The Scottish Government

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Section Four: Summary of recommendations

Overall, the research has made a number of significant gains in taking forward a consideration of the future role of and outcomes for unpaid carers. ³³ It is the first time that unpaid care has been the specific focus of a 'futures' research project in the UK or Europe. It is anticipated that the recommendations within this report will consolidate existing thinking on support for unpaid carers, whilst also creating new solutions for the future. The research concludes that if the recommendations within the report are implemented the future for unpaid carers in Scotland will be a positive one.

Summary of recommendations

Recommendation 1: We recommend that the Scottish Executive should develop a Carers' Rights Charter in Scotland

• The charter should be consistent with the principles of the Universal Declaration of Human Rights ( UDHR).
• It should fully recognise carers for their huge contribution to society in supporting relatives and friends.
• It should make specific reference to the UN Convention on the Rights of the Child ( UNCRC) to ensure young carers are supported in their development as children and young people in a family setting, and not just as care givers.
• The charter should be developed by all agencies whose activities impact on the quality of life for unpaid carers and, in particular, carers' organisations, local authority and health organisations and employers.

Recommendation 2: We recommend that a national forum representing the views of young carers be established and supported by a separate Young Carers Strategy

The strategy should focus on the following areas as priorities:

• implementation of clear agency responsibilities to aid early young carer identification and support, particularly for school, education and health services
• enhanced joint working between agencies with young carers and their families
• a person-centred, life-planning focus to harness the ability of young people and their families to create appropriate support
• a need for sustainable voluntary sector organisations and networks that can offer young carers peer support, breaks from living and caring routines, and person-centred learning and development support.

Recommendation 3: We recommend that a range of measures to enable greater control and choice (including shifting the balance of 'purchasing power' to carers and users) be fully explored by the Scottish Executive

This may include:

• the further use of self-directed care through direct payments and exploration of individualised budgets for services provided or commissioned by local authorities.

Recommendation 4: We recommend the development of a national 'expert carer' programme. This should include training for people to develop their own caring skills, knowledge and expertise

This should be developed by partner agencies and should:

• Be delivered locally
• Contain generic and condition-specific training
• Focus specifically on carers of people with chronic conditions, and carers likely to provide intensive and long-term care
• Be accessible to all carers, and particularly tailored to the cultural needs of carers from BME communities and the needs of carers with communications issues
• Draw on established and best practice
• Be free to carers, with additional funding for alternative caring arrangements.

Recommendation 5: We recommend that all frontline staff with direct responsibilities for supporting the needs of carers in 'first contact' agencies (local authorities, health and voluntary organisations) are properly equipped to advise unpaid carers about their rights, entitlements and available services

Adherence to this recommendation should form an important part of the performance management of these organisations by the relevant inspection and regulatory bodies.

Recommendation 6: We recommend NHS Carer Information Strategies should be implemented as an early priority in all localities and that the requirements are extended to include local authorities

This needs to be properly resourced by the Scottish Executive and strongly performance managed by the relevant inspection and regulatory bodies.

Recommendation 7: We recommend that professional training for all health and social care staff should include a substantial component which relates to unpaid carers as partners in care, carers' needs and the diversity of the unpaid caring experience

• Individuals with direct experience of caring should be involved in delivering this.
• Education staff should also have training inputs on the issues faced by young carers.
• Specific cultural and communication needs of carers should feature in professional training

Recommendation 8: We recommend a greater role for carer representative organisations in the joint planning and development of care and other services (especially housing, leisure and transport) at a national and local level

Recommendation 9: We recommend that the Scottish Executive and other policy makers integrate the issues facing unpaid carers into their policy development and planning processes

This will ensure all agencies 'future proof' the impact and implementation of policy on unpaid carers in the same way as for age, race or gender equality; or other specific issues.

Recommendation 10: We recommend that service providers ensure they meet the needs of the whole caring community, taking account of carers with special needs and the specific cultural and language needs of minority ethnic groups

Recommendation 11: We recommend that the Scottish Executive continues to update the Carers' Strategy to incorporate the impact of demographic and social change and to plan for resourcing of future need

Recommendation 12: We recommend that carers' organisations should have a greater role in the inspection of local services that support unpaid carers and users

Regulatory and inspection bodies should support the involvement of unpaid carers and service users as lay assessors in the inspection of local services, reflecting the principle that unpaid carers are key partners in the planning, provision, and inspection of services.

