Joint Carers Strategy

Transcription

1 Joint Carers Strategy Newham s Joint Carers Strategy February

2 Newham s Joint Carers Strategy February

3 Contents Foreword 4 Our Vision 5 1. Introduction Who is a carer? Customers What is in this document? Who is this document for? 8 2. National and local drivers The national picture The local picture adults The local picture young carers 9 3. National, local and policy context Recognised Valued and Supported: Next Steps for the 10 Carers Strategy. Department of Health (2010) 3.2 The Draft Young Carers Regulation The Children Act (2004) The Children and Families Act (2014) The Care Act (2014) The Power of Information: putting us all in control of the health 12 and care information we need. Department of Health (2012) 3.7 NHS Care Objectives: Mandate to NHS Commissioning Board (2012) NHS Operating Framework ( ) Welfare Reform (2012) Local context Principles underpinning this strategy Co-producing the strategy with carers Outcomes sought and monitoring our progress Review of current provision and support for carers National survey: carers view Young carers (carers under the age of 18) Young adult carers (carers aged 18 to 25) Summary Challenges faced The way forward Commissioning intentions to achieve outcomes Commissioning intentions for Outcome One Commissioning intentions for Outcome Two Commissioning intention for Outcome Three Commissioning intentions for Outcome Four Commissioning intentions for Outcome Five Finances Current funding strategy Current and anticipated funding sources Future funding sources Anticipated changes and financial plan Next steps 26 GLOSSARY 27 Appendix One: Strategy implementation plan 30 Appendix Two: Groups consulted 37 3

4 Newham s Joint Carers Strategy February 2015 Foreword As a carer and a Carers Champion, I fully understand and appreciate the value of all carers getting the right support at the right time. Most family carers have made conscious choices to care for their loved ones because they want to. The caring process is generally fraught with difficulties, hence the need to provide the right support to enable them to care for their loved ones for as long as they wish to, signposting them to available help that will make caring easier. London Borough of Newham and NHS Newham Clinical Commissioning Group have co-produced this strategy with carers to ensure that carers are supported to carry out their tasks less strenuously and to ensure that help is provided where needed. Implementing the plans as stated in this strategy will go a long way to improve the support that carers get, especially when partners work together to improve the overall support to carers, particularly concerning their health and wellbeing. I am pleased that this strategy covers all carers, spanning all age groups, including young carers and sandwich carers who care for both young and old, siblings and parents or grandparents in their family. This strategy will ensure that young carers have the best support, especially during transition from young to adult carers. We would like to extend our thanks to all those who have participated in the development of this document. Especially local carer groups including: African Caribbean Carers Group Asian Carers Group Learning Disability Carers Group Mental Health Carers group Newham Carers Forum Young Carers Group I look forward to seeing the successful implementation of this strategy. Dr Remi Osunsanya Joint Chair Newham Carers Strategy Group 4

5 Our Vision Our vision is for carers in Newham to feel recognised, valued and included as partners in the care and support of the person they care for. Also, that they are able to access the necessary information and support to enable them to make positive choices in their caring role and in their quality of life. Newham carer 5

6 Newham s Joint Carers Strategy February Introduction This is a joint strategy between London Borough of Newham Social Care (both Adult Social Care and Children and Young People s Services) and NHS Newham Clinical Commissioning Group. The priorities and action plan have been informed and shaped by a review of carers support undertaken by Carers UK. It has also taken into account the views of carers and stakeholders. 1 This strategy is a statement of how the London Borough of Newham and NHS Newham Clinical Commissioning Group (NCCG) will support carers to maintain their health and wellbeing whilst caring, building on the Carers Work Plan April 2010 to March The 2011 Census shows that Newham has 24,604 unpaid carers; this includes family members, friends and neighbours. Carers play an important role supporting vulnerable people; enabling those cared for to stay in their own homes and local communities. Carers often do this because they want to support their loved ones. We recognise that caring can impact negatively on carers health and wellbeing and value the key role that carers play in supporting the cared for person. This strategy provides a local framework and action plan which: embodies both national and local priorities for carers addresses statutory responsibilities and good practice guidance outlines a framework for the continued development of services for carers in Newham details the proposed actions over the next three years. The strategy has been developed under the auspices of the Carers Strategy Group which is comprised of carers, Carers Champions, representatives from the voluntary sector, as well as representatives from the London Borough of Newham and NCCG. It also takes into consideration the East London NHS Foundation Trust s Carers Strategy ( ). 1.1 Who is a carer? Within this strategy the term carer is taken from the Government s National Carers Strategy: A carer is someone who spends a significant proportion of their time providing unpaid support to a family member, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems. 2 Carers in this document are people who provide unpaid help and support to a partner, child, parent, relative, friend or neighbour who cannot manage without their help due to long term illness, disability, mental health needs, alcohol and/or substance misuse, fragility or who for other reasons cannot care for themselves. They are commonly referred to as informal carers. Our definition of carers includes those who no longer do caring for up to a year after the caring role ceases. This group of carers is not to be confused with paid Care Workers or Personal Assistants, Shared Lives Carers or Volunteer Carers. We refer to four broad categories of carers: 1. Adult Carer: an adult aged 18 years and over who is caring for another adult such as spouse, parent, partner, friend, neighbour or relative. 6 1 Please see Appendix 2: Groups consulted 2 Carers at the Heart of 21st Century Families and Communities, Department of Health, 10/06/2008 (GW ref. 9971)

