Adult Carers Policy

1. Scope of this policy

1.1   This policy is for:

(a) Carers of adults with care and support needs. This includes: 

• Carers of adults with needs that are not being met by health or social care services.
• Carers who are not in touch with Adult Social Care.
• Those who do not recognise themselves as Carers.

(b) Young Carers in transition to adulthood.  

(c) Parent Carers whose children are approaching adulthood.

1.2   A Carer is someone who provides practical or emotional support to a family member, partner or friend who needs help because of frailty, physical or mental illness, or disability. This does not usually include people who are care-workers and paid, or who are volunteers.

1.3 Carer support is the joint responsibility of NHS and Social Care. This can be read in the “Commitment to Carers” also known as Devon Carers Charter and the Caring Well strategy.. This Policy is principally concerned with the responsibilities of Devon County Council and sets out the steps Devon County Council (“we”) will take to fulfil these, including through partnership arrangements.

1.4   This Policy informs Carers about what to expect and guides managers, staff and partners.

2. Legislation

2.1   The Care Act 2014 outlines the duties of Local Authorities to carers. These include to provide information, advice, preventive support, carers’ assessments, and support for carers whose needs are “eligible” in the terms of the Act. It also provides a clear framework for protecting adults at risk of abuse or neglect (who may be carers, or the person(s) for whom they care): Link to Safeguarding Adults page   

2.2   The Care Act 2014 makes it clear that the duties towards a carer are with the local authority in which the person with the care needs is ordinarily resident.

2.3   We recognise the valuable contribution of carers and the impact the caring role can have on their wellbeing. We are committed to fulfilling our duties to Carers under the Care Act, to prevent, reduce and delay the development of needs, to promote independence, and, where these cannot be met otherwise, to meet carers “eligible needs”.

2.4   The Children and Families Act 2014 gives rights to Young Carers and to Parent Carers of children with disabilities to have an assessment of their needs. These duties are the responsibilities of DCC Children’s Services. However, DCC Adult Services will arrange to provide information and signposting for young carers and parent carers.

2.5   The Mental Capacity (Amendment) Act 2019 changed processes for authorising the care or treatment of people who lack capacity to consent. Liberty Protection Safeguards can affect people’s lives in their own homes if someone is deprived of their liberty. This can be particularly important where young people are in transition to adulthood.

2.6   The Health and Care Act 2022 gave new rights to carers in relation to Hospital discharge planning.

2.7   The Care Act 2014 allows Local Authority delegation of certain social care duties to other organisations. Organisations carrying out duties on behalf of DCC are required to operate in accordance with this policy.

3. Promoting independence: Our vision for adult social care in Devon 2023-28

3.1   The Care Act requires that we consider promoting independence and reducing the needs of the people we support at every opportunity.

3.2   In delivering our duties and exercising our powers we will always take into account the Council’s Promoting Independence policy.

3.3   Vision and policy. This is set out specifically for carers in the “Caring Well In Devon” a Strategy for Devon County Council”, published June 2023.

3.4 Through our strategy our aims are to:

• Encourage you to stay well and support you to help yourself

• Work with you when you need help through personalised, strength-based support to keep you connected to your community

3.5 For Carers this means we will:

• Help you to remain fit and well, or to improve or maintain your current abilities for longer by making informed choices.
• Encourage you to do as much as you can for yourself as well as the person you care for with support from your family, friends, and community networks.
• Promote the use of technology and digital solutions where they can play a role in helping to maintain or improve your well-being and independence.
• Work with other organisations to ensure you can access advice and find out about local support and other services to help you look after both the person you care for and yourself in your community.
• Contribute to making your local places, healthy and safe places that support you in your role. We will collaborate with partners, in particular the NHS, GPs, and the Voluntary Sector, to achieve this.
• Help you to find the support that increases your ability to manage the specific care needs of the person you care for and for yourself.
• Work with you where the young person you care for is approaching adulthood to prepare for that transition so that it is a positive experience.
• Work with you when you are a young carer approaching adulthood yourself so that experience is positive and contributes towards a healthy and fulfilling future.

