Information

Carers Legislation - Analysis of Consultation Responses

Report of the independent analysis of the responses to the Carers Legislation public consultation


3 The Carer's Assessment: Carer's Support Plan

In summary,

The Carer's Assessment: Carer's Support Plan

  • There was majority support for all proposals in this section of the consultation.
  • A large majority supported a name change from Carer's Assessment to Carer's Support Plan. The main reasons for this were that the current name acts as a barrier to take-up as it has negative connotations and can discourage carers, as it can appear judgemental.
  • Most respondents agreed with the removal of the substantial and regular test and welcomed the fact that this would allow everyone access to an assessment.
  • Most respondents agreed with the removal of the part of the existing carer assessment process whereby the cared-for person is a person for whom the local authority must or may provide community care services/ children's services. Reasons given included that the current requirements can act as a barrier to accessing support and the need for a Carer's Support Plan for every carer.
  • Almost all respondents who replied supported the introduction of two routes through to the Carer's Support Plan. Once again, a main theme to emerge was that this proposal will enable all carers to access support.
  • Most respondents agreed with the removal from statute of the wording about the carer's ability to provide care. Many said this has negative connotations and acts as another barrier to carers accessing support. There was also widespread support for a move to an outcomes-based approach.
  • Most respondents agreed with a duty for local authorities to inform the carer of the length of time it is likely to take to receive the Carer's Support Plan and if it exceeds this time, to be advised of the reasons. Some respondents, however, commented on the need to set a timescale or a maximum waiting time.
  • Some respondents commented on informing the carer of the length of time being an administrative and bureaucratic process.
  • Many respondents felt that portability of assessment is a significant issue for service users and carers. Reasons included that carers should not have to go through a reassessment, issues with differences across local authority areas and the need for consistency and standardisation.
  • Almost all of those who replied agreed that the Scottish Government and COSLA with relevant interests work together to take forward improvements to the portability of assessment, some for the reasons given in the paragraph above.

3.1 Under the existing law, carers who provide a substantial amount of care on a regular basis are entitled to a carer's assessment to look at their support needs. Over the years, different local authorities have adopted different approaches to this assessment. In addition, there are other assessments also being used to assess the support needs of carers and young carers.

CARER'S ASSESSMENT

3.2 The Scottish Government has proposed that the name 'carer's assessment' is changed to Carer's Support Plan.

Question 1: Should we change the name of the carer's assessment to the Carer's Support Plan?

Table 3.1: Question 1

Respondent group Yes No Other Nil response
Individuals (32) 23 3 1 5
Carer/ User support (81) 72 - 3 6
Local authority (24) 15 6 3 -
Health (13) 9 - 1 3
CHCP (6) 2 2 2 -
Public body (3) 2 - - 1
Professional body (3) 1 - - 2
Representative body (3) 1 1 1 -
TOTAL (165) 125 12 11 17

3.3 As can be seen in the table above, almost all of those who replied said yes (125), twelve, half of which were from the local authority group, said no and eleven gave other answers. One hundred and twenty-five respondents commented further on this question and the main themes to emerge from these responses are outlined below.

Supportive of changing the name

3.4 Most of the 125 respondents who said 'yes' provided further comment on the effect of terminology. In practice the term 'carer's assessment' can be interpreted by the carer as a judgement on their ability to care and is believed to play a part in poor take up. The phrase 'carer's support plan' was thought to indicate that the purpose is to support the carer in their role. The Carer's Support Plan is already used in some areas. The need for a clear explanation of the purpose of the assessment and plan was also highlighted as important.

3.5 Several respondents commented that the name is less important than action and budgets to address support needs for carers. It was pointed out that support plan may lead to a presumption of support following the assessment that may not always be the case.

3.6 A small number commented on support for young carers. This included the importance of a plan for young carers. There were differences on what may be the most appropriate system: a young carers representative organisation stated that a Carer's Support Plan (CSP) and/ or Child's Plan should be offered; whilst a local authority voiced concern over introduction of another mechanism for planning for young carers.

3.7 There was also a comment on the need to ensure the assessment process is fit for purpose in relation to minority ethnic communities.

Against changing the name to Carer's Support Plan

3.8 All 12 respondents who said 'no' also commented, with most saying that the name Carer's Assessment is sometimes perceived in a negative way but giving various reason for not supporting a change of name at all, or a change to Carer's Support Plan specifically.

