NHS HMR Clinical Commissioning Group
1

Contents
Foreward
Executive Summary
Pages
5
8
Sections:
1.0 Introduction
1.1 Purpose of the Strategy
1.2 Our Vision for Carers in Rochdale
1.3 Developing the Strategy
2.0 The Legislative and National Policy Framework for Carers
3.0 Carers in Context
3.1 Who is a Carer?
4.0 Outcomes for Carers
5.0 The Facts about Carers
5.1 What do Carers do?
5.2 Demographic Profile of Carers
5.3 Carers in Rochdale Borough
6.0 Young Carers
7.0 Registered Carers with T he Carers’ Resource
8.0 Needs Analysis
8.1 National Research
8.2 Equalities
8.3 Impact on the Health and Well Being
8.4 Local Research
8.5 Future Demographics 28
9.0 Progress made in Meeting the needs of Carers 28
9.1 Beacon Status for Supporting Carers
9.2 Care Quality Commissioning – Evidence
9.3 Current and Anticipated Financial Resources
9.4 Other Resources
10.0 Eligibility and Charging
28
29
30
30
31
25
25
26
26
27
14
15
15
15
12
12
13
13
17
17
18
21
23
24
2

11.0 Priorities
11.1 Universal Carers’ Support
11.2 Targeted Carers ’ Support
11.3 Personalised Carers ’ Support
11.4 Draft Care and Support Bill
12.0 Financial Security
13.0 Carer Involvement in Planning, Shaping and Delivering Services
14.0 Young Carers
32
33
35
36
38
38
39
39
15.0 Parent Carers
16.0 Strategic Aims and Objectives
17.0 Managing Performance
18.0 Reviewing the Strategy
40
40
43
43
Appendices
Appendix 1 Action Plan
Appendix 2 Legislation, Policy and Research
Appendix 3 Spend on Carers’ Services
Pages
45
57
64
3

On behalf of Rochdale Borough Adult Social Care, NHS Heywood Middleton and
Rochdale Clinical Commissioning Groups (NHS HMRCCG) and Carers
’
Association (Rochdale Middleton, Heywood and Pennines) we would like to thank and acknowledge the carers and others who have assisted in developing this strategy either by making comments on the working drafts, or by making their own work available for reference.
If you have any feedback on this document or would like to get involved in improving services for carers please contact us. W e’d like to hear from you!
Julie Parrish
Carers ’ Commissioning Manager
The Carers’ Resource
Newbold Buildings
35 – 37 Oldham Road
Rochdale
OL16 5QJ
T 01706 925808
Email julie.parrish@rochdale.gov.uk
4

Foreword
This foreword has three key contributors who each fully support meeting the needs of carers via this joint strategy: Councillor Jean Hornby the portfolio holder for Adult Social Care Services, Councillor Donna Martin portfolio holder for
Children, Schools and Families and NHS Heywood, Middleton and Rochdale
Clinical Commissioning Group.
Councillor Jean Hornby
Portfolio Holder for Adult Social Care Service
I’m Councillor Jean Hornby, Portfolio holder for the Adult Social Care Service and
I’m very pleased to have been asked to write a brief introduction to the new Joint
Carers Strategy. This joint Strategy is so important, with Health & Social Care working together to better meet the needs of carers.
Carers continue to be an Adult Social Care priority and I have a long standing involvement with carers which goes back to around 2001. I wish to state at the outset that I am totally committed to the carers; to supporting them, valuing and respecting them in every possible way we can, to enable them to carry on
‘caring’.
I believe this document builds on our strengths in supporting carers and demonstrates the commitment we have across the Council, Health and the 3 rd
Sector, to constantly strive to improve on this. We’ve come a long way, and achieved a great deal in our support for carers. I feel however with this future framework we can achieve a great deal more!
I’m sure we are all aware of the huge contribution the carers make to our borough. We also need to be very much aware of the significant impact that
‘caring’ has on carers’ health. Some of the figures in the report are quite staggering. For instance: 22.2% of carers providing 50+ hours of care report that they are in ‘poor health’. Therefore, helping GP’s to identify carers - to have a better understanding of their needs and then referring them to carer’s support - is key! This assists us in being able to help them take better care of their own health – in other words ‘Caring for the Carers’.
I know at first hand how difficult it is to be a carer. I also know of the commitment our local carers show to the person they care for. I also feel very proud of what we have achieved for carers in the borough. Firstly we have the ‘Carers
Resource’ which has grown from strength to strength and in 2012 celebrated it’s
10 th Anniversary. We have seen carers develop into the ‘umbrella’ organisation –
The Carers Association (of) Rochdale, Middleton, Heywood and Pennines
(RMHP) – for all the carers across the borough. They are a charity and a thriving organisation constantly achieving and developing. They hold regular (and successful) Carers ’ Forums which deal with the latest issues and I’m sure many
5

of you will be aware of the successful Carers
’ Choir which takes the message out into the community.
Beacon Status was also achieved for ‘Supporting Carers’ and there are a wide range of ‘Breaks’ services for carers.
I believe also that it is particularly important to mention safeguarding – we need to make sure carers are not in harmful caring roles, and that we protect vulnerable adults from harm, neglect and exploitation. With carers firmly in our sights we have adopted a protocol which sets them at the heart of safeguarding.
Finally – I wish to use my introduction of the Joint Strategy Document as a vehicle for launching a new Campaign ‘Every Carer Counts’. By raising the profile in this way, we feel it would be a huge help in being able to identify the 23,260 carers in the Borough .
Councillor Donna Martin
Portfolio Holder for Children, Schools and Families
I’m Councillor Donna Martin and the Portfolio Holder for Children, Schools and
Families. My role covers both parent carers and young carers and this strategy is key to making sure we support adult carers, parent carers and young carers.
My role in this strategy is to ensure that we deliver appropriate support to parent carers and young carers in the borough. I believe that the strategy gives us a framework for this and the action plan gives us clear work streams which, through partnership working, we will achieve. I want to champion the role of parent carers and young carers, many of whom are hidden and don’t get the support they need. There are some key aspects we need to focus on, including the transition of young carers into adult carers’ services and parent carers whose sons and daughters move into adult services. Some parents are isolated, regardless of whether their son or daughter uses mainstream or special education. We need to be able to link these parents into support. We need to build on and promote the Parents ’ Forum which we have seen grow from strength to strength in recent years.
Young Carers are invaluable to the people they care for, the family unit and more importantly to us in Society. Young carers have dual roles as school children and carers and research shows that young carers are often bullied or stigmatised because of their caring role. It is our mission to change these perceptions but more importantly ensure that young carers receive the support they need to have aspirations and the same life chances as young people who do not have a caring role.
My role is to act as a champion for young carers and ensure that they do not go unnoticed, unrecognised and unsupported. We know there are 175,000 in the
UK with somewhere between 2,000 and 6,000 in our borough. We need to be able to identify how many there are locally and provide appropriate support from
6

a wide network of services. This strategy will promote partnership working across adult and childcare services, with colleagues in health, education and youth services. In the Beacon Status for Supporting Carers we were praised for our whole family approach with young carers and their families. We will build on that position for both parent carers and young carers.
It is vital we protect and safeguard children and young people from harmful or neglectful situations and this strategy recognises the partnership working we need to ensure that young carers are safeguarded.
I fully support this strategy and believe it will ensure we deliver effective and efficient partnerships to support the wide range of carers in our borough.
NHS Heywood, Middleton and Rochdale Clinical Commissioning Group
Heywood Middleton and Rochdale Clinical Commissioning Group’s (HMRCCG)
Integrated Commissioning Plan has been developed to support the emergent
CCG on its journey to become a fully constituted, well governed, authorised and successful Clinical Commissioning Group.
Recent changes to the NHS offers us a unique opportunity to lead and shape safe, effective, clinically led services for the people of the Borough of Rochdale and secure better quality of life and health for our population who experience some of the poorest health outcomes in the country.
HMRCCG aims to have a population of healthier people with better futures, offering those who need it, the highest quality of healthcare at the right time. This can only come about by inclusive Patient, Public and Stakeholder engagement in the work of our CCG, built on a foundation of transparency, openness and trust.
Carers play a vital role in the provision of care, making an enormous contribution to supporting people in the community. Our overall direction is to work in ways which give people real control and choice over how they are supported. At a time when the NHS and the Council are facing major changes in the way both organisations op erate, it’s really important that we make sure that carers are not forgotten.
We are committed to working together with service users and carers to plan and develop integrated services for local people. Our Joint Strategy for Carers will provide a framework for identifying needs and commissioning the best possible services to meet the needs of carers in the Borough of Rochdale.
7

Carers provide an important role in supporting vulnerable people with both health and social care needs across the borough. It is recognised nationally that Carers save the government, and therefore the council, a substantial amount of money through caring for their ill and disabled relatives. The economic value of the contribution made by carers in the UK i s estimated to be £119 billion per year which is equivalent to £2.3 billion per week. Based on these figures, in 2007 and
2011, respectively carers in Rochdale provided care valued at 333.9million and
426.7 million per year.
For the past fourteen years, the Council has already been commissioning services that support carers in their caring role. The strategy is the first carers strategy to be produced and is a joint strategy with health partners. It has been developed with the input of carers and reflects their priorities. The Joint Strategy covers all carers, adult carers, parent carers and young carers.
The Strategy has been developed through a partnership with carers, RMBC,
NHS HMR, Clinical Commissioning Group (NHS HMRCCG) and Carers
Association. The strategy and action plan is aimed at improving services for carers, enhancing the quality of life for the people they care for, and increasing the effectiveness and efficiency of health and social care services. It recognises the key roles that carers play in providing unpaid support to family or friends and the impact it has on their health and well-being. It emphasises that reduced levels of caring by carers would have an adverse effect on many aspects of society, such as increased NHS cost, increased social care costs, and that caring has a negative impact on some carers e.g. poor school performance by young carers and less paid employment in working age carers.
The strategy presents needs analysis information on carers in Rochdale Borough and some key facts are detailed below:

The 2011 census shows that there are 23,260 people in the borough who describe themselves as carers, a likely underestimation

This is 10.6% of the population and above the national average (10.2%).

Carers can be of any age but the majority in Rochdale are in the 35-64 age group with most becoming carers between 55 and 59.

There are estimated to be between 2,000 and 6,000 young carers in
Rochdale who take on caring responsibility for a family member, undertaking tasks appropriate for an adult alongside full-time education.

Research indicates that 27% of carers of secondary-school age experience problems at school.

58% of carers in Rochdale are female

The majority of carers provide between 1 and 19 hours of care a week
(13,550 carers) whilst 6,105 carers provide 50+ hours of caring a week.
8


Carers are more likely to experience poor health than those people without caring responsibilities including stress, anxiety and depression.
The Joint Carers Strategy has been produced in response to the refreshed
National
Strategy: “Recognised, Valued and Supported Carers Strategy 2010” which identifies the following priorities:
1) Carers should be recognised and supported as expert care partners
2) Carers should not suffer financial hardship
3) Carers should be able to enjoy a life outside their caring role
4) Carers should be supported to stay mentally and physically well and
treated with dignity
5) Young carers should be supported to thrive and not have inappropriate
caring roles
Based on the priorities in the National Strategy, the needs analysis and the input of carers the strategy outlines the vision for carers in Rochdale Borough as:

Carers are recognised, valued, appreciated and supported for the positive contribution they make to our community.

