Agenda item

The Chairman welcomed those present to the meeting.  Mr Gary Collier advised that the report provided the Committee with an annual update and preceded a report which would be considered by Cabinet.  The report had included the draft strategy which aligned with the outcomes in the delivery plan for 2023/24.  The strategy reflected the vision and mission statements considered by the Committee in the update report in 2022.  The report also included case studies.  Some information from the previous year's report had been included in this report to provide Members with a fuller picture and, as it was now available, data from the 2021 census had also been included.  The latter showed a reduction in the number of those identifying themselves as carers compared to the 2011 census and feedback from the Office of National Statistics (ONS) suggested that this could be related to the census being conducted under Covid lockdown conditions.

Mr Collier advised that, in addition to the 2021 census, the key sources of comparative data about carers were the annual national short and long term (SALT) services return (completed by all local authorities with adult social services responsibilities) and the Adult Social Care Outcomes Framework measures for carers tested through the biennial National Carer Survey, which was currently in progress.  The meeting was informed that there were limitations with the SALT data as strict criteria meant that carers who had not gone through a carer’s assessment were not counted.  As a result, adult carers being supported by the Carer Support Service who had not had a carers assessment had not been included in this data.  Mr Collier advised the Committee that the Carer Support Service contract was between the Council and Carers Trust Hillingdon, who acted as lead provider on behalf of a consortium known as the Hillingdon Carers Partnership.  The contract represented the main Council support offer to young carers and an important part of the offer to adult carers.

Mr Collier advised that SALT was being replaced with new reporting requirements called Client Level Data (CLD) that would start to be collected from 1 April 2023.  This had less strict inclusion criteria in relation to which carers were included and would provide more information about types and levels of care provided.  Comparative information from this data was unlikely to be available until October or November 2024.  This would enable Hillingdon to benchmark against comparable local authorities.

It was noted that there had been a reduction in the number of carers who had declined a carers assessment (81% of carers who were offered an assessment declined in 2021/22 and 77% in 2022/23).  Although the reasons for refusal were not recorded, the reasons given anecdotally included: the services offered through the Carer Support Service already met their needs; and the service offer available following an assessment did not justify the time taken to complete it.  The Committee was informed that feedback from the Carers Forum identified that some carers were concerned about what would be expected from them if they were identified as a carer, i.e., they might be asked to do more than they felt willing to do.  It was noted that carers did not need to have had a carers assessment to be able to access the Carer Support Service.  Members requested that it be explored further why carers declined to have a carers assessment. 

Mr Collier informed the meeting that Carers Trust hosted the Carers Register and carers of all ages were encouraged to register.  The register had the dual function of providing a means to target information to carers and also providing demographic data about carers in Hillingdon.

Members noted that there had been a lot of good work being undertaken but queried whether this activity would have taken place anyway, regardless of whether or not the draft strategy had been developed.  They also queried how success would be measured and how the draft strategy would help to deliver objectives.  Mr Collier advised that a number of actions had been included in the draft strategy which would help with the delivery of the intended outcomes but that there would be challenges with measuring impact.  Deciding metrics presented a challenge as a balance had to be found between the effectiveness of the metric in measuring impact against the resource implications of collection and analysis of data.  Actions included in the delivery plan had been discussed with partners and were considered as ones that would contribute to achieving intended outcomes.  It was acknowledged that some actions reflected national police and were therefore ‘must dos’. 

Members were advised that the Carer Support Service was a successful model that had contributed to considerable additional funding being secured for carers in Hillingdon.  This was particularly relevant for young carers as a high proportion of the service for young carers provided by Carers Trust was funded through external funding additional to that received from the Council under the contract.

It was noted that national drivers such as the statutory hospital discharge guidance were driving some of the actions at Hillingdon Hospital in respect of identifying and recognising carers but other actions arose from feedback from carers.  The inclusion of a carer flag on the new Cerner patient database at Hillingdon Hospital demonstrated a recognition of the importance of the role of carers.

Mr Collier acknowledged that some of the actions within the delivery plan were not new and that was because the issues were also not new but ongoing.  He advised that one of the aims with the delivery plan was to only include those actions that were over and above business as usual.  This meant that the plan should reduce in size over time, although actions might reappear as local circumstances, including personnel, would change.

Mr Richard Ellis, Joint Lead Borough Director at North West London Integrated Care Board (NWL ICB), advised that the local authority recognised the contribution made by carers, especially young carers.  It was interesting that there were no national targets set in relation to carers and resources needed to carved out that would otherwise be used to meet statutory duties.  Mr Ellis advised that accountability probably did need to be revisited and picked up with Hillingdon Health and Care Partners (HHCP).  A lot of progress had been made but further work was needed to identify where action was still required. 

Progress against the action plan would be taken through the governance structure for the Hillingdon Health and Care System which had been set out in the report.  Members suggested that the current structure illustrated the reporting lines but not how the decision making was held to account.  Mr Collier advised that accountability would sit with the Hillingdon Health and Care Partners Delivery Board. 

