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Introduction
1. The Executive welcomes the Care 21 report The Future of Unpaid Care in Scotland as a comprehensive study and a valuable tool for guiding our approach to supporting Scotland's carers.
2. The Executive commissioned this report in recognition of the contribution which unpaid carers make to the provision and quality of care in Scotland. Unpaid care is likely to grow in importance as people live longer and receive more care at home. The quality of support we give to family carers is therefore crucial.
3. We commissioned the study to help us consider the main factors which need to shape the development and funding of services so that we can best support the contribution of unpaid carers over the next 10 years. The Executive made a good start to its commitment to carers with the Strategy for Carers in Scotland (November 1999). This resulted in significant investment in services to support carers, new carer legislation and associated guidance, and a recognition of carers as key partners in the provision of care. The Care 21 Report will help us build on these achievements.
4. A big issue addressed by the report was the future role of unpaid care in delivering health and social care services in a fast-changing world. A world where:
- medical advances and life-style changes contribute to people living longer, growing older and increasingly living alone;
- we have higher expectations of the care we should receive;
- public services will need to change and develop with public expectation; and
- people's willingness or ability to accept the loss of independence, financial instability and the health risks that caring brings may decrease, for example because of long- term financial commitments.
5. The report concluded that, whilst greater personal wealth would leave many older people able to fund more of their care, increased caring pressures will be much more prevalent in socially deprived communities, where poor health continues to be an issue.
6. The Future of Unpaid Care in Scotland has delivered on its objectives. The wealth of evidence, a comprehensive literature review, a household survey and the involvement of over 7,000 stakeholders - including over 5,000 carers and former carers from all parts of the country - give this study valuable weight. Both the evidence base and the report's 22 recommendations are revitalising the Strategy for Carers in Scotland. It has created an agenda for continuing change in the way carers are valued and supported in our society.
7. At the launch of the report on 30 September 2005, Lewis Macdonald, Deputy Minister for Health and Community Care, explained that Ministers would need to consider timescales and resource implications before responding to the report. Those recommendations with significant resource implications would need to be considered in the next Spending Review. The Executive undertook to maintain the momentum of the report by responding in spring 2006 following a period of scoping of the implications of the report's recommendations.
8. This scoping exercise included an appraisal of opportunities for mainstreaming carer support across the government's public sector work. The vision of the Care 21 report highlights the importance of recognising carers' interests across public services, not least in the way that NHSScotland and social care services respond to the future needs of patients and those with care needs.
9. The Executive's response therefore takes account of parallel policy developments such as Delivering for Health and Changing Lives - on the future of the NHS and social care respectively - as well as a raft of other developments in health and social care, and other relevant areas such as transport. Given the needs of parent carers and young carers, it also takes account of key policy developments in children's services such as Getting it Right for every Child and the Additional Support for Learning Act. A more detailed consideration of the 22 recommendations and a response to each are at the Annex to this response.
10. We are grateful to stakeholders for their input to the Executive's assessment of the implications of the report's recommendations. In the spirit of our partnership approach to policy development, we shared an interim assessment with national carer organisations and local statutory partners and received helpful comments and proposals. These have helped to inform this response and will inform future developments.
Response Overview
11. The Future of Unpaid Care in Scotland sets a 10 year agenda - an agenda not only for the Executive and statutory care providers but for groups and agencies in every sector and locality.
12. To ensure real outcomes for carers and early gains, we need to select early priorities without losing sight of other important objectives. Effective action also depends on maximising opportunities which arise from a range of parallel policy developments. Responding to the priorities set out by carers in the report, and in consultation with national carer organisations, the Executive has identified four early priorities:
- young carers;
- respite;
- carers health; and
- carer training.
Young Carers
13. Better support for young carers is a widely-shared concern, the subject of much media interest and of detailed Parliamentary debate. The Executive agrees with the need for a strategic focus on young carers. We propose to achieve this initially by integrating and mainstreaming young carers within current policy and service priorities for children and young people.
14. The Executive's response sets out a number of measures to achieve this through actions flowing from the Additional Support for Learning Act, from integrated children's services planning, and from the implementation of proposals in Getting it Right for Every Child. At the same time, joint inspections by the Social Work Inspection Agency, Her Majesty's Inspectorate of Education and the Care Commission of child protection services are now being rolled out, and a new cross-agency assessment tool for young carer services is under development.
15. All these measures are designed to improve services working with children and young people, and to improve outcomes for young people and their families. We believe that this approach will deliver better outcomes for young carers than would the development of a separate strategy at this stage. This will help to meet the principle adopted by organisations supporting young carers that young carers are children and young people first and foremost.
