Two years ago, a government-backed national campaign to recruit
7,000 foster carers highlighted a crisis in foster carer
recruitment. But what is less well known is that there is a similar
crisis in the recruitment of short-break carers for disabled

Short-break services for families (also known as shared care or
family-link services), help disabled children develop new
friendships and broaden their horizons while providing a regular
break for their primary carers. The care usually takes place in the
short-break carer’s own home, although there is increasing
diversification, with some schemes offering sitting and befriending

The Department of Health estimates that there are currently around
10,000 users of family-based short-break services.1
However, a survey carried out by the Shared Care Network in 1999
showed that a further 5,000 children are on waiting lists for
services.2 Some of the reasons given for this shortfall
included a lack of carers and the increasing support needs of the
children. The number of children with complex health care needs has
risen considerably during the past few years. In part this is
because of advances in medical care as more children are surviving
premature birth and neonatal complications, and because the life
expectancy of children with degenerative conditions is

Traditionally, short-break carers have provided care on a voluntary
and expenses-only basis. More recently, however, some schemes have
attempted to address recruitment problems by introducing payments
for short-break carers. Enhanced payments such as fees and salaries
have been introduced to attract carers with the skills required to
take on children for whom it is more difficult to find

The extent to which enhanced payment arrangements may improve
services for children and their families is the subject of the
Better Rewards project. As part of the project, researchers
undertook in-depth interviews with co-ordinators from 10
short-break schemes that used enhanced payment systems for some, if
not all, of their carers. The interviews explored types of
payments, number of children linked to carers, care agreements,
training, and the benefits and challenges associated with paying
short-break carers.

The payment mechanisms used varied considerably across schemes, and
were made up of combinations including salaries, fees, expenses,
allowances and enhancements. Each of these components had a
different impact on carers’ pay and conditions with, for example,
salaried carers receiving a more comprehensive package than
fee-paid carers.

Consequently, it was thought that each type of payment might
influence carer recruitment and retention. So the researchers asked
scheme co-ordinators their views on the impact of enhanced payments
on users, carers and schemes to assess the relative benefits and
costs of different payment mechanisms.

All the interviewees were enthusiastic about the benefits of
providing an enhanced carer service. The predominant theme was an
improvement in stability of placements for children.

Scheme co-ordinators suggested that the increased status and
responsibility of the enhanced carer increased carers’ self-esteem,
confidence and job satisfaction. For some carers, the chance to
work in a home-based environment was beneficial in itself.
Additionally, because some short-break carers could now receive a
working wage, they could, if they wished, give up other jobs and so
devote more time and energy to the care of the children.

Co-ordinators believed that parents’ confidence in using the system
improved, and that more trust in short-break carers was engendered.
In addition, co-ordinators said that parents felt more able to ask
for short breaks.

These arrangements also led a number of co-ordinators to say that
they felt that the more “professional” status of enhanced carers
attracted individuals with greater caring experience and skill.
This included people with nursing or similar qualifications. As one
commented: “We are tapping a different pool. Other professionals
comment on the calibre of our carers – they are impressed with
their professionalism”.

Another benefit was a greater level of commitment to the scheme
from these carers, who were now in a position to rely on a more
secure income and could therefore provide a more stable service.
Co-ordinators said that they now had a degree of expertise and
experience, which has been built up over time and that “the
reliability factor is higher”.

Also, co-ordinators said that the enhanced model of care had a
positive effect on waiting lists, for some children with more
complex needs could now be placed. Short-break carers receiving
payments were typically linked to more children than “standard”
carers and were more likely to be linked with children with more
complex needs.

Of course, providing enhanced carers’ schemes inevitably involves a
number of set up costs as well as the costs of expanding their
remit to children with more complex disabilities. The largest
expense was for adaptations to homes. Other smaller, but still
sizeable costs, included extra heating costs and the provision of
aids for child care, such as hoists and bedding.

In general, co-ordinators believed that the short-term costs of
enhanced carers were slightly higher than those of standard carers,
for example, higher recruitment costs. However, they argued that
over the long-term, costs would be recouped as a result of reduced
turnover of carers. For example, the longer they retained carers,
the lower the year-on-year costs of adaptations to homes. In
addition, increased time spent with each child tended to result in
improved carer competence and easier management of the scheme,
which also had the effect of reducing costs per head.

One element that is very important in assessing the real economic
cost of enhanced carer short-break schemes is the cost of providing
alternative services, had the model of care not been available. In
particular, where enhanced carers enable schemes to care for
children with complex health care needs, these young people may
require less community, residential and hospital care. Spending on
enhanced short breaks therefore may be offset by savings in other
social services, health or voluntary sector budgets.

Short-break scheme co-ordinators in this study believe that better
rewards for carers carry many advantages and since the research
began in 1999 there has since been a marked increase in the number
of schemes exploring salaried carers or carers who are paid a

As schemes struggle to recruit carers to meet the needs of children
for whom it is harder to find placements, payments for skills may
offer a way forward. The continuing research, which is funded by
the NHS executive, includes a systematic evaluation of the full
costs and effects of enhanced payment mechanisms, and an assessment
of user and carer satisfaction. The results will be available in

Helen Weatherly is a research fellow at the centre for health
economics, University of York: Sarah Byford is a senior lecturer at
the centre for the economics of mental health in the Institute of
Psychiatry: Pauline Heslop is research fellow at the Norah Fry
Research Centre at the University of Bristol: Vicky Jones is
co-director of the Shared Care Network (the umbrella organisation
for family-based short break services in England, Wales and
Northern Ireland. She was the winner of the 1999 Community Care
Readers Award).


1 Department of Health,
Disabled Children: Directions for their Future, DoH

2 B Prewett, Short -Term
Break, Long-Term Benefit. Family-Based Short-Term care for Disabled
Children and Adults
, Joint Unit for Social Services Research,
University of Sheffield, 1999

3 R Servian, V Jones, C
Lenehan, and S Spires, for the Shared Care Network, Towards a
Healthy Future. Multi-agency Working in the Management of Invasive
and Life-saving Procedures for Children in Family-Based
, The Policy Press, 1998

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