PAN WALES CARERS LIN
Findings of Mapping Questionnaire
Carers’ Needs Assessments: All Wales Local Authorities
Background:
The Carers LIN Carers’ Needs Assessment workgroup is reviewing Local Authorities’ approach to Carers’ Needs Assessments across Wales in order to compile an information resource that aims to maximise the effectiveness of the Carers Needs Assessment process.
It is hoped that this will assist local authorities in further developing the effectiveness of their own processes in meeting the intentions of the Carers’ Needs Assessment process.
The intention of the Carers’ Needs Assessment Process is to ensure that Carers are supported… (VISION STATEMENT)
o To carry out or continue to carry out their caring role, at the Carer’s chosen level, in support of a person they care for remaining in the community (i.e. their own home/ living space etc).
o To maintain a life outside of their caring role; minimising negative impacts that may be experienced by the Carer from carrying out their caring role (including consideration of whether the Carer works or wishes to work, or is undertaking or wishes to undertake education, training or a leisure activity).
The Questionnaire was sent to all 22 Local Authorities to gather information on current practice around Carers’ Needs Assessments. Responses were received from 12 authorities.
Summary of Findings:
(1 = poor 5 = good)
1 Do you have a written referral pathway describing how Carers access a Carer’s Needs Assessment / 11 / 2.5
2 Do you have a separate Carer Assessment Form / 14 / 3.42
3 Do you have a Carers’ Self Assessment tool? / 3 / n/a
4 Do you routinely make use of a Carer’s Plan or Carer’s Action Plan following identification of the Carer’s needs (ie not the UA care plan when organising Carers services) / 9 / 1.92
5 Do you assess if a Carer provides regular and substantial care before offering a Carer’s Needs Assessment? / 7 / 1.25
6 Do you apply eligibility criteria to determine whether a Carer receives services following assessment? / 6 / n/a
7 Do you have a review process for Carers’ Needs Assessments? / 8 / 1.33
8 Do you have a process for recording unmet needs of Carers. If yes, what is the process and how do you use the information gathered? / 9 / 1.25
9 Do you have a ‘Carers’ training module for practitioners? / 8 / 1.25
10 Do you have separate Carer Assessment Forms for any specific Carer groups (eg Mental Health, Young Carers, LD Carers) / 5 / n/a
11 Do you have a Carers’ Policy and Procedures document, including IT guidance, available for staff? / 10 / 1.67
12. Do you have staff guidance on transitional processes for Carers? / Question lacked clarity therefore not analysed.
13 Does your Carers’ Policy relate to Carers of all ages? / 5 / n/a
14 Do you have a Carers’ Policy to support local authority employees who are Carers? / 6 / n/a
Where less than half responded – not graphed (greyed out above)
QUESTIONS AND ANSWERS: FINDINGS AND CONSLUSIONS
CARERS NEEDS ASSESSMENT PROCESS
1. Do you have a written referral pathway describing how Carers access a Carer’s Needs Assessment
Findings:
o Majority of authorities have written referral pathway that they evidenced to work for both Carers and the authority, ie practitioners, IT systems and PI reporting
o Some in review, some indicated need to develop process. (eg ‘Approach needs to be more personalized and focussed on outcomes’ ‘Carers can find intake process unhelpful’)
Conclusion:
o Good practice does not necessarily happen despite written protocols; “This does not always happen despite written protocols. And Carers apparently often decline an assessment.” “Still hap-hazard and dependent on individual S/Ws”.
o Subsequent questions cast concern over the quality of the outcomes from the process following access to CNA
o Quality of process reported to be dependent on quality of the personnel carrying out the assessment process.
