Social work practice with carers “lacks clarity and consistency”, resulting in carers’ needs not being assessed or informing service users’ support plans, research has found.
Though carers were involved in all stages of the personal budgets process for service users, separate assessments of their needs were uncommon and seldom conducted before service user support was planned, found the York University study on carers and personalisation. Researchers based their findings on a survey of 16 councils, in-depth research in three of these and interviews with carers and service users.
Carers’ role valued but assessed narrowly
Carers were commonly involved in supporting service users who had cognitive or communication impairments during assessment and this role was valued by service users and practitioners alike.
Managers and practitioners said carers were routinely asked about their willingness to continue providing support at this stage, aided by prompts on service users’ assessments forms, and some practitioners used these to ask carers about their own support needs.
However, service user assessment forms had limited space to record carers’ needs while some practitioners saw these “mini” carer assessments as too narrow and overlooking the emotional aspects of care. Most carers interviewed could not remember being asked in detail about their own needs during user assessments.
Lack of carer’s assessments
While carers providing or intending to provide a “substantial amount of care on a regular basis” have a right to a full carer’s assessment, these were uncommon and sometimes conducted some time after the service user assessment so they could not inform support plans.
Such assessments should go beyond the consideration of the carers’ willingness and ability to continue to provide care to cover their needs for support to access work or leisure activities.
Councils should reduce the level of a personal budget to take into account the input of carers, but only after a carer’s assessment has taken place, states the Department of Health’s Carers and personalisation: improving outcomes guidance from 2010.
Discretion used in recording carers’ input
But the research found “little consistency and transparency” in how this was done. Practitioners sometimes used discretion in reporting carers’ input so as not to reduce the level of the personal budget, while even where separate carer assessments were conducted, these were rarely linked to users’ own assessments to inform the personal budget level.
Though carers were heavily involved in support planning for service users, there was no evidence of carers having their own support plans that addressed work or leisure activities. Few had separate reviews of their own needs and even where carers’ needs were reviewed, it was unclear how the information from this informed service users’ support plans or personal budgets.
The research said there was a need for greater clarity on how practitioners should:-
- Identify and respond to carers’ own needs and aspirations, including for work and leisure, going beyond considering their willingness to continue caring;
- Create closer links between carer assessments and reviews and those for service users, reflecting information from the former in the latter;
- Conduct separate, regular reviews of carers’ own support needs as these may change independently of the service users’ needs;
- Consider how any support specifically for carers should be delivered, whether as part of a service user’s personal budget or through a separate carer personal budget.
How the Care Bill will reshape practice
From April 2015, councils will have a duty to assess the needs of carers if it appears they have needs for support, and then provide support if they meet a defined eligibility threshold, under the Care Bill currently going through Parliament. This lowers the threshold for a carer’s assessment and, for the first time, provides a right to support for those who meet eligibility thresholds.
The bill also places a duty on councils to involve carers in assessments of older and disabled people, and a power for councils to provide carers and service users with a joint assessment if they agree to this.
“The research demonstrates the challenges that lie ahead to ensure that practice consistently reflects the intentions of existing and new legislation to support and empower carers,” said Helena Herklots, chief executive of Carers UK.
About the research
The study, Carers and personalisation: What roles do carers play in personalised adults social care? What roles do carers and service users want carers to play?, was conducted by Dr Wendy Mitchell, Dr Jenni Brooks and Professor Caroline Glendinning at York University’s social policy research unit. It was commissioned by the National Institute for Health Research School for Social Care Research, which is itself funded by the Department of Health.
It ran from January 2011-December 2012 and involved an email survey of 16 local authorities in two regions, in-depth investigation of practice in three of the councils through interviews with senior managers and carer leads and focus groups with practitioners, and separate interviews with carers and older disabled people.
For further information contact Wendy Mitchell at firstname.lastname@example.org or on 01904 321 971.