Carers Strategy 2024-27

Foreword by County Councillor Graham Gooch, Cabinet Member for Adult Social Care

Across the country, millions of people provide unpaid care for an ill, older, or disabled family member or friend. The number of unpaid Carers is increasing as our population ages and these Carers play a vital role in keeping their loved ones safe and independent at home and in protecting the NHS. Our health and social care partners would be severely affected without them.

Carers across the county do fantastic work and we want to support them to continue in their caring roles. We understand the strain and additional pressures put on Carers by the pandemic and many other external factors and challenges affecting people’s lives. This strategy intends to put Carers at the heart of what we do to ensure they have a good quality of life.

Lancashire is already supporting Carers in many ways, but we want to do as much as we can to ensure Carers can access support they need, when they need it. After talking to and meeting with Carers to inform this strategy in 2023, we want to put in place support that is informed by what they have told us, what matters to them, and learn from what they think of the services they currently receive.

This strategy outlines the areas we want to focus on to support Carers further, working with the NHS and our wider key partners, and ensure we are involving them in shaping and designing services that make a difference to them and the person they care for.

We are focused on:

What Carers have told us matters to them.
What we intend to do to deliver on the challenges identified in this strategy.
How we will know we have made a difference.

This strategy will continue to develop the work between the county council and the new Lancashire and South Cumbria Integrated Care Board so that health and social care providers work together to put in place a shared vision that recognises and supports Carers and the work they do.

Introduction

This strategy is for all unpaid adult Carers who live in, or care for someone who lives in, the area administered by Lancashire County Council. The strategy sets out what we will do to improve the health and wellbeing of Carers.

We will:

ensure Carers are respected and that we understand more about what it means to be a Carer.
develop high quality support services for Carers that meet their needs and improves their lives as Carers.
recognise Carers and value them as partners in delivering services.

To do this, we will work with the new Lancashire and South Cumbria Integrated Care Board to improve how Carers are identified and supported. We will make the best use of joint resources and deliver consistent services across the county.

Adult Carers from Lancashire have shaped this strategy. Carers' voices and experiences are directing the future of services and support which are important to them. We will continue to co-produce with Carers, other stakeholders, and providers of carer services to help develop future support for Carers. The priorities we have identified through these discussions are based on recognising the vital role played by Carers and we will continue to be guided by what Carers tell us as we implement our plans.

Who is a Carer?

The Care Act 2014 defines a Carer as “an adult who provides or intends to provide care for another adult” and “someone who helps another person, usually a relative or friend, in their day-to-day life. This is different from someone who provides care professionally, or through a voluntary organisation.”

A Carer is anyone who provides unpaid care for a friend or family member, neighbour or loved one, who due to age, illness, disability, a mental health problem or substance misuse or other issues, cannot live day to day without their support. Each caring situation is unique. Often a caring role arises unexpectedly and is undertaken alongside the Carer's work or education. Many Carers, especially early in their caring journey, do not see themselves as Carers or recognise that the support they provide is helping someone close to them.

There are many kinds of unpaid Carers of all ages and backgrounds, including Parent Carers, Young Carers, and Young Adult Carers. This strategy concentrates on adult Carers who access support and care from Adult Social Care, but we will collaborate with colleagues in Children’s Services, our NHS partners, and community and voluntary organisations, to deliver the actions from this strategy.

According to Census data there are 113,097 CARERS in the Lancashire County Council Area this is 9.65% OF POPULATION - ALMOST 1 IN 10 PEOPLE.

Our vision

We are committed to delivering strength-based support through Living Better Lives in Lancashire, our vision for adult social care that helps residents lives as independently as possible. Our vision is to create a true partnership with Carers so they can achieve healthy, fulfilled lives, and be supported in ways that recognise the breadth and impact of their caring role.

Our principles

The following principles will underpin the work we do to support Carers, and from these detailed action plans will be created to identify the specific things that will develop our services further. Our principles are:

To identify and support Carers as early as possible.
To support Carers' health and wellbeing and help them to maintain their independence.
To tailor support directly to Carers' needs.
To ensure Carers have a voice and that they are respected, listened to, and treated as “experts by experience.”
To communicate clearly and regularly with Carers.
To deliver high quality services across the health and social care system to meet the needs of all Carers and the people they care for.
To reduce bureaucracy and making it easier for Carers to access support.
To prevent Carer isolation and reach under-served parts of our community.
To support Carers to remain in work, training, or education.
To make the best use of our resources in supporting Carers.