Recommendation 13: We recommend that local authorities should work with unpaid carers to develop person-centred life plans alongside the established carers' assessment process

This should view the carer holistically and cover every aspect of the carer's life as requested, including financial planning. Should individuals not request a full life plan, this should not prevent them from accessing support as per existing processes.

Recommendation 14: We recommend that the UK Government complete an early review on carers' benefit entitlements, tax credit and pensions with a particular focus on removing the barriers to work which are inherent in the way current financial arrangements are constructed

Recommendation 15: We recommend that the UK Government should develop a national awareness campaign to ensure that employers of all sizes are made more aware of both their roles and their responsibilities towards carers, and the overall contribution of unpaid carers

This should be in line with the Equal Opportunities Commission's priorities which are:

• better access to flexible working arrangements;
• better framework of employment rights for carers; and
• pensions framework that does not penalise people for the time spent caring.

A range of measures should be considered by the Government, in partnership with employer and industry representative bodies, to enhance the understanding of employers in order to enable unpaid carers to balance work and care.

Recommendation 16: We recommend that the Scottish Executive, Local Authorities and NHS agencies along with partner agencies, focus strongly on the health and well-being of unpaid carers

Professor David Kerr's Report on the future of the NHS in Scotland included the following recommendations:

• Make carers' health a public health issue
• Implement fully NHS carer information strategies
• Encourage carer participation and partnership involvement in planning
• Develop and provide carer training

Further to these recommendations, we recommend that:

• Increased access to counselling and emotional support services is made available to unpaid carers
• Occupational health provision matches that of paid care staff
• Roll-out of best practice to form national standards and to ensure that such standards become systematised across Scotland
• Action to address carers' health needs should be prioritised in national and local public health strategies.

It is further recommended that the five key recommendations relating to carers' health and well-being from the Kerr report are considered as mutually reinforcing to those made here.

Recommendation 17: We recommend that issues facing unpaid carers are given proper consideration when new technology is applied to caring situations.

Recommendation 18: We recommend that Scotland's existing network of local carer support organisations is strengthened

The Scottish Executive and local and health authorities should consider increasing the capacity of these local voluntary sector partners to deliver a range of local support to include:

• carer training and peer support
• emotional support and counselling
• breaks from caring
• carer advocacy

We recommend that the management and leadership capacity be strengthened within these organisations with inclusion of relevant staff on national leadership and management programmes.

Recommendation 19: We recommend that national carer organisations focus on their collective role as the 'voice of carers' and coordinate effectively their capacity in the planning, development and monitoring of carer policy and support services

The Scottish Executive should also continue to facilitate regular dialogue between government and ministers, and national carer organisations to develop all aspects of Scotland's carers strategy.

Recommendation 20: We recommend that as an urgent priority the Scottish Executive develops a national strategic framework with service providers to ensure unpaid carers are given a statutory entitlement to appropriate short breaks and breaks from caring

• The breaks should include opportunities for breaks with or without the 'cared for' person.
• The national strategic framework should be supported by guidance and properly resourced at the local level to enable commissioners and providers of respite care to develop capacity for all care groups.
• The national framework should enable access to flexible person-centred short break arrangements

Recommendation 21: We recommend that the report's recommendations are incorporated into providers' performance management systems and progress monitored by the Scottish Executive and, where appropriate, relevant regulatory and inspection bodies

• Particular attention should be drawn to the number of carer assessments completed by local authorities and health providers with an expectation that such assessments should be supported by person-centred planning and become more widely available.

Recommendation 22: We recommend that good policy must continue to be based on good research including reliable statistical evidence with attention to the diverse experiences of unpaid carers

• This includes a further development of the Scottish Household Survey to provide more detailed information on prevalence, intensity and trends of caring. This will assist in the long-term future planning of care provision in Scotland.
• Active engagement with European networks on unpaid carers should also be established to increase the research base on unpaid carers.
• Further research on the issues facing younger carers, carers from minority ethnic communities, lesbian and gay carers, high intensity carers, older carers, and carers for individuals with addictions.
• This also includes the requirement for local authorities to collate aggregated information from individual assessments on unmet need for use in planning services.This includes a further development of the Scottish Household Survey to provide more detailed information on prevalence, intensity and trends of caring. This will assist in the long-term future planning of care provision in Scotland.
• Active engagement with European networks on unpaid carers should also be established to increase the research base on unpaid carers.
• Further research on the issues facing younger carers, carers from minority ethnic communities, lesbian and gay carers, high intensity carers, older carers, and carers for individuals with addictions.
• This also includes the requirement for local authorities to collate aggregated information from individual assessments on unmet need for use in planning services.

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