Integration of services – but what about people?

Note: The following blogpost is from Lynn Williams, Policy officer in Scotland at The Princess Royal Trust for Carers.

Lynn Williams at work

As policy officer for The Princess Royal Trust for Carers in Scotland and an unpaid carer, I have a dual interest in policies which affect unpaid carers and their families.  Having gone through social care services recently with my husband I find myself very interested in the Scottish Government’s recent announcement of plans to integrate health and social care for adults in Scotland. The initial focus will be on older people.

At the heart of this announcement is the recognition that the current set up through Community Health/Care Partnerships has not worked as well as it could have. There is also a recognition that for many families, it is easy to get lost between services e.g. during discharge from hospital – and that sometimes it’s easier for families to give up when they cannot make sense of what is out there. 

As the Scottish population gets older, social care and health services must work together more effectively. Is this announcement about saving money?  Partly, but the Deputy First Minister, Nicola Sturgeon, has made it clear that she wants integration of health and social care to be about better services for older people and those who care for them.  See here for the official record of a recent debate on these issues

Planned legislation will create new health and social care partnerships under one accountable officer. Legislation will also create mechanisms for health and social care to integrate their budgets.  There will be a strong focus on clinicians and professionals as experts in the new set up – very important but what about unpaid carers and the expertise they have?  Already, the focus seems to be on structures, on finance, on staff roles and  it will take a lot to make integration happen.

I represented The Trust and gave evidence to the Health and Sport Committee at the Scottish Parliament this week. The Committee is undertaking a brief enquiry into integration prior to the Government publishing its plan.  

In amongst the nerves I felt in giving evidence, I hoped to make clear that whatever the plans look like, we cannot lose sight of what matters the most – the families and unpaid carers who rely on services provided by health and social care. I also emphasised the fact that integrated services will not work without taking account of the needs of Scotland’s 650,000 unpaid carers and the £10.3 billion contribution they make each year.  Unpaid carers and supporting them in their role must underpin the Government’s plans.

Preventing Crisis for Scotland’s Carers – So where do we go next?

Note: This is the final of the three-part blog post by Lynn Williams, the Policy Officer for Scotland at The Princess Royal Trust for Carers.

Well, for an initial investment of just £1 million, this project directly supported over 3,000 unpaid carers – it would cost at least £30 million to replace the care they provide if they remained unsupported in their caring role.  That’s a pretty significant return on the initial investment. To top that, the support workers trained and worked directly with some 4,000 health and social care professionals.  Bear in mind that the budget for NHS Education Scotland sits at just under £400 million alone.

The project recommendations highlight the need for more effective working between health and social care and unpaid carers are the lynchpin of the overall support and service delivery infrastructure.  We have been fighting for political parties to recognise and deliver clear policy commitments which ensure unpaid carers are recognised and better supported and there is no doubt that the Moffat work will help us demonstrate the value of doing this.

The £70 million Change Fund outlined in the draft budget could be used to drive real change in discharge planning and in improving how professionals and services are planned and delivered.  It will be focussed on helping health and social care services work together to maximise people’s independence and wellbeing.  Those involved in planning how this Fund will be spent – in a year – could begin by looking at the outcomes of the Moffat project and the impact that dedicated carer support workers had at local level.

And yet, recent press coverage in the Herald suggests that things will go backwards rather than forwards. Local authority plans may well decimate social care and carer support services in Scotland. How shortsighted – and in the long run, this will be far more costly for statutory services. Any permanent benefit and changes in working practices which Moffat achieved may well be undone.

Unpaid carers have been there when paid care workers couldn’t get to their clients; they continue to provide care no matter what the weather. Small investments such as the £1 million invested in the infrastructure by the Moffat Charitable Trust can make a huge difference and save money in these tough times.  That’s a message we will ask all politicians to take on board in the coming months.

To all carers and families out there, seasons greetings and all the very best for 2011.

Lynn

Preventing Crisis for Scotland’s Carers – The Answer in the Moffat Report

Note: This is the second of a three-part blog post by Lynn Williams, the Policy Officer in the Glasgow office at The Princess Royal Trust for Carers. The first part of the blog post talked about the changing weather and the problems for Scotland carers.

And this is where the lessons from the Moffat project come in.  Funded through a gift from the Moffat Charitable Trust, the project involved The Princess Royal Trust for Carers and Carers’ Centres in Lothians and the Borders, Glasgow, and East Ayrshire working in partnership to improve the situation described above.  With hugely ambitious aims, Support Workers who were part of Carers’ Centre teams, set out to identify carers as early as possible in their caring journey; to help them connect to key services and to get support which maintained their own health and wellbeing. They also worked to ensure that carers were involved in discharge planning.

An independent evaluation of this work by Glasgow Caledonian University highlights the benefits of early identification and specific support provided to unpaid carers. The work carried out helped to vastly increase professionals’ awareness of unpaid carers and their need to involve carers in discharge planning and processes.