Our purpose

The purpose of our Carers Strategy is to provide an overall direction for how Carers in the Lancashire County Council area will be supported. It is not intended to be an action plan, but a plan will follow the strategy. This plan will detail how the Carers Strategy will lead to better services and support for Carers.

The Action Plan will sit behind the Carers Strategy and show the actions needed to implement the strategy. We will share the strategy and Action Plan with the Lancashire and South Cumbria Integrated Care System (ICS) to inform their Carers Strategy, scheduled for 2024.

We will continue to work with the NHS and community and voluntary providers to make our plans achievable, agree who is responsible for conducting specific actions, and ensure that we hold each other accountable. Services which specifically support Carers will be recommissioned in line with the principles and direction set out in the Carers Strategy and Action Plan. These services help to identify Carers and include information and advice, Carers' assessments, respite and emergency planning, and peer support. The contracts for these services are managed by Lancashire County Council and its partners and are reviewed regularly.

Our carer support services will collaborate with local partners to deliver services that meet the needs of communities and neighbourhoods. All social care, health, and other partners across Lancashire recognise that we need to do more to support Carers. Lancashire’s Health and Well Being Strategy identifies support for Carers as one of its key themes and priorities. The Integrated Care Strategy also says Carers are a big part of their plans. We will align this Carers Strategy to the county council’s wider service plans to ensure that all staff and services are working towards the delivery of the strategy, backed by national guidance and legislation.

The strategy also fits with the county council’s plans to transform how we deliver social care and will mean we do more to talk to Carers and identify what they need and what they want for themselves. We will also draw on what has worked elsewhere as we implement the priorities identified here.

What Carers have told us

The voices and experiences of Carers are the most powerful influence on this strategy.

Throughout 2023 we visited Carer Cafes – local groups of Carers run by the Lancashire Carers Service – to speak with Carers about their experiences, the services they receive, and how we could better support them. These conversations and the feedback we received, along with the data presented on the following pages, have helped us to prioritise the areas we need to focus on and what we need to do next. We will continue to engage with the Carers groups throughout the lifetime of the strategy to assess whether we are meeting our goals.

Getting support

"I'm not computer literate. Phone is better for me."

"I didn’t go online at all until my father’s diagnosis."

"I struggle when something is only available online. I forget passwords and things like that. It’s difficult to schedule Zoom calls, so I need some help with that."

"I had a social worker at first but then my allocated worker got taken away. Social workers aren’t always contactable."

Information, Advice and Guidance

"People don’t know the help is there. We need to promote the services more."

"Trying to find things out is difficult. I don’t know what I’m entitled to. The benefits system can be difficult to understand. There isn’t enough communication with us."

"I want information about Carer's Allowance. Nobody explains this stuff to you."

"I want good, reliable information, simply expressed."

"I don’t know about my rights to benefits and council tax or water bills or any type of entitlements. You don’t know what you’re entitled to."

"I need help and information with budgets and benefits. Help with Lasting Power of Attorney, information, and advice, help to apply. Council tax reductions – no one knows about them. Talking to other carers is the only way you find out."

Being recognised as a Carer

"It’s a job. An unpaid job. I have so much on my mind all the time. You always put yourself on the back burner until you crack up."

"I don’t feel valued. Recognition is important, it’s not always about the money."

"We’re a forgotten, invisible army. I’m so tired, stressed, and exhausted."

"It’s as if you don’t exist. You feel like you’re invisible."

"Afterwards you realise what you did as a carer. You don’t realise at the time as you just have to get on with it."

"I didn’t recognise myself as a carer, my daughter did. It’s been a real eyeopener to see how nice it was to chat with other carers. It was time just for me. You tend to lose friends when you become a carer."

Support from other Carers

"I’d like more opportunities to share my experiences with other carers."

"It would be good to have someone to talk to and confide in regularly."

"I'd like to do more things with other carers. Just listening to other carers really helps."

"I like peer support. Other Carers know exactly what I’m talking about. More opportunities to get together would be great."

"Caring for someone is very socially isolating and talking to other carers really helps me."

Taking a break

"I really struggle with getting my mum on a bus to go to day care, it just feels too hard and easier just to stay at home, even though it means that I won’t get a break."

