We move on to agenda item 3, which is two evidence-taking sessions on the Carers (Scotland) Bill. I apologise for the delay, but it was important to finish stage 2 of the Mental Health (Scotland) Bill.
Until now, our oral evidence has mainly focused on carers, but today it is the turn of local authorities and health services. We welcome to the committee Councillor David O’Neill, president, and Beth Hall, policy manager for health and social care, the Convention of Scottish Local Authorities; Paul Henderson, service manager for Perth city, mental health, drug and alcohol, Perth and Kinross Council; Penny Nowell, joint planning and commissioning manager and carers strategy lead officer, Dumfries and Galloway Council; and Alison Jarvis, community nursing programme manager, NHS Lothian.
We will go directly to questions.
11:15
A key feature of the evidence that we have heard from carers is on whether eligibility criteria for support should be set locally or nationally. The carers organisations believe very strongly that only if some element of those criteria is set nationally will there be equity and certainty for carers. Many of them pointed to the situation in social care more generally, where over the years eligibility thresholds have been raised as resources have become more constrained, and they are concerned that resources will be focused on crisis care to the detriment of preventative support.
I am aware that in its evidence COSLA puts the opposite view and suggests that we focus on the local setting of criteria. However, there was some variation between the councils. What are the panel’s thoughts on the matter? Do you have sympathy with the views of the carers organisations and do you think that they will get equity if criteria are set locally?
I have sympathy with the view that has been expressed and I understand why carers would think that way. However, we have lots of evidence that shows that the closer you take decisions to the service user and the community that the services are aimed at, the better the outcomes you get. Setting out the criteria in legislation will reduce flexibility, innovation and the ability to deal with people on an individual basis. Our client base is made up of people who are very diverse and who have different needs and aspirations, and to have one set of eligibility criteria for the whole of Scotland would not serve them well. I understand where the carers are coming from and that there should be a focus on outcomes—the outcome that we want to achieve for individuals—but it would be counterproductive to try to find a one-size-fits-all approach for every community and individual in Scotland.
I agree with those comments about local democracy and the fact that councils should be able to set their own criteria. We find that we are already making allowances for carers, particularly in the preventative approach that we are taking, and we would not want to have criteria that missed that out. Our approach is based on a locality model, in which we listen to the needs of local carers, and our fear would be that a single set of criteria would drive that away.
I can see both sides of the argument. I understand what people are saying; although variation is good, a degree of consistency, too, can be important. I understand where both the carers organisations and COSLA are coming from, and I could be persuaded either way.
I understand the concern about the need for consistency, but that can be addressed through being consistently transparent about how eligibility is approached. In the context of finite resources and demand that will always outstrip the available resource, there must be some way of deciding who gets what and of prioritising and targeting resources. That needs to be done locally, because demand varies not just between councils but within council areas and over time. It is constantly fluctuating.
As a result, councils need to be able to adjust eligibility criteria at a local level in order to manage demand. As David O’Neill has said, that is how we get the best fit between demand and provision and is the best way of ensuring that resources are used flexibly to meet outcomes. Trying to do that at a national level would be like using a much blunter tool, and it is not the best way of getting the most flexibility and the best outcomes for individual carers.
Like Alison Jarvis, I can see the carers’ point of view, but I also fully endorse what my colleagues have said about councils needing flexibility. Dumfries and Galloway is a very rural region and we need to be able to flex to take that rurality into account. A lot of people who are retiring to the region do not have family connections and so on, and we need to find ways of supporting those carers, depending on priority of need.
I, too, can see both sides of the argument. Personally, I think that, not just in this but in lots of fields, decisions are often best made at as local a level as possible. That said, although it is a cliché, I understand the concerns about the postcode lottery that quite a lot of carers have expressed. They are appreciably concerned about that.
In the past few years, authorities and health boards have seen the implementation of the national carers strategy and the carers information strategy. In Dumfries and Galloway, quite a lot of services are accessible to all carers; there is information and support on specific conditions such as dementia and other mental health conditions, and there is generic region-wide support. That situation will not change.
I agree with that. From a practical—and a value—point of view, I think that, because we are supporting more older people in the community for longer, we are, by necessity, having to support more carers. We are doing that already, and we are addressing carers’ needs in a more preventative way, because, in the majority of cases, they are the people who are keeping people in the community for longer. As I have said, we are already going down that route out of necessity.
We have been going down the self-directed care road for the past while now. If we do something that specifies a particular part of a service for the service users for whom we are trying to provide, that kind of contradicts what we are doing with self-directed care, the purpose of which is to give people flexibility and decision-making powers.
We have a couple of supplementary questions on that area.
On flexibility, my understanding is that even if there are national criteria, there will still be some flexibility to ensure that areas such as Dumfries and Galloway or, indeed, my constituency of Aberdeenshire West are covered. However, I have a problem with the local aspect. Having worked in social care for more than 30 years, I am aware of the restriction of resources. With regard to outcomes and prevention, which has just been mentioned, my concern is that the bar gets raised too high. That is what has been happening in local authorities for years; when the needs increase and you have less resource to meet them, you raise the bar. However, if you raise the bar too high, people do not get a service, and we need some assurance that we are providing a level playing field across all authorities to ensure that we are meeting carers’ demands.
What we are picking up is that in some areas eligibility criteria are being used to manage diminishing resources.
That is what I am getting at, convener.
I understand where people are coming from on that. Our support for carers operates according to local needs, but if you set nationally agreed criteria, some people will get a lesser service than they currently get. Local authorities have, in conjunction with service users, been able to design services that are suitable for them, but if there are national criteria, they might have to impose something less suitable.
Nonsense.
No, it is not nonsense.
I am not having heckling, Dennis—not even from you.
I was following up on my question, convener.
I heard a wee shout there—we are not having that. Other people want to contribute to this discussion; indeed, I see Bob Doris, Mike MacKenzie and Rhoda Grant. If you want to ask a follow-up question, I ask that, first of all, we get a response to your previous question from the panel.
David O’Neill has already responded. Does anyone else wish to?
Following on from my last comment, I make it clear that this is about a preventative approach. We are now supporting people who you might say had fallen outside the community care eligibility criteria, and we recognise that if we do not put preventative services in place now, we will end up having to provide more crisis support later. That is a key factor, particularly in relation to supporting carers. What we are finding is that, if we do not put the support in place now, it has to come in later as crisis support, which requires more costly services.
Going back to the national criteria and where the bar should be set, I think that if you have national eligibility criteria that guarantee that carers’ needs above a moderate level, or whatever the level might be, will be met, it becomes necessary to meet any increase in demand by shifting resource from other social care groups in order to maintain the absolute bar or level that has been set for one particular group—in this case, the carers. I think that that was what David O’Neill was trying to highlight. Within the context of finite resources, protecting provision at one end means that resources have to come from somewhere else when demand increases. That brings me back to my earlier point about the need to be able to respond to the fact that demand fluctuates. Let us face it: we are all dealing with a situation in which resources are finite.
I call Bob Doris.
I did not realise that I was going to get in so early, convener. That is good.
I am sure that it is not deliberate, but I wonder whether we are conflating eligibility criteria with locally provided resource. For example, it has been decided nationally that any young person at primary school who stays three miles away from their school must get a bus pass. However, some local authorities have decided to provide a pass to young people who stay two miles away, and there is a cost implication to that. What is the panel’s view of the notion of eligibility criteria that are set nationally in consultation with COSLA and other local authorities and stakeholders to identify the carers who should definitely be provided with a service? Local authorities can then prioritise at a local level if they so choose and have local discretion to give added value to that.
I have to say that I am picking up resistance to any direction at all from the centre. Given that, as MSPs, we get the phrase “postcode lottery” thrown at us all the time, we expect national standards on, for example, who pays prescription charges. In that case, it has been decided at a national level that nobody pays, but I have not heard anyone say that the fact that one part of the country cannot decide whether to charge for prescriptions goes against local democracy.
