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Fact sheet

A checklist for the Government

  1. Will you strengthen the system for performance managing and rating PCTs to give clearer recognition to the importance of providing support for carers and introduce a statutory duty on PCTs to promote the health of carers?
  2. Will you ensure that Non-Executives appointed to the PCTs include people who can demonstrate an understanding of carers’ issues?
  3. Will you strengthen and widen the requirement to identify carers and set a new date by which GPs, members of Primary Care Teams and Social Services staff are asked to identify carers in line with the national priorities guidance issued in September 1998?
  4. Will you ensure that all relevant National Service Frameworks include a standard relating to the recognition and support of carers?
  5. Will you consult widely and ensure flexibility in the implementation of the Expert Carers’ Programme heralded in the White Paper?
  6. Will you set targets for the establishment of carers’ health checks in primary care?
  7. Will you ensure that PCTs and Local Authorities are funded to improve and extend support and services for carers in primary care?
  8. Will you ensure that there is funding to introduce pilot programmes to identify the most effective ways of improving carers’ health, and to encourage the development of carer-friendly services in primary care?
  9. Will you run a national publicity and awareness raising campaign to encourage carers to identify themselves as such to their GPs?
  10. Will you introduce into legislation the proposals contained in Barbara Keeley’s Bill to require GP practices to take the needs of carers into account in the provision of their services?

1. Will you strengthen the system for performance managing and rating PCTs to give clearer recognition to the importance of providing support for carers and introduce a statutory duty on PCTs to promote the health of carers?

Although carers are mentioned in a number of the quality assurance standards for PCTs used by the Healthcare Commission, none of them is exclusively related to services and support for carers. This does not help to promote the message of the National Strategy for Carers or the philosophy of the recent White Paper. PCTs need incentives and encouragement to give greater priority to this work. It is recommended that the quality assurance framework be reviewed in this light.

The provisions of the Bill introduced into Parliament by Barbara Keeley M.P would impose a statutory duty on PCTs to promote and safeguard the health and welfare of carers, and we believe that this proposal, if implemented, would be a huge step forward for carers.

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2. Will you ensure that Non-Executives appointed to the PCTs include people who can demonstrate an understanding of carers issues?

It is important that those ultimately responsible for the work and performance of PCTs include people who have an understanding of carers issues. The NHS in Wales recognised this by having a carers representative on each Health Board. It is hoped that those appointed to the new PCTs will include a significant proportion of people who have this knowledge and experience. If this proves not to be the case, it is recommended that the person specification for future appointments be amended accordingly.

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3. Will you strengthen and widen the requirement to identify carers and set a new date by which GPs, members of Primary Care Teams and Social Services staff are asked to identify carers in line with the national priorities guidance issued in September 1998?

The Government originally set a target date of April 2000 for the identification of carers. This was subsequently deferred, but no new date has been set. As well as sending out a negative message about the importance of this work, this deferral caused great uncertainty about the work that was started. It is important to set a new date as soon as possible.

This should be considered in conjunction with the new GP contract which was introduced in 2005. This gave an optional three points (out of 1050) for GPs who established systems for identifying carers and referring them to the Local Authority for an assessment.

Even though the large majority of GPs have opted to establish such a system and are being paid for so doing, we do not believe that this is adequate and should be modified in three ways :

  1. The number of points should be increased, or;
  2. It should include referral to other relevant agencies as well as for Local Authority Assessments;
  3. It should be widened to relate to the services provided by the GPs themselves.

In this context, we support the provisions of Barbara Keeley’s Bill to require PCTs to ‘ensure that effective procedures exist to identify patients who are carers’.

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4. Will you ensure that all relevant National Service Frameworks include a standard relating to the recognition and support of carers?

Standard six of the National Service Framework for Mental Health relates specifically to carers. Other relevant NSFs, such as that for Older People, mention carers but do not include a specific standard relating to them. It is important that the role of carers is specifically recognised in NSF standards and is not just referred to in less specific terms.

