Contact: Chris Taylor, ext 7275/ Alison Heywood, ext 7235

1. SUMMARY

1.1 This report advises the Social Services Policy Review Committee of the outcomes of the Best Value Review of Carers' Services and Respite Care.

1.2 The services under review comprise services delivered directly to carers of adults and children. These include: information and advice; assessment; support to individuals and their networks; and breaks services funded through The Carers' Special Grant (`Take a Break'). The services under review also comprise residential and non-residential respite care which provides an indirect service to carers. Combined expenditure on direct and indirect services for 2000/2001 totals £7.2 million. In addition, the review acknowledges that carers derive simultaneous benefit from a proportion of day and domiciliary care delivered directly to service users. The value of these `simultaneous services' in 2000/2001 is estimated at £10.3 million.

1.3 In line with the department's inclusive approach in relation to the provision of support to young people with care responsibilities, it is recommended that their needs are considered in the Best Value Review of Children in the Community scheduled for next year, 2002/2003.

1.4 The key findings of the Review are outlined below together with the main challenges in terms of providing services for carers and respite care.

1.5 The cost of services to replace the care currently provided by carers in Hampshire has been estimated at £945 million per annum. This figure is expected to rise as demands on carers increase demonstrating the need for continued investment in services and support to carers within the context of their overall contribution to society.

1.6 Information and advice for carers that exists is useful and valued and has increased in local and county-wide coverage. However, there is an urgent need to co-ordinate this information more effectively and to link to developments providing direct access to services and signposting to other agencies.

1.7 A three-year project to be undertaken from April 2002 will assist the development of a `one-stop-shop' approach to providing information for carers.

1.8 During the consultation for this review, difficulties in engaging with groups of carers who are hard to reach highlighted the need to target communication with specific groups. There is evidence that black and minority ethnic carers are under represented in services for carers. There is also evidence from research by Age Concern and from gay carers' networks that this particular group of carers experience discrimination and have difficulties accessing support from existing services.

1.9 Further work is required to establish links with individuals and their networks and to consult with them about their needs. Training for key groups of staff has also been identified as a priority for action to raise awareness of the needs of carers in hard to reach groups.

1.10 Performance in relation to carers' assessments is good but could be better if recruitment of care managers is improved. It is also essential that the replacement care management IT system (SCIS) will allow care managers to record both users' and carers' assessments in order to evidence this performance. It is recommended that the department continues to promote the choice of separate assessments of carers or joint assessments with service users as this approach is consistent with the findings of research by the department (C.Lupton/SSRIU 2000, `Separate Assessment of Carers'). Recommendations to address the difficulties in accessing care managers and delays in assessments highlighted through the consultation with carers will be made by the Best Value Review of Care Management/Reception and Assessment (reporting options to this PRC meeting and final recommendations in May 2002).

1.11 The department has promoted the recognition of the rights and needs of carers through the provision and support of local carers' support services. While these services are highly valued by carers and offer a wealth of local knowledge, and community links, there is a need to strike a balance between providing locally responsive services and ensuring greater consistency and accountability across the county. It is envisaged that the management of contracts from one source to a common set of standards together with a remodelled service will accrue some efficiency gains to be reinvested in support to carers and strengthen the business case for further investment.

1.12 The Carers' Special Grant (`Take a Break') has contributed significantly towards the provision of breaks for carers from their caring role. The Grant has been extended until 2003/4 and will annually rise by approximately 25%. To ensure the focus of the Grant will be on the provision of more flexible carer replacement services, it is intended to target the annual increase towards the roll out of voucher-type schemes across the county and to monitor the range of services purchased through the Grant.

1.13 The needs of carers of adults with mental health problems have been given particular prominence within the review in the light of the requirements contained in the National Service Framework for Mental Health. Consequently, separate outcomes together with a comprehensive set of improvements to make services more responsive to the needs of carers of people with mental health problems have been detailed in the improvement plan.