In the context of eligibility criteria that were nationally set and consulted on, the question would be about who qualified for support rather than what that support would be. There would be a permissive power to allow local authorities to go further if they wished. I understand the financial pressures that local authorities are under, but the carers whom I represent will see a defensive approach from the witnesses here this morning. In the spirit of the way in which I am asking my question—that is, in terms of certain key benchmarks that we can all agree nationally for carers, irrespective of whether they live in an urban or rural area, and without saying what the localised manifestation of that support would be—can you at least concede that we should perhaps consider some form of national eligibility criteria and then a permissive power for local authorities to go further if they wish? We would not be stipulating the service that you had to deliver, just putting in place some sort of gateway mechanism to ensure that carers, irrespective of where they were in the country, got a degree of service.
My understanding of the bill is that it sets out a duty; indeed, it is prescriptive even to the extent that it includes what would normally be covered in guidance. As a result, it will remove flexibility; it is seeking to design a one-size-fits-all service, and we do not think that that is a particularly good way to go for individuals. Services have to be designed to suit the individual and cannot be one size fits all. If there were to be legislation that prescribed the strategic outcomes, that would be fine, but, as I understand it, the bill as it currently stands is prescriptive.
11:30
Expanding on that, I think that there is a bigger issue about democratic accountability with regard to use of resources. Prescription charges, for example, are not dealt with at local level, whereas social care is the responsibility of local authorities, which have to be democratically accountable for the resources that they invest in that respect. Part of that accountability and responsibility means coming up with a way to decide who gets what when there is a finite amount of resource. If the committee is picking up a theme about that needing to happen at a local level, what is probably underpinning it is the fact that, as I have said, social care is the responsibility of local authorities. The other issue is that moving away from that model of democratic accountability for the use of resources—and setting aside for the moment what that means for councils—means that one group of people who use social care services will have nationally defined entitlement while another will have locally defined entitlement.
It would be useful to be clear what we are talking about. When we talk about eligibility, we are talking about an eligibility framework that consists of eligibility criteria and eligibility thresholds. Those are two different things, and the distinction is quite important. The criteria are about how we categorise need; because that needs to be transparent, we categorise it as critical, substantial and moderate. In a sense, that system already operates at a national level, in as much as we have national eligibility criteria that can be used. As for thresholds, they are about deciding at what level those needs will call for the provision of services. From a local authority perspective, the difference between the two is very important, and we are saying that eligibility thresholds need to be set locally.
It is not entirely clear in the bill what is meant by the term “eligibility criteria”. We would understand that to mean how we categorise need, rather than the thresholds that we use to decide whether someone is eligible for a service. There is a lot in there and if, in our responses, we seem to be coming down on both sides or are perhaps not being clear, that might be why.
I do not want to appear defensive; we are very supportive of carers and wish to support them more. As Beth Hall has said, it is important to clarify what is meant by “eligibility criteria”. For example, there are national eligibility criteria for adult care, but within those criteria, councils can set the thresholds. For us, the issue is the permission to set the thresholds rather than what we have to provide being fixed at a national level. It is important that councils have the local accountability to set their own thresholds.
Again, I am sorry if we appear defensive, but our social work departments are struggling to balance the books in order to deliver a range of services to meet very diverse needs.
I have spent a lot of time trying to model what kind of costs we are looking at. I know that that takes us further than eligibility criteria, but that process is really challenging because, even in a relatively small authority like Dumfries and Galloway, we do not know all the carers who identified themselves as carers in the last census. We do not think that that is relevant—or rather, we do not think that the census is accurate, because we have identified even more carers through other means. If we do not even know the figures, it is hard to model these things and come to some idea of the kinds of costs that we are looking at.
I will not reply on that point, as it is a separate question and, as the convener pointed out, I was asking a supplementary.
I thank Ms Hall and Mr Henderson in particular for giving a bit of light and shade to the discussion about national eligibility criteria. The bill says “may” rather than “must”, but there is more discussion to be had about what those might look like.
I want to go into the financial aspects of this. There seems to be an issue about how you gauge the criteria. COSLA’s submission points out that the financial memorandum uses the figure of £300 for a short break, although COSLA’s estimate of the average cost is closer to £967. There will be a whole range of figures depending on where someone lives in the country. Given that we are not sure how many carers will be eligible or what costs are to be accrued, have councils done any work on what the costs will be? Some of the services are already being provided to carers, so surely there must be an idea of costs, using the census and other work. Also, the bill is not based on every carer being covered from day 1, which concerns me, but is based on increasing percentages being covered going forward, so the costs will increase over time. Has any work been done on realistic costs or on where the financial memorandum might fall short? What work does the committee need to do when examining the bill?
We have been working with our members, asking them for information on costs. We have shared that information with the Scottish Government, which has considered that, along with data provided by colleagues. As the committee will have gathered from COSLA’s submission, we do not agree with the figures in the financial memorandum. There are three main reasons for that: we do not agree with the unit cost of assessment that is presented, we are concerned about the speed at which carers may come forward following the announcement of the new duties, and we are concerned about the total numbers.
On the unit cost of assessment, when we initially had discussions with the Government we were happy with the figure that was arrived at. We took information from councils, removed the outliers and looked at average costs and the figure came out at £176 per assessment. However, in the financial memorandum, £176 per assessment was presented not as the mid-point but as the top point, with other costs below that. We are concerned that that is not realistic and is not a reflection of our understanding of the costs.
Rhoda Grant spoke about carers not being covered immediately by the bill. In the sense that the duties of the bill would apply across all 759,000 of Scotland’s carers from day 1, all carers will be covered immediately. We then find ourselves in the business of trying to figure out how many of those 759,000 people will come forward and how quickly. That is very difficult, as we recognised in our submission to the Finance Committee.
We looked at other areas of service provision where there is a universal entitlement—the bill will introduce a universal entitlement to a carer’s assessment, although not all people will take that up. If you look at how demand built for free personal and nursing care, for example, you see that the rise was much sharper than is profiled in the financial memorandum to this bill, where the profile is low and slow.
Similar legislation has been introduced in England but has only just come into force. The Government had to revisit its impact assessment—the UK version of a financial memorandum—twice, to revise the figures up. That indicates that demand is coming through quicker than expected in England.
We are saying that there is a high risk that demand will outstrip the resource that is made available, as more carers come forward or as carers come forward more quickly. At the moment, all that risk lies with local authorities and with carers, as they will have increased expectations of what can be delivered.
You asked about the committee doing further work. Our further work has involved asking the Government to revisit the figures and agree with us a model for estimating costs. They cannot be certain; we just want to agree a model. We want to monitor the true cost of implementation and for the Scottish Government to fund any excess requirement, if demand exceeds capacity. That would be a more appropriate sharing of risk, but so far we have been unable to secure agreement to all that.
That was quite a long answer, but there are many unknowns and it is a difficult area.
In Dumfries and Galloway, we have tried to model some of the costs. We did an initial, basic version when we responded to the COSLA questionnaire back in January and I have revisited it a number of times since. When I discussed it with my colleagues in the third sector, they told me that I had forgotten to take into account the fact that we do not have the capacity in the third sector at the moment. That is a significant issue to take on board. Although we welcome the growth of the third sector in helping us to deliver support to carers, it obviously has its processes and so on to go through, which must be taken into consideration.
In Perth and Kinross, we have done some financial modelling, based on the stats that we have. Our unit cost for completing a carer’s assessment came in at £215, which is much higher than the high-level cost that is presented. We asked a social worker how long it took to complete a carer’s assessment and they said that it was a day and a half. The unit cost was a proportion of a social worker’s salary, based on that figure.
We have concerns. We have approximately 3,600 registered carers, yet we know from the 2011 census that 13,000 people identified themselves as carers. We have extrapolated from that what we would need if every one of those 13,000 people needed a carer support plan, which is another £200,000.
We have been working on the care costs of providing respite or replacement care, although it is quite difficult to get a sense of what they would be. We are more concerned about the waiving of charges and how that is interpreted. Does that just include some form of respite care? Do you start looking at day care as a form of respite? That is one of our concerns on that area, although maybe that is going off the subject a bit.
The question was a supplementary flowing from the question on eligibility criteria, so we will leave it at that. I will bring in Mike MacKenzie.
