Agenda item

The Chair welcomed those present to the meeting.

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the report provided Members with an annual update on the delivery of the Carers’ Strategy and would be considered by Cabinet at its meeting in September 2024.  The report included priorities for 2024/25 and case studies which made it more real for the Committee by illustrating the issues faced by carers as well as the support provided to them.

It was noted that the Carers’ Strategy consultation had concluded and that it had received some positive feedback.  This feedback had resulted in changes to some of the wording in the Strategy to make it more accessible.  As it covered adult carers and young carers, the Strategy would need to be signed off by Councillor Jane Palmer, Cabinet Member for Health and Social Care, and Councillor Susan O’Brien, Cabinet Member for Children, Families and Education.

Mr Collier noted that there had been some deliberate repetition in this report from the last report to give Members a more rounded picture.  This would not be continued in the next report to the Committee where reference would just be made to the last report.

The report stated that Kensington and Chelsea, Westminster and Hammersmith and Fulham had a higher number of carers supported by the local authority than in Hillingdon.  However, it was noted that the SALT data did not include, for example, the carers supported by Hillingdon Carers Partnership (HCP) under the Carer Support Service contract.  These higher numbers supported meant that there were also greater numbers of carers receiving carers assessments and Mr Collier informed the meeting that the Council continued to experience large numbers of carers declining an assessment.  He stated that these local authorities would be contacted to identify whether there was any learning that could be applied in Hillingdon.

Ms Sally Chandler, Strategic Director at Carers Trust Hillingdon and Ealing (CT), advised that CT was the lead partner for HCP which provided a single point of access for carers.  The meeting was informed that CT was a carer-led organisation with 67% of its board of trustees and staff team having lived experience as carers.  HCP had been created 7-8 years ago and subcontracted a range of specialist support services such as dementia support from the Alzheimer’s Society.  Ms Chandler believed that the partnership worked really well and that the offer provided in Hillingdon was second to none, ensuring that the right services were wrapped around carers in one contact rather than multiple contacts.

It was noted that carers were required to fill in multiple assessments for a range of reasons.  As they were able to access many of the services provided by HCP without filling one in, carers would often not want to complete the Carers Assessment (CA).  This caused some tension as the Council needed to report on the number of CAs completed but the carers did not necessarily want to complete it (completion of the CA could take anything from half an hour to half a day depending on the complexity of needs).

Ms Chandler advised that HCP had worked with the Council to develop a two tiered approach.  The tier one assessment would fulfil the Government needs but, if certain triggers were met during its completion, a tier two assessment would need to be completed (or a joint needs assessment).  Consideration would be given to the development of a young carers assessment in the near future.

Members were advised that, once partners had worked with a carer for a while, they were able to quickly build up a picture of their needs.  A tick list had been developed to help prepare carers for completing the CA but it was noted that they were able to get benefits without completing the CA.  It was agreed that the Committee be updated on the uptake of CAs in a year.

The issue about receiving feedback from the Council following a referral was raised but the difficulties regarding GDPR were acknowledged.  Limitations on the ability of the third sector to share information with the Council related to GDPR were also highlighted by Ms Chandler.

Ms Chandler raised concerns about the significant increase in the number of carers with low level mental health issues as well as the increase in carers with more complex mental health needs.

Ms Chandler advised that HCP had raised £1.5m in funding for carer related benefits in 2023-24 and £1.8m in grants for projects over eight years, which had been supported by evidence from carers about the need for the services.  This had been achieved because HCP partners worked together and fed the carers’ voice into the aims and objectives of everything that it did, including a multiagency strategy group.  She noted that coproduction was in CT’s DNA which meant that the limited resources available would not be wasted as services were not decided upon, designed and delivered without speaking to carers first.  Feedback and opinions were solicited in a number of ways including through the five Carers Cafés  across Hillingdon and through pre/post training assessments.

Ms Angela Stangoe, Chief Executive at Hillingdon Mind (HM), advised that, as well as being part of HCP, HM was also part of H4All.  She noted that carers often ended up with poor mental health and that HM provided them with a range of support services (including counselling and creative groups) as well as information about other services, which was a benefit of partnership working.  It was noted that HM had secured Big Lottery funding for a five-year project to meet the increasing demand to support the psychological needs of carers.

Ms Evelyn Cecil, Deputy Chief Executive at HM, noted that the joined-up approach of HCP meant that carers were able to get timely access to a range of services without having to repeat their story.  However, the more complex nature of the cases coming through meant that each case was taking longer to address.

All services provided by HM were coproduced with service users to ensure that the needs of carers were being identified and addressed and that they were provided with a holistic approach to their wellbeing. HM had access to a wide range of information and guidance and was able to signpost carers when needed.

Mr Steve Curry, Chief Executive Officer at Harlington Hospice and Harlington Care (HHHC), advised that HHHC provided support so that carers were able to have short breaks.  Harlington Care provided cover to enable carers to take a break of 2-4 hours funded under the Combined Carers Services contract - a large number of people using this service (around 70%) cared for someone with dementia.  If they wanted to, a carer was able to ‘bank’ these hours over a period, and then use them all together for a big event such as a wedding.  Wherever possible, the team tried to use the same support staff for a particular cared for person so that it provided continuity and enabled relationships to be built.

Mr Curry advised that HHHC provided ‘Caring with Confidence’ courses as well as hospice services and pre-bereavement services.  This support had been helpful for young carers, particularly those who were neurodiverse, and the team at Harlington had worked closely with the Young Carers team at CT.

