Give me a break

Everybody needs a break. Unfortunately, for the estimated six
million carers in the UK, enjoying just a few hours away from the
person they care for can be complicated, and covering longer
absences can become mission impossible. Yet these people save the
country about £57bn a year and deserve breaks that are
frequent and easy rather than irregular and a hassle.

The carers grant was intended to make it easier for carers to take
breaks. It was introduced in 1999 initially on a three-year basis
and was broken into funding segments:£20m for the first year,
£50m in 2000-1 and £70m in 2001-2. Two years ago, the
government extended the grant for a further two years and increased
the fund to £85m in 2002-3 and £100m in 2003-4.

The grant’s long-term future was secured last month when health
secretary Alan Milburn announced that not only would it be extended
to 2006 but by then would more than double to
£185m.¹ Without the millions of carers, the
services provided by the NHS and local councils could not do their
job, he said, adding that “carers put so much into the community it
is right they should get something back”.

The finer details of how the additional funding will be spent will
not be known until the autumn, but Milburn indicated that respite
care would be more widely used so that more carers could take short
breaks. Carers would also receive the services they themselves
needed in order to continue caring.

Leading carers’ organisation Carers UK has welcomed the additional
resources, which are ring-fenced, and the confirmation that the
grant is to continue for two more years.

Chief executive Diana Whitworth says it is important to look at
examples of good practice in order to decide how best to spend the
money. And, although more local authority staff may need to be
employed to carry out carers’ assessments, she does not want the
grant to be spent on this. “It is important that it is spent on
direct services to carers and not on big infrastructures,” she
says.

Whitworth believes the grant has had a positive effect. “There are
pockets where there are problems and things haven’t gone well but
my impression is that it has resulted in innovation and, for some
carers, has been a complete godsend.” She thinks the grant has made
such a difference because it is ring-fenced, preventing it being
used to underpin existing services or plug the social services
deficit.

However, she says that the reasons for the less successful areas
vary. The one-size-fits-all idea is inappropriate, she says,
particularly regarding black and ethnic minority carers who have
different cultural and language needs. Also little thought has been
given to the services required for people with mental health
problems. She also feels more attention needs to be devoted to
people in rural areas. “People are isolated and remote, getting
home help or domiciliary care is extremely difficult, and getting
breaks is even more difficult,” she says.

An analysis of the second year of the grant (2000-1) by the King’s
Fund concluded that the money was “going some considerable way” to
promoting and realising flexible breaks for carers, but that local
implementation varied. It found that relatively few carers had
benefited compared with the probable unmet need.

But it also revealed a broader range of services for carers in
different situations and a shift away from traditional residential
provision. There were “encouraging examples” of services tailored
to the needs of service users and promising signs that carers’
issues were being incorporated into mainstream
planning.²

In his announcement Milburn suggested that an extra 130,000 carers
would be helped with the new money. This all sounded very promising
but, according to the calculations of Alison Thompson, chief
executive of Crossroads – Caring for Carers, this works out at a
mere £142 per carer per year. “At the cost of our services
that would buy about one hour per month,” she says. “His targets
are on the high side but breaks are important so we are pleased
that it is being continued.”

Thompson also wants the money to be used specifically for carers.
“We don’t want this grant to be diluted. It must be for break
services as some carers are not getting the breaks they
need.”

By contrast, others want to see more flexibility permitted in the
grant. Government guidance on the grant for 2002-3³
includes a number of seemingly prescriptive “target spends” that
councils are expected to follow. For example, 95 per cent of the
grant should be spent on services that provide carers with a break
from caring, while 20 per cent of that should be spent providing
breaks for families with children.

“We’ve been seeking more flexibility in the use of the grant,” says
Andrew Cozens, spokesperson on carers’ issues for the Association
of Directors of Social Services and Leicester Council’s health and
social care director. “We want more flexibility within the
framework of being monitored so that we can respond to local
problems.”

He is arguing for a loosening of the grant’s conditions to enable
local authorities to carry out more assessments. But he believes
that the infrastructures are generally already in place in councils
and that the extra money will allow them to buy more services.
Since the Carers Act 1995 many authorities have “raised their game”
towards carers, he says, with specialist development officers
appointed and a detailed carers’ strategy drawn up.

Other observers argue that the grant needs to be more widely
publicised. Peter Tihanyi, head of policy at the Princess Royal
Trust for Carers, feels that a campaign through the media, schools
and libraries is needed. “An awful lot of carers don’t know it
exists in their areas and haven’t accessed it,” he says, adding
that when they do discover it most find it invaluable. He also
argues that the grant’s criteria should be widened from its
principal focus on breaks to include other support services such as
training, practical help and information.

The carers’ sector is relieved that the grant has been extended for
a further two years, and delighted that it has been increased.
According to Milburn, carers are owed “an enormous debt of
gratitude” – and giving them some time off is one way to repay the
debt. But while 129,000 carers benefited from breaks during
2000-2001 – and Milburn expects this figure to rise by a further
130,000 over the next few years – this is still a drop in the vast
ocean of six million carers.

¹ Alan Milburn, Expanded Services and
Increased Choice for Older people, Department of Health.July
2002,

³ Department of Health, Guidance on Carers Grant
2002/2003, DoH, 2002

Carers grant break services

• Somerset: flexible day care provided in the evening and over
  the weekend in day centres. One family accessed a day centre’s
  evening services twice a week for a disabled mother, allowing the
  father time to focus on the children.
• Kensington and Chelsea: focused on identifying and serving
  families from ethnic minorities. A local organisation provides
  home-based care, including night-sitting services.
• Gloucestershire: a residential weekend study support break
  helped young carers to prepare for their GCSE and A level exams.
  Seven young carers, average age 14, received training on study
  techniques, time management and how to approach social services and
  other resources for information, help and support.
• Lincolnshire: a hospice at home project provides support to
  carers of individuals who are terminally ill. A local organisation
  provides day care and occasional overnight care to people who are
  long-term sick and terminally ill using care workers supervised by
  nurses who are trained in palliative care.