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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 children.

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 services.

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 rising.³

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 placements.

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 fee.

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 2003.

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).

References

¹ Department of Health, Disabled Children: Directions for their Future, DoH 1998

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 Services, The Policy Press, 1998