3.9 One CHCP respondent felt the name Carer's Support Plan could lead to confusion between the initial assessment stage and any subsequent support plan and several other respondents echoed this view. There were also concerns, especially from some local authority respondents, that the name Carer's Support Plan predetermines the outcome when, in fact, some assessments may not lead to a support plan.

3.10 Other views included the need for outcome-focused engagement with carers rather than a name change.

SUBSTANTIAL AND REGULAR TEST

3.11 At present, some local authorities undertake an assessment to decide if carers care on a regular and substantial basis, and some local authorities do not. In addition to changing the name, it is also proposed that all carers will be eligible for the Carer's Support Plan.

Question 2: Should we remove the substantial and regular test so that all carers will be eligible for the Carer's Support Plan?

Table 3.2: Question 2

Respondent group Yes No Other Nil response
Individuals (32) 24 3 1 4
Carer/ User support (81) 73 - 1 7
Local authority (24) 13 6 5 -
Health (13) 9 - 1 3
CHCP (6) 4 1 1 -
Public body (3) 2 - 1
Professional body (3) 1 - 2
Representative body (3) 1 2 - -
TOTAL (165) 127 12 9 17

3.12 The table above shows that 127 said yes. Twelve said no; half of these respondents came from the local authority group. Nine respondents did not specify and instead made other comments. There were further comments from 121 respondents. The main themes to emerge from these respondents are outlined below.

Agreement with the removal of the substantial and regular test

3.13 One hundred and one respondents who agreed with the removal of the substantial and regular test so that all carers will be eligible for the Carer's Support Plan commented further.

3.14 Some examples of typical responses from the carer/user group include:

  • "All carers should have access to receiving a support plan, regardless of the hours they do."
  • "Removing the substantial and regular test would better account for the impact that illness and disability can have on people's lives, and enable more people who would benefit from carers support to access it."
  • "The inconsistency of what each local authority deems 'regular' and 'substantial' care has led to a 'postcode lottery' of support to carers with some not receiving any support as a result."
  • "It would help ensure the needs of carers who would not have met this test are supported."

3.15 Many respondents, across groups, who agreed with the removal of the test welcomed the fact that this would allow assessments for everyone, including those who need only low level or intermittent support.

3.16 Many respondents from the carer/ user group who welcomed the change said this would ensure assessments are carried out at an early point rather than when a crisis has been reached. Several other respondents from various groups were keen to see preventative rather than responsive support.

3.17 The substantial and regular test was described by many respondents as an artificial barrier which has for many years prevented some carers from accessing services. Carer/ user organisations in particular commented that under the current test, many carers are "invisible" with some struggling to cope with changing demands due to the condition of the cared-for person, or are juggling work and care with no support.

3.18 There were also comments that there is no standard definition for 'substantial and regular' and it is therefore confusing for carers and for staff.

3.19 There were calls, from carer/ user respondents, for eligibility for a Carer's Support Plan to be clear and standardised across all areas, including standard response times. A small number mentioned that, at present, it appears that some local authorities are unsure which carers should be assessed.

3.20 Several commented on inconsistencies across local authority areas. A local authority commented: "As there is no clear definition of what constitutes substantial and regular it currently leads to significant interpretation and varying levels of application across Scotland". Some of these respondents felt that removing the test could help address this but only if accompanied by national guidance: "We are aware of the inconsistency of support across local authority areas at present and there is a risk that removal of the substantial and regular test could further exacerbate this problem without national guidance on an alternative" (public body).

3.21 A carer/ user respondent expressed concern that the change may leave the system open to abuse and said, for this reason, it is important that there is a clear and consistent definition of carer.

3.22 There were, however, concerns across respondent groups over the cost and resource issues that would result from making all carers eligible for the Carer's Support Plan for both local authorities and third sector organisations. A public body said: "removal of the test may present a significant challenge for authorities in delivering higher volumes of support to greater numbers of carers at a time of financial constraint." Implications for the workforce were also of concern, with one local authority respondent commenting: "We believe, however, this will result in an increased uptake of carers' assessments and in service demands that flow from these. It is essential that additional funding and a range of resources are in place to address this". There were comments on the need to work closely and effectively with the third sector and the role voluntary organisations can play in assisting with support planning.

3.23 There was also concern from some in the carer/ user group that, while there is a right to an assessment, there is no corresponding right to support and the resources needed to provide this support.

3.24 A small number of carer/ user respondents said that support can only be provided if the cared-for person accepts it; this can mean some carers who need support are not receiving it. These respondents wanted to see the rights of carers taken into account in these situations and mediation used to support these rights.

