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Appendix 1

A Plan for Doncaster Carers – Foreword

Suggested titles:

1. Working Together: Your compassion, our understanding (or our responsibility)

2. A better helping hand for Carers

In Doncaster today there are around 33000 people who look after their loved ones, family

and friends simply because they care that the health of their loved ones is not as good as

other peoples. They don’t get paid to do this and don’t often recognise themselves as being

any different from other people.

They are husbands, wives, daughters, sons, nieces, nephews, grandchildren or friends.

Sometimes they are children who also need to get to school and perhaps shouldn’t be

caring or parents whose children are disabled and need to be assured that their child gets a

good education as well as receiving help from the Health and Social Care system.

We call them Carers.

From helping their loved ones to get up and get dressed, get washed, and have a meal to

running errands, doing the shopping, sorting out appointments at the clinic, Carers just get

on with living life and helping their loved ones make life the best it can be when their health

has deteriorated.

These caring tasks can be a drain on them and can affect their own health and well-being. If

they don’t get good support to carry on caring, they can end up in hospital and their loved

one often has to be admitted to residential care, losing their independence. Or they can be

forced to give up work, and can find it difficult to make ends meet because it’s not easy to

know what benefits they are entitled to and how to get them.

If this care and support had to be provided by Health and Social Care workers, it would

break our Health and Social Care budget. Yet when we ask Carers how we can help them,

often they just want to be listened to, to be recognised as understanding best what their

loved one needs from Education, Health and Social Care, to be able to offload about how

caring is impacting on their life, and to have some breaks at the right time, tailored to their

own circumstances so they can recharge their batteries.

Doncaster Council and Doncaster NHS Clinical Commissioning Group along with other

partner organisations want to recognise the important contribution Carers make to

Doncaster society. We want to support Carers in the best way possible so they can continue

to care and stay healthy and well themselves, balancing their right to a life of their own with

their desire to care and continue to look after their loved ones.

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There are some important recent changes in the law that we need to take account of which

strengthen the rights of Carers. We are already responding by assessing Carers needs and

providing them with support as a result, but we want to go further in improving the way in

which we do this.

We have been trying to understand the needs of Carers by collecting all sorts of

information; looking at the range of services we currently provide; how well used they are

and whether they work for Carers; looking at survey information; talking to Carers and

organisations that work with Carers.

From this information we think we need to do three things:

1. Make improvements now where we know we can and where Carers and our analysis

tells us that we need to

2. Get a much deeper understanding of Carers needs and have a longer term view

about making more radical changes to the Education, Health and Social Care system,

so that Carers are supported in a much better way

3. Understand what works and doesn’t work for Carers and their loved ones.

We know we haven’t got enough Carers working with us to tell us their story and work out

together how to make those changes. So that’s where we think we need to start, by

securing a strong Doncaster Carer voice to shape up a new Carers offer of support from the

Council, NHS and all our partners.

We’ve developed a plan of action that will help guide us and drive us forward in achieving

these three things over the next year and beyond. You’ll find the plan and our intentions

about the way we will do this in the following pages.

We trust you will agree with us that recognising and supporting Carers is really important

and that you will help us to do this now and in the years to come.

Councillor Glyn Jones, Portfolio Holder

David Hamilton, Director Adults Health and Wellbeing

Eleanor Brazil, Director Children and Young Peoples Services

Paul Moffatt, Chief Executive Doncaster Childrens Trust

Chris Stainforth, Chief Operating Officer, Doncaster Clinical Commissioning Group

Bernard Rounthwaite, Chair Doncaster Carers Forum

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CARERS PLAN 2015/16 Phase 1 and 2 Getting Started

