Epic): Evaluation of Impact of Learning and Development Activity and Resources

Home , National epic

Equal Partners in Care (EPiC): Evaluation of impact of learning and development activity and resources

NHS Education Scotland

March 2015

Authors:

Glenys Watt, Director

Ian Christie, Consultant

Sarah Richard, Consultant

54 Manor Place, Edinburgh, EH3 7EH T: 0131 225 5600 E: [email protected] www.blakestevenson.co.uk

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

CONTENTS

Chapter Page

Executive Summary ...... i 1. Introduction and context ...... 1 2. Summary of national and local EPiC activity ...... 8 3. The impact of EPiC activity ...... 24 4. Sustainability considerations...... 40 5. Conclusions and recommendations ...... 43

APPENDICES:

Appendix 1: Research tools

Appendix 2: List of consultees in case study areas

Appendix 3: List of Stakeholder Interviews

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Executive Summary

Introduction

NHS Education for Scotland (NES) commissioned Blake Stevenson Ltd in August 2014 to undertake an evaluation of the impact of the Equal Partners in Care (EPiC) learning and development activity and resources. The research questions the evaluation sought to address were:

 To what extent have expectations around EPiC been realised?  What has been the impact of learning related to EPiC in terms of: -staff confidence and capability in relation to working with carers and young carers? -staff values and attitudes in relation to supporting carers or young carers? -changes in work practice, processes and policy as a result of using the EPiC core principles? -changes in the workplace environment as a result of becoming more carer aware?  What are the facilitators and barriers to applying EPiC core principles?  To what extent has good practice in relation to carers and young carers been disseminated and used by other colleagues and team members?  What are the perceptions of the sustainability of any changes in practice?

The evaluation team used the following methods:

 a review of documentation from the five demonstrator sites followed by site visits to these areas, plus two additional areas where it was known implementation activity had taken place, to interview a range of staff and stakeholders;  a survey to individuals to follow up on “pledges” they had made at three learning and sharing events;  interviews with 21 stakeholders; and  attendance at events to undertake further consultation.

Activity undertaken

The report provides a summary of activity undertaken at national and local levels. At national level it focuses on the reach of the centrally developed resources and events including three learning and sharing events, the development of an email network (964 members), a range of printed resources (over 10,000 copies distributed) and the development of an online Level 1 e- module (with Levels 2 and 3 currently in development).

At local level the report sets out a summary of activity undertaken within the seven areas visited during the fieldwork. The areas were:

 NHS Dumfries and Galloway;  NHS Grampian;  NHS Greater Glasgow and Clyde;

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

 NHS Highland;  Inverclyde CHCP;  North Lanarkshire Carers Together; and  Prince and Princess of Wales Hospice, Glasgow.

In addition the report provides examples of other areas and organisations where activity to implement the EPiC core principles and framework has taken place.

Findings

The findings from the evaluation focus on the impact of all of this activity. They cover:

 the impact on staff;  the impact on organisations; and  the impact on carers

The findings also describe the enablers and challenges associated with the implementation of the EPiC core principles and framework learning and development activities.

Impact on staff

In relation to the impact on staff the report highlights the following:

 improved confidence and ability to identify carers and refer them to appropriate support;

There are examples where staff are reported to have greater confidence in having the conversations with carers as well as knowing the appropriate sources of support to refer them to.

 improved understanding of the issues that affect carers;

Staff who had taken part in training reported that they were more able to identify carers and the range of people who may be carers (including young carers). Some of those who had taken part in training had recognised that they themselves/or a member of their family were carers for the first time.

 involving carers as equal partners in care;

There are examples of improved awareness of the importance of involving carers as equal partners and in some instances practical action to ensure that this happens. In some cases action was already underway prior to the EPiC core principles being developed but these have reinforced what is being attempted.

 engaging staff beyond the health and social care sectors.

While the main focus has been on awareness raising within the health and social care sectors there are examples where staff within education settings have used EPiC to raise awareness of young carers.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Impact on organisations

EPiC has assisted organisations to implement other strands of work they are involved with such as dementia strategies and Reshaping Care for Older People. It is seen as helping to provide a consistent approach to working with carers for the health and social care integration agenda.

The raised levels of awareness among staff have in some cases led to changes in processes and practice. For example: changes to documentation to remind staff to ask about carers; adapting electronic records to record if a patient is a carer; commissioning processes that require organisations to show what they are doing to raise awareness of carers. As staff become more aware of carers and carers’ issues they see what else has to change or could be changed.

Impact on carers

The evidence of impact on carers is limited to date but there are some examples of increased involvement of carers in hospitals and some evidence that EPiC has helped increase carers’ own understanding of their entitlements.

Enablers and challenges

The report identifies a number of facilitators and challenges relating to the implementation of the EPiC learning and development activities.

The key enabling factors include the credibility of the EPiC core principles as having been developed with involvement from carers and as having the double branding from both NES and SSSC. Interviewees like the fact that the principles are written in plain language and are easy to follow. People also like the fact that they can adapt the resources to suit their own local circumstances. Many interviewees commented positively on the support from the central project team. In some areas partnership working between the public and third sector was perceived as having facilitated the implementation of the EPiC core principles. Some areas had found that making the training mandatory was helpful while other areas had built the EPiC training into other training they were undertaking and found this a useful approach. Where strategic level staff have been closely involved this was seen to have helped in implementation: for example in Highland they used EPiC core principles to help develop the Carers Strategy and in North Lanarkshire it was used to inform Reshaping Care for Older People (RCOP) planning.

The main challenges identified included the competing priorities for training time, although a number of areas had found ways to overcome this challenge such as taking the training into wards and building it in with other training that was being delivered. There was recognition that there is a huge cultural change required and that involvement of those at strategic level will be essential. Some areas faced challenges with the compatibility of e-learning platforms and software which made it impossible to use the e-module directly.

iii

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Sustainability

Interviewees perceived the EPiC core principles to be sustainable in that they will not go easily out of date. The EPiC core principles are seen to fit well with a range of national policies but some interviewees thought that this strategic alignment needs to be better communicated. While training is one aspect of promoting change it is recognised that structures, systems and processes also need to be in place. However the new Carer Positive Employers Kitemark is seen as a key development to sustaining the impact of the EPiC resources as it is hoped that employers will be directed to the core principles and framework. It is hoped that initial efforts made to date to build the EPiC training into further and higher education courses will continue.

There was also concern by a number of consultees that without the central project team in place the momentum that has been developed will be lost.

Conclusions

This evaluation demonstrates that much has been achieved in implementing the EPiC core principles and associated learning and development resources since 2013. For a limited budget the reach has been significant in terms of the different approaches and activities being implemented.

In terms of numerical reach to the overall health and social care workforce it is clear that there is a long way still to go. Rolling out Level 1 of the EPiC core principles is essential and it appears from the evidence that there are two useful ways in which to consider doing this: making it a mandatory part of induction training for those working in Health and Social Care Partnerships and other settings; and embedding it with other key areas of training (either topic specific such as with dementia or embedding it within curricula such as with Flying Start or at further and higher education levels).

While it has not been possible to quantify the impact that various activities being undertaken have had to date, the qualitative evidence gathered in this report illustrates that awareness is growing and with it the confidence and ability to identify and involve carers more. It is assumed that this in turn will lead to more positive outcomes for carers, although at this stage the evidence for this is not available.

There is some recognition that training alone will not change the culture, structures and systems to bring about significant changes for carers and that buy-in at strategic level is essential for this to happen. For this reason efforts to engage senior managers in Level 3 training are seen to be important as it is hoped this will lead to the strategic buy-in that is needed. Where senior managers have been involved it is shown that this can lead to significant change.

At the time of carrying out the evaluation there was a concern that momentum may be lost as the funding for the central project team was due to come to an end: the enthusiasm and commitment of the project lead and team has been widely commended. Since the completion of the evaluation some funding has been secured to support the continued embedding of EPiC

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

during 2015/16. Some interviewees thought that further central funding would be helpful over the next few years as carers legislation is steered through the Scottish Parliament.

It is hoped that one of the ways in which the EPiC resources will continue to be promoted and used is through the Carer Positive Employers Kitemark which encourages employers to support workers who have caring responsibilities to remain in the workforce.

Recommendations

The report makes the following recommendations based on the evaluation findings.

1. All Health and Social Care Partnerships should ensure that the EPiC core principles are embedded in their processes and systems, including induction training for staff and relevant training on other topics wherever this is appropriate;

2. Continued efforts should be made to see EPiC core principles included in further and higher education courses;

3. NES should ensure the EPiC core principles feature in learning materials for all its other learning/education initiatives (Flying Start/Effective Practitioner and so on);

4. NES, SSSC and the Scottish Government should all aspire to the Carer Positive Employers Kitemark and encourage their associated organisations to do likewise: for example it would be helpful to see all Health and Social Care Partnerships holding the Kitemark;

5. Scottish Government, NHS bodies, SSSC and COSLA should seek to include mention of the EPiC core principles as appropriate in all relevant polices and strategies;

6. Scottish Government/NES/SSSC should consider how at least the minimum level of central support (for example keeping the website updated) can be achieved; and

7. Scottish Government/NES/SSSC should consider some form of evaluative research with carers in a couple of years’ time to assess whether outcomes are improving for them.

It is hoped that the process of implementing the EPiC core principles started over the past two years will be embedded and sustained across health and social care organisations in Scotland so that carers are supported and involved in appropriate ways at all levels.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

1. Introduction and context

Introduction

1.1 Since 2011 NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) have been jointly leading a project to implement the workforce education and learning actions identified in Caring Together and Getting it Right for Young Carers, the national carers strategy 2010-15. The strategy requires a significant change in the way health and social services in Scotland respond to carers and young carers so that it becomes “everyone’s job to actively identify and support carers”. Workforce education is key to achieving this and so a Workforce Training and Education Plan was agreed in 2011 by the project’s steering group.

1.2 As part of this Plan, during 2011-2012 NES and SSSC undertook an analysis of existing training and education to support the health and social care workforce and this was followed during 2012-2013 by the development of the Equal Partners in Care (EPiC) Core Principles for Working with Carers and Young Carers, framework and resources linked to them. Since 2013 the project team has been involved in a number of development and dissemination activities to support good practice in workforce learning and development related to EPiC (we outline these further in Para.1.7 below). The current funding ends in March 2015 but agreement has been reached to fund aspects of the project for one more year to support embedding.

1.3 In August 2014, NHS Education Scotland (NES) commissioned Blake Stevenson Ltd to evaluate the impact of the learning and development activity and resources associated with EPiC. This report sets out the findings from this evaluation.

The EPiC core principles and framework

1.4 NES and SSSC designed the EPiC core principles and framework during 2012-13 to enable managers and employers to support staff to improve their practice with carers. The principles are linked to career development frameworks such as the NHS Knowledge and Skills Framework, the Continuous Learning Framework and the National Occupational Standards. They are intended for inclusion in any appropriate workforce education and learning situation, for example in induction and CPD modules for staff and health and social care courses in higher and further education.