It is all right, convener. We have explored the area thoroughly.
There is just one question that I would like to ask about the calculations of cost. Has any calculation been done on the benefits of proactive engagement with carers or the preventive benefits that might flow from early engagement with those carers who do not require anything at present, but who might do in future?
11:45
A cost benefit analysis of that has not been carried out, but in our plans, particularly when it comes to information and advice, we think that such preventative support would stop a crisis later on. We have not worked out an amount for that, but we know that it is something that we need to do. We support that element—it would help to provide information, support and advice early on—but we have not done any calculations about the extent to which that would alleviate things.
I did such a calculation—it was just a back-of-the-envelope calculation that involved thinking about how many carers we have in Dumfries and Galloway and knowing how many carers we have who care for more than 50 hours. An amazing number of care hours are being delivered every week. I came up with a staggering figure of millions of care hours per year. If that is translated into an overall cost using a basic unit cost of £18 an hour, it is a huge amount of money—even at £10 an hour, say, it is a huge amount. That is the amount of money that is being saved in health and social care provision. We undoubtedly all see working in partnership with carers as a vital element as we move forward with the delivery of health and social care.
This point does not relate to the convener’s question, but in the discussion about preventative care the idea that there are small interventions that can make a big difference comes up time and again, not just with patient groups on long-term conditions but with carers. The concern is always that, if the focus is on the high end of caring or on the discussion about eligibility criteria, we will miss the opportunity for preventative interventions, whether in health or social care. If we think about the push towards preventive and anticipatory care, we must invest at such relatively low levels, because that will make a big difference.
A final point is that I have often found that if carers have the knowledge that support is available, they do not access it. At one point in my life, I was a carers support worker. I tried to encourage carers to come to mental health support groups, but I think that I used to meet more people in Tesco than I met at the carers support groups, because people would say things like, “I’ll come along when I need to—I’m sure you need to support someone else who has a greater level of need than I have at the moment.” People felt that that safety net was very important for them.
Did COSLA do any work on the possible benefits of the bill in terms of early intervention or prevention?
In common with Paul Henderson, we have not done a considered piece of work at national level to look at the financial benefits of those outcomes. That is quite complicated to do in a robust way; it involves looking at things such as social return on investment models. I think that all the work that underpinned the joint carers strategy and the joint young carers strategy took as a starting point consideration of how more preventative approaches could be maximised in the knowledge that that would take demand out of the system later on, which is better for everyone.
In addition to those two pieces of work, there was the work that was done on the change fund. Part of the change fund was to be used to improve support services for carers. The premise for that was that it was very much about shifting the balance of care and looking at much earlier intervention.
Did local authorities achieve that with the change fund, or was that another case in which the money was used just to meet the current demand rather than to pursue the preventive aspect?
No. I have not brought figures on the change fund today, but there was a focus on looking at and reporting on what that money went on and that is in the public domain. I am sorry that I cannot give you a summary read-out today, but the information is available.
It is always difficult to cost something that has not happened, whether it is that someone did not go into hospital, or that their length of stay in hospital was shorter, or that there was not a complaint, or whatever. That is a problem with all preventative spending. A lot of the change fund spend was for things that did not happen, in a positive way. To cost that and show the benefit, or even to prove it, is always a huge challenge.
We estimate that most of the support we provide is not discretely provided for carers. It is provided for the service user or the client, usually in some form of day care, and invariably benefits the carer as well. We estimate that we spend approximately £800,000 on carers specifically, but we know that we support carers in many other ways with up to about £14 million for day care and so on.
It is quite hard to say that this particular amount is for the carer and this is for the service user or client. That is what made some of the financial modelling figures we were producing for the COSLA submission quite difficult. We had to try to extrapolate parts of spend. The amount that we spend for carers discretely is not all that we are providing for carers.
I am interested in discussing finances.
Alison Jarvis talked about innovation, using money more cleverly and not allowing eligibility criteria, irrespective of where and how they are set, to squeeze out innovation.
A lot of carers are looking after elderly loved ones. We have health and social care integration, with integrated boards at the forefront now. I know that this is not specific to the bill, but I wonder whether there needs to be some reflection on the opportunities that that brings to have more early intervention for carers, using not just local authority cash but the whole gamut of cash that now comes on to the table from health and social care integration. Even some brief comments would be helpful, to get that on the record. Also, should there be some cognisance of the need to promote best practice, either in the bill or in the regulations that follow?
It is always good to support innovation, it is always good to support early intervention and it is always good to support anticipatory care. The challenge is that resources get sucked into dealing with crisis care and the people who are most in need. That is a dilemma in all sorts of areas. It certainly is in healthcare.
The change funds have been useful, but some have been more useful than others. We have been more successful with some than others. As the convener hinted and Alison Jarvis has just said, when the aim is to disinvest from something to put resources into what the change fund has shown to be successful, a care crisis that comes along can be particularly difficult to handle. Should we nevertheless do it? Should we be doing more in the way of prevention? Absolutely.
I could not agree more about harnessing the resources of a wider range of services and using the opportunities that are afforded us through integration. There is a lot that can still be done to use resources in a smarter way. We know that there are challenges around eligibility and finite resources.
We were keen to see greater consideration of self-directed support approaches in a health context. The needs of someone who is in receipt of services under integration should not have to be categorised into social care needs, with flexibility through the self-directed support option, and healthcare needs, where SDS does not apply.
When the Social Care (Self-directed Support) (Scotland) Act 2013 was going through Parliament, COSLA made a case for that duty to be extended to the NHS. That did not happen, but that does not mean that further work could not be done through guidance and through future bits of legislation harnessing those opportunities. One of the things that we have learned, which underpins self-directed support, is that sometimes a carer is accessing a very expensive service that is not actually the best way of meeting their needs and that, if you give the carer a personal budget, their outcomes will be met in a far more innovative way than we have managed previously.
There are lots of examples of using the change fund and the integrated care fund to provide preventative services. We have set up carers cafes and dementia cafes. There are carers workers in the hospital to support that part of the discharge. More recently, we have developed carers support workers to be part of an integrated care team, particularly to identify people earlier, before they are in crisis. We put in respite and replacement care before they end up in crisis, because crisis breakdowns cost us huge amounts of money.
And they cause the carer distress.
Absolutely.
I will not follow up on self-directed support. It has not worked well at a local level in Glasgow. I will not indulge myself by telling you why I do not think that it has worked well in the slightest—it has withdrawn choice from a lot of vulnerable people whom I represent. Is there an opportunity for the bill, as scrutinised and amended, to focus the mind of the new integration boards more than might happen otherwise by using wider moneys to support carers to do some of that preventative work? You do not have to answer that—it is up to you.
I would support that. It was disappointing to see something that was mostly targeted at a duty on local authorities just as we were about to get into the discussions and work around developing strategic plans and locality plans. I am pleased that carers are being considered—they are being considered in Dumfries and Galloway—but it would be good to see that beefed up a bit more in the legislation.
Dennis, will you help me out by pursuing the questions that you have been asking about getting it right for every child and young carers?
Yes. I will explore the setting out of a duty to undertake appropriate assessments. Is the current legislative framework adequate or do we need to improve it for our young carers?
Our approach has always been to say that young carers need to be treated as children and young people first and as carers second. It is important that young carers have the same right to have their outcomes met as other children and young people have.
We have a concern about how what is set out in the bill fits with GIRFEC and its outcomes approach. Having a separate young carer statement will mean that a young person has two parallel plans, which will have an impact on holistic planning and co-ordination of support—everything that GIRFEC is trying to achieve. There is a risk that young carers will be put in silos and that there will be a subset of needs that is treated differently.
If the decision is made to proceed with introducing the young carer statement, we would like the statement to be part of the child’s plan when one is in place. We should not go down the road of having separate plans for subsets of needs.
That also raises the question whether, if there is a separate plan for young carers, there should be a separate plan for young people with disabilities or from black and minority ethnic communities. A separate plan would run counter to the policy direction, which is about focusing on outcomes for children and young people and ensuring that those are delivered, irrespective of the needs that give rise to them. That is where our thoughts are at present.