2. THE SERVICES UNDER REVIEW

2.1 A carer is defined as anyone who provides a substantial amount of care on a regular basis and does not provide that care on the basis of a contract of employment or other formal arrangement (Carers' Recognition & Services Act 1995).

2.2 Respite care is a service delivered to someone living in the community who has been assessed as needing personal care and/or supervision as an alternative to their usual care provider. Respite care is generally delivered within a fixed time frame. On an annualised basis the majority of care will be provided by the usual care provider. However, implicit respite care may also be provided without a time limitation by services not formally recognised as respite care but which benefit user and carer simultaneously e.g. long term attendance at a day unit.

2.3 The following carers' services are delivered directly to carers:

· Information, advice and signposting to other services;

· Out-of-hours service providing information, advice, counselling and practical help through the Carers' Helpline;

· Assessment of carers needs-either separately or jointly with the service user;

· Support to individual carers and to carers' networks e.g. counselling, development workers;

· The provision of breaks to carers using the Carers' Special Grant.

2.4 Services delivered to service users which are of simultaneous benefit to carers include the following:

· Respite care (including short-stay residential care, sitting and companion services, family-based care e.g. Family Link, holiday schemes, opportunity and play groups);

· Day and domiciliary care (where a carer is enabled to take a break).

2.5 Budget Summary 2001/2002

	£
Carers' Special Grant Allocation	1,367,000
Carers' Support Services	195,000
Carers' Help Line	89,000
Short-stay residential care (adults) Short-stay residential care (children)	2,585,000 2,231,793
Other respite services (adults and children)	737,660
'Simultaneous services' (30% total day and domiciliary care budgets)	10,283,400
Total	17,488,853

3. THE REVIEW PROCESS

3.1 Review Areas

3.2 The review was organised into six main areas:

i. Information, advice and signposting

ii. Carers' assessments (in parallel with the Best Value Review of Care Management/Reception and Assessment)

iii. Carers' support services

iv. Respite care and breaks services

v. Carers of adults with mental health problems

vi. Other specific groups of carers including; parent carers, black and minority ethnic carers and gay carers.

3.3 Context

The review has been carried out within the context of increased national recognition of the rights and needs of carers and has been informed by the imperatives contained within the legislation and national strategies outlined below.

i) The Carers (Recognition & Services) Act 1995 which defines a carer and establishes the right of carers to request their own assessment of need.

ii) The National Carers' Strategy (February 1999) which has established a national agenda of recognition and support for carers to enable them to continue with their caring role while maintaining their own quality of life.

iii) The provisions of the Carers' and Disabled Children Act 2000 as they affect carers of children. These include the right for carers to request their own assessment without the person being cared for having to be assessed. The Act introduces the power to provide services direct to carers as well as the power to charge carers for services delivered directly to them. This Act also introduces both Direct Payments and Voucher Schemes for carers.

iv) Following on from the Government's National Carers' Strategy, the emphasis on carers issues is also reflected through the following:

- The National Service Framework for Mental Health

- The National Service Framework for Older People

- The National Learning Disability Strategy

3.4 Challenge

Challenge has been provided from external members of the review team (a voluntary sector manager, an adult carer and a parent carer) and from consultation through their networks. Further opportunities for challenge arose through consultation with carers.

3.5 Consultation

The approach to this review was based on the outcomes from the consultation with carers in 1999. Carers identified a range of requirements in relation to services and support. The six requirements listed below, have been used to assess the current performance of carers' services and to appraise the options for improvement.

· Quality

· Flexibility

· Access

· Communication

· Wider choice and control

· Working in partnership

3.6 The following methods were used to consult with carers:

i) Consultation with carers in 1999 outlining carers' requirements from the Carers' Special Grant (`Take a Break');

ii) Three consultation events organised through Carers Together in July 2001 attended by 70 carers who reported on the impact of the Carers' Special Grant and the development of services to support carers;

iii) A questionnaire completed by 88 carers identifying key messages to the department;

iv) Circulation of the questionnaire to community groups including the Chinese Association, Vietnamese Society, Bangladeshi Association and the Multicultural Society;

v) Conference for carers of Mental Health users, June 2001;

vi) Externally commissioned consultation with service users and carers focusing on assessments, care planning, services and outcomes, (Southampton Centre for Independent Living, Consumer Audit Project) September-November 2001;

vii) Consultation with carers' groups.

