Chapter 4 Support to carers (other than information and advice)
This chapter seeks views on whether we should retain the discretionary power to support carers in the Social Care (Self-directed) Support Act 2013 or whether we should repeal that provision and introduce a duty to support carers within the context of an eligibility framework.
We also seek views on introducing provisions about short breaks.
1) Presently, there are no provisions within social care law to directly support carers. Where local authorities support carers directly now, they are using the power to advance wellbeing in section 20 of the Local Government in Scotland Act 2003.
Discretionary power to support carers
2) As from 1 April 2014, local authorities will have a discretionary power to support carers when the Social Care (Self-directed Support) (Scotland) Act 2013 comes into force. The local authority must carry out a carer's assessment, consider the assessment and then decide whether the carer has needs in relation to the care provided to the cared-for person. If the local authority decides that the carer has needs, the authority then has to consider whether the needs could be satisfied (wholly or partly) by the provision of support and decide whether to provide such support. The support is then provided to the carer by one of the four options for self-directed support set out in the legislation. Young carers too are eligible for support in similar fashion.
3) As stated, the power is discretionary. It might be used in relation to existing carers who receive support and to some new carers. It might be used to support carers in crisis or who are deemed to have critical or substantial needs. It might also be used to support carers on a preventative basis to help ensure that they can continue caring in good health and to have a life alongside caring. We envisage that the type of support provided directly to carers using this power would mostly be short breaks but could also include advocacy, help with the cost of transportation, driving lessons, leisure activities, counselling and anything that helps promote positive outcomes for carers. Other types of support such as information and advice would generally be provided universally in any event.4) The first option is to maintain the status quo by retaining the discretionary power to support carers and young carers as it stands.
Duty to support carers
5) Another option is to repeal the power to support carers and to introduce instead a duty to support carers. However, it would not be possible, realistic or desirable for local authorities to support all carers. Therefore, the duty would need to be linked to an eligibility framework. This means that local authorities would be required to support carers on a consistent basis across the country, but allowing for local variation in the type of support available and in accordance with an eligibility framework. The eligibility framework would be set out in regulations or guidance rather than in primary legislation. This would give flexibility for the eligibility framework to be amended from time to time after consultation.
6) With the introduction of an eligibility framework, it would have to be accepted that the carer's needs could be met (wholly or partly) by the provision of services to the cared-for person. We have evidence through the Reshaping Care for Older People Programme Change Fund that carers' needs can be met though support to the cared-for person. However, this would need to be agreed through the Carer's Support Plan and it is most certainly the case that the carer's needs for support can often be met by direct support to the carer. Indeed, it will often be a combination of direct and indirect support which will result in the best outcomes for carers.
7) Any duty to support carers would herald an approach similar to that used for the people they care for. An important point, where carers are being supported directly, is that the costs of doing so are relatively modest. For example, help with gardening, gym membership, buying a laptop to keep in touch with family and friends are low-cost interventions to help the carer look after his or her own health and wellbeing. Some types of support will cost more but should help the carer to care for longer in better health and to avoid breakdown or crisis.
8) The second option is to introduce a duty for local authorities to support carers according to an eligibility framework and by either direct support to the carer and/or by the provision of services to the cared-for person.
Duty to support young carers
9) Under the Children and Young People (Scotland) Bill, there will be a duty on Health Boards and local authorities to promote, support and safeguard the wellbeing of children. Where there is a concern about any aspect of wellbeing, the Named Person will start a process to identify and assess wellbeing needs and put in place appropriate support to improve wellbeing outcomes.
10) In some cases a child with a wellbeing need may require a targeted intervention which is the provision of a service directed at meeting the needs of children whose needs are not normally capable of being met, or met fully, by the services which are provided generally to children by the authority.
11) The Child's Plan will not determine eligibility for support. Rather, access to support will be determined by the needs and circumstances of individual children. This means, in effect, that young carers could access support whether or not they have a Child's Plan. We envisage that the circumstances where young carers do not have a Child's Plan will be rare. Support to young carers not provided through universal services will be agreed and recorded in the Child's Plan.
12) Some young carers are likely to require support through a targeted intervention. If we introduce a duty within carers' legislation for local authorities to support young carers according to an eligibility framework, the support would in effect be a targeted intervention. The eligibility framework would need to be consistent with GIRFEC principles and values.
13) This type of targeted intervention could allow young carers access to
self-directed support, including direct payments in order to help promote their health and wellbeing so that they can care in good health and maintain their childhood.
14) If a duty to support carers and young carers is introduced, we would also expect that local authorities would have a discretionary power to support carers and young carers where they do not meet the criteria for the eligibility framework.
15) One of the most sought-after and important interventions to support carers and young carers and the people they care for in order to achieve good outcomes is short breaks. By short breaks, we mean any provision which supports carers and young carers to have time out from caring in order to recharge their batteries. The short break can include holidays, time out for leisure activities, time to meet up with friends and breaks away together. Sometimes the short break is an activity for the cared-for person which the carer joins in, or an activity exclusively for the cared-for person.
16) There is evidence that carers who did not receive a break in a recent demonstrator pilot in England were more likely to show deterioration in wellbeing scores.
17) There has been progress in Scotland in rolling out short breaks provision but it remains patchy with variation across geographic areas and care groups.
18) We could consider introducing a duty for local authorities to provide and promote short breaks. This would be by means of a duty to provide short breaks services in the area which would be available to eligible carers or to the people they care for. One argument against this - apart from the important issue of cost - is that any power or duty to support carers already takes account of short breaks' provision within it, without naming it as such. Moreover, it could be argued that short breaks provision is an input to produce an outcome of improved carer health and wellbeing, so why concentrate on an input. Finally, not all carers want short breaks.
19) Set against this, a duty to provide short breaks could dovetail with a power or duty to provide other forms of support which are not specified. A duty could provide a great opportunity for innovation to tackle specifically the key concern about lack of adequate, personalised, life-changing provision meeting the needs of carers and the people they care for.
20) Any duty could specify that local authorities publish and promote a Short Breaks Statement, an explanation of what people could expect, eligibility criteria and how the range of services offered (including those universal community-based ones) is designed to meet the identified needs.
21) We might expect that establishing a duty with regard to short breaks would be costly. We would need to undertake financial modelling before we introduced any legislative duty.
22) A duty with regard to short breaks' provision could be desirable as short breaks' provision can be seen as an 'add-on' when in fact it often produces very good outcomes for carers. With a considerable amount of innovative thinking, services can potentially be reconfigured in order to provide for such a commitment. Some services can be underutilised with a silo approach to provision for different care groups which is not always efficient or effective. A duty could act as an incentive to develop the market in order to provide the short breaks.
23) We would like to invite views on a duty with regard to short breaks.
What Do We Want To Know From You?
Question 9: Should we introduce a duty to support carers and young carers, linked to an eligibility framework?
Question 10: Alternatively, should we retain the existing discretionary power to support carers and young carers?
Question 11: Should we introduce a duty to provide short breaks?
Email: Alun Ellis