services by identifying the actions they need to take to help third sector organisations maintain their services. Extent of consultation on prevention plans Councils carried out internal consultation in developing their prevention policies Across the responses we received it is clear that many councils are carrying out internal consultation processes across their various departments in deciding how to commission care and support services. Staffordshire County Council, for example, stated in its response that it has developed a whole system redesign of Carers Services following consultation with Stoke-on-Trent City Council and the local clinical commissioning group. Doncaster City Council and Barking and Dagenham Borough Councils both reported that their care and support services are being overseen and managed in partnership with their health and wellbeing board. Carers Trust welcomes these practices. By ensuring that multiple departments are working towards the prevention agenda, councils can increase the touchpoints in their local community that are in contact with carers and are able to offer them advice and support. West Sussex, Gateshead, and York authorities reported that this approach is already proving to be successful in their localities: libraries, GP surgeries and leisure centres are being asked to become carer champions and staff are being trained to identify and support carers. Sutton Borough Council also stated in its response that it is now considering how to spread the prevention culture to the private and third sector organisations it commissions to deliver its carer support services. The council has developed a Prevention Prospectus and is now reviewing its existing contracts to ensure that it is delivering the prevention requirements created by the Care Act. Carers Trust 19

20 Following these examples Carers Trust recommends that councils use the opportunity provided by the requirement, laid down in the Care Act, for them to produce a Market Position Statement (Department of Health, 2014b) as an opportunity to consult with providers and across departments to ensure a joined up approach to care and support is delivered. Limited consultation with carers Few councils explicitly stated that they have consulted on their prevention policies with carers. Those that have, describe examples of practice which may be useful elsewhere. Blackpool Council reported that it has established a Carers Partnership Board which brings together representatives from across health and social care including the Carers Trust Network Partner to monitor the council s compliance with the new Care Act duties. Plymouth City Council stated that it has established a Carers Strategic Partnership Board which consists of a wide range of carer representatives and organisations and health and social care commissioners that is working to implement its Carers Strategy. It is vitally important to ensure that services are being designed and commissioned in a way that reflects the needs of carers. Only then can we ensure that the provision of support avoids being generic and the delivery of councils prevention plans is responsive to the changing needs of carers. We therefore recommend that all councils seek out ways to engage carers and local carer organisations in the development and ongoing monitoring of their prevention plans. Carers Trust recommends establishing a what works database With 152 councils consulting on the best approaches to delivering social care, a huge variety of different systems are being developed. As we have also seen, councils are still developing best practice in prevention and testing approaches as they go. As this process continues we recommend that central government establishes an online resource for councils to share best practice on prevention on supporting carers. This could not only share tried and tested methods but will also help develop a more joined up approach to providing support, reducing the likelihood that carers will face a postcode lottery when it comes to the services available to them. Carers Trust 20

21 Our recommendations Based on the findings of our research, we make the following recommendations to both central and local government: Councils should ensure that they are providing up to date, quality, detailed information to carers on the support available to them and that this information is communicated through a range of channels. All councils should consider adopting a new prevention strategy which takes into account the new duties and requirements created by the Care Act to prevent, reduce, and delay carers from developing a need for support and which details the different kinds of support that will be provided to carers specifically depending on their level of need. Councils that are still developing their prevention strategies should ensure they consult widely across their own departments, with the general public, with voluntary and third sector organisations, and with carers themselves. That way, they can ensure their approach responds to the current and future needs of the people it is supposed to help, draws on best practice, and can be delivered in a coordinated approach via a range of council services. The requirement on councils to develop a Market Position Statement as part of their new Care Act duties offers a useful opportunity for councils to deploy such an approach. To help ensure that carers who have, or might develop, needs for support are not missed, a more focused approach on identifying carers in primary care services should be adopted. As councils continue to develop their prevention plans, those plans should include activities and strategies specifically designed around the needs and aspirations of carers. In commissioning prevention services, councils must ensure that their local market of support is sustainable and offers choice to carers, reflecting the fact that carers of different ages and backgrounds will have different needs for support. They should ensure that local, voluntary sector organisations are sufficiently funded to provide the services required by their local community. Councils should ensure that as well as providing universal prevention services, such as information and advice, they also offer support Carers Trust 21

22 counselling, training, and one-to-one advice that can be tailored to individual needs. Councils should provide training to staff on the new prevention agenda and what it means for the services they commission. That way, prevention can be automatically designed into the services being delivered or commissioned by local councils. Central government should establish an online resource for councils to share best practice on how to deliver prevention strategies. This will not only share best practice methods but will also help develop a more joined up approach to providing support. Carers Trust 22