Members noted that the NWL Integrated Care Partnership had been developing and questioned how the patterns of service delivery and demand had changed and how the offer had therefore changed.  Mr Collier advised that there was still room for improvement with regard to the Direct Payments as the take up from carers was quite low in comparison with some other NWL boroughs.  Action was also needed to explore the scope for Personal Health Budgets to be used to address the health needs of carers.  Work was already underway at a Primary Care Network (PCN) level by H4All to identify carers as part of case finding arrangements which led to referrals into the Hillingdon Carer Support Service. 

Mr Ellis advised that there had been progress in primary care with GPs flagging when a carer was calling on behalf of a cared-for person.  THH had also improved its practice of logging who the carers were and ensuring that a patient’s package of care at discharge also took account of the needs of the carers.  Considered needed to be given to when the carer themselves needed urgent medical attention, particularly in relation to mental health needs, and the support provided for the continuing care of the looked-after person. 

Concern was expressed regarding the decline in the number of carers that wanted to be assessed and the impact on those accessing support.  Members were aware that there might be some stigma for some carers who might be friends, neighbours or extended family who might see caring as their duty rather than seeing themselves as carers and queried how this was addressed and how those who slipped though the net were picked up.  Mr Collier advised that all partners needed to be thinking from a carer perspective and, as a result, notable improvements had been made at THH and in primary care.  Identification within primary care was essential and this was where the role of the carer lead in practices was particularly important.

The Committee believed that more work was needed to take this into communities as, although not everyone who provided care wanted to be seen as a carer, there would be some who had just not recognised themselves as carers.  Carers Trust staff were good at explaining what it was that a carer did that made them a carer.  Volunteers from certain community groups were able to go back to their communities to explain their experience and to provide peer support.  Members asked that progress over the next twelve months be reported back to the Select Committee.  Mr Collier advised of the intention to come back to the Committee in June 2024 in advance of the 2023/24 update to Cabinet. 

H4All and Carers Trust had been undertaking roadshows across the Borough and had identified a large number carers that had been previously unknown to partners, particularly in the south of the Borough. 

Mr Ellis advised that there were three statutory definitions of carers explained in the report which captured a large proportion of those who gave care but did not cover them all.  The Council had worked hard to support people in communities in positions of respect and provided them with information about the support available to carers so that they could disseminate it to those that might need it.  

Concern was expressed that there was a high proportion of residents self-funding in the south of the Borough and a lower number in the north.  It was noted that these figures did not refer to self-funders but were carers supported by the Carer Support Service.  Members were also advised that men were less likely to consider themselves ‘carers’ than women.  Although work was being undertaken to address this, officers would need to report back on the outcomes of these actions.

Members queried whether it would be possible to breakdown the data on young carers even further as there would be a significant difference between the role or a carer aged 10 and that of one aged 18.  Similarly, there would be differences between the role of a 10 year old and a 65 year old.  Although the census data was not that granular, Mr Collier advised that he would look into what detailed information was being collected by the Carer Support Service (or could be collected).

Whilst it was acknowledged that the Carers Trust had undertaken engagement with carers, Members queried how well engagement mechanisms were now working and whether the Carers Trust was thought to be representative of the carer community.  Mr Collier advised that, as there were resource constraints, engagement activity needed to be prioritised.  Work had been undertaken in various communities, some of which had been successful in identifying carers and some not as successful.   Carers Trust had been attending various groups but there was a limitation on how often this could be done.  Further information on this would be included in the Committee’s next annual update report in 2024 and a representative from Carers Trust would be invited to attend.  It was also agreed that Members hear from young carers and get an update on what was going on in schools such as Oakwood to support young carers. 

Mr Collier stated that further work with schools had been planned.  In addition, the GP Confederation had been working in partnership with the Carers Trust to encourage more GP practices to establish carer leads, although it was emphasised that they could not be compelled to do so.  Mr Ellis advised that he would like to revisit this with the GP Confederation and the PCNs as almost every practice should have identified a carer lead. 

It was suggested that, as well as identifying carers, it was important to know about the care that carers were providing.  It was felt that the use of consistent categories of care and support would everyone to be use the same terminology in discussions. 

Members thanked Mr Collier for his excellent report and for the inclusion of case studies therein which brought the information to life.  However, they were disappointed that not all GPs had been engaging in the work that had been undertaken. 

The Democratic, Civic and Ceremonial Manager was asked to draft a short summary of the Committee’s comments in relation to the report.  This would then be circulated to Members before inclusion in the report to Cabinet.

RESOLVED:  That:

1.    progress against the Carers Strategy delivery plan activity for 2022/23 and against the delivery plan for 2023/24 be noted; and

2.    the Democratic, Civic and Ceremonial Manager collate and circulate the Committee’s comments prior to inclusion in the annual delivery plan update report to Cabinet.