1

Evaluation Report CSH Surrey Carers Prescription Pilot

December 2014

December 2014

2

Foreword

“As a one of the carers who was involved in the development of the Carers Prescription, I am delighted that it has now been adopted as routine practice following the pilot. Over 20 years ago when I first realised I was a Carer my GP felt helpless to help to alleviate the enormous stress I was under. I will never forget how desperate she was to help, yet she didn’t know what was available or how to signpost me to those who could help with carer support. Now there is so much more to support Carers – yet the same problem of access remained, until the development of the Carers Prescription. This is a win win development that enables GPs to signpost carers to the services that can help. I was able to be involved in the scheme without having to attend meetings – which is often difficult for carers to do. Everything I contributed was done at a distance through email and by telephone, showing us that the valuable insight carers can offer is not impossible to capture.”

Janice Clark- Action for Carers (Surrey) Ambassador

Key Results

The pilot operated during August – October 2014

Total Number of Carer Prescriptions - 43

Total Number of carers’ services provided - 152

Background

In 2011 NHS Surrey undertook an Adult Carers Health Survey. The subsequent report evidenced how

caring impacted on the overall health and well being of carers.

83% surveyed reported a negative impact on their physical health

87% surveyed reported a negative impact on their mental health

As a result of this report NHS Surrey commissioned Surrey Independent Living Council (SILC) to host

a GP Carers Breaks Service. The Surrey GP Carers Breaks Scheme encourages GP surgeries to identify

carers within their patient groups whose health or well-being would benefit from a break from

caring. The GP can refer eligible carers for a direct payment of up to £500 which can be used to

purchase replacement care, to fund a break or other activity or to purchase equipment that would

improve the carer’s health or well-being

This new service has been welcome by both carers and GPs however the funding available does not

match the level of need. There are 108,000 adult carers and over 14,000 young carers in Surrey and

only 2,407 breaks available on an annual basis.

To alleviate the pressure on the GP Carers Breaks Service and to improve awareness of other carers’

services available here in Surrey a new GP Carers Prescription service was launched in April 2014.

During the first half of the year 217 Carers Prescriptions were made to 931 carer’s services.

3

As well as identifying the need for more carers breaks the Surrey Adult Carers Health Survey also

identified the need to develop a generic carers pathway.

Surrey Carers Pathway

The Carers Prescription is an evolution of the Surrey Carers Pathway which was launched in 2012.

This pathway was co-designed and co-produced as a link to existing patient care pathways and

hospital discharge procedures. The aim is to support health staff in identifying, recognising and

supporting carers (including young carers).

Website: http://www.carerspathway.org.uk

CSH Surrey – Carers Prescription Pilot Details

Why CSH Surrey?

Surrey hosts a Carers and NHS provider’s network where examples of best practice are shared to

help raise standards and improving carers’ outcome across community and acute providers.

The Carers Lead for CSH, Karen Masetti (Head of Quality and Nursing) expressed an interest in the

GP Carers Prescription and asked whether it could be adapted and used within a community setting.

Aims

The Pilot’s aim was to build capacity to improve the support available to carers from CSH by proactively supporting their staff to identify carers within their patient groups and offer a prescription for specialist carers’ support

Objectives

To evolve a culture of “carer aware” within CSH by embedding carer support solutions into everyday practice.

To increase the number of carers identified by CSH.

To provide a preventative solution for carers, who with the appropriate support will be able to maintain their caring role with less impact on their health and wellbeing.

To find “hidden” carers and prevent their health deterioration by introducing support earlier.

To assess the potential benefits of early intervention including reduction of admissions to hospital or residential care or allowing planned admissions.

Process

A dedicated webpage was created for CSH Surrey staff to access the Carers Prescription and to

provide them with other information about supporting carers.

Link: www.cshcarersprescription.org.uk

4

The webpage contains details of services available to carers throughout Surrey and any specific

eligibility criteria.

The process is simple and delivers secure forms directly to the appropriate voluntary or statutory

agency so they can provide the Carer with a rapid responsive service. Once the referral has been

received it is then processed and if necessary the details are forwarded on to the authorised third

party for example: Carers Support, Crossroads, Rethink etc.

The process is:

1) The health practitioner pulls up the Carers Prescription Form from the CSH Surrey intranet

webpage. They complete the carer’s details including obtaining consent to share data with a third

party and submit the form. Once they have submitted the form a hard copy can be printed to file in

the patient’s notes or alternatively a screen shot can be taken and scanned to the patient’s notes.

2) The form is then processed by the trusted receiver. In future this will be done by Surrey

Independent Living Council.

Surrey Independent Living Council (SILC) has been issued with a password to open the forms and

receive the confidential data. They process the form by either sending out a carers information pack

including a carers emergency card or forwarding on a separate form to the specific service provider

requested by the referee. You can view the form on the following

link https://fs4.formsite.com/surreygp/form20/index.html

3) If the service requested is for one of our independent carers services, SILC complete a separate

form and forward on to the appropriate service for that area. The referrer does not need to know

the geographical boundaries for each service. That provider will receive an email alerting them to

the fact that a referral has been made and they then enter their own unique passcode to access the

data

4) Finally the referee receives notification that the carer has been contacted and a service provided.