3.6 Carers who we support should be able to say:

• I have choice in and about my caring role.
• I find support in my community and from local community organisations.
• I can easily find the information and advice I need in my caring role.
• I have a contingency plan for when I cannot care.
• I am respected as an expert partner in care.
• I can care safely, confidently, and effectively.
• I can maintain my own health, wellbeing, and independence.
• I can achieve my own most important life goals, including education, training, and working.
• I am assured of the quality of the services I and the person(s) I care for use, and that my views are considered.
• I am supported to achieve the above when I have difficulty in doing so and participate in designing the support I need.
• I am involved throughout the time the person I care for is in hospital and especially in planning for their return home
• I can share my experience and skills as a carer with other carers

4. Identifying Carers

4.1   Our policy is to identify as many carers as possible as early as possible in their caring journey and refer them to appropriate support. This includes Parent Carers and all Young Carers.

4.2   We have developed a Carers Recognition Tool to help health, social care, housing, education, and other professionals recognise if someone they encounter is a carer and to refer them to appropriate support.

5. How we arrange services for carers

5.1   We commission, with the NHS, services from independent providers who provide information, advice, prevention support, assessment, eligibility, resource allocation and support planning.  

5.2   These are mainly provided through Devon Carers, which is a carer-led arm of Westbank Community Health and Care.

5.3 This does not prevent us acting directly to deliver on our Statutory Duties in respect of Assessment, Reviews and Support Planning and there will be times when it makes more sense to Carers that we undertake this directly with them. This includes through partnership arrangements However services are delivered in response to our statutory duties, we retain responsibility for how they are provided and their quality.

6. How we arrange replacement care

6.1   Replacement Care is classed in law as a service for a cared-for person, when a carer needs to take a break, or must meet other eligible needs, then replacement care is a service provided to a cared-for person to enable their carer the time to do that.

6.2   We arrange replacement care (not Devon Carers). We do this either by a Direct Payment or directly with a service provider, usually after the carer has had a Carers Assessment

6.3   Replacement care will be personalised to assure that the needs of the person(s) who are cared-for are met and that their independence is promoted as far as possible. If through the financial assessment process a charge is to be made for replacement care, the charge will be to the person with care and support needs, not the carer.

7. Information and universal services

7.1   We will provide Carers with information and advice on universal services available in the community, regardless of need and without any requirement for an assessment.

7.2   We have arranged for information and some online services from Carers UK to be available freely and simply for carers in Devon: The “Upfront Guide to Caring” is particularly useful in guiding carers to the many types of information they may need depending on their personal caring role. (https://www.carersuk.org/help-and-advice/guides-and-tools/online-tools-to-help-with-caring/)

7.3   Devon Carers issues a “new carer pack” to all Carers registering with them, which will include the Carer Identity Card and the Carer Passport.

7.4   The full information available includes:

• All community services including “targeted” preventative services and carer-specific services
• Availability and types of carer assessment
• What is available to those with eligible needs
• Signposting to services to support people with care needs
• Advocacy services
• NHS Patient Advice and Liaison Services
• Advice about Benefits and work options
• Care services which carers and their families can purchase for themselves.

7.5   We also encourage and support carers to prepare “Contingency Plans” for when they cannot care, in the short and longer terms.

7.6   Carers can access this information online and from the Devon Carers Contact Centre or telephone 0845 643 4435.

8. Carer Conversations (“assessments”)

8.1   We aim to give as much support as possible to Carers without a formal assessment.

8.2   We will actively support carers to be involved in assessing, planning, and reviewing their support. We will facilitate the involvement of any person they require to help them participate. We will make reasonable adjustments in line with our duties under the Equality Act 2010 and the Care Act 2014 to overcome any barriers to their involvement. Providing Information in Alternative Formats. Independent Advocacy Policy Statement.

8.3   When carers need more help, we will work in a personalised “strength-based” way. “Strength-based” working “is a collaboration between service professionals, you and your family and community, which draws on your skills, abilities and networks. This approach supports you to remain happier and independent for longer and resilient in your caring role, whilst staying socially connected.

8.4   Where direct adult social care support is needed, we will make sure that the care and support is personalised and strength-based, to keep people connected to their communities and fully cognisant of your needs as a carer.

8.5   We have two main forms of Carer Assessment to provide an experience “proportionate” to need and complexity. A simple “contact” assessment is used where needs are easily understood, and solutions easily found. The full Carer Health and Wellbeing Check is used where needs are more complex. This is an integrated health and care service. It is available through Devon Carers and focusses on protecting and maintaining carers’ own health and wellbeing as well as preventing needs from becoming worse, and determining “eligible” need. We are also developing an online self-assessment.