12:00
It is important that we think about the transition from young carer to adult carer. The transition points are always tricky, but they present an opportunity, too. We should consider how the transition process works for someone who is moving away from being a child under the GIRFEC strategy. It is important that we pick that up.
To draw on that point, some of the feedback that I have had from carers centres has focused on the value of the young carer statement as the person moves towards becoming a young adult carer. However, I have also had feedback suggesting that terminology such as “statement” feels a bit official—like a police statement, for example—whereas the GIRFEC plan is perhaps less controversial.
Would having a statement in place highlight the fact that someone has a lead or key worker? That could be achieved through GIRFEC, but having a young carer statement in place would facilitate a process that is not currently provided for and would perhaps help with the transition period. Do you agree?
The key point is that the provision for such a lead is not in place. Our concern relates to the fact that a major new piece of legislation, the Children and Young People (Scotland) Act 2014, will come into force in August next year. It will require a named person for every child and a clear focus on ensuring that the child is safe, healthy, achieving, nurtured, active, respected, responsible and included, according to the SHANARRI outcomes. That leads us to question whether a separate bill is needed, given that it will be passed just before the 2014 act, which will cover that area, comes into force. That runs the risk of confusing the situation and making co-ordinated planning for young people more difficult.
Convener, I have a supplementary question and a substantive question. Can I ask both?
Yes.
A point has been raised about how the named person requirement and the child’s plan will interact with the young carer statement. According to some of the evidence that we have received, young carers are reluctant to have the statement shared with their named person, especially if they are caring for someone with drug and alcohol problems. They are not clear that they would want that information to be known—for example, by their school headteacher. That would depend on how sympathetic a person might be on the issue.
If a young carer wanted their information to be confidential, how would it be dealt with? Could services be set up to support someone and highlight to the named person that the young person is a young carer—that is important in a school setting so that adjustments can be made to allow the young person to benefit from education—while not including or passing on some of the more personal aspects of that caring role?
The key point is that the child or young person should be in control of the information and of which details are shared with whom. I am sure that the witnesses who will give evidence in the next session will go into how that all plays out with regard to the 2014 act.
The quick answer to your question is that, irrespective of whether we have a separate young carer statement, the approach to the named person and the child’s plan and the way in which information is shared among the professionals involved should be predicated on involving the child or young person in deciding what information is shared with whom.
My other question is about information and advice services. I have spoken to groups of carers and I know that some services have been set up in an ad hoc way by people who have been carers and have noted a lack of information and advice for carers in their communities. A number of organisations in the third sector provide such services, but there is a concern that, because the bill places a duty on local authorities, they will bring all that work in house and some of the good local knowledge will be lost.
I am looking for a bit of comfort for those organisations. I feel that, if those services are out there, it is for local authorities to support and develop them to ensure that they provide the services that the bill requires. Will you give me some thoughts on that?
When we in Perth and Kinross Council have consulted carers locally, information and advice has come up again and again. In response, we are commissioning an information and advice service from the independent sector. We do not necessarily see such a service as lying only within the local authority, but nor do we have independent sector services that are doing that work. We are commissioning a special service to ensure that we provide that information and advice. It will not be a local authority service; it will be a partnership.
Ensuring that carers get the right information and advice at the right time is a challenge. We, too, commission the third sector to deliver that. Through the carer aware training that the third, independent and statutory sectors are delivering—we are starting to deliver it to people such as hairdressers—we are trying to make everyone aware of where they can signpost people to. Unfortunately, that will always be an on-going challenge. We find that, particularly in rural areas, people can be caring for a long time before they find out that a simple service is available. I hope that the adult support plans will help to benefit carers in that way.
The public sector does not have a monopoly on wisdom or knowledge. If somebody out there, such as in the third sector, knows what they are talking about, let us use them.
We have good evidence that lots of carers out there do not realise that they are carers or what services there are. I mentioned information and advice services, which there are not enough of, given what we need to do.
Another issue is people declining carer assessments. We have about 625 carers a year declining a carer assessment when the client is assessed. Why is that? It might relate partly to information and training for social workers, but it is not enough just to provide an information and advice service. We need to do a lot more among our workforce and the public to raise awareness of carer issues.
There is so much information and advice out there, so we should not reinvent the wheel. Whether the provider is NHS 24, NHS inform or local services, the information and advice needs to be gathered in one central place so that people know where to find it, and people need to be signposted. Often, the information is out there, but people do not know where to look for it or, as Paul Henderson said, they do not realise that they are a carer and that there is information and support that would make a difference to them.
Alison, you are representing the national health service. What is its role and what part does it play? There are critical points for the identification of carers that the committee has heard about lots of times, which involve discharge policy and unplanned admission to hospital. Does that identification happen, should it happen and what responsibility should the national health service have for identifying carers and informing them at that point?
The health service has a huge responsibility, which we have touched on a bit. The issue is hugely complex. Some of it concerns self-awareness and ensuring that staff make the most of opportune moments to identify carers, because people often do not realise that they are carers.
I draw the committee’s attention to research that was done with primary care and carers of people who are at the end of life or who have advanced illness. We would think that that group of carers would be easy to identify and that those people would see themselves as carers.
However, in a relatively small study that was done in Edinburgh, there were three main barriers to identifying carers. One was that becoming a carer is often a gradual process. That is true for lots of illnesses, such as lung cancer, dementia and so on; there are not many situations such as a stroke when people are catapulted into a caring role. More often the process is gradual, and people do not appreciate that they are carers until they are quite far down the line. Often as the cared-for person’s condition deteriorates, the caring role becomes so engulfing that the carer can no longer separate out their needs as a carer from those in looking after the cared-for person.
Another issue is legitimacy. There is ambiguity about the legitimacy of the carer’s needs not only in the carer’s mind but in the professional’s mind. General practitioners and hospital staff often think that their focus has to be on the care recipient. Lots of work has been done in NHS Lothian and in other board areas on staff awareness training, but sometimes we focus only on the cared-for person. Carers are so focused on the cared-for person that there is a need to be explicit about the legitimacy of carers’ needs.
It is assumed that, if we open up a universal right, huge numbers of carers will self-identify. That fairly small study showed that the vast majority of people who were identified as carers did not self-identify; they were identified through opportunistic conversations with a range of people in a practice, such as reception staff, GPs and nurses. People are often hesitant to identify themselves as carers.
There is a lot of work to be done on staff awareness and confidence. Sometimes people do not ask because they are anxious about opening up a Pandora’s box of needs and service demand that cannot be met. However, that should not be the case; often what is needed is just a recognition and a validation of what carers are doing, rather than large service inputs.
I will bring in the local authorities. There is a big responsibility for all this on the national health service. Does it fulfil that responsibility? Can I provoke a response?
For instance, as an anecdote, I arrived at a situation where emergency services had been called. If I had not been there that day, that relative would have gone into hospital. The presence of a carer and the reassurance that it gave prevented the hospital admission; the precautionary, default position was that that 88-year-old person would have gone into hospital that day as a result of a fall in the house.
The role of carers relates to notification of admission to hospital and discharge from hospital. Whether we are working effectively with that role and whether the bill will encourage doing so is the wider question today.
I thought that you were asking me to have a fight with the NHS.
I thought that I would liven the session up—we have only about five minutes left anyway.
In the past we have been particularly poor at joined-up working. Health and social care integration is absolutely the right thing to do. I think that five pilots have been running for about seven years. In my neck of the woods—Ayrshire—the health and social care partnerships are up and running, and the rest of Scotland is coming along. That will go an awful long way to addressing a lot of the issues.
Should attention be paid to the role of carers in health and social care integration? Absolutely, because carers play a vital role. There is recognition of the amount of money that is saved in the public sector because of the role of carers, and they deserve to get our support in return.
12:15
I will come in on the back of what Alison Jarvis said. We find that carers might be told about the support, information and advice that they can get and where they can access that, but they often move forward with it only when they are told about it by another carer or by a professional such as a GP or primary care worker. We tend to forget about the influence of those people in motivating people to lift the phone and make the initial contact. For a carer in the middle of the complexities of life generally and with caring responsibilities on top of that, finding the time to do something as simple as lifting the phone can be challenging. Integration needs to have a far greater role in the bill to bring all those things together.