Members expressed concern about the availability of wrap around care when HHHC was selling Lansdowne House.  Mr Curry noted that all hospices were facing financial challenges and that effort had been made to reduce costs at Harlington Hospice and Michael Sobell House (MSH) without reducing services.  Centralised costs had been reduced and additional inpatient beds had been opened at MSH.

It was noted that Lansdowne House in Harlington provided two services (counselling and lymphoedema services) and that the building was only used for one third of the time, costing around £60k per year to run.  Planning permission to develop the building had been refused and the existing configuration did not lend itself to conversion.  Consideration had been given to selling the building to Heathrow Airport and renting it back and, although this had not happened, the property was now for sale on the open market.

Mr Curry stated that, if the building was not sold, there would have to be a reduction in the services provided.  However, if the building was sold, the services currently provided therein could be relocated elsewhere.  Conversations were already taking place with organisations such as Brunel University, Stockley Park, the NHS and the local authority about alternative venues.  It was agreed that the issue of hospice service provision across the Borough be considered at a future Committee meeting.

Ms Chandler advised that the HCP partners provided a number of support services in the Hayes and Harlington area that were well used.  However, the provision of services in other parts of the Heathrow Villages had proved more challenging.  A Carers Café had been piloted in Harmondsworth but only two or three people had attended.

Ms Taiyaba Zeria, Service Manager at Alzheimer’s Society (AS), advised that she had been working with HCP to deliver dementia support.  HCP offered a one stop shop for carers where they didn’t have to repeat their story and where they were able to access a range of services from different providers in one place, for example, support in relation to anything from finances to mental health.

The biggest challenge being faced by AS was coming up with ways to meet the increasing demand for their services.  The number of people being diagnosed with Alzheimer’s or dementia had been increasing and managing this increase whilst still trying to deliver good quality services was a significant challenge.

The report stated that the main actions derived from the survey results were unchanged from the 2021/22 survey.  Members queried whether this meant that respondents didn’t actually care about things like exploring the expansion of Personal Budgets for carers (including Direct Payments), flexible short break options or social opportunities. Mr Collier advised that HCP had been successful in increasing the range of short break options available in response to feedback.  However, bed-based respite had been more difficult as care home providers were reluctant to provide this for less than fourteen days.  Work continued to try to address this.

Members were advised that Direct Payments were a way of using Personal Budgets and increasing uptake was a significant piece of work.  Further work would be undertaken on this in 2024/25, including looking at the offer provided by inner London boroughs that had more people with Direct Payments.  It was agreed that progress on increasing the number of carers in receipt of Direct Payments and bed-based respite arrangements would be included in the next update report on the delivery of the Carers Strategy to the Committee in the summer of July 2025.

With regard to engagement, Ms Cecil advised that HM went out into the communities to hold specific awareness raising sessions and to look at how support could be tailored for specific communities.  In addition, consideration could be given to the provision of childcare facilities at these events and generic resources were available in multiple languages.  Interpreters were also available.  Ms Zeria advised that, as AS was a national organisation, a range of information was available in multiple community languages and different formats online and effort was made to engage with marginalised groups in a way that was appropriate for them.  A mapping exercise had been undertaken to identify and reach out to the hard-to-reach groups.  For example, a dementia café had been set up in the Gurdwara Temple and the possibility of support being provided by the local Farsi Clinic was being considered.

Ms Chandler advised that HCP stretched resources as far as it could to get the best value for money and the best return on investment.  For example, CT had trained carers so that they were able to run peer support groups (which were something that carers had said that they wanted), therefore avoiding the cost of them being run by paid staff.  Consideration had also been given to Corporate Social Responsibility and identifying businesses that would be willing to get involved or to financially support the charity.

As a proportion of the cohort, it seemed that there were more young carers registered on the carers register than adult carers.  Ms Chandler advised that their work in schools had led to improved awareness and a better identification rate of young carers with onward referral.  Conversely, adult carers would often not recognise themselves as carers and saw what they were doing as being part of their role as a spouse, parent, etc.  Strangely, the number of people that identified themselves as carers had decreased in the 2021 Census.  It had been thought that this might have been as a result of a change in the wording used which had caused confusion and the fact that it had been conducted during the pandemic.

Given that keeping up with current demand was currently one of the biggest challenges faced by the partners, Members queried what action was being taken to keep pace with the continued increase in future demand.  Ms Chandler advised that CT had achieved back office economies of scale between Hillingdon and Ealing and had had to be more careful about targeting resources to where they were most needed.  For example, there were some young carers who were responsible for looking after their siblings and the household as well as providing significant support to their parent.  Ms Cecil noted that better use of self care strategies and enabling people to independently navigate through the services that were available would free up resources.

Ms Zeria advised that AS had a strong reliance on volunteers to support staff.  They worked with the memory clinic and dementia advisors, nurses, etc, and could provide individuals with information and advice at drop in sessions whilst they waited for appointments.  Work was currently underway to automate the invitation to the drop in sessions once they were diagnosed so that they were not waiting around.

It was recognised that prevention was obviously a better approach but there were still challenges when it came to Alzheimer’s and dementia and the BAME community.  Ms Zeria advised that digital and technological opportunities were being explored but that work had also been undertaken to get specific communities to identify how they would like to be engaged.  For example, in Tower Hamlets, the Chinese community had requested that they be engaged in a totally different way that had never been done before and it had worked.

RESOLVED:  That:

1. progress against the carers strategy delivery plan activity for 2023/24 be noted;
2. the carer support priorities for 2024/25 be noted;
3. the Committee be updated on the uptake of Carers Assessments in July 2025;
4. the Committee be updated on Direct Payments and bed-based respite in July 2025; and
5. the issue of hospice service provision across the Borough be considered at a future Committee meeting.