8.6   The Care Act 2014 requires us to inform Carers who will have an assessment about the questions we will ask. Where an assessment is a Carer Health and Wellbeing Check, carers will usually be invited to undertake the first part of the assessment themselves. We will provide a booklet to help guide carers through the process, including the questions to be considered. Carers can use the booklet to help them decide where they want to focus attention in the assessment discussion. The carer can also get telephone advice from Devon Carers on this. Our aim is that the conversation that takes place to complete a Carer Health and Wellbeing Check is a helpful experience in itself.

8.7   Carers have told us that social isolation and loneliness are big problems in Devon, so staff will have this in mind, and it is likely to be a focus of most assessments.

8.8   Whoever conducts the carers assessment Devon County Council (DCC) is responsible for the quality of the assessment. The quality of carers assessments is monitored through contract monitoring, practice quality assurance processes and management information reporting.

8.9   If someone is concerned about how an assessment by a Devon Carers worker, has been conducted we would usually expect them to raise the concern with Devon Carers in the first instance.

8.10   If someone is concerned about how an assessment has been conducted by another organisation, we would usually expect them to raise the concern with that organisation in the first instance.

8.11   We may ‘suspend’ the assessment process by providing or arranging support that may prevent, reduce, or delay the development of needs for carer support. 

8.12   We will respect the right of a Carer to decline assessment or completion of a full Care Act assessment (Carer Health and Wellbeing Check with eligibility decision). 

8.13   We may combine a carer’s assessment with another related assessment or offer a joint assessment where another authority (for example the NHS) also wishes to assess needs, and where all parties consent.

8.14   On completion of a full carers assessment (Carers Health and Wellbeing Check) the organisation conducting the assessment will:

• assure itself that assessment information is an accurate and complete reflection of needs, outcomes, and the impact on the carer’s wellbeing 
• make the eligibility decision
• provide a copy of the assessment to the carer (and anyone that they wish to share it with). 

8.15   Where a Care Health and Wellbeing Check identifies needs that are eligible for care and support services provided by the Council we will develop a Support Plan.

8.16   If we identify that a carer has no eligible needs, then we will produce an “Action Plan”. This will be like a support plan and will provide carers with advice and information about services that they can use to help them.

9. Eligibility

9.1   Care Act regulations have detailed national carers eligibility criteria. This is set out in the Appendix to this document. [Link Eligibility for Adult Social Care and Support – policy guidance]

9.2   We will advise the carer and / or their representative in writing of the eligibility decision. We will also provide advice about what help and support may be available to meet, prevent, reduce or delay needs which do not meet eligibility criteria. 

10. Young carers becoming an adult carer of an adult and Parent Carers where the cared-for child is moving into adulthood

10.1   The Care Act requires a local authority to undertake a transition assessment for:

• a Young Carer if it considers that they are likely to have needs for support after becoming 18 years old; and
• a Parent Carer if it considers that they are likely to have needs for support after their child becomes eighteen.

10.2   We will aim to arrange these transition assessments at a time which is most likely to benefit the carer.

10.3   Transition assessments will also consider the sustainability of the Carer’s role and how their caring role could be impacting on their life aspirations, such as employment or education.

11. Outcomes for Carers

11.1   The outcomes we recognise and track for Carers who have a Carers Assessment are shown in this diagram. This forms part of the Carer Health and Wellbeing Check Booklet enabling carers to actively guide where they feel attention needs to be.

12. Support planning and personalisation

12.1   When eligible needs have been identified during a Carer’s Assessment a support plan will be written. In all cases we will seek to promote independence.

12.2   We will seek out cost-effective solutions for carers that will provide support in the most appropriate and efficient way. Support planning will be based on the Council’s policy on “Promoting Independence”.

12.3   Where no other solutions can meet the need, we may propose an amount of money to meet the Carer’s eligible needs. We call this a “Personal Budget”.

12.4   Personal budgets for carers will usually be either:

• A one-off payment, for example to support a Carers’ Break, or to pay for an item that will enable a Carer to remain or recover their independence.
• A short-term payment in a crisis or until longer term solutions can be arranged.
• Longer term carers personal budget payments, but we expect these to be less frequent.

12.5   Carers Support Plans and any personal budget arrangements will be based on carers individual circumstances.

12.6   Carers are able to receive their Personal Budget as a Direct Payment. This gives them greater choice and control of the support they need. We will support carers to do this if they choose to.