7 2. Young Adult Carer: someone aged between 18 and 25 who is caring for another child, a young person or an adult. 3. Parent Carer: a parent or guardian who provides care to an ill or disabled child or young person to a degree greater than would be expected in a parenting role. This would include a child or young person who is misusing or abusing substances and/or alcohol. For the purposes of this strategy, a Parent Carer is the parent/guardian of a disabled child up to the age of Young Carer: a child or young person under the age of 18 who provides regular, ongoing care and emotional support to a family member, friend or neighbour who is physically ill, living with mental health needs, is disabled or misuses alcohol and/or substances. The care provided is over and above helping out, or the usual caring for an adult or sibling within the family. 5. Other carers: These are carers who have ceased the caring role, usually as a result of a change in condition of the person they care for. This includes the death of the person, the person recovering and no longer needing care, or the carer wanting/having to stop providing informal care. Carers can be from any race, faith or social background, of any ethnicity and of any sexual orientation. Carers can care for more than one person, may be studying, working or unemployed, and may have their own disabilities or illnesses. This strategy covers carers who are: living in Newham but supporting people who use services outside Newham (who are the responsibility of Newham) living in Newham and supporting people who live in Newham living outside Newham but supporting people who are living in Newham former carers - i.e. any of the above group of carers for up to a year after they cease their caring role. Carers activities Carers may undertake a range of activities beyond that which is expected of a parent, friend, partner or neighbour. These additional activities may include, but are not limited to: providing support with practical tasks, for example shopping, cooking and housework providing emotional support, social support, and/or supervising someone to keep them safe collecting and administering medication, supervising someone to ensure that they comply with medication/social care regimes, and helping them to deal with difficult emotional needs thus ensuring they can still live at home assisting with physical care, such as lifting, helping someone to use the stairs, physiotherapy helping the person to access services including assisting with travel, getting to hospital appointments and primary care appointments assisting with personal care, such as washing, dressing and supporting with toileting needs assisting with financial management of their affairs including managing budgets and collecting benefits identifying signs of relapse and providing support that may minimise the risks of readmission to hospital acting as interpreters where there are communication barriers including language, and breaking down complex information so the person being supported can understand explaining information on conditions, treatment, services and day to day living skills. 7

8 Newham s Joint Carers Strategy February Customers A customer is someone who is being cared for (supported by the carer). The customer may be ill, frail, disabled, living with mental health needs, or alcohol and/or substance misuse issues that make them unable to cope without support. Depending on the health and social care setting, a customer may be referred to as a service user, patient or client. 1.3 What is in this document? This document sets out how services for carers will be designed, delivered and monitored by Newham Council and NCCG, informing how we plan to utilise the resources available, and our priorities over the next three years. The document details areas that we will be focussing on across Newham to improve the health and wellbeing of carers, building on examples of good practice to further improve outcomes and strengthen links with commissioned providers to ensure that carers benefit from the wide range of universal services available in the borough. 1.4 Who is this document for? This document will be of interest to: a. All carers and the people they support: It sets out what carers can expect from partners to the strategy. b. Providers of health and social care services: It will influence the development of the market in Newham. c. Statutory and non-statutory partners: It gives a clear outline of the Newham approach to supporting carers, which might in turn shape how they provide services to carers and patients/customers. 8