3.7 The majority of carers attending the consultation events in July 2001 agreed that there has been a general improvement in the way the department responds to the needs of carers and reported satisfaction with services where they are being provided. Carers highlighted the following areas for concern:

i) A perceived lack of equity of service provision across Hampshire and variations in the quality of care available;

ii) Shortages of social workers, care managers and care workers causing delays in assessments and accessing services;

iii) The need for improved communication and joint working between agencies who provide services to carers;

iv) The need for single points of contact for services and information;

v) The need for better promotion of developments to support carers and tangible evidence of improvement.

3.8 Comparison

Comparison with Surrey County Council's Best Value Review of Carers' Support Services identified several areas for joint learning including promoting awareness of carers needs through the equalities agenda, responding to the needs of black and minority ethnic carers and developing carers' support services. Comparison with Surrey also identified variations in the way Surrey and Hampshire invest in services to carers. Expenditure by Surrey on direct services to carers (in the form of investment in carers' organisations and support networks) is considerably greater than Hampshire's. However, Hampshire's expenditure on services which deliver simultaneous benefits to both user and carer (e.g. day and domiciliary care) is higher.

Comparisons in relation to support for carers of mental health service users have been made through a separate benchmarking exercise. The exercise was carried out with neighbouring counties and Hampshire's comparator counties, 12 in total, to establish procedures and practice in relation to issues such as carer involvement and policy.

Internal comparisons have been made through mapping the range of carers and respite services across care groups and Social Services areas. Further comparisons have been made by evaluating contracted carers' support services using the Standards for Carers' Centres.

3.9 Competition

Opportunities for competition regarding the provision of respite care are limited. The department provides the bulk of residential respite care across the county and will continue to dominate the market since this form of provision is financially unattractive to other sectors. The high costs of residential short stays and difficulties in maximising occupancy levels are offset by the benefits to carers and service users. Competition will be a consideration when reviewing the model of contracted carers' services. However, the aim of this review was to explore opportunities for partnership working as opposed to competition. The Partnership Plan for carers due to be launched in June 2002 provides the basis for improved co-ordination and planning to deliver a range of services and support to carers and establishes a framework for the working relationship between carers and the following:

-Social Services

-Voluntary Sector

-Education

-Health Authorities

-Primary Care Trusts

3.10 Equalities

A range of issues in relation to equalities were highlighted through the challenge provided by external members of the Review Team. These included the needs of gay carers and carers from black and ethnic minority groups. The Review is making a number of recommendations to establish links with carers from these groups and to promote awareness of their needs through training for staff.

3.11 Sustainability

Consideration of the Corporate Sustainable Development Strategy by the Review Team highlighted the contribution made by services to carers in achieving the following objectives:

(i) Improving health and social well being;

(ii) Social inclusion;

(iii) Developing a sustainable local economy.

The Review has endeavoured to quantify the value of care provided by carers in Hampshire in order to illustrate their contribution to the economic prosperity of the county and to the quality of life of many of its residents.

The figures below have not been used before in Hampshire. Research by Carers UK (2001), based on findings from the General Household Survey 1995, has indicated that the demand for carers will rise progressively by approximately 65% over the next thirty years with a corresponding increase in demand from carers on statutory agencies.

a) Number of carers in Hampshire 2001:

Number of carers 164,000 Annual turnover of carers 33,000 Carers providing over 20 hrs care per week 47,000 Carers providing over 50 hrs care per week 25,000

b) Value of care provided by carers in Hampshire on a care cost replacement basis:

Estimate based on 1995 figures £945 million per annum Value of care provided by carers providing 50 hrs care pw £149 million per annum Value of care provided by carers providing 20 hrs care pw £280 million per annum

3.12 E-Government

The recommendations outlined in 6.1 will employ a number of E-government solutions to improve access for carers and professionals to information about the help and services available to carers.