Locally, the health service supports carers, particularly through the change fund. For example, we had health check workers for carers and we had a care support worker, as I previously mentioned, who was based in our local hospital and did fantastic preventative work. From our point of view, it would be great if there was more of a health presence in the bill, because it seems to be almost purely focused on the local authority, which jars with the integration agenda, as has been mentioned.
Under the change fund we, too, offered carers across the region a health and wellbeing check, followed by mentoring support if it was identified that they needed extra support on things that would help their health and wellbeing, such as losing weight or stopping smoking. Unfortunately, that support came to an end when the funding from the change fund ran out.
It is the role of primary care to give such support, because carers are also patients of GPs. That support could have been picked up by primary care but we have failed—in Dumfries and Galloway, anyway—to follow that through, at least at the moment.
I will flip that on its head for a second. Rather than ask what we would have liked to see in the bill as duties on health boards or the direction on health, we should think about our ambitions for integration authorities to result in more flexible and better integrated services, improved locality planning and the delivery of greater involvement for communities in how services are shaped locally.
COSLA’s response outlined key concerns about where we think that the bill is too prescriptive and restrictive. For example, although duties will be placed on local authorities, the services will be very much devolved. We have concerns about that on behalf of health as an integration partner.
To flip the issue on its head, we see integration authorities as the way to drive forward improvements for carers. We outlined in our submission concerns about there being too much prescription of processes and inputs and not enough focus on outcomes—that applies to health, too.
I have a question for all the witnesses. The bill places a duty on local authorities to have an information and advice service for carers, rather than local authorities just being able to establish one. Would an information and advice service provide opportunities for carers and others to take up available resources? Should there be a duty to establish an information and advice service?
Can we widen that question? We discussed advice earlier. As well as the issue of resources, there is the question of how capacity would be affected by such a responsibility. We have been through the money thing. We will argue that we do not get enough from Westminster; you will argue that you do not get enough from the Scottish Government. That negotiation will take place somewhere other than in the committee.
Will we be able to deliver on the expectations that such a requirement will create, given the capacity issues that exist? Dennis Robertson mentioned access to good independent advice, but there are also the assessments that will need to be carried out and the increase in the number of people who will be involved. What calculations have been done on the capacity issues and whether the bill’s ambition will be delivered? When it comes to outcomes, how will a duty to provide information and advice make a difference to individuals?
Local authorities already have information and advice duties under the Social Care (Self-directed Support) (Scotland) Act 2013, which also apply to carers. We recognise that we need to get better at providing information and advice, but we are not sure that the bill needs to layer additional duties on top of the duties under the 2013 act.
Greater investment in information and advice will make things better. It is a case of ensuring that the information and advice is accessible for a range of groups. We were surprised that additional duties on information and advice were included in the bill, for the reasons that I have outlined.
Information and advice is already dealt with in the national carers strategy. As I mentioned, at local level carers tell us again and again that they want an information and advice service, which is why we have commissioned one. They say that they want a single telephone number and a single website that they can use to get information. We feel that that is already part of our strategic objectives. Providing information and advice is essential to meeting the need for a preventative approach. That is part of our plans, and I am not sure whether a duty is needed, because that is already a strategic objective.
Is the point that we have an information and advice service in some places but not in others? In the places that have it, it is working well, because there is a hub or a one-stop shop, but other areas have no such facility. Paul Henderson has identified good practice, but that good practice might not be replicated in other areas.
Perhaps the committee has a biased sample here. A desire on the part of carers for information and advice comes up regularly. As I said, the information and advice might be out there, but people do not always find it.
As there are no other questions from the committee, I thank the panellists for attending. I am sorry for the delay in starting. We have your written evidence, which is clear and will assist us in our deliberations. Thank you for joining us.
12:23 Meeting suspended.
We have delayed our second panel of witnesses on the Carers (Scotland) Bill long enough. I welcome Trisha Hall, social worker and manager, Scottish Association of Social Workers; David Formstone, convener of the community care standing committee, Social Work Scotland; Fred Beckett, north-east social work carer team manager, Glasgow City Council social work services; and Tam Baillie, Scotland’s Commissioner for Children and Young People. We will move directly to questions.
The bill talks about young carers and about removing the caring role from pre-school children. Is that the right approach? Is it possible to do it, and should it cover children who are in school as well as pre-school children?
I absolutely agree that it is the right approach. For children who are under school age, we have to approach this from the point of view that they are children first and carers second. There should be no acceptance of very young children, in particular, having a caring role. It may be that they can make a contribution, but I really do not think that it is feasible for them to have a caring role. Even for children above that age, we have to strike a balance between the child’s capacity and our expectations in relation to their caring role.
That is not to say that caring is always burdensome. Children sometimes thrive in caring situations, which can give them a sense of responsibility, but we have to make sure that they have a childhood. One of the complaints of children who are young carers is that they do not get recognition and, as a result, do not receive support. We have witnessed many children quite literally being deprived of their childhood because of overbearing caring responsibilities. If the bill does nothing else, it will help to redress that balance, which too often is stacked too much towards our expectations of the child in their caring role.
I agree. Particularly for younger children, there is a risk of formalising the caring role and almost placing a formal responsibility on them for their parent. An older carer may be able and willing to take on that responsibility but, particularly where there may be protection issues, there is a conflict there. Certainly, it is not desirable for younger children to have that caring role.
I absolutely agree that it is not acceptable for children to be working. The law is really clear that children under the age of 13 are not allowed to work in private enterprise or anything like that, and we should not accept them working in any other way.
By the same token, this is about making a sympathetic assessment of what is needed so that a child deemed to be in need does not become a child at risk. We need to be clear about the support systems that we are putting in. I hope that the bill will lead to people seeking support in situations in which they might have been wary about doing so previously for fear of getting an assessment that might have ended up with their child being taken away. The message has to be very clear that that is not going to be the case and that we are trying very hard to put in support mechanisms so that a child can have a childhood.
I absolutely agree with that. Having a child who is below school age take on a caring role is a sad indictment of our society; we should do everything that we can to alleviate that caring role and give that child a childhood.
You will be aware of comments from previous witnesses about the young carer statement and the child’s plan. The committee heard concerns from representatives of young carers groups about confidentiality and the child’s willingness to have their young carer statement shared with their named person. The child might have concerns, for various reasons, about the named person knowing that information.
Where should the line be drawn? Can the statement and the plan interact? Is there a need for two separate plans, or should there be just one? How can we best support young carers?
It is about developing a relationship and making it clear that information should be shared with—we would hope—the consent of the young carer. If there is no consent, the information should be shared only if it is deemed that the young person may be at risk. There are very clear guidelines on that.
It is clear that there will be a use for both the plan and the statement. For example, where a child does not have a child’s plan and is primarily a young carer, they will have only a young carer statement. Where there is an overlap and the child is thought to be in need or at risk, we would be concerned about the existence of parallel plans.
The point about confidentiality was made earlier. Keeping the child at the centre and consulting them is really important, but there will be occasions on which there will be a need to share information. For example, if there were concerns about a parent with drug or alcohol issues, and that information was being kept by one social worker as part of a carer statement but was not known to the named person or the lead professional under the GIRFEC arrangements, that would certainly carry risks. We would have to share with the child the need to breach confidentiality to ensure that the information was known to the named person and other people with a responsibility for protecting that child. Protection should be paramount.
The issue is tricky. The named person provision is central to new legislation—the Children and Young People (Scotland) Act 2014—which is about to come into force. As I understand it, under the bill, the issues for young carers will be highlighted through the young carer statement, but the whole purpose of the 2014 act was to take us down the route of having a single plan.
For children who have a child’s plan in place, that is fine—we can include the young carer statement as part of that. However, a much bigger group of children will have a young carer statement, and I am puzzled about where that sits in the overall legislative landscape.
