It feels sometimes like I live, sleep and eat the Triangle of Care, as the project which I lead on nationally goes from strength to strength.
For those who haven’t heard of the Triangle of Care this is a set of standards establishing a therapeutic alliance between the mental health professionals, the carer(s) and the service user(s).
Over the past two years Carers Trust has held regional events in all parts of England, given presentations, developed leaflets, promoted the project to MPs and set up a membership scheme that mental health providers can join.
As we enter my third year of working on Triangle of Care we have got 48 mental health trusts involved in the project and 11 of them have signed up to the membership scheme.
With so many professionals, carers and third sector organisations involved in the project across England (and now I’m delighted to say Scotland) I felt it was important to offer them an opportunity to come together and share their knowledge, ask questions, find out what is working in different areas, share their challenges and most importantly their successes.
Last week we held a two day event in Manchester to offer this opportunity. Over 100 people attended the event which – even if I say so myself – was a huge success; we even had a waiting list, the event was so popular!
The two days packed a lot in – we had presentations from Network Partners who have worked together with their statutory mental health provider to drive forward the Triangle of Care and another from mental health providers talking about their journey to carer involvement and joining the Triangle of Care scheme.
We had a presentation from a carer involved the Triangle of Care implementation in Sussex and spoke positively about including service users in this work; demonstrating the Triangle of Care in action. In addition we had an inspiring presentation about implementing the Triangle of Care in a high secure setting – which I believe shows if you can do it there you can do it anywhere.
As I live and breathe Triangle of Care it is sometimes easy to underestimate the extent of the work that is taking place across England and how passionate people are about the standards of the Triangle of Care and trying to ensure that carers are involved and supported in mental health care.
I hope those who attended will be able to go back to their organisations and localities re-inspired and re-invigorated to work to ensure carers are included and supported and ultimately I hope that this is another step towards a cultural shift in how carers of people with serious mental health problems are included and supported by mental health services.
Were you at our Triangle of Care event? Share your feedback in the comments below. If you weren’t there, you can catch up with highlights of the event from Twitter via our #Triangleofcare Storify.
In my head, CCG may well stand for Clinical Commissioning Group, but it increasingly also stands for ‘Commissioners Coming and Going’.
Local organisations have to work with a whole range of commissioners – local authority and NHS – to keep themselves viable. With all the changes and cuts in recent years, no sooner have local services made relationships, building up their local profile and making the case for carers, than that person is off and it all starts all over again.
So now, one month in to the new arrangements for NHS Commissioning, what does this mean on the ground? A new dawn of choice and options, or chaos and confusion, or just simply no change?
Below, the CEO of one of a large Carers Trust Network Partner says how it is for them…
Well, the morning came and the biggest change to NHS commissioning did at least make BBC headline news, after the biggest changes in welfare benefits story. April 2nd was the start of a new era of GP involvement and more locally relevant commissioning and also, hopefully, a big step towards the end of a lot of uncertainty during the 2 years since the announcement. Am I being too optimistic, I wondered?
Our area has a large Clinical Commissioning Group with many Local Commissioning Groups (LCGs) and we have had a top level transition/shadow team for 12 months. This has meant lots of new faces, structures, Terms of Reference and priorities emerging.
Everyone’s had bigger fish to fry though, starting with their own jobs; plus high level priorities and budgets. At least the decision that many services in the budget for 2012-13 carried over to this year’s budget (including ours), took some pressure away from trying to get valuable services recognised by a new audience, quickly.
That’s still a problem throughout our voluntary sector, from talking to colleagues — who in ‘Health’ they need to see and how to do that physically, when we have no central carers lead and carers services devolve to the LCGs.
Is this because carers weren’t in their mapping? Won’t this mean losing economies of scale and synergies and replicating bureaucracy? But the positives could be more innovative and decisive and integrated commissioning than traditionally seen in social care. Am I just trying to be optimistic?
The CCG has an action plan and the Voluntary Sector were late invitees to the Joined Up Service Transformation workshops and have made it into the top 11 priorities for the CCG. But we need to be innovative and offer more joined up and single point of access services ourselves, to succeed and be commissioned effectively. Are commissioners being too optimistic, I wonder? Will they go elsewhere?
