developing innovative partnerships to improve services to carers establishing an evidence base james...
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Developing Innovative Partnerships to improve Services to CarersEstablishing an Evidence Base
James Drummond Lead Officer Integrated Carers Services
Torbay NHS Care Trust
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Measure Up – Torbay’s Interagency Carers Strategy
First published 2000 – a long term commitment and process
Three year cycle - Third edition 2008-10 Contains 6 key aims plus Annual Action PlansReflects the needs and aspirations of local carers
from consultationsLinked to Torbay’s Joint Strategic Needs Assessment
and Local Area Agreement
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Reflections on Partnership Working to improve Carers Services
Partnership with Primary Health CarePartnership with Voluntary SectorPartnership with secondary Mental Health
ServicesPartnership with independent sector
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Partnership with Primary Health Care ‘Carers Support Workers in GP Surgeries’
• Ownership by GP’s and Primary Health Care Teams
• Using recognised research methodology (GHQ 12) – evidence of ‘health gain’
• Provide Carers Support Workers with a Baywide support network
• Link to Practice Based Commissioning
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Partnership with Voluntary Sector (1)COOL Young Carers Service
• Addressing specific needs of young carers of adults with Mental Health and/or substance misuse problems
• Young Carers Service lacked expertise but it is available in voluntary sector
• COOL offered support to whole family and a bridge to ‘hard to reach’ families
• Additional benefit was access to start-up funding not otherwise available
• Sharing resources from Community Mental Health teams, Drug and Alcohol team and COOL House
• Young Carers on Steering Group for project
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Partnership with Voluntary Sector (2) Older Family Carers Initiative - Mencap
• Target was the significant number of older carers not in touch with services at all or not being actively care managed
• Project set up as ‘arms length’ service (but steered by a group of carers, statutory staff and Mencap) independent of statutory team
• Creating informal network of low level support (a tea and cakes approach) but with intent to help bridge the gap to Learning Disability Services where appropriate
• Developed credibility amongst carers and ‘word of mouth’ became main means of identifying hidden carers
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Partnership with Secondary Mental Health Services Haytor Carers Group – in patient psychiatric unit
• Offering ‘drop in’ support at point of crisis with easy access
• Simple but creative approach adapted to particular circumstances – ‘learn by doing’
• ‘Group’ facilitated by member of ward Staff and Carers Involvement Worker
• Catalyst for change in practice and culture of ward
• Some partnerships require patience (carpe diem)
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Partnership with Independent Sector Providers Emotional Support Scheme for Carers
• Recognition of psychological impact of caring and carers own mental health needs
• Carers receive 10 sessions of counselling choosing from a ‘pool’ of local counsellors (a voucher scheme)
• Using existing expert resource (qualified and experienced counsellors) but developing specialism in carers issues
• Cost effective service structure• Benchmarking service against other NHS
counselling provision helps monitor standards (CORE)
• High level of commitment from providers and very high levels of satisfaction and improvement for carers
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Getting Carers on the Public Health Agenda
• Build Carers health needs into Joint Strategic Needs Assessment (JSNA) which feeds into Local Area Agreements (LAA)
• Cite relevant government documentsExamples:- Health Inequalities Progress and Next Steps (DoH 2008)- Chapter 5 Health and Wellbeing National Carers Strategy- NHS Operating Framework
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Establishing an Evidence Base for Carer Support
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Collating Known Data
• 1/10th of average practice caseload are carers (2001 Census)
• More than 80% of carers say that caring has damaged their health (General Household Survey 2000)
• 21% of carers caring for more than 50 hours per week are not in good health compared with 11% of non carers (2001 Census)
• Research suggests carers under report health problems• Bring together known evidence e.g. Princess Royal Trust
for Carers
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Evaluation and Research – Experience from Torbay
• General Health questionnaire (GHQ12 – measures carer burden)
• CORE (Clinical Outcomes Routine Evaluation) evaluating counselling services in NHS
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What is a CORE benchmarkingWhat is a CORE benchmarking ‘thermometer’?‘thermometer’?
0
10
20
30
40
50
60
70
80
90
1001
% patients achieving clinical & reliable change
Performance of lowest 25% of services
National Average
A specific measure of service performance
Lowest performing service
Highest performing service
Implicit message “green = good”
← Torbay Average 2006 – 07 = 71.5%
TORBAY’S EMOTIONAL SUPPORT SCHEME FOR CARERS
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Evaluation and Research – Experience from Torbay (Continued)
• Enhanced Annual Health checks – identifying hidden carers
• Health and access to health services questionnaire (adapted from POMED 36)
• Adapt existing processes in Health e.g. new patient questionnaire/EARLI