Although the carers grant has remained the same for the last three years, it is not ring-fenced. This has led to disparity between councils in the level and quality of services they provide to carers.
In the comprehensive spending review this year, the government announced that the carers grant would remain as a distinct, but not ring-fenced, funding source at £185m per year – the level it has been at for three years. This means that, since 1999, the carers grant has given councils over £1bn to help them support carers.
The grant is allocated according to a formula: 20% of it is intended for young carers under 18 and the parents of disabled children, 24% is intended for working age adults, and the rest is for older carers.
Most people will associate the carers grant with the provision of breaks for carers, and local authorities usually set aside a pot of money for this purpose. But the guidance to the grant states that it should be used for a range of purposes, including building “innovative and high quality carers’ services in response to local needs”, developing “pragmatic, outcome-focused approaches to the carer’s assessment” and funding activities relating to “local carers strategies and consultation with carers”.
The guidance is broad in recognition of the fact that there is no point providing breaks for carers if there is not a range of services in place to find, assess and support carers from all communities. It lists non-traditional solutions to providing carers with activities or choices beyond caring such as driving lessons and confidence-building activities that might lead to “new learning and/or work or volunteering opportunities”.
The carers grant has been the mainstay of funding for specialist carers’ services in England, including the carers’ breaks and respite services provided by Crossroads Caring for Carers and others; and the one-stop advice, information and advocacy services provided by carers’ centres in The Princess Royal Trust for Carers’ network. Carers’ centres have used core funding from the grant as the springboard for a range of innovative approaches to supporting carers, including partnerships with primary care trusts to provide carers’ support within GPs’ surgeries; emergency planning and response schemes; and specialist carers’ support, provided by mental health or substance misuse carers support workers, who link with appropriate agencies to provide a more tailored service.
Where does the money really go?
With a specific funding stream for councils, and a wealth of positive policy coming from the Department of Health, you could be forgiven for thinking that carers have never had it so good. In some local authorities, this would indeed be the case. The carers beacon authorities of Hertfordshire, Sefton, Sunderland and Rochdale continue to drive forward good practice.
However, in its State of Social Care report, the Commission for Social Care Inspection indicated that grave concerns remain: “Only 20% of councils are taking a strategic approach to meeting the needs of carers and thus there is a significant disparity between councils in the type, level and quality of services …Nearly half of all councils cite financial constraints as a barrier to developing support to carers…There is no data on the numbers, but evidence indicates that carers are bearing the burden of ever-tightening eligibility criteria.”
A recent survey of our network of carers’ centres in England found that nearly all respondents felt that at least one of their services would be at risk in the next financial year. They uniformly expected getting funding for carers’ services to become harder, and thought the Department of Health was not doing enough to ensure that national aspirations were reflected in local commissioning. A fifth feared closing altogether.
Any attempt to establish to what extent money intended for carers is being spent on them is very challenging. There is inconsistency in the way councils report spending, with some double counting and a focus on meeting assessment targets regardless of outcomes. Most local authorities have delayed making any announcement on the future of their carers’ services after March, citing the timing of the announcement of the comprehensive spending review and uncertainty until that point over whether the carers grant would continue to be identified as a separate funding stream.
These are, of course, the same local authorities who have successfully lobbied for the freedom to spend their budgets as they wish, because they were better placed than the DH to decide on local priorities. The carers grant has not been ringfenced for some time, and the DH has been clear all along that the amount of money it represents would be given to local authorities next year, whether or not as a distinct grant. At the time of writing, one or two authorities are saying that they have decided to cut their carers’ services funding, ahead of receiving their carers grant allocation, which is likely to be similar to last year’s. No risk or impact assessment appears to have gone into these decisions and certainly no consultation with carers or service providers.
Areas which stop investing in their carers’ support provider base are heading for a fall. CSCI has consistently indicated that authorities will be inspected on support to carers and that no joint strategic needs assessment will be complete if it does not consider carers’ support. There is a carers indicator in the new national indicator set and all areas will be measured against it, whether or not authorities choose this indicator as an improvement target. The concept of a core offer or entitlement – what carers everywhere should be able to expect as a minimum – is emerging from the national strategy review. Rising numbers of cared for people and the decreasing size of the paid care workforce means that carers will be increasingly relied upon. The personalisation agenda is undeliverable without carers receiving the support they need to ensure that support packages are sustainable.
Addressing the gap
So what has gone so wrong in some areas? Limited resources might do as an answer if some areas weren’t performing so well. Carers support was not uniformly established as core work before the DH gave away its top-down role in steering councils. Levers do, of course, remain and while the government has communicated its aspirations, it has not given a clear enough account of the legal duties, the business case for supporting carers and the inspection consequences of not doing so. Health commissioning is even patchier than that of councils, with little NHS guidance and no clear legal duties. The new strategy will have to address this gap if it is to achieve anything.
It must also tackle poor commissioning practice, which does not always recognise that the project-funded work that carers’ services have developed to address carers’ health, education and employment needs will not survive with a core-funded organisation. Many young carers’ services would close without their hosting carers’ service. Some authorities are planning to stop investing in carers’ services with the ill-thought out intention of all carers’ support being purchased by carers using their individual budget allocations. Carers need specialist services to identify them before an individual budget can be offered, and they need agencies in place to provide those services.
It’s the best of times and worst of times for carers’ services. We understand that this year’s star ratings will give a picture of carers support in every local authority. This may be a wake up call for some to follow the lead of those who have embedded carers support as part of their core business. Let’s hope that the message gets through and the new National Carers Strategy is not launched by Gordon Brown just as some carers are seeing their support services vanish.
DH guidance on carers grant
Alex Fox is assistant director, policy and service development, at The Princess Royal Trust for Carers