1.5 The core principles are based on six key outcomes for carers and young carers, as shown in the figure below. Each outcome is linked to the knowledge and skills workers need to work effectively with carers to achieve this outcome.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Figure 1. EPiC Core Principles for working with carers and young carers

1.6 The core principles are supported by a framework of knowledge and skills. The framework is designed around three levels, to reflect different job roles and nature of contact with carers. We provide a brief summary of these level descriptors below.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Figure 2. EPiC Levels

Implementation activities

1.7 Key implementation activities since the development of the EPiC core principles and framework have included:

 development of a portal hosted on the Knowledge Network and Social Services Knowledge Scotland (SSKS), designed to be a community of practice and one-stop shop for information and learning resources related to carers and young carers;

 development of EPiC printed materials and leaflets;

 development of e-learning modules based on the different levels of the EPiC core principles and framework (Level 1 was launched in June 2014; Levels 2 and 3 are due to be launched in June 2015);

 facilitating learning and sharing events with a broad range of stakeholders; and

 setting up service-level agreements (SLAs) with five demonstrator sites to test the implementation of the core principles into practice (which are described in more detail below).

EPiC Implementation Demonstrator Sites

1.8 During 2013-14 the project supported five ‘demonstrator sites’ representing a variety of different practice settings to test the implementation of the EPiC core principles and framework within practice and provide feedback on the effectiveness of the approach.

1.9 A Service-Level Agreement was put in place with each of the five demonstrator sites and small grants of between £1,500-2,000 made available to support this work. The sites

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

were: NHS Dumfries and Galloway; Prince and Princess of Wales Hospice, Glasgow; NHS Grampian; Inverclyde CHCP; and North Lanarkshire Carers Together.

1.10 The project team provided the demonstrator sites with a template evaluation framework to aid with measuring and reporting the outcomes of their EPiC activities. The sites each provided NES with a short evaluation report in March 2014 setting out the activities they had delivered and / or intended to deliver. At this stage of the process very few of the sites had much evaluation data to report as the majority were still in the early days of delivering their activities.

1.11 The evaluation team used these reports to explore what data already existed and to build on this information in the fieldwork in each site.

Management of the EPiC project

1.12 The EPiC project is jointly managed by NES and SSSC and is led by a Steering Group comprising representatives from NES, SSSC, Scottish Government, and providers of workforce learning across health and social services, further education, and the voluntary and independent sector.

1.13 There has been a dedicated project lead since the development of the EPiC core principles and framework in 2012. The two managers for this work within NES and SSSC changed during 2013. Additional staff were added in 2013/14 (an administrator in NES and a part-time joint project lead sharing a post with the Scottish Government) which gave the team greater capacity to implement the activities above.

Funding

1.14 Total funding for the overall project (to March 2015) has consisted of £263,000 (2011- 2015). It is worth noting here that the work was established as a project at the outset rather than a programme (which would have had more significant funding and a longer timescale) as this has been commented on by research participants and will be referred to later in the report.

The evaluation

1.15 The evaluation sought to address the following questions:

To what extent have expectations around EPiC been realised?

What has been the impact of learning related to EPiC in terms of:

- staff confidence and capability in relation to working with carers and young carers?

- staff values and attitudes in relation to supporting carers or young carers?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

- changes in practice, processes and policy as a result of using the EPiC core principles?

- changes in the workplace environment as a result of becoming more carer aware?

What are the facilitators and barriers to applying the EPiC core principles?

To what extent has good practice in relation to carers and young carers been disseminated and used by other colleagues and team members?

What are the perceptions of the sustainability of any changes in practice?

Methodology

1.16 In discussion at the inception meeting it was agreed that the significant focus of the evaluation should be on gathering stories and perspectives from those who had begun the process of implementing the principles into practice as this would have the greatest value – primarily from the demonstrator sites plus another couple of areas where the project team understood there had been significant implementation activity. It was acknowledged that “hard” data on impact might be limited as it is still early in the process of implementation.

1.17 It was also agreed at this stage to gather information from individuals who had made ‘pledges’ to use EPiC in their settings at the learning and sharing events – to explore what activities had taken place and any impact from them.

1.18 We summarise the agreed methodology for this evaluation below with further detail for each element in the paragraphs following it:

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Figure 3. The evaluation methodology

Review of project and demo site documentation

Demo (and Consultation at other) site visits, learning and interviews and sharing events focus groups

Survey to Interviews with individuals who stakeholders made EPiC 'pledges'

Review of project and demonstrator site documentation

1.19 We reviewed the strategic documents in relation to EPiC, including the EPiC Action Plans, development material and Steering Group minutes. We also reviewed data provided to us by the project team on known usage of the portal and other resources, and on the pledges made by individuals who had attended one or more of the networking and learning events.

1.20 We reviewed the Service Level Agreements with the demonstrator sites and the sites’ activity and evaluation plans, and followed this up with an initial scoping phonecall to demonstrator site project leads in order to develop a bespoke evaluation plan for each of the sites.

1.21 Following this activity, we designed the research tools. We provide these in Appendix 1.

Local demonstrator site visits, interviews and focus groups

1.22 Each of the demonstrator sites has taken a different approach to their implementation activities and, as such, the evaluation team developed interview and focus group schedules designed to gather information from the most appropriate stakeholders in each site. For example, in areas where Level 1 training had been delivered we held focus groups and interviews with staff who had participated in the training. We also interviewed a range of local stakeholders, such as carers, those involved in shaping the training, staff

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

with a strategic oversight, and where relevant, staff in other organisations who could comment on changes in practice or outcomes.

1.23 We visited each site to conduct the fieldwork and carried out telephone interviews where it was not possible to speak to some staff on site. We used a semi-structured interview approach and informed respondents that their views would be anonymised. Appendix 2 contains a summary list of those interviewed in each site.

Survey to individuals who made EPiC ‘pledges’

1.24 We developed a short survey which was disseminated to individuals known to the EPiC project team who had made a ‘pledge’ at a learning event to use the EPiC core principles in their own practice and settings. The survey sought to find additional examples, where they existed, of EPiC being implemented in local settings and to explore the impact and any issues arising from their experiences.

1.25 We received a total of 16 responses to the survey, and this gave us 15 examples to draw on.

Interviews with stakeholders

1.26 We conducted 21 face-to-face and telephone interviews with stakeholders using contacts provided to us by the EPiC project team. The stakeholders comprised people closely associated with the project – on the project team, the steering group or from organisations who had been involved in developing and implementing interesting approaches. Appendix 3 contains the full list of interviewees.

Consultation at learning and sharing events

1.27 We attended the meeting of the Carers Information Strategy Network (November 2014) and the National Carers Strategy Learning and Sharing event (February 2015), in order to gather additional information about any impact from using the EPiC core principles and resources.

Report layout

1.28 The remainder of this report is set out under the following headings:

 Chapter 2: Summary of national and local EPiC activity

 Chapter 3: The impact of EPiC activity

 Chapter 4: Sustainability considerations

 Chapter 5: Conclusions and recommendations

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

2. Summary of national and local EPiC activity

Sources of data for activity-mapping

2.1 The EPiC core principles and framework were launched with the intention they would support the learning and practice of those working within health, social care and other services to identify, support and involve carers. The principles and accompanying resources were designed to allow local areas and settings to adapt them for their own use.

2.2 The evaluation team has sought to gather information and data from a broad range of sources in order to build as full a picture as possible about the ways EPiC has been used in different settings across Scotland. However the open access nature of the EPiC resources means there may be additional uses and activities related to EPiC in settings which are not captured within the scope of this evaluation.

2.3 In the remainder of this chapter we describe the activity at national level in relation to EPiC and its resources followed by a summary of activity at local level taken from the range of sources examined in this evaluation.

Reach of national EPiC resources and activity

2.4 We provide a summary below of the reach of the centrally-developed EPiC resources.

 158 people attended one of three EPiC learning and sharing events organised in Aberdeen, Edinburgh and Glasgow. At these events 72 participants made a pledge to use or develop activities within their local settings.

 There are 964 members of the EPiC email network. These members receive regular updates from the EPiC team about new resources, invitations to events, and information and good practice examples related to EPiC. Many within this network are likely to be involved in cascading the information to others within their organisations.

 Over 10,000 copies of EPiC printed resources have been distributed across Scotland (EPiC pocket guides, EPiC Core Principles leaflets, EPiC concertina guides)

 To date a small number of individuals in three health boards have accessed the Level 1 e-module on Learn Pro, and a further three Boards have adapted the module for use on their own learning platforms, however the usage figures for these are unknown. Two further health boards have requested the source files for the module.

2.5 The EPiC portal went live on the NHS Scotland Knowledge Network in 2013. By the end of January 2015 there had been 6,174 visits to the EPiC portal on the Knowledge Network and 636 to the portal on SSKS, from 2882 and 418 individual users respectively.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Activities and resources undertaken in partnership with the national project

2.6 The EPiC project has comprised a wide range of activities and initiatives, and careful thought has been given to identifying opportunities to develop the profile of the EPiC resources and link in with national and local educational and policy developments. The work of the EPiC project team has been shaped by a yearly action plan, with provides a comprehensive overview of the activities and resources that have been developed in each phase of the project.

2.7 The list of activities below is far from exhaustive but is intended to give a snapshot of the range of partnership activities that have been developed by the EPiC project group.

 Development of Working with Carers and Young Carers SQA units at Level 7 for Personal Development Award based on EPiC level 2.

 Partnership with Open University and Carer Positive Employers Kitemark to develop Caring Counts in the Workplace online course, aligned to level 3.

 Hosting a joint event with Step into Leadership on Supporting Carer Leadership (due to be held in March 2015).

 Involvement in Advisory Group for College Development Network resource on Supporting Student Carers, and aligning it to EPiC.

 Workshops and presentations at range of learning events, including Promoting Excellence conferences, University learning days, Open University symposium, national and local carer consultation events, and Carers Parliaments/Summits.

Approaches taken by the demonstrator sites

2.8 A key focus of the EPiC project has been to support the implementation of the EPiC core principles into local contexts and settings. As well as providing access to resources and support for workforce learning the project team also opened up an opportunity for areas to apply to become a ‘demonstrator site’, the purpose of which was to test approaches to implementing EPiC within different contexts and to share the learning. Sites were given a large degree of freedom to determine their approaches, and supported to develop their implementation and evaluation plans. The successful applicant sites were:

 NHS Dumfries and Galloway;

 NHS Grampian (three separate projects);

 Inverclyde CHCP;

 North Lanarkshire Carers Together; and

 Prince and Princess of Wales Hospice, Glasgow.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

2.9 We were also asked to consider two additional areas which were not part of the demonstrator site projects but which were known to the EPiC project team to have undertaken implementation work. These were:

 NHS Greater Glasgow & Clyde; and

 NHS Highland.

2.10 We applied the same methodology to all the selected areas. This involved developing evaluation questions and conducting onsite visits, interviews and focus groups to determine what activities had been developed and the impact of these activities.

2.11 The tables below provide a brief overview of how the seven detailed case study sites approached their EPiC-related activities. They set the context for subsequent discussion of the approaches and their perceived impact.

Overview of selected local area activity

Table1. NHS Dumfries and Galloway EPiC Levels 1 and 2 – Face-to-face training with health, social services and third sector staff Activities delivered Dumfries and Galloway developed their own training materials prior to the development of the EPiC framework and resources but have incorporated the EPiC resources into their own. “The EPiC core principles put a framework around what we’d done.”

They have undertaken workforce training across health, social work, care homes, and the third sector. They have had particular success with social work services and with a GP practice. They have a local DVD (showing examples of carers) in the process of development (the filming is done) (CIS resource used to produce this).