16. To guide the delivery of these objectives, the Executive will move quickly to establish a task group to provide advice and information when guidance is being updated or new information is being produced. This will help ensure consistency of messages, reflection of young carers' needs and concerns, and a systematic approach to local young carer support. To assist with consideration in next year's spending review, we will also ask the task group to:
- assess existing capacity of local agencies and projects whose primary or major focus is young carer support, making recommendations on minimum requirements for sustainable local services; and
- assess the potential role and implications of a national young carer forum.
17. As part of our review in 2008 of this response as a whole, we will review the need for a separate young carers strategy. We will also explore opportunities for a national young carer event at that stage to help take stock of young carer support.
Respite/Breaks from Caring
18. The Executive acknowledges that carers have placed respite services and regular breaks from caring as a top priority for support to help them sustain the level of care they provide. We therefore accept the need for a strategic approach to respite provision for carers.
19. We will move quickly to establish a task group to assess respite provision in Scotland; update national strategic guidance for respite services and help promote local service redesign to shift the focus of local provision to preventative, personalised respite care. Whilst the work will reflect the interests of cared for people, its primary focus will be on breaks from caring for the benefit of adult carers. (Breaks for young carers will be considered by the group set up to look at young carers' issues in general.)
20. The group's work will include an assessment of information on existing models of respite provision and need. This will assist with consideration of the recommendation for additional provision in the spending review.
21. The group will review existing respite guidance and update it where necessary to set out what should be covered in local service planning and to underpin Local Improvement Targets for respite services.
22. In relation to the report's recommendation for a statutory minimum entitlement to respite, we are concerned that this could cut across existing local authority responsibilities for providing care and support in the light of assessment of needs and a prioritisation of available resources. If, after conclusion of the work outlined above, it appears that a statutory entitlement to respite might have a useful role to play, we will reconsider the issue.
Carers Health and Carer Information Strategies
23. The Executive recognises the health impacts that caring can have. Safeguarding the health of carers (recommendation 16) will be an early priority. It requires that carers are identified early and systematically, that they receive the information and advice they require, and that they are referred to appropriate sources of support to ease the task of caring and prevent crisis or ill-health.
24. To this end we are today issuing final guidance to NHS Boards on the development of local Carer Information Strategies, to identify carers and inform them of their rights to support. We have also taken other relevant measures. New enhanced incentives for GP practices to identify a named person with responsibility for carer identification, set up carer registers, and refer carers to local support came into effect in April. And a toolkit for Community Health Partnerships to assess their management of long-term conditions - to issue later this year - will highlight the support which carers require to support patients with long-term care needs.
25. The Executive's response also highlights a carer focus in new Prevention 2010 pilot programmes for health improvement in deprived communities; in a national Review of Nursing in the Community; and in plans for patients and carers to have access to their own electronic health records.
Carer Training
26. The Executive recognises the value of training to help carers develop the knowledge and skills to manage their vital role while minimising the impact of caring on their own health. The need for the 'expert carer' is brought out in The Future of Unpaid Care in Scotland but also in Delivering for Health. That is why we have made carer training an important element of our guidance on NHS Carer Information Strategies (recommendation 6) and have funded Carers Scotland to pilot a new carer training programme.
27. Early results from a study by the Coalition of Carers in Scotland and the Princess Royal Trust for Carers show excellent training practice in some areas. The overall picture, however, is varied and patchy. We will discuss with stakeholders the development of a national 'expert carer' training framework to help improve consistency and share best practice. We will also consider the recommendation for an expansion of carer training in next year's spending review.
Financial Implications and Review of Response
28. The Executive will not lose sight of other objectives. A more detailed response to each of the 22 recommendations is contained in the Annex to this response. In addressing early priority areas and subsequent work our approach will continue to be guided by the priorities of carers and by close partnership working with national carer organisations and local partners.
29. Many of the recommendations in The Future of Unpaid Care in Scotland have significant funding implications. In line with the Executive's normal approach to significant funding issues, these will need to be considered in next year's spending review. Therefore, alongside our priorities identified above, the response indicates areas where we will work to assess further the costs and benefits of certain recommendations in advance of the spending review.
30. In 2008, following the Spending Review and in light of progress with the actions identified in this response, the Executive will revisit its priorities in response to the 22 recommendations.
Conclusion
31. The Future of Unpaid Care in Scotland is very valuable in guiding public policy for carers in Scotland over the next 10 years. The Executive takes the report's recommendations seriously. In this initial response, we have set out how we intend to focus on initial priorities while not losing sight of wider objectives. We recognise the crucial contribution which unpaid carers make to Scottish society and the report's messages that unpaid care is likely to grow in importance. Support for carers is a crucial strand of health and social care policy and delivery. We need to maintain and strengthen that strand by continuing to work with carers and other stakeholders to take forward the actions set out in this response.
Scottish Executive
24 April 2006
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