MPS: Adult carers

Types of services that support carers

There are three main types of provision/resources that support carers:

Caring Well in Devon, a specifically commissioned carers support service, (they also commission some services such as training for carers)
general social care (usually personal care) or technology
general community facilities, services and resources not involving personal care.

Unless universally available, services for carers will usually be paid for by carers through carers’ personal budgets.

1. Caring Well in Devon

Caring Well in Devon is the primary specific commissioned service for carers, delivered by a consortium led by Westbank’s Devon Carers and is carer-led. It has been let to April 2023 plus possible two one – year extensions. It is underpinned by themes of independence, resilience, wellbeing, and strengths-based working. Its focus is on providing a strong universal offer and targeted interventions to improve carer wellbeing and reduce the risk of crisis from occurring.

There are three levels to the carer offer

Level 1 – Universal Offer for carers
Level 2 – Targeted Services for carers
Level 3 – Personal Offer for carers. More detail is contained in the appendix to this statement

The service also provides carer assessments, support planning and reviews as delegated statutory functions.
[For carers of people with mental health needs, we (Devon County Council) have delegated the same statutory duties to the Devon Partnership NHS Trust.]

Working in close association with Devon Carers are two other contracted provisions:

Looking after me – a training provision to support self-care.
Working-age carers –benefits advice for carers considering taking up, leaving, reducing or increasing their commitment to work, and appeals.

2. General social care services and technology

These services aim to:

complement care provided by the carer
meet the carers’ own eligible needs, including ‘replacement care’ (sometimes referred to as respite)
substitute for the carer in the short term when the carer is not available to undertake their usual care – for example if the carer is hospitalised
improve the independence of the cared-for person and/or enable the carer to do so. This includes ‘enabling’ in collaboration with carers and training for carers.

Where personal care is provided to the cared-for person, this may be offered via a personal budget to the cared-for person or commissioned for them, and any charges related to this are paid by the cared-for person, not the carer.

More information is available on technology can also be found in the MPS Commissioning Statement sections:

3. General community facilities, services and resources (not involving personal care)

Carers access a range of community-based and commercial services to achieve their outcomes, including:

breaks not involving replacement care, for example:
- relaxation and exercise classes
- leisure centres and swimming pools
gyms and active leisure facilities (for health)
training for employment and job coaching
volunteer support
digital shopping services
cleaning or gardening, most usually so that carer’s needs for a break or healthful activity can then be undertaken
personal assistance, such as helping a carer who has lost control of household and personal administration to get back on top of it, or to de-clutter.

What do we want from this area in the future?

General characteristics for all services in the market

All services should work collaboratively with carers in line with the following principles:

carers, and the essential role they play, are identified at first contact or as soon as possible thereafter
staff are carer-aware and trained in carer engagement strategies
policy and practice protocols regarding confidentiality and sharing information
defined roles which focus on carers issues are in place – for example a lead senior manager, team champions
information for carers on the service is available across the pathways
carers are enabled to access a range of carer support services.

In addition, providers as employers should be aware of and support the carers who work or want to work for them

Our assessment is that there is room for improvement across all markets in these respects. Providers who can demonstrate these qualities will be more successful, both in meeting outcomes and securing future business.

Advice on improving carer awareness and responsiveness can be secured from Devon Carers Mr Billy Hartstein, Head of Carers’ Services, Farm House Rise, Exminster, Exeter EX6 8AT, email billy.hartstein@devoncarers.org.uk
Advice on employment practice is available from Employers for Carers
Devon County Council’s membership of Employers for Carers covers Devon-based small to medium enterprises (SMEs) which therefore allows providers to access policy and practice resources free of cost. (Plymouth and Torbay also have this membership).

Specific characteristics – services for carers

While we wish to develop services based on evidence, it is acknowledged nationally that there is insufficient evidence on what works for carers

Training is the exception to this. This is arranged by and accessed through Devon Carers.
Carers tell us that support from other carers can be the best there is. This is also sourced through Caring Well in Devon
Breaks and services that support the sustainability of the caring role are critical; this can include a very wide range of services and facilities.

We need to see innovation in approaches to support and the use of digital resources and technology to increase the choices of, and access to, services available to carers and provide best value. More technology information is in the Technology Enabled Care and Support (TECS) Commissioning Statement.

We need to see expansion and innovation in replacement care, especially to meet the needs of carers who are supporting a cared-for person with complex needs. For further information, refer to the Replacement Care Commissioning Statement.

For example, a person with complex mental health needs, and on the autistic spectrum, although living in supported accommodation away from home and theoretically independent, had frequent escalations of need and the parent/carers were the only source of support acceptable to that person.