3.25 Some respondents reported that the test is already taken into account in their area and gave details of the processes that are followed.

3.26 There were many comments on the need to take particular account of the specific needs of a variety of different groups including: young carers, those affected by poverty, carers of those with fluctuating conditions, mental health carers and carers within equality groups.

3.27 While some respondents said that young carers should be included, there was some concern that a Child's Plan "may not be sufficiently focused and specialised with regards to the needs of young carers". Some respondents representing young people reported that their own consultations had found that most young people "would prefer to have a Carer's Support Plan, or a Young Carer's Support Plan, in place of the current proposals". There was also a concern, from other respondents in this group, that assessments for young carers are conducted by the voluntary sector. This was seen by one carer/ user organisation as "a missed opportunity to ensure that young carers have their caring needs assessed and are able to have the support they need to allow them to be children and young people first".

Disagreement with the removal of the substantial and regular test

3.28 Eleven of the respondents who disagreed with the removal of the substantial and regular test commented further.

3.29 A small number of local authorities, individuals and representative bodies voiced concern about the impact the removal of the test would have on limited resources. There was a comment on the need to make clear that the proposal to offer assessment to all should not be seen as a general entitlement to support. These respondents were concerned that this step could lead to those in most need of support not receiving it, or not receiving it quickly enough, as resources are targeted at a much larger group of carers.

3.30 Some were also concerned about a lack of clarity over some proposals, a lack of definitions and guidance and what were seen as contradictory proposals. For example: "There is a further query that this approach would be in contradiction of national eligibility criteria for service users and legislation for other groups who are in need".

3.31 The need for a set definition of carer was again raised and a local authority said that "emphasis has to remain on the needs of the cared-for person and the impact of caring for that particular person not just the personal situation of someone who regards themselves as a carer".

COMMUNITY CARE/ CHILDREN'S SERVICES

3.32 The existing carer assessment is only available if the cared-for person is a person for whom the local authority must or may provide community care services/ children's services. The Scottish Government proposes to remove this requirement as not all cared-for people need or receive such services, some may refuse them and some may have medical needs only.

Question 3: Should we remove that part of the existing carer assessment process whereby the cared-for person is a person for whom the local authority must or may provide community care services/children's services?

Table 3.3: Question 3

Respondent group Yes No Other Nil response
Individuals (32) 19 8 1 4
Carer/ User support (81) 61 3 3 14
Local authority (24) 19 4 1 -
Health (13) 6 2 1 4
CHCP (6) 6 - - -
Public body (3) 2 - - 1
Professional body (3) 1 - - 2
Representative body (3) 1 1 1 -
TOTAL (165) 115 18 7 25

3.33 As can be seen in the table above, 115 respondents said yes and 18, across a range of respondent groups, said no. Seven made other comments. One hundred and twelve respondents commented on this question and the main themes from these responses are outlined below.

Agreement with the removal of the requirement

3.34 Ninety-five of those who agreed that the requirement should be removed commented further; several respondents made brief comments reiterating or stressing their agreement. Many of the comments noted on responses to this question were similar to those seen at the previous questions in this section.

3.35 The need for a Carer's Support Plan for every carer once again emerged as a main theme in responses. One local authority said: "We strongly believe that a carer's role must be defined in relation to the cared-for person and the activities undertaken with them or on their behalf. It follows then that the development of the Carer Support Plan should reflect the totality of the carer role that is being undertaken and should not be dependent on whether the cared-for person receives a service from the local authority".

3.36 Once again, respondents commented that the current requirements can act as a barrier to accessing support and welcomed the proposal to remove any barrier to support for carers and cared-for people.

3.37 Several respondents commented that this step would make it easier to identify all carers as, at present, many are caring without assessment or support. Some of the local authority respondents pointed out that, under the present system, many carers are not known to their local authority. One said: "Not all carers recognise themselves as carers and even less are known to the local authority. A carer might be providing care without support from any organisation, or they might be getting support from family/ friends, health services or third sector organisations".

3.38 Some, from the carer/ user group, said that in many cases the cared-for person prefers to be supported by family rather than accept care services and that it is important to identify these cases to ensure the carer is supported and not left to care alone. One carer/ user respondent said: "We know from experience that in some cases the cared-for person may not need such services or might refuse the support, however this should not prevent the carer from receiving a Carer's Assessment".

3.39 Others commented on the number of cared-for people who do not currently meet the criteria; again this means their carers are unsupported.