Rhoda Grant has asked a tough question with regard to information sharing. The information-sharing provision in the 2014 act takes a rather light-touch approach—as does the guidance—to the question of which information should be shared and which should not be shared. Practice on that will develop, but there is a light touch because so much comes down to the judgment of the people who hold the information and who, on the basis of wellbeing, are expected—or, rather, are under a duty—to pass it on.
I checked the advice in the latest guidance on the parts of the 2014 act that contain the named person and child’s plan provisions. There are only two mentions of young carers, and both of those are examples. In fact, in the section of the guidance on the child’s plan, there is no mention of young carers. The bill may highlight that there is a gap in the considerations that go into developing a child’s plan. The issue is not just with the bill, but with the 2014 act, which is just about to come into force.
I am absolutely behind the notion of shining a brighter light on young carers, but, because of the all-encompassing nature of the 2014 act, we have to think carefully about how future legislation maps on to that landscape, especially as we are just at the start of that process.
There are a lot of issues to be sorted with regard to the named person. I support the named person, but it presents challenges when there is a desire—as there is in the bill—to focus on a group of children who have specific needs, such as young carers.
Does anyone have comments on what Tam Baillie has said?
On implementing the approach in practice, in Glasgow we are working hand in hand with the education service on that service having the child’s plan. We currently have a young carer’s assessment, but we will match the SHANARRI and GIRFEC indicators so that we build on the assessment in relation to the caring role.
Currently, we are looking to share information with the named person, whether they come to us first or come through education. We have issues around confidentiality and how we support young people—obviously, there is a tie-in with child protection.
We are concerned about duplication, although we think that GIRFEC is the way ahead and that we should be working hand in hand with schools, which are ideally placed to identify young carers. We have not got to the minutiae of how we can share the information—we will be guided on that—but clearly the direction of travel is for us to work hand in hand with the education service, and to base that work around the child’s plan.
I will pursue the point. You mention integration with the education service, but there is also integration involving child and adolescent mental health services, given that we are looking at local authority and health board integration. Do you think that, through the young carer statement, the bill will help children who come to the attention of CAMHS because of issues around caring?
I would go wider than just CAMHS. Essentially, any service that deals with adults but with which children are involved, such as those that deal with drugs, alcohol or substance misuse, mental ill health or disability, should consider the needs of children.
Most often, the issue of information sharing has come up in tragic situations where there have been child protection issues, but there is also the question whether a child is taking on any caring responsibilities and whether that is appropriate given their age and stage of maturity. Should we be making sure that those children have the necessary support?
Identification is principally done through schools and through GPs and health services, but specialist services that deal with some of our most vulnerable families may well become aware of children who are living in such situations and who are in need of protective measures or additional support. Children who are identified as young carers can be in some quite difficult situations.
The bill will help attune people to asking whether a child is assuming caring responsibilities, whether that is appropriate and what support should be put into that family, not just for the adult who requires support, but in the best interests of any child who is living in that situation, in order to meet their needs.
To that extent, the bill will help, because it will make people much more aware of what we think is a huge number of children who are not being identified right now.
I really struggled to get feedback from members of our association on the bill—that was partly because there has been so much new legislation this year on mental health, children and young people, self-directed support, public bodies and so on.
An example that stands out for me is that of the police, as the referring agency, recognising that a young person in a household is doing things that, in the police’s view, they should not be doing. Three of our members raised different scenarios in which the police identified that something needed to be done. The strapline is that it is common sense to see that; how common sense relates to support mechanisms is another debate.
There is more recognition of young carers’ issues now than there has been in previous years.
12:45
I echo Tam Baillie’s point. With the integration of health and social care, in a number of authorities, including my own, children’s services and adult services will be separated—they will essentially be two different organisations. I guess that the inclusion in the bill of a young carer statement and an adult statement should focus social workers’ minds, whether they are working in children’s teams or adult teams, when they come across children—or, indeed, adults—who have caring responsibilities. I certainly see the statements as a benefit of the bill.
The bill provides a significant opportunity for the future. Last year, we identified 300-odd young carers across Glasgow, through GP referrals, for example—predominantly, through the firefighting side of things. However, we do not see the most vulnerable children—the ones who are living with mental health issues or addiction. However, those children go to school. The Children and Young People (Scotland) Act 2014 and the bill give us an opportunity to pick up those children and do the preventative and anticipatory work, rather than the firefighting work. Dennis Robertson is absolutely right that, by the time they get to the CAMHS team, the children are very damaged and vulnerable. The bill gives us the biggest opportunity that we have had to get into schools—the key agency in a child’s socialisation—so that we can look at them holistically and make a difference in their lives. We need to get this right, otherwise, 10 years from now we will still be doing traditional, firefighting social work. We know who the children are, and we know that they are vulnerable. We have a huge opportunity to get education on board and work in a preventative and anticipatory way to support them for the future.
I have a supplementary on Mr Beckett’s point about cases in which the parents have addiction problems. Have any of you been consulted about the drug and alcohol information system—DAISy? Do you know about it? The current working group is examining the new data collection system for drug and alcohol addiction. I tried to design a system in 2007, but it has never been followed through—it was one in which the children’s needs were looked at in the addiction services, so that that information could be transmitted properly.
Are you on the group?
No. Because I am a politician, I had to come off the whole thing. The group subsequently found a way to abandon the programme that I had got to the point of the development of a piece of software in 2007. The powers that be decided that, once I was out of the way, they would not continue it. Here we are, eight years later and still without a collective data collection system.
The committee could usefully write to DAISy to say that the issue of data collection has been raised and that there is an opportunity to at least flag it up as part of its consideration.
Yes—if you feel that that would be useful. Thank you.
You see—it was worth waiting to give your evidence. Dr Simpson and Mr Baillie are a great double act. I invite responses from other panel members.
In a previous life, I worked for Aberlour Child Care Trust. We worked with a lot of substance abuse services and we started an evaluation study whereby we used the wellbeing indicators for the adults as well as for the children involved. We started following them over the years. Sadly, it was the usual story and we did not have enough funding and so on. The committee might want to look at measuring longer-term outcomes to see whether they are being achieved. We are very process driven. We keep coming up with new ideas and systems, but it would be really helpful if we also put in some of the measurements in order to state at the end of a period whether we have made a difference and to show the evidence and see the impact.
Members tell me that what really works for them is hearing about areas in which things are working. The integration of health and social care in the Highlands has gone a wee bit faster because it was the pathfinder area. Our members there have had more success—and perhaps more funding—than some other areas have had. People have found it useful to hear about what worked in the Highlands.
It is about not just measuring what works but sharing it by getting people together, rather than through another website, because nobody has time to read them anymore.
Certainly carers—or however they would define themselves—of people with drug and alcohol problems, whether they are parents, spouses or other family members, are a hidden carer group. They are less likely to receive formal community care services, such as home helps, day care or whatever. They may have occasional residential rehab admissions, but on the whole they are less known to social work departments and others. There is a need to raise their profile.
I hesitate to return to the process, because I think that the committee agrees that we need to identify best practice, focus on outcomes and look at the role of prevention. However, we need to go back to the issue of process.
The earlier evidence session got quite heated around the question of identifying and supporting carers who are not identified and supported. Is there a capacity issue around such assessments of children and adults? The witnesses in that session questioned whether there was sufficient capacity. We anticipate that more carers will be identified and helped, which might prevent certain things from happening. However, given the pressure in the system, what capacity does social work in particular have to identify particular groups of carers who might be a lower priority in terms of what is currently being addressed? What will the impact of that be on capacity and, indeed, on outcomes for those who are a higher priority but will see some capacity drift away from them?
I will answer the question about identification, because I think that my colleagues can answer the question about capacity.
For the past five years, I have had the privilege of attending the young carers festival. The messages from young carers are quite mixed—on the one hand, they want relevant people such as teachers to know about their caring role so that they can be sympathetic and give them some flexibility when it comes to expectations about homework production, or the time that they come into school; on the other hand, some young people say that it is their family’s business and they do not want people to know about it.
