Chapter 8 Identification
This chapter sets out issues about the identification of carers and young carers.
Its purpose is to seek views on the way forward to help support the identification of carers and young carers.
1) It is necessary to identify carers so that they can have access to a carer's assessment (Carer's Support Plan) (see chapter 2) and to support (see chapters 3 and 4). Young carers will have their assessment of wellbeing and support planning taken forward within the Getting it Right for Every Child (GIRFEC) approach and the statutory framework within the Children and Young People (Scotland) Bill.
2) Yet identification remains a challenge. Some people will not wish to be identified as carers at all whilst others will initially reject the idea of identification to then seek identification later on as the caring role intensifies. Identification of oneself as a carer can also depend on other factors such as the illness of the person being largely self-managed until the point of it becoming more serious.
3) Carers and young carers can be identified by social work, health and other professionals in different ways, including:
- when a patient is admitted to hospital;
- when a patient is discharged from hospital;
- at the GP surgery either for their own appointment or when they accompany the person they care for to the surgery;
- when in contact with community health services;
- at the pharmacy when they pick up prescriptions for the person they care for or for themselves;
- when the person they care for is assessed by social work; and
- through day-to-day interactions in a school, college or university setting.
4) There are various national policy initiatives to help support the identification of carers by professionals. These include the Scottish Government's funding of NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) and the College Development Network for workforce development. The Royal College of General Practitioners Scotland's guidance on carer identification is available to GPs. The Scottish Government has published an Admission, Transfer and Discharge Protocol for hospital patients, which has a role in carer identification.
5) There are local initiatives too. A few local authorities, for example, run public information campaigns aimed at people who provide unpaid care, and particularly those who are hidden and who are not accessing support.
6) NHS Boards have a role in carer identification as the first point of contact for many carers is with health centres, GP practices and in hospitals. A few Boards fund the voluntary sector to have a presence in some GP practices whilst another approach is to run awareness-raising sessions in libraries and other community facilities.
7) One of the ways to help ensure the identification of carers is through the requirement of GPs to hold a Register of Carers as this is included in the core element of the GP Contract and is therefore a contractual agreement.
8) In the GP clinical system a 'read code' is applied to identify a carer, and a search can then be undertaken within the GP clinical system, which is effectively the Register.
9) The aim is to identify carers within the GP practice so that they can be referred on for a carer's assessment and potential support.
10) Some GP practices offer carers on the Register access to extended appointments, health checks and information on the flu vaccine. However, under the core contract there is no requirement for this to take place. Since carers are nonetheless entitled to the flu immunisation, we would expect GP practices to target carers. Carers may indeed need longer consultations at times as will be the case with others such as people with learning disabilities, mental health issues, multi-morbidity and people who are asylum seekers.
11) In order to facilitate further carer identification through active Registers of Carers held by GP practices, we have considered whether we should have a statutory requirement in relation to GPs to identify carers through use of the Register of Carers. We have, however, ruled this out.
12) Instead, we see merit in ensuring that good practice is widely shared amongst Health Boards. We know, for example, that one Health Board has NHS Carer Support Teams that raise awareness about carers in GP practices.
The majority of Lanarkshire GP practices now have a member of staff with Carer Liaison responsibilities who will help identify carers, encourage them to be entered on the GP Carers Register and signpost them to appropriate services and supports. During 2012-13 the Lanarkshire Carers Support Team made some 407 visits to GP practices across Lanarkshire and provided some 160 carer awareness raising sessions to 1,530 NHS and GP practice staff. The success of this work is reflected in the number of carers on the GP Carers Register, with 5,347 carers registered at 31 March 2013 (an increase of 6% from 2011-12) of which 59% were encouraged to access routine screening/monitoring appointments during 2011-12.
13) We also see merit in asking Health Boards to monitor compliance with the core contractual elements and to confirm the outcome to the Scottish Government.
14) We have also considered whether local authorities should have a Carers Register - a few local authorities operate such a Register already. It makes sense for the local authority to work towards identifying carers at key points, for example, when the social worker is assessing needs of the cared-for person.
15) One of the issues with local authorities holding and publicising a Carers Register to be used proactively for carer identification is that it could lead to multiple Registers given the GP requirement to have a Register of Carers. This could lead to confusion and duplication of activity.
16) There would also need to be compliance with data protection legislation and ensuring that consent and confidentiality issues are robustly dealt with. Moreover, there would need to be a facility for other agencies and organisations such as Scotland's colleges and universities to be able to add or remove names from the Register.
17) On balance, carer identification is an area where we have reservations about enshrining duties in law on local authorities or GPs as we are not convinced that more carers will be identified as a result of legislative provision. There is a need, however, to continue with further policy and practice developments.
18) The policy thrust must remain on the identification of young carers in schools (primary and secondary), colleges, universities, at the GP surgery and in hospitals.
What Do We Want To Know From You?
Question 20: Should there be no legislative provision for GPs or local authorities to maintain a Carers Register in order to support the identification of carers?
Question 21: Should the Scottish Government ensure that good practice is widely spread amongst Health Boards about the proactive use of Registers of Carers within GP practices?
Question 22: Should the Scottish Government ask Health Boards to monitor compliance with the core contractual elements of the GP contract?
Email: Alun Ellis