1. Strategic context and scope

Organisational arrangements

Our Carers plan is being sponsored by: David Hamilton and Chris Stainforth The senior responsible officers are: Shane Hayward-Giles and Laura Sherburn The project lead is: Martin Walker The steering group from the Council and NHS are co-producing the strategy with Doncaster Carers Forum, Doncaster Parent Carers Forum and Doncaster Young Carers Forum. These groups are made up of Carers and third sector organisations who work with and for Carers. Planned development of this partnership includes the business sector and the Children’s Trust. The timetable is: Phase 1 Milestone 1: Board Established March 2015 Milestone 2: Year 1 Plan Drafted April 2015 Milestone 3: Year 1 Plan Agreed May 2015 Sign-off date: June 2015 Phase 2 June 2015 commence Phase 2 Milestone 4:Produce a transformational Carers Strategy to be signed-off by November

2015 Milestone 5: Launch Strategy on Carers Rights Day November 2015

Purpose The purpose of this plan will be: To secure broad partnership commitment to transforming the way we support Doncaster

Carers To outline the case for change and the need to strengthen the voice of Doncaster Carers To agree short term improvements to the current offer for Carers To agree work can commence on Phase 2 to develop and produce a transformational

Carers Strategy for Adults and Children and Young People with our partners for launch on Carers Rights Day November 2015.

Related strategies, legislation and plans Our Carers plan will be relevant to the following high-level strategies, legislation and plans: The National Carers Strategy and Action Plans The Care Act 2014 Children and Families Act 2014 The Five Year Forward View for the NHS 2014 Adult Social Care Prevention Strategy ”Towards Independence and Wellbeing” Adult Social Care Commissioning Strategy “Building the Road towards person-centred

commissioning” Doncaster CCG Commissioning Strategy “Moving Forward, Getting Better”

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Better Care Fund plan Adult Social Care Modernisation Strategy ”Building the Road to Independence” Dementia Strategy “Getting There” SEND Code of Practice 2014 Short Breaks Statement for parents of disabled children Digital Council Programme

Better support to Carers will support these strategies, legislation and plans in the following ways: Early intervention and prevention : Crisis and breakdown of Carer support will be

prevented thus avoiding Accident & Emergency presentations, hospital admissions and early admissions to long term residential care and short term emergency admissions to residential care

Increasing choice and control: Carers will be able to tailor support both for themselves and for their cared for so that it is person centered and meaningful to them and responds to their needs

Supporting more people at home: Helping people lead more normal lives in a supportive community by drawing on both personal and community strengths

It will need to take account of the following very important developments, that are already under way or planned: Doncaster’s Social Care Rescript Doncaster’s Local Offer for Children and Families ‘Having a Good Day’ the Second round of Doncaster’s Innovation Fund Prospectus Planned increase in people receiving a direct payment Dementia Carer’s Call to Action Personal budgets for children and young people Doncaster Primary Care Strategy Doncaster community nursing transformation programme Doncaster Intermediate Care review

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2. Where are we now?

From what we have found out about local people’s experience of being a Carer, our

improvement goals are:

1. To help people to identify themselves as Carers so that they can access information, advice and support

2. To provide more flexible options for Carers to have a break from their caring role 3. To provide more flexibility for Carers to design support that works for them using

resources they are entitled to 4. To improve Carers experience of contacting Health and Social Care services 5. For Carers to be recognised by practitioners as experts in the condition or

circumstance of their cared for and in their own circumstances (Findings from Doncaster Carers Survey, Personal Outcomes Evaluation Tool (POET) survey and conversations with carers issued with short break vouchers for their cared for)

From our analysis of population needs, our key target groups are:

1. Dementia Carers 2. Carers providing 50 or more hours care per week 3. Carers aged 75 and above 4. Carers whose caring situation is at risk of breaking down 5. Carers from Black, Asian and Minority Ethnic (BAME) communities 6. Carers of people with substance misuse issues 7. Young Carers 8. Parent Carers

From our assessment of the current provision of support to Carers, our improvement

goals are: 1. Increase the number of Carers having their needs assessed (Carers Assessments) 2. Increase the number of Carers receiving a Direct Payment to meet their needs 3. Increase the number of Carers registered on the Carers Emergency Contact Scheme 4. Increase the number of Carers who can have a break from their Caring role enabled

through their cared for person using respite resource allocations flexibly 5. Increase the number of Carers who are satisfied with the way their contact with the