Staff receive certificates on completion of the training that are personally signed by the Chief Executives of both the health board and local authority. Outputs e.g. numbers of staff involved in the training Level 1: 721 Level 2: 315 These include sessions across local authority social services, NHS and third sector organisations as well as sessions for elected members. Intended changes in practice / outcomes  Wanted to start early and train the workforce across sectors to be more aware of carers  Hoped to train the non-executive directors of the NHS Board but this has not happened as yet. Observed changes in practice / outcomes

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

There are some observed changes in practice but it is not possible to say whether these would have happened anyway as a result of the Carers Strategy and the work around implementing that. The EPiC framework as a product of the Carers Strategy has helped drive things forward.  One of the medical practices has implemented a broad range of initiatives to improve the way they identify, support and involve carers. This includes incorporating a reminder at the top of the patient screen to ask about the carer, setting up a carers focus group for the practice and involving them in decision-making. The practice went on to win the RCGP Caring for Carers award at both Scotland and UK levels.  The Commissioning Officer has recognised the influence her position can bring and builds in the carers’ element to negotiating contracts with service providers: for example a residential mental health unit will now consult with carers as routine. She is also seeking to embed “carers as equal partners” throughout relevant documentation.  The head of Adult Social Services in Nithsdale insisted that all staff undertook both Levels 1 and 2 training. He is now Head of Adult Services for the whole of Dumfries and Galloway and has asked all areas to undertake this training. He is also looking to involve the Carers Centre at the frontline desk. Further activities in development The Joint Strategic Planning Officer has allocated funding for a further nine months from the Carers Strategy resources in order to keep the training going: they still see there is a lot to do to reach people with the Carer Aware training.

They are still hoping to do non-Executive director training for NHS Board members, and they would like to get a reference to EPiC/carers incorporated into high level documents.

They hope to increase reach and embed across all sectors and see the potential to gain greater involvement from NHS managers by approaching it from the perspective of the NHS as an employer of staff who may also themselves be unpaid carers (and this in turn links to the Carer Positive Employers Kitemark).

Table 2. NHS Grampian EPiC Level 1 – Incorporating the EPiC core principles into several workforce education activities EPiC Level 2 – Some resources are being developed at this level Activities delivered NHS Grampian’s Learning and Development Facilitator for the Carer Information Strategy explained that, rather than developing a standalone EPiC training programme, NHS Grampian has incorporated the EPiC core principles “into pretty much everything we do that’s associated with carers”.

EPiC has been incorporated into several strands of workforce education activity, including training for hospital staff working with people with dementia, a toolkit and training programme

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

related to young carers being developed in partnership with Aberdeenshire Council for schools, moving and handling training for NHS staff who work with carers, a pilot using the Triangle of Care tool in a mental health hospital, coaching skills training for NHS staff working with carers, and a series of awareness raising talks by carer campaigner Tommy Whitelaw.

In addition, NHS Grampian has developed a localised version of the level 1 EPiC e-learning module and this was launched on NHS Grampian’s e-learning platform in March 2015. This is based largely on the EPiC e-learning module, but has been amended to suit NHS Grampian’s e-learning platform to allow staff to link the module to their eKSF. The module also includes some localised information including signposting to local support services. Outputs e.g. numbers of staff involved in the training  Dementia in the Acute Hospital study day: 156 participants since the EPiC principles were incorporated into this training  Skills for Coaching with Carers training for staff: 30  EPiC e-learning module: to be launched in early 2015  Young carer awareness training for school teachers: to be launched in spring 2015  Tommy Whitelaw talks: 630 attendees (including staff, carers and members of the public)  20 staff members took part in a session for the NHS Board Intended changes in practice / outcomes  Improve awareness and knowledge among staff of carers, carers’ issues and carer support services so they can identify carers, support them and involve them as equal partners in care. Observed changes in practice / outcomes Evaluating the impact of EPiC in Grampian is difficult because it has been incorporated into so many different strands of work, and because it is still “early days”. However, interviewees felt that EPiC is having a positive impact in Grampian.

The Carer Information Strategy Learning and Development Facilitator noted that there is evidence that “our staff... are certainly more aware, better at identification and starting to signpost a lot more.” Staff members we interviewed noted that awareness of the EPiC principles has improved their ability to identify and support carers.

NHS Grampian asked participants in the Dementia in the Acute Hospital study day to complete an evaluation form before and after the study day with questions based on the EPiC framework. The feedback from participants shows that participants increased their knowledge and awareness of issues related to the EPiC principles and there are indications that there have been some changes in practice and attitude. For example, before the training, 28% of the 29 participants said that they were ‘able to raise the issue with a person if you suspect they have a caring role, in a sensitive and empathetic manner’, but this figure after the training was 69%. Similarly, 38% of participants said that they ‘respect and value the knowledge and expertise

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

that carers have in relation to the person they care for’ but this figure increased to 86% after the training.

Staff told us that EPiC is valuable in providing reassurance that involving carers is an important, credible and valued priority, and in providing a useful framework and resources for workforce education related to working with carers and person-centred care more generally. Staff with a responsibility for workforce development said that the principles and resources gave them a valuable tool to promote carer awareness among staff.

EPiC has supported several initiatives at the operational level designed to support carers and increase their involvement in care planning and delivery. For example, there has been increased use of the Getting to Know Me documentation, admission documentation has been amended to prompt nurses to record information about the carer and to gather information from the carer about the patient where appropriate, increased signposting to carers service, open visiting, improved admission and discharge processes, a trial person centred care planning process involving carers, and increased distribution of NHS Grampian’s ‘do you look after someone?’ signposting Z card. It is important to note that much of this work was underway before EPiC was launched, but EPiC has provided reassurance to staff that initiatives like this are worthwhile, and provided added credibility to carers support work more generally.

There is some evidence that these changes are beginning to have an impact - for example, one care of the elderly ward that has introduced several initiatives to involve carers more has seen a reduction in complaints to zero.

Similarly, EPiC has supported initiatives at a strategic level related to working with carers. For instance, the Dementia Nurse Consultant described EPiC as a “tool to help us achieve” national Dementia Care Action 8, which refers to working as equal partners with family, friends and carers. In addition, the officer responsible for developing resources for schools said that “the principles have given me a real framework and structure for my workforce training in particular but also with the strategies and policy that I will be implementing over the next year within education”. Further activities in development NHS Grampian will continue to incorporate the EPiC core principles into workforce education activity related to working with carers. The Carer Lead hopes that this will mean that “these core principles are embedded as part of everyday practice”.

There are plans to develop an online training course at Level 2 and a Level 2 two-day course, which will incorporate the EPiC core principles, is under development.

NHS Grampian is considering using the EPiC core principles as a basis for NHS Grampian’s Carer Information Strategy Action Plan.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Table 3. NHS Greater Glasgow & Clyde EPiC Level 1 and 2 – Face-to-face training to health and social care staff, third sector and volunteers Activities delivered: NHS Greater Glasgow & Clyde’s Carers Working Group has used EPiC to help deliver elements of its Action Plan in relation to improving the consistency of carer awareness training within the Board.

Through its demonstrator site work EPiC has been embedded within several strands across GGC: within Health Behaviour training with midwives; within Dementia work; and within the acute setting more broadly (a particular focus on the stroke team).

The idea has been about challenging culture and systems and is based on a service improvement model i.e. getting teams to look at barriers and the opportunities to make improvement.

The training takes a two tier approach, currently delivered face to face. Both tiers focus on the components of identification, provision of information and how to access support. Level 1 is awareness raising with Level 2 predominantly used as a service improvement tool where teams work on what is required in order to action the three components using the core principles.

Two levels of training were developed based on EPiC: a short 20 minute on- the- ward training and an hour-long workshop session. The training has been embedded where possible within other training e.g. linking or incorporating it in with other planned training.

In parallel with the training, the project lead has influenced and piloted new processes and systems that will better enable staff to have conversations about the caring journey, record having had them and ensure that they are followed up appropriately. For example, EPiC was rolled out with a new conversation aid for stroke ward staff, ensuring that conversations about the caring situation are incorporated within the stroke patient pathway. Outputs e.g. numbers of staff involved in the training From Sep 2013 – Feb 15: Level 1 – 460 staff Level 2 – 218 staff Figures for awareness training within Discharge Training and Dementia Training are not included in the above. Intended changes in practice / outcomes  Providing the right information and support to carers.  Making sure that conversations happen earlier in the acute setting so that issues can be acted on before a crisis happens.  Avoiding inappropriate discharge.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Observed changes in practice / outcomes Impact has been difficult to measure as it is part of a wider programme of work and because it has been incorporated in with other initiatives.

Stroke ward example In the stroke ward there has been felt to be a particularly beneficial and immediate impact in terms of staff awareness about what services are available for carers. Prior to the training, the team would spend ages trying to get hold of a social worker; however they now know that there are services within Glasgow – both the carers service within NHS Greater Glasgow & Clyde and local carers centres – that they can refer people to.

The Stroke SCN felt that the caring conversations are happening more due to the training and the conversation aid being incorporated in the pathway. As a result of the training there are also advisors who come to the stroke ward at certain times of the week who can provide direct advice to carers and there is now specific carers’ information in the ward. Further activities in development There are plans to roll the training out to more staff and to adapt the EPiC level 1 e-learning to incorporate Greater Glasgow & Clyde-specific information.

Table 4. NHS Highland EPiC Level 1 - Carer awareness training for staff EPiC Level 2 - Training for staff EPiC Level 3 - Strategy development Activities delivered NHS Highland used the EPiC framework to form the basis of its new Carers Strategy and Young Carer Strategy. “We thought ‘why re-invent the wheel?’ Why not use those principles and build the strategy around about that framework so that’s exactly what we did”.

Connecting Carers, a third sector organisation that delivers carer awareness training on behalf of NHS Highland, has incorporated the EPiC core principles into carer awareness training for NHS staff. Outputs e.g. numbers of staff involved in the training  The new Highland Carers Strategy and Young Carer Strategy, both 2014-17, have been written and launched  The “EPiC” name is used on publications  Number of staff taking part in Level 1 Carer Awareness training since the EPiC core principles were incorporated: 20-25 staff Intended changes in practice / outcomes  Support the development of a new Carers Strategy and Young Carer Strategy for Highland.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

 Support the health and social care integration process by promoting a consistent approach to working with carers among health and social care staff.  Improve awareness of carers and carers’ issues among staff.  Improve the skills, knowledge and confidence of staff working with carers. Observed changes in practice / outcomes Interviewees told us that the EPiC framework was very valuable in supporting the development of the new strategy in a number of ways. Firstly, interviewees noted that EPiC “gave us the framework” for the strategy and, secondly, EPiC’s clear, simple and jargon-free structure made it easier for carers and carers’ organisations to take part in the strategy development process and to respond to consultation documents. Finally, the consultees felt that, because the EPiC framework is part of a national initiative and because carers were consulted in its development, using the EPiC framework gave the strategy development process “legitimacy” and “gave us confidence to know that when we were consulting with carers we were operating in the right paradigm”.

Interviewees felt that it is quite early to evaluate the impact of the strategy and other activities related to EPiC on staff practice in Highland, and attribution is difficult because EPiC is one of many initiatives designed to promote carer awareness and involvement.

However, NHS Highland’s Carer Lead noted that the new strategy has “raised the profile of carers throughout the organisation” and “legitimised them (staff) taking more notice of carers and being more aware of carers”. In addition, the strategy “has raised the profile of carer support plans and made it much more common currency... a lot more carers have benefitted from carer support plans this year than previously”.