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5. Will you consult widely and ensure flexibility in the implementation of the Expert Carers’ Programme heralded in the White Paper?

In the checklist (in Primary Carers) we called for a national Expert Carers Programme. Those directly involved with carers issues will be delighted that the Government has agreed to do this. It is important to recognise and support the role of carers, given the extent to which the NHS and other statutory services actually rely on the knowledge and experience of carers in the management of many chronic conditions. Part of that support involves training. But it is important to have flexibility in the implementation of this programme.

In the Good Practice section of this report we have identified a range of issues which need to be considered when the Expert Carers Programme is formulated and we recommend that these are fully taken into account.

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6. Will you set targets for the establishment of carers’ health checks in primary care?

As outlined in the White Paper ‘spearhead PCTs’ will pilot NHS ‘Life Checks’. It is now firmly established that the health of carers, particularly those with a heavy caring commitment, is likely to suffer as a result of their caring role. The effects can cover a diverse range of conditions, some of which were identified by the carers in our latest study and are listed in Section 4: The Demonstration Projects. Maintaining and improving carers’ health is correct in principle. It is also a cost-effective way of maintaining the essential support for the cared for person. It can reduce hospital admissions or other forms of alternative care. Therefore it makes sense for the NHS to prioritise this area.

The National Strategy for Carers identified the importance of establishing regular health checks for carers. This is taking place in some practices but there are insufficient incentives for it to be very widely implemented. If primary care is to give appropriate priority to the monitoring and improvement of carers’ health, there needs to be a framework of financial rewards payments and targets, analogous to those given for other target groups of patients, such as those suffering from diabetes or heart disease. The GP contract should be amended to provide such incentives. It will be necessary to set targets for the introduction of a structured programme of health checks offered to carers, and guidance on how this can be done.

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7. Will you ensure that PCTs and Local Authorities are funded to improve and extend support and services for carers in primary care?

Initiatives to support carers need to be properly funded if they are to be effective. It is appropriate that this work should be developed as a partnership between the NHS and Local Authorities, because it impacts on both the demand for services and the statutory role of both.

Pooling of budgets under new partnership arrangements should assist this. An effective strategy for carers cannot be developed by either the NHS or the Local Authority in isolation from the other. It is important that the resources devoted to supporting carers do not suffer as a result of the Carers Grant no longer being ring-fenced.

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8. Will you ensure that there is funding to introduce pilot programmes to identify the most effective ways of improving carers’ health, and to encourage the development of carer-friendly services in primary care?

This is an area in which innovative schemes should be encouraged and the learning disseminated. Many of the programmes and projects run by The Princess Royal Trust Carers' Centres have insecure and short-term funding. At times of financial pressure, they often do not receive the priority they merit, often resulting in high staff turnover. There is an argument for a national programme of such schemes, perhaps as part of the NHS Research programme.

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9. Will you run a national publicity and awareness raising campaign to encourage carers to identify themselves as such to their GPs?

The Government undertakes a lot of national campaigns to promote its priorities, including many in the area of health promotion. A national campaign is a cost-effective way of getting the message across, both because it avoids the inefficiency of replicating campaign planning and design work across the country, and it gives a clear message of the importance attached to the area by the Government. We believe that a national awareness campaign targeted at carers would be a powerful tool in taking this agenda forward. However, it must, of course, be done in conjunction with the other recommendations in this report to avoid raising expectations from carers that cannot be met.

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10. Will you introduce into legislation the proposals contained in Barbara Keeley’s Bill to require GP practices to take the needs of carers into account in the provision of their services?

Further impetus is needed to achieve real change in the way these services are delivered. Although we have identified examples of good practice, these are far from universal. There is a need to require PCTs to ensure that the needs of carers are taken into account in the operation of appointments systems, prescription procedures and waiting room arrangements. Legislation would be an effective way of ensuring this, but if this is not possible, then the performance management framework should be used robustly for this purpose.