9 2. National and local drivers 2.1 The national picture The 2011 census shows that there were 5,800,246 people who identified themselves as carers nationwide. This is an increase of 11% compared to The 2011 census identified 178,000 young carers in England and Wales alone; an 83% increase in the number of young carers aged five to seven years and a 55% increase in the number of children caring who are aged eight to nine years compared to Research carried out by the BBC in 2010 indicated that there may be as many as 700,000 young carers. The BBC survey of more than 4,000 UK school pupils found that one in 12 had moderate or high levels of caring responsibility, four times the official figure. 2.2 The local picture adults The picture in Newham exceeds the national trend with a greater increase in the number of people identifying themselves as carers. Table 1 illustrates the increase, excluding young carers between the 2001 and 2011 Census. Almost a quarter of identified carers provide 50 hours or more unpaid care per week. As customers strive to maintain their independence and live in their own homes for as long as possible, it is anticipated that more residents will become carers. The 2013 report entitled Carers Picture in Newham (2013) has more information on demographics. 2.3 The local picture young carers Although the numbers of young carers broken down by borough from the 2011 census is now available, obtaining the details has been a challenge as the age range for the census includes 0 to nineteen. We have, therefore, for the purpose of this strategy estimated the number of young carers aged five to 17. Our estimation shows that we have 2,408 carers aged 0 to seventeen, of which 1,809 provide 1-19 hours unpaid care per week, 294 provide hours, and 305 provide 50 hours or more. Table 1: Census figures of those identifying themselves as carers Total increase % increase Total Carers Total Carers in Newham in Newham 20,663 24,604 3,941 19% 9

10 Newham s Joint Carers Strategy February National and local policy context The legal framework currently governing support for carers is being re-examined nationally and it is anticipated that there will be significant changes in how carers are supported. This strategy has taken into account current legislation and anticipated changes. These are summarised below. 3.1 Recognised Valued and Supported: next steps for the Carers strategy. Department of Health (2010) This was the 2010 refresh of the 2008 Carers Strategy Carers at the heart of the 21st Century families and communities. The strategy states that more should be done to identify and support young carers, with particular emphasis on involving and supporting schools to be more carer aware. There should be a Memorandum of Understanding between Adult Social Care and Children and Young People s Services on how to ensure that they will work positively together to support young carers. The strategy also stated that carers should be: respected as expert partners in care and have access to the integrated and personalised services they need to support them in their caring role able to have a life of their own and not forced into financial hardship by their caring role supported to stay mentally and physically well and treated with dignity children and young people (young carers) should be supported in their need to learn, develop and thrive, to enjoy positive childhoods and to achieve positive educational and social outcomes, while being protected from inappropriate levels of caring. 3.2 The Draft Young Carers Regulation These regulations relate to Section 96 of the Children and Families Act (2014) and detail the duties of Local Authorities in assessing the needs of Young Carers. The draft regulations set out: the matters to which a local authority must have regard in carrying out a young carer s needs assessment the manner and form of a young carer s needs assessment the matters which a local authority must take into account when carrying out a young carer s needs assessment the definition of the term whole family approach. When the final regulations are published (expected March 2015), the action plan for implementing this strategy will be updated to take account of the new regulations. 3.3 The Children Act (2004) This Act highlights the importance of providing services to children and young people to prevent the escalation of need. The Act is supported by legislation related directly to the rights of carers (including young carers) and targeted guidance for meeting the needs of young people (including carers). This legislation cross-references: Children Act (1989) Carers (Recognition and Services) Act (1995) Carers and Disabled Children s Act (2000) National Service Framework for Children, Young People and Maternity Services Children Act (2004) Carers (Equal Opportunities) Act (2004) 3.4 The Children and Families Act (2014) The Act has introduced changes in the way in which young carers are identified and supported. The changes include: the same right to assessment and support for young carers as adult carers who support a 10

