www.stgeorgehealthcaregroup.co.uk St George Healthcare Group Ltd. Registered in England No. 05355434 Registered Office: Floyd Drive, Warrington, WA2 8DB

Working Effectively with

Families and Carers

St George Healthcare Group Annual Strategy

2014/15

1. Introduction

Carers play an enormously valuable role supporting someone throughout illness and on the journey to recovery. They provide a range of emotional and physical supports without which many people would not be able to live independent and fulfilling lives. Over six million people in the UK provide unpaid help and support to individuals who are ill, frail or disabled (Carers UK survey 2011) and this number is likely to increase as the population expands and people live longer. A recent report by Carers UK (2011) estimated that carers save the economy £119 billion per year, an average of £18,473 per carer, equivalent to the whole budget for the NHS. The current national Carers’ Strategy ‘Recognised, valued and supported: Next steps for the Carers’ Strategy’ (DH Nov 2010) is a development of the previous government’s strategy ‘Carers at the heart of 21st - century families and communities’ (DH 2008). It sets out 4 key priorities which this strategy reflects:

1. Supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages.

2. Enabling those with caring responsibilities to fulfil their educational and employment potential.

3. Personalised support both for carers and those they support, enabling them to have a family and community life, including support through carer breaks.

4. Supporting carers to remain mentally and physically well. It echoes the previous policy aim of increased accountability of services to communities and carers themselves. Since the first National Mental Health Service Framework (Department of Health, 1999) which included elements of a Carers’ Strategy, and the introduction of the Carers’ Grant, there has been significant progress in the support provided to carers at a national and local level. The cross government mental health strategy ‘No Health without Mental Health’, (Feb 2011) defines current government policy for mental health for all ages. In 2010, the National Mental Health Development Unit produced the ‘Triangle of Care’, in conjunction with the Princess Royal Trust, following years of research into carers needs. This document provides guidance for mental health services to improve the way in which they work with carers. It recommends the creation of a therapeutic alliance between healthcare professional, service user and carer in a ‘triangle of care’. This will promote safety, engagement and enabling, and support recovery and sustain wellbeing. St George Healthcare Group is committed to involving Patients, Carers, Families and Friends as much as practicably possible all aspects of their treatment, care and

support. This first Carers Strategy aims to ensure that St George Healthcare Group staff listen and respond to the needs, views and aspirations of Carers and work with Carers as “partners in care”. It also aims to ensure that we help support them to maintain their wellbeing whilst also outlining our approach to delivering this vision, the key areas in which we want to make improvements and how we will implement and review the strategy.

2. Purpose

The 5 core aims of this 2014 Carers Strategy are as follows:

1. To recognise Carers, Families and Friends at all levels within St George Healthcare Group

2. To communicate effectively with Carers, Families and Friends 3. To involve Carers, Families and Friends in Patient care and delivery of

services 4. To support Carers, Families and Friends to maintain their own wellbeing 5. To support our staff to be more aware of Carers’, Families’ and Friends’

needs and issues

3. Scope This strategy applies to all of St George Healthcare Group’s services. It sets out a number of steps that must be taken in these services to ensure all staff and all parts of St George Healthcare Group listen and respond to carers’ needs and views as well as involving them as partners in care. This strategy will, outline the specific ways in which carers of people who use our services will be supported. When someone they care for is first diagnosed with an illness or admitted to hospital, it can be a difficult time for carers and it can impact on their own health. By improving our engagement with carers we hope to ease some of this difficulty. It is important to understand the different nature of mental illness compared with physical illness and that families need to be better supported in the community. We want to be clear that listening to, involving, communicating with and supporting carers is an important part of caring for the people we provide services for. We understand that service users do not exist in isolation, but rather they exist within families or social networks.

4. Definitions

A carer is someone who spends a significant amount of their time providing unpaid support to a family member, partner or friend. This could be caring for someone who is, ill, frail, disabled has learning disabilities or has a mental illness, substance or alcohol misuse problem. A carer can be any age. They need not necessarily live in the same house or area as the person they care for. The caring may be practical or emotional.

A carer could be a parent whose child has been diagnosed with a condition for the first time and who needs some support and information, a partner struggling to cope with their loved one’s condition, or a neighbour who collects the weekly shopping for someone who needs support. The carer may also be someone who visits the service user in hospital and keeps them in touch with life outside the hospital.