There is some evidence that the carer awareness training is having a positive impact. The interviewee from Connecting Carers said that the staff training has “raised awareness of where carers can be signposted to and increased our connection with staff in various hospitals”, leading to an increase in referrals to Connecting Carers from hospital staff. Further activities in development Interviewees from NHS Highland and Connecting Carers observed that culture change is required to facilitate sustained changes in staff practice and that to achieve this “much more than just a brief awareness session” is needed. Consequently, they are developing training at EPiC level 3 designed to engage more fully with managers. It is hoped that, by gaining support from leaders and managers, a ‘top-down’ culture change will occur and carers will be involved as equal partners in care.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Table 5. Inverclyde CHCP EPiC Level 1 – Face-to-face training with frontline CHCP staff Activities delivered Working in partnership with the Inverclyde Carers Centre, Inverclyde CHCP developed and delivered Carer Awareness training based on EPiC level 1. The training was delivered to targeted groups of frontline staff in the CHCP, including homecare staff, Mental Health Team staff and GP practice administrative staff.

Elements of the face-to-face training included a drama by local carers to showcase good practice in communicating with carers and a short film produced by local young carers focusing on a day in their lives. The training incorporated workshops for staff to discuss their roles in identifying and supporting carers.

A key element of the session was to inform staff about services available at the Inverclyde Carers Centre and about the Inverclyde Carers’ Self-assessment Tool which had recently been developed and piloted by the CHCP and the Carers Centre.

Outputs e.g. numbers of staff involved in the training 8 Social Care administrative staff 10 GP Practice Managers 87 GP Practice receptionists and healthcare assistants 12 Community mental health team staff 62 Homecare staff Involvement of 60 carers and professionals at presentation of Carers Strategy Review Intended changes in practice / outcomes  Improve staff knowledge of carers, carers issues and local carers services with frontline staff so that they can identify and signpost carers to appropriate support.  Improve consistency within the CHCP about how carers are referred on to support. Observed changes in practice / outcomes While still early days, most of the interviewees felt EPiC was having a positive impact, including those who took part in the training. Some participants said that they feel they now have a much better idea about identifying carers (not realising for example that young people could be carers) and about the issues that are important to them.

Interviewees said they had not realised what was on offer at the Carers Centre and now feel in a better position to refer carers there for support. A few people mentioned that some of those who took part in the training identified themselves as carers and it got them thinking about the caring role and the support that they (or colleagues who are carers) might need.

It is still early days to measure the impact on actual numbers of referrals coming through and to what extent this is due to EPiC, however the Inverclyde Carers Centre Manager believes there has already been an increase in referrals seen over this time period.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Further activities in development There are plans to continue to roll out the training and to make it a mandatory part of the CHCP induction for all staff.

Table 6. North Lanarkshire Carers Together EPiC Level 3 – Face-to-face training for strategic leads EPiC Level 1 – Face-to-face training to third sector and volunteers Activities delivered: In North Lanarkshire EPiC was initially used as a resource to make sure that carer support is at the forefront of activities within the Reshaping Care for Older people (RCOP) Community Capacity Building and Carer Support Programme (CCB&CSP). A multi-agency working group was established to develop a training programme based around the core principles of EPiC. This training was launched at a learning and sharing event organised by North Lanarkshire Carers Together (NLCT) and aimed at the CCB&CSP Thematic Leads. Leads were supported to develop Action Plans based around the EPiC core principles for how they would support, identify and involve carers in their own programmes of work. 50% of RCOP funding was allocated to this carers work.

The second strand of the EPiC work was targeted around the members of the six local consortiums which aligned to the CCB&CSP. These consortiums are made up of multi-agency staff and local voluntary groups and services who work closely with the thematic programmes of work. As a direct result of this targeted work local consortiums were supported to cascade EPiC level one training to their staff and volunteers working within the 6 localities of North Lanarkshire.

At Personal Outcome Events, RCOP Programme leads worked with NLCT to roll out Level 3 training to staff within health, social work and the third sector including carer organisations. These Personal Outcome Events were established in order to inform the workforce of some of the changes that are taking place as part of integration of health and social work and the development of Locality Modelling.

Outputs e.g. numbers of staff involved in the training Level 3 50 participants at EPiC event RCOP Theme Leads and Partners 62 Consortium members 134 attendees at EPiC Personal Outcome Events 30 Social Work Senior Managers

Level 1 400 community learning and development staff, third sector and volunteers (to date)

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Intended changes in practice / outcomes  For all RCOP action plans to recognise and involve carers.  Make all staff across health and social care and voluntary services better equipped to identify and support carers.  Ensure more carers are identified before crisis point.  Ensure more carers are receiving consistent and appropriate support (referral to the right carers organisations, and support to attain personalised outcomes).  Increase the voice of carers in the planning and delivery of services.

Observed changes in practice / outcomes The Level 3 training with RCOP leads has had strategic impact. All the RCOP thematic leads have developed EPiC action plans setting out how they will involve and support carers. It was felt that the voice of carers in planning and delivery has been greatly improved thanks to the Level 3 awareness training and the follow on work by NLCT in facilitating carers and their representatives to have a voice at the table within the CCB&CSPHCP.

As a result of the Level 3 work with the Thematic Lead for Digital Inclusion, all community learning and development staff are now receiving Level 1 training. A carers working group has also been established with involvement of both North Lanarkshire Council and NHS Lanarkshire to look at how the core principles of EPiC can be implemented into a range of training for all staff within the statutory sector.

Most people felt it is having a positive impact so far in terms of the numbers of people undertaking Level 1 training and the positive anecdotal evidence coming back from those who participated in it.

The Princess Royal Trust Lanarkshire Carers Centre is starting to see increased referrals since EPiC was delivered as part of the CCB&CSP; however, it’s difficult to identify causality as there have also been increases in centre staff numbers and many other contributing factors.

There are some stories of carers being identified before reaching a crisis and having their outcomes identified and better supported.

Further activities in development Plans for the future include widening the reach of face-to-face sessions where appropriate, widening the context to beyond RCOP, and doing more level 2 training for those who work closely with carers. The multi-agency working group which involves strategic managers from both NHS Lanarkshire, North Lanarkshire Council and carer organisations is also leading on work to localise the Level 1 online module which will be made available across Lanarkshire to NHS and council staff.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Table 7. Prince and Princess of Wales Hospice, Glasgow EPiC Level 1 – Face-to-face training to all hospice staff Activities delivered: A programme of carer awareness training has been incorporated into mandatory training for all hospice staff. They have adapted the EPiC resources to suit their needs and the context of the hospice. The hour-long training is delivered to small groups every month, with all staff taking part in the training within the year.

In parallel the hospice has launched a carers drop-in group at the hospice which offers peer support and organised talks specifically for carers each week (e.g. from lawyers about advanced care planning, wills etc). The training module encourages all staff working in the hospice, whatever their role, to be sensitive to carers’ needs as well as to inform carers about the hospice’s carers’ drop-in and other carers’ services e.g. the local Carers Centre. Outputs e.g. numbers of staff involved in the training All staff in the hospice have been involved in the training (144 staff). (Clinical Administration; Fundraising staff; Consultants; Specialty Doctors; Ward Nurses; Clinical Nurse Specialists; Health Care Assistants; Family Support Team; Art Project; Hospice Support Staff - Kitchen staff; Domestic staff; Porters; Finance and HR Teams) Intended changes in practice / outcomes  Staff to have an increased awareness of what caring involves and to be sensitive to that.  All staff to feel able to have conversations with carers about support they might need.  More carers aware of and referred to the hospice carers group.  Increased referrals to the carers centres. Observed changes in practice / outcomes The training has been very well-received by staff. Staff feedback has been overwhelmingly positive, saying that they are now more carer aware as a result of the training. This was backed up by participants in the focus group of staff.

The local carers centre is starting to see increased referrals to the centre which they think is partly down to this training. The in-hospice carers group is also seeing increased referrals to and increased staff / carer awareness of it.

The training was evaluated through a self-assessment form and the hospice produced a summary of the results in February 2015. This evaluation demonstrated 97-98% positive results against the training objectives.

Staff in the focus groups said the training gave them a better understanding of: - the extent of what is involved in caring and the burden that caring can involve. - the importance of asking carers about their needs and if they are aware of support, and ways in which to do this. - the importance of helping carers to identify themselves as carers.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

- the different support that there is available and where to signpost people to (both the in-house hospice group and carers centres).

The carer who took part in the focus group said that she was helped to identify herself as a carer by hospice staff and found the staff to be very supportive. She now attends the hospice group and has benefitted enormously from the peer support, being able to talk, and the practical sessions for carers. Further activities in development The hospice plans to use EPiC to drive forward greater co-production with carers in the hospice.

Other uses of EPiC resources

2.12 In addition to the detailed case study areas above, we have sought to gather other examples where organisations have used, adapted and implemented the EPiC resources and framework and explore to what extent EPiC has had an impact in these local settings. These examples have come from the range of sources used during the research, including the “pledges” survey responses and stakeholder interviews.

2.13 We summarise examples of activity from these other sources below.

Aberdeenshire Council adapted the EPiC Level 1 e-module to make it relevant to the local context local and launched it in January 2015. The intention is for the e- learning module to raise awareness of carers among staff across all council departments so that they should “always consider the carer". The decision to integrate EPiC within the Council training plan was made by the Carers Strategic Outcomes Group, a group involving council staff and a range of third sector organisations that support carers. The EPiC module was considered to be a good tool on which to base workforce training.

Carers Scotland is a key partner in the Carer Positive Employers Kitemark, the Scottish Government initiative to recognise employers who have policies and practices that support carers in their workforce. The Carers Positive Employers Kitemark was developed by Carers Scotland and launched in June 2014. Carers Scotland considers EPiC to be a good example of how an employer could raise carer awareness and support carers in the workplace. It suggests EPiC could be used as a tool for employers to demonstrate their supporting practice as evidence for obtaining the Kitemark.

Carers Link East Dunbartonshire delivers training and information sessions through Carers Information Strategy (CIS) funding. It has integrated EPiC into carer awareness training and outreach work with professionals, including GPs, medical staff, allied health professionals and homecare and social work staff. EPiC has also been integrated into training with carers, so that carers understand how health boards and

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

local authorities should be supporting and involving them as equal partners in care. EPiC is now a standing agenda item at the Carer Working Group (NHS, local authority and voluntary sector) for East Dunbartonshire.

The College Development Network (CDN) has a specific workstream aimed at supporting colleges across Scotland to support student carers. It has used the EPiC project to raise colleges' awareness of the need to support student carers. The CDN developed an online training resource package based on EPiC level 1 which comprises a resources for college trainers to deliver to their staff. The aim is to encourage college staff to think about what they will do differently in their settings to identify and support student carers, while studying and applying for jobs. The impact is beginning to be seen. For example, several colleges now ask potential students on their application form to identify themselves as carers if they wish to so that colleges can signpost and support them effectively.

NHS Lothian has delivered workforce carer awareness training through its CIS funding since 2010. A dedicated Training Coordinator from VOCAL Carer Centre delivers the training on behalf of the Board. While it pre-dates EPiC, the principles and design of the workforce training - based on a Think CARER model[1] - are very closely aligned with EPiC. The training is delivered to staff and students through e- learning and through face-to-face sessions. One of the major successes to date has been getting a 45 minute slot on the Flying Start Programme for all newly qualified nurses. While developed independently from EPiC, interviewees from both VOCAL Carer Centre and NHS Lothian CIS feel that EPiC has provided valuable practical support and networking as well as helpful national impetus for carer awareness training.