11 parent or sibling (sister or brother) giving parent carers the same right to assessment and support as adult carers a general duty on local authorities to improve the wellbeing of young carers who are ordinary residents of the area the identification of people who may be receiving care from a child or young person the provision of medical services to patients who are young carers within twelve months of the passing of the Act, schools must have a process in place for the identification of young carers schools must put in place a mechanism for the provision of appropriate support to promote the wellbeing and improve the educational attainment of young carers within their school. 3.5 The Care Act (2014) The Act brings together previous legislation into one act. The Act for the most part will be operational from April 2015 with the funding reforms operational from April This strategy has taken into account the following: A new duty on local authorities to provide information and advice to help people understand how the care service works, what services are available locally and how they can be accessed. Local Authorities will have to ensure a diverse range of quality services are available to meet the needs of people and work with various organisations to integrate services. A new duty on local authorities to take a proactive approach to meet the needs of people, make earlier interventions and provide more services that are intended to prevent, delay or reduce the need for care and support. Carers for the first time have a legal right to an assessment of their needs regardless of their level of caring. This duty is comparable to that of the people for whom they provide care. A new framework for assessing eligibility will be set out in the regulations. A new duty on local authorities to meet a carer s eligible needs and to review their care and support plan regularly to ensure that their needs are met. Eligible needs can be met by provision of services to either the person cared for or the carer. The act allows for the carer s needs to be met by providing support directly to the cared for person through replacement care, enabling the carer to take a break from their caring duties. Carers will have the right to be consulted in relation to the assessment and support plan of the people they care for and to have a copy of their support plan. Young carers under the age of 18 who care for an adult will continue to be supported by Children s Services rather than Adult Social Care. At the age of 18 Adult Social Care will take over the responsibility, although they can be brought into the transition planning before the young carer s 18th birthday, but only at the young carer s request. There will be a new duty to continue with any services a young carer is receiving past the age of 18 if appropriate adult care and support is not in place. New provision for parent carers to be assessed for services that they may currently be unable to use. New provision for deferred payment options to delay the payment of care charges from the sale of the customer s home will be routinely offered, with the possibility that local authorities will be able to charge interest on any deferred payment. A new single, consistent route to establishing entitlement to care and support for adults, with eligibility to be determined by a national threshold. A requirement for local authorities to develop and promote diversity and equality in the provision of services. The act proposes a whole family approach: assessment must take into account the needs of the whole family when assessing the needs of 11

12 Newham s Joint Carers Strategy February 2015 the person in need of service. This must include ensuring that any child present in the family is not undertaking an inappropriate level of caring. Local authorities may combine the assessment of a carer with that of the cared for person if they are in agreement with this. When carrying out a carers assessment, local authorities may work jointly with other agencies undertaking an assessment relating to the same carer. 3.6 The Power of Information: putting us all in control of the health and care information we need. Department of Health (2012) This information strategy by the Department of Health commits to a single integrated national website for health and social care information. It will offer carers the ability to access the health and care records of the person cared for, subject to their authorisation. It will also offer access to information on how to support the cared for person. It is anticipated that the portal will offer up to date information on the management of long term conditions, patients organisations, treatment options, housing support, benefits, local care services, self help and support groups. 3.7 NHS Care Objectives: Mandate to NHS Commissioning Board (2012) Objectives include: Improve the quality of information available about NHS Services. Improve the support carers receive from the NHS, in particular early identification of a greater proportion of carers, signposting to information, sources of advice and support; and working in collaboration with local authorities and local carers organisations to deliver a range of support including respite care. 3.8 NHS Operating Framework ( ) This requires Clinical Commissioning Groups (CCGs) to agree funding and support for carers in their localities. CCGs have to publish how much money they are allocating to support carers and transfer these funds to local authorities. They also have to publish plans on how they intend to support carers and set out how many breaks the allocated funding will provide for carers. 3.9 Welfare Reform Act (2012) The Welfare Reform Act (2012) sets out changes to the welfare system, with the aims of simplifying the benefit system and reducing welfare dependency. This includes the introduction of a single workingage benefit ( universal credit ), which draws together existing elements of means-tested support for employment, housing and childcare into a single award that will be paid direct to the claimant monthly in arrears. It also introduced the spare room subsidy, in which tenants who receive financial support towards the cost of their rent will get a proportional reduction in their support if they have one or more spare rooms. 12

13 4. Local context In Newham, our priorities shared across health and social care shape our approach to how communities are supported. These priorities are: Earlier intervention across the Health and Social Care system. Earlier intervention with re-ablement to support and promote independence and wellbeing. Linking carers into the Integrated Care Framework, thus ensuring that carers and patients are supported jointly and seamlessly across health and social care. Supporting self care and the management of conditions/illnesses through education and access to appropriate information. Another priority driving change is the Council s Resilience agenda. 3 Resilience is about enabling residents and communities to be self-reliant rather than dependent. It is about facilitating resilience at the individual, community and economic level. It involves residents and carers being given the tools they need to manage and support their conditions and needs. This is further supported by national strategies that support carers to have the same opportunities as non-carers for education, employment, training and a social and community life. 3 Quid Pro Quo not Status Quo: why we need a welfare state that builds resilience, Newham Council (2011) 13