Carers are enabled and empowered to take control of their own lives.
Our vision is based on the aspiration of carers who:

Want to be able to identify their own needs.

Want increased choice in how they meet their needs.

Want access to high-quality, flexible support for themselves and the

people they care for.

Want improved information and advice to support them in their caring role.

Want a choice about caring and the opportunity of a life outside of caring.

Want young carers to thrive and enjoy their childhood and be prevented from taking on inappropriate caring roles.
A stepped service delivery model has been developed to meet the needs carers depending on their requirements:
STEP 1: Universal information, advice and support services available to all carers to prevent breakdown in carer relationships.
STEP 2: Targeted support aimed at carers with more specific needs e.g. carers of people with learning disabilities or mental health problems
9

STEP 3: Personalised services for carers of people with complex and ongoing support needs who are eligible for social care services.
Some key priorities identified from consultation with carers and included in the strategy and action plan are:

The need to identify carers, particularly in health settings

The need to identify young carers, adopting a whole family approach to vulnerability / disability

The need to raise the profile of carers and the need to support carers across all agencies

The need to increase the number of carers accessing information, advice and support to maintain their caring role.

The need to maximize the number of carers assessments carried out in adult social care

The need to enable carers to take short breaks which are flexible, personalised and innovative

The promotion and development of personal budgets for carers and particularly joint ones with health

The need to improve the health and well being of carers, particularly older carers.

The need to provide carers with support in emergencies and develop
Assistive Technology to support carers to maintain their caring role

The need to provide training for carers to support them in their caring roles e.g. confidence building

The need to maximise the income of carers, providing information and advice on benefit entitlement and carers rights in the workplace

The need to involve carers in the development and commissioning of carers services
Based on the national strategic framework for carers, the needs analysis and the input of carers the following strategic aims and objectives of the strategy have been developed:

To increase the number of carers accessing services to support them in their caring role

To address the health needs of carers particularly those of older carers.

To increase the number and range of carers involved in the development and implementation of carers services.

To provide more personalised carers services.
10


To provide carers short breaks in innovative and personalised ways

To maximise the income available to carers

To ensure commissioned services provide value for money and quality services for carers

To ensure professionals treat carers as expert care partners

To ensure young carers are supported, thrive and enjoy the same opportunities as other children and young people
 To ensure young carers are supported so they don’t have inappropriate caring responsibilities

To ensure all carers are protected from harmful caring roles and service users are protected from harm or neglect
The Strategy sets out how these aims will be achieved through a SMART
Action Plan which is attached to the strategy at Appendix One.
11

There are many reasons why carers should be supported. This strategy recognises:
Demography and life expectancy
• Our life expectancy has improved and we can all expect to live longer – our chances of becoming a carer or being cared for are increasing
• We live in an ageing population that is demographically changing
• Advances in medical and assistive technologies have increased our life chances
• Demographic changes will affect how and when we care
Financial
• Costeffectiveness of ‘informal’ caring
• Carers should be recognised and valued for the enormous contribution they make and for the hard job that they do every day
• Health and social care systems would break down without carers
Enabling
• If we support carers appropriately, we can alleviate health problems brought about by the caring role
• We can enable carers to balance work, education, training and social activities within their caring role
• We can enable carers to thrive within their own communities and to better understand both the well-being and universal services that can help them
• We can help carers by raising the awareness of the practical and emotional support that is available
Citizenship Involvement
• We can learn from carers and use their expertise, skills and knowledge in our service planning and development
• We can consult with carers to give us added value and to inform our policies and procedures
• Valuing carers as genuine partners can improve our services and will foster a better relationship between carers and care professionals
• Carers must be recognised and their views and opinions encouraged
1.1 Purpose of the Strategy
Commissioning is the strategic activity of assessing needs, resources and current services and developing a strategy to make best use of available resources to meet identified needs. The Carers
’ Strategy and Commissioning Strategy 2013 –
16 sets out the plans and ‘commissioning intentions’ for how services will be designed and delivered to carers across Rochdale Borough over the next three
12

years. The plan is expected to be achievable within current and likely future resources. It will provide an integrated approach to commissioning by ensuring joint plans are devised between Adult Services and NHS HMR CCG in delivering services to carers. It sets out what kind of services we intend to commission from the voluntary and independent sectors and where those services should be located.
1.2 Our Vision for carers in Rochdale
Our vision for carers in Rochdale Borough is for a future in which:

Carers are recognised, valued, appreciated and supported for the positive contribution they make to our community.

Carers are enabled and empowered to take control of their own lives.
Our vision is based on the aspiration of carers who:

Want to be able to identify their own needs

Want increased choice in how they meet their needs.

Want access to high-quality, flexible support for themselves and the people they care for.

Want improved information and advice to support them in their caring role.

Want a choice about caring and the opportunity of a life outside of caring.

Want young carers to thrive and enjoy their childhood and be prevented from taking on inappropriate caring roles
1.3 Developing the Strategy
This strategy has been developed with the involvement of carers, Rochdale
Metropolitan Borough Council (RMBC) services, health partners, the 3 rd sector and the independent sector. The development of the strategy has been led by carers themselves in partnership with the Carers ’ Association (Rochdale,
Middleton, Heywood and Pennines) as the voice of carers in the borough.
It provides a strategic framework for delivering on the carers ’ agenda in the
Borough of Rochdale over the next three years. It establishes a set of key standards in the form of a Carers ’ Compact that provide organisations (both statutory, non statutory and 3 rd Sector) with a framework against which they can measure how well they are meeting the needs of carers locally.
It also sets out the commissioning priorities for carers’ services over the next three years. It makes explicit, our plans to commission services from resources that have been identified as directly for carers’ services (previously known as the
Carers Special Grant) and the Clinical Commissioning Group funding for carers ’ short breaks.
13

Rochdale Borough
’s Joint Carers Strategy is informed by the following main legislation, national guidance and policy drivers that impacts on carers:
Draft Care and Support Bill 2012 will be the main legislative framework and effectively replaces many statutes from the last 60 years and the three Private
Member’s Bills which formed the cornerstone of carers’ rights.
Recognised, valued and supported: next steps for the Carers
’ Strategy
2010 is the refresh of the National Carers ’ Strategy (2008) produced under the
Coalition Government.
Carers at the heart of 21 st century families and communities 2008 is the
National Carers ’ Strategy and sets the vision for supporting carers for 10 years to
2018. It includes emphasis on improving breaks provision, support for carers through the NHS, recognition of the needs of young carers and carers in employment.
Carers investment from central government to PCT’s to invest in carers
’ services and breaks for carers inline with the Operating Framework in the NHS
Putting People First 2007 – a protocol agreed between the National Health
Service (NHS), Association of Directors of Adult Social Services (ADASS) and the Local Government Association (LGA) which sets out an agreed approach to the provision of health and social care services into the future. The new system is based on the creation of personal budgets and the increasing use of direct payments which will allow service users and carers to have a large measure of control over how their services are provided. Significantly, carers are to be treated as ‘experts and care partners’ except where their views are opposed to those of the service user.
The Whitepaper - Our Health, our Care, our Say 2006 sets a new direction for the health and social care system, emphasising promotion of independence, choice and a stronger voice for both carers and the people they care for.
Carers (Equal Opportunities) Act 2004 confirms the duty to inform carers of their rights to assessment and requires considerat ion of carers’ needs or wishes to work or undertake education, training or leisure.
Carers and Disabled Children Act 2000 extends carers’ rights to assessment in circumstances where a service user refuses assessment or services and empowers local authorities to provide services to carers.
Carers (Recognition and Services) Act 1995 requires a local authority as part of the assessment of a service user, to assess the needs of a carer, who is providing or intends to provide a substantial amount of care on a regular basis.
See Appendix 2 for legislative framework
14

3.1 Who is a Carer?
The Government defines a carer as a person that ‘provides a substantial amount of care on a regular basis for a relevant person’. It is important to make the following distinction:
The role of ‘carer’ should not be confused with ‘care worker’ or ‘care staff’ who are either paid to provide care as part of a contract of employment or volunteer attached to a voluntary organisation. This distinction is made in law through the
Carers’ (Recognition and Services) Act 1995.
For the purpose of this strategy:
A carer is someone who provides unpaid care to a spouse, partner, parent, child, sibling other relative or friend who due to illness or disability, would not be able to live in the community without their help. This could be due to age, physical or sensory impairment, mental illness or addiction.
A parent carer is a parent or guardian who is likely to provide more support than other parents because their child is ill or disabled. Parent carers will often view themselves as parents rather than carers, but their child will have considerable additional care needs.
A young carer is a child or young person under the age of 18, who provides care to another family member, usually an adult, who has a physical or sensory impairment, mental ill health, has problematic use of drugs or alcohol or is HIV positive. The level of care they provide would usually be undertaken by an adult and as a result of this has a significant impact on their normal childhood 3
This carers’ strategy seeks to support three main groups of outcomes for carers, in line with the National Carers Strategy, People First, and the Every Child
Matters outcomes. The lists below are not exclusive, and not all outcomes will be relevant to all carers, but they describe many carers’ priorities and provide the basis for needs assessment and the commissioning of services: a. All carers, including parent-carers, are recognised and supported in their caring role
The carer is able to define the limits of their role (level of involvement and nature of task)

Feels skilled, confident and knowledgeable
15


Has a sense of satisfaction or achievement in caring

Has a sense of shared responsibility/being emotionally supported

Is able to manage the physical/practical tasks of caring.

