Chapter 2 The Carer's Assessment (the Carer's Support Plan)
This chapter discusses a number of proposed changes to the carer's assessment process which are relevant once carers are identified. Chapter 8 covers carer identification.
The changes are designed to improve take-up and reach of the carer's assessment (renamed Carer's Support Plan), to achieve a personal outcomes focus for carers and to ensure a straightforward, tailored process.
The new Carer's Support Plan would not apply to young carers whose wellbeing needs should be considered within the Getting it Right for Every Child (GIRFEC) approach and who may be eligible for the Child's Plan under the Children and Young People (Scotland) Bill.
This chapter also sets out issues about the portability of assessment and seeks views.
1) Under the existing law, carers who provide a substantial amount of care on a regular basis are entitled to a carer's assessment. This applies whether or not the carer is a child. Carers request the local authority to make an assessment of their ability to provide care. The cared-for person must appear to the local authority to be a person for whom they must or may provide community care services or children's services. Local authorities must also notify carers that they may be entitled to receive a carer's assessment.
2) The carer's assessment is the gateway to potential support for the carer. Carers should have the opportunity to discuss their need for support to enable them to achieve the personal outcomes they desire.
3) Over the years, local authorities have adopted many different approaches to the undertaking of the carer's assessment. Some carry out the carer's assessment themselves whilst others delegate this function, in whole or in part, to Health Boards or to the Third Sector. Some take account of the guidance on interpreting a 'substantial amount of care on a regular basis' whilst others do not. Some have lengthy carer's assessment forms and others have shorter forms. Some call the carer's assessment by that name whilst others have different names such as the Carer's Support Plan. Some assess a carer whilst others have a conversation or journey. Some have introduced self-assessment for carers and others have not.
4) Some authorities provide low-level support to carers without a carer's assessment in order to provide a quick form of preventative support. However, as the carer is still being asked questions in order to determine need and outcomes to be achieved, this is really a light-touch assessment.
5) Presently, the carer's assessment is not the only form of assessment for carers. Carers can be assessed with cared-for persons through the community care assessment. They can be assessed separately or in conjunction with an assessment of the person they care for.
6) Talking Points: A Personal Outcomes Approach is a driver for continuous improvement in achieving good outcomes for carers through the carer's assessment.
7) There nonetheless remain concerns about both the number of carer's assessments undertaken and the quality of assessments. Whilst the Scottish Government does not collect data on the number of assessments carried out we do know from a variety of sources that numbers are relatively low, compared with the number of people who are identified as carers. However, this will vary across the country. Moreover, some identified carers do not want a carer's assessment.
8) More can be done through continuous policy and practice improvement to build on the quality and numbers of assessments. We do see merit though in making some changes through law.
Change name of the carer's assessment to the Carer's Support Plan
9) Some carers, including those who are new to caring, feel stigmatised by the use of the term, 'carer's assessment.' The idea of 'assessment' has connotations of judgment and stigma. We propose therefore to change the name to the Carer's Support Plan.
Removal of substantial and regular test
10) Some local authorities undertake an assessment to decide if carers care on a regular and substantial basis. Some do not. We propose to remove the substantial and regular test so that all carers will be eligible for the Carer's Support Plan. This will reduce any extra work amongst those authorities that do make a decision on whether a carer cares on a regular and substantial basis. There will be greater consistency in approach to eligibility for the Carer's Support Plan. Carers will be put on the same footing as service users in terms of access to an assessment (Carer's Support Plan).
11) With the removal of the regular and substantial test, the duty to prepare a Carer's Support Plan will apply to a wider group of carers including those who have some caring responsibilities but who might not have particular difficulties or needs connected with those responsibilities at a particular point in time. We expect that carers who do not want a Carer's Support Plan will self-select themselves out of the process. For other carers who prefer to have a Carer's Support Plan but whose caring is not having a big impact on them, we would expect a light-touch Carer's Support Plan with potentially low-level preventative support being offered, including effective signposting to community supports. Carers' needs can however change quite dramatically in a short space of time and it is important to keep the Carer's Support Plan under review. We propose that statutory guidance will set out differing types of Carer's Support Plan that can be taken forward with the carer. The aim is to have a Carer's Support Plan which is carer-friendly, personalised, outcome-focussed, light-touch where necessary and more rigorous as required.
Removal of other existing criteria
12) We propose removing 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. This is because cared-for people don't always need or receive such services, or they might refuse them. Moreover, they might have medical needs only. This includes children with medical needs who do not receive local authority support.
13) We propose to retain the requirement that the carer may request a local authority to make an assessment (Carer's Support Plan). However, since not all carers will know to request a Carer's Support Plan, we propose also to introduce a requirement that a local authority must offer a Carer's Support Plan. This means that there would be two possible routes through to the Carer's Support Plan.
14) We propose to remove the wording in existing law that the carer's ability to provide care is being assessed. The term, 'ability to care' has sometimes been interpreted to imply a negative view of the carer's competence or skills. This is clearly not the case. Instead, we will introduce an outcomes-based approach so that the Carer's Support Plan must consider the outcomes that the carer wishes to achieve both in day-to-day life and in the future. These outcomes are likely to relate principally to being able to maintain and manage the caring role and having a life alongside caring.
15) We do not propose to include in the new law a list of issues that the Carer's Support Plan must include. By having a list, it might be construed as a 'tick-box' exercise. We do, however, propose to have statutory guidance covering a wide range of issues appropriate for a Carer's Support Plan to include: taking into account the carer's willingness to continue caring, whether the carer works or wishes to do so, emergency and future planning and so on.