4. MEMBER INPUT

Four members (Councillors Heath, Gillett, Ludlow and Mrs West) were at the latter stage of the review nominated to provide input. Members have had limited opportunities to contribute to the review through individual briefing sessions and a workshop of the Social Care Policy and Review Committee in November. Several members have raised concerns that the needs of young people with caring responsibilities have not been included in this review. It is acknowledged that the needs of this group of carers deserve more focused attention and it is recommended that their needs are considered in the Best Value Review of Children in the Community scheduled for next year, 2002/2003.

5. LESSONS LEARNT

The following learning points have emerged from the review:

· As involvement of councillors did not take place until late in the review process, they were unable to exercise their challenge role fully;

· Consultation events were utilised to involve carers in the review and to enable them to contribute an element of challenge. However, there were difficulties in accommodating the wide range of views expressed;

· Obtaining key information was problematic, particularly trend analysis as data relating to many aspects of carers' services had not previously been collected or could not be disaggregated from present systems;

· The difficulties in managing consensus where local perspectives prevail should not be underestimated. This point was particularly evident when reviewing carers' support services;

· As the carers were in a minority in the review team, the group experienced some difficulties in involving them and sustaining their challenge;

· Despite efforts to the contrary, the approach to reviewing respite care remained care group focussed;

· Inclusion of a representative from Children and Families' services in the review team could have enabled the review to cover this aspect of the service more comprehensively.

6. CONCLUSIONS

6.1 Information, advice and signposting.

With regard to information for carers, the department has developed a range of innovative solutions and resources that have been nationally commended and adopted elsewhere in the country. However, better links are required in order to improve access for carers and professionals to key sources of information. It is, therefore, recommended that a three-year project be undertaken from April 2002 to develop a `one-stop-shop' approach to information for carers. This will entail the following:

(i) Creating a new database of resources that are available to carers;

(ii) Setting up a website to allow professionals and carers to access this database and other facilities;

(iii) Employing a development worker to maintain the new database and publicise information sources.

The database and website will improve access to information for professionals and assist them in their role of signposting carers to services and support. These developments will also enable carers to seek out their own solutions via information and advice. The project makes use of IT solutions and will improve links between existing information sources with the potential to establish local and national links with Social Services Direct and NHS Online. The estimated annual cost of £29,000, will be met by reallocating expenditure from the grant associated with The Carers' (Recognition and Services) Act 1995.

6.2 Communication with hard to reach groups.

Current performance regarding communication with groups of carers who are hard to reach appears to be inconsistent and patchy. A set of baseline reports is required to obtain a clearer picture of performance in this area. It is recommended that the following measures be implemented to improve communication and support for carers from black and ethnic minorities and for gay carers;

(i) To incorporate a requirement to target communication with hard to reach groups of carers within contracts with carers' support services by April 2003;

(ii) To establish links with carers from black and minority ethnic groups by extending the remit of the Direct Payments outreach worker;

(iii) Strategic Development Manager to update current training for care managers by including awareness of the needs of gay carers and of other groups of carers who are hard to reach.

The additional `one-off' cost incurred by the employment of the Direct Payments outreach worker is partly met by the Social Care Award of £10,000. However, the capacity to develop this work would be dependent on securing additional funding.

6.3 Carers' assessments.

Hampshire performed well (4 blobs-`good') against the PAF indicator D42 (the number of informal carers receiving an assessment as a proportion of the total number of clients and carers receiving assessments).

Carer Assessments, delivering a combined total of 9,142 carer assessments carried out jointly or separately in 2000/2001 (the first year this data has been gathered). However, maintaining current levels of performance or increasing the number of carer assessments would be dependent on the availability of care managers.

It is recommended that the department continues to promote the choice of separate assessments of carers or joint assessments with service users, and that the replacement care management system (SCIS) will allow care managers to record both categories of assessment. Proposals which address carers' difficulties in accessing care managers and delays in assessments are contained in the parallel Best Value review of Care Management/Reception and Assessment (reporting options to this PRC meeting and final recommendations in May 2002).

