Developing Innovative Partnerships to improve Services to CarersEstablishing an Evidence Base

James Drummond Lead Officer Integrated Carers Services

Torbay NHS Care Trust

Measure Up – Torbay’s Interagency Carers Strategy

First published 2000 – a long term commitment and process

Three year cycle - Third edition 2008-10 Contains 6 key aims plus Annual Action PlansReflects the needs and aspirations of local carers

from consultationsLinked to Torbay’s Joint Strategic Needs Assessment

and Local Area Agreement

Reflections on Partnership Working to improve Carers Services

Partnership with Primary Health CarePartnership with Voluntary SectorPartnership with secondary Mental Health

ServicesPartnership with independent sector

Partnership with Primary Health Care ‘Carers Support Workers in GP Surgeries’

• Ownership by GP’s and Primary Health Care Teams

• Using recognised research methodology (GHQ 12) – evidence of ‘health gain’

• Provide Carers Support Workers with a Baywide support network

• Link to Practice Based Commissioning

Partnership with Voluntary Sector (1)COOL Young Carers Service

• Addressing specific needs of young carers of adults with Mental Health and/or substance misuse problems

• Young Carers Service lacked expertise but it is available in voluntary sector

• COOL offered support to whole family and a bridge to ‘hard to reach’ families

• Additional benefit was access to start-up funding not otherwise available

• Sharing resources from Community Mental Health teams, Drug and Alcohol team and COOL House

• Young Carers on Steering Group for project

Partnership with Voluntary Sector (2) Older Family Carers Initiative - Mencap

• Target was the significant number of older carers not in touch with services at all or not being actively care managed

• Project set up as ‘arms length’ service (but steered by a group of carers, statutory staff and Mencap) independent of statutory team

• Creating informal network of low level support (a tea and cakes approach) but with intent to help bridge the gap to Learning Disability Services where appropriate

• Developed credibility amongst carers and ‘word of mouth’ became main means of identifying hidden carers

Partnership with Secondary Mental Health Services Haytor Carers Group – in patient psychiatric unit

• Offering ‘drop in’ support at point of crisis with easy access

• Simple but creative approach adapted to particular circumstances – ‘learn by doing’

• ‘Group’ facilitated by member of ward Staff and Carers Involvement Worker

• Catalyst for change in practice and culture of ward

• Some partnerships require patience (carpe diem)

Partnership with Independent Sector Providers Emotional Support Scheme for Carers

• Recognition of psychological impact of caring and carers own mental health needs

• Carers receive 10 sessions of counselling choosing from a ‘pool’ of local counsellors (a voucher scheme)

• Using existing expert resource (qualified and experienced counsellors) but developing specialism in carers issues

• Cost effective service structure• Benchmarking service against other NHS

counselling provision helps monitor standards (CORE)

• High level of commitment from providers and very high levels of satisfaction and improvement for carers

Getting Carers on the Public Health Agenda

• Build Carers health needs into Joint Strategic Needs Assessment (JSNA) which feeds into Local Area Agreements (LAA)

• Cite relevant government documentsExamples:- Health Inequalities Progress and Next Steps (DoH 2008)- Chapter 5 Health and Wellbeing National Carers Strategy- NHS Operating Framework

Establishing an Evidence Base for Carer Support

Collating Known Data

• 1/10th of average practice caseload are carers (2001 Census)

• More than 80% of carers say that caring has damaged their health (General Household Survey 2000)

• 21% of carers caring for more than 50 hours per week are not in good health compared with 11% of non carers (2001 Census)

• Research suggests carers under report health problems• Bring together known evidence e.g. Princess Royal Trust

for Carers

Evaluation and Research – Experience from Torbay

• General Health questionnaire (GHQ12 – measures carer burden)

• CORE (Clinical Outcomes Routine Evaluation) evaluating counselling services in NHS

What is a CORE benchmarkingWhat is a CORE benchmarking ‘thermometer’?‘thermometer’?

0

10

20

30

40

50

60

70

80

90

1001

% patients achieving clinical & reliable change

Performance of lowest 25% of services

National Average

A specific measure of service performance

Lowest performing service

Highest performing service

Implicit message “green = good”

← Torbay Average 2006 – 07 = 71.5%

TORBAY’S EMOTIONAL SUPPORT SCHEME FOR CARERS

Evaluation and Research – Experience from Torbay (Continued)

• Enhanced Annual Health checks – identifying hidden carers

• Health and access to health services questionnaire (adapted from POMED 36)

• Adapt existing processes in Health e.g. new patient questionnaire/EARLI