Tommy Whitelaw was a carer for his mother who had dementia and now delivers a significant amount of talks to professionals and the public as part of the Dementia Carer Voices project. He promotes EPiC in these talks and hands out the EPiC literature. He has very broad reach - he delivered 186 talks across Scotland and England in 2014, attended by 10,000-12,000 people, including the public, unpaid carers and health and social care professionals. He hopes that the outcome of doing this will be so that “the principles are achieved, carers are identified and recognised as equal partners”.

NHS Lanarkshire has integrated EPiC within existing programmes and initiatives undertaken through the CIS. For example, EPiC core principles have been reflected in its Carer Champion Programme, a one-day training programme for NHS and GP practice staff. To date there are 135 Carer Champions across NHS Lanarkshire, including 25 in GP practices. By the end of December 2014, there were plans to have

[1] VOCAL’s Think CARER acronym: Consider, Awareness, Recognise, Empower, Refer

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

a Carer Champion in every acute ward in NHS Lanarkshire. The CIS Lead noted that EPiC adds value to the CIS work as it helps convey the importance of carer awareness workforce training and has helped reinforce the Lanarkshire approach by providing a ‘Quality Standard’ to underpin the work.

Unity Enterprise North Ayrshire Carers Centre reported taking steps to engage carers who do not usually get involved in consultation and planning. This included inviting older carers to an event and visiting rural areas.

The Scottish Health Council Aberdeen held an event with carers of people with mental health issues to enable them to share their views about their involvement in planning the care of the person they care for.

Glasgow Caledonian University is taking steps to involve carers in the education of mental health nursing students.

NHS Fife pledged to “ensure carers are mentioned in all documentation when developing and revising procedures, policies and strategies”.

Thistle Healthcare aimed to embed the EPiC core principles into welcome packs for people who use their care homes and their carers and to place greater emphasis on training staff to comply with best practice.

Support in Mind Scotland disseminates information about the EPiC core principles to its staff and services that work with people with mental health issues and their carers.

The University of Dundee has incorporated the EPiC core principles into a core module about working with carers as part of the MSc in Social Work.

Dundee City Council is developing a Carers Commissioning Statement which uses the EPiC core principles and links these to outcomes for carers and how it will invest in support for carers. It is hoped to produce the statement by August 2015. It is the intention to go for the Carer Positive Employers Kitemark in the longer term. Their view is that they want to embed EPiC at strategic level rather than simply seeing it as a series of training sessions.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3. The impact of EPiC activity

3.1 This chapter examines the impact that EPiC resources and activities have had from across those areas that have been implementing a programme of EPiC-associated activity.

Scope for measuring impact

3.2 Some areas have established mechanisms to evaluate the impact of their activities locally and we have presented some data from local evaluation activity here. However, the exploration of impact has mainly been focused on perceptions of impact from those involved, and on examples of changes in practice that have been observed and associated with EPiC.

3.3 The timing of the evaluation in relation to the work being implemented has also had an effect on the ability to gather and report robust data on impact. Some of the demonstrator sites we visited were still in the process of implementing their training and were therefore unable to provide substantial evidence of changes in practice. We aimed wherever appropriate to gather the views of strategic managers, those involved in designing and providing training, participants, and others who are in a position to observe impact on their services, for example Carers Centres and, where possible, carers. We gathered anecdotal evidence which was helpful in building a picture of emerging impact.

Indicators and areas of impact

3.4 In our evaluation we have looked for examples of where EPiC resources and activities have contributed towards a culture in which workers, carers and the people they care for are recognised and valued as equal partners. We have explored the impact of EPiC where staff have developed knowledge and skills aligned with the different levels of the EPiC framework (see Table 8 below), and where there have been any positive changes in practice or policy that reflect the six core principles of EPiC.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Table 8. Key knowledge and skills aligned to EPiC levels Level 1: Carer Aware  Understand that anyone can be a carer

 Provide relevant information at the right time

 Signpost to support and assessment

Level 2: Caring together  Understand and use a person-centred, outcomes-focused approach  Sensitively manage conflict in the caring relationship  Be aware of equality and diversity issues Level 3: Planning with  Involve carers in planning services Carers as Equal Partners  Support staff to reflect on their practice and work in a person- centred way  Contribute to change in culture

3.5 Most activity we examined focused on EPiC Level 1 but there was some Level 2 and 3 activity in Dumfries and Galloway, Grampian, Highland and North Lanarkshire. The intended outcomes across the areas were primarily geared towards staff being ‘Carer Aware’.

3.6 We have also explored whether there have been any resulting and / or related changes in practice or culture within the organisation associated with this training and, where it is possible to identify, any consequent impact on the way carers are identified, supported and involved as equal partners in care.

3.7 We set out the evidence of impact in the following paragraphs under these three headings: impact on staff; impact on organisations; and impact on carers.

Impact on staff

3.8 Interviewees commented that it is too early to assess the full impact of the EPiC core principles and associated learning and development activities which they suggested will not be known for some time. Interviewees also noted that it is difficult to isolate the impact of EPiC because it sits alongside other initiatives designed to improve carer involvement. However, interviewees did provide some evidence that learning and development activities linked to EPiC have already begun to have a positive impact on NHS, social services and third sector staff, including the following:

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Improved confidence and Improved Engaging staff ability to identify understanding Involving carers beyond the carers and refer of the issues as equal health and social them to that affect partners in care care sectors appropriate carers support

Improved confidence and ability to identify carers and refer them to appropriate support

3.9 Interviewees told us that staff who have been involved in learning and development activity related to EPiC have improved confidence and ability to identify carers and refer them to appropriate sources of support.

3.10 For example, the manager of Inverclyde Carers Centre reported that carer awareness training for targeted groups of staff (including GP practice administrators, mental health teams and home care staff) appeared to result in an increase in the number of carers referred by these staff to the Carers Centre for support. The Carers Centre Manager explained that before the training staff were not aware of carer support services and were “scared to open up a can of worms” but now, following training, “there has been a huge increase in referrals from health and social care (to the carers centre) and some of this will be down to EPiC”. A home care worker who took part in the training said that “it’s making staff more aware of what their responsibility is - making the person aware that there are services there and steering them towards the Carers Centre”.

3.11 Other examples provided included:

interviewees in Lanarkshire identified examples of staff being better able to identify carers as a result of training, including examples of carers who had been identified before reaching a crisis and receiving better support as a result;

Carers Centre staff reported an increase in referrals as a result of mandatory carer awareness training delivered to all Prince and Princess of Wales Hospice (PPWH) staff;

Connecting Carers, a carers support service in Highland, reported an increase in referrals from hospital staff after delivering carer awareness training in hospitals;

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

the Carers Centre in Dumfries report that they have seen some new people referring carers to the Centre who have not done this before, although cannot directly attribute this to training around carer awareness;

a Senior Charge Nurse from a Stroke Ward in NHS Greater Glasgow & Clyde told us that “the training had an immediate impact for [ward] staff. Before they didn’t realise what services were available for carers… now they know there are services within Glasgow… that they can refer people to”;

a Training and Information Officer at Fife Carers Centre said “more people are carer aware and more confident about identifying and approaching carers to let them know that there is help available to them”; and

the Head Porter at PPWH now sees his role as reassuring carers when they visit the hospice and raising any issues of concern with staff who can help.

3.12 As well as increased confidence about where to refer carers and services available, there is evidence that confidence to have the conversation with carers about their role has increased. This is particularly evidenced in the example of the stroke unit in NHS Greater Glasgow and Clyde which has incorporated a tool to aid these conversations to take place.

3.13 It is important to note that in some areas the training about being carer aware has been followed through by systems to support practice: for example, in the stroke unit in NHS Greater Glasgow & Clyde the paperwork that healthcare professionals complete now contains prompts to remind staff to ask patients and carers questions about caring responsibilities. As the SCN said, “it’s about ensuring that people don’t slip through the net”. In Aberdeen Royal Infirmary, nursing documentation has been amended in some wards to prompt nurses to identify and record cases where a carer is involved with a patient. In Dumfries and Galloway a medical practice has included a “carer” reminder at the top of patients’ case notes.

Improved understanding of issues that affect carers

3.14 There is some evidence that staff who have taken part in EPiC-related learning and development activities have improved their understanding of the issues that affect carers. Evaluation data collected by health boards provides some evidence of this. For example, PPWH delivered mandatory carer awareness training to 144 staff and 97% of those who completed an evaluation form after the session described themselves as more aware of:

the diverse range of carers including hidden carers and young carers;

the impact of caring;

carers’ rights; and

information, advice and support available to carers.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.15 Inverclyde CHCP staff who took part in interviews and focus groups indicated that they feel they now have a much better idea about identifying carers (not realising, for example, that young people could be carers) and about the issues that are important to them.

3.16 A number of consultees across the demonstrator sites mentioned that the EPiC-based training had led them to recognise themselves, their friends or colleagues as carers for the first time and were much better informed about what it is to be a carer. A member of staff at PPWH hospice explained: “As part of the reflection element of the training we wrote a job description for a carer and the resulting list was overwhelming. It’s not a job anyone would do by choice. It opened my eyes to what carers have to do, and that’s on top of their other jobs and responsibilities”.

3.17 The GP Practice Manager in Dumfries and Galloway implemented a broad range of system processes within his practice following the carer awareness training he attended. The training gave him “a greater insight into the challenges carers face and how we can help them” and while the changes may have taken place without the training, “it helped [us] get there quicker”.

Involving carers as equal partners in care

3.18 Most of the EPiC-related training and development activity that has taken place so far is targeted at Level 1 of the EPiC framework (carer awareness). The evidence presented above shows that this has had a positive impact on staff awareness of carers and their ability to identify carers and refer them to appropriate support.

3.19 However, there is also some evidence to suggest that local activity related to EPiC is leading to improved outcomes at Level 2 of the EPiC framework (caring together), and there is some evidence that some units and staff are beginning to involve carers more as equal partners in care. For example:

80% (12) of respondents to our survey said that the pledge they had made in relation to EPiC had led to improved awareness of the importance of involving carers as equal partners in care among staff in their organisation and 73% (11) said there was increased awareness of the importance of engaging carers in the planning and shaping of services;

76% of staff who took part in training related to working with people with dementia in NHS Grampian said after the training that they take time to listen to carers and help them identify support needs, compared with 38% before the training; and

69% of acute hospital staff in NHS Greater Glasgow and Clyde who took part in carer awareness training related to EPiC said they felt confident raising the issue of caring with patients and relatives before the training but this figure increased to 100% after the training.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.20 Some interviewees gave us examples of initiatives such as introducing open visiting, carer support plans and increased involvement of carers in admission and discharge procedures. Some of these activities were introduced in response to EPiC, and some were already underway before EPiC was launched, but EPiC has provided added momentum and reminded staff that involving carers is an important and national priority.

3.21 A nurse who works on a care of the elderly ward in Grampian, for example, said that they have been implementing initiatives for two years to promote carer involvement, and EPiC has reassured her and her team that this work is valuable. Similarly, a Young Carers Education Officer from Stirling Carers Centre said that “as a service we are supporting young carers and listening to them as much as we can. The pledge [made at an EPiC event] helps remind us what we are doing and what we are working for. It is helpful motivation”.