3.40 There were comments that, in both the above situations, support for the carer would allow them to continue caring for longer and therefore the investment in carer support would pay for itself as it may reduce the need for the cared-for person to access services. The need for a preventative, rather than responsive, system was again a theme in many responses with comments on the need to provide support to carers before crisis point is reached.

3.41 Several groups of cared-for people were mentioned as either falling outwith the criteria at present or perhaps being resistant to or unsure of statutory services. This included people with mental health problems, those who are affected by substance misuse, people living with HIV, elderly people, people from BME communities, those awaiting diagnosis and people with a medical condition; carer/ user respondents stressed the need for support for the carers in these groups.

3.42 There were also many comments on the need to support all young carers, some stressed that this must be done using the GIRFEC approach. A local authority said: "This is particularly important in relation to young carers where the cared-for person does not want to obtain support or does not recognise the need for support". A representative body reported: "The young carers and young people we consulted with felt that, in many situations, the cared-for person does not want, or perhaps need, this type of support, but still requires a significant amount of care".

3.43 One carer/ user respondent pointed out that some carers have multiple caring roles and said that while individually none of the cared-for people met the criteria for access to services, the combined roles meant that the carer had an intensive caring role and was in need of support.

3.44 Again, several areas reported that they currently offer assessment regardless of whether the cared-for person is in receipt of services and outlined their processes. COSLA and one local authority said that they understood that the requirement had been removed under the 2002 Community Care Health Act and they have, therefore, been offering assessments to all carers.

3.45 One CHCP respondent commented: "We would suggest that the tone of entitlement within the narrative of this proposed legislation is unhelpful as existing legislation and guidance are (sic) already providing a framework for delivery which supports local partnerships to identify and address the needs of their local communities".

3.46 Respondents were uncertain about the impact this change would have on resources and, therefore, on services for those in most need. Respondents said that there would need to be adequate resources in place to meet the increased demand. One carer/ user respondent said that their members were divided over the issue as, some felt, the current criteria are indicators of priority. Another respondent from the same group, however, suggested that giving every carer a support plan would allow professionals to more easily assess unmet needs.

3.47 A local authority respondent detailed suggestions in relation to the financial implications of this proposal:

"It would be necessary to undertake substantial financial modelling to project the current and future demands this proposal will have on the public sector both in terms of funding and workforce. The modelling should consider the potential operational resources needed to deliver carers' support plans in practice and, delivering on the commitment to provide the right services at the right time within a reasonable timescale. In conjunction with this work and to complement any future statutory guidance, it would be good practice to develop a clear set of outcome measures and data set alongside any financial modelling. This approach would provide a baseline for the public sector to report against the national outcomes framework."

3.48 Other recurring comments included:

  • The importance of integrated service provision.
  • The need to clarify the role of other bodies, for example the role of the NHS where the cared-for person has medical needs only.

Disagreement with the removal of the requirement

3.49 Ten respondents said they did not want to see the requirement removed and gave their reasons.

3.50 One main theme to emerge from these responses was the need to ensure that the needs of the cared-for person are taken into account and any support they require provided.

3.51 A representative body pointed out that the requirement is not that cared-for people 'must' be in receipt of services, but that they 'may' be eligible to receive them.

ROUTES THROUGH TO THE CARER'S SUPPORT PLAN

3.52 The Scottish Government proposes to retain the current requirement for a carer to be able to ask their local authority to make an assessment towards a Carer's Support Plan. Recognising that not all carers will make this request, there is a further proposal to introduce a requirement for local authorities that they must offer a Carer's Support Plan. This means that there would be two possible routes to the Carer's Support Plan.

Question 4: Should we introduce two routes through to the Carer's Support Plan - at the carer's request and by the local authority making an offer?

Table 3.4: Question 4

Respondent group Yes No Other Nil response
Individuals (32) 28 - - 4
Carer/ User support (81) 55 1 - 25
Local authority (24) 22 1 1 -
Health (13) 8 - 1 4
CHCP (6) 5 - 1 -
Public body (3) 2 - - 1
Professional body (3) 1 - - 2
Representative body (3) 2 - - 1
TOTAL (165) 123 2 3 37

3.53 The table above shows that almost all of those who replied said yes (123), two respondents said no, three made other comments. Ninety-eight respondents commented further on this question and the key themes to emerge are outlined below.

Support for two routes

3.54 Ninety-three of those who said 'yes' gave their reasons for supporting the introduction of two routes through to the Carer's Support Plan. In addition, three who did not specify agreement or disagreement made similar comments to those seen in 'yes' responses.

