AGENDA ITEM

REPORT TO HEALTH AND
WELLBEING COMMISSIONING GROUP

REPORT OF George Irving Service Manager

TITLE: Carer Support Update

SUMMARY

To update Commissioning Group on work undertaken since the last report of 19th April 2016and with regard to the: current standing of the Carers’Support Contract with Sanctuary Care; contract review; and,future commissioning models.

RECOMMENDATIONS

Commissioning Board is recommended to:

  1. Note and approve further work on the planned approach to the range of Carersactivityin Stockton on Tees to be coproduced with Carers.
  1. Approve the incorporation of Better Care Fund (BCF) Dementia Strandsupported Carers’ contracts within the scope of services for a future Stockton-on-Tees model of Carer support.
  1. Note and approve further work on the development of the Carers’ Hub as part of future commissioned service arrangements.
  1. Note a request for funding of the Carers’ Hub development and Commissioning Manager capacity to support coproduction and implementation of refreshed Carers’’ services from available ‘one-off’ budget.

DETAIL

1.Role of Carers

1.1Carers provide (or intend to provide) a substantial amount of care on a regular basis to people who require support to maximise and/or maintain their independence.
Recognising Carers and their contribution is important insupporting Carers to continue their caring role. Although services have developed over time, many Carers remain socially excluded, suffer from caring-related ill-health and, once they have ceased caring, find themselves in a difficult economic position, often with little or no pension provision. This can lead to the Carer needing to access health and social care services for themselves and may impair their ability to continue providing care.

TheCarers’ Strategy 2013/17 details the guiding principles behind support offered to Carers’ in Stockton –n Tees.

The important role of Carersis reinforced through the Care Act 2014 and the Childrens and Families Act 2014 which place a duty on councils to identify Carers with unmet needs, and offer Carersan assessment that considersCarers’ preferred outcomes, and activities beyond their caring responsibilities. The Acts reinforce the key outcomes identified in the Carers’ Strategy Second National Action Plan 2014-16 of:

  • Identification of Carers
  • Realising and releasing potential
  • A life alongside caring
  • Supporting Carers to stay healthy

The economic value of unpaid care is estimated to be £132 billion nationally (Carers UK & University of Leeds, 2015). For Stockton-On-Tees this is around £464 million.

1.3Strategy and Service Development

It is timely to consider a refresh of the Carers’ Support Strategy coproduced with Carers and support organisations in light of experience since 2014 and recent statutory changes.

Key Carer priorities will be set out within the new Adult Strategy and informed by the Sanctuary contract review and monitoring activity. Key market issues for Carerswill be developed against commissioning intentions within the Market Position Statement refresh.

Further work has taken place in considering the Carers’ offer within Stockton on Tees inclusive of the potential consolidation of several income strands into a singleCarers’’ framework to tender, inclusive of Carers’ grant, and existing Carers’projects funded through the BCF dementia strand (£464k).Finance colleagues confirm that ‘one-off ‘funding is available in the Carers’ budget. For 2016/17 an additional amount of £116,500 is included within the budget. Utilisation of this ‘one-off’ resource is considered within the commissioning options set out at paragraph 3 of this report.

1.4Demographic Profile

1.4.1The National Carers’ Strategy (DH, 2010) identifiesCarer needsin five main areas:

  • Carersare respected as expert care partners and have access to integrated and personalised services to support their caring role.
  • Carersare able to have a life of their own alongside their caring role.
  • Carersare supported so that they are not forced into financial hardship.
  • Carersare supported to stay mentally and physically well and treated with dignity.
  • Children and young people are protected from inappropriate caring and have the support they need to learn, develop and thrive and to enjoy positive childhoods.

1.4.2All Carers are at risk of poor health and well-being due to their caring role.Carers of different client groups face different challenges but these challenges can put them all at risk of poor health and well-being. However, some have an increased risk of poor physical and mental health.

1.4.3The 2001 Census shows the peak age for caring is 50 to 59. More than one-in-five people aged 50-59 (1.5 million across the UK) provide some unpaid care (Carers UK, 2012).