14 Newham s Joint Carers Strategy February Principles underpinning this strategy The partners to this strategy (Newham Council and NCCG) commit to the following underlying principles: We recognise the vital contribution made by carers to the lives of people who are vulnerable, ill, disabled or misusing alcohol and/or substances. We recognise that the unpaid support provided by carers allows individuals to retain their independence and improves their quality of life. We will work with carers to ensure that they get the support they need from health and social care, including support from General Practitioners (GPs) to help carers maintain their caring role for as long as they want to. We will develop responses that make a real difference to carers lives, ensuring that our responses meet their needs. We recognise carers as experts on the person they care for and we will be putting carers at the forefront of partnership work with commissioners and providers to identify needs, priorities and responses. We recognise the diverse needs of carers in Newham s multi-cultural community and will address equality of access to information, appointments, meetings etc. We will work to ensure that carers not currently known to services are made aware of support available to them. We recognise the wide range in the ages of carers and will help them to access support that is appropriate to their age. We will work in co-production with carers to ensure that their right to lives of their own is a practical reality. We will build on our co-production practices and build carers capacity to lead on activities, events and services that affect their lives. 5.1 Co-producing the strategy with carers This strategy has been co-produced with both young and adult carers. Carers were engaged through workshops, meetings and events and have shaped the themes, ideas on service provision and commissioning. They have also helped to identify gaps in the current system that have informed the development of this strategy. Carers UK were commissioned to conduct an initial review of carers in Newham, who were consulted via questionnaires and focus groups. 5.2 Outcomes sought and monitoring our progress Strategic priorities and commissioning intentions will be closely performance monitored throughout the life span of this strategy, 2015 to All providers will be required to feed back on how their service supports carers. Measures and outcomes relating to carers will be incorporated into all strategic documents and relevant services will be measured on how they deliver on the outcomes in the table below. Outcome One Carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role. Outcome Two Carers will be able to have a life of their own alongside their caring role. Outcome Three Carers will be supported so that they are not forced into financial hardship by their caring role. Outcome Four Carers will be supported to stay mentally and physically well and will be treated with dignity. Outcome Five Children and young people will be protected from inappropriate caring roles and have the support they need to learn, develop and thrive and to enjoy positive childhoods. 14

15 We have worked closely with carers to develop an outcome-based performance framework that will be used to monitor all services. This will include the establishment of an improved contract monitoring system. We will, wherever possible, incorporate carers into existing surveys to help improve the feedback we get from carers, especially carers who access information and advice services only. We will improve our data collection on carers across both statutory providers and commissioned service. We will use the data collated, including that from carers assessment and carers health checks, to indicate the level of need and to evaluate the impact of service provision. 5.3 Review of current provision and support for carers Carers UK, the national carers organisation, was commissioned to conduct an independent evaluation of provision in Newham and map out the gaps; this was done over a period of three months, from June to September Carers UK sent out 1,700 questionnaires to carers known to Adult Social Care services. An additional 500 surveys were placed in community venues including libraries and community centres. 500 surveys were sent to Adult Social Care customers with low care packages. In addition, four focus groups were held with carers including one with young carers. Interviews were held with providers and professionals in both health and social care (adult and children). The review and validation exercise confirmed that we currently provide or commission a range of services or projects that deliver: advice information advocacy dedicated Carers Team Adult Carers Support Service Young Carers Support Service breaks or respite offer to eligible adult carers preventive services, including physical activities health checks provided by GPs specialist support groups for carers of customers with dementia, stroke, substance misuse dedicated Carer Liaison Officers for carers of mental health customers with learning disabilities. The exercise highlighted: Lack of consistency and connectivity across carers services, resulting in a wide disparity in the level of support available to the individual carers of the different client groups. As a result, only some carers had been able to access the carers fund, counselling and peer groups while others could not. Lack of connectivity between health and social care, resulting in services that do not meet carers stated aspirations or support the strategic objectives of the Adult Social Care or NCCG. Likewise, carers abilities to access information vary and are dependent on their knowledge of services. For example, the uptake of the Carers Emergency Scheme has been limited to carers of mental health service users and a few others. Lack of clarity on the commissioning model and the expected outcomes from commissioned services, thus making it difficult to determine if services are meeting their objectives. The level and detail of data collected across both health and social care is low, especially in relation to young carers. 15