Council was handled (or reduce the number dissatisfied) 6. Ensure Carers commissioned services are flexible, responsive and what Carers

need to support them in their caring role 7. Reduce the gap in Emergency Respite provision for children and young people 8. Increase the support provided to Carers of people living with Dementia 9. Increase the number of children registered on the children’s disability register

Together Information Exchange (TIE)

From our assessment of other statutory support to Carers, and of key national resources, the key issues we must address are:

1. Carers need better and timely access to information – on the illness or condition of

the person they are caring for; on appropriate caring; on accessing benefits and other support; and on financial and employment issues;

2. Carers can often feel excluded by clinicians – both health and social care professionals should respect, inform and involve carers more as expert partners in care;

3. Carers find accessing assessments overly bureaucratic and slow, and are often disappointed about the scarceness of the services that follow;

4. Carers often feel forced to give up work to care; 5. Carers often neglect their own health and need advice to maintain their wellbeing; 6. Carers need breaks from caring in order to sustain their role as a carer; 7. Carers feel that the value of Carer’s Allowance is inadequate, the rules around

overlapping benefits are unfair and the earnings limit is a disincentive to work;

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8. More should be done to identify and support young carers – in particular, schools should be more carer aware and the memorandum of understanding Working together to support young carers should be embedded.

From our assessment of specialist Carer services, our improvement goals are:

1. Review the effectiveness of the ‘Face of Carers’ campaign in helping Carers to

identify themselves as such 2. Increase the availability of emotional support through contracted provision 3. Review the effectiveness of Information and Advice provision 4. Evaluate the effectiveness of new models of delivery that respond to Carer need

From our assessment of our other community assets, our improvement goals are:

1. To build on the strength of partnership working already established in the Carer

community 2. To work with Communities and Health to widen the reach of this work 3. To connect with other strong networks to further widen the work such as the Dementia

Action Alliance; Stronger Communities Partnership

Thoughts on relevant new developments and on-going work:

We believe that the following on-going developments are exceptionally important and relevant, and will be key building blocks of our Strategy:

1. The introduction of Carer eligibility and entitlement to support under the Care Act 2014 and Children and Families Act 2014

2. The introduction for Adults of a new Carers Assessment and Resource Allocation System and proportionate support planning underpinned by Carers Direct Payments

3. The introduction of more flexible use of respite allocations made to the cared for person

4. A strategic move from the provision of Council Day Services to the offer of support to ‘have a good day’ for the cared for person

5. The development of a policy and new processes for Children and Young People to benefit from Personal Budgets

6. The development of a Doncaster primary care strategic framework, to deliver holistic and responsive primary care for all

7. The on-going reviews of current intermediate care and community nursing services, to identify and address the issues relevant to carers as well as the cared for

Thoughts on the quality of our provision: From our assessment, we believe that much good support is available to Doncaster Carers, but we have the following challenges:

1. Education, Health and Social Care practitioners are not all aware of what is available or how to help Carers access this

2. Education, Health and Social Care practitioners don’t always acknowledge carers expertise

3. Education, Health and Social Care practitioners don’t always identify carers when a pupil, patient or service user engages / presents to them

4. Information and advice is not consistent across partners nor is it embedded in pathways

Thoughts on joining things up: The Care Act 2014 and Children and Families Act 2014 give us a responsibility to help join up support to Carers locally, with partners working more collaboratively.

