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Annex One: Policy and context - the story so far 34
The starting point for the development of a Carers Strategy in Scotland was the UK Strategy, 'Caring for Carers', launched in February 1999. The UK Strategy heralded, for the first time in the UK, a substantial policy package for unpaid carers and it put carers' issues firmly on the political map. This was despite the fact that the first real legislative rights for carers, primarily the right of 'regular and substantial' carers to have their needs assessed as part of an assessment of the overall needs of the person being cared for, had been put in place under the UK-wide Carers (Recognition and Services) Act 1995. Implementation of the 1995 Act was patchy throughout the UK and given low priority, in Scotland primarily because of the sizeable impact at that time of local government reorganisation.
Following elections in May 1999, the first Scottish Parliament since 1707 took up its new devolved powers, which included responsibility for health and social care. One of the earliest policy documents to be produced by the new Scottish Parliament was the 'Strategy for Carers in Scotland', launched in November 1999. The Scottish 'Carers Strategy' mirrored the commitments set out in the UK Strategy and set a framework for delivering those within a Scottish context.
The Scottish Carers Strategy highlighted the vital contribution made by unpaid carers and set out a national commitment to supporting carers, bringing carers and carers groups into the policy process locally and nationally, and making local authorities more accountable to the Scottish Executive and users and carers. The strategy specifically targets young carers and provides a commitment to greater levels of training on the needs of carers for staff in local authorities, social services and the NHS.
As a direct result of the Strategy, there were several significant legislative developments within Scotland. The Community Care and Health (Scotland) Act 2002 is one of several milestones in ensuring that carers are adequately recognised and supported by local authorities and the NHS within Scotland. The Act provides a universal entitlement for carers to request an assessment of their needs, independent of any assessment of the dependent. Essentially, it recognises carers as 'providers of care' with a need to access adequate support and resources, rather than another group of 'service users'. The Act allows carers to be the focus of local authority and social work resources and it cements the centrality of the role of unpaid carers as 'co-producers' of outcomes. Significantly, subsequent guidance to the Act formally recognised carers as key partners in the provision of care. This change of status formalised a partnership approach with carers that already existed in a few forward-thinking areas of Scotland as a result of the Carers Strategy, and sought to standardise that approach nationwide. This re-conceptualisation of carers has yet to be mirrored elsewhere in the UK.
The 2002 Act and subsequent guidance continued the existing legal definition of a carer (someone who cares on a regular and substantial basis) and applied this to the new right to a formal and independent assessment of the carer's support needs. However, it also sought to promote early intervention as a means of preventing future break down of the caring relationship, through the early provision of information/advice and practical support. The 2002 Act also extended the scope of direct payments, allowing some parents, guardians or carers to receive payments on behalf of the dependent, which increased their ability to access more flexible support.
The 2002 Act takes the carers' agenda to the very heart of the NHS in Scotland through the proposed introduction of NHS Carer Information Strategies. Although not yet implemented, the strategies should put in place long-term mechanisms for identifying carers in primary and acute settings and ensuring that they are provided with appropriate training and information to help them with their caring role, either by the NHS directly, or by NHS staff signposting carers to appropriate sources of advice and support. This is expected to have significant benefits in ensuring that carers are identified and supported as early as possible and at key stages in their caring role.
The need for the NHS to play its part in supporting carers is recognised in key health policy documents, the most recent being 'Building a Health Service Fit for the Future' (2005). This report, also known as the 'Kerr Report', sets out a 20-year plan for the NHS and shifts the emphasis from hospital-based care to preventative, anticipatory care rather than reactive management. It recommends full implementation of NHS Carer Information Strategies as a means of helping to protect the health of unpaid carers and in assisting them to provide effective care in the community.
The 2001 Regulation of Care Act established the Care Commission and set in place the legislative framework for the development and monitoring of national care standards. This included the setting and inspection of national standards for respite services and care at home and housing support services.
In Scotland, there is also a concerted drive to deliver more integrated health and social care. The recommendations of the 'Joint Futures Group' helped shape the future of health and social care policy in Scotland, concentrating on the need to improve joint working, between the NHS and social work but also between the statutory and the voluntary sectors. The aim is to provide single shared assessments, integrated services, quicker and faster decision making, and service provision. The development of Community Health Partnerships is also in line with integration and focus on linking services and planning processes to address the wider health needs of communities.
Further to the integration agenda, the Scottish Executive has recognised the need for change in the delivery of social work services to adapt to changing demographics and public expectations. As such, the 21st Century Review of Social Work Services chaired by William Roe, has been tasked with producing the most fundamental review of social work services since the Social Work (Scotland) Act 1968. All recommendations from this exercise will be forwarded to and noted by the Social Work Review Group.
Links with emerging UK-wide health and social care policy
The Adult Social Care Green Paper for England and Wales, 'Independence, Well-being and Choice', anticipates greater personalisation and choice for service users and includes positive messages about user empowerment. However, compared to carer policy in Scotland and emerging messages from Care 21's report on the future of unpaid carers, the Green Paper appeared to fall short of fully recognising carers as key individual care providers and as the UK's largest care force. It seemed to perpetuate a perception of unpaid carers as another client group with demands for 'services' rather than as a provider group.
Care 21's report implies that the vision for building greater capacity for social care will not be possible without adequate recognition and support of unpaid carers as knowledgeable, experienced and highly flexible care providers. The Health and Social Care ('Care Outside of Hospital') White Paper due in England and Wales later this year is expected to pick up where the consultation around the Adult Social Care Green Paper left off. Care 21's report on the future of unpaid care in Scotland may be timely for consideration of policy developments in England and Wales.
Efforts are required to preserve the achievements of the Green Paper on user choice and personalisation whilst also building a more rounded agenda, involving broader considerations of prevention, well being and independence, which draw on a range of contributions: local authority services, the community and independent sector, and not least unpaid carers.
In summary, comparing the carer dimension in recent strategic reviews in England and Scotland ( e.g. Green Paper and Kerr Report) shows that recognition, partnership and joint working with carers currently remains more integrated in Scottish social policy.
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