12.7  Direct Payments to carers will be subject to the Councils Direct Payment Policy .

12.8 Carers’ Personal Budgets must be used to meet the assessed eligible needs of the Carer. They cannot be used for care for the person they support. The care for that person’s needs will be met through their own support plan. Usually, the Carer will agree with the person undertaking their Support Planning what it will be used for. 

12.9 When the Council has agreed to meet needs, we will support carers to be as actively involved as they can be in planning and reviewing their support arrangements. We will involve any suitable adult the carer wishes to involve and anyone necessary to support the carer’s involvement, for example an independent advocate. 

12.10 We will record arrangements agreed with the carer, including any services that may meet/reduce carer’s need(s) in the carer’s support plan and provide a copy to the carer and / or their representative and others as appropriate. 

12.11 Sometimes Direct Payments are inappropriate. For example, this may happen in Hospital Discharge situations where the carer wants us to arrange help directly. Sometimes, we may arrange support with a local voluntary organisation, or loan or provide a small item of equipment of a particular kind (examples have included “robo-pets” and electronic tablets).

13. Reviews

13.1 The purpose of reviews is to ensure that the Support Pan is enabling the Carer to move forward in achieving their agreed outcomes and that resources are being used in accordance with DCC policies. When we undertake a review, we should also consider the role that carers have in preventing the needs of a person for whom they care from increasing.

13.2 The frequency of reviews will depend on the needs and circumstances of the individual.

13.3 In most cases, the Council will review support arrangements within 6 to 8 weeks of signing off a support plan to check that arrangements are meeting needs.  

13.4 We will then review arrangements at regular intervals, at least annually or more frequently if needs change. We may align a review with the annual review of direct payments if the carer chose this option for meeting needs.  

13.5 Carers may ask that a review is conducted earlier than usual. We will consider the following factors in deciding when to hold the next review:

• The carer’s needs have changed
• The carer’s circumstances have changed, e.g. changes in living arrangements or support networks
• The current care and support plan is not working
• The requirement for or the amount of a Personal Budget

Appendix: The Care and Support (Eligibility Criteria) Regulations 2014

Needs which meet the eligibility criteria:

(1) A carer’s needs meet the eligibility criteria if—

• a) the needs arise as a consequence of providing necessary care for an adult
• b) the effect of the carer’s needs is that any of the circumstances specified in paragraph (2) apply to the carer, and
• c) as a consequence of that fact there is, or is likely to be, a significant impact on the carer’s well-being.

(2) The circumstances specified in this paragraph are as follows—

• a) the carer’s physical or mental health is, or is at risk of, deteriorating.
• b) the carer is unable to achieve any of the following outcomes
• i. carrying out any caring responsibilities the carer has for a child.
• ii. providing care to other persons for whom the carer provides care.
• iii. maintaining a habitable home environment in the carer’s home (whether or not this is also the home of the adult needing care).
• iv. managing and maintaining nutrition.
• v. developing and maintaining family or other personal relationships.
• vi. engaging in work, training, education or volunteering.
• vii. making use of necessary facilities or services in the local community, including recreational facilities or services; and
• viii. engaging in recreational activities.

(3) For the purposes of paragraph (2) a carer is to be regarded as being unable to achieve an outcome if the carer—

• a) is unable to achieve it without assistance.
• b) is able to achieve it without assistance but doing so causes the carer significant pain, distress, or anxiety; or
• c) is able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the carer, or of others.

(4) Where the level of a carer’s needs fluctuates, in determining whether the carer’s needs meet the eligibility criteria, the local authority must take into account the carer’s circumstances over such period as it considers necessary to establish accurately the carer’s level of need.

Version	2.0
Strategic Owner	Keri Storey, Head of Integrated Adult Social Care Operations
Business Owner	Ian Hobbs, Senior Commissioning Manager (Market Management, Personal Care and Carers) Sue Younger-Ross, Joint Carers Lead, NHS Devon & DCC
Author	James Martin, Policy Manager
Date of approval and commencement
Last review date	July 2023
Last reviewer	Sue Younger Ross, Joint Carers Lead James Martin, Policy Manager
Next review date	Q2 2025/6
Changes at last review	Updates to legislation, language & terminology. Information added about replacement care. Removed information about ordinary residence and continuing healthcare as this is covered in other policies.