8. IDENTIFICATION OF CARERS
The purpose of this chapter is to set out the measures to take forward effective carer identification by ensuring that the health and social care workforce have the necessary skills. Self-identification is also important. Identification is the precursor to a carer's assessment and to receipt of support. Appendix 8 sets out a carer pathway from carer identification or self-identification through to support.
8.1 There are a number of different ways to identify carers. Different models have been tried and tested and two lessons have emerged as the most effective way of identifying carers:
- It is widely recognised that practitioners in the NHS and social care professions are best placed to identify carers through their contact with patients and their families; and
- Integrating carer identification into the core professional role of health and social care professionals supports effective carer identification and signposting to support.
8.2 Once identified, a carer may not want to be over-burdened with information. As their caring role changes, they may require a certain level or different type of information. Mental health carers tell us that many of them need information at the pre-diagnosis stage, especially if their relative seems to have severe problems and erratic behaviour, but where there is no diagnosis as yet.
8.3 It is important to keep a focus on carer identification, as this is the first important step to having a carer's assessment and also to accessing appropriate support to meet carers' needs. As part of this, there needs to be a continued emphasis on carer identification within GP practices and in hospital and other settings.
Perth Carers Centre said:
Usually when someone cares for someone with a long-term condition, the care professionals are maintaining the cared-for person and they do not always offer the carer support automatically - this is changing as they are more aware of the needs of carers through networking meetings, conferences being held and so on. Also staff working in the GP practices and raising the profile of our carers centre enables these people to come forward for support and for health care staff to recognise carers centre staff and how they provide carers with support.22
8.4 Carers were included in The Scottish Enhanced Services Programme for Primary and Community Care (2007-2009). This programme will continue until April 2011. The enhanced services are maximising the opportunities to identify carers through the work of general practice and by understanding the carers' role and its associated risks. This enables the practice team to support carers in their caring role and to help carers protect their own health. GP practices providing these services are expected to establish a structure to support the overall needs of patients who are carers.
8.5 NHS Boards have developed strategies to identify carers and many are doing so. For example, in South Lanarkshire a Primary Care Co-ordinator works with the 55 GP practices to identify and support carers. A Blood Borne Virus Support Worker identifies BME carers, some of whom are affected by BBV. A GP Liaison Worker in NHS Borders works with GPs to help identify carers.
The Scottish Government expects NHS Boards to maintain a focus on carer identification through the Carer Information Strategies.
8.6 The Princess Royal Trust for Carers has taken forward the Moffat Programme, sponsored by the Moffat Charitable Trust, with four NHS Boards - NHS Lothian, NHS Greater Glasgow and Clyde, NHS Ayrshire and Arran and NHS Borders. The main aim of the Moffat Programme is to promote early identification, intervention and support for carers to prevent unnecessary crisis, including a breakdown in carers' own health.
8.7 Carers Scotland is continuing to work with GPs and other primary health care personnel to raise awareness of carers, to help staff identify carers and to help carers self-identify. They have produced a resource pack for GP practices which provides a range of tools and a notice board. Carers centres across Scotland are working with GP practices too.
8.8 The workforce training initiative set out in chapter 14 on carer and workforce training will help promote carer identification. The emphasis on training social care staff in the undertaking of carers' assessments set out in chapter 9 will be critical to this process.
8.9 There is scope for the Scottish Government to work with Alcohol and Drug Partnerships ( ADPs) and with the new Scottish Drugs Recovery Consortium ( SDRC) to promote the need for the identification of, and support to, carers of people with substance misuse problems. The Scottish Government expects ADPs to engage with all relevant aspects of community planning to help secure the best outcomes both for people with addiction problems and for their carers and families. The SDRC will be working closely with ADPs by assisting service user groups, family support networks and local communities. Carers of people with drug and alcohol problems can make an important contribution to the recovery of the people they are caring for, and the welfare of carers is an important part of this agenda.
ACTION POINT 8.1
From 2010 onwards, the Scottish Government will promote this strategy with Alcohol and Drug Partnerships ( ADPs) and with the Scottish Drugs Recovery Consortium ( SDRC) and will work with ADPs and with the SDRC to help identify and support carers of people with substance misuse problems.
8.10 The Royal College of General Practitioners Scotland has decided to make carer and young carer identification and support one of its key priorities in 2010-11 through its Patient Partnership in Practice (P3) group. This means that the RCGPS working with others, will develop guidance for GP practices in Scotland on carer identification and support.
8.11 In addition, the RCGPS, in partnership with the Princess Royal Trust for Carers, is launching a UK-wide Award to recognise the excellent work of GP practices in identifying and supporting carers. These awards will be presented in the four UK countries, with an overall winner receiving the UK Award later in 2010.
ACTION POINT 8.2
The Scottish Government will approach all relevant national training and qualification accreditation bodies to agree how they could integrate carer identification and awareness into the curriculum by 2013.
ACTION POINT 8.3
In 2011-12 and beyond, local authorities, Health Boards and all carer support organisations are to identify carers and young carers in the hard to reach groups, including BME carers.
ACTION POINT 8.4
In 2010-11, the Scottish Government will work with the Royal College of General Practitioners Scotland on its plans to provide guidance to GP practices in Scotland on carer and young carer identification and support.
8.12 People can identify themselves as carers ( self-identification). However, that is not straightforward. There is a widespread view that caring for or looking after someone, particularly a family member, is 'what you do.'
8.13 It can also be difficult to determine when 'the caring journey' starts, depending, for example, on the condition of the would-be carer's relative or partner, who may initially keep quite good health. As people become older, frailer, sicker, and/or increasingly disabled, become addicted to alcohol and/or illegal drugs or have a diagnosed mental health problem, the role of carer becomes more apparent.
"My sister constantly told me that I was a carer and that I should ask for help and for a long time I ignored her. I didn't think of myself as a carer and despite many visits to the GP and workers coming to see mum at home, no one had ever spoken to me about getting support for myself, so that reinforced my view that I couldn't get help."
Eileen, who cares for her mother, who has a combination of medical needs and is also frail.
8.14 Many people who support family members with mental health problems or drug or alcohol addiction do not seek to identify themselves as carers as there is still a stigma attached to this role. In addition, the person with care needs may deny that they need or are getting support from a family member or partner.
8.15 There are hard-to-reach or hidden carers, including BME and LGBT carers. For BME carers, problems of language and communication may make self identification more difficult. Professional attitudes and beliefs such as 'they look after their own' can also impact on how BME carers are identified by practitioners.