3.22 The GP practice in Dumfries and Galloway is a positive example of how the training influenced greater involvement of carers. The Practice Manager set up a carers focus group in the practice, chaired by the Carers Centre and with representation from eight patient members who are or have been carers. This group helps shape decisions and processes within the practice. It also discusses health board issues that may affect carers. The range of actions implemented led to patients nominating the practice for a RCGP Caring for Carers award, which it won at both Scotland and UK-levels.

Engaging staff beyond the health and social care sectors

3.23 While the main focus of EPiC activity has been on staff in health and social care sectors, some interviewees said that EPiC activity had had an impact on staff beyond these sectors, most notably in education.

3.24 For instance, a joint project between NHS Grampian and Aberdeenshire Council is developing resources and training to raise awareness of young carers among teachers and improve their ability to identify and support young carers, and in Stirling, the Young Carers Education Officer reminds teachers about EPiC and its benefits when speaking in schools. In addition, a survey respondent from Carers Link East Dunbartonshire reported that “my work in local schools has meant there has been a rise in awareness of young carers within the school environment”.

3.25 The College Development Network’s project to use EPiC to raise college staff’s awareness of student carers is beginning to have an impact, with at least four colleges now known to have incorporated questions about whether student applicants are carers into their application process.

Impact on organisations

3.26 EPiC has had an impact at organisational level in the following ways:

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Supporting Supporting Changes in other local and processes strands of national and work priorities systems

Supporting other strands of work

3.27 EPiC has been valuable in supporting organisations to implement other strands of work related to carer awareness, involvement and support. We have listed some examples of the EPiC core principles being embedded into training activity below.

NHS Grampian has embedded the EPiC core principles into several staff training programmes including a Dementia in the Acute Hospital Study Day, moving and handling training, coaching skills training for staff and training for teachers.

In NHS Greater Glasgow & Clyde EPiC is incorporated within existing planned training and explicitly tied in with other initiatives, e.g. person-centred care and dementia strategies. EPiC is presented as a mechanism for staff to support aspects of these other initiatives, and there is a specific focus on delivering dementia awareness and carer awareness training together: “Caring for people with dementia means really connecting with patients and carers. The work on EPiC really dovetails in with that.”

North Lanarkshire Carers Together developed EPiC level 3 training for staff leading the Reshaping Care for Older People (ROCP) Community Capacity Building and Carer Support Programme. This training resulted in the thematic leads developing EPiC action plans for the ROCP programme.

A lecturer on the MSc in Social Work at the University of Dundee reported that the EPiC core principles form part of a core module about working with carers.

The Scottish Ambulance Service included an article about EPiC in a workforce development handbook for staff, to support ambulance staff to identify previously unidentified carers.

NHS Grampian and Aberdeenshire Council have “been using the EPiC core principles as an underlying framework for workforce education for education staff”.

3.28 EPiC has also been used to support other carer initiatives in addition to training activity.

Carers Scotland noted that EPiC could help employers obtain the Carer Positive Employers Kitemark: "EPIC is a good example of how an employer could be supporting working carers if they are using the EPIC framework, if they are actively doing that within their workplace".

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

NHS Highland used the EPiC core principles as the foundation for the development of its Carers Strategy and Young Carer Strategy, 2014-17.

In Inverclyde EPiC has helped pave the way for greater involvement of and co- production with carers within the health and social care partnership: “Carers are a statutory equal partner in the new HSC partnership so strategically EPiC is an excellent fit for HSC integration”.

3.29 Interviewees acknowledged that these initiatives may have happened anyway, or, in some cases, were already planned or in existence, but EPiC has given the activity a higher profile and “legitimacy” and a valuable framework for activities. As an interviewee in North Lanarkshire said:

“The [EPiC] principles added value to the work already being done to identify, support and involve carers. It wouldn’t have been as easy to achieve the same outcomes without the framework. It provided the tool to frame it all in and ensure consistency in understanding and workforce learning”.

Supporting local and national priorities

3.30 Interviewees described EPiC as a facilitator in implementing local and national priorities around personalisation, reshaping care for older people, dementia care, self-directed support and national and local carers strategies. In particular, EPiC is seen as valuable in helping to prepare for the integration of health and social care by promoting a consistent approach to working with carers among NHS and local authority staff.

Changes in processes and systems

3.31 EPiC has prompted changes in processes and systems in some organisations. For example:

admission documentation has been amended in some wards in NHS Grampian and NHS Greater Glasgow & Clyde to identify and record cases where carers are involved with patients;

there are several Scottish colleges that now ask potential students on their application form to identify themselves as carers if they wish to;

The Scottish Health Council described a “change in the way we work, at times to enable carers to be more engaged in our work and at a time that is suitable for them”. For example, the organisation recently hosted an event for carers of people with mental health issues to gather their views of their involvement in the care of the person they care for;

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

NHS Fife reports planning to involve carers and young carers more in policy and service development processes - “a larger commitment to ensure carers and young carers are considered and included when introducing or improving services”;

The Dumfries and Galloway GP practice who won the RCGP Caring for Carers award implemented a number of procedural changes designed to improve the way staff identify, support and involve carers. These included incorporating a flag on their system so that GPs and other staff recognise the patient is a carer, arranging ‘keep well checks’ for carers and setting up a carers focus group (discussed above); and

The Scottish Personal Assistant Network is “now more focused on ensuring that all our materials and services also consider the views of carers”.

Impact on carers

3.32 Interviewees felt that, although there has been significant activity to improve staff members’ awareness of carers and their support needs, the full impact of this on carer experiences is yet to materialise. The evidence gathered illustrates examples under the following headings:

Increased Increased involvement confidence and support

Increased involvement and support

3.33 Ultimately, EPiC aims to increase carers’ involvement in the planning and delivery of the care of the person they care for. While it is too early to gather extensive evidence of this, some interviewees have observed an improvement. For example, a care of the elderly ward in NHS Grampian has introduced several initiatives such as open visiting and said that carers have the opportunity to be more involved in meal times and hands on care if they wish.

3.34 In addition, a survey respondent said that carers they work with “feel that they are respected as equal partners in the care of their sons/daughters and that their skills are accepted and appreciated”.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.35 Several areas, including NHS Highland and NHS Dumfries and Galloway, commented that they are focusing more on carer support plans/carer assessments so that they can be more certain that such support is put in place.

3.36 A respondent from the Scottish Health Council commented that “as a team we’ve been offering carers more of an opportunity to be involved in shaping services for the future, hopefully leading to them being better able to influence the services they receive as well as the services the person they care for receives”.

3.37 In North Lanarkshire numerous stakeholders felt that the voice of carers in planning and delivery has been greatly improved, attributing this to both the level 3 awareness training and the follow on work by North Lanarkshire Carers Together in facilitating carers and their representatives to have a voice at the table.

Increased confidence

3.38 Some interviewees felt that EPiC has had a positive impact on carers’ awareness of what they are entitled to, thereby improving their confidence to negotiate with health and social care services and “self-advocate” for involvement in the planning and delivery of the care of the person they care for. As an interviewee said, “carers who have attended our training are now better informed and more aware of their rights and the rights of those they are providing care for”.

3.39 One carer who attended a focus group at the PPWH stated that she was helped to identify herself as a carer by hospice staff and found the staff to be very supportive. She now attends the hospice group and has benefitted enormously from the peer support, being able to talk, and the practical sessions for carers.

Factors contributing to effective implementation

3.40 Below we discuss some key factors that have facilitated the effective implementation of EPiC-related activities.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Figure 4. Facilitating factors to EPiC implementation

Credibility

Clear, simple Strategic buy- and trusted in principles

Mandatory Facilitators training/ embedding Adaptability EPiC in existing training

Support from Partnership NES and SSSC working team

Credibility

3.41 Interviewees reported that the EPiC core principles, and the fact that EPiC is badged as a national initiative backed by both NES and SSSC, has given added credibility to initiatives designed to promote carer awareness and involvement.

3.42 For example, an interviewee who was responsible for developing carer awareness training noted that EPiC was valuable in delivering this training by helping them “to focus on how to get the message across. It created the space and justification to spend training time on carers. I don’t think we’d have been able to do it without EPiC. The fact that NES and SSSC were behind it and pushing it forward legitimised it”.

3.43 A staff member in NHS Grampian responsible for workforce education feels that the involvement of NES and SSSC gives the EPiC e-learning module added “kudos” and hopes this will lead to greater uptake of the module than Grampian’s previous carer awareness e-learning module.

Clear, simple and trusted principles

3.44 Interviewees praised the EPiC core principles as clear, simple and jargon-free, and this makes them easily understandable for staff and carers.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.45 EPiC’s credibility is further increased by the rigorous development process, in particular the consultation with carers and carer support organisations that NES and SSSC undertook to develop the EPiC core principles. This has given local staff the confidence to use the principles in local training and development work and to signpost local staff to the principles. As the Carer Lead in NHS Highland said, “we knew that they were reliable in the sense that they were the outcomes that carers were looking for... gave us confidence to know that when we were consulting with carers we were operating in the right paradigm”.

Adaptability

3.46 Interviewees value the EPiC learning resources because of their adaptability. All the case study areas we visited had developed tailored training resources and approaches to reflect the needs of different staff groups and local information, structures and initiatives. They stressed that this adaptability was a key strength of the EPiC resources and that, without this flexibility, EPiC would have less of an impact.

Support from the NES and SSSC EPiC team

3.47 Many interviewees commented on the valuable support, advice and guidance that the NES and SSSC project team has provided for local staff implementing EPiC activities. For example, an interviewee from the Scottish Ambulance Service reported that the team helped him to develop an article on EPiC for a staff development handbook.

3.48 Interviewees were highly positive about the resources that the project team provides and said that they supported local training and development activity. In particular, many areas spoke positively about the EPiC e-learning module, and the ability to tailor this module with local information. Interviewees also value the other resources provided by the EPiC team. For example:

an interviewee from SSSC told us that the EPiC materials had been incorporated into a learning guide distributed to 5,000 staff who work with people with dementia, and the availability of EPiC resources saved the SSSC from having to create their own resources;

in Inverclyde, “the [EPiC] materials meant we didn’t have to start from scratch”;

NHS Grampian’s Learning and Development Facilitator described many of the resources as very useful, and in particular praised the “brilliant” plain English summary; and

an interviewee from VOCAL Carer Centre who delivers carer awareness training across NHS Lothian told us that the EPiC network and resources were useful for sharing good practice and linking up with others delivering similar training across Scotland.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Partnership working

3.49 Partnership working among health boards, local authorities and third sector carer support organisations has supported the effective implementation of the EPiC core principles. For example, in NHS Highland, a third sector organisation delivers training to health board staff, and in Inverclyde a good existing partnership between the CHCP and Carers Centre facilitated co-delivery of carer awareness training.

3.50 In Dumfries and Galloway the relationship between social services and the Carers Centre is continuing to develop with the possibility that the latter will shortly be placing staff members, alongside other third sector organisations, with frontline social services staff.

3.51 The North Lanarkshire EPiC activities were focused on delivering training across health, social care and voluntary sector organisations. All stakeholders commented on how the strong existing partnerships and history of joint working between health, social care and the voluntary sector were critical to EPiC having the reach and impact it has.

