Carers in Practice Supporting Carers in Primary Care

North East Wales Carers Information Service in conjunction with The Princess Royal Trust for Carers

‘Carers in Practice’ – Supporting Carers in Primary Care An all Wales conference for GPs, Primary Health Care staff, Carers and Statutory and Voluntary representatives.

A Summary Report Funded by The Welsh Assembly Government

2 Acknowledgements

The North Wales Carers’ Information Service and The Princess Royal Trust for Carers would like to thank the following individuals and organisations for their support and assistance in making the ‘Carers in Practice’ Conference a success.

The carers who attended and provided invaluable input

The Welsh Assembly Government

The staff at Wrexham Medical Institute with particular thanks to Lynne Bowen

The Carers Centres and Outreach Services who assisted carers to attend

The organisations who displayed literature and information

Mike Shooter and Peter Tihanyi

Gavin Parry

Lyndon Miles

Dr Mark Boulter

Maureen Howell and the Young Carers from the NCH Project

Heather West, Mike Powell and Penny Muir

Claire Sullivan and Elaine Jones

Doris Dallimore

3 Contents

Acknowledgments

Introduction

The Conference

Key Note Speakers

Workshops

Questions to the Panel

Evaluation of conference

Comments

Conclusion

Appendices a) Programme of the day b) Key note speaker slides c) Workshop slides d) Evaluation form

4 Aims

The conference was primarily aimed at professionals who worked within Primary Health Care both in statutory and voluntary organisations. They were the target audience as it was the intention of the conference to raise awareness of the needs of carers and the importance of embracing and developing Central Government’s guidance on utilising Carers’ Registers.

The Welsh Assembly Government agreed with the importance of such an event and following a successful bid by The Princess Royal Trust for Carers, the Assembly provided the finance for this to take place. The conference provided examples of good practice and methods to reach carers within Primary Health and referral schemes that were already in place in some GP Surgeries and Health Practices.

Carers from across Wales were also invited to provide input and real life scenarios to aid Health Professionals’ understanding of what carers face in their daily life and the support they need.

Introduction

Following a similar event organised by The Princess Royal Trust for Carers in England in 2006, Wales’ Regional Office of The Princess Royal Trust for Carers decided a conference inviting Primary Health Care professionals to come together to evaluate how their practices relate to carers would be most valuable at a time where many Health Practices have redundant Carers Registers.

The North East Wales Carers’ Information Service agreed to host the event in their main office’s town of Wrexham. There are 350,000 carers in Wales and many are known to their GPs and other Primary Health Care organisations but few referrals take place from this point of contact to other services that carers might benefit from.

The Regional Office utilised the excellent knowledge of the 11 centers that are affiliated to The Princess Royal Trust for Carers in Wales to invite Health Professionals from their areas and to invite members of Local Health Boards to attend.

This summary report aims to demonstrate the good practice that is taking place across Wales and to highlight methods of how Health Practitioners can improve their service to carers. In total, over 200 invitations were sent out to relevant organisations and individuals and 125 delegates returned a positive reply. On the day of the conference 110 people were in attendance and all workshops were amply filled.

5 Organising the Conference

The Princess Royal Trust for Carers (The Trust) is the largest provider of comprehensive carers’ support services in the UK. Through it’s unique network of independently managed Carers Centres, young carers services and interactive website www.carers.org, The Trust provides quality information, advice and support services to a quarter of a million carers including 13,000 young carers.

The North East Wales Carers Information Service (NEWCIS) covers three counties; Wrexham, Denbighshire and Flintshire and offers services to over 2,300 carers. NEWCIS provides regular direct support through the medium of small groups, where some training is also offered in areas such as moving and positioning, relaxation techniques and first aid.

Wrexham was chosen out of the three counties that NEWCIS covers as the rail links to this large university town are very good. We were aware that holding the conference this far North might pose some problems for those wishing to attend from the South of Wales. The staff at the Medical Institute informed us that as the event was directly related to the medical profession and so rooms would be available on that day free of charge.

Gavin Parry represented The Welsh Assembly providing attendees with an informative talk about The Welsh Government and their dedicated support for carers.

110 delegates attended the conference, travelling from a range of locations from Bangor, North Wales to Aberystwyth in the West and Bridgend and Pembrokeshire in the South of Wales. Many of the delegates attending were employees of voluntary organisations that directly deal with primary health care professionals and many were GP and Nursing Practitioner members of their Local Health Boards. A number of GPs, Practice Managers and practice nurses were also in attendance.