"I don’t know where to start getting Respite. How do you get it?"

"Overnight respite care for those with dementia would be great as it would allow us to catch up on missed sleep. I’m up most of the night with my mum who has dementia, and it is absolutely exhausting."

"There is far too much paperwork – it’s too complicated."

"I feel guilty that my mum doesn’t get out much and I would welcome the opportunity to be able to take her out more. However, it’s really hard pushing a wheelchair, so we are really limited."

"I was allocated respite of 2 hours per week, however, as I live in a rural location it doesn’t really provide much time for me to get out and about and do things that I enjoy."

What did Carers tell us is working for them?

"There are lots of complicated forms to fill out but someone from the Carers' Service helped me."

"The county council clearly put the quality of carers services at the top of the priority list. Long may that continue."

"I was put in touch with a social prescriber who introduced me to carers' services, social activities I could take my mother to and social events for myself. Really helpful."

"The Carers' Service has been a lifeline for me – you can throw a problem at them. They might not have all the answers, but they are really helpful."

What do we know about Carers in Lancashire?

73.4% of cared-for people are over 55 years of age.

67.9% are 65 years of age or older.

Caring for someone is at least a full-time job (35+ hours a week) for more than half (55.1%) of Carers, with more than a third (36.7%) spending more than 75 hours a week caring and 29.7% devoting 100 hours or more to caring for someone.

A quarter (24%) of Carers took over 5 years to identify as a Carer, and 9% took over 10 years.

Of the Carers who had received support or services, over a third (36.9%) felt they were very or extremely satisfied with the support they received. Only 8.2% felt they were very or extremely dissatisfied.

61.3% have been looking after or helping the person they care for more than five years.

Carers report that they feel socially isolated. The proportion of Carers who feel they have as much social contact as they want with people they like decreased to 27.6% in 2021-22 from 30.3% in 2018-19. The proportion that has little social contact and feel socially isolated increased from 14.5% to almost one in five (19.8%)

Only 13.4% of Carers say they are “able to spend my time as I want, doing things I value or enjoy,” with 86.6 % of Carers reporting that either they do not do enough of these things or that they don’t do anything they value or enjoy, which highlights a major concern regarding the stresses and pressures Carers feel because of their role. The percentage of Carers that feel they have encouragement and support has increased from 32.5% in 2018-19 to 37.4% in 2021-22, bucking the national trend (nationally, this metric decreased over the same period by 3.1%).

Most cared-for people (73.2%) live with their Carer.

Carers rely heavily on information and advice services, with more than half reporting use in the last 12 months (56.1%) and 60% of Carers saying they find it helpful. But only 12.8% of Carers in Lancashire say this is very easy to find and more than a quarter (26.5%) say it is difficult to find.

Over one-third of Carers 35.9% reported accessing support from carers' groups or by speaking with other Carers in the last 12 months, but 61.4% said they had not, which points to the potential to increase the awareness of these types of services.

Many Carers are retired 60.4% or not in paid work 18.2%

2 in 10 Carers are in full or part-time work.

Around a quarter of Carers receive some sort of income (whether they are working full-time or part-time or are employed or self-employed). More than one-in-five (21.3%) say their caring role prevents them from working.

The proportion of Carers who reported that the person they care for had used any type of take-a-break service at short notice decreased from one-in-five (20%) in 2017-18 to just over one in ten (12.1%) in 2020-21.

Unsurprisingly, the burden on Carers – often caring for very long hours, day after day – affects their health and well-being. More than three quarters of Carers (78.6%) say they feel tired. Many Carers say they are stressed (61.8%), with more than two-in-five (44%) saying they feel depressed or irritable (41.5%).

Only a small minority of Carers (7.9%) say they have not suffered any negative impact on their physical or mental health and well-being.

What does Lancashire County Council do to support Carers?

We arrange for Carers to receive distinct types of support through our Lancashire Carers Service. The Service is delivered free of charge to Carers in Lancashire by several organisations working together across the county. Services provide Carers with information, advice, and a wide range of specialist support designed to help them continue in their caring role. The aim is to reduce the impact of their caring role on their health and wellbeing. The Lancashire Carers Service works directly with individual carers to discuss their needs and concerns and design a tailored, personalised support package.

