Agenda Item No:
HERTFORDSHIRE COUNTY COUNCIL
HEALTH AND ADULT CARE CABINET PANEL
WEDNESDAY 4 JULY 2012 AT 2.00 PM
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PROPOSED SITE FOR A PILOT CARER-FRIENDLY COMMUNITY
Report of the Director Health & Community Services
Hannah Rignell, Commissioning Manager – Community
Wellbeing
Tel: 01438 844427]
[Author:
Executive Member: Colette Wyatt-Lowe (Health & Adult Care)
1.
Purpose of report
1.1
To present a recommendation for Stevenage as the site of a pilot carerfriendly community.
2.
Summary
2.1
The aim of the pilot carer-friendly community is to identify the impact of
improved, locally driven support for family carers on residential care
admissions. The pilot is intended to run from September 2012 until
September 2013. It will involve improving the way current services
work together in the local area to support carers, as well as the
development of peer support networks and the focussed engagement
of local GP practices. Local leadership will be crucial, as the pilot will
involve raising awareness in all areas of the community – from the local
population to businesses who could offer carer discounts – about the
need to value the contribution of family carers.
2.2
The analysis of potential sites for the pilot carer-friendly community was
based on the following factors:

Presence of target population – namely older carers (and their
cared-for) at risk of carer breakdown

Existing local support for carers, including support from
Members, GPs and the voluntary sector

Proximity to an acute hospital with an emergency department,
given the related project to pilot a carer-friendly hospital.
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3.
Recommendation
3.1
The Health and Adult Care Cabinet Panel is invited to recommend to
the Director Health & Community Services that Stevenage be agreed
as the site of the pilot carer-friendly community.
4.
Background
4.1
The underlying rationale for the carer-friendly community pilot is that it
is cost-effective to help carers continue to care. In Hertfordshire, 17%
of residential care admissions are the result of carer breakdown, when
a carer is unable to carry on caring. This could be the result of:

The carer themselves becoming ill, or having an injury which
means they cannot continue to care;

The cared for has a sudden deterioration as a result of a single
incident (e.g. a fall) which the carer does not feel able to deal
with;

The cared for has a prolonged worsening of an existing
condition (e.g. dementia) which leaves the carer unable to cope;

The ability of the carer to continue caring is gradually worn down
over time due to the demands of the caring role, leaving the
carer unable to cope.
There is therefore significant potential to generate savings from the
residential care budget by improving the Council’s support for carers.
Improved support for carers would help carers to carry on caring for
longer, thereby delaying admission to permanent residential care and
the associated costs.
4.2
The pilot carer-friendly community is the first phase of a wider
project which aims to help carers continue to care for longer. A
detailed Council for the Future business case explaining this wider
project was presented to the Health and Community Services
Senior Management Board in March. The aim of the first (pilot)
phase is to monitor the impact of improved support to carers in a
single locality on delaying residential care admissions, in
comparison to control groups elsewhere in the county. If the
financial benefits of the approach are proven through the pilot, the
second stage of the project would involve rolling out the model to
other communities throughout the county from April 2014 to April
2016. Total financial benefits to be derived over the life of the
project would be £3.1m. This is based on an initial investment of
£568,000 in set up costs and £445,000 in maintenance costs over
the five year life of the project, and a revenue commitment of
£200,000 per year thereafter.
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4.3
The wider project also includes setting up a carer-friendly hospital in
Hertfordshire and the development of a ‘Hertfordshire Commitment to
Carers’. The hospital, and in particular emergency care, is a key point
for many carers in their caring journey, so interventions at this point are
likely to be cost effective. The carer-friendly hospital will:



routinely collect carer data
have strong clinical leadership to raise awareness of the carers’
agenda at all levels
hold expert patient training programmes for carers and Carers’
Clinics within the hospital
There are strong links to the carer-friendly community pilot; for example,
a more carer-friendly community may have an impact on emergency
hospital admissions as a result of carer breakdown. For this reason,
selecting a community with an acute hospital is recommended here.
4.4
The Hertfordshire Commitment to Carers (HCtC) is used to describe
what every carer should expect to have access to, wherever they
happen to ‘hit the system’. The key lever for embedding this will be a
monitoring and accreditation system, where organisations signed up to
the ‘Hertfordshire Commitment to Carers’ have to demonstrate they are
meeting the minimum offer to carers. It is anticipated that this will be led
by and for carers. The carer-friendly community will demonstrate the
potential of the HCtC as it involves implementing it in a focussed way
with local organisations in a specific locality.
4.4
The comparative analysis of potential sites for the pilot carer-friendly
community is attached at Appendix A. In summary, the rationale for
recommending Stevenage is as follows:

Stevenage has a consistently high number of households likely
to have a regular and substantial carer, with a cared-for who is
likely to be council-funded if they enter residential care (as
according to a Mosaic ‘profile’ of households likely to have a
regular and substantial carer, attached at Appendix B). It has
the second highest proportion in Hertfordshire of retired people
living in areas where older people experience deprivation.

Lister Hospital (East & North Herts NHS Trust) is based in
Stevenage, a hospital with an emergency department relatively
close to the town centre. This means the carer-friendly hospital
could be piloted in the same locality, allowing the joint benefits of
a carer-friendly local health and social care system to be
measured. Stevenage has the highest rate of emergency
admissions for falls amongst over 65s in Hertfordshire.
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
Stevenage has a high number of residential care admissions in a
relatively small area and relatively small population. This would
make the role of the first Development Co-ordinator easier
logistically. It is also justifiable in terms of the investment per
residential care admission for the locality.

Existing local carer support is strong. Stevenage Borough
Council retains a local health and wellbeing partnership, and
their community strategy includes a commitment to developing
the provision of preventive carers support. Carer-led peer
support groups meet regularly in the area and are well attended.
Voluntary sector services, specific to Stevenage, include
Crossroads Day Centre, Douglas Drive Day Centre, and
GEMMS day service.
4.5
The carer-friendly community is a completely new innovation which has
not been tried elsewhere. Maximising the chances of success therefore
means selecting a relatively compact locality which has some existing
level of carer awareness, as well as substantial numbers of residential
care admissions. Success in Stevenage will prove the validity of the
underlying argument – that supporting carers is cost effective – whilst
also allowing lessons to be learned about how it might be implemented
in different communities.
5.
Financial Implications
5.1
The total cost of piloting the carer friendly community will be £60,000. A
saving of £50,000 from delaying residential care admissions is
anticipated, to accrue from helping eight carers continue to care for one
year.
6.
Equalities Implications
6.1
Carers of elderly or disabled people are explicitly protected under the
Equalities Act 2010 by association with their cared-for. The law protects
these carers against direct discrimination or harassment due to their
caring responsibilities. In this sense, the pilot will advance equality of
opportunity for these carers (and, by association, their cared-for) as it
aims to make a whole community carer friendly.
6.2
However, carers are not a homogenous group. Older people are more
likely to have caring responsibilities, but the number of younger carers
is growing. In Hertfordshire in 2001, 6% of all carers were under the
age of 24. Young carers under the age of 18 often have different
experiences to older carers in balancing school work, friends, and the
individual which they care for. Similarly, carers from different cultural
groups will experience their caring responsibilities differently: Black
African, Indian and in particular Bangladeshi and Pakistani people have
an above average likelihood of becoming carers, with those from the
Bangladeshi and Pakistani communities 2.5 times more likely to
become carers compared to their white counterparts. There are also
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cultural assumptions that “they look after their own” which place
additional challenges in the way of BME carers getting support1.
6.3
The design of the carer friendly community pilot will need to reflect the
different needs of these different types of carers. Importantly, the carerfriendly community model will allow this approach by facilitating
improved support for carers which is specific to the needs to the local
population. The evaluation of the pilot will need to include equalities
monitoring data to ensure this is the case.
1
Carers UK Who Cares? Geographic variation in unpaid caregiving in England and Wales: evidence
from the 2001 Census –Office of national Statistics
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