2. Do you have a separate Carer Assessment Form
Findings:
o All authorities have separate Carers Needs Assessment record form.
o Majority have scored effectiveness of the form as 3 or above, however comments received suggest that effectiveness of Carers Needs Assessment process could be improved (improvements throughout the process, including the form). One authority has indicated that their form is “too long, questions not outcome focussed resulting in negative experience for the Carer”. Another authority has indicated that the form “is completed to varying levels of quality”.
o Two pilots are currently ongoing, using a developed process including improved forms.
o 3 authorities have embedded their assessment form into their IT system.
Conclusion:
o The assessment form cannot be seen as the whole Carers Needs Assessment process. It is merely a ‘tool’ that facilitates part of the process.
o Given the frequency of reviews across authorities in Wales, this suggests that the process is in need of review, and then the structure and content of the form will become more obvious.
[Possible follow up: - Blaenau Gwent – full systems review ongoing]
3. Do you have a Carers’ Self Assessment tool?
Findings:
o Majority of authorities do not have a self assessment tool. Five authorities do send out assessment forms for Carers to complete independently, however, almost all respondents comment that this practice is discouraged. Two authorities report that these are often not completed and returned. In cases where they are completed, information is not of sufficient quality to form part of the assessment process.
Conclusion:
o Assessment process is recognised to be most effective when carried out between a Carer and a skilled Assessor. The Assessment form is often available to be sent out to Carers but “is rarely returned and does not often give information good enough to be able to make decisions on, requiring staff to then reassess”.
o The true intention of sending the form out to Carers is to meet practice guidance which indicates “it will be helpful if the Carer has time to think through issues in advance”; this could more appropriately be described as ‘increased Carer self-awareness’ which facilitates the Carer’s engagement with the CNA process thus maximising it’s effectiveness in supporting the Carer to achieve positive outcomes.
o It might therefore be beneficial to have a leaflet or checklist that supports Carers to think about their circumstances in relation to the role and to themselves as individuals, to prepare them to engage effectively in the needs assessment process. (Check out this link to Carers Choices – see “Looking after someone? See what help you can get” labelled as a “short assessment” however could possibly be better described as a ‘self-awareness questionnaire’ http://www.nhs.uk/Carersdirect/Pages/CarersDirectHome.aspx )
4. Do you routinely make use of a Carer’s Plan or Carer’s Action Plan following identification of the Carer’s needs (ie not the UA Care Plan) when organising Carers services?
Findings:
o 50% of authorities say that they have a separate Carers Action Plan or ‘Care Plan’, 4 of these being under development currently.
o Just one authority indicated that their Carers Action Plan was particularly effective, with the majority of scores at 2 or 3 indicating that these are neither particularly effective nor ineffective.
Conclusion:
o Carers Action Plan or Outcome Focussed Summary of actions in support of the Carers’ needs has to be a ‘working tool’ or practical solution that is useable for the Carer to organise and prompt the actions which support the Carer to achieve their positive outcomes. “This is a separate agenda from the unified assessment approach”.
o The Carers Action Plan or Outcome Focussed Summary of actions in support of the Carers’ needs is distinctly different to a cared-for person’s Care Plan which prescribes services to meet the cared-for person’s eligible needs to maximise their independence. However, it is recognised that some services on a cared-for’s Care Plan are there to meet the needs of the Carer, identified via the Carers Needs Assessment process – this CNA process is connected to and symbiotic to the UA process where present.
o “Many workers still meet Carers needs only by changes to services for the cared-for [person] rather than services directly to the Carer”. This statement indicates that current practice can reinforce the negative stereotype that ‘all that Carers want is respite or increased replacement care for the person they care for; by supporting the person cared-for, the Carer is sorted!’ and the opportunity to identify the Carers holistic needs and take wider actions to support the achievement of positive outcomes, is lost – hindering/ barring achievement of the Vision...
5. Do you assess if a Carer provides regular and substantial care before offering a Carer’s Needs Assessment?
Findings:
o Two thirds of authorities define a Carer within the cared-for’s assessment of need via UA Domain 2 Carers Perspective.
o One authority has a separate screening self assessment process.
o Two authorities engage with the Carer’s needs assessment process to define if they provide regular and substantial care.