Young people with caring responsibilities will be identified, and support and services provided to enable them to withdraw from inappropriate caring. b. Carers, including young carers and parent-carers, have free time to themselves

The carer receives appropriate breaks from their caring responsibilities
 Services offered are flexible, providing a ‘good fit’ with existing life routines and care giving. c. Carers, including young carers and parent-carers, experience improved quality of life for themselves

The carer is supported to maintain their physical health and well being

Has access to emotional/mental health support

Is free from excessive anxiety about the person they care for

Is able to have a life of their own (i.e. to pursue interests, educational

Can avoid social isolation

Is able to retain or gain paid employment if of working age


Maintains adequate material circumstances (income/housing)

Young carers do not miss out on their educational, health, leisure and career opportunities due to caring responsibilities.
These outcomes will be delivered through services that are based on the following principles:

The carer is valued/respected as an individual

His/her expertise as a carer is recognised

He/she has a say in the way help is provided

Services offer good value for money

The voice of carers will be listened to, and included both at an individual level in determining how needs will be met, and at a policy level in developing services.
16

Carers are the main providers of care in the community. The Health and Social
Care system relies on carers being willing, able and fit enough to continue caring.
The economic value of the contribution of carers in the UK 4 was estimated in
2007 to be £87 billion per year and 119 billion in 2011. Based on these figures, in Rochdale Borough alone, carers provided care valued at 333.9million in 2007 and 426.7 million in 2011. This is an increase of 28%.
Investing in support for carers to maintain their caring role, if they choose to do so, reduces the demand for statutory services and supports people to continue to live independently for as long as possible. This leads to better outcomes for both the carer and the cared for person. Carers services are, therefore, preventative services which reduce demand for more acute services in both the health and social care sector.
5.1 What do Carers do?
The General Household Survey (1995) and the Survey of Carers in Households
(2009) found that providing care ranged from regularly helping with practical and physical needs to emotional support. 60% of carers looking after someone in their own home provided personal care, such as washing, bathing, dressing and toileting. A similar percentage provided physical help with getting in and out of bed, walking and using the stairs.
3
North West Quality Protects Group
4
Valuing Carers – Calculating the value of unpaid care, University of Leeds and Carers UK, 2007 and 2011
17

Providing care can range from helping with the shopping on a regular basis to providing continuous care. The 2000 GHS found that:

51% of carers looking after someone within their own home provided personal care such as bathing, washing, dressing and toileting.

57% provided physical help with getting in and out of bed, walking and getting up and down stairs.

26% were involved in providing personal care such as washing; 22% administer medicines and 71% give other practical help.
The General Household Survey also found that where the carer and the person cared for lived in the same household, the amount of care provided increased.

63% of carers in the same household spent 20 hours or more a week caring and

31% spent at least 50 hours per week caring.
The support provided by carers is unpaid, brings no status, contract of employment or record of learning and skills acquired. Caring responsibilities may vary over time and may be unpredictable. Missing out on job opportunities, giving up work or being unable to undertake paid work because of caring responsibilities, leads to many carers facing social exclusion and financial hardship.
5.2
Demographic profile of carers in the UK
5.2.1 Carers in Britain
For the first time, the 2001 Census, asked a question about whether people provided unpaid care for a family member or friend and for how many hours.
This revealed that across England and Wales 10 per cent of the population – almost 5.2 million people
– provide unpaid care. Almost 3.9 million of those are of working age. The 2011 Census also asked about carers. The initial release of carer information details the carer demographic and hours spent caring. Further detail will be released in Spring 2013.
18

Fig. 1: Carers by age and sex, April 2001, England & Wales
More than one-in-five people aged 50-59 are providing some unpaid care. A greater proportion of women than men are carers, both in the population as a whole and in age groups up to 64 years (Fig 1).
Nationally 21 per cent of carers spend 50 or more hours a week caring (Fig 2), almost half
– 48 per cent - are not in paid employment (Fig 3) and 11 per cent consider themselves to be in poor health.
50 + hours per wek
1,247,261
21%
20 - 49 hours per week
659,170
11%
20 hours per week
3,952,604
68%
Fig 2: Carers by time spent caring per week, April 2001, UK
19

Part time work
946,657
16%
Not in paid employment
2,810,987
48%
Full time work
2,101,391
36%
Fig 3:, Carers by employment status April 2001, UK
The 2001 Census also identified that there are approximately 174,995 Young
Carers in the UK. Of these, around 18,000 provided 20 hours of care or more a week, and nearly 9000 provided at least 50 hours. Indian, Bangladeshi and
Pakistani children were most likely to be carers, around 1.5 per cent of each group.
Fig 4: Carers by ethnic group and time spent caring per week, April 2001, UK
20

1 in 10 White British and Indian people provide unpaid care to relatives, friends or neighbours. The amount of time that people spend caring differs by ethnic origin
(Fig 4). The White Irish, Bangladeshi, Pakistani and White British groups provide the highest rates of unpaid care spending 50 hours a week or more caring. A high proportion of young Pakistani and Bangladeshi men and women combine paid work and unpaid care - one in eight men and one in seven women from these ethnic groups as compared with just one in twenty five of their White British counterparts.
5.2.2 Carers in the Workplace
The 2001 Census found that over 3 million people combined work with caring responsibilities for a disabled, ill or frail relative or friend. This is roughly one in eight workers in the UK. Of these, over 2 million carers work full time and 1 million part-time.
5.2.3 Young Carers in School
Research 5 indicates 24% of all young Carers age 5-15 years old were missing school or experiencing difficulties. This can result in limited friendships, less opportunities and limited access to formal examinations. High levels of caring can often have an adverse affect on school and home work.
The 2011 census shows Rochdale Borough to have a population of 211,699 and
23,260 people who describe themselves as carers. Although this is likely to be an underestimation of the total number of people providing unpaid care, it represents
10.6
% of Rochdale Borough’s population and is above the national average.
(England average of 10.2%). Detailed analysis of the census data and local research is shown below, together with headline trends.
5.3.1 Age of Carers
The profile of carers in Rochdale Borough is similar to the profile of carers nationally. The greatest numbers of carers are of working age, particularly between the ages of 35-64 with the highest number of people in Rochdale
Borough becoming carers between the ages of 55 and 59.
5.3.2 Gender of Carers
Carers in Rochdale are most likely to be female (58%) with the highest proportion of female carers being within the working age band.
5
Young Carers in the UK 2004
21

5.3.3 Hours provided by Carers
The majority of carers provide between one and 19 hours’ care per week
(13,550). A smaller number of carers (3,605) provide 20-49 hours and 6,105 provide 50+ hours per week. However, the trend is for the number of hours of care to increase with the age of the carer.
Amount of time unpaid caring per week
2001 Census
Number of
Carers
2011 Census
1-19 hours
14, 521
20-49 hours
2,665
50 + hours
4,802
Total
21,988
Number of
Carers
- or +
13,550
-971
3,605
+940
6,105
+1,303
23,260
+1,272 (6%)
5.3.4 Health of Carers
Carers who provide high levels of care for sick, or disabled relatives and friends, unpaid, are more than twice as likely to suffer from poor health compared to people without caring responsibilities. 6
6
In Poor Health
– the impact of caring on health, Carers UK 2004
22

Both statutory and independent sector service providers have a key role in helping to maintain carers’ health and well being, and helping to sustain carers in their caring role for as long as it is both their choice and the choice of the person they care for.
Carers UK undertook research 7 and found that locally 22.2% of carers providing
50+ hours of care report they are in poor health against 13.77% of the non-carer population (21% and 11% nationally).
Causes of carer poor health were described as:

Lack of information

Lack of breaks

Lack of appropriate support

Isolation

Financial stress
Caring can be physically and mentally demanding. Carers providing substantial care can suffer physical strain due to the associated tasks, 24 hour on call, lack of sleep or disturbed sleep as well as mental health problems including depression.
Carers are twice as likely to suffer mental ill health if they do not get a break from caring. 36% of Carers providing substantial amounts of care and who did not get a break suffered ill-health compared to 17% of those who accessed a break. The same study found a third of carers (35%) without good social support suffered illhealth compared to those with good support (15%) 8
Young carers form an invisible group of vulnerable children. A young carer typically takes on caring responsibility for a family member, undertaking tasks appropriate for an adult, trying to keep their family together alongside full-time education. In order to protect him or herself, the young carer may choose to keep his or her role secret. This both makes them vulnerable to bullying, and conflicts with the demands of school life, particularly with regard to regular attendance and completion of homework. The young carer should receive support without the threat of the break up of their family. Research indicates that 27% of carers of secondary-school age experience problems at school.
9
Young Carers want their school, teachers and other school staff to be more supportive of their caring role, recognising that they are balancing a demanding home life with education. Young Carers can be bullied/socially isolated and this can have an adverse impact on their education and social development.
7
Health Reports, Carers UK
8
In Poor Health - the impact of caring on health, Carers UK 2004
9
Department of Health Practice Guide 5. Implementing the Carer (Equal Opportunities) Act 2004.
23

According to the Princess Royal Trust
10
(now Carers trust with Crossroads) figures there are:
• 175,000 Young Carers in the UK.
• 13,000 care for over fifty hours a week.
•
50,000 children and young people look after someone with a mental health problem in the UK.
• 68% of young Carers are bullied in school.
A study 10 of 6,178 young carers in eighty-seven projects indicates that the average age of young carers is twelve years. 56% of the young carers were girls;
84% were white; 56% were living in lone parent families; and 10% were caring for more than one person. There are estimated to be between 2,000 and over 6,000 young carers in Rochdale Borough, many of whom will not be reaching their full potential because of the impact of caring on their lives.
A principle of this strategy is that young carers are, and should be enabled to be, children and young people first.
The Carers’ Resource service (RBMC funded) and run in partnership with local carers and the Carers ’ Association (Rochdale, Middleton, Heywood and
Pennines) maintains and develops a database of the borough’s carers. There are 1,814 carers on the database.
7.1 The database enables the Local Authority to understand the number of people accessing carers
’ services, the client group they provide care for, their ethnicity, locality and whether they are known to the local authority. It enables carers ’ support services to target carers, and consult with and involve carers in policy and service development on behalf of a wide range of statutory \ voluntary and community organisations.
Based on the database carers in Rochdale Borough are:
7.1.1 Gender
Females 74.5%
Males 25.5%
10
Dearden and Becker 2004, Young Carers in the UK, Carers UK \ the Children’s Society.
24

7.1.2 Ethnicity
White British 73.4%
BME carers 23.8%
White Irish 1.1%
White Other .77%
Other .9%
7.1.3 Ages
18
– 24 2.4%
26 – 49 34.6%
50 – 65 32.1%
66
– 75 13.8%
76+ 11%
Not known 6.1%
7.1.4 Cared for groups
Of those who have declared who they care for, below shows the client groups:
Mental health 24.6%
Learning disabilities 18.2%
Alzheimer’s or dementia 11.4%
Stroke 4.2%
Autism 2.4%
Terminal Illness 2.2%
(undisclosed 37%)
Looking at older carers as a whole (i.e. those aged 65 and over), this group comprises almost 20% of Rochdale Borough ’s carers:
Detailed in section 10 below are the aims and objectives of this strategy which are based on the demographic information outlined above and on both national and local research into the needs of carers detailed below:
8.1 National Research :
A major new study 11 from the University of Leeds, commissioned by Carers UK, has provided detailed evidence based on analysis of the 2001 census and findings from questionnaires and interviews from carers and professionals in 10 councils across England, Scotland and Wales.
One report of a series 11 shows that in return for the massive contribution carers make to the social economy and to the well being, independence and security of those they care for, they receive penalties rather than rewards.
25

These penalties can be grouped into three main categories:
First, carers pay a significant health penalty for caring and there is now more strong evidence to suggest that the longer you provide care and the more of it you give, the more likely you are to be in poor health.
Second, the research shows financial penalties hit new carers quickly, which is related to giving up work or reducing working hours, as well as the cost associated with caring for someone who is ill or disabled. It is a problem that worsens as caring continues, and many carers will still suffer a financial penalty when they reach pension age.
Third, carers become socially excluded. The research shows that carers frequently feel isolated and lonely. Due to their caring responsibilities, carers have difficulty in continuing with the life they led before their caring responsibilities began – work, education, leisure and community participation. All are difficult to sustain as caring responsibilities continue and most worry about this, feeling it damaged family relationships and personal life as well as preventing them from contributing to wider society.
8.2 Equalities
8.2.1 Hidden carers do not identify themselves as carers and therefore may not seek support and information that would benefit them. In particular, problems in identifying individuals in some specific groups can lead workers to believe, incorrectly, that these individuals do not need or want services or support. These include the following carers:
• Minority ethnic backgrounds as well as those from the new migrant population.
• Lesbian, gay, bisexual and transsexual people.
• People with mental health problems.
• People who look after someone with a drug or alcohol problem .
Given this diversity no two caring situations are the same and it is important to acknowledge the impact of caring for each individual carer.
8.3 The Impact of Caring on Health and Wellbeing
In carer research carried out by Carers UK 12 86% reported that they suffered from:

stress

anxiety

depression
70% reported back or shoulder pain.
11
The Carer, Employment and Services, The University of Leeds and Carers UK, 2007
26

Many carers admitted feeling ill, anxious or exhausted.