It is difficult to get the right balance. I would always advocate listening to the views of children and young people, but in this case their views on what they want to happen are quite mixed. We should err on the side of asking the question of the young person, so that we know at least who has a caring role. There is some doubt over how many young carers we have. I do not think that we will know the actual number until we start to ask young people more systematically about their caring responsibilities. That goes back to the awareness of those who work with them, such as those in schools, GPs or specialist workers who deal with the adults who are cared for. Through that, we will get a better idea of the numbers.
How do they shift the resource that is dealing with the front-line? The house is burning down and if they leave that, given the resource capacity, to go and do assessments for people who have a lower priority, what happens?
We are talking about universal services, so they should be able to do that.
Yes, but I am just asking the practitioners.
I have a Glasgow perspective on the issue, which I will just throw out to you. Capacity is not a new challenge for us; in 2009 we were inspected by the then Social Work Inspection Agency when we had done only 86 carers assessments, and its recommendation was that we must offer all carers an assessment. We then had to get our house in order.
To put our services in context, social work is in partnership with primary care, acute care and third sector carer centres. Over time, we have learned that we cannot look at the carers agenda in isolation but must see it in context, in that a person becomes a carer only when someone is diagnosed with a long-term condition. Around 10 years ago, we were looking for carers in the Tesco car park but now we go to the GPs and the acute sector hospitals and identify people by design rather than by accident.
In 2011, we launched a carers partnership and had challenges around capacity. We identified 3,200 new carers last year, but we did not identify the tens of thousands that we were expecting—a figure of 76,000 has been quoted in that regard. However, we started to identify people earlier—in GP surgeries and closer to diagnosis—and prevented them from getting into crisis situations.
Last year, 470 of our referrals came from primary care and 105 came from acute care. However, 72 per cent of our referrals came in early through our preventative red-amber-green eligibility system. On the challenges in responding to demand, a colleague in the voluntary sector described demand as a dripping tap rather than a flood, and I would adhere to that description. We responded to demand by providing anticipatory preventative services and creating a type of assessment that was level with the risk. We could not do a comprehensive, eight-page carers assessment for everyone, so we started screening assessments and delivering services in that way.
What we have learned, overwhelmingly, is that we can get caught up in the processes. We may have trained a social worker, but are we providing the right level of assessment? The feedback that we get from individuals who are accessing the service in a preventative way suggests that they are very happy with what they are getting, so we need to continue with that work.
The challenges in delivering services are nothing new to us. Carer assessments are an add-on to the traditional social work role, and they may be part of our work in conducting a single shared assessment. We are not expecting to do it all, but that way of working has helped us to rise to some of the challenges, and we will—I hope—not be seeing tens of thousands of people knocking on the door.
The point was made earlier about the need to work with the NHS in an integrated way. We need the NHS to tell us as soon as possible when someone is diagnosed with a long-term condition so that we can help and support that person in a preventative, anticipatory way. When we get that right, we avoid people getting to crisis point, and we deliver better outcomes in a way that is less resource intensive.
In the old days—10 years ago, for instance—people just turned up on their hands and knees to see the duty social work team. We have tried to turn that around, because we have better ways of delivering services.
As an association that represents senior social work managers, we are not in favour of having an unrestricted definition of carers, for reasons that I am sure have already been covered this morning.
First, there is the impact on practitioner time: the ability of practitioners carrying case loads to prioritise their work to deal with the people who are most in need and most at risk would be prejudiced. Notwithstanding the extra funding that might accompany the bill, it is unlikely in this day and age that local authorities will significantly increase the size of social work teams. They would be wary of creating new posts and permanent posts, so it is likely that social work teams will remain the same size. Social work time could be diverted away from pressing matters towards issues—albeit very important ones—concerning carers.
An accompanying issue concerns the diversion of scarce resources. Again, councils are currently dealing with budgets that are declining or staying at the same level. If we are talking about diverting resources not necessarily towards the cared-for person but for the benefit of the carer, that would, without any additional resources, be a second concern for us.
There is a slightly more conceptual point that relates to concern about universalising the caring role. There would potentially be quite a shift from private to public, with the carer role bringing carers into the social work net when there are other ways of dealing with the situation such as capacity building in the community, along with a much wider carers strategy. I can go into that point in more detail later: it is not just about improving social care, but about putting in place a range of other measures that will help carers to continue in their role.
People sometimes still go back to section 12(1) of the Social Work (Scotland) Act 1968, which places a duty on local authorities
“to promote social welfare by making available advice, guidance and assistance on such a scale as may be appropriate for their area”.
That legislation has never been repealed, although there are variations in new bills that have come to fruition.
I think that a lot of social workers still really want to work as change agents and community workers, as part of a hub working in the community. That is a culture change that we still need to promote as much as we can. There is nothing as damaging as individual social workers doing detailed assessments and identifying need, and then saying, “But we can’t do anything about it, because we do not have the resources.”
There must be a fine balance. If a need is identified, we need to be confident that we can meet that need. Glasgow is a good example of the way in which we do that. Other authorities have tried to have that conversation in order to move more towards a public health model, to be more preventative and to enable that culture change. Rather than making it the duty of certain professionals to do the work that needs to be done, those authorities have tried to make it something that resides in the community so that people in the community have a role to play. In that context, it is very important that we maintain some of the support mechanisms that already exist.
A young carer whom I knew used to go to the youth club. That was her time away—it really kept her going. The youth club is now closed, because there was no money. Such examples are very simple, but they are very important in this context.
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David Formstone mentioned wider support. Tam Baillie talked about how people see the role of the family and the extent to which they see caring as the family’s business. I suppose that I am trying to get at what the balance should be between intrusion and support, in terms not simply of community capacity but of the family’s capacity to care. How can we support that without being too intrusive, to the extent that we chase the carer away when the assessment shows that a carer should be there? We do not want to clash with any of that.
I absolutely agree. In case my comments were seen as negative, I should say that I think that there are a lot of positive aspects to the bill. My concern is about raised expectations. Carers might be drawn to come and ask for a support plan, but that might or might not be the appropriate avenue for them. I appreciate that the committee is concentrating on devolved powers around social care, but if we are to support carers properly, we must take into account all kinds of tax and welfare benefits, as well as access to further education and flexibility around employment; I am sure that the committee is well aware of all those matters. A national carers strategy needs to reflect all those things instead of being targeted at a particular profession, such as social work or health. It should not be a case of implementing support plans, regardless of whether that is what people are looking for; they might want better community-wide support.
There will be occasions when a child is part of a range of supports in the wider family network. There might well be no need for support that is additional to whatever role that child is playing, but there will be other occasions when there is a need for some additional support. I question whether that must always come through social work. A range of agencies could be involved with the family. There was quite a debate about the role of health services. There are voluntary sector organisations, and there might be specialist organisations that could play a role. I do not necessarily see the burden of support falling just on social work. We should use a range of organisations around a child to enable them to have the best family life that they can, whatever their circumstances.
We are learning a lot about the needs of carers. I keep going back to the long-term conditions. We have had nurses in our teams for some time. We can predict which conditions people will be diagnosed with that will have a high care burden—they include motor neurone disease, Parkinson’s and multiple sclerosis. There is a role to be played by the NHS. I was a social worker. If you walk into a health service and say, “Have you got any carers?”, you do not get very far, so we recruited nurses. As a result, we have had a massive increase in getting people identified earlier in primary care.
There is a role for the NHS to play as part of the standards of contract in identifying patients, supporting them and their carers, and providing specialist information about how to manage conditions. Social work does not have to do all that. There is a role for the NHS to play. It is already doing that, but perhaps that is not counted in however it looks at its services.
Equally, much of the information that the carers who come to us as part of the partnership want—we work hand in hand with Alzheimer Scotland and Chest Heart & Stroke Scotland—is about managing the condition. One of the biggest increases in demand in Glasgow is for training—people want to be shown how to move with assistance and how to manage conditions. Increasing that capacity does not all have to be down to the local authority or carers. We need to work with condition-specific services on the long-term conditions; I am talking about tier 1 self-supported care.