1.4.4Young Carers:

The 2011 Census identifies over 166,000 Young Carers aged 5-17 in England, an increase of over 26,000 since 2001. There are 344 Young Carers, age 15 or younger, in Stockton on Tees who provide unpaid care. Of these 269 provide 1-19 hours, 45 provide 20-49 and 30 provide 50 or more hours care and support.Some Carers can be as young as 5 years old. Younger Carers encounter specific problems with 68% reporting they are bullied at school.The 2011 Census showed growing evidence that Young Carers are at risk of not only poor health and well-being, but their caring role can also impact on their emotional and social development and education.

1.4.5 Working Age Carers:

There is little information about Working Age Carers althoughmost Carers fall into this age group.The 2011 Census showed the majority ofCarers are of working age and the peak age for caring is 50-64 with over 2 million people in this age bracket, One in five people aged 50-64 are Carer’ .Nationally, just less than one in eight (13%) adults aged 16 to 64 in full-time employment care for a sick, disabled or older person. However, the prevalence of caring is highest among the economically inactive, just over one in five (21 per cent) of whom spend time caring for someone. About 50% of Carers spending the most time (between 20 and 49 hours) caring per week were in employment in 2001. The challenges of combining paid work and informal care particularly affects those undertaking substantial hours of caring per week (DWP, 2009).

1.4.6 Older Carers:

This group is at higher risk of poor health as they have additional problems associated with ageing.A survey of experiences of Older Carers showed that 65% had long-term conditions or disabilities themselves, and 69% said their caring role had an adverse effect on their mental health (Princess Trust for Carers’, 2011). There are 1.2 million people in England aged 65 and over who are providing unpaid care to a disabled, seriously ill or older relative or friend. The number of Carers aged 85 and over grew by 128% in just ten years (Carers UK & Age UK (2015) Caring into Later Life).

1.4.7 Gender:

More women than men have a caring role with 58% of Carersbeing women and 42% men (Carers UK, 2012). Significantly, more women than men in the age group 50-64 were providing care. However, there has been a shift in the age group of 65 and above – more men were providing care than women in 2011. Nearly 3 in 5 (59%) Carers aged 85 are male (Carers’ UK & Age UK (2015) Caring into Later Life). Female Carers more likely to provide round the clock care with 60% of those caring for over 50 hours.

1.4.8Socio-economic status:

Over one in five (21%) economically inactive people are Carers, a rate that is more than 50% higher than for people in full-time employment (Department of Work and Pensions, 2009).

For Carers who give up work there will be an impact on pension contributions and an increased risk of poverty in later life. Amongst Carers:

  • 45% are depressed about their financial position,
  • 62% have no savings,
  • 15% have turned to drink or drugs to cope with their financial situation (Princess Royal Trust for Carers’, 2010).

The skills of Carers are lost to the workforce and economy.

1.4.9 Ethnicity:

Carers in the BME community can be reluctant to seek help, are often unaware of the support available and can become isolated in their role. Bangledeshi and Pakistani men and women are three times more likely to provide care compared with their white British counterparts (Carers UK, 2012).

1.5 Projected Demand for Carer Support Services
There is a projected increase of 28% in the older population (65 and over) during the next ten years. In particular it is expected that the number of people aged over 90 will increase by over 80% by 2020. This will impact on the need for support as the number of Carers increases.

Older Persons

Projected increase in population aged 65 and over, Stockton-on-Tees, 2010 to 2020
Age / 2010 / 2015 / % change 2010 to 2015 / 2020 / % change 2010 to 2020
65 - 69 / 8,500 / 10,800 / 31% / 10,500 / 24%
70 - 74 / 7,400 / 7,800 / 5% / 10,000 / 38%
75 - 79 / 6,100 / 6,500 / 5% / 6,800 / 11%
80 - 84 / 4,200 / 4,800 / 12% / 5,300 / 24%
85 - 89 / 2,500 / 2,600 / 12% / 3,300 / 32%
Over 90 / 1,100 / 1,400 / 45% / 1,900 / 72%
Total / 29,800 / 33,900 / 15% / 37,800 / 27%
(source: POPPI –