Mandatory training/embedding in existing training/training techniques

3.52 Some areas have decided that the training linked to EPiC is so important it should be mandatory. For instance, PPWH provides mandatory training for all hospice staff about carer awareness, and this has led to increased carer awareness among staff and an increase in the number of referrals made to the local Carers Centre. Others, such as Inverclyde CHCP, are hoping to build carer awareness training into mandatory induction training for all staff. It is also recognised however that there is already a lot of mandatory training for NHS staff and finding ways to link EPiC training into other training and learning events may be more successful.

3.53 Incorporating the EPiC core principles into existing training so it is not stand-alone has given it greater reach in some areas. NHS Highland, NHS Grampian, NHS Lothian and NHS Greater Glasgow & Clyde are examples of health boards that have taken this approach.

3.54 Interviewees stated that using interactive and visual training techniques such as DVD clips and drama increases the impact of the message.

Strategic buy-in

3.55 Some areas have taken steps to raise awareness of the EPiC core principles among senior staff. For example, North Lanarkshire Carers Together has developed and delivered level 3 training and successfully included EPiC in the planning for the Reshaping Care for Older People Community Capacity Building and Carer Support Programme. NHS Highland is also developing training at level 3 in recognition that buy-in from strategic managers is required to facilitate the culture change needed to embed EPiC in everyday practice.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.56 Many stakeholders recognised that having strong strategic buy-in was a key facilitator to being able to implement the EPiC work in local areas, particularly in a context of ‘competing priorities’ and difficulties in releasing staff to take part in training. All the case study areas we visited were perceived to have prioritised carers at strategic level. This was demonstrated in some areas by the allocation of additional funding and staff resources to deliver carer awareness training (in Inverclyde CHCP, NHS Dumfries and Galloway and NHS Greater Glasgow & Clyde), or to implement activities resulting from the training (for example, the Lanarkshire Change Fund allocated 50% of RCOP funding for carers).

3.57 Buy-in at strategic and manager level was also recognised to be key in enabling the workforce to subsequently put the learning into practice. One consultee from a Carers Centre commented that “health and social care staff have to have time to prioritise carers; carers are always going to be secondary otherwise. It has to be supported from on high. Referrals and carer signposting have to be prioritised from managers and team leaders – there needs to the buy in. Where that has happened it has been really effective – where they’ve been given the space to consider the carer.”

Challenges and barriers to effective implementation

3.58 We discuss the challenges and barriers associated with implementing the EPiC core principles on the following page.

Figure 5. Challenges and barriers to EPiC implementation

Competing priorities and lack of time

Challenges Achieving with e- Challenges culture learning /barriers change module

Structural challenges

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Competing priorities and lack of time

3.59 The main challenge in implementing EPiC learning activity is encouraging staff to undertake training in the midst of competing duties and training priorities. Staff often find it difficult to be released from their normal duties to undertake training, particularly in a context of resource constraints and lack of cover.

3.60 Some consultees from the independent sector felt that EPiC lacked a high profile within the independent caring sector and that the caring sector struggled to prioritise it among competing priorities and demands.

3.61 One of the ways some consultees had overcome the problem of competing priorities and demands on time was to build EPiC training in alongside other training wherever possible. Another solution adopted includes the development of on-the-job training inputs such as on the wards in NHS Greater Glasgow & Clyde and NHS Lothian (VOCAL training).

Achieving culture change

3.62 Interviewees noted that embedding the approach of involving carers as equal partners in care will require a significant change in culture, attitude and practice among staff, and that this is notoriously difficult to do. As an interviewee in Highland said, to achieve culture change “you need much more than just a brief carer awareness session”. Achieving culture change is likely to require buy-in from strategic managers and for this reason some areas including NHS Highland and North Lanarkshire, have used or are intending to use Level 3 EPiC training for senior staff to raise the profile of carer awareness issues at manager level.

Structural challenges

3.63 Some interviewees expressed concern that, given the size of the health and social care sector, EPiC-related training inputs that have occurred so far are a ‘drop in the ocean’ and there needs to be activity on a much larger scale to promote culture change and embed changes in staff practice that involve carers as equal partners in care. For this reason, it is seen as important to promote the principles at a strategic level and to include the EPiC core principles and/or carer awareness training as part of induction and ongoing training wherever possible.

Challenges with e-learning module

3.64 While many interviewees commented on the value of the EPiC e-learning module, a small number of interviewees expressed some concerns about the module. The development of the Level 1 e-learning module was only completed in 2013 and this has caused some issues with organisations not being able to implement this as early as they would have liked.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

3.65 There were a number of technical challenges around the initial compatibility with local e- learning platforms, a challenge that has been partially addressed by the EPiC information support officer in NES Knowledge Services.

3.66 Some interviewees stressed the need to localise the information to make staff aware, for example, of local referral routes and carers organisations and also to include richer content, for example, short clips prepared by local carers and links to local strategies and information.

3.67 One area has not promoted the module to staff for fear of making them less likely to do face-to-face training which is perceived to be more valuable. In other areas electronic EPiC training is considered to be a useful resource in addition to face-to-face training and in these areas they envisage using the e-module (or an adapted version) for specific groups of staff or as part of a general induction, with face-to-face sessions continuing to be delivered for other groups of staff.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

4. Sustainability considerations

4.1 The work to implement the learning activity and resources linked to the EPiC core principles and framework has only just started in terms of the size of the overall health and social care workforce (total around 300,000). The evidence gathered in this evaluation shows that some good progress has been made but that much remains to be done.

4.2 There was a unanimous perception from all consultees that the principles themselves will remain valid and not easily go out of date. Several people mentioned that EPiC will become even more important as the role of carers continues to be recognised:

“There’s no aspect of healthcare that doesn’t fit with carers’ issues”.

“It’s the red thread that has to go through everything”.

“It’s a priority that straddles whatever sector you’re working in”.

4.3 Everyone commented on how well the EPiC core principles and framework fitted with national and local strategies including:

o Promoting Excellence o Reshaping Care for Older People o Dementia Strategy o National / local carers strategies o Carer Positive Employers Kitemark o Forthcoming carers’ legislation o Asset-based approaches

4.4 Some, however, thought that this strategic alignment needs to be better communicated, and that at the moment EPiC can still appear to be a stand-alone project (particularly from a national policy perspective). It was considered important to ensure that the EPiC core principles are referred to as often as possible in relevant national policy documents in order to gain even stronger national policy support and endorsement.

4.5 Training alone is recognised by some interviewees as not being enough to embed and sustain the changes that it is hoped the EPiC core principles and framework would encourage. It is essential to have structures, systems and processes in place to support the implementation of the principles and what people are learning e.g. involvement of carers and carer organisations in strategic decision-making; commissioning processes that ensure that carers are built in to new service contracts; documentation that is aligned to identifying carers; clear referral pathways; and mechanisms to put the learning into

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

practice. The forthcoming Carers Bill also provides an opportunity to further embed and sustain the core principles in practice.

4.6 At local level sustainability concerns related to the continuing training and learning activities that have been developed. Several demonstrator sites mentioned concerns about maintaining the resource to deliver training – particularly where the training was delivered face to face (Inverclyde CHCP, NHS Greater Glasgow & Clyde, and North Lanarkshire Carers Together). In one of the areas (Dumfries and Galloway) the decision had been taken to continue funding for face to face training activity at least for the next nine months. There was a strong perception from those who had taken part in face to face training that this was crucial and that an online module wouldn’t have the same impact. They thought that what made it meaningful was having the opportunity to consider and self-reflect, linking it up to their roles and local initiatives, alongside colleagues.

4.7 People thought that incorporating the face to face training in with other training opportunities could help sustain it and the impact it might have: on a practical level it meant being able to offer more training opportunities by linking in with other training already taking place. This approach also helped sustain the principles by demonstrating the links with and importance to other national and local policy initiatives and / or organisational strategies (NHS Greater Glasgow & Clyde, PPWH, Inverclyde CHCP, NHS Grampian, and NHS Lothian).

4.8 There is a high level of concern that without the central project team in place, momentum and progress will be lost. Several interviewees stated they thought it needs continued national funding to develop and realise the aims, and that the funding to support implementation is being brought to an end too soon. This related back to the fact that it was set up as a project, rather than a programme which might have had longer-term funding and timescale. Some interviewees thought that a programmatic approach would have been more appropriate. In practical terms, there are concerns about who is going to maintain the website and ensure the centrally-developed resources stay up to date.

4.9 Some of the local and national stakeholders saw embedding EPiC within the Carer Positive Employers Kitemark as a key future development to sustaining the impact of the EPiC resources that have been developed as it is hoped that employers will be encouraged to ensure that the workforce is, at the very least, carer aware.

4.10 Another way to sustain the impact of EPiC is to ensure it is built in to further and higher education courses. Getting the recognition of unpaid carers into pre-qualification curricula would help workers see it as integral to their role not just an add on. There have been good starts made on this with the SQA work and also the (non-EPiC) example from VOCAL within Lothian e.g. the Flying Start programme. The example from Dundee University’s MSc in Social Work is also encouraging in this respect.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

4.11 If the work begun over the past few years is to be sustained it will require local and national strategic leaders to make sure that learning and development within the workforce around the core principles continues and that structures and systems are aligned to this activity.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

5. Conclusions and recommendations

5.1 This evaluation demonstrates that a lot has been achieved to implement the EPiC core principles and associated learning and development resources since 2013. For a limited budget the reach has been significant in terms of the different approaches and activities being implemented. As one interviewee stated:

“It’s one of those pieces of work that has delivered more than it was asked to do”.

5.2 In terms of numerical reach to the overall health and social care workforce it is clear that there is a long way still to go. Rolling out Level 1, carer aware, is essential and it appears from the evidence that there are two useful ways in which to consider doing this: making it a mandatory part of induction training for those working in health and social care partnerships; and embedding it with other key areas of education and training (either topic specific such as with dementia or embedding within health and social care curricula such as Flying Start or at further and higher education levels).

5.3 While it has not been possible to quantify the impact the various activities being undertaken have had to date, the qualitative evidence gathered in this report illustrates that awareness is growing and with it the confidence and ability to identify and involve carers more. It is assumed that this in turn will lead to more positive outcomes for carers even although at this stage the evidence for this is not available.

“More and more people are becoming aware of EPiC and its value. It’s recognised as a really good framework and a really useful tool”.

5.4 There is some recognition that training alone will not change the culture, structures and systems to bring about significant changes for carers and that buy-in at strategic level is essential for this to happen. For this reason efforts to engage senior managers in Level 3 training are seen to be important as it is hoped this will lead to the strategic buy-in that is needed. Where senior managers have been involved it is shown that this can lead to significant change.

5.5 There is concern that momentum may be lost if the funding for the central project team comes to an end: the enthusiasm and commitment of the project lead and team has been widely commended. Some interviewees thought that further central funding would have been helpful over the next few years as carers legislation is steered through parliament.

5.6 It is hoped that one of the ways in which the EPiC resources will continue to be promoted and used is through the Carer Positive Employers Kitemark which encourages employers to support workers who have caring responsibilities to remain in the workforce.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Recommendations

5.7 Based on this evaluation we recommend the following:

2. Continued efforts should be made to see EPiC core principles included in further and higher education courses;

3. NES should ensure the EPiC core principles feature in learning materials for all its other learning/education initiatives (Flying Start/Effective Practitioner and so on);

5. Scottish Government, NHS bodies, SSSC and COSLA should seek to include mention of the EPiC core principles as appropriate in all relevant polices and strategies;

6. Scottish Government/NES/SSSC should consider how at least the minimum level of central support (for example keeping the website updated) can be achieved; and

7. Scottish Government/NES/SSSC should consider some form of evaluative research with carers in a couple of years’ time to assess whether outcomes are improving for them.