55% had not discussed any concerns about their mental or physical health with someone else (either a friend or healthcare professional).

54% felt isolated and could not socialise with friends or family.
This highlights the isolation and selflessness many carers experience on a daily basis.

96% were very concerned who would take over should they fall ill.

41% suffer from a range of health problems (for example arthritis, high blood pressure, diabetes, Irritable Bowel Syndrome) caused or exacerbated by their caring role.

34% experienced exhaustion.

10% experienced frustration, resentment and anger.
8.4 Local Research:
Earlier local research undertaken by Carers UK on behalf of RMBC bears out many of the issues highlighted above but also drills down to carers’ individual and collective experiences at a local level.
It highlights carers want the following:

Greater flexibility, choice and control in breaks services

More out of hours provision

To see an increase in the take up of carers direct payments
In 2008, NHS HMR undertook a series of five community engagement events across the Borough known as ‘Mission Equality’. These events were held to support the internal review of equality and diversity and to help the PCT understand the needs of the communities they support. They also influenced the development of the Single Equality Scheme 2010-13. The findings were also reinforced at the Equalities Listening Event 2012. Concerns were expressed at these events by those who informally care for others, with the following areas of improvement identified:
 GP information on a patient’s role as a carer (and the impact on health and well-being)

Support for carers (e.g. mentors, community partnerships, and Family
Welfare Association)
12
C arers UK “In Poor Health: The Impact of Caring on Health’ 2004 and “Sick, Tired and Caring - The impact of caring on health and long term conditions”, 2011 .
27


Addressing the specific needs of young carers

Addressing the needs of BME carers accessing healthcare

Addressing the needs of carers who care for people with dementia and learning disabilities

Ensure equal access to carers ’ services for all carer groups
8.5 Future Demographics:
The main demographic factor affecting future need is the anticipated growth of the number of older people in Rochdale Borough. The Joint Strategic Needs
Assessment for Older People, indicates that the population aged 65 plus is expected to increase by 30% from 2001-2021: the population aged 85 and over is expected to increase by 50% from 2001-2021. This group usually create the greatest demand in terms of volume on the health and social care sector. The diversity of the over 65 ’s is expected to increase, with the non-white population expected to have increased by 2.5% in 2021 compared with 2001. The balance of working age population and ‘dependent’ population will change, with an increasing proportion being dependent. This will mean an increase in the number of older people needing support to live independently and older carers providing much of it. The known correlation between age of carer and issues of ill health will mean an increase of elderly carers in poor health which presents a considerable challenge. The carer population has already risen locally by 6% in the last decade.
It is important to recognise the progress made to date in supporting carers and the significant developments which have shaped carers support, services and this strategy.
9.1 Beacon Status for Supporting

Support to Carers from Black and Minority Ethnic (BME) communities;

Consulting, involving and empowering carers;

The focus on carers training and employment support;

Whole family support to young carers and their families.
A key contributing factor in this recognition, particularly in relation to empowering carers, was the establishment of T he Carers’ Resource service in 2002 and the subsequent establishment of the Carers ’ Association (RMHP).
The Carers
’ Resource provides:

Information

Advice

Support

Social networks and peer support
28


Coordinates access to mainstream services

Outreach

Out of hours support for working carers
Carers UK was commissioned to undertake local research (2001/02), “Getting a
Break
– the views of carers and staff on current and future break services”, this informed service improvements including increased and more flexible out of hour ’s services to carers and an increase in the number of dedicated respite beds available to older people with additional enhanced easier access through a central booking point. Robust monitoring systems are in place which directly feed into commissioning processes on the beds spread across the borough. Carers also wanted more home based sitting services which have been commissioned.
The Young Carers Service commissioned with Family Action delivers an innovative and holistic service to young carers and their families through the provision of the following:

Assessments;

whole family support;

case work;

emotional support;

activities for young people
Key to the achievement of positive outcomes within this service has been through the innovative design and delivery of young carers
’ assessments. On average 44 young carers assessments are completed annually. The completion of assessments with young carers is recognised as being key to the delivery of a high quality service, and in Rochdale Borough, has ensured that young carers are able to access activities, sessions or life experiences they would not otherwise have had, in line with the vision of Every Child Matters, Child Care
Services
, the Children’s Trust and the National Carers’ Strategy.
9.2 Care Quality Commission Evidence
In RMBC’s APA 2009, CQC praised carers’ services, in particular the support for carers from diverse communities including achieving the following outcomes:

a 16% increase in carers accessing breaks;

22 BME carers have taken part in well being groups, yoga classes (in partnership with WEA and NHS Health Trainers);

26% of carers registered with the Carers Resource service are from BME communities;

Delivering a range of health initiatives to support carers including carers ’ health checks

Volunteer carer providing language support for other carers and a weekly drop-in session;
29


Funding for social events for people with physical and sensory impairments and their carers;

Supporting and engaging with BME communities including Aashiyana
Carers Group and LGBT carers;

Increased number of carers receiving a needs assessment or review of specific carers
’ service;

Comprehensive range of carer support initiatives to enable carers to balance their caring role with employment if they choose;

Carer Champions ’ group – professionals involved in planning carers week;

Overall evidence that RMBC has improved access to services for carers;
9.3 Current and Anticipated Financial Resources
This strategy is based on the financial resources made available for carers
’ services from RMBC and Heywood, Middleton and Rochdale Clinical
Commissioning Group.
The funding available for the next 3 years to support carers is
£600,646
,
£576,012 and £613,411. It should be noted however that the government are currently reviewing the legislation that governs Adult Care services and it is proposed that carers will have a statutory right to an assessment and to services.
This could have budget implications for future years but the impact of this is not yet fully understood.
Health will also be spending £315,494 on services for carers in 2013/14.
Adult Social Care service supports carers with professional support as well as through support services and breaks
’ services. In addition, Heywood, Middleton and Rochdale Clinical Commissioning Group also have an investment plan for carers ’ services.
9.4 Other Resources
Besides resources available to commission carers services used to directly support carers, Rochdale Council provide services to service users that have the effect of also supporting carers, such as day services and home care services.
In most cases, these services are provided to meet the needs of the cared for person, but they may also be provided with the direct intention of supporting the carer, perhaps as a result of a Carer ’s Assessment. Even when they are provided to expressly support a carer, such services can legally only be provided with the agreement of the cared for person. The assumption of this strategy is that such services will be funded from community care budgets. This is supported by Government guidance on the former Carers ’ Grant, which recognises that
‘the results of a Carers’ Assessment will usually be the provision of ‘community care services for the service user’ (DOH, 2006) . However, their
30

vital role in supporting carers means that this strategy will be used to inform planning and commissioning of those services across all service areas and to inform Contracts and Service Level Agreements with directly provided services.
We recognise the preventative role that carers play in supporting the cared for person and we will not apply eligibility criteria or charge for carers ’ services. In assessing carers for support, the guidance has shifted from ‘regular and substantial amounts of care’ and to assessing the ‘impact’ caring is having on an individual.
31

Detailed below is Rochdale Borough’s Service Delivery model for Carers’
Services:
Personalised
Services
Personalised support \ services for carers of people with eligible, complex and ongoing support needs,
Carers RAS, support planning
Targeted Services
Support aimed at specific groups of carers, LD, MH, OP,
EOLC, P and S Impairment , including breaks’ services,
‘triage’ service for carers, entering ASC service
Universal Services
Baseline offer of personalised advice and information and in addition: -
Carers’ Hub – The Carers’ Resource, Carers’
Association, advice and information, training, peer support and employment support, drop-ins, groups, events, events for professionals, outreach to community\ links to other organisations\services
Our Model of Delivery for Carers ’ Service
32

The model is a stepped model with three levels;

Universal information, advice and support services available to all carers to prevent breakdown in carer relationships

Targeted support aimed at carers with more specific needs e.g. carers of people with learning disabilities or mental health problems

Personalised services for carers of people with complex eligible needs.
11.1 Universal Support
11.1.1 Step One; Universal information, advice and support services available to all carers to prevent breakdown in carer relationships.
11.1.2 Providing Information, Advice and Support to Carers:
Engaging with carers is a key challenge for all service areas and agencies. Not all carers readily identify themselves as carers and each carer will require differing types of support and services. However, all carers need relevant and timely information so that they can effectively sustain their caring role.
The consultation with carers in Rochdale Borough confirmed the central importance to carers of being provided with timely, accurate and helpful information and advice within health settings.
We will continue to commission substantial levels of information, advice and support services from the third sector. Yet, we will undertake a review of services currently commissioned to ensure that they address the principles contained in this strategy and meet with the Kings Fund Quality Standards for
Carers
’ Support Services. This will include ensuring systems are in place to measure levels of carer satisfaction and that this along with other relevant service monitoring information, is used to inform future commissioning.
In order to address the challenge of identifying and engaging with carers, we will work with our colleagues in the Heywood, Middleton and Rochdale Clinical
Commissioning Group, Pennine Acute Hospital Trusts and Pennine Care
Foundation Trusts to develop existing systems for identifying and supporting carers within health settings by introducing ‘Carers Champions’ across both social care and health. This will ensure all relevant staff and service areas are able to identify, signpost and provide information and advice to carers that they encounter.
We have developed a Carers
’ Strategy with Pennine Acute Trust which is aimed at supporting carers, staff in the workforce who are carers and ensuring all health care staff are more ‘carer aware’.
33