Working Age Adults

Predicted figures for Stockton in 2015
2011 / 2015 / Change
Total population / 192,800 / 195,700 / +4,100
People aged 18 & over with moderate to severe learning disability / 741 / 756 / +15
People aged 18 - 64 with mental health problems / 20,859 / 20,830 / -29
People aged 18 – 64 with moderate to severe physical disabilities / 12,355 / 12,335 / -20
(Source: PANSI –

2.Current Carer Support Provisions

2.1Stockton Carer Centre

2.1.1Sanctuary Supported Living was commissioned to deliver adult Carer support on behalf of the Council from April 2014. The contract is jointly commissioned with the Clinical Commissioning Group to deliver support services to unpaid adult Carers, caring for other adults, within the Borough. The service is currently located in Stockton Business Centre in Brunswick Street. A report presented to ACMT in April 2016 highlighted the provider was failing to deliver the full range and quality of services set out in the contract specification and identified a need for a review of Carers’ services.

The contract commenced from the 1st April 2014 and expires the 31st March 2017 with the option of extending for one year. The cost of the contract is £348,732 per annum, including £50K p.a for Carer breaks (a total value for 3yrs+1 optional year is £1,394,928). A budget breakdown for the service is embedded at Appendix 4.

Carers are invited to register for the service there but there is no requirement to register to access support. There are 666 Carers registered with the service as of June 2016.

Carerssupported through the service include both those known to Adult Services and others who are not.

A review of the service against the service specification was carried out in September 2016 (appendix I)and showed that although there had been improvement in the provision there were still significant areas that were not delivering on the contract.

Specifically there were relatively low number of Carers accessing the service in comparison to the number of Carers’ “on the books” of the previous Carers’ support service and known to the Council.

2.1.2Services provided by or accessed through the existing Carers’ Centre arrangement include:

  • Advice and Information Programme

A programme of information sessions held in the Carers’ Centre covering a wide variety of topics which help Carers in their caring role. Each session is delivered by a guest speaker with specialist knowledge on the subject. The topics for sessions are decided by consultation with Carers.

  • Support for Carers’ of people affected by dementia

Dementia Support Workers provide advice, information and emotional support for Carers’ of people affected by dementia. The service helps Carers understand dementia, how to deliver more effective care and how to develop coping strategies to reduce stress. It also provides information about entitlements and other additional services that may be beneficial in supporting the Carer or the cared for person.
A Support Worker is working with Carers of people affected by dementia from the BME community and “hard to reach” groups to help and support them to overcome barriers to accessing advice, information and support.

  • Support for Carers’ from the BME community and “hard to reach” groups

A Support Worker helping Carers from the BME community and “hard to reach” groups is based in the Carers’ Centre to help and support overcome any barriers to accessing advice, information and support.

  • Breaks for Carers

Carers’ grants up to £250 single payments available

  • ‘Sitting’ Service

Enables Carers to take a break from home, provides short-term up to 8 hours per month, social support and basic personal care, rather than longer breaks.

  • Other Services / Support groups
  • Health Checks for Carers
  • Sitting Service
  • Access for Well Being Grant after an assessment has been completed
  • Support Group mainly for older people caring for a loved one with dementia, this group is now working in partnership with the BCF funded Dementia project.
  • Luncheon Club
  • Focus Groups Learning disability Groups
  • Volunteering service offering befrienders
  • Attending appointments

2.1.3. The Commissioning Group at its meeting of 19th April 2016 considered the performance of the Carers’ Contract provided by Sanctuary Care. Adult Strategy Team (AST) continues to work with Sanctuary to review the existing arrangement in year 3 with a view to both improving performance and identify lessons learned for a revised tender in 2017 should a decision be taken not to further extend the current contract.

