This is the speech I made on the launch of the Carers’ Action Plan.
The Carers Action Plan identifies areas for change which can be delivered during this term of government to improve support for people who have a significant unpaid role caring for family members or friends.
I will tell you in a moment about what has already been achieved from a Health & Care point of view, but first I want to emphasise that this plan is for all organisations in the Bailiwick who have contact with carers. It helps us to work together, as a Partnership of Purpose, to support the health and wellbeing of carers and their participation across society. Health and Social Care has a role in delivering some of the plan, but partnership means that the community has its part to play too.
The plan represents the first step on a journey of change towards a society that is more inclusive and supportive for people who have caring responsibilities.
So, what has HSC done so far?
We recognise that currently respite services are not all that they could be and we have been making changes to improve provision.
There will be increased funding for the Respite at Home service, and increased availability.
HSC has employed a respite coordinator based in community services whose role is to help people with pre-booking respite in advance or in emergency situations and to help them navigate the system. This means that there will be one point of contact, a one-stop shop if you like, for carers who need a break. The respite coordinator will help carers to find placements for planned and emergency respite for all adult services, with the exception of respite for people who have learning disabilities, which is already well established.
The Short Break at Home service, historically known as the ‘sitting service’ and senior carer service has seen recent investment and recruited new staff. The senior carer service has been able to provide respite at home for a number of people as an alternative to respite in a care home in an emergency.
We understand the need to offer a carers assessment and to acknowledge the carers’ needs alongside the cared-for person. We are therefore trialling an approach where all carers who care for someone for 35 hours a week or more, will be given the opportunity to have an assessment of their own needs. The introduction of carers’ assessments is a really positive step.
We are in the process of recruiting and have had funding approval for one full-time social worker, based in the adult community team, whose role will focus on carers assessments and case work management that arises from that assessment. We recognise that carers who are providing 35 hours a week or more are the people most in need of support themselves as it’s likely they are caring for those whose needs are more complex.
We recognise that these people are providing a higher level of care and may, by definition, require a higher level of support in their own right.
HSC’s responsibility is to work in the areas where people have most complex needs. The social worker whose main role will be in undertaking carers assessments will be helping us to refine our approach in identifying those who most need those services and initially the focus will be on those people who are in receipt of carers allowance.
We have made a commitment to include carers in the development and review of care plans and discharge plans for the person or people that they are caring for. We know how important this is to carers and it is something that they told us they wish to be involved in, particularly at key points such as when they are discharged from services, or at the transition from children’s to adult services.
We are developing a new reablement service. This is something the Committee has been wanting to establish for nearly 2 years but it has taken a while to secure the funding. Reablement involves providing personal care such as help with daily living activities and other practical tasks, usually for up to six weeks, in the home of the service user. This encourages them to develop the confidence and skills to carry out these activities for themselves and continue to live independently at home. Reablement services tend to be provided to people who have just been discharged from hospital or who may be risk of entering the care system following a crisis. This is relevant for carers who are caring for someone who may benefit from reablement after being admitted to hospital or due to a worsening of their condition. We have only been provided with funding for a year, which is a concern but we hope that, as the benefits are seen that it can become permanent.
HSC’s proposals for health and care regulation were approved by the States in February.
Regulation seeks to ensure, as far as is reasonably possible, the safety of those accessing and using our health and care system, including the most vulnerable islanders.
The proposals include the setting up of an independent regulatory body or commission.
The Commission will be established under a new Enabling Law – a piece of primary legislation – which will govern the regulation of those working within the health and care sector as well as the premises and systems. The emphasis throughout has been on an approach which is both proportionate and appropriate to our size. It will not be a replica of the incredibly complex regulatory systems in other larger jurisdictions, most notably England.
The proposals were formed following a review of local regulation which identified key areas of risk in terms of public safety through the lack of regulatory oversight.
I must emphasise at this point, that the proposals do not affect those providing care for relatives or friends. Any concerns relating to care provided on this basis should be raised through existing safeguarding channels.
A top priority will be addressing what is known as the “unregistered workforce” – this includes carers, domiciliary care workers or those who work within people’s homes, as well as Care Support Workers working in residential and nursing homes, extra care housing, and clinical settings such as the hospital.
There is significant concern over the potential for harm to those receiving such care. At present there is no legal requirement for Carers and Care Support Workers to undergo criminal background checks, mandatory training, to be insured, or supervised. This is what we are seeking to address.
We recognise that responsible employers in the care sector already ensure that their employees are suitable, have background checks and training. Indeed HSC, itself ensures that its employees are subject to enhanced DBS checks before working with vulnerable adults. We have also recently introduced the Care Certificate as part of the induction of carers which assesses employees over 15 standards including dignity in care and hydration of clients over their 6 month induction period.
During the formation of our policy letter on regulation, we met with many providers of health and care across our islands and will continue to actively consult with care providers when the standards surrounding the unregistered workforce are drafted, as well as how it is funded. This will be done with providers, relevant government Committees such as Employment and Social Security, third sector, and users of health and care services.
So, HSC is not standing still. This is not just a document that will gather dust on some virtual bookshelf. We have a big part to play in making the Plan real and are committed to doing so as I hope I was demonstrated.
In addition, we will shortly be publishing our first Joint Strategic Needs Assessment on the over 50s. Work on that has fed into this Plan, but it does provide the bigger picture which will help inform what will become the universal offer across health and care.
There is more to do of course and I think a key area of work has to be in signposting. This is a critical aspect of the new model of health and care. We need to be able to make it far easier for people to know what is out there. However, we need to do this in a far more coordinated manner so we can provide, for want of a better description, a single version of the truth. There is a lot of information but it is all over the place in leaflets, on various websites and what is worse than having no information on services available is having a jumble of information, often not updated, not enough and not in one place.
I’ll just finish by saying that, from a personal point of view I have seen the impact of having to care 24 hours a day for a loved one can have. I have seen it cause mental stress and physical illness. I also know how difficult it is for someone looking after their loved one to see themselves as a full-time carer, especially where it happens gradually over time. That is why I think government can and must do more, to provide support. However, I also saw how others who come into contact with carers and those who they are caring for, could do more.
As I said at the start, this is not just an HSC, or a States of Guernsey issue for that matter. We all of us need to work together – States Committees, GPs, consultants, third sector and the wider community if real positive lasting change is going to happen and that rings as true for the Carer’s Action Plan as it does for the wider world of health and care.
Thank you.