We will continue to work in partnership with the Carers
’ Association (RMHP) in informing and supporting carers across the Borough.
11.1.3 Identification of carers and the importance of early identification of carers
Most people do not recognise their caring role, seeing themselves as a husband, wife, mother, father, brother, sister or friend. At the Mission Equality events 2008,
Equalities Big Listen in 2012 and Dementia Listening events 2011, carers, including the young, made it clear that they felt professionals, including GPs, could do much more to identify them as carers.
Health professionals are in a unique position to identify carers and young carers and to ensure that they are supported and provided with appropriate information from early on in their caring role.
This early identification also gives health staff the opportunity to work in partnership with the local authority and with carers including young carers as
“equal and expert” and in their role as “key partner in care”. The benefits that can be gained by such a working relationship are immeasurable for health professionals, patients and carers.
Evidence shows us that where we have helped carers to identify early in the
‘caring journey’ the outcome is better for the carer, the cared for person and for the Council \ health services. We will develop a range of initiatives which will help carers and professionals to self identify or identify carers earlier. GP’s, primary care and adult social care staff play a key role. We will explore different ways of engaging carers earlier including targeted work in health settings for example GP practices, awareness raising into acute services including outpatients clinics and target condition related support.
11.1.4 Training for Carers
The Consultation with Carers and Professionals Report (2007) demonstrates the important role that carers consider training has in supporting them to cope with their caring responsibilities.
In order to better support carers in their caring role and in recognition of them as partners in care RMBC through The Carers’ Resource continue to deliver a range of training for carers. Training is vocational \ non vocational and much of the training is peer facilitated.
In addition to this key development we will continue to commission training that aims to support carers in their caring role (including specialist training about particular illnesses or conditions), that enables carers to maintain their own health and wellbeing and supports them to achieve personal aspirations.
34

11.2 Targeted support for carers
11.2.1 STEP 2: Targeted support aimed at carers with more specific needs e.g.
carers of people with learning disabilities, mental health
problems or condition related support
11.2.2
Targeted Support
There are a number of ways we support carers with more specific or targeted support to meet their needs. These services provide more than the broad offer of
‘universal’ support for all carers. They are targeted at those carers who provide a lot of care either emotionally or physically and where the impact on the carer is high. For example they are more likely to be condition or illness specific eg breaks for carers of adults with mental health problems, dementia or learning disabilites.
Recent consultation with carers in the borough confirmed the high priority that carers continue to place on being able to take short breaks from caring on a regular basis and in times of crisis. It also highlighted that carers want short break services to be flexible enabling them to take a break when they want to and that services should be appropriate to the needs of both the carer and cared for person.
We will review all our targeted breaks services to ensure we commission a range of services for carers which provide quality services and are what carers want, meet identified and eligible needs and give value for money. The reviews will address the principles contained in this strategy and meet the standards in the
Kings Fund Quality Standards for Carers
’ Support Services. This will include ensuring systems are in place to measure levels of carer satisfaction and that this, along with other relevant service monitoring information, is used to inform future commissioning.
11.2.3 Carers’ Assessments
RMBC is committed to the continued improvement in the quality and quantity of carers’ assessments by enuring the process is accessible and seamless.
Currently in the borough carers can choose how an assessment of their needs is undertaken including:

Joint assessment as part of a Community Care Assessment of the cared for person ’s needs;

Separate Carer
’s Assessment;
There are fluctuations in the number of Carers ’ Assessments and the reasons for this are varied and numerous. They include carers
’ perceptions of the
35

assessment process, how carers are informed about carers
’ assessments – the process, reasons for doing it and possible outcomes, as well as recording systems to capture assessments and outcomes. This represents a significant challenge in increasing and monitoring the number of Carers
’ Assessments being undertaken.
To increase the number of Carers
’ Assessments and improve monitoring, we will:

Promote Carers
’ Assessments, specifically informing carers of their rights to an assessment of their own needs and have their eligible needs met;

Undertake a comprehensive review of the policy and documentation for
Adult Carers ’ Assessments;

Provide relevant practitioners with training on Carers ’ Assessments and the types of support available to meet carers’ identified needs;
 Introduce an information bulletin for practitioners and ‘Carer Leads’ containing up-to-date information about local and national developments in relation to the Carers ’ Agenda;
There are proposed changes under the Draft Care and Support Bill which will affect carers. Including eligibility to a Carers Assessment, requesting a Carers
Assessment and providing services to meet the carers needs.
11.3 Personalised Carers’ Services
11.3.1
STEP 3: Personalised services for carers of people with complex and
ongoing support needs who are eligible for social care
services
11.3.2 Personalised Support
It is recognised that there needs to be a balance between putting money directly in the hands of carers and commissioning services on carers’ behalf. It will remain essential to continue commissioning services that benefit carers as a whole - such as the provision of information and advice. It is also likely that ‘bulk’ commissioning of some services will achieve better value for money
– such as sitting services.
We currently support carers with a carer
’s specific service (such as a Carer’s
Personal Budget). With Heywood, Middleton and Rochdale Clinical
Commissioning Group, we now have carers’ joint personal budgets. The aim is to increase the number of carers supported to manage their own budget to meet the need for their break. We aim to increase the number of Carers ’ Personal
Budgets and this will largely be achieved through the measures indicated below.
36

We will undertake a review of services currently commissioned to ensure that they address the principles contained in this strategy and meet the Kings Fund
Quality Standards for Carers ’ Support Services. This will include ensuring systems are in place to measure levels of carer satisfaction and that this, along with other relevant service monitoring information, is used to inform future commissioning.
Local consultation identifies that often carers need support from an independent party when dealing with professionals and situations when their needs and wishes differ to those of the person they care for. As of yet, the term advocacy would not be one that they would readily identify with or use. We will promote existing sources of support for carers and continue to provide advocacy services for carers.
Putting real control into the hands of individuals, carers and families sits at the heart of Government policy for improving choice and control for people needing social care support and is of vital importance to all of us. Individual Budgets are a key element in the health and social care white paper ‘ Our Health, Our Care,
Our Say ’ (DOH, 2006) and are designed to help people take control of their own budgets, manage their own support and choose the services that suit them best.
Individual budgets aim to bring together a number of different funding streams and offer a transparent way of allocating resources to individuals.
RMBC has implemented personal budgets for service users and the Resource
Allocation System to meet individual’s eligible needs. RMBC and HMR Clinical
Commissioning Group will work closely together to ensure we support as many carers as possible, across cared for groups, with eligible needs to have a carers joint personal budget.
11.3.3 Carers and Emergencies
The previous Government prioritised the need to support carers in emergencies.
Locally the carers’ emergency card is used to register carers and link them with a
24 hour staffed response service in case of such an emergency.
We are actively promoting Assistive Technology with carers and we will continue to ask carers about their emergency plans on their Carers
’ Assessment and provide carers with relevant telephone numbers for example the Out of Hours
(Emergency Duty Team). We will consult with carers to ask what more or different services they need.
37

11.4 Draft Care and Support Bill
There are proposals under the new bill which will affect carers and replace many pieces of existing legislation from the last 60 years and the three private
Members bills which have been the cornerstone of carers’ rights.
Some of the changes affecting carers include:-
The righ t to a Carer’s Assessment is currently limited to those who are providing or intending to provide ” a substantial amount of care on a regular basis
” – see the
Carers (Recognition and Services) Act 1995. The draft Care and Support Bill will open up access to a Carer’s Assessment to any individual who provides or intends to provide care for another adult, unless the care is being provided pursuant to a contract or where the caring is voluntary work,
The carer no longer has to ‘request’ a carers assessment. The local authority’s duty will be triggered automatically as soon as it appears to the authority that the carer may have needs for support either currently or in the future.
The focus of the Carer’s Assessment will also be different. Under the existing law, its focus is on sustainability: the object is to assess his/her “ ability to provide and to continue to provide care of the relevant person ”. Under the Care and
Support Bill, the object will be to assess whether the carer has any needs for support currently or likely to in future and, if so , what they are.
As part of carrying out a needs assessment on an adult needing care (ANC), the authority will, under the Care and Support Bill, have a duty to consult the ANC’s carer, so far as that consultation is feasible.
It is well evidenced that caring impacts on earnings and caring costs money.
Carers are financially disadvantaged because of their caring responsibilities and as a result have a low quality of life and feel undervalued which negatively impacts on both them and their family.
We will ensure that carers in Rochdale have every opportunity to maximise their income by providing them with clear and accessible information on their entitlement to benefits and by signposting them to agencies that can provide specialist welfare and benefits advice.
We will continue to support the work of the Rochdale Carers ’ Association
(RMHP) by promoting carers
’ rights in the workplace and supporting the needs of working carers.
38

In recognition of the Carers
’ (Equal Opportunities) Act 2004 and recommendations from local consultation with carers, we will continue to develop partnerships with organisations such as Job Centre Plus and seek to develop systems that help carers access paid employment, including specialist advice and support from The Carers’ Resource.
Carer involvement and empowerment has been the foundation on which developments on the Carers ’ Agenda in Rochdale Borough has continued to be built. To ensure open and honest dialogue with carers, we employ a number of methods including holding an annual carers ’ event and working with the Carers’
Association (RMHP). We value enormously the contributions that carers make but recognise that current mechanisms need to be advanced to enable all carers to participate fully.
We will ensure carers continue to be fully involved in the commissioning of carers
’ services; the Carers’ Association (RMHP) is our key stakeholder group.
We will ensure carers continue to be at the heart of service planning, design and delivery.
We will continue to promote Carers ’ Association (RHMP) and work in partnership with them. We will jointly hold four Carers ’ Forums per year. We will work with them to promote themselves as the ‘voice for carers’ and grow their membership, to be fully inclusive and as representative as possible.
There is widespread agreement that children and young people should not be undertaking substantial and regular levels of care that would usually be undertaken by an adult. Local Authorities have a responsibility to ensure that the person needing care has appropriate services and this should include assistance with parenting. Current legislation recognises that, while support might be in place for the cared for person, young people may continue to undertake caring tasks that can have a detrimental effect on them. Even when the care provided is adequate, children may have impact in other ways
– such as feeling guilty about leaving their parent alone or worrying about their parents ’ welfare or financial situation.
Adult Care Services, in addition to supporting the needs of disabled parents, have a key role in identifying young carers, as they will often be the first point of contact. We will continue to build on the joint work between child care and adult care services and monitor the difference this is making to young carers and their families.
39

We will encourage practitioners to adopt a whole-family approach to assessment and develop better services and support for disabled parents to reduce the impact and number of young people with caring responsibilities.
Adult and Children’s Services will continue to work together and in partnership with other agencies in identifying and meeting the needs of young carers and their families. We will adopt the ADASS Memorandum of Understanding between children and adult services. We will ensure we work closely with the commissioned young carers ’ service.
This strategy is focussed on adult carers which includes parent carers of disabled children. We jointly recognise that being a parent carer is an important, complex and challenging task. We are committed to supporting the needs of parent carers so that together all parent carers, children and young people are supported in achieving their full potential.
Rochdale Borough
’s Parenting Strategy sets out a framework to help understand the services offered to support parents and carers. The strategy will enable parents and carers to make confident, informed choices that they feel are right for themselves and their family. It aims to guarantee that a full range of services are available, which will result in positive outcomes for parents, carers and their children.
Rochdale
Children’s (Child Care) Services have made significant advances in the types of support available to parent carers they have – signed up to Every
Disabled Child Matters Charter, worked with Heywood, Middleton and Rochdale
Clinical Commissioning Group and the third sector and developed a whole range of short breaks ’ services which is now part of the core offer.
We are aware that there are a high number of extended family members in the borough providing care for children and young people within the family
– such as grandparents supporting grandchildren who can’t stay with parents due to alcohol or substance misuse. It is recognised that Adult and Children’s Services need to work together with other relevant agencies to better identify and support these vulnerable families.
We will continue to work with the established Parents
’ Forum, the umbrella organisation for the voice and campaigning organisation for parent carers.
The following Strategic Aims and Objectives for this strategy have been developed based on the national strategic framework for carers, the needs analysis and the input of carers:
40

Strategic Aim 1: To increase the number of carers accessing services to support them in their caring role
Objectives

To provide training for carers to support them to cope with their caring responsibilities

To be proactive in identifying and, where appropriate, assessing the needs of adult and young carers across the borough
 To extend the carers enablement pilot ‘Time that makes the difference’

To address the needs of carers within health settings particularly in respect of support through GP surgeries and the discharge of the cared for person from hospital, including provider services within Pennine Acute and
Pennine Mental Health Foundation Trusts

To identify and reach groups who currently do not access carers ’ support
Strategic Aim 2: To address the health needs of carers particularly those of older carers.
Objectives

To increase the funding and support for carers from health services.