3.55 Several of the carer/ user organisations commented that the proposal will allow those who may not wish to seek help to be offered support even when they do not request it. However, the question of how local authorities will identify carers was raised in many responses, with some suggestions for 'triggers' that might alert the local authority to someone taking on a caring role, or the use of other agencies to signpost people to the local authority:

3.56 Several also raised the question of how the information should be publicised to ensure all carers are aware of the right to a Carer's Support Plan.

3.57 There was an appetite for multiple routes rather than simply the two outlined. Several carer/ user organisations felt the proposal could go further and there were calls for it to be extended to NHS and integrated. One carer/ user organisation suggested: "more routes would be even better and specifically getting GPs to refer for carer support plans" while a local authority commented:

"In an integrated world there should be the opportunity for a number of routes toward the development of a Carer's Support Plan. Rather than the local authority making an offer, perhaps there should be an obligation on statutory agencies to signpost carers to whomever can assist them in developing their Support Plans."

3.58 Several respondents from the carer/ user group were keen to see independent and/ or voluntary agencies involved in the process with one such organisation reporting that they are becoming involved in undertaking carer assessments on behalf of the local authority. Another from this group said: "There may be a requirement for the local authority to 'offer' the assessment, however we believe that the undertaking of the assessment sits best with independent organisations such as Carers' Centres".

3.59 Many, across respondent groups, said that this two-route system already exists in their area: "This reflects current practice" (CHCP) and "The introduction of two routes for a Carer's Support Plan will remove any ambiguity caused by existing legislation and also reflects our current practice" (local authority).

3.60 Many respondents also commented on the importance of involving the voluntary sector in the process, for example: "Carers can currently request an assessment independently or they can be offered one by a local authority. Many carers will be prompted to request an assessment by third sector organisations" (carer/ user).

3.61 Commenting on the process they currently use to offer support to carers, one local authority said: "there has been training provided for a wide range of staff, and the expectation is that all staff involved with a cared-for person will make the carer aware of the Carer's Journey and will support the carer to complete this, as required."

3.62 Some respondents stressed the need for local authorities to ensure proper training and resources for front-line staff to allow them to offer an assessment and support wherever possible. There were also calls for local authorities to do as much as possible to make carers aware of their right to a Carer's Support Plan.

3.63 A small number of responses again included specific reference to young carers. Particular issues for this group of carers included concern that the proposals aimed at making available a Support Plan to every carer does not, under the proposals outlined in the consultation document, extend to young carers. A carer/ user respondent pointed out that the proposals do not guarantee a Child's Plan for every young carer and wanted to see this anomaly rectified. One carer/ user respondent asked: "will young people be able to request a Child's Plan, so that they receive all the support they are entitled to? This would be fair and would ensure that there is parity between how adult carers and young carers are treated". Other comments on this issue included:

"The proposals seem unclear in relation to supporting young carers who are not eligible for a Child's Plan. There could be a risk that young people are not identified as carers, which would affect their ability to access the range of support measures available to carers. The proposals do not go into sufficient detail about how the rights of young carers will be strengthened." (carer/ user)

"Under these proposals, any carer or young adult carer will be able to request a CSP, or be automatically offered one where they have been identified as a carer. Yet, the Scottish Government has acknowledged that not every young carer will be eligible to receive a Child's Plan where they have been identified as a young carer." (representative body)

3.64 There were some other recurring points and these included:

  • That it should be mandatory for the local authority to offer all carers a Carer's Support Plan.
  • The need for a yearly review.
  • A question as to whether this needs to be laid down in legislation; a local authority felt guidance would suffice.
  • The need for a consistent approach in all areas.
  • Concern over funding and resources and concern that unless these are addressed, the proposal will raise unrealistic expectations.
  • The need for a clear definition of carer.

Opposition to two routes

3.65 Two carer/ user respondents said no and provided additional comments. One wanted to see multiple routes. The other said that some provisions already exist: "There is already a duty to assess under Section 22 of the Children (Scotland) Act 1995".

CARER'S ABILITY TO PROVIDE CARE

3.66 The consultation explained that, at present, the legislation includes wording about assessment of the carer's ability to provide care. This has been seen as a negative view of the carer's competence or skills and the Scottish Government propose to remove this wording and introduce and outcomes-based approach.

Question 5: Should we remove from statute the wording about the carer's ability to provide care?

