I've visited eight adult social care departments this year, and talked with front line staff in all of them.
This week, Carers Week is celebrating and recognising carers for the invaluable role they play, both in supporting children and adults to live their lives, and in terms of the vital contribution they make to the wider health and social care system. Their importance – and the lack of support they often receive – was recognised last week by the government in the Carers Action Plan 2018-2020, which rightly states that ‘a sustainable settlement for social care will simply not be possible without focusing on how our society supports carers.’
An increasing amount of iMPOWER’s work involves supporting clients who are working at the interface between health and social care. Their key challenges include high rates of delayed transfers of care (DTOC), increased demand on A&E departments, rising hospital re-admission rates and growing demand for home care, and residential and nursing placements.
With budgets shrinking, these organisations cannot afford to simply accept this situation – they must look for ways to better manage, reduce and delay demand. Given their frontline role, carers are an essential component of any drive to tackle demand differently – but there is a fundamental stumbling block to involving them. Not enough is being done to identify carers – many do not recognise themselves as such – or to support them.
One key opportunity for identifying carers is when the person they are caring for presents at A&E, or is admitted to hospital, and many CCGs, Trusts and local authorities are now recognising this. Many have provided funds for carer organisations from the voluntary and community sector to operate within acute settings. However, these organisations are still reliant on A&E and ward staff to support the identification of potential carers.
Such staff need to have knowledge of what carers organisations can do, how they can access their services, and an understanding of how their work can help to avoid re-admissions or the need for someone to go into more specialist support such as residential or nursing care.
Thinking about carers needs to be an essential part of capturing initial information on a person who requires care , as well as part of discharge planning. As already highlighted, not all people will identify themselves as carers, and indeed, not all patients may recognise that a family member, partner or friend is about to become one. A&E and ward staff therefore need to be skilled at talking to patients and teasing out who could support them in order to enable a return home. They also need good training and positive messages around carers to be re-enforced. Resources are available to support carers, but more could be done to identify them during times of crisis.
Carers are an absolutely essential resource – the health and social care systems simply could not function without them – and this importance will only grow. One estimate suggests that the number of disabled older adults (65+) receiving informal care in England will increase from around 2.2 million in 2015 to around 3.5 million by 2035 – an increase of 63%.
Carers could then have a growing role to play in an increasingly critical task – managing demand. It is therefore vital that both systems work in partnership to identify and support the hidden parts of this workforce.