Examples of the templates used can be seen on the next pages:

5

6

7

8

Results of Pilot

The pilot was launched with the Palliative Care Team in August 2014 and continues to remain

operational.

For the purposes of this report the results have been collected up to 31st October 2014.

To facilitate the launch of the pilot 2 staff training sessions were held at the palliative care staff

forum meeting.

Total Number of Carer Prescriptions - 43

Total Number of carers services provided - 152

To put these figures into context during the same time period 55 GP Carers Prescriptions were

received from across all of Surreys 128 practices.

Age Group

0

2

4

6

8

10

12

14

Age Range 1920 -30 1930-40 1940-50 1950-60 1960-70 1970-80 1990 - 20

9

Gender

Condition Cared For

Dementia

Pulmonary Fibrosis Stroke

Mytonic Dystrophy Parkinson’s

Multiple Sclerosis

Congestive Cardiac Failure

Frail, Elderly COPD

Cerebral Palsy

Cancer

12 1 9 1 3 1 3 9 2 1 1

0

5

10

15

20

25

30

Male Female

0

2

4

6

8

10

12

14

10

Type of Services Provided:

The most popular referrals were for carers information packs, carers emergency cards and local

Carers Support services. Referrals were received for nearly all the services available except for Surrey

Young Carers Service, Mencap and Learning and Work Service. Referrals to Crossroads included their

EOL Carers support service.

The Impact on Carers

The big advantage of the process for the carer is speed. The whole process can be actioned within a

couple of days and the carers receive timely support.

From the health practitioners perspective they can access support from multiple providers of carers

services all from one secure form.

It is worth noting that the profile of some of the carers who received a referral. Many had been

caring for a person with a long term condition over a number of years. It is interesting that they had

not accessed universal carers’ services until this point which for many would have been the end of

their caring journey.

On average Carers UK report it takes 5 years for a carer either to self identify themselves or for a

professional to identify them as carer.

11

How has the work been funded?

The work was commissioned through the multiagency Surrey Carers Commissioning Group.

Cost were incurred in officers work hours and the purchase of a website domain and secure form

mechanism.

No additional funding was required. The absorption of future running costs will form part of an

annual grant agreement between Surrey Carers Commissioning Group and SILC.

CSH Surrey Staff Feedback

During the pilot CSH Surrey staff were encouraged to feedback on the process. As a result, the

following changes occurred:

Change in the template to take out ‘Patient’ reference.

Consent moved to the top of the template.

Facility included to count carers who were identified but who declined service.

Agreed the process for recording a Carers Prescription in drop down patient notes.

Response back to the referee added to inform referee that the Carers’ Prescription has been

processed.

Carers Services Feedback

The need to add a risk assessment question to inform on staff safety.

The Impact on commissioners and providers

The pilot meets the requirements of the recently published NHS England Commissioning for Carers (December 2014)

Link: http://www.england.nhs.uk/commissioning/comm-carers/

The Principles are based on the latest research, case-studies and best-practice and are the vital and common ingredients to deliver better outcomes for carers, patients, commissioners, practitioners and local communities. They are:

1. Think Carer, Think Family; Make Every Contact Count

2. Support what works for carers, share and learn from others

3. Right care, right time, right place for carers

4. Measure what matters to carers

5. Support for carers depends on partnership working

6. Leadership for carers at all levels

7. Train staff to identify and support carers

8. Prioritise carers’ health and wellbeing

12

9. Invest in carers to sustain and save

10. Support carers to access local resources

Care Act 2014 and Children and Families Act 2014

Finally the Carers Prescription allows us to meet the requirements of the Care Act and Children

and Families Act to refer carers for a carer’s assessment (Clause 3 of Care Act, NHS duty of

cooperation). This comes into effect on the 1st April 2015 when we will add a further option of

a carer’s assessment to the top of the menu list.

What next?

The pilot has now closed and the service is up and running. Regular reports of activities will be made

available on a quarterly basis to CSH Surrey and the Surrey Carers Commissioning Group.

Recommendations

The pilot will now be launched across other Surrey NHS providers. A phased introduction will start in

January 2015.

Initially this will be with Continuing Health Care and Surrey & Borders Partnership Trust.

It is hoped that CSH Surrey will continue to roll out the Carers’ Prescriptions in house to other

services and promote the identification of young carers in services.

Acknowledgements

The Partnership Manager for Carers NHS Guildford and Waverley, East Surrey and Surrey Downs CCG would like to acknowledge the support of all the carers who helped to co-design and coproduce this new service. Specifically: Janice Clark – Action for Carers (Surrey) Ambassador Karen Masetti CSH Surrey Carers Lead and Head of Quality and Nursing for her leadership and for initiating the pilot. The CSH Surrey Palliative Care Team Ron Critcher, Surrey County Council Carers policy officer, for all his technical and practical support. Finally the author of this report is especially grateful to all partners of the Surrey’s Joint Carers Commissioning Group, including Surrey County Council and Action for Carers (Surrey), for their advice guidance and support. Published by NHS Surrey Downs CCG Authors: Debbie Hustings, NHS Guildford and Waverley, East Surrey and Surrey Downs Carers Partnership Manager. Date: December 2014