6 Key Note Speakers

Dr Lyndon Miles Lyndon Miles is a GP and Local Health Board member for Gwynedd County. Lyndon spoke about the importance of partnership work between carers and GPs and what barriers prevent this from happening successfully. He highlighted the issues faced by the many carers of varying ages and circumstances and how local authority strategies reflect their needs but do not suggest methods of delivering the services and support.

Dr Miles laid out a model concentrating on community services within ‘Pyramid Tiers’. These cover the areas of health and social care delivery and take into account the individual needs of carers and patients. This model demonstrated the importance of Locality Services working closely together. This would result in a ‘seamless’ services from Health, Social and Voluntary bodies.

Dr Mark Boulter

Dr Mark Boulter is a GP in a surgery in Llandovery, near Carmarthenshire. Dr Boulter’s surgery has a very successful carers project that works out of the surgery. He informed the delegates of how the project developed from an ineffective project to a very successful and growing scheme. The aim of the initial pilot was to ascertain if there was a need for a formal funded scheme to support carers.

Using the knowledge of all surgery staff more than 80 carers were identified and the staff then began on developing a business plan to provide the support and services needed by the carers. Professional bridges were built with other local services and also the LHB and Local Authority. The project offered information and signposting. Having an employed member of staff dedicated to carers within a GP Surgery has resulted in an increase in Carers’ Assessments and the improvement of referrals to health and social care agencies. It has improved recognition not only for the new service but also for carers. Through the use of a questionnaire based on the General Health Questionnaire, the Carers’ Project can demonstrate that the scheme is having a positive effect on the lives of those accessing it and not only on those health and social care professionals involved.

Through the time the project has been working, Dr Boulter has been able to demonstrate why a GP Practice is an invaluable place to have this project; it can be accessed by all and is already known by many and importantly encourages other primary care staff to consider the needs of carers and what support and information they might need to continue their role and to make their life easier.

7 The Workshops

Workshop 1 – ‘Meeting the Health and Well Being Needs of Young Carers’ Presenters - Maureen Howell and Amanda Edwards from the NCH Young Carers Project, accompanied by young carers. (The young carers provided the group with a short play on how difficult some of their circumstances can be). (12 delegates in attendance)

Maureen Howells is a Project Manager and Amanda Edwards is a Project Worker for NCH Cymru. Both are well qualified and well experienced in issues regarding young people, carers and social care, providing valuable input to Wrexham County Council’s social care policies and strategies.

The aim of the workshop was to develop practitioners’ thinking and to develop solutions to issues and problems raised concerning the health and well being of young carers. The presenters provided the workshop with data from Wrexham’s project and posed the question ‘What can Primary Health do better to support the health and well being of Young Carers?’

When the workshop group returned to the main conference room the points they brought back were:-  The importance of having a specific worker within Primary Care to enable effective and correct information sharing;  A Carers’ Assessment for the young carer to enable relevant information regarding support and services available to be provided;  Positive aspects of caring should be publicised to allow carer to be recognised for the work they do – not only for the hardships they face.

Workshop 2 – Ceredigion Investors in Carers Presenters – Heather West: Carers’ Development Officer, Penny Muir: Carers’ Fieldworker, British Red Cross and Mike Powell: Primary Health Care. (20 delegates in attendance)

Heather West is employed by Ceredigion Local Authority to develop carers’ services within the county, Penny Muir works for the British Red Cross for the Carers Project and Mike Powell is the Acting Director for Ceredigion Primary Health Board.

Heather began the presentation by informing the workshop of the history behind the scheme she had developed in Ceredigion. There are 16 GP surgeries in Ceredigion who have signed up for the Ceredigion Investors in Carers Award (CiiC) and the aim of the scheme is to work towards a clearer system to enable GPs to support carers. The scheme was developed through consultation with GPs and carers and is based on a self-assessment file that offers evidence of carers support services.

The workshop discussed what would make this project work elsewhere and what was needed to make an effective Carers Protocol. 8 The group returned to the conference room with three points that were agreed on to determine effective methods to make such a scheme work;  Partnership work between agencies is paramount to providing support to GP Practices.  Surgeries with existing good practices should move forward by naming a specific worker for carers within that practice.  A change in attitude was required by agencies to recognise the unpaid work that carers provide and the support and information that they need.