Table 3.5: Question 5

Respondent group Yes No Other Nil response
Individuals (32) 18 8 2 4
Carer/ User support (81) 48 4 2 27
Local authority (24) 20 3 1 -
Health (13) 8 2 - 3
CHCP (6) 5 - 1 -
Public body (3) 2 - - 1
Professional body (3) 1 - - 2
Representative body (3) 3 - - -
TOTAL (165) 105 17 6 37

3.67 One hundred and five respondents said yes, 17 said no and six made other comments. One hundred and five respondents commented on this question.

Agreement with the removal of the wording

3.68 Eighty-five of those who said yes commented. The main themes that emerged from these responses was general support for this proposal and, in particular, support for a move to an outcomes-based approach. Most respondents agreed that the current wording has negative connotations and acts as another barrier to carers accessing support. It was suggested that the concept of 'capacity' to care was more appropriate than ability.

3.69 There were comments, particularly from local authority respondents, that the move to an outcomes-based approach will allow for individual support plans and tailored support to ensure the carer's health and wellbeing is not compromised by their caring role and to ensure they can have a life outside of caring. As such it is proposed that assessments should cover carer's capacity and their own circumstances, health, aspirations and support needs.

3.70 Several respondents commented on the need to see carers as partners and to acknowledge the valuable role they play and to provide the support they require to enable them to carry out their caring role.

3.71 The need to engage with and listen to carers and to have regular reviews of their needs was also highlighted as important.

Disagreement with the removal of the wording

3.72 Thirteen respondents, mainly individuals and carer/ user respondents, who disagreed that the wording should be removed also commented further.

3.73 Three carer/ user respondents felt a change could cause confusion and suggested instead that a reference to mental and physical health could be added as it is important that these are taken into account. The term 'willingness' was not supported by two of these respondents as they thought this suggests a matter of choice when, in many cases, there is none. One carer/ user respondent, along with one from the health group who answered no, felt the word 'capacity' would be a better substitute than 'willingness'. Another carer/ user respondent reported their members felt 'ability' to be important as any shift in this ability would indicate a need for change to their support.

3.74 The individual respondents pointed out the strain that the caring role places on carers with one pointing out that to care you have to be able to care.

3.75 Local authority respondents said that in some cases it will be important to consider ability; the criteria should instead be expanded and some reported the indicators used in their area to support this, for example willing and able to continue caring. One also said "To not consider the ability to care conflicts with adult support and protection guidelines."

TIME TO RECEIVE CARER'S SUPPORT PLAN

3.76 As mentioned in the consultation document, there is some anecdotal evidence to show that it can sometimes take a long time for carers to be offered a carer's assessment. The Scottish Government proposes to introduce a duty to inform the carer of the length of time it is likely to take to receive the Carer's Support Plan. In addition, if the Carer's Support Plan is not received within that time carers must be informed of the reasons.

Question 6: Should we introduce a duty for local authorities to inform the carer of the length of time it is likely to take to receive the Carer's Support Plan and if it exceeds this time, to be advised of the reasons?

Table 3.6: Question 6

Respondent group Yes No Other Nil response
Individuals (32) 27 - 1 4
Carer/ User support (81) 61 - 5 15
Local authority (24) 12 9 3 -
Health (13) 9 - 1 3
CHCP (6) 4 2 - -
Public body (3) 1 - 1 1
Professional body (3) 1 - 1 1
Representative body (3) 1 2 - -
TOTAL (165) 116 13 12 24

3.77 The majority of those who replied said yes (116). Thirteen said no and these respondents came mainly from the local authority group. Twelve respondents gave other answers; perhaps, not sure and "yes and no". Further comments were noted in 119 responses to this question.

Agreement with the introduction of the duty

3.78 Ninety-four of those who said yes commented further on this question and the main theme to emerge in a large number of these responses was reiteration of their agreement with this proposal. A very small number agreed with the process but felt it would be better set as guidance rather than a duty.

3.79 In a fairly large number of responses, however, there were also comments on the need to set a timescale or a maximum waiting time. Respondents, mainly from the carer/ user group, felt that there should be either a duty or that a standard for a reasonable timescale should be set out in statutory guidance. A small number stressed the need for a set timescale particularly for those carers who are providing end-of-life care.

3.80 Some respondents commented on the strain placed on carers while waiting for an unspecified time. One, from the carer/ user group, said that carers are under enormous emotional pressure and should not be made to feel they have been abandoned; nor should they have to chase for their assessment. Another carer/ user group included the following comment from one of their members: "Been trying to get help for 15 months. There should be a published process which is consistent. This should also have a timeframe in which this must be done."