Two events help shape my early thinking. Our LCG-led bid to extend an existing service to all parts of the CCG fails. The new criteria are very heavily weighted at evidenced cost savings (even more than previously), but we get the feedback that “the powerbases are moving” and there’s time for “corridor lobbying” before trying again. Who, what and when?
Optimism is receding… then I hear from a former GP who attended the first Public Meeting of the Governing Body of the CCG. She detected a huge cultural shift from her early experience of trying to engage GPs as part of the ‘system’ in the early 90s and also in the PCT with the professional executive committee of GPs in the early noughties. “These GPs seem prepared to engage with the concept of being responsible for the population, not just their individual practices.”
Pragmatism must be the answer. We all want the same outcomes, so must keep working – people to meet, places to go!
CEOs of Carers Trust Network Partners will be blogging for us throughout the year telling us what the changes mean on the ground. Much more to come!
I’m a person who has hobby horses. No, I don’t mean the toys, but issues that I keep coming back to because, in my mind, they are just so obviously important. And at the moment, one of my hobby horses is carers assessments.
Carers assessments in some places have a bit of a bad rep. Many carers say they don’t know if they’ve had one, or if they have, they feel nothing really came of it.
There are lots of issues here. The term “assessment” is problematic. Some carers worry about this and think they’re being tested and might be told they’re not good enough. Others feel it’s just a tick box process and their needs are not being taken seriously.
However, what I feel passionately about, is that if a carers assessment is done well it has the potential to be a really positive experience. For some carers it may result in the provision of a service or a personal budget, but for others it might not. It should nevertheless result in the identification of what support and resources could help, and the chance to talk through what is working and what is not. Sometimes this might be the only time a carer might feel anyone is listening to them and their needs, so it’s important this is done properly.
The draft Care and Support Bill opens up the way for more carers in England to have access to a carers assessment, and so it’s an opportune time to be thinking about how we can ensure theyare done well.
Carers Trust has been working with Skills for Care to find out more about what carers think on this matter. We carried out three focus groups, and the keys things carers said were needed were:
- An assessment where there is a clear outcome. Carers welcomed receiving a note of the discussion and a clear menu of support options, whether these are general or universal sources of advice and support, and/or more in-depth support. A creative outcomes-focused approach, exploring a broad range of ways in which needs are met, is valued. This feedback should be received quickly after the assessment.
- A positive, courageous and exploratory approach. Carers value an approach which looks beyond the day to day coping mechanisms to tease out problems, whilst recognising the skills and expertise of the carer. Most carers said they had no trouble taking about what they can do but have difficulty expressing where they are struggling or need help. Sensitivity and courage is needed on the part of professions to talk through issues such as whether the person is willing or able to continue caring and putting together emergency plans.
- Clear communication. Clear communication is needed before, during and after the assessment so that carers feel they are clear about the purpose of the assessment, the choices available to them and the whole process. They also need to feel like they are treated as experts who bring a great deal of skill and knowledge to the caring role, and are able to make their own decisions.
You can see our report here. Perhaps none of this is a surprise, but it is a concern that carers often felt these things weren’t happening.
An assessment is the gateway to wider support, and can be the foundation of an ongoing dialogue so that carers know that they are valued as an individual, not just as a provider of care, and there is support there if they need it.
How do we make sure this happens? Well that’s the next project. We’ll keep you posted.
Guest post: Maia Lask from the Save Legal Aid Campaign tells us how changes to the legal aid system could affect carers’ benefits—and the importance of seeking help before the new tax year on 1st April.
On April Fools’ Day – April 1st – this year, there will be huge changes to the way the legal aid system operates. As of April 1st, legal aid will no longer be available for several areas of law, meaning that in these areas you will no longer be entitled to free legal advice. This means that if you cannot afford to pay for legal advice, and you have a legal problem, March is the time to seek help!
