After a damning report which revealed the increasing burden on friends and family members who support people with care needs, Amy Taylor, Mary Garboden and Simeon Brody look at the reasons behind the crisis and whether it is retrievableLast week’s state of social care report from the Commission for Social Care Inspection outlined a sector desperately in need of funding, with two-thirds of local authorities now restricting services to people with substantial or critical needs.(1)
As a result, more friends and family members are stepping into caring roles to fill the gap – but the council services to support these carers are still inadequate.
The Carers (Equal Opportunities) 2004 Act was intended to produce a cultural change in the way carers were treated so they were seen as people in their own right and not simply unpaid providers of care. But CSCI said this was yet to happen.
It found that about one-fifth of councils were taking a strategic approach to carers’ services, with most focusing on supporting them in their caring role.
A quarter of councils also said they had encountered challenges in developing and sustaining successful partnerships with agencies such as health, education and leisure in carers’ services.
Imelda Redmond, chief executive of Carers UK, says the findings reflect the charity’s experience. She had hoped the creation of the role of director of adult social services last year would change the situation but this has not happened. Guidance on the role, issued last March, called for directors to promote social inclusion and well-being alongside their social care responsibilities.
However, Redmond says: “[Social services] are thinking of themselves as social services departments, not of their relationship to the total community. They are not thinking ‘what are our housing policies or what is our access to free parking facilities?’ We know a lot of the solutions [for carers] lie outside social services.”
The knock-on effect of financial pressures in the NHS on social care is well-documented and a quarter of councils cited this as a barrier to delivering carers’ services, the report said.
Shan Nicholas, chief executive of the Princess Royal Trust for Carers, says research by the carers support charity last year found that three-quarters of carers had health needs, making collaboration between social care and the NHS particularly important. She accuses many councils of short-sightedness in their lack of support, pointing out that if the carer becomes sick the authority may have to care for two people rather than one.”
There’s an anxiety that if you look into this too closely you are opening up a pandora’s box in terms of what carers need,” she says.
The Carers and Disabled Children Act 2000 gave carers the right to an assessment of their needs independently of the assessment of the person they care for. But CSCI found that many carers were still not being told about this, even though the act placed a duty on councils to do so.
Nicholas sees a clear role for CSCI in tackling this issue: “There’s a need to tighten up on inspection because there’s still fundamentally a big mismatch between legislation and government policy and aspirations, and what happens on the ground.”
Training for carers was another area CSCI found to be lacking. Denise Platt, chair of CSCI, says training should cover the range of issues carers may face, such as the effect caring may have on their relationship with their partner or how to access education.
She says: “Children’s centres have lots of amazing classes helping ?parents to be parents. When I look at carers’ training it’s about half a day on how you lift and handle.”
Platt adds that in the US, where there is more high quality training, research has shown that the information stayed with carers for years.
Several councils told CSCI that they did not have the resources to provide services to carers. Platt admits more money is required but emphasises councils are not using existing money well enough.
The report found little evidence of councils involving carers in deciding what their priorities should be and one Beacon council told the CSCI that there was also a tendency for the simple and cheaper services that were often a carer’s top priority, such as help with housework, to be overlooked.
The plans for carers in last year’s health and social care white paper (see “A new deal“) do come with £32m of funding attached, but Redmond says the government has not ?confirmed how many years this will run for.
She says the charity is now looking to this summer’s comprehensive spending review for the white paper funding to be confirmed for a lengthy period and for the carers’ grant – councils’ main source of funding for the group – to be guaranteed beyond 2008, alongside new pots of cash.
Nicholas says many people are shocked when they find out they are not entitled to social care services and as a result their friends and family come to caring unprepared.”
There needs to be a debate on how we are going to care for our frail and disabled and how much dignity we attach to the carer as well as the person receiving the service. And that’s about what kind of society we want to live in.”
(1) The State of Social Care in England 2005-6
The right response
The CSCI report singled out Sunderland Council for its good practice on carers.
A spokesperson for the council says: “Our overall vision is to work with carers and those they care for to develop and plan services that support them both in their caring role and their personal lives.”
With the participation of The Princess Royal Trust Sunderland Carers Centre, which the council funds, the authority involves carers through training and briefings as well as providing respite and meeting transport costs for them.
The council says its main vehicles for carer involvement in social care and health services are its Modernisation and Reform Groups (MaRGs). The MaRG for patient, public and carer involvement, which is co-chaired by a carer, ensures that other MaRGs consider carers in their work.
A Voice for Carers, created by the council and facilitated by Sunderland Carers Centre, is an umbrella group consisting of carer support groups city-wide. It has a key role in ensuring that the voice of carers is heard at all levels of the authority.
Find out more
1995: Carers (Recognition and Services) Act. Gave carers the right to request an assessment of their needs on the condition that the person they are caring for has been assessed as well.
1999: Government’s first national strategy for carers, Caring about Carers. Created a grant for carers in England and focused on providing breaks for carers and services to support them.
2000: Carers and Disabled Children Act. Fixed the loophole in the Carers (Recognition and Services) Act 1995, entitling carers to an assessment in their own right upon request, regardless of whether the person they were caring for had been assessed.
2004: Carers (Equal Opportunities) Act. Obliged councils to inform carers of their rights to an assessment and extended assessments to cover carers’ opportunities for education, leisure, training, and employment.
A new deal (back)
The white paper sets out a “new deal for carers” including:
* A review of the national strategy for carers.
* The development of an expert carer programme.
* Improved emergency respite.
* A national helpline.
Specific proposals from the government on carers are due out shortly.
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Amy Taylor, Simeon Brody and Mary Garboden