23 Conclusion The need to provide services that prevent, reduce, and delay a person developing a need for support has shifted the focus of health and social care policy. It has moved the priority of services away from those that deliver support only when a person reaches crisis towards those that can intervene at an earlier stage while also enhancing their wellbeing. Councils are still in the process of absorbing this new prevention agenda. Across the 132 local authorities we analysed we found very different approaches to providing prevention services, both in the manner in which councils research and develop their plans and the kind of services they commission. Nonetheless, some common threads do emerge and it has left Carers Trust concerned about how many councils are adopting their new prevention duties. Many councils failed to demonstrate in their FOI responses that they are recognising carers new rights to support. Councils prevention approaches remain focused on supporting people with care needs and in the rare incidences where carer-specific support was identified it tended to form part a wider approach to prevention rather than being designed specifically and uniquely to support carers through their different levels of need. Further, we are also concerned about how councils are interpreting their role in prevention. Rather than proactively working to identify people who have or could develop support needs, councils are relying on the provision of universal services. In order to benefit from these facilities, carers have to know about and have the time to access these facilities. Unless more targeted support services are put in place, this support will remain inadequate. There is, however, opportunity to still ensure that the important new rights created for carers by the Care Act are still realised. Many councils are in the process of developing their prevention strategies. We urge them to view the prevention agenda and the new rights given to carers as a fundamental change in the way that health and social policy is delivered. We recommend that councils refresh their prevention strategies in light of the Care Act and that they do so by borrowing best practice examples of support highlighted in this report. Carers Trust 23

24 Support available from Carers Trust Network Partners for councils commissioning prevention services Carers Trust provides support to unpaid carers in England through our Network Partners a unique network of 86 independent carers centres and 47 schemes with 75 of these providing support to young carers. They support carers in their local area by giving them access to quality assured breaks, information and advice, education, training, and employment opportunities as well as working to identify hidden carers through outreach work in GP surgeries, hospital wards, and schools. Carers Trust invites councils to explore how Network Partners could be commissioned to provide prevention services and help them meet their new prevention duties. Prevention services that our Network Partners can provide include: Carers breaks and respite. Information and advice. Counselling. One-to-one advice. Coffee mornings. Training. Money and benefits advice. Peer support groups. Mentoring in schools. Family clubs. Liaison with GP practices and acute NHS services. Carers Trust Network Partners are also able to offer advice to councils on how best to commission services that work for carers. With new duties being introduced to councils, we would encourage them to open, maintain, or expand their dialogue with our local Network Partners and explore how they can help them meet those new responsibilities. To find out if there is a Network Partner in your area, please either contact Carers Trust directly on info@carers.org or visit this page of our website. Carers Trust 24

25 References Audit Commission (July 2010), Against the Odds: Re-engaging Young People in Education, Employment and Training. Available online: people/auditcommission/ characteristicsofyoungpeopleneetforagainsttheodds.pdf Department of Health (2014a), The Care Act 2014 (The Stationery Office). Department of Health (2014b), Care Act 2014: Statutory Guidance for Implementation (Department of Health). Gov.uk (2015), Disability Facts and Figures. Available online: Local Government Association (2014), Adult Social Care Funding: 2014 State of the Nation Report (Local Government Association). Personal Social Services Research Unit (PSSRU) (2008), Future Demand for Social Care, 2005 to 2041 (PSSRU). UK Census (2011), Source: Office for National Statistics licensed under the Open Government Licence v.1.0. Carers Trust 25

26 Appendix 1: Freedom of information request sent to all councils in England with responsibility for social care* Dear Freedom of Information Officer, This is a request for information issued by the charity Carers Trust under the Freedom of Information Act The information requested relates to the implementation by your council of the Care Act 2014 which came into force on April 1st We would like to know: 1. What actions your council is taking or intends to take to ensure it complies with Clause 2.23 of the Care Act Statutory Guidance ( Developing a local approach to preventative support ) which requires a local authority to: provide or arrange for services, facilities or resources which would prevent, delay or reduce individuals needs for care and support, or the needs for support of carers. Local authorities should develop a clear, local approach to prevention which sets out how they plan to fulfil this responsibility, taking into account the different types and focus of preventative support as described above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support. 2. Relating to Clause 14 of the Care Act 2014 ( Power of local authority to charge ), whether or not your council: I. Currently charges carers for their own support, or; II. Does not charge carers for their own support but intends to either introduce charges or consult or debate on the introduction of charges in the next 12 months, or; III. Does not charge carers for their own support and has no current plans to introduce charges. 3. If your council does charges carers we would like to know further details of how these charges are applied, specifically: I. How your council calculates the amount a carer will be charged for the support they receive; II. The average charge per carer in your local authority; and III. The support services the charges apply to. Carers Trust 26