2.2Better Care Fund Carers’ Support

2.2.1A number of programmes of support for Carers are currently supported through the BCFDementia Strand:

2.2.1.1Support forCarers of people with a dementia

The BCFDementia Strand commissioned AgeUK Teesside to deliver a maintenance cognitive stimulation therapy (MCST) programme to enableCarersto access regular short breaks. The contract started on 1st January 2016 for 12 months ending on 31st December 2016 at a cost of £57,600 with the potential to extend to a further 12 months subject to funding approval. During the contract period, AgeUK will deliver 2 group programmes in 3 localities and deliver one-to-one MCST programme in client’s home for 50 people with a dementia.

To May 2015, there are a total of 1882 people on the Stockton-On-Tees GP dementia registers with an 82% diagnosis rate. However, it is not clear how many Carersthere are as the registers do not record whether the person with dementia has a Carer or not and the GPs’ Carer registers do not record the circumstances of the person they are caring for.

BCF has also commissioned a specific review on Carers’ engagement, delivered in June 2016, and which makes clear recommendations regarding the delivery of accessible information and support for Carers. A copy of the report is embedded at Appendix 2 and is linked to the development of a Carers’ Hub

The effective use of technology is increasing and the Commissioning Group is aware of the development of the Stockton Information Directory (SID) and its’ growing usage as a means of signposting and supporting access to universal services. Adult Strategy Team manages the directory and is exploring the links which could be made specifically for Carers to a web-based ‘Carers’ Hub’ which would provide a one-stop resource hub linked to SID forCarers to self-serve as well as a Carers’ workflow system to manage activity, including Carer self-assessment, and signposting to universal services.

A description of the Carers’ Hub is embedded at Appendix 3. The first year project costs for the Hub are £25,000.00 plus an annual licence fee of £15,000.00.

For the avoidance of doubt BCF Carer engagement and developments relate solely to the Carers of people with a dementia.

2.3Young Carers’ Support

The impacts of caring on Young Carersare considerable and the support needs of Young Carersvary greatly throughout different periods and events within their life.Young people are not always seen as Carers’ and in need of support and their identified needs may fall below existing service thresholds.

Access to support for Young Carers differs between family structures where there are other family members present who are able to enlist external support, and those where the Young Carer is the only available support which can severely impede their normal opportunities for social, psychological and emotional development.

In 2015 a national program of support and development relating to Young Carers’ was launched in which Stockton took part. The programme, Making A Step Change: Putting it into Practice, delivered by the Carers’ Trust and The Children’s Society, was a one year Department for Education funded project to support the effective implementation of the duties required under the Care Act 2014 and the Childrenand Families Act 2014 with regard to Young Carersand their families.The new statutory responsibilities require that Young Carers should be identified, assessed and their families supported.

As part of the programme, Children’s and Adult Social Services were asked to implement processes to deliver against these new responsibilities and also signify their commitment to do so by signing up to the revised Memorandum of Understanding which commits to adults and children’s services working together adopting a whole system, whole council, whole family approach to providing support for Young Carers and their families.

Current Contract and Service Delivery

The current contracted service is provided by Eastern Ravens Trust and works with all Carers aged 5 to 18 years of age and supports146 Young Carers’ at June 2016.

The contract commenced 1Oct 2014 and will expire 30 Sept 2017with one option to extend by 12 months. The value per year is as follows: year 1 - £102,989; year 2 - £102,259; and year 3 - £102,009.

Total value of contract (including all optional extensions): £409,266.00

2.5.Public HealthSupport Services for Families and Carers Affected by Drug & Alcohol Misuse (ADFAM) – Family and Carer Support Service

Stigma is often an issue raised by ADFAMCarers’ about other services eg pharmacies; hospital staff; universal services staff regarding the perception of bad parenting by them as a cause of the substance misuse by their loved one.

ADFAM has consulted specifically on a need for a specialist Carers’ support service with a strong response that Carers of people with other needs do not understand, stigmatise and discriminate against Carers’ of drug and alcohol users therefore they would be reluctant to engage with a universal Carer service. They also believed that expertise in the issues that drug and alcohol problems bring to a family is very important in order to provide the best support to the Carers and other family members.