5.8 It is to be hoped that the process of implementing the EPiC core principles started over the past two years will be embedded and sustained across health and social care organisations in Scotland so that carers are supported and involved in appropriate ways at all levels.

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

APPENDIX 1 – RESEARCH TOOLS

A. Case study area Interview Schedule (1) – For strategic leads and partners involved in delivering EPiC activities

Your organisation’s use of the EPiC framework

1. Please briefly describe your role.

2. How has your organisation used the EPiC core principles/framework? a. What learning and development activities did your organisation develop from the EPiC core principles / framework? b. What other activities did your organisation undertake around the EPiC framework (for example, strategy development, other resources or programmes of work) c. Did you partner or work with other organisations in any of these activities? What role did the partners have?

The intended / observed impact of EPiC activities

3. What changes were you / are you hoping to achieve through these activities? For example, changes to: a. Staff attitudes and confidence in working with carers? b. Changes in practice and behaviours in working with carers? c. Organisational culture change, strategy or policy in relation to carers? d. Experiences of carers and young carers?

4. What needs or gaps were / are the activities designed to address? What specific challenges was the organisation or staff experiencing in identifying and supporting carers? (please give examples)

5. To what extent to do you think the activities have been effective? What changes have you, your staff or partners observed? (please give examples) a. Staff attitudes and confidence in working with carers? b. Changes in practice and behaviours in working with carers? c. Organisational culture change, strategy or policy in relation to carers? d. Experiences of carers and young carers?

6. Have there been additional or unintended impacts as a result of these EPiC activities? (for example, on the staff involved, on other staff, on the organisation or other organisations)

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

Specific impact questions relating to relevant activity / EPiC outcomes.

For organisations focused on Level 1. Carer Aware 7. Which specific Carer / Young Carer outcomes have the activities been geared towards? (Refer to the principles as prompts – they may have been geared towards them all or just one or two)

8. In what ways are staff who received this training more ‘carer aware’ as a result of the activities you have implemented? Please give examples (Refer to the principles as prompts)

9. How are you measuring this, and can you provide examples of this impact? For example, they might be measuring it through staff surveys, carer feedback, specific measures such as referrals, use of pathways etc.

10. How did you use EPiC resources do shape these activities (for example, the online learning module, the principles themselves etc)? How useful were they in developing your workforce learning activities?

For organisations focused on Level 2. Caring Together 11. Which specific Carer / Young Carer outcomes have the activities been geared towards? (Refer to the principles as prompts – they may have been geared towards them all or just one or two)

12. What has been the impact of this training? Are the staff concerned working with carers differently / in a more person-centred way?

13. How are you measuring this, and can you provide examples of this impact? For example, they might be measuring it through staff surveys, carer feedback, specific measures such as referrals, use of pathways etc.

14. How did you use EPiC resources do shape these activities (for example, the online learning module, the principles themselves etc)? How useful were they in developing your workforce learning activities?

For organisations focused on Level 3. Planning with Carers as Equal Partners 15. Which specific Carer / Young Carer outcomes have the activities been geared towards? (Refer to the principles as prompts – they may have been geared towards them all or just one or two)

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

16. What has been the impact of your Level 3 activities? Has it led to carers being embedded throughout the practice / service as equal partners in care?

17. How are you measuring this, and can you provide examples of this impact? For example, they might be measuring it through staff surveys, carer feedback, specific measures such as referrals, use of pathways etc.

18. How did you use EPiC resources do shape these activities (for example, the online learning module, the principles themselves etc)? How useful were they in developing your workforce learning activities?

The value and effectiveness of the EPiC core principles / framework

19. How did the EPiC core principles / framework add value to your organisation’s existing workforce learning and practice? Would the changes you have mentioned have happened without the EPiC core principles / framework?

20. Do you think that the EPiC core principles provide an effective framework for workforce learning?

21. How well does EPiC link to other national drivers such as Integration, Reshaping Care, Personalisation, SDS and Dementia?

22. How well does EPiC link to local drivers and priorities in your organisation?

Barriers and facilitators

23. Have there been any barriers or challenges in applying the EPiC core principles / framework in practice, if any? How did you overcome them / how do you envisage overcoming them?

24. Have there been any facilitating factors in applying the EPiC core principles / framework in practice?

Sustainability of EPiC core principles / framework

25. How sustainable are the changes brought about by the EPiC core principles / framework in your organisation?

26. What needs to be done to sustain the changes (e.g. in practice, policy and processes) your organisation has observed / hopes to see?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

27. What do you hope EPiC will achieve in the future?

28. Would you like to make any further comments about EPiC?

B. Case study area Interview Schedule (2) – For managers and staff participating in EPiC training activities

1. For Level 1 activities). In what ways did the training support [you / those whom you work with] to be more carer aware? Ask for specific examples and explore confidence, knowledge, awareness, changes to practice etc.

2. (For Level 2 activities) In what ways are [you / those whom you work with] working with carers differently / in a more person-centred way? Ask for specific examples

3. (For Level 3 activities) Have the activities led to carers being embedded throughout your practice / service as equal partners in care? Ask for specific examples

4. What impact, if any, have the EPiC activities had on the experiences of carers and young carers in your service / area?

5. Have you used the EPiC core principles / framework in other ways?

6. Is there anything about the EPiC core principles / framework that you have found especially useful / less useful? How can it be improved or further embedded in your organisation?

7. How well does EPiC link to local drivers and priorities in your organisation?

8. How do you envisage using / building on EPiC in your own practice in the future?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

C. Stakeholder Interview Schedule

Your role 1. Please briefly describe your role.

2. How do you and your organisation use the EPiC core principles/framework?

3. How do you and your organisation use learning and development activity and resources related to EPiC?

EPiC learning and development activity and resources 4. What is good about the learning and development activity and resources?

5. What is not so good? What could be improved?

6. Are any activities/resources more effective than others? Why?

Impact 7. What has been the impact of learning and development activities related to the EPiC core principles/framework on (seek full examples): a. your organisation’s strategy or policy? Can you give any examples or evidence of this? b. your organisation’s processes related to carers and young carers? Can you give any examples of this? c. staff values and attitudes in relation to supporting carers and young carers? Can you give any examples or evidence of this? d. staff confidence in working with carers and young carers? Can you give any examples or evidence of this? e. staff capability/skills in working with carers and young carers? Can you give any examples or evidence of this? f. staff practice in working with carers and young carers? Can you give any examples or evidence of this?

8. What has been the impact of the EPiC core principles/framework on how carer aware your workplace is? Can you provide details?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

9. What has been the impact of the EPiC core principles/framework on experiences and outcomes for carers and young carers? (seek examples)

10. Has there been any impact on organisations you work with? (seek examples)

Disseminating good practice 11. How is good practice in relation to carers and young carers disseminated in your organisation/area?

Barriers and facilitators 12. What are the barriers to applying the EPiC core principles/framework in practice, if any? How could these be overcome?

13. What are the facilitators, if any?

Expectations and views of EPiC 14. What were your expectations for EPiC?

15. Has EPiC met your expectations so far? If no, what did you hope EPiC would achieve that it has not?

16. What do you hope you will achieve by using the EPiC core principles/framework in the future?

Sustainability 17. How sustainable are the changes brought about by the use you have made of the EPiC core principles/framework?

18. What needs to be done to sustain the changes in practice, policy and processes brought about by the EPiC core principles/framework?

Other comments 19. Would you like to make any further comments about EPiC?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

D. Survey to practitioners who made pledges

Your pledge 1. Have you implemented action on your pledge? a. Yes b. No

If you have not implemented action on your pledge 2. Why not? (Please tick all that apply) a. Insufficient support from colleagues b. Insufficient support from managers c. Insufficient support from other professional groups d. Insufficient support from carers e. Insufficient support from service users f. Insufficient time available to implement change g. My role is insufficiently senior h. My own level of knowledge i. My own level of confidence j. My own level of skills k. Insufficient resources available to support change (e.g. money, materials, technology) l. Other (please specify)

If you have implemented action on your pledge 3. Please tell us about the impact of your pledge on you, your colleagues and the service you work for. What is different now as a result of your pledge?

4. What has been the impact of your pledge on you, your colleagues and the service you work for? (Please tick all that apply) a. Improved awareness of carers’ rights b. Improved ability to identify carers c. Improved awareness of the importance of supporting carers to manage their caring role d. Improved awareness of the importance of involving carers as equal partners in care e. Improved awareness of the importance of engaging carers in the planning and shaping of services f. Improved awareness of the importance of supporting carers to have a life outside of caring g. More confidence in working with carers

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

h. Improved skills/abilities in working with carers i. Other (please specify)

5. Please tell us about the impact of your pledge on carers and young carers. What is different now as a result of your pledge?

The EPiC Core Principles/Framework 6. Have you used the EPiC core principles/framework in any other way? a. Yes b. No

7. If yes, please give a summary.

8. If no, why not?

Further support 9. Is there anything else that could be done nationally to support you in working with carers?

Other comments 10. Do you have any other comments that you would like to make?

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

APPENDIX 2 – LIST OF CONSULTEES IN CASE STUDY AREAS

Demonstrator / Additional site Numbers / type of interview

NHS Greater Glasgow & Clyde 4 interviews with project stakeholders (additional site)

Inverclyde Community Health 6 interviews with project stakeholders and Care Partnership Focus group with 3 staff training participants

3 telephone interviews with staff training participants

North Lanarkshire Carers 8 interviews with project stakeholders Together (and partners)

Prince and Princess of Wales 2 interviews with project stakeholders Hospice Focus group with 3 staff training participants, a carer / service user and a Carers Centre representative

Grampian 1 interview with NHS Grampian’s Carer Information Strategy Learning and Development Facilitator

6 interviews with project stakeholders

Interviews with 3 nursing staff

1 interview with a Practice Educator

1 interview with a carer

Highland (additional site) 1 interview with NHS Highland’s Lead Officer for Carers

1 interview with Carers Centre (training provider)

1 paired interview with Carers Strategy authors

Dumfries and Galloway 2 strategic manager interviews

1 interview with training provider

1 group interview with social work manager and staff member

1 telephone interview with medical practice

1 telephone interview with Carers Centre

Blake Stevenson Ltd EPiC: Evaluation of learning and development activity and resources

APPENDIX 3 – LIST OF STAKEHOLDER INTERVIEWS

Stakeholder name Organisation Alison Jarvis NHS Lothian Andree Carruthers College Development Network David Rennie Scottish Care Florence Burke Carers Trust Frances Simpson Support in Mind Scotland Jane Davies NHS Education Scotland Jon Berry Carers Link East Dunbartonshire Kerry Cannon Scottish Social Services Council Martin Esposito Scottish Ambulance Service Susan Levy University of Dundee Sue Mclintock Carers Scotland Tommy Whitelaw Carer Wendy Probert Aberdeenshire Council Julie Robb Scottish Government Patricia Clark Carers Scotland Roslyn Rafferty NHS Lanarkshire Gill Ryan NHS Education Scotland (EPiC Project Lead) Audrey Taylor NHS Education Scotland Alison Upton Scottish Social Services Council Alison Guthrie Scottish Social Services Council Marion McParland NHS Education Scotland / Scottish Government