To build upon the work into GP Practices

To identify and support more carers not known to adult care service or in receipt of services

To increase the number of carers receiving health checks

To promote carers mental, emotional wellbeing and physical health and undertake a range of activities \ events

To look at implementing the WEBWEM scale to assess carers
’ emotional and mental health and wellbeing
Strategic Aim 3: To increase the number and range of carers involved in the development and implementation of carers
’ services.
Objectives

Increase the number of carers accessing and actively engaging in The
Carers’ Resource and the Carers’ Association (Rochdale, Middleton,
Heywood and Pennines)

Ensure that carers ’ services meet the needs of all carers including, but not exclusive, to BME groups, Male Carers, Parent Carers and Young Carers.

Involve carers in developing and implementing carers
’ services, maximising the opportunities for peer support in service provision and peer review of service provision

To work with Carers ’ Association (RMHP) to grow their membership, be an umbrella and a representative voice for carers
Strategic Aim 4: To provide more personalised carers ’ services.
Objectives

To increase the number of carers accessing personal budgets to support them in their caring responsibility
41


To ensure carers understand the choice and control in service provision available to the cared for via adult care personal budgets

To encourage and support carers to manage cash personal budgets on behalf of the cared for person
Strategic Aim 5: To provide carers short breaks in innovative and personalised ways
Objectives

To review the block booked beds system for carers ’ respite

To review the current carers ’ breaks services

To develop alternative more personalised ways of providing carers ’ breaks e.g. supported holidays, care at home that give service users choice in how they want to be supported whilst their carer has a break
Implement carers ’ joint (health) personal budgets
Strategic Aim 6: To maximise the income available to carers
Objectives

Support carers to access benefits advice and maximise their income

Address the challenge of the large number of carers of working age who need support to access work, remain in work or return to work
Strategic Aim 7: To ensure commissioned services provide value for money and quality services for carers
Objectives

All existing contracts to be reviewed within the Adult Care Contract review process.

Implement the Kings Funds Quality Standards in Carers ’ Support
 Ensure all contracts comply with the Council’s Contract procedure rules

Tender services if required
Strategic Aim 8: To ensure professionals treat carers as expert care partners
Objectives

Ensure carers are respected as equal partners when sharing expertise and knowledge
 Raise awareness of carers, carers’ needs and carers’ early identification

Ensure staff in care services treat carers with dignity and respect

Ensure carers are involved in assessments processes and decisions
Strategic Aim 9: To ensure young carers are supported, thrive and enjoy the same opportunities as other children and young people
Objectives

To ensure the Every Child Matters outcomes are met for young carers

To ensure young carers have access to a range of services including breaks and fun
Strategic Aim 10: To ensure young carers are supported so they don’t have inappropriate caring responsibilities
Objectives

To adopt the ADASS Memorandum o f Understanding between children’s and adult services
42

Strategic Aim 11: To ensure all carers are protected from harmful caring roles and service users are protected from harm or neglect
Objectives

Implementing the ADASS Carers and Safeguarding policy
A SMART Action plan, attached as Appendix 1, has been developed to ensure that these strategic aims and objectives are delivered.
Significant progress has been made over many years with the development of management information systems to more accurately record need, numbers, outcomes and performance. The Carers ’ Association (RMHP) receives six monthly updates from the Service Director and Adult Social Care Performance
Manager by giving feedback on the Local Accounts.
We will ensure this strategy will address the issues in relation to carers by:

Establishing
‘Quality Standards for Local Carer Support Services’ as the quality standards against which carers ’ services are measured.

Establishing improved monitoring of existing contracts, built on consistent and regular monitoring reports from providers (including the views of users of the service);

Focusing monitoring and evaluation on outcomes being achieved for carers through service provision;

Using data from Carers ’ Assessments to indicate levels of need;
 Establishing routine monitoring of carers support including ‘indirect’ services provided to the cared for person;

Aggregating available data from all services to evaluate the impact of service provision.

We will develop a local strategic, multi agency group to oversee the
Governance of this Strategy and Action Plan
Rochdale Borough ’s Joint Carers’ Strategy will be formally monitored (by way of an action plan accessible on the Carers ’ Strategy pages of the RMBC website www.rochdale.gov.uk) and reviewed on an annual basis by the Carers
’ Joint
Commissioning Group and amended and developed as necessary. It will also be
43

available for review and revision at any point if significant issues arise that need to be taken into account of within the document.
If you have any questions or comments about the B orough’s Carers’ Strategy please contact:
Julie Parrish
Carers
’ Commissioning Manager
Adult Care Service
The Carers’ Resource
Newbold Building
35
– 37 Oldham Road
Rochdale
OL16 5QJ t: 01706 925808 email: julie.parrish@rochdale.gov.uk
44

Strategic Aim 1 To increase the number of carers accessing services to support them in their caring role.
Number Task Group
Responsible
Lead When
Start End
Outcomes for carers
1
2
3
4
Review current training provided for carers at The
Carers’ Resource and devise a plan for courses aimed at taking care of the carer and the health of the carer.
Develop a proactive approach in identifying and, where appropriate, assessing the needs of adult, parent and young carers across the borough
Extend the carers enablement pilot ‘Time that makes the difference’
Address the needs of carers within health settings particularly in respect of support through
GP surgeries and the discharge of the cared for person from hospital
Carers health and wellbeing group \
Training subgroup
Early identification and intervention group
Early intervention and intervention group
Carers health and wellbeing group
Julie Parrish and CCG
Lead
Julie Parrish and Young
Carers
Service
Manager
July 2013 - Sept 2013 Carers will be provided with a range of training for carers to support them to cope with their caring responsibilities
Oct 2013 - Nov
2013
Julie Parrish May 2013 - March 2014
Julie Parrish and CCG
Lead
Adult carers, parent carers, young carers and those in transition will be appropriately assessed and supported
Carers not in receipt of services will be identified across health and social care services and supported.
Sept 2013 - March 2014 A greater number of carers will be identified through the
GP practices and referred to carers support.
Carers will feel more involved in hospital discharge and have a
45

5
6
Develop a ‘network’ across the GP Carer Local
Enhancement Scheme practices
Carers health and wellbeing group
Julie Parrish and CCG
Lead
June 2013 - Dec 2013 positive experience of hospital discharge.
GP practice staff, especially
Carers Advocates will feel more skilled and confident in identifying carers and referring them for carers support
Carers Advocates have a forum to share good
Assess which carer groups access carers support and identify which carer groups are not. Action plan to increase their participation and access into support.
Early identification and intervention group
Julie Parrish and Sandra
Montgomery practice.
June 2013 - Sept 2013 A wider range of carers accessing support and carers services.
Reduced barriers and greater participation of carers accessing support.
Strategic Aim 2 To address the health needs of carers particularly those of older carers
Number Task Lead
1
2
Identify current spend and further funding opportunities for carers services with health partners
Greater work into GP practices
Increase involvement of
GP practices in identifying and supporting the health and wellbeing of carers
Group
Responsible
Carers health and wellbeing group
Carers health and wellbeing group
Julie Parrish and CCG
Lead
Julie Parrish and CCG
Lead
When
Start End
Outcomes
April 2013 - March 2014 Identified spend on carers services with potential opportunities for increased funding and services for carers.
June 2013 -March 2014 Greater awareness of carers in GP practices and amongst Carers Advocates.
More carers identified and supported from health
46

3
4
5
6
Further develop the Time that makes a difference service
Work in partnership with
GP practices to promote events and activities to improve carers health and wellbeing
Carers health and wellbeing group
Carers health and wellbeing group
More carers supported with health checks
Carers health and wellbeing group
Introduce the WEBWEM scale into monitoring information for providers.
Carers health and wellbeing group
Julie Parrish and CCG
Lead
Julie Parrish and CCG
Lead
Julie Parrish and CCG
Lead
Julie Parrish and CCG
Lead
May 2013 - March 2014 Greater number of carers supported, who are not known to adult care service.
June 2013 - June 2014 Carers good practice in GP practices will be shared. A range of events and activities will be arranged to improve carers health and wellbeing.
More carers receive health June 2013 - June 2014 checks. Carers have improved mental health, emotional wellbeing and physical health.
June 2013 - Sept 2013 The WEBWEM scale is used and records carers emotional and mental health and wellbeing
47

1
Strategic Aim 3 To increase the number and range of carers involved in the development and implementation of carers services.
Number Task
To increase the membership of the Carers
Association (RMHP) ensuring it is representative of the age, ethnicity and gender profile of the local population
Carers Choir to receive commissions to perform at events and functions and audiences leafleted with information on the choir and carers support service
Audit current use of adult carers \ parent carers and young carers services.
Audit the take up of services from male carers and carers from black and minority ethnic communities.
Carers Association
(RMHP) involved in commissioning processes for carers services.
Group
Responsible
Commissioning group
Commissioning group
Commissioning group
Lead
Julie
Parrish,
Sandra
Montgomery and Carers
Association
(RMHP)
Julie
Parrish,
Sandra
Montgomery
,
Appropriate childcare lead
Julie Parrish and Carers
Association
(RMHP)
When
Start End
Outcomes
June 2013 - March 2014 More carers accessing and actively engaging in
The Carers’ Resource and Carers Association
(RMHP).
Carers Association
(RMHP) grow their membership and are the representative and umbrella organisation for carers
– the voice of carers
June 2013 - Sept 2013 Services are accessed and meet the needs as appropriate of adult carers, parent carers and young carers.
Services are accessed and meet the needs of
BME carers and male carers.
Sept 2013 - March 2014 Involve carers in developing and commissioning carers services.
48