We do not always come with a bowl and say, “Give us more money”; we look at how we can provide that anticipatory support in a creative way across all the services out there and how we can get them to work together more effectively. Ideally, by doing that, we will deliver better outcomes for carers and the person whom they support; we will also shift the balance of care by reducing the numbers of falls, hospital admissions and accident and emergency appointments. That meets the strategic priorities as well as delivering on the better outcomes.
Before I go on to my substantive questions, I will mirror what Mr Formstone said about the wider carer strategy, irrespective of where powers or responsibilities sit. I have been told by some carers that, for example, the carer’s allowance is £10 less a week than jobseekers allowance. It is often the case that carer’s allowance goes unclaimed because there is clawback from other benefits, and there is an underlying entitlement that passports a person on to other benefits. Therefore, we appreciate that the matter is more complex than just having young carer statements, adult carer support plans and the like.
My questions are on the young carer statement. My first question is just to get some brief information on the record. The bill says that, when a young person reaches the age of 18, if an adult carer support plan is not in place the young carer statement should stay valid and deal with the transitions. Is that desirable? Is that the correct way to go? Do you have any additional steer to give the committee or the Government on how to ensure that that works effectively?
Transitions are difficult for a whole range of aspects of children’s lives. Generally, we are very poor at the transition from children’s services to adult services. It is welcome that consideration is being given to how the young carer statement would somehow carry forward until such time as an adult carer statement is in place, if that is the right terminology. However, you would need to put a time limit on that.
The issue of when children move from child-focused services to adult services is worthy of consideration. We have exactly the same problems with additional support for learning when young people are leaving care and even when they are moving from education to employment. Those are difficult times for those young people. The proposal to continue a young carer statement in those circumstances is a modest one. It may help, but you may want to think about how long it should continue for. The expectation should be that an adult carer support plan is in place before a person’s young carer statement ends.
It makes sense not to have a sudden cut-off at 18. One would assume that a young carer is caring for an adult. Therefore, if the adult is receiving services, those services will be in place and provided through adult social work teams. That aspect should therefore not be a problem.
The issue may be about how to support an 18 or 19-year-old meaningfully with their plan. That may have happened with their named person or children’s social worker; moving into adult services, where social workers have a much higher number of client service users, the issue may be about whether a young person could be intensively supported for any length of time.
We are on new ground when children turn 18. In Glasgow, we have an integrated service, so we have adult workers working alongside young carer workers. The fundamental change is when a person hits 18. A person’s caring role should be alleviated up to the age of 18; they should then be supported in their caring role when they are 18-plus.
Each circumstance is individual, and we would need to look at it. Where we have had young people who were detrimentally affected by their caring role, we have looked at self-directed support. For example, it is not appropriate for children with parents with MS to be taking on moving with assistance or a personal caring role. Therefore, we have supported those children to return to school and to have a childhood. The issues overlap.
If we have known that a child has been a carer from a young age, and they are hitting 18 or are older and they are still detrimentally affected, we should be looking at ourselves and asking what we have been doing with them up to the age of 18. We should be asking big questions not just of social work but of wider services and how we alleviate the impact on children.
We have adopted a family-based approach. There are ways of taking children out of households, providing the services and then putting them back into the same environment. We must raise questions with the whole family. If we need to move down the adult support protection route or the child protection route, we have to do that, but we should be asking families what they are doing to allow their child to have a future. We should be asking whether there are small changes that we can make to prevent us hitting a crisis further down the road.
There are also a lot of services that support young people in schools, such as careers advice. Are they aware of the issues that face young carers? Do we just write off people’s future plans for college or higher education because they are a young carer, or do we look at how their named person finds out about the situation? They are passing through the system—they do not just get into crisis at 18. It is a question of having preventative, anticipatory services.
I fully agree with what has been said, but I also think that it is helpful for there to be a formal point of recognition that there is somebody or something that allows for the young carer to have additional input. It may well be that somebody has divided loyalties and will not want to say that they want to move out or to have a relationship and go somewhere else. There may be issues about attachments and about being frightened, or they might not want to say, “I want more help”. However, the fact that they are coming to the end of their support statement and going into something else might allow for somebody else to come in to make an assessment and allow a bit more freedom.
That is very helpful. Having all of that on the record will help us with our scrutiny and enable us to pose some questions to the Government.
We have heard that the young carer statement will allow anticipatory planning and that, if people can see an emergency happening down the line, they will be able to mitigate the effect, but the young carers we met as part of our evidence session in Glasgow—I am not talking about the legalistic aspect of the bill, because they were over 18, but they still define themselves as young carers as they are young and in a caring role—said that going to college and getting on with their life was their respite break.
How do we tie in other agencies to future planning? That is not about mitigating the burden of care or anticipatory planning for emergencies; it is just about future life planning. Is there a role for wider public agencies such as schools, colleges, universities and Skills Development Scotland in relation to the awarding of apprenticeships? Who is doing that job? Where does it fit in?
I am trying to paint a picture of a web of support to allow young people who happen to be carers to get on with their lives in as close to normality—or their normality—as possible. They will have the same aspirations as everyone else. Sometimes, although not today, the chat has been about how we support young carers who have significant burdens of care to get some respite, but my question is about the longer term planning aspects and ensuring that they are not held back in their personal lives as individuals because of the burden of care.
Does the bill fit into any of that? Can you give us any pointers on how we can give a nod to some of it? That is the evidence that I got from the session that we had in Glasgow recently.
You might want to look to the approach to corporate parenting responsibilities that is taken in the Children and Young People (Scotland) Act 2014. There is a long list of public bodies in schedule 4 to that act, and they are now under the obligations in part 9 of the act. For example, my office is part of the corporate parenting responsibilities—people who read this evidence will find it quite amusing, because we opposed the proposal.
The 2014 act takes a wide perspective to the agencies that are responsible for young people leaving care, and a long list of bodies were included as having duties under it. If you have a list of relevant agencies, you might want to think about that. My advice would be to keep the list to those that are absolutely relevant. You have already mentioned some of them.
I take on board Mr Doris’s point, but I would like to widen out the support to include all carers.
Transitions are important. For example, carers who are parents might get full-time support from schools and, often, a lot of support from health services. Suddenly, the child leaves school—maybe a special school—and the local authority might struggle to provide a five-day replacement service through day care and other activities. Carers who are in employment might then struggle to stay in work, and they come to us saying, “If you don’t give us this support, I’ll have to give up my job.” In other cases, carers may want to take on education, or they may be reconsidering the whole caring role, saying, “I have done this for 21 years. I would like some respite.”
That touches on one of our concerns about the whole issue of outcomes as opposed to needs, which you may have rehearsed previously. How do we distinguish between personal outcomes for the carer and outcomes that are to do with the caring role? If the bill is couched in terms of aspirations and outcomes, we may struggle to distinguish a caring outcome from wider outcomes.
I reiterate what David Formstone says about the difficulties of looking at the carer in isolation and looking at the cared-for person.
We need to get better at future planning. A child does not just decide at age 18 to go to college or university. If they decide further back down the road, there is an opportunity for conversations. We overlap with SDS. We look at telecare and assistive technology in order to allow people to have more freedom and more choices. We need to get better at looking forward at those issues and planning for them.
I may be picking this up wrong, but I am slightly concerned by David Formstone’s remarks. I am looking at empowering carers as individuals to have lives of their own outwith the caring role. If I understand David’s remarks, he is saying that he is concerned that he may not be able to facilitate the care of a person if their carer suddenly spreads their wings and goes off to college, university, employment or wherever and leaves a vacuum. Is that what you are saying—that the resources might not be there to facilitate care?
I would be absolutely in favour of empowering a carer or person who no longer wants to be a full-time carer to be allowed to do all those things, and we should be doing our part to facilitate that, but there is a harsh reality of limited resources. The fact is that social work departments and local authorities are increasingly struggling to fill in a whole week of support to allow a carer to carry on employment or enter education.
It is certainly not something that we would be against. We would absolutely wish to empower carers as far as possible.
If there are no other questions, I thank the witnesses for being with us today and take note of the written evidence that they have given us. That concludes our business for today.
Meeting closed at 13:17.