Timescales for carrying out the Carer's Support Plan
16) There is some evidence that it can sometimes take quite a long time for carers to be offered a carer's assessment and/or to be reassessed. We have ruled out introducing timescales for the undertaking of the Carer's Support Plan as this must be determined locally. Instead, we propose to introduce a duty for local authorities or other bodies carrying out the assessment process 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.
Other forms of assessment
17) There is sometimes a lack of clarity for both practitioners and carers as to why there is a separate carer's assessment. This is because sometimes the carer's needs can be met if they are assessed with the cared-for person as part of the community care assessment. Indeed, the relationship between the carer and the cared-for person can point to one assessment covering both as the way forward. This might suit some people. However, some carers assessed through this route are clear that the main focus is the cared-for person and they are sometimes even unaware that they have been assessed themselves. Moreover, recent research (covering three local authorities) indicates that a separate focus on the carer can be lower down the priority list for local authorities in comparison with work that is done with the cared-for person.
18) Some parent-carers of disabled children in particular would however favour what they call a family-based assessment so that the needs of the whole family unit can be assessed and addressed. Whilst we understand the point made, it would be difficult to legislate for a type of assessment which covers both individual and common needs, actions, outcomes and so on. Assessments for each member of a family can however cross-reference each other and could be carried out by the same professionals at the same time if that suited the requirements of those involved. Moreover, under the Children and Young People (Scotland) Bill, the Child's Plan for children with a wellbeing need will need to take into account, where reasonably practicable, the child's parents views. Parent-carers will of course be eligible for a Carer's Support Plan in the same way that they are currently eligible, if they are a regular and substantial carer, for a carer's assessment.
19) It is important that a Carer's Support Plan is offered so that the carer's needs are identified in their own right and the carer is supported to identify and achieve their own personal outcomes. Rather than the carer's needs being assessed with those of the cared-for person as part of one community care assessment we would suggest that the Carer's Support Plan can be considered at the same time as a section 12A community care assessment or Child's Plan if the carer and cared-for person agree to this.
Role of the Third Sector
20) Local authorities have the statutory responsibility for carrying out the carer's assessment although other bodies can be involved. Local authorities however ultimately remain statutorily responsible for the overall performance of the assessment.
21) Some local authority areas over the past few years have witnessed a maturation in the relationship between the council and the Third Sector, including carers' centres, with regard to carrying out the carer's assessment. In the Borders, for example, the carers' centre is the only body carrying out the carer's assessment, and this has led to stronger working relationships with the local authority at strategic and practitioner level.
22) As noted in the footnote to paragraph 3 there is already statutory provision allowing local authorities to arrange for the Third Sector to assist in the performance of their functions. There is no need therefore to introduce any other provision. We will however make clear in statutory guidance that the local authority can use the existing legal provisions to involve the Third Sector in the undertaking of the Carer's Support Plan.
23) The proposals for the Carer's Support Plan outlined in this chapter do not apply to young carers. Young carers should instead have their wellbeing assessed within the GIRFEC framework and with consideration being given as to whether they require a Child's Plan under the Children and Young People (Scotland) Bill.
Portability of Assessment
24) There are issues to be addressed about the portability of assessment, primarily for service users (adults and children) but also for carers. This means considering the assessment process when people move from one local authority area to another to change jobs or to live closer to each other or for another reason. Gypsies/Travellers may also face similar issues when they move from one local authority area to another.
25) There will always be variability of service in different local authority areas. Each local authority in Scotland is required to determine the best mix of service in its area to meet the needs of local residents. There are duties on local authorities to assess and to respond to the needs of people who are ordinarily resident in their areas. As a result of this duty, there is inevitable variation in the types of services available to residents in each area. These are influenced by a number of factors such as the dispersion of population, physical geography, the availability of trained staff and local attitudes to different types of care. There will also be variations in charging policies from one area to another, dependent on a wide range of factors. Whilst local democratic decision-making and accountability is important, there is scope for improvement to the consistency of services and support.
26) Service users and carers may experience frustrations about assessment when moving from one area to another. If some parts of the service user's care and support package are interrupted until a new assessment is carried out, then this is a cause for concern as is any requirement to repeat their history and experiences in order to access services and support.
27) With regard to carers, if a service user moves local authority area to be closer to the carer, the carer might need a new Carer's Support Plan to take account of the new caring arrangement, for example, there might be less travelling required but more in situ caring being undertaken.
28) We are of the view that 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. Therefore, the Scottish Government and COSLA, with relevant interests, will work together to take this forward. We will be able to consider issues about improved cooperation, communication and protocols between local authorities, and access to as much information as possible - before any move takes place - about the availability of services and support in the new local authority area.
29) For young carers the transfer of their Child's Plan will be governed by the legislation and guidance relating to the management and transfer of Child's Plans. The Child's Plan will support the statutory provisions and duties in relation to other children's plans such as looked after children's plans and coordinated support plans that may include planning to address the wellbeing needs of a young carer.
What Do We Want To Know From You?
Question 1: Should we change the name of the carer's assessment to 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?
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?
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?
Question 5: Should we remove from statute the wording about the carer's ability to provide care?
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?
Question 7: How significant an issue is portability of assessment for service users and carers?
Question 8: Should the Scottish Government and COSLA with relevant interests work together to take forward improvements to the portability of assessment?
Email: Alun Ellis