We need to see innovation from non-social care services so that people with care and support needs can be adequately supported in the absence of their carer(s) so that people are not forced into care settings unnecessarily.

The outcomes and benefits we expect to see are contained in the Appendix.

What is the assessment of need?

It is estimated that there are 86,595 adult carers in Devon, rising to 89,384 by 2024. 21,000 are known to Adult Care and Health or Devon Carers. Further analysis of need is shown in the appendix to this statement.

Key characteristics:

Just over half of all known carers are retired, and half are in employment, volunteering or in education.
We know proportionately fewer male than female carers.
The ethnicity profile of carers broadly follows that of the Devon population.
Particularly at-risk carer groups include those aged 85+, carers with a learning disability in employment, and ‘sandwich’ carers who care for people across a range of ages.

The need for replacement care is likely to be most required for those carers of working age, those aged 85+, and carers looking after young children while they are also caring for older or other people with disabilities.

Many carers do not seek assessment and support and many are aware that for formal social care services the person(s) they care for would be regarded as self-funding. So, the assessment of need presented here may be an understatement and may suggest a market opportunity for providers to offer services more widely to carers.

For further information, refer to the Replacement Care Commissioning Statement.

3. General community facilities, services and resources (not involving personal care)

Carers have similar needs to access community facilities, services and resources as other members of the community but experience higher barriers to doing so, notably:

finance – carers are in general poorer than the general community
time – caring can severely restrict the time carers have to access resources
attitudes – putting the needs of the person(s) they care for before their own
health – carers are in generally in poorer health than the wider population
rurality – carers in remote rural areas are highly likely to have needs for access to community resources which they cannot fulfil.

What is the assessment of supply?

The range and availability of services to support carers is varied across Devon. Providers may wish to think about the services they can offer to carers to extend their portfolio and strengthen commercial sustainability. For example, where staff are employed on shifts, it might be possible to deploy those staff during less bust times to offer affordable carer support. Or personal assistants (PAs) may see and opportunity to develop their offer.

The market is particularly weak in relation to:

community-based replacement care in rural areas, for example, affordable sitting services
bed-based replacement care
day time replacement care – building or non-buildings based
Personal Assistants (PAs) available to provide replacement care
bookable services to enable carers to take planned breaks – all services.

What changes are we looking for?

What changes are we looking for from this service in the future, including any market opportunities? And what can Devon County Council do to help to move towards these changes?

Challenges exist for all services to identify carers, inform carers about sources of information and support, involve them as expert partners in the care of their loved one(s), and put them in touch with carers’ support services.

We will increasingly be looking at how providers relate to carers as employees and potential employees.

1. Caring Well in Devon

Challenges for the service Caring Well in Devon include:

‘hidden carers’, where the carers do not recognise themselves as carers, or where there is stigma or other inhibition on self-identification (for example where caring for someone with a substance misuse problem)
male carers and working-age carers
carers in rural or coastal areas
carers from minority community groups, including Gypsies and Travellers who may be reluctant to have contact with services
LBGTQ+ carers, who may feel uncomfortable with accessing services.

Devon Carers is keen to work with providers to shape services and providers are encouraged to explore opportunities for partnering or business development in the following areas:

Training for carers, especially in relation to caring safely and effectively
Volunteer and staff – provided support, including at short notice, to support carers to prevent hospital admission or facilitate discharge
Training for staff in carer awareness (for purchase by providers).

2. General social care services and technology

We need to develop the offer for replacement care available for longer periods (for example a weekend up to a fortnight) in domiciliary or residential settings and bookable ahead (more than six weeks in advance).

However, we are looking to innovation in this area beyond traditional service approaches and to making the delivery of replacement care more personalised and sensitive to individual needs. Refer to examples below:

We are looking to innovation in this area beyond traditional service approaches and to making the delivery of replacement care more personalised and sensitive to individual needs. For example:

carers who have not had a break because the type of care they provide is not easily replaced. For example, parents who provide emotional and some physical care to an adult with complex mental health needs, learning disabilities and or Autistic Spectrum conditions when there are escalations or crises, which occur without warning, frequently and at random intervals.
host family provision might be further developed for daytime or short stay services, so that families can develop longer term relationships and plan ahead.

The availability of low–cost sitting services is a priority for carers, and we are often purchasing personal care services to cover needs for sitting when a non-regulated provision would be adequate.

We are exploring how these can be made more readily available and are starting with the potential contribution of volunteer-provided sitting services.

The timescale for the introduction of the new replacement care arrangements is set out the Replacement Care Commissioning Statement.

3. General community facilities, services and resources (not involving personal care)

(Return to the Market Position Statement)

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Last updated: 16/09/2020