Conclusion:
o In order to establish whether a Carer is providing regular and substantial care, a fairly robust assessment of the impact of caring on the Carer has to be carried out.
o With reference to the rule of proportionality, the process of Carers Needs Assessment has already begun at this point.
o This concurs with guidance.
o Outcomes may vary depending on level of impact experienced by Carer, ie from very little planning, to provision of services specifically for the Carer and maybe even review of cared-for services.
6. Do you apply eligibility criteria to determine whether a Carer receives services following assessment?
Findings:
o Of the 12 responses, 6 LAs state that they do apply eligibility criteria, 5 do not and 2 have not responded – given this response level, just 5 responses scored the effectiveness of this element of the CNA process. 1 Local Authority commented that Carers do not necessarily require an assessment to access services. This is probably the case in most local authorities as many Carers services are commissioned to voluntary sector organisations have an open access policy. Although this is another area for research, it is worth pointing out that an increased awareness of those Carers experiencing the greater impact of caring will lead to greater demands on services and a need to prioritise service availability. This is further compounded by reduced resources to provide services.
o Where the effectiveness of this element of the CNA process was scored by respondents, three of the five scores were at level 4 indicating the perception that the mechanism for scoring was working well (Gwynedd, RCT, Ynys Môn)
o Several authorities use critical, substantial, moderate and low criteria as the method for delivering Carers eligibility for services (1 authority links Carers eligibility to “the assessment of critical and substantial needs of the cared-for individual”). This raises the question, given that LAs have the power to provide services and not a duty, if the Carer’s needs are determined to be substantial or critical, are we compelled to provide a service, and does this make local authorities culpable (within the bounds of the principle of ‘duty to care’)?
Conclusion:
o This survey did not ask how eligibility was determined practically and possibly this is an area that may require further study – given that demand for Carers services is likely to increase (increased awareness and take up of CNAP and increased number of Carers in the population) and resources will become more pressured.
o One authority mentions that they have an agreed protocol to determine eligibility for services and this may be a good example of how eligibility can be determined objectively, although “this is not always applied as rigorously as it should be”.
7. Do you have a review process for Carers’ Needs Assessments?
Findings:
o All authorities who responded to this question stated the need for CNAs to be reviewed as a formal part of the CNA process.
o In practice, it was communicated, there was a range of methods and actual achievement of this.
o There was a range of frequency reported from “rarely” to “linked to cared-for’s UA review”.
o Methods used ranged from a specific CNA review process to annual telephone reviews.
o Half the responders indicated that the process for review does not perform to its full potential within their authority. This is reinforced by an average effectiveness score of 1.33. One authority, however, considers their process to be robust including annual telephone reviews with all Carers registered.
Conclusion:
o There is strong evidence that a review process is needed. This is to ensure that the Carer’s changing needs are foremost in any response or activity.
o In practice the review element of the process does not work to meet that aim across all authorities.
8. Do you have a process for recording unmet needs of Carers? If yes, what is the process and how do you use the information gathered?
Findings:
o Two-thirds of respondents have mechanisms to record unmet need and the need to collect this information is recognised by authorities who have no current method. “This is a lack of which we are aware and which we would like to rectify”.
o However, the effectiveness level is low at 1.25 possibly indicating the need for attention to improve effectiveness.
o Mechanisms generally include identification and recording of unmet needs on the CNA form during the CNA Process.
o The effectiveness of all mechanisms was seen to depend on the quality of recording.
Conclusions:
o Evidence suggests that this is an important element of the assessment process. Information about unmet need directly informs commissioning processes ensuring that LAs are able to offer support to those Carers and the people they care for who are most in need.
9. Do you have a ‘Carers’ training module for practitioners?
Findings:
o Approx half the respondent’s state that they currently have a training module for practitioners. 2 authorities are developing a process and 1 authority state they had a programme but this is not active at present.