5. Roles and Responsibilities

Board of Directors - The Board of Directors will be responsible for overseeing the implementation of this strategy across the Group and monitoring the requirements for training and support. Registered Hospital Managers - Registered Hospital Managers will be responsible for monitoring the implementation of this strategy across each Hospital. They will also be responsible for engaging with Carer’s Representatives and producing a yearly action plan and a report that details how they have addressed the actions in this Strategy. Staff who work directly with patients in St George Healthcare Group’s services Staff who work directly with patients will be responsible for ensuring that families and carers are involved in the care, support and treatment of the patient. Service Managers and Team Leaders - The Service Manager and Team Leader will be responsible for developing a local protocol for the involvement of carers in the care, support and treatment of the patient and for overseeing the staff team’s involvement of carers and family members.

6. 2014 Annual Strategy

Recognising Carers, Families and Friends at all levels within St George Healthcare Group It is essential that Carers have access to the right information at the right time. The Patient’s consent to share information with specific named carers, family and friends should be sought when they enter the hospital, and reviewed at regular intervals throughout the patient’s hospital stay. It is vital to understand that Carers are people; they differ in background, experience, circumstances, personality and attitudes. Some may initially resist being labelled as Carers and be reluctant to accept advice and support. Some carers think of themselves as Mother, Brother, Partner or Friend. BME (black and minority ethnic) communities, in particular, have different ideas of what care giving means. Some languages have no word that translates into 'Carer'. Recognising a Carer and understanding their circumstances is the first step in ensuring that they are offered an assessment of their own needs and provided with the right information, advice and support.

St George Healthcare Group is committed to:

1. Raising awareness of the Carer role and assisting care teams to clarify the definition of a Carer through the roll out of this strategy.

2. Ensuring that Patients are informed of our commitment to Carers, and are asked about the people who support them at regular intervals within Named Nurse and Psychotherapeutic sessions.

3. Ensuring that our staff actively seek to identify young Carers and signpost them to Young Carers Services.

4. Ensuring that Carers information within case files is complete and up to date at all times.

5. Being ready to act as the first contact point to give Carers advice and support through the development of leaflets and internet resources.

6. Implementing staff training in Carer awareness so that, once identified, Carers are recognised for the crucial role that they play.

Communicating effectively with Carers, Families and Friends It is widely acknowledged that Carers feel that a major barrier to their engagement with services is the issue of communication. Carers would like specific information about the person they care for and general information about the illness and recommended treatments. They want to understand more about the mental or physical health issues the person they care for has. They want to understand how to cope with these. They also want to know what they can expect from our services and local resources. In addition, they want to be informed about who they can contact and what information can be shared with them. St George Healthcare Group is committed to:

1. Ensuring that information about services and wards is available and visible where services are accessed e.g. posters, leaflets and notices will be available in all visiting rooms and areas.

2. Providing information for carers on noticeboards across St George Healthcare Group.

3. Redesigning our website to include accurate and up-to-date information for Carers.

4. Sending out newsletters to include accurate and up-to-date information about our services (appendix 1).

5. Ensuring that all teams have information about services available for families and carers.

6. Developing and implementing a Carers’, Families’ and Friends’ Experience Questionnaire (appendix 2).

7. Appointing a Named Nurse for each patient who will have responsibility for co-ordinating services, and liaising with the Patient’s Carers and their families.

Involving Carers, Families and Friends in Patient care and delivery of services Carers often have a great deal of experience of both what works when caring for people and the services provided for those they care for. Carers often become experts in the care of the person they care for; they have first-hand experience of their presentation and carers are often the first to recognise the early signs of a relapse. Furthermore, they may be required to take on responsibilities essential to the care process, especially when care is provided at home or when the Patient is discharged from hospital. Carers want to be involved in the care, treatment and support of the person that they care for, particularly when there are important decisions to be made, and the default position within our services should be that the carer is involved . Carers often have a great deal of experience of the services provided for those they care for. They often want to be able to comment on these services and be involved in the planning, shaping and review of these services. The Care Programme Approach (CPA) aims to effectively maximise the patient’s and carer’s and/or family’s participation in the planning, provision and review of care. The continuity of care is enhanced by the use of the care co-ordinators, supported by an effective multidisciplinary team. St George Healthcare Group is committed to:

1. Taking social and family histories into account following admission, and recording relevant information in the patient’s case file.

2. Drawing up, reviewing and agreeing treatment plans, ensuring staff, Carers and families are kept fully informed of these procedures

3. Ensuring Carers and families are informed of opportunities to make appointments to see the care co-ordinators responsible, the Responsible Clinician, Consultant, or other staff within a reasonable time.