Workshop 3 – ‘What support do carers need from primary care – a carers’ perspective’ Presenters – Claire Sullivan: NEWCIS, Elaine Jones: Carer (21 delegates in attendance)

Claire Sullivan has been employed by NEWCIS for a number of years and is presently the Carer Service Coordinator and Primary Care Facilitator in Flintshire, Elaine Jones cares for her mother who is elderly and suffers from Alzheimer’s.

This presentation was intended to demonstrate how vital the support of Primary Care Professionals is to carers. Elaine discussed with the group the aspects that would have made her role far easier from the point of diagnosis.

The group returned to the main conference with three points that highlighted the support that carers need from Primary Care:  Training of all professionals should include recognition of all carers. Staff in GP surgeries and Social Workers should be able to identify a carer.  Recognition of being a carer is required to maintain the caring role. Family should be regarded partners to health professionals.  There should be an equality of services to carers - it should not depend on a postcode lottery.

Workshop 4 – ‘Partnership working in Primary Care – How the Voluntary Sector can support and work in partnership with Primary Care providers’ Presenter – Doris Dallimore: Bridgend Carers Centre (20 delegates in attendance)

Doris has been invloved with Bridgend Carers Centre since it’s conception many years ago. Doris is now the Chief Executive of the centre and is invloved in improving and developing services for carers within voluntary and statutory agencies.

This workshop discussed methods and techniques to effective working between agencies to provide the support needed for carers. The workshop looks at the carers’ perspective, good practice and benefits for partnership organisations.

9 When the group returned to the main conference room they relayed three main points that were agreed upon to enable the voluntary and primary care sectors to work together effectively.  GPs must have recognition and an awareness of what services are available from the voluntary sector and community to enable a good quality service and full partnership working.  There needs to be a named person within the practice – a Carers’ Champion.  There must be continuity of services; details of services that are used to refer carers to must be updated and an insurance that the service is available must be made.

Questions to the Panel

Following the workshop feedback sessions, delegates were given the opportunity to pose questions to the key note speakers and workshop presenters. The delegates’ packs contained a question slip that could be filled in and passed to a member of NEWCIS staff or the chairperson and these questions would then be put to the panel in the afternoon.

A number of questions were received and due to time restriction only four were able to be answered. The delegates remaining in the afternoon were positively vocal and this resulted in an excellent opportunity for debate and discussion.

The content of the questions were mainly concerned with the inequalities of services for carers and that there was a lack of conformity by local authorities. Financial support for carers was also raised in the question session, where the lack of benefits that are available for younger carers and those adults caring for more than one person.

Evaluation of Conference

Evaluation forms were provided in each delegate pack and at the end of the day each delegate was requested to hand them in, either to a member of NEWCIS staff, at the registration desk on the way out of the building or via email after the event. 43 forms were completed and returned out of the 80 that were given out.

One of the clear issues, as with all evaluation forms is the neglect of delegates to return them completed. An additional problem on this occasion was that the final questions were on the reverse of the form and not all delegates realised this and so some forms were returned incomplete.

Over 72% of the forms returned included comments regarding aspects of the day, from the refreshments, to the venue, to the speakers. .

10 Conclusion

Some of the recommendations that came from this conference were simple methods of partnership working and a need for recognition of the role of the unpaid carers. This could be achieved through aspects of training being added to all staff induction in the primary care setting and following from this, the naming of a specific worker within the primary care facility to allow carers to contact them for information. These two areas would allow staff to understand the difficulties that some carers face and the knowledge that other organisations are equipped to assist and support carers. This would encourage partnership working across various agencies, especially health and social services and with the full acknowledgment that voluntary and local bodies provide invaluable services within the community. With the partnership working and acknowledgment of the caring role this should result in an increased number of Carers Assessments being completed, one of the issues raised at the conference was the different needs of the young carer and the requirement for a separate assessment to ascertain the needs of the young person.

Generally, the outcome of the conference was positive and the desire to improve the services to carers was unanimous. However, what was apparent with delegates from across Wales was the fact that services were not provided on an equal basis but more in line with a lottery postcode. This is an apparent issue that does not reflect the caring role of all carers across Wales.