There is a wide range of support already in place across Lancashire which includes:

Carers assessments, reviews, and support planning.
Coffee and Chat/Carer Cafe support groups across Lancashire.
Regular magazines and bulletins providing information on local groups, activities, and courses.
Support for contingency and emergency planning.
A huge range of digital resources.
Understanding dementia and mental health for Carers courses.
A volunteer CHAT line in operation 24 hours a day, 365 days a year.
Access to our volunteer befriending and sitting-in services to help Carers take a break from caring and provide additional company and support.
Opportunities for Carers who are not “IT savvy” to become members of a Volunteer-led Pen Pals scheme.
Access to other community, health, and wellbeing services.
Opportunities to volunteer, make friends, and offer peer support.
Access to bespoke counselling support and wellbeing coaches.
Carers’ Awareness Briefings for professionals.
Carers Count – a specialised advocacy service exclusively for Carers in Lancashire.

Carers can also join the Carers' Community Network to share their experiences, connect with other Carers, and stay informed of any new support. The county council also provides Carers with support to take a break from their caring role by offering short or long-term respite to the cared-for person, whether in residential care or a day centre, and we will be looking at several ways we can improve and expand upon this part of our offer.

Our priorities

From all the activity we have detailed here – looking at data and surveys, reviewing the latest reports and studies on being a Carer and, most importantly, speaking directly with Carers in Lancashire - we have identified five key priorities that make up this strategy. These are backed by “I” statements which describe what quality support should look and feel like for Carers. In response to these “I” statements, the county council will use established “We” statements to respond to Carer’s needs and explain how we should be meeting them. These components will become part of our core offer to Carers and form the basis of a new Lancashire Carers Service:

Better information and advice.
Health and wellbeing and living a fulfilled life.
Giving Carers a voice.
Carers have access to quality short breaks.
Reshape and join-up services for Carers.

Priority 1: Better information, advice, and guidance for Carers that is easy to find and understand

Carers should be confident in the information we provide, and professionals should offer a consistent and connected message to Carers about what they can expect.

“I” Statements

I can get information and advice that is accurate, up-to-date, and provided in a way that I can understand.
I know what my rights are and can get information and advice on all the options for my health and care.
I can get information and advice that helps me think about and plan my life.

“We” Statements

We provide free information and advice to everyone, including people who arrange or fund their own support and care.
We provide accurate and up-to-date information in formats tailored to individual needs.
We tell people about person-centred approaches to planning and managing their support and make sure that they have the information, advice, and support to think through what will work best for them.

Priority 2: Health and wellbeing and living a fulfilled life

Carers should be able to access relevant support easily so they can look after their health and do more of the things they want to do. Professionals should understand the impact of a Carer’s role and tailor support to Carer’s individual needs.

“I” Statements

I can live the life I want and do the things that are important to me as independently as possible.
I am treated with respect and dignity.
I am supported to manage my health in a way that makes sense to me.

"We" statements

We have conversations with people to discover what they want from life and the care and support that will enable this.
We work with people to make sure that their support plans promote wellbeing and enable them to be as independent as possible.
We think creatively about solutions that enable people to do things that matter to them.

Priority 3: Giving Carers a voice

Carers are recognised and respected as “experts by experience.” Opportunities to have their say are frequent and purposeful. Carers can get support from other Carers.

“I” Statements

I feel valued, and my views and experiences are listened to by professionals and others.
I have a co-produced personal plan that sets out how I can be active and involved in my community, including opportunities to learn and pursue my interests.
I can meet people who share my interests and can join and participate in a range of groups

“We” Statements

We talk with people to find out what matters most to them, their strengths, and what they want to achieve, and build these into their care and support plans and our services.
We make sure that Carers can be as active and involved in their community as possible, doing things that are important to them, especially with other Carers.
We have a clear picture of all the community groups and resources in our area and use this when supporting people and planning services.

Priority 4: Carers have access to quality short breaks

These should be flexible, varied, and easy to arrange, and help support Carers’ health and wellbeing.

“I” Statements

I can access different types of bespoke, flexible, and timely respite, including short breaks, to meet my needs.
I can get information and advice about respite when I need it.
I am supported to plan for important changes in life that I can anticipate.

“We” Statements

We will ensure Carers have access to the right information, advice, and support when they need it, including help in planning for short breaks and emergency situations.
We will provide Carers with options to take breaks from caring, to maintain

their own physical and mental health and wellbeing.