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From our assessment, we believe we have already established some good links between agencies, and have demonstrated that our arrangements work well in the following ways:

1. A number of engagement events have been successfully held involving all members of the Carers Forum: Carers Rights Day, Carers Week, Dementia forum,

2. The Carers Forum has been strengthened over the past eighteen months and now involves a wide range of stakeholders who are participating regularly

3. Recent work in developing this plan involved this partnership considering Doncaster Council Carer Insight reports

4. A Parent Carer Forum is active and well supported by partners and contracted providers

We have found scope to create stronger links, and to improve support to Carers, in the following ways:

1. Key strategic partners have been engaged and are keen to participate in the development of this plan which itself is jointly sponsored by DMBC and DCCG: Doncaster and Bassetlaw Hospital Trust; Rotherham Doncaster and South Humberside Mental Health Trust; Doncaster Council Children and Young Peoples Services; Doncaster Council Communities, Healthwatch and Doncaster Carers Forum

2. Linking to strategic work in other areas of the Health and Social Care Transformation programme and Better Care Fund: Information and Advice improvement; Doncaster’s Dementia Strategy, strategic partnership and action alliance; Reducing Long Term Care placements; Doncaster’s Social Care Rescript

3. Leadership at Doncaster Council want to secure high level political support to improving the offer to Carers and ensuring that Carers in Doncaster have a strong voice to influence that offer

Thoughts on becoming more efficient: In the current climate, we have a responsibility to be as efficient as we can – optimising “value for money” across the whole system. Our senior responsible officers have given us the following initial guidance about the level of investment that can be made in this area: Resources from the Better Care Fund have been earmarked specifically to mitigate the anticipated impact of new Carers entitlements under the Care Act 2014 From our assessment, we have concluded that the following areas may be under-resourced:

1. Allocations to the Cared for person to enable a break for the Carer (respite) 2. The provision of emotional support to Carers, particularly those whose cared for

person has Mental Health issues or is a substance misuser 3. Workforce capacity to move to a re-scripted approach to the assessment and review

of Carers needs However, we have also found scope to achieve efficiencies. Our ideas are:

1. To move to a Resource Allocation System to assess and allocate resources to Carers to meet their needs. To utilise commitments made in a new Direct Payment policy to enable Carers to use these resources flexibly to meet their need in a meaningful way, rather than configuring and specifying services on a contracted basis (typical system wide saving approx. 10%)

2. By decommissioning some contracted elements of the current Carers offer: Caravan breaks; Gardening Service

Other headline thoughts on our strengths, weaknesses, opportunities and threats:

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From our assessment, we have some other thoughts about what we can feel confident about, and what we are concerned about: Strengths

1. Partner buy-in 2. Breadth of current offer to Carers 3. The face of Carers promotional campaign 4. Information and Advice service 5. Emotional support provision

Weaknesses

1. Lack of presence of a strong, engaged Carer voice in numbers 2. Lack of coordination of the current offer and of partner provision 3. Lack of Education, Health and Social Care practitioner knowledge of the current offer 4. Lack of take-up of current offer to Carers 5. Accessibility of Information and Advice

Opportunities

1. To redefine the Carers offer 2. Promotional: Carers week; Carers Rights Day; Dementia Awareness week; 3. Partnership developments and interfaces: Dementia Action Alliance; on-going

engagement with LD family Carers; Parkinsons Society; Doncaster 50+; 4. Social Care Rescript 5. The Better Care Fund and Doncaster’s Health and Social Care Transformation

Programme 6. The Care Act and Children and Families Act 2014

Threats

1. Current economic climate: Cuts to services in the current offer 2. Traditional thinking about solutions to meet Carer need

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3. Where we would like to be Our Vision, Approach and Priorities

Our Vision Carers in Doncaster will be recognised for their vital contribution and expertise, supported to continue this and helped to improve their own health and wellbeing. They will have a strong voice that influences improvement.