For carers and their families, one area that is particularly concerning is the removal of legal aid for benefits appeals. This means that from April, if you want to challenge a decision on benefit entitlement, you will no longer be able to get legal aid to do so. The government’s own Equality Impact Assessment into the impact of the legal aid cuts found that 58% of people seeking legal aid for benefits advice are disabled, meaning that disabled people and their families will be the group most disproportionately affected by these changes.
What this means for carers’ benefits appeals
This will have a real impact on problems faced by disabled people and carers. For example, there was a case in the Court of Appeal last year about an individual who required a full time care worker, meaning that he needed to live in a two-bed flat to accommodate them. Because he was living in privately rented accommodation, the Housing Benefit rules assessed him, as a single man, as being only entitled to the Housing Benefit entitlement for a one-bedroom flat, leaving him with a huge shortfall in rent.
In the same appeal was the case of a family with three daughters, two of whom were disabled, and therefore unable to share a room. The family therefore needed a four-bed house. As the girls were both young children and expected to share a room, however, the Housing Benefit entitlement for the family was only for a three-bed house, leaving this family with a similar shortfall in rent.
Using legal aid, the decisions on Housing Benefit entitlement in both of these cases were appealed to the Tribunal, and eventually all the way up to the Court of Appeal, which decided that the way that the rules worked was unjustifiably discriminatory to disabled people. It is the ability to appeal precisely this sort of unfair decision using legal aid which will be lost on April 1st.
If you need legal advice—act now
So if you have any concerns about your benefits which may require legal assistance, remember to do it before the 1st April, whilst free advice is still available. Spread the word to your friends, family, colleagues, and anyone else you know who may be in need of legal advice. So act now, seek legal help with your problems before April 1st, and don’t be an April fool.
For more information on the impact of the cuts, and the other areas of law which are being removed from scope, go to the Save Ledal Aid website.
To find your nearest legal aid lawyer visit the Government’s legal adviser finder page.
After 6 months of working behind the scenes putting together the evidence, the Children and Families Bill finally hit the House of Commons recently, in the form of the second reading debate.
Emma, our Senior Policy and Parliamentary Officer, has been working her socks off getting briefings written and circulated to MPs to let them know what they need to do to make a significant change for young carers.
The odd thing is that usually when you write a briefing, you’re writing about what’s in a Bill—not what’s absent. And that’s the thing: the Bill is absolutely silent on young carers. Unless some amendments are added in, we’re going to end up in a situation where adult carers’ rights are improved (a good thing, of course) but young carers’ rights are left behind. This is untenable.
Work of National Young Carers Coalition pays off
We have spent months meeting with officials and the Minister, and with our partners in the National Young Carers Coalition (which includes Barnardos, Family Action, Action for Children, and The Children’s Society), and I like to think we are becoming a force to be reckoned with.
We’ve had positive words of support. The Scrutiny Committee of the Care and Support Bill, in a recent session, made it very clear that they think we’ve got a very good point.
Still, it wasn’t guaranteed we’d get a good hearing. There were lots of important issues debated today – adoption and fostering, special educational needs, family justice – all things that need their air time. But it was fantastic to listen to the debate and hear the support for young carers.
Encouraging words of support from MPs
Barbara Keeley MP, a real champion for carers, managed to make a point during the Minister Ed Timpson’s speech, which resulted in him acknowledging the importance of the issue and saying that he would “continue to listen” to us.
This may not sound like much, but in parliamentary language it means there’s at least a chance we might get somewhere with this. And responding to the Minister’s speech, Stephen Twigg MP laid out that we can’t have a position where young carers have lesser rights than their adult counterparts.
Many other MPs spoke. Some had more time to spend on this issue than others, but we’re grateful to all who showed their support. The next step is Committee stage where we’ll need to push the amendments we need – and we will need strong parliamentary pressure, so if you care about this, write to your MP.
There’s a long way to go yet and today was only the beginning. But it was definitely a good start.
One of the things we know about carers is that many often don’t recognise themselves as being one — in other words, they don’t realise that they are a carer. They don’t know about available help until quite late on, often after their own health and wellbeing has become badly affected.
Especially for adult carers, we know that the one service they are almost bound to come into contact with is GPs, if not for their own health then for the health of the people they are caring for. So it makes sense that GPS should identify carers and refer them to their local carers organisation for support.