We will work with community groups and resources in our area and use these when supporting people and planning services.

Priority 5: Reshape and join-up services for Carers so they can more easily access care and support for themselves and the person they care for

We will continue to transform and improve the way we deliver social care and do more to work with the NHS to make things simpler and easier for Carers.

“I” Statements

I have care and support that is coordinated, and everyone works well together and with me.
When I or the person I care for moves between services, settings, or areas,

there is a plan for what happens next and who will do what, and all the practical arrangements are in place before change happens.

I can get skilled advice and support to understand how care and support and personal budgets work.

“We” Statements

We work in partnership with others to make sure that all our services work seamlessly together from the perspective of the person accessing services.
We work with people as equal partners and combine our respective knowledge and experience to support joint decision-making.
We make sure that our organisational policies and procedures reflect the duties and spirit of the law and do not inadvertently restrict people's choice and control. the law

Our plans for the future

While we are proud of the support we offer Carers in Lancashire, we are always aware of the challenges in getting them the support they need. Economic uncertainty, the impact of COVID-19, and the pace of social and technological change have further highlighted these challenges in recent years.

Where these challenges have led to gaps in support in the past, we aim to address these in response to what Carers have told us. By building on what has worked for Carers across health and social care, we will involve our Carers in the design and delivery of what their support will look like during the life of this strategy and beyond. The next step is to co-produce our Action Plan, tied to our priorities and detailing the specific projects that will help us to meet them.

We will focus on measurable and achievable goals and ensure we are working in ways that Carers support:

Improve professional awareness and understanding of the role of Carers, including more training and education, and formal commitments to acknowledging Carers, using the new Carers Charter.
A new and comprehensive information, advice, and guidance offer for Carers in Lancashire, providing access to digital solutions and technology where required, backed by new industry standards.
Identification and support for Carers through social care needs assessments of the

people they care for and strength-based discussions with the Carer.

More opportunities for Carers to be represented and involved in strategic planning and commissioning decisions through a new Carers' Partnership Board.
Offer short breaks or replacement care for Carers that are flexible, accessible, and available to meet Carers needs and prevent carer breakdown. Access to some of these services may be dependent on meeting certain eligibility criteria.
A complete review of current service provision before procurement of a new Lancashire Carers' Service, including specific reviews of Carers' provision in acute, reablement, mental health and Occupational Therapy settings, including new practice pathways for health and social care practitioners.
Working better with NHS colleagues to increase the number of Carers who are identified in hospitals and community health settings and ensuring patients who are registered with their GP practice as a Carer are referred to the Lancashire Carers Service.
Review of our assessment and eligibility criteria for Carers and Carers' Payments.
Revamping of our current Peace of Mind 4 Carers contingency planning and provision service.
Break down barriers where communication and sharing of information about the cared for person is an issue.
Find ways to improve access to support for Carers who are ‘seldom heard from’ and Carers from minority ethnic groups to reduce social isolation and address health inequalities.
Develop support for county council employees who are Carers and advice and information for businesses with Carers in their workforce.

Legislation and Safeguarding

The Care Act 2014 recognises that supporting adult carers is as important as supporting the people they care for. The Care Act gives adult carers the right to support from their local authority, which can include information and advice, preventative services, carers’ assessments, and support to meet carers’ needs based on national eligibility criteria. The Care Act also places a duty on local authorities to identify Young Carers and provide support for Parent Carers and Young Carers as a young person becomes an adult. The Children and Families Act 2014 covers the rights of both Young Carers and Parent Carers.

The NHS Long Term Plan calls on the NHS to improve identification and support for Carers, emphasising the need for us to work with the NHS to improve services for Carers. The Plan also says that the NHS will introduce ‘Carer Quality Markers’ in primary care, provide better support for carers in emergencies, and make sure that Carers benefit from wider use of social prescribing.

The Work and Families Act 2006 and the Employment Rights Act 1996 give Carers the right to ask for support at work that can help them manage work and caring responsibilities. The Equality Act 2010 protects Carers against discrimination or harassment due to their caring responsibilities.

Safeguarding protects an adult’s right to live in safety, free from abuse and neglect. The emphasis is on people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted. Safeguarding is for people who, because of issues such as dementia, learning disability, mental ill-health, or substance abuse, have care and support needs that may make them more vulnerable to abuse or neglect.