Our Approach/Principles Being pro-active – Seeking out Carers who engage with the Education, Health and

Social Care system and helping them to identify themselves as Carers

Being personalised – Making sure the Health and Social Care systems respond flexibly to Carers needs and that Carers are in control of tailoring support individually

Being innovative– Introducing new ways for Carers to self-serve from a range of support options available across a range of communication mediums so they can self-manage solutions to their needs

Being preventative – supporting Carers at an early stage to help them improve their Health and Wellbeing and maintain their caring role

Being asset-based and promoting independence – Helping Carers to identify and draw on personal ,family and community strengths to ensure they can have a life alongside their caring role

Being joined up – A strong partnership championing the rights of Carers, celebrating their contribution, supporting them in their caring role

Ensuring high quality – Making sure that support to Carers meets their needs at the right time in the right way

Being efficient – Avoiding duplication, providing simplified pathways to support, enabling Carers the opportunity to access meaningful solutions that meet their needs

Being co-productive – Developing plans, shaping improvements and delivering services in an equal relationship with involved, empowered Carers

Our Priorities Our priorities will be:

Developing and publishing a transformational Carers Strategy

Identifying adult and young carers at the earliest stage to support and maintain their health and well being

Recognising and raising the profile of carers within the community

Providing easily accessible timely information and advice

Providing flexible, reliable, quality services for carers

Involving carers in admission, discharge, assessment, decisions and choices at all levels improving carers experience of Health and Social care services

How we will improve people’s experience Outcomes

Carers will receive support earlier to help them maintain their health and wellbeing

Carers will feel valued and recognised for their contribution to our society

Carers will be given timely information and advice and access it easily to make informed choices and be in control

Carers will have confidence in the range of services and solutions they can choose from to meet their care and support needs

Carers will have confidence in the range and quality of replacement care to enable them to have a break from caring

Carers will feel valued, supported and listened to when they are included in decisions affecting the person they care for

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Measures Our aim is that by April 2016

More Carers will say their Health related quality of life has improved (NHSOF 2.4)

More Carers will receive a Direct Payment (ASCOF indicator 1C(2))

More Carers will report improved Quality of Life (ASCOF indicator 1D)

More Carers in Doncaster than the England average will say they have as much social contact as they would like (ASCOF 1/2)

More Carers will say they are satisfied with social services (ASCOF 3B)

More Carers will say they have felt included or consulted in decisions (ASCOF 3C)

More Carers will say they find it easy to get information (ASCOF 3D(2)

More Carers will register on the Carers Emergency Contact Scheme (local measure)

More Carers will take up flexible respite and shared lives provision to enable a short break from their caring role (local measure)

More Carers with protected characteristics under the Equality Act identify themselves as Carers (local measure)

There is a reduction in admissions of cared for into Short Term Residential Care (local measure)

There is a reduction of admissions of cared for into long term residential care (ASCOF 2A)

There is a reduction in emergency admissions of the cared for into hospital

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HOW WILL WE GET THERE?

4. Action Plan 2015/16

Measure Action By When/ Annual Target

Lead Officer

Priority 1 Develop and publish a transformational Carers Strategy

Strategy agreed and published

Secure a strong Carer voice in developing the strategy

July 2015

Martin Walker

Broaden partner involvement July 2015

Ensure Carers and partners influence the development of

the strategy September 2015

First draft complete September 2015

Second draft complete October 2015

Commence sign-off across all partners

October 2015

Complete sign-off across all partners

November 2015

Priority 2 Identifying adult and young carers at the earliest stage to support and maintain their health and well being

Number of people registered on the

Carers Emergency Card Scheme

Increase the number of people registered on the Carers

Emergency Card Scheme (Age UK Contract)

Baseline 1119 Target 1400

Fay Wood

Explore the options for including Parent Carers and

Young Carers in the Emergency Card Scheme

September 2015 Fay Wood

Michael McGuigan

Number of Young Carers registered on

the Young Carers Card

Increase the number of Young Carers registered on the Young

Carers Card (Barnado’s Contract)

Baseline 0 Target To be established

Michael McGuigan

Number of Carers recorded on GP

registers

Establish whether all GP’s keep a register of Carers supporting their patients

September 2015

Laura Sherburn Increase the number of Carers

recorded on GP registers across the Borough

Set once baseline established

Number of Carers Assessments

(Adults)