16 Newham s Joint Carers Strategy February National survey: the carer s view We know from the National Carers Survey (2012), of which Newham had a response rate of 36%, that: carers expressed some level of dissatisfaction with the assessment process, especially in relation to information on assessment and any further support once the assessment was over respondents were, however, much more satisfied with their involvement in the assessment and care planning of the people they cared for and the support they received from Adult Social Care services respondents felt it was easy to find information. The following areas were indicated by carers as being of key importance: Breaks need to be more flexible and tailored to meet individual needs. Examples of good practice and innovative support planning for carers and the people they care for for should be more widely shared, with support planners being encouraged to be more innovative. Support planning processes should be speeded up with a more streamlined, faster turnaround between assessment and support planning. Better communication, both before and after an assessment has taken place. Improved integration of services between health and social care. Greater support from GPs, including early identification, flexible appointment and access to health checks. Improved access and signposting to emotional support systems such as peer groups and counselling. Time-appropriate access to advice, information, guidance and advocacy relevant to the specific carer s role. Improved identification of carers who are not known to statutory services. More training and awareness of the management of long-term conditions. Improved training in carer awareness for staff working in statutory organisations. Access to services that maintain carers health and wellbeing, including more preventative services. More training in areas that will assist carers, such as emotional support and practical skills like budgeting, medicine management and confidence building / assertiveness training. Improved transition planning, especially for transitioning from young to adult carers, and for carers when the conditions of the people they care for change, or when caring ceases. Greater support for young carers with caring roles. Improved safeguarding awareness for carers. Improved visibility and range of specialist services available for carers of mental health and substance misuse service users, and parent carers. 5.5 Young carers (under the age of 18) The review found that, whilst the commissioned service for young carers is universally applauded on the delivery of its services, there are areas for improvement and these are set out below. One of the key challenges is the identification of inappropriate caring roles or long hours of caring which are likely to be detrimental to the lives of young carers, including their health and educational opportunities. One of the major challenges is how to manage this when families choose not to seek support from statutory services due to fear of losing the child or family breakdown. The review recommended that GPs play a more active role in the identification of young carers. There is the impression that the level of awareness and identification of young carers 16

17 appears to have improved over the past few years as the provider of the Young Carers Service reports that they now get young people signposted to the service by schools. There is, however, recognition that health, social care and educational services need to do more in the identification of young carers and in recognising the impact that caring has on young carers, such as restrictions in accessing the same opportunities as their peers. Most referrals come from a handful of secondary schools. Appreciation of the impact will help to reduce the assumption that families are able to cope and ensure that appropriate support is given to the person requiring care. There needs to be a realisation that young carers are often reluctant to seek support for their caring role and are often likely to refuse assistance or support. The level of support given to young carers is often deemed by young carers to be inadequate. The perception of young carers is that being identified as a carer leaves them exposed to bullying and/or social isolation. 5.6 Young adult carers (aged 18 to 25) The review and consultation with young adult carers highlighted that there were additional issues faced by this group. These were often different from those faced by young carers or adult carers, and related to the fact that they are in a transitional phase of their lives. Some young adult carers experience financial hardship. Some who continued with education struggled with the additional pressure of having to care whilst continuing full-time studies and not being able to access part-time employment like their peers. Young adult carers who pursued employment expressed concerns that they have to restrict their choices to low paid employment that would enable them to combine their caring role with their desire or need to be employed. They pointed out that securing employment is seen as the sensible option if a family is on low income and the adult is unable to work. Some families reported having to make a choice between one sibling pursuing education or a career whilst another stayed at home to care. This is potentially influenced along gender lines. Other young adult carers felt that paid employment was not an option as their level of caring was in itself full time employment. Young adult carers often develop valuable skills that are transferable in the market place, but these are not recognised as there are no means of evidencing them. Young adult carers expressed concern that they would be moved to the adult support service. Many of the young adult carers felt that they got appropriate support from the young carers service and would like to remain with this service for as long as possible. They also expressed the need for more training on management of longterm conditions, first aid, manual handling and practical life skills like cooking and budgeting. 5.7 Summary In summary the review identified the following gaps: Lack of clear pathways to make it easy for carers to be signposted to the relevant support. Failure to identify carers, especially young carers and carers of those with mental health needs and / alcohol and/or substance misuse issues. Lack of robust data collection and service monitoring to enable tracking of the support provided, especially to young carers. Lack of recognition/identification of financial contributions made to support carers by both 17

18 Newham s Joint Carers Strategy February 2015 the local authority and NCCG. Restricted access to readily available, upto-date information and advice. Effective coordination of all information provided and available to carers, taking into account the different services that carers access. Lack of effective coordination of services across health, social care, voluntary sector and community services. Lack of joint offer, especially for flexible respite and/or short break opportunities. market is underdeveloped with a handful of providers providing services to carers. One of the challenges is how best to stimulate the market to ensure that personalisation for carers becomes a reality. 5.8 Challenges faced The demand for services that support carers is projected to increase as life expectancy and the number of residents living with long term conditions and/or disability increase. This, along with the anticipated increase in the number of older people, people with memory related illnesses and the changes to service provision in community settings away from institutions, will increase the number of people in an unpaid caring role. Newham has seen an increase in the number of customers and patients who wish to live in their own communities for as long as possible rather than enter residential care. This undoubtedly comes with the risk of social isolation, particularly where carers are experiencing declining health themselves. There are the additional challenges of identifying hidden carers and those (usually young carers) who might be reluctant to be identified due to the perceived assumption of stigma by their peers. All these issues, while in the midst of an economic downturn and a real cut in the budgets of health and social care, highlights that the challenges are real. Our overall challenge is to identify how Newham can best support carers to have a life of their own whilst maintaining their caring role. The current market for carers services is based predominately in the third sector. The 18