4. Providing the opportunity for Carers to voice their opinions and concerns on a regular basis within a families and carers forum.

5. Facilitating open visiting with refreshments provided free and a meal with a small charge.

6. Offering practical assistance wherever possible when this support is required.

7. Carrying out Group wide Carers survey to find out what services Carers need from us.

8. Developing the role of ‘Carers Representative’ to cover all sites and locations within the Group (appendix 3).

Supporting Carers, Families and Friends to maintain their own wellbeing Caring for someone who is living with an illness, disability, learning disability or mental health condition can be challenging for the carer and it is essential that they are supported as much as possible in their caring role. Carers want staff to be sensitive to their needs and their concerns, and also to have an awareness of the external support services available such as carer training courses, Carer’s assessments and local support groups. We need to improve the way in which we support carers within our services and also enable carers to access external sources of support. St George Healthcare Group is committed to:

1. Maintain contact details for organisations offering support to carers, and make referrals to these organisations where required.

2. Building on existing links with local partners to improve communications with them.

3. Provide more support to Carers using skills that staff already have e.g. family therapy and counselling.

Supporting our staff to be more aware of Carers’, Families’ and

Friends’ needs and issues

The responsiveness of staff particularly during the carer's first contact with services is vitally important. Carers want staff to be able to identify them, provide them with information, help them to access support services, listen to their views and involve them in the care process. Staff need to be sensitive to the needs of Carers, particularly during their first contact with our services, and recognise them as partners in care. St George Healthcare Group is committed to:

1. Implementing training across the Group to develop the skills of our workforce in dealing with Carers.

2. Encouraging staff to periodically update themselves on what support services are available to Carers in the local area.

7. Strategy Implementation This strategy will be implemented across the organisation as appropriate. A memo, along with a copy of the strategy will circulated to all Medical staff, Service Managers, Team Leaders and Clinical Nurses for information and published in the central Policy Shared Folder for on-going accessibility.

9. Strategy Monitoring St George Healthcare Group will undertake the following actions to ensure that this Strategy is effectively implemented, reviewed and monitored:

Each Hospital to produce a yearly action plan and a report that details how they have addressed the actions in this Strategy

To report on the implementation of the strategy monthly within Hospital Governance meetings

To report on the implementation of the strategy quarterly within Corporate Governance meetings

To report on the implementation of the strategy six-monthly to the Board of Directors

To review the Carers’ Strategy and its implementation annually.

Overall improvement of the carer experience will be monitored using a Carers’, Families’ and Friends’ Experience Questionnaire. The results from this survey will be used to update the Carers’ Strategy for 2015.

Where monitoring has identified deficiencies, appropriate recommendations and action plans will be developed and changes implemented accordingly. Progress will be reported to the Clinical Governance & Quality Committee via the Policy Review Group. The monitoring of this strategy is defined in the matrix below.

10. Strategy Review

Overall improvement of the carer experience will be monitored using a Carers’, Families’ and Friends’ Experience Questionnaire. The results from this survey will be used to update the Carers’ Strategy for 2015.

Appendix 2 Family and Carer Questionnaire 2014 At St George Healthcare Group we want to know about the experiences of Carers St George Healthcare Group is reviewing the quality of support that it provides to Carers and the people they care for. Please tell us what we are doing well and what we need to change. The answers should be given from your point of view as a Carer. The information you give will be treated as confidential. ******************************************************************************** Which service/hospital within St George Healthcare Group are you currently involved with: St. Mary’s Hospital All Saints Hospital St. Cyril’s Rehabilitation Unit What do you think about the overall quality of the support provided by St George Healthcare Group?

Excellent Good Okay Poor Very Poor Comments: How reliable do you consider us to be?

Excellent Good Okay Poor Very Poor

Comments:

How good is communication between you and St George Healthcare Group? Excellent Good Okay Poor Very Poor

Comments: Over the last 6 months which have you received relating to service delivery at St George Healthcare Group? Please tick all that apply:

Newsletters

Emails

Telephone calls from a Named Nurse

Telephone calls from the Manager or Team Leader

Patient Meetings

Carer’s Forums

Other events Comments: Over the last 6 months which of these Patient meetings have you attended? Please tick all that apply:

CPA Meeting

MHA Hospital Manager’s Review Meeting

MHA Review Tribunal Meeting

Other Review Meeting Comments:

Over the last 6 months what do you think St George Healthcare Group has done really well? Comments: Over the last 6 months what do you think St George Healthcare Group needed to improve on? Comments: We are constantly striving to improve the quality of our work. Do you have any suggestions for what we should do? Comments: We are constantly striving to improve the quality of our staff training programmes. Do you have any suggestions for what we should do? Are there any areas that you feel that we could improve our training? Comments:

How well trained are our staff in supporting you as a Carer? Excellent Good Okay Poor Very Poor

Comments: How well do you feel we are doing with maintaining continuity of staff?