Over 3,000 new carers were identified – including an 85 year old man who provides care for his 100 year old sister.   This substantial figure also included a 49 year old woman who was left to run the family business after her husband had a stroke.  As a result of the direct involvement and input of carer support workers, carers reported that agencies worked better together; carers were assessed in their own right; they were also helped to access benefits and grants to minimise the financial impact of caring. Carers reported that health professionals increasingly recognised their contribution and expertise and increasingly understood that carers themselves need support in their own right.

Over 4000 health and social carer professionals received training and worked with carer support staff to improve support mechanisms for unpaid carers.

The impact of having dedicated carer support workers based in hospitals working with health care professionals and unpaid carers in health settings has been recognised in some of the project areas;  continuation funding in the Borders, Lothians and Ayrshire mean that the partnerships, referral pathways and improved joint working will not be lost. As we look ahead to next year’s Draft Scottish budget, a further £5 million has been allocated to support Carer Information Strategy activity – we would strongly argue that it should be allocated for the type of work which the Moffat workers delivered.

Carers Centres involved in the project have seen the benefits and challenges of improved local partnerships.  The challenges include massively increased demand for support with standstill budgets and increasing costs.

Preventing Crisis for Scotland’s Carers

Note: This is the first of a three-part blog post from Lynn Williams the Policy Officer at The Princess Royal Trust for Carers. The blog post talks about a recently published Moffat Report, its need and its findings.

So the awful cold weather continues, and the country prepares for the next onslaught of snow and arctic weather.

Yet in homes across the country, unpaid carers continue to provide support to family members despite the cold weather – they battle ice and frost to get out to buy food and to get their loved ones to hospital and doctor’s appointments; they keep the heating on because the person they look after needs to keep warm; they do what they can to ensure the person they support has the best quality of life possible even when mother nature works against them!!

Throughout the political ‘fallout’ over the Government’s response to last week’s chaos, there was very little recognition or acknowledgement of the wider impact of this awful weather on families and unpaid carers.

What it means is that many of the people who could not live without unpaid care are more likely to go into hospital.  Carers may be thrust into an intensive caring role for the first time as family members are hospitalised. Cold weather brings more falls, breaks, ill health; it can exacerbate long term conditions. That creates new carers and puts increased pressure on existing unpaid carers and young carers.

Despite government commitments, policies and strategies, the support that unpaid carers themselves receive in these situations remains a real postcode lottery. Disconnections between hospital and community care still exist; planning for discharge once a loved one gets better is pretty much hit and miss and the chances of the main carer being involved in that process are non existent in some areas. The current and impending cuts in social care services will only make this situation worse.

…Keep a look out for Part II of this blog post “The answer in the Moffat report”…

Will the Law Commission’s new proposals change the lives of carers?

It’s probably not wise to announce this in public, but I’m probably going to break the law this weekend. I’m sure that at one point, I will jump into my girlfriend’s Ford Ka and end up doing 33 or 34 MPH when the legal speed limit is 30. But hey, everybody knows that whilst 30MPH is the law, you’re allowed to go 10% or so over the legal limit.

The Law Commission’s proposals will not change the lives of carers wholesale, but they will raise the bar of what local authorities must do.

The practice differs from the law and sometimes you cannot change behaviour by simply changing the law, but it is to the law that we often turn to first.

The Law Commission are proposing to merge various community care laws enacted since 1948 into one legal statute. But more than just amalgamating existing laws, they are also suggesting new ones.

Some of these could significantly impact upon carers such as withdrawing the need for carers to be providing substantial and regular care to trigger the local authority’s duty to assess if requested.

The Law Commission also propose a national eligibility framework for carers (although not services users). There are other important questions such as whether young carers should have the same rights as adult carers or whether the carer’s assessment should be merged with the community care assessment. And even the most fundamental question is up for grabs – should this new statute apply to England and Wales or just England?

The big question for carers is not any of the above though. It must be whether these legal changes will improve the practice of social services to make sure that carers are identified and assessed. But even if identification and assessment rates increase, there is no guarantee of increased support.

However, let’s go back to my speeding. Why is it that I do 33 and not 36? It’s because the legal limit is 30MPH and the leeway I give myself is based on that. If the limit was 35MPH, I would probably do 38MPH. The law does matter and it does influence behaviour even if we don’t always follow the letter of the law. The Law Commission’s proposals will not change the lives of carers wholesale, but they will raise the bar of what local authorities must do. That has to be a good thing.

Leave a comment here on my blog and I will send you a summary of the proposals – and it would be great to hear what people think. You can also take part in a short survey that will inform our response to the Law Commission: www.surveymonkey.com/s/lawcommission

The consultation closes 1st July: www.lawcom.gov.uk/adult_social_care.htm

Take care
Gordon