Develop a peer review process for carers services
Maximise carers involvement in peer support in service provision and peer review of service provision.
Strategic Aim 4 To provide more personalised carers services
Number Task Group Lead
1 Develop a plan and promote carers joint
Responsible
Carers personalisation group
Julie Parrish and CCG
Lead personal budgets. With adult care staff, carers support organisations and health partners.
To work with health partners to identify a lead person to sit on the carers personal budget panel.
2 Share and promote good practice of personalisation with carers.
Support carers to manage a cash personal budget for the cared for person.
Carers personalisation group
When
Start End
Outcomes
May 2013 - March 2014 More carers will have carers personal budgets to support them in their caring role.
A lead from health will be a member of the Carers
Personal Budget Panel meeting
Julie Parrish May 2013 - March 2014 To ensure carers understand choice and control in service provision available to the cared for person via adult care personal budgets.
To encourage more carers to support and manage a cash personal budget on behalf of the
49

3
Audit current carers’ services, highlight gaps and have a clear commissioning plan.
Develop a carers framework agreement with a preferred provider list
Commissioning group
Julie Parrish and CCG
Lead cared for person.
June 2013 -March 2014 To support the development of the market to ensure there are breaks services which carers want to purchase which meet their needs within their budgets.
Services are in place for carers which they can openly access, access through care managed services and purchase with a carers personal budget.
Strategic Aim 5 To provide carers short breaks in innovative and personalised ways
Number Task Group
Responsible
Lead When
Start End
1 Review carers services including planned respite in the block booked beds
Commissioning group
Julie
Parrish and
CCG Lead
June 2013 - March 2014
Outcomes
Carers services are reviewed and a framework agreement is in place with providers of carers services
Greater choice of more personalised carers breaks services
2 Have a clear pathway for carers joint personal budgets across health
Carers personalisation group
Julie
Parrish
May 2013 - Aug 2013 Joint carers personal budgets are embedded
50

3 and social care services
Undertake market development with providers of carers services
Commissioning group
Julie
Parrish and
CCG lead
Strategic Aim 6 To maximise the income available to carers
Number Task Group
Responsible
Lead
1 Develop an ongoing programme of work which helps carers access unclaimed benefits
Carers
Financial group
Julie Parrish and Sandra
Montgomery
2
3
Develop an ongoing programme of work for information and advice sessions to pro-actively support carers with the welfare reform changes
Embed employment support into practice at
The Carers’ Resource
Carers
Financial group
Julie Parrish and Sandra
Montgomery
Julie Parrish and Sandra
Montgomery
Sept 2013 - March 2014 A market place of providers of carers services is thriving
When
Start End
Outcomes
April 2013 - March 2014 Evidence of carers maximising their income and claiming benefits they are entitled to and unclaimed benefits
April 2013 - March 2014 Evidence of carers supported pro-actively through the welfare reforms
April 2013- March 2014 Carers are supported into
\ remain in employment
Evidence of the numbers of carers supported into employment of working age
51

Strategic Aim 7 To ensure commissioned services provide value for money and quality services for carers
Number
1
Task
All existing services are reviewed within the adult care contract review process
Group
Responsible
Commissioning
Group
Lead
Julie
Parrish
When
Start End
Outcomes
June 2013 -March 2014 Services commissioned will be in line with what carers want, at the right price and procured in the right way
Develop a framework agreement for carers
2 Embed the Kings Fund
Quality Standards in
Carers Support into contracts for commissioned carers services
Commissioning group
Julie
Parrish
Dec 2013 - March 2014 services with a preferred provider list
Quality Standards in
Carer Support are embedded into contracts.
Strategic Aim 8 To ensure professionals treat carers as expert care partners
Number Task Group
Responsible
Lead When
Start End
1 To audit staff skills in relation to carers.
Raise awareness of carers and their needs amongst health and social care staff.
Training group Julie Parrish and CCG
Lead
Outcomes
Sept 2013 - March 2014 Staff are trained to treat carers as experts and equal partners.
Carers feel recognised and valued and treated as experts and equal
Provide staff in health and social care with training on carers and partners.
Carers feel they are treated with dignity and
52

2 good practice in carers assessments.
Health and adult care assessment staff work with carers pro-actively to support them in assessment processes and decision making
Training group Julie Parrish Oct 2013 - March 2014 respect
Carers are involved in assessment processes and decisions.
Strategic Aim 9 To ensure young carers are supported, thrive and enjoy the same opportunities as other children and young people
Number Task Lead
1
2
Mapping of young carers support
Gaps identified
Review of the carers services, outcomes identified and a young carers service recommissioned.
Young carers identify breaks and fun, they value
Group
Responsible
Young Carers group
Young Carers group
Julie Parrish and lead from childcare services
Julie Parrish and lead from childcare services
When Outcomes
Start End
Aug 2013 - March 2014 Every Child Matters outcomes are met for young carers
June 2013 - March 2014 Young carers have access to a range of services including breaks and fun
3 Holistic support and whole family support for young carers and their families
Young Carers group
Julie Parrish and lead from childcare
June 2013- March 2014 Young carers will be provided with young carers assessments and a range of services
53

4
5
6
Identify the number of young carers across the borough
Work with schools to raise the profile of young carers and the need for support
Integrate young carers into the Early Years
Strategy
Young Carers group
Young Carers group
Young Carers group services
Julie Parrish and lead from childcare services
Julie Parrish and lead from childcare services
Julie Parrish and lead from childcare services including youth work, 1:1 interventions and group work
June 2013 - March 2014 Understanding of the
Sept 2013 - Sept 2014 numbers of young carers requiring support in the borough
Support will be available at the earliest opportunity
June 2013 - March 2014 Young carers will be embedded into strategic documents within a corporate framework
Strategic Aim 10: - To ensure young carers are supported so they don’t have inappropriate caring responsibilities
Number Task Lead
1 A time limited working group to agree and propose a joint policy
Group
Responsible
Stronger
Families Group
Amanda
Jackson and
Julie Parrish
When
Start End
Outcomes
June 2013-Oct 2014 The ADASS
Memorandum or similar document is adopted across children’s and adults social care services. Providing a clear protocol which supports working with families where there is an
54

Strategic Aim 11: - To ensure all carers are protected from harmful caring roles and service users are protected from harm or neglect
Number Task Group
Responsible
Lead When
Start End
Outcomes
1
2
3
4
Raise awareness of safeguarding amongst carers
Embed carers in safeguarding service users
Implement the ADASS
Carers and
Safeguarding policy
Implement the ADASS or similar policy document across children’s and adults social care service.
Carers and
Safeguarding group
Carers and
Safeguarding group
Carers and
Safeguarding group
Carers and
Safeguarding group and the
Stronger
Families group adult who is disabled or ill or with substance misuse and the young carer is providing care.
Julie Parrish March 2013-March 2014 Carers are protected from harmful caring roles and service users are protected from harm or neglect.
Julie Parrish April 2013 - March 2014 Carers are embraced as the ‘eyes and ears’ of
Julie Parrish with Jane
Timson and
CCG Lead
March 2013-March
2014 care services and we acknowledge their skills and knowledge
Adoption of the ADASS policy guidance on
Carers and Safeguarding and integrated into Multi-
Julie
Parrish,
Jane
Timson,
Amanda
Agency Safeguarding policy and procedures, training and practice.
May 2013 - Aug 2013 A joint protocol in place between children’s and adults social care services to ensure we protect young carers.
55

Jackson and CCG
Lead
56

ADASS (Association of Directors of Adult Social Services), 2011 ‘Carers and Safeguarding Adults’ – Working together to Improve Outcomes
This updated review document considers the issues around carers and safeguarding adults. Within the underpinning principles within the Vision of Adult
Social Care, the priorities of the refreshed national strategy for carers:
Recognised, Valued and Supported and the Coalition Government statement of policy on adult safeguarding.
‘Carers have a range of roles regarding safeguarding: as partners and informants; themselves as vulnerable to harm and abuse; as abusers’. 2011
ADASS Safeguarding Advice Note.
Equality Act 2010 provides a new cross-cutting legislative framework to protect the rights of individuals and advance equality of opportunity for all; to update, simplify and strengthen the previous legislation and to deliver a simple, modern and accessible framework of discrimination law which protects individuals from unfair treatments and promotes a more fair and equal society. The basic framework is protection against direct and indirect discrimination, harassment and victimisation in services and public functions; premises; work; education; associations and transport.
Valuing People Now, 2009
“Valuing People Now: a three year strategy for people with learning disabilities”
(HM Government 2009) highlights one of the recommendations of Health care for all. “ Family and other carers should be involved as a matter of course in the provision of treatment and care ” (pg65).
This Strategy is written in the context of the emerging direction of travel for community services set out in the government White Paper “Our Health, Our
Care, Our Say”(19) (Department of Health 2006) which established the following main goals:
1. Better prevention and early intervention
2. Giving people more choice and a louder voice
3. Tackling inequalities and improving access
It is also informed by the Care Quality Commission for Social Care inspection outcomes framework for the performance assessment for adult social care.
These require Adult Social Care to provide services that improve the lives of service users and carers in the following ways:
1. Improved health and well-being – (e.g. access to appropriate health care, advice for healthy lifestyles and opportunity for physical activity)
57

2. Improved quality of life (e.g. access to leisure, social activities, education and transport).
3. Ability to make a positive contribution (e.g. through employment or voluntary opportunities or being involved in policy development and decision making).
4. Increased choice and control (e.g. by maximising independence and having access to information).
5. Freedom from discrimination (e.g. equality of access to services).
6. Economic well-being (e.g. access to income and resources).
7. Maintaining personal dignity and respect (e.g. keeping clean and comfortable and having one’s beliefs and lifestyle choices respected).
Adult Social Care also needs to ensure that:
8. People experience services that are well led and managed.
9. They deliver services to clear standards of quality and cost by the most effective, economic and efficient means.
Putting People First Concordat December 2007
In December 2007 Government launched “Putting People First”. It sets out the shared aims and values of the Government, Local Authorities and the National
Health Service which will help the transformation of adult social care and support the Government’s commitment to independent living for all adults. This move to personalisation will have implications for all service users and carers as we transform to create systems that are fair, accessible and responsive to the individual needs of those who use services and their carers.
Personalisation means:
“The way in which services are tailored to the needs and preferences of citizens.
The overall vision is that the state should empower citizens to shape their own lives and the services they receive”
This means that everyone who receives social care support regardless of their level of need, in any setting whether from statutory services, third community sector or private sector or by funding it themselves, should have choice and control over how it is delivered. The introduction of personalisation is being hailed as the biggest chan ge to the delivery of social care since the “NHS and
Community Care Act 1990.”
There are five elements of the vision for transformation:
1. A new relationship between Government, Local Authorities, the NHS,
Independent sector providers and the regulator.
2. A major shift of resources and practice to prevention, early intervention and reenablement.
58

3. High quality accessible information and advice available to all, irrespective of financial means.
4. A commitment to treating carers as partners.
5. Maximum power, control and choice in the hands of people who use these services and their carers.
Government guidance on personalisation states that by March 2011, people who use services and their carers, frontline staff and providers should experience significant progress in all local authority areas.
Local Government and Public Involvement in Health Act 2007 set up Local
Involvement Networks (LINks) requiring the primary care trust and the local authority to consult and involve service users and carers.
Aiming High for Disabled Children: Better Support for Families
May 2007
The Disabled Children's Standard is part of the National Service Framework for
Children, Young People and Maternity Services (NSF for Children). The NSF for
Children is an important part of the policy context for the “Aiming High for
Disabled Children programme”(12). The standard is accompanied by exemplars on autism and complex disability. The main themes of the “Disabled Children's
Standard” are:

Services that promote social inclusion for disabled children and young people, to enable them to participate in childhood, family and community activities.