Excellent Good Okay Poor Very Poor

Comments: ******************************************************************************** The questionnaire can be returned anonymously, but if you are comfortable to sign it then that will help us to respond more effectively to your comments and suggestions. Thank you. Name: Telephone No.: Address: Email:

Appendix 3 Carer Representative Role Profile Title: Carer Representative Time Commitment: The duration and frequency of meetings are

at the discretion of the Registered Hospital Manager.

Meetings are typically held between every

month and every three months. Venue: Meetings will be held at St. Mary’s Hospital,

Warrington All Saints Hospital, Oldham St. Cyril’s Rehabilitation Unit, Chester Expenses: Out of pocket expenses for travel only Accountable to: Registered Hospital Manager Supported by: Registered Hospital Manager and

Independent Mental Health Advocate Tenure of Office: 1 Year (extension/renewal will be through

mutual agreement with the Registered Hospital Manager)

Key Relationships:

• Registered Hospital Manager and Deputy • Independent Mental Health Advocates • Service Managers • Clinical Ward Staff • Patients

St George Healthcare Group values the role that family and Carer representatives play in bringing a unique perspective to our Hospital wide meetings, and Groups. Individuals who have experience of life changing diseases, injury or disability find ways to adjust to what life throws at them. They look for creative solutions to challenges and identify opportunities for improvement. They are experts by experience. We believe these experiences, both good and bad, empower patients, family and Carers to be meaningfully engaged in discussions around quality, and service and system improvement.

St George Healthcare Group provides care and rehabilitation for people with a Brain Injury, Autistic Spectrum Conditions, Deafness and Mental Health issues, in addition to a wide range of neurological conditions. We are committed to providing the highest possible quality of Patient centred care that respects the rights for dignity, privacy and individuality. We believe Carers and families can help us to deliver on this commitment.

1. Formal St George Healthcare Group Representatives Roles Carer Representatives are included at all levels of the formal governance structure of St George Healthcare Group These include membership of:

• Hospital Governance Meeting • Family Forums • Staff Recruitment and Interview Panels

Further information relating to the roles and responsibilities of these groups can be found by contacting the Registered Hospital Manager or by emailing familyforum@stgeorgehealthcaregroup.co.uk

2. Specific Roles and Responsibilities for Representatives The role of Carer Representatives at St George Healthcare Group Governance Meeting is to ensure that the views of patients, carers and families are taken into consideration during relevant discussions and heard throughout St George Healthcare Group as a wider organisation, whenever decisions that affect patient care are made. Carer Representatives who serve at this meeting are expected to contribute to this decision making process.

Carer Representatives will work to:

• Contribute to relevant meetings in a constructive manner, offering ideas and opinions which reflect the voice of Patients, Carers and their families

• Where appropriate and applicable, Carer Representatives should seek views and feedback from other patient groups on the work of St George Healthcare Group

• Keep abreast of local and national news and developments with regards to healthcare policy and patient experience, and consider the impact of this on the activities on St George Healthcare Group Patients

• Seek to attend training from St George Healthcare Group when offered, if considered useful and applicable

• Work on projects which have been identified as an area of focus by the membership, and agreed by the Registered Hospital Manager. This may sometimes require collaborative working with other team members and at other times working autonomously

• Provide a commitment to the St George Healthcare Group attending as many meetings as they are able, and acting as a representative of the company when required

• Carer Representatives should not agree to take on projects, which they feel are outside of their remit, beyond their skill or knowledge level, or would require a time commitment which they are unable to keep.

If Carer Representatives have any queries relating to their role and responsibilities, they should contact the Registered Hospital Manager. Carer Representatives will be asked to sign a confidentiality agreement. We strive to ensure that all groups and meetings have an Independent Patient Advocate who acts to support Carer Representatives through providing them with any necessary information or interpretation during meetings and ensuring their voice is heard and their viewpoints considered. If a Carer Representative has any concerns relating to activity at St George Healthcare Group and feel unable to raise this at the relevant meeting, they should contact their corresponding Independent Patient Advocate in the first instance