That’s all they really have to do. It’s as straightforward as saying: “Well Mrs McGonigle, you’re doing a brilliant job of looking after your husband but I’m wondering whether there are things we could do to help you too. Did you know there’s a Carers’ Centre that can give you some help? Here’s the number. Why don’t you call them? And I can add you to my list so we can make sure we support you as a carer.” Sounds simple, huh?
Simple as it is, it often just doesn’t happen. GP surgeries get a payment for having a carers’ register. 10% of the population are carers — however, even when GPs are being proactive, it’s rare for a practice to have more than 3% of their list registered as carers.
Signs of progress
Across the country, Carers’ Centres and Crossroads schemes work with GPs surgeries to provide them with what they need to support carers better, and real progress has been made. The Government put some cash into this, and Carers Trust has been working with The Royal College of GPs and Carers UK to build better awareness.
For those of you who work for a Carers Trust network partner liaising with GPs surgeries, you can join our Facebook group where staff in similar roles share good ideas and support each other.
But things are changing. The indicator which means GPs get rewarded financially for having a carers register (QOF Management Standard 9 I believe) is being removed. Something similar will stay for carers of people with dementia, and it is suggested that they will also get a health check.
Getting GP practices engaged with carers
This is great, but what about everyone else? There are plans to put the requirement to identify carers in the outcomes indicators for Clinical Commissioning Groups but it’s not clear to me what teeth this will have, or whether practices will just be able to ignore it with impunity.
The current system isn’t great. It’s not well used, and it means GPs can identify a few carers, put them on a list and then do nothing to support them. But at least they do have to come up with some evidence at some point that they have met the outcome and they do it because there’s money attached.
It gives local carers’ organisations the hook they need to get GP practices talking to them. If the CCG outcome indicators have no teeth, that will be a step backwards. We need to know more.
As you’ll have seen if you read regularly, we are pleased that the Care and Support Bill recognises the importance of carers and getting them assessed, and ensuring they receive support. All of this is very welcome. The law as it stands is all over the place and confusing so the proposed consolidation will really help.
However there are a couple of areas which we’re not so happy about. In law, children’s issues and adults’ issues are usually dealt with in different pieces of legislation.
This means that although the Care and Support Bill will improve things for the majority of carers in England, it leaves carers who are under 18 or who are parent carers in the same situation as they are now, except it will be even more confusing.
We can’t have a situation where some carers have greater rights than others – it’s unfair and it just makes no sense . It particularly makes no sense if one of those groups with lesser rights is children.
We’ve been working hard on this and it does feel like we’re making some progress. I gave evidence to the Scrutiny Committee of the draft Care and Support Bill last week – you can read the uncorrected transcript here . The Committee was keen to hear what impact the proposals would have on all carers, and were concerned that young carers have been left out in the cold.
I explained that we need two pieces of legislation which talk to each other thereby making a joined up system. The Bill for adults should ensure that someone who is a parent has any needs for their parenting role as well as their independence and wellbeing met. But children’s legislation also needs to identify, if services are working with a child, where there is a parent who is not receiving support that is needed, so that adult services can ensure that support is provided – otherwise there will continue to be care needs which the child has to meet.
The risk, if we don’t take a strongly preventative and joined up approach, is that we just accept young people’s caring roles rather than asking the question of why they are in that role, whether they should be, and whether this is having a negative impact on them. They are children, first and foremost, and our responsibility is to ensure they have the same chance to learn, develop and thrive as any other child.
It seems like the Government is listening. Officials at the Department of Health and the Department of Education are now talking to each other to try to sort this out, and yesterday, with colleagues from Barnardo’s and The Children’s Society (we are all part of the National Young Carers Coalition) we had a positive meeting with Edward Timpson MP, one of the children’s ministers. He took on board what we were saying and has requested we continue to put together the evidence for change so that we can try to find the best way forward. This is sounding positive, although we’re a way off the solution yet.
In my job, it’s sometimes hard to see progress – often it takes years of pushing at an issue before any change. And for young carers it has taken years, but finally the moment for action has presented itself. We hope the Government will grasp this opportunity.