19 6. The way forward The focus of the previous section has been on the current position. This section articulates what the strategy hopes to deliver. It also states the commissioning intentions that will support the delivery of the strategy s agreed outcomes. All partners signed up to this strategy want to ensure that carers are supported in their caring role. We want carers to have accessible advice and guidance, good quality preventative services and the opportunity to work. We have worked in partnership with carers to develop our stated outcomes and the resulting commissioning intentions are the blueprint for delivering these. 6.1 Commissioning intentions to achieve outcomes These commissioning intentions are applicable to adult carers, parent carers, young carers, former carers and in some instances sibling carers. The strategy recognises that some commissioning intentions cut across all the agreed outcomes and these are stated below. We will work to ensure that contracts with providers are used to encourage the identification and support of carers, especially in hospitals and community services. We will support carers for a year after the person cared for has deceased or no longer requires care and assistance. We will improve access to assistive technology and equipment, providing the necessary training and support to ensure carers, are able to use these to support them in their caring role. We will improve access to universal services for carers, especially for sibling carers who are less likely to be known to services like activenewham and NHS Health Checks. We will strengthen the performance framework and contract monitoring across both commissioned and provided services, using the process to identify needs and improve delivery. We will streamline and continue to improve Newham s offer to carers from both NCCG and social care. We will ensure that the carers offer is widely publicised and kept under review. The next section sets out our specific commissioning intentions in relation to each outcome. 6.2 Commissioning intentions for Outcome One Using a whole family approach, carers will be respected as expert care partners at the heart of decision making and will have access to the integrated and personalised services they need to support them in their caring role. Information and advice We will ensure that information, advice and guidance are available in a wide range of formats to ensure we reach as wide a pool of carers as possible. We will improve the range of opportunities to carers and improve staff knowledge of these services. Communication materials targeting carers, especially young carers, will be user-friendly, reassuring and age-specific, utilising a wide range of resources and media. We will improve access to independent financial advice and advocacy for carers, former carers and their families. We will improve communication to carers and former carers so that information on support available is current and relevant. We will take full advantage of social media and digital platforms to increase awareness among young people about who a young carer is. 19

20 Newham s Joint Carers Strategy February 2015 Identification of carers We will work with partners, especially across front line services such as occupational therapy, to improve the mechanism and process for the identification and signposting of carers (especially young carers) across health, social care, education and the voluntary sector. We will support those with caring roles to identify themselves as carers at the earliest possible stage of their caring roles, recognising the value of their contribution and involving them from the outset in planning, designing and monitoring local planned services and care packages. Assessment of carers We will work to improve the assessment process, deliver a whole family approach, and ensure that young carers and sibling carers are part of the standard assessment process. Likewise we will improve the turnaround time between assessment, review and support planning. We will work with providers of services to ensure that support offered to carers is personalised and suits their individual circumstances. We will develop processes for assessing the needs of young carers and sibling carers alongside the adult or child who is cared for. We will ensure that assessment and development of the care plan of an adult service user will take into account the educational and social needs of any identified young carer. Co-production We will work with providers of acute care to improve the discharge planning process so that it takes carers needs into consideration. We will ensure that Newham s Health and Social Care Integrated Care Plan takes into account the needs of carers Commissioning intentions for Outcome Two Carers will be supported to have a life of their own alongside their caring role. Young carers We will ensure that demands for unnecessary and inappropriate levels of care are not placed on young carers. This will be addressed through the support planning process and improving the communication and exchange of information between Adult Social Care and Children and Young People s Services. We will ensure that the Young Carers Support Service works closely with childrens services to ensure access to support. We will continue to work with schools to ensure the early identification of young carers and the provision of appropriate support. We will continue to work with schools to ensure that young carers can remain in education for as long as they want to. We will work with partners to improve signposting of sibling carers to universal services. We will work with the providers of young carers services and adult social care to improve access to after school learning opportunities available in the borough. All carers Workforce development We will ensure that care professionals and partners receive continuous training and guidance to ensure they provide timely and appropriate support to carers. We will deliver a core training offer for carers to support them in their caring route, such as the management of long term conditions, good back care, health and safety in the home. 20