Increased access to hospital and primary health care services, therapy and equipment services and social services for disabled children and young people.

Services coordinated around the needs of the child and family.

Services which provide early identification of health conditions, impairments and any social and physical barriers to inclusion, through integrated diagnosis and assessment processes.

Better early intervention and support to parents of disabled children through the development of multi-agency packages of care, including the use of direct payments and employment of key workers.

Palliative care is available for those who need it. A range of flexible, sensitive services is available to support families in the event of the death of a child.

Services have robust systems to safeguard disabled children and young people, who are more likely to be vulnerable to abuse than non-disabled children.

Multi-agency transition planning takes place to improve support for disabled young people entering adulthood.
59

Aiming High for Disabled Children (Department for Children, Schools and
Families [DCSF] 2007 provides additional funding in three priority areas to improve outcomes for disabled children: access and empowerment; responsive services and timely support; improving quality and capacity. New national indicator looks at parental experience of services for disabled children (aged 0 -
19) and assess to the extent to which services for disabled children are delivered according to the 'core offer' standards:
The Work and Families Act 2006
Gives carers the right to request flexible working from their employer. They can ask their employer to change their work pattern. It can only be refused if it will damage business or have an impact on other employees.
Childcare Act 2006 requires local authorities to provide information, advice and assistance to parents.
Children Act 2004 places a duty to co-operate on public bodies in relation to organising services for children, supported by the introduction of the Common
Assessment Framework.
Community Care Assessment Directions 2004 LAC 2004 provides a legal framework for placing existing good practice and guidance on conducting care assessments and care planning.
Community Care (Delayed Discharges etc) Act 2003 confirms the right of carers to have their needs assessed as part of the assessment of needs of a person who may require a community care service to achieve safe discharge from hospital.
We Care Too: A Good Practice Guide for People Working with Black Carers
2002 which is also being reviewed and updated. This document was developed by The National Black Carers Workers ’ Network in association with the Afiya
Trust to address the needs of black carers in the UK. The guide highlights examples of good practice and gaps in service provision for black carers. It also identifies ways of enabling black carers to be involved in the design, delivery and review of services.
Human Rights Act 1998
At the core of a human rights approach are the principles of equality, dignity, respect, fairness and autonomy.
The key articles relevant to the delivery of health and social care include:
Article 2 Everyone has the right to life, except in very limited circumstances
Article 3 No one shall be subjected to degrading or dehumanising treatment
Article 5 Everyone has the right to liberty and security of person
60

Article 8 Everyone has the right to respect for their private and family life
Article 10 Everyone has the right to freedom of expression, subject to the same requirements as in Article 9, but the exercise of those freedoms carries duties and responsibilities to the rights of others
Article 11 A person has the right to assemble with other people in a peaceful way. They have the right to associate with other people. These rights may only be restricted in specified circumstances
Article 14 Prohibition on discrimination
– the enjoyment of rights and freedoms set out in the Convention shall be secured without discrimination on any grounds such as sex, race, colour, language, religion, political or other opinion, national or social origin
Education Act 1996 states that schools and the local authority have responsibility to identify, assess and make provision for a child's special educational needs based on a shared perspective.
The National Stroke Strategy promotes the carers support throughout the patient journey. The strategy focuses on early supported discharge (which it has been argued is often unachievable without carers support). There are a number of Quality Markers (QMs) for NHS bodies to work towards including:

People who have had a stroke and their relatives and carers have access to practical advice, emotional support, advocacy and information throughout the care pathway and life-long. (QM3)

Individuals and their carers are involved in developing and monitoring services. (QM4).

A range of services needs to be locally available to support the individual long term needs of people who have had a stroke and their carers.
(QM13).

Assessment and review of the needs of those affected by stroke.(QM14).
The End of life Care Strategy
“The End of Life Care Strategy” sets out three key principles about how carers should be involved in end of life care:

Carers should be treated as co-workers with the health and social care team.

Carers have their own needs and should be offered an assessment and a formal “carers’ care plan” which should be subject to regular review.

The condition of the person who receives care should not affect how the carer is treated or the services the carer may be able to access
61

Practically this means that carers should be:

Closely involved in decision making alongside recognition of their own needs.
 Offered information about the person’s condition and services which are available.

Offered support in their caring role.

Offered practical and emotional support both during the life of the person receiving care and after their bereavement.
The National Dementia Strategy
“ Living Well with Dementia ”(The National Dementia strategy) states that “ Family carers are the most important resources available for people with dementia ”
(pg12). The Secretary of State’s forward states “ We must develop a range of services for people with dementia and their carers which fully meets their changing needs over time” (pg4). Information for carers on the condition and support available should be offered at the point of diagnosis and throughout their caring role (pg11) with specialist dementia advisers able to advise both those with dementia and their carers. Implementing the Carers
’ Strategy is one of the key objectives of this Strategy.
National Framework for Continuing Healthcare
Increasing numbers of people with complex long-term medical needs are being offered care packages from NHS Continuing Care. The views of carers should not be overlooked. The Framework includes (Section 35) “ Assessments of eligibility for NHS Continuing Healthcare and NHS funded nursing care should be organised so that the individual being assessed and their representative, understand the process and receive advice and information that will maximise their ability to participate in informed-decision making about their future care.
Decisions and rationales that relate to eligibility should be transparent from the outset for individuals, carers, family and staff alike
” (Section 45) and Primary
Care Trusts and Local Authorities should bear in mind that a carer who provides
(or intends to provide) substantial care on a regular basis has a right to have their needs as a carer assessed (Carers Equal Opportunities Act 2004).
NHS and Community Care Act 1990 requires a local authority to assess the needs of a person aged 18 or over if it appears that that person may be in need of community care services.
In Poor Health – the impact of caring on health http://professionals.carers.org/health/articles/in-poor-health-the-impact-of-caringon-health,904,PR.html
62

Sick, Tired and Caring: the impact of unpaid caring on health and long term conditions http://lx.iriss.org.uk/content/sick-tired-and-caring-impact-unpaidcaring-health-and-long-term-conditions
The Equality Act 2010 http://www.ecu.ac.uk/law/equality-act
63

Carers of people with: Provider
Universal support for carers:-

Carers ’ Personal
Budget’s
 The Carers’
Resource
Carers ’ commission the services themselves
Adult Care Service
Older People’s respite

block contract respite bed in residential homes
Emergency Care for carers including the carers ’ enablement
(short breaks) service independent sector residential care home in Middleton \
Pennines
Home Care Support
(Human Support
Group)
Mental Health problems Making Space
Families with an adult with mental health problems and a young
Family Action
Breaks provided
Carers have greater choice and control over their breaks
A borough-wide one stop shop for carers providing breaks, advice, information, support, training, employment support and carer volunteering
Enables carers to plan respite, which helps carers of older people carry on caring
Carers ’ enablement service for carers not in receipt of any other services \ breaks ’ services.
Emergency support for carers
Flexible breaks including carers
’ personal budgets, organised theatre trips, bulk-reduced cost breaks
Targeted breaks for young carers with a parent with mental health problems
Budget
50k
£274,788
£40,821 internal support service charges
£40k
£37,432
£50,300
£11,200
64

carer
Families with an adult mis-using substances and a young carer
End of Life Care
Family Action
Springhill Hospice
People with Learning
Disabilities

Weekend respite

Single Sex
Service

Aashiyana
Carers ’ Group

Harelands ’ outreach service

Parents who are older carers of adult sons and daughters with learning disabilities
People with physical and sensory impairment
Gateway
Gateway
Gateway
Adult Care Service
Friends of Parent
Carers
Kickstart
Targeted breaks for young carers whose parents are mis-using substances
Joint work with the hospice to take care of the carer of adults in the end stages of life
A range of services which support carers with breaks over the weekend, provide carers with culturally appropriate services to young Asian women with learning disabilities (not in receipt of services) and a carers ’ support group for carers from south Asian communities
Provides an alternative to residential respite
Provides advocacy, befriending, advice and support to older carers of adults with sons\daughters with learning disabilities
£5k
£4,800
£49,173
£15,621
£44,918
A support and social group for carers of people with physical and sensory impairments (often recently acquired disabilities)
£5,626
65

Health investment in carers support
Carers
’ Personal
Budgets
Carers LES (locally enhanced service)
Carers
’ Enablement
Service
Clinical Commissioning
Group:-
Carers ’ Choir
Carers
’ Emergency
Packs
Promoting independence of
Joint project with
Rochdale MBC
GP Practices
Joint initiative with
Rochdale MBC
Carers ’ Association
(Rochdale,
Middleton, Heywood and Pennines)
CVSR
Friends of Older
Parent Carers
Henshaw’s for Blind
People
To support carers in flexible ways to organise and manage their own breaks
A specific project working into
GP practices with a carers ’ advocate indentified in each practice and clear referral process to The Carers’ Resource
To provide the staffing, development and take up of the carers
’ enablement service (short breaks) service
The Carer s’ Choir seeks to promote the voice of carers, promote carers and Carers
’
Association – what they do, support they need and bring about improvements in choir members (all carers) health and wellbeing
Specific packs for carers who find themselves in emergencies
IT equipment for carers
£5,000
£4,800
35k
35k
30k
£5,000
Service to promote independence of severely sight
£6,761
66

severely sight impaired people
Supporting carers through primary care services with prescribed breaks
Sports development for able bodied and disabled children
Support to families with a child with autism whose behaviour is affected
Support to families affected by cancer
Carers
’ Support
Crossroads Caring for Carers
Seashells Trust
Homestart
British Red Cross
Cancer Support
British Red Cross
Carers ’ Support
Gaddum Centre Bereavement support for families
Collaborative Bid:-
Gaddum Centre and
Derian House
Children’s Hospice
Gaddum Centre and
Derian House
Children’s Hospice impaired people
Breaks for Carers through GP’s and primary care
Hiring venues, travel, coach hire etc
Support to families
Support to families affected by cancer
Support for carers
Children and Families bereavement support
Support for children with life limiting illnesses and their parents
£25,000
£19,634.
£24,819.
£24,560.
£24,920.
£25,000.
£50,000
67

68