Carers play a central role in many healthcare users’ lives. Although services are recognising that they must be valued and supported, there is much more to be done to ensure this unpaid workforce’s wellbeing
Patients are already more involved in planning their own care. But the next stage is to involve their carers.
Primary care, acute and mental health trusts have different legal responsibilities when it comes to supporting carers - people who look after a family member or friend unpaid. Mental health trusts, for example, have a responsibility to make sure they are assessed and have their needs taken into account.
Assessment of carers looks at how much care they provide, what they find difficult, their health, and their aspirations for work, learning and time off.
Carers UK policy director Emily Holzhausen says: “PCTs should be doing health checks for carers because we know from research that 95 per cent of those providing substantial care cover up health problems in order to manage.”
Carers who are at risk can then be targeted for health promotion. Trusts also need to ensure there is support available so carers can attend health promotion clinics or screening.
Strategically, it is important for trusts to think about the impact on carers when they commission services. If patients will need to travel to a service, for example, hospital transport systems should be arranged.
Humber Mental Health Teaching trust chair Jane Fenwick signed up to be a carers’ champion because she feels passionate about the need to involve carers and decided the way to drive it was for the chair of the board to lead the work.
Ms Fenwick meets with carers and families and listens to what they say about the trust’s services. In addition to her regular visits, carers have open access to her through email and telephone.
“Slowly, by having this very open dialogue we are able to improve services and change the way that our staff work,” says Ms Fenwick.
Open the doors
The key is having that channel of communication. The trust now has a carers’ champion on every inpatient unit and in nearly all community mental health teams. The champions attend regular meetings to pool information and look for trends.
Ms Fenwick explains: “It might be a particular member of staff that really needs some retraining, or needs to be disciplined.”
Humber offers all its carers an assessment and provides counselling support for them, some of whom are buckling under the strain - for example, pensioners who are caring for children with a severe mental health problem.
Ms Fenwick’s biggest piece of advice for trusts who want to help carers is to open the doors and let them talk.
“You might get a deluge of complaints and that’s fine, just deal with them, listen to them and cope with it,” she says. “But I think, slowly, by listening, opening the doors and communicating with them, you do build up a working trust and that helps.”
The Princess Royal Trust for Carers has a website aimed at helping professionals to support carers. The website is a one stop shop of specialist information, including legislation, news, toolkits and good practice examples on identifying and supporting carers. Carers’ leads can sign up to receive policy briefings.
Michele Lambert, the charity’s web manager, says the aim is to raise professionals’ awareness of carers’ needs, point them to good practice and provide tools to put that good practice into action.
Devon GP project
Using a £200,000 grant from the government’s Partnerships for Older People programme, five GP practices in Devon piloted a project to offer support to carers, including health checks and a dedicated counselling service.
Carers in Devon had said they wanted GP practices to be more proactive in identifying carers and offering them support.
An external evaluation, available at www.devon.gov.uk, shows an improvement in carers’ self-reported health and wellbeing. Having carers’ support within their GP practice also helped in situations such as a downturn in the health of the person they were caring for.
Halfway through the research evaluation, four out of five practices said they didn’t think the service was sustainable, but by the end of the pilot all practices wanted to see it as part of their core business.
“For me that’s a really significant turnaround and it says something in terms of change management,” says Clare Cotter, joint planning and strategic commissioning manager for carers at Devon PCT and Devon County Council.
She hopes to pump prime changes in more GP practices and has bid for £800,000 from the Department of Health to become a demonstrator site providing health and wellbeing checks for carers.
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