3.81 The following typical examples come from other carer/ user responses:

  • "LA should have a duty to set realistic waiting times, advise individuals of these and explain reasons if waiting times are exceeded."
  • "Carers of those with a terminal illness and/ or at the end-of-life could require intense support in a very short space of time of becoming a carer and may only require this support for a short period until the person they are caring for dies."

3.82 The issue of resources was again raised in a number of responses from both carer/ users and others with respondents saying more resources will need to be put in place to allow for this duty to be fulfilled as local authority budgets are already under pressure.

3.83 There also were calls to improve waiting times; one member of a carer/ user organisation said "12 week timescale for assessment - totally unacceptable!" However, while respondents suggested a number of different maximum waiting times; 12 weeks was the most common. For example "We believe that there should therefore be publication of the agreed timescale (e.g. preferably 28 days but certainly not exceeding 12 weeks) to ensure that carers do not go beyond crisis point before they receive support".

3.84 A small number again commented that early or proactive support can help a carer's health and well-being.

3.85 Several respondents commented on a wide difference in waiting times across different local authorities and wanted to see consistency across the country: "Carers are currently waiting for a variable amount of time to receive their assessment. This ranges from weeks to years across local authorities" (carer/ user). A duty, best practice and guidance were all suggested as a means to achieve this.

3.86 Many respondents also wanted to see greater accountability with monitoring and reporting procedures put in place. Several suggested that data should be collected and information from different local authorities collated to show how waiting times are managed in different areas. There were also comments on the need to ensure management of waiting times does not become a bureaucratic, box-ticking exercise but actually improves the process for carers.

3.87 In addition to suggesting a maximum waiting time for assessment, several respondents, again mainly from the carer/ user group but also a small number of local authority respondents, also wanted to see a maximum waiting time for receipt of services. However, this would also have resource implications. One CHCP respondent said: "Defining a length of time in legislation would not be supported at this point, as there would be a need for local authorities to consider levels of demand following implementation of proposed legislation and the related impact on current staffing resource in terms of assessment and care management staff".

3.88 There were some comments that a similar process is already in place in some local authority areas.

3.89 One local authority felt that the process should be the same as for a cared-for person: "the assessment process is more meaningful and transparent if the same rigour is placed upon this regarding timeframes and accountability as is placed upon assessment of the cared-for person".

Disagreement with the introduction of the duty

3.90 Thirteen of those who did not agree with this proposal commented further; many of the points raised echoed some themes from the 'yes' responses, including:

  • The need for guidance rather than legislation.
  • Resource issues.
  • The need to avoid bureaucracy.
  • That many local authorities already follow this procedure.
  • How will the duty be monitored or enforced?

3.91 There were also queries as to the usefulness of a duty or standardisation:

  • "It is difficult to see how creating a duty in this circumstance would positively impact on service provision; it shifts the emphasis from a local partnership model based on need, to an emphasis on statutory monitoring". (CHCP)
  • "The situation of carers will vary widely and professional judgement (if necessary backed by local procedures) would be preferable to standardised timescales." (local authority)

Other comments

3.92 Twelve respondents made other comments, with several saying they are unsure or undecided over the introduction of this duty.

3.93 Again, some similar comments emerged including: the need for similar processes for both carers and cared-for people; the need for a person-centred process; that guidance would be preferable to a duty; the need for clear timescales or a maximum timescale; the need for ongoing contact with carers; the need to include young carers; that this is current practice in some areas; and that complying with the duty may require additional resources.

3.94 There was also a comment that timescales can be difficult to assess and that regular contact with, and updates to, a carer are also very important.

3.95 One local authority said the duty should not be required: "If the development of Carer Support Plans is to be aligned with SDS the carer should remain in control and hold their own plans (like hand-held maternity records). This control includes setting their own timescales and self-assessment about their own carer-journey and their readiness to look at other aspects (or reviewing aspects) of their caring role".

SIGNIFICANCE OF PORTABILITY OF ASSESSMENT

3.96 The consultation also looked at issues around portability of assessment; where a carer, or the person they care for, moves from one local authority area to another.

Question 7: How significant an issue is portability of assessment for service users and carers?

3.97 One hundred and sixty-five respondents commented on this question. A large number, including respondents across groups, described portability variously as significant, very significant, hugely significant, a big issue, a challenge or similar.

3.98 Many respondents included reasons for their view and one of the main themes to emerge related to the differences that exist across local authority areas and the need for consistency in eligibility, assessment and support services. This included examples such as different respite entitlements across areas. Several, especially carer/ user and individual respondents, talked about the 'postcode' lottery of procedures and services that they feel exist at present.