Increase the number of Carers Assessments completed by

Social Care staff

Baseline 1789 Target 2000

Andy Waterworth

Number of Carers Assessments (Young

Carers)

Reduce the number of Young Carers undertaking

inappropriate caring roles by introducing appropriate referral protocols between Adults and Children and Young Peoples

December 2015

Andy Waterworth Michael

McGuigan Childrens Trust

Rep

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assessment services –to include prompts within

assessment documentation

Increase the number of Young Carers and Parent Carers

Assessments completed by Social Care staff

Baseline To be established

Target Set once baseline

established

Childrens Trust Representative

Priority 3 Recognising and raising the profile of carers

Carer quality of life

More Carers will say their quality of life has improved

Baseline 8.3 Target – Achieve national average

or better

Martin Walker

More Carers will say their health related quality of life has

improved

Baseline 0.782 (National 0.804) Target –Achieve national average

or better

Laura Sherburn

Review the face of Carers campaign June 2015

Fay Wood Michael

McGuigan

Raise awareness of Carers rights and support available

June 2015 & November 2015

Martin Walker Michael

McGuigan

Demographic profile of Carers with protected characteristics under

the Equality Act

Understand why the demographic profile of Carers

with protected characteristics is different from the profile of the Doncaster population to inform positive actions in the strategy

December 2015 Lynn Murphy

Priority 4 Providing easily accessible timely information and advice

Number of Carers supported to access

information and advice

Increase the number of Carers who say they find it easy to get

information and advice

Baseline 71.9% Target 75%

Martin Walker Michael

McGuigan

Make information available in different formats across a

range of channels September 2015 Gemma White

Co-ordinate an approach with partners to ensure consistency September 2015 Gemma White

Review all commissioned information and advice

provision April 2016 Fay Wood

Transform the Education focussed Parent Partnership

Service into a Education, Health and Social Care

focussed Support Advice and Information Service

(SAIDSEND)

April 2016 Michael

McGuigan

Review the Together Information Exchange (TIE) register of disabled children

Baseline 1070 Michael

McGuigan

Priority 5 Providing flexible, reliable, quality services for carers

Direct Payments made to Carers

Increase the number of Direct payments made to Carers

Baseline 111 Target 200 Andy Waterworth

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Personal Budgets for Children and Young

People

Expand children’s Personal Budgets systems to cover

Health and Education where appropriate

Date to follow Michael

McGuigan

Increase the choices available in short breaks for Children and

Young People Date to follow

Michael McGuigan

Consider the options to extend Personal Budgets to siblings

Date to follow Michael

McGuigan

Respite allocation usage

(Adults)

Increase the use of respite resource allocation

Baseline 7562 overnight stays Target 10000

Martin Walker

Replace short break vouchers for overnight residential

accommodation with Direct Payments

September 2015 Angela

Dungworth

Review the success of the Carers Toolbox and

incorporate an appropriate provision in the Help To Live At

Home Tender

September 2015 Fay Wood

Promote flexible respite allocation use across Social Care Assessment workforce

June 2015 Lynn Murphy

Admissions to Long Term Residential Care

(Cared For Person)

Understand the relationship between the Carers

Emergency Card scheme replacement care provision,

Carer respite offer and uptake, and Carer breakdowns,

establishing baseline data

September 2015 Catherine Miller

Review the success of existing Carers contracted services

September 2015 Fay Wood

Priority 6 Ensuring Carers are seen as experts in the care and support provided to their cared for

Carers feel included or consulted in decisions

Increase the number of Carers who feel included or consulted

in decisions

Baseline 76% Target 80% Martin Walker

Engage Education, Health and Social Care practitioners in the

Carers agenda December 2015

Lynn Murphy Michael

McGuigan

Identify and promote good practice in NHS Pathways

September 2015 Laura Sherburn

Identify and promote good practice in Social Care

Pathways September 2015 Andy Waterworth

Identify and promote good practice in C& YP Pathways-

policy and pathway documents to be co-produced with

Parents’ Forum

September 2015 Michael

McGuigan