21 We will support carers to access routes into education, training and employment, to enble them to have a life of their own. Market development When practicable, health and social care will jointly commission or have a lead role in the commissioning of support services. We will improve access for carers and former carers to the range of volunteering and befriending schemes in the borough currently available to the person cared for. We will improve the range of services available to carers by developing the range of providers locally. Support planning We will ensure that the need for a break is appropriately taken into account during the process of support planning. We will ensure that each support plan is outcomes based and flexible to ensure it is of value to carers. 6.4 Commissioning intentions for Outcome Three Carers will be supported so that they are not forced into financial hardship by their caring role. Partnership working We will work with all partners including the retail and leisure sectors to develop a concessionary carer s card for both adult carers and young carers. We will work with local employers to highlight the needs of working carers, promoting the need to support carers to stay in employment. We will work to ensure that carers are informed of their employment rights. We will work with training providers to improve the opportunities available for carers to become paid care assistants. We will work with the Department for Work and Pensions and local employment support organisations to improve access to work opportunities for carers. Young adult carers (aged 18 to 25) We will work with partners to ensure the delivery of life skills training. 6.5 Commissioning intentions for Outcome Four Carers will be supported to stay mentally and physically well and treated with dignity. Partnership working We will ensure that NCCG s Primary Care Strategy reflects the needs of carers. We will promote health checks for all carers, especially young carers. We will work with GPs to encourage flexible health appointments for carers. We will work to improve carers access to services that provide support, especially GP services and emotional support, including counselling, peer support and interest groups. We will work with local providers to ensure carers are supported to access community mental health services, where appropriate. We will improve carers access to universal services that exist in the borough, especially commissioned preventive services. We will improve carers access to home adaptation equipment, providing training and conducting reviews as and when the need for equipment changes. We will formalise carers access to home adaptation equipment for up to a year after the person cared for no longer requires the equipment. 21

22 Newham s Joint Carers Strategy February 2015 We will work with partners and providers to deliver and increase access to training on the management of long-term conditions for carers and medicine management so they can better support the person cared for. 6.6 Commissioning intentions for Outcome Five Children and young people will be protected from inappropriate caring roles and have the support they need to learn, develop and thrive, and to enjoy positive childhoods. Partnership working We will work together with partners, especially schools and health services, to improve identification of young carers, especially during the assessment of an adult or young service user. We will work with educational establishments, youth organisations and training and employment providers on how best to identify and support young carers. Information and technology We will improve the use of social media and online support mechanisms for young carers. Market development We will ensure that young carers with caring roles for siblings are supported to access universal services in the borough for young people, including youth centres, schools and libraries. 22

23 7. Finances 7.1 Current funding strategy Newham Council and NCCG currently commit over 1.7 million per annum in total to support carers. This includes the provision of in-house services to carers such as assessment and carers breaks. The table below reflects current investment in carer support by both NCCG and social care (both adults and children s). A key challenge has been determining the level of investment in carers by NCCG. It is unclear how much of the 49 million spent in the block contracts held with Community Health Service and Mental Health contracts is utilised in supporting carers. Currently we do not have a methodology that can determine the element that supports carers specifically in their role as carers. It is our commissioning intention to develop new specifications and new Key Performance Indicators to address this in the coming financial year. Name of service Service provider Commissioned/ funded by Cost value ( ) 13/14 Adult carers Newham Carers Network Newham Council 150,000 support services Carers health checks GPs NHS England Part of primary care Stroke family and The Stroke Association Newham Council 58,500 carers support services Support to carers and Carers UK Newham Council 4,624 carers support group Newham branch Active and Connected Age UK & Stay Newham Council and NCCG 56,000 Well Partnership Forget Me Not service East London NHS Newham Council 80,000 Foundation Trust Carer engagement/ Newham Carers Network Newham Council and NCCG 45,000 co-production Individual advocacy VoiceAbility Newham Council and NCCG 200,583 Services for people with Headway East London Newham Council 64,182 acquired brain injury Carers specific strategic Newham Council Newham Council 305,000 and operational support Carers Assessments Newham Council Newham Council 100,000 Social care support Alzheimer s Society Newham Council, NCCG 43,000 for memory services and Tudor Trust Nulife (adults with Newham Council Newham Council Carers specific learning disabilities) service provided as part of the service Samuel Boyce Centre Newham Council Newham Council Carers specific (dementia) service provided as core part of the service 23