6.4 Carers' support services.

The current configuration of carers' services has developed over a number of years. While current providers can demonstrate considerable local knowledge, community links and investment, there is a lack of consistency and accountability across the county. This is evidenced by the differences in priorities, governance and structures, duplication of on-costs, the absence of a common set of standards and variable performance measures. The review recommends that contracts with carers' centres be managed from one source from April 2002. Current contracts and service level agreements with carers' centres will be extended for 12 months from March 2002 to allow for consultation with stakeholders regarding options for remodelling carers' centres to be conducted during this period.

Proposals to develop a `hub and spoke' model (i.e. core functions carried out by a single central unit supporting a network of smaller local groups) will be considered as part of this consultation together with alternative options.

A remodelled service should bring a number of benefits including; reduced management costs, a stronger and unified voice for carers together with the potential to develop a single access point to information. The costs of implementing these recommendations will be met within the current expenditure level of £195,000 per annum.

Efficiency gains achieved through remodelling will be invested in this way in carers' support services. However, this proposal does pose a threat to the existing providers and greater involvement of stakeholders is required to obtain wider agreement. While one group has expressed their support for these proposals, another group has voiced significant concern that the proposals will result in a reduction in service or closure of a local carers' centre

In view of the difficulties of managing consensus where strong local perspectives prevail, the review is recommending that consultation with stakeholders commence from April 2002 and that an independent person be engaged to oversee this work and to maintain stability for carers. Barriers to achieving consensus include differences in ideology between services, a fear of reduction in grants and concerns over future investment and stability of employment for staff in carers' centres.

6.5 Respite care and breaks services.

Consultation with carers and mapping of respite care and breaks services indicates a need to improve the range of flexible services including those delivered in the home. It is recommended that voucher-type schemes delivering flexible carer replacement services be rolled out across the county over three years from April 2002. The extension of the voucher-type schemes builds on the success of the Havant/Petersfield scheme, piloted for the Department of Health, which delivers a combined sitting and replacement care service in the home.

This recommendation will be funded from an element of the Carers' Special Grant (`Take a Break') in order to increase the range of flexible breaks services across the county. The roll-out of these schemes is dependent upon the quality and capacity of providers. There will be some variation between areas in the levels of resourcing from the Grant until the roll-out is completed. Costs will be met from the annual increase in the Carers' Special Grant. This means that £260,000 (17%) of the Grant will be used in this way in 2002/2003 and £280,000 (15%) will be used in this way in 2003/2004.

Current performance indicates that there is some scope for improving efficiency of in-house services through maximising occupancy of residential services providing short stays. It is recommended that care group leads in the Learning Disability, Physical Disability and Children and Families sectors develop proposals on how to maximise occupancy levels of in-house short-stay residential services. It is also recommended that effective respite care be included in the Learning Disability Improvement Programme. Performance targets on occupancy levels will be developed in the course of this work.

Parent carers have highlighted the need for more respite care and breaks services with increased availability at peak times and greater flexibility to allow them to take a break when they and their families need to. It is recommended that the following actions be carried out by the lead Strategic Service Managers, Children and Families to increase the range of flexible respite services for parent carers:

i. Raise the ceiling of ten families receiving Direct Payments;

ii. Develop additional respite facilities for children with a disability in targeted areas (as identified in the county-wide audit of respite services 2001);

iii. Identify options to increase availability of respite care for parent carers at peak times by April 2003.

6.6 Carers of people with mental health problems.

The lack of engagement of carers of people with mental health problems has highlighted a need for a number of improvements to deliver services that are more responsive to the needs of this group of carers. The review is recommending an improved service requiring additional resources outlined in the improvement plan. A detailed Mental Health Action Plan has been devised in addition to this report.

7. REVIEW SUMMARY

Section 100D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

Records of the Best Value Library service review team meetings and working papers of the Best Value Review, held by the Review Team Leader.

None