3.99 While a small number of local authorities supported a move towards greater consistency, a similar number pointed out that these differences exist because of different needs in different areas. One said: "We would be concerned that portability of assessment requires consistency in provision and it is noted within the consultation papers that there is acknowledgement that there will be difference in provisions across Local Authority boundary areas for a variety of reasons".

3.100 In addition, a public body suggested: "This should continue as best practice rather than as a statutory duty, maintaining the importance of local democracy and the importance of allocating resources according to local need".

3.101 Several respondents said that portability in itself is not significant, consistency is most important and this includes consistency of eligibility. Current rules were described, by respondents in the carer/ user and local authority groups, as confusing, unclear and open to interpretation.

3.102 There was also a small number of comments on the need to look at what happens when carers and/ or cared-for people move to other parts of the UK.

3.103 The issue of ownership was also raised in some responses with respondents from the carer/ user and CHCP groups commenting that, subject to capacity, it should be the carer and cared-for person that own their assessment or Plan.

3.104 There were calls, including a selection of local authorities, health boards, carers and the people they care for, for a process for reviewing an existing Carers Support Plan if they move to another area, some said this should be done before the move. This would help to manage the process and ensure that there was minimum disruption. "There is the potential for significant risk especially where the person being cared for has complex needs and there is a break in the provision of support" (health).

3.105 A small number commented on the importance of portability for those groups likely to move often, for example those with alcohol or drug problems living difficult lifestyles, and minority ethnic communities such as gypsy travellers.

3.106 Several respondents acknowledged that portability is a growing issue. One carer/ user respondent said: "It is likely to be an issue of growing significance given the aging of the population and the fact that there will be fewer family members (given the smaller size of families and the distance people live from one another) available to provide care".

3.107 Several respondents, across most groups, said that portability is not an issue in their area, or that they are aware of, however several also said that this may be a growing area of concern and suggested more research and information will be needed before any solutions can be devised.

"This has not been raised as a significant issue in our area and in our feedback from carers but we do support the need for some more research in this area as longer-distance caring increases because of geographical and social mobility." (local authority)

3.108 Finally, at this question, the issue of young carers was again raised with some commenting on the need for portability to apply when they move away from home, for example:

"Many young adult carers continue to provide care, but may have moved out of the family home to attend college, university or work in a different local authority area. The portability of assessment for young adult carers in this situation is potentially very important in order to ensure they receive the support that is appropriate for the person they care for and for themselves." (representative body)

IMPROVEMENTS TO PORTABILITY OF ASSESSMENT

3.109 The consultation went on to say that the Scottish Government thinks improvements can be made to the assessment process in order to make it easier for service users and carers to move from one part of the country to another.

Question 8: Should the Scottish Government and COSLA with relevant interests work together to take forward improvements to the portability of assessment?

Table 3.8: Question 8

Respondent group Yes No Other Nil response
Individuals (32) 26 - - 6
Carer/ User support (81) 52 - - 29
Local authority (24) 20 1 2 1
Health (13) 9 - - 4
CHCP (6) 5 - 1 -
Public body (3) 1 - - 2
Professional body (3) - - - 3
Representative body (3) 2 - - 1
TOTAL (165) 115 1 3 46

3.110 As shown in the table above, almost all of those who replied said, or implied in their answer, that they agree with this proposal (115); one local authority said no and three respondents made other comments. Seventy-six respondents commented further on this question.

Agreement with working together to take forward improvements

3.111 Seventy-one respondents who answered 'yes' commented further; several of these respondents referred to the answer they had given at the previous question. The main themes that emerged from the others were also similar to those seen at the previous question.

3.112 The main comments made at this question included:

  • The need for the Carer's Support Plan to be portable.
  • The importance of portability, consistency and minimising any stress or distress for carers.
  • Welcome for any improvements that can be made to portability.
  • The need to discuss portability with all individuals, agencies and organisations that may be involved and not just local authorities.
  • That there is likely to be more cross-boundary caring in the future and the need to consider cross-UK border issues.
  • The need to involve carers and cared-for people in discussions and decisions.
  • The need for clear guidelines for local authorities.
  • The need for a commitment to improving portability, not to discussions about improving portability.
  • The need to consult with carers, young carers and cared-for people on any proposed changes to portability.
  • The need for clear guidance.
  • The need to develop minimum standards of service and protocols.
  • That the assessment and Plan should belong to the individual and not to the local authority.

Contact

Email: Connie Smith

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