Surrey Community Pharmacy Conference Carer Awareness 13th January 2015

Aims for this session: Participants will have the opportunity to: Introductions Carer Awareness Facts and figures about carers Carers Rights What services available in Surrey How Community Pharmacy can support carers? Carer friendly pharmacy

Definitions of a carer …… A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. Carers are often required to administer medicines, and to order and collect prescriptions on behalf of the person they care for. Who is not a carers Paid Care Workers Parents looking after non disabled children Volunteer workers Carers Trust - 2015

A Life Outside of Caring Surrey Carers Commissioning and Development Strategy 2016 -17 to 2018-19

Surrey Facts About Carers 108,000 Carers (9.6% of population). Breakdown: 78,920 provide 1 -19 hrs 11,039 provide 20 – 49 hrs 18,474 provide 50+ hrs (18.23%) Young Carers – 3 in every room class Every day 6,000 people take on caring responsibilities i.e. 2.3 million every year 6.5 million Carers -including 700,000 Young Carers Takes on average 5 years for a carer to be identified Over the next 30 years the number of carers will increase by 60% due to demographical changes and a rising older population. National Surrey

Demographics Gender 58% Women – 42% Men Age Peak age for caring is 45– 65 years (working age) Ethnicity 9.2% of carers come from a BAME group Black Asian and Minority Ethnic Group Carers have particular challenges around accessing support Census 2011

Young Carers A young carer is a child or young person under 18 who provides regular and ongoing care and emotional support to a family member who is physically or mentally ill, disabled or misuses substances. The term young carer does not apply to everyday or occasional help that may occur in all families. It is specific to care that is relied upon in maintaining the health, safety or day to day wellbeing of the person receiving support or care Lets not forget Young Carers!

Money Talks: How much do carers save the health and social care economy Carers save the UK economy £132 billion per annum (Equivalent to NHS budget) £1.8 Billion in Surrey Each carer saves the state £18,473 annually in replacement care costs alone. Baker Tilly Report - £1 invested nets £4 in health savings 75% of carers struggle to pay basic bills and 40% of carers report they are in debt due to their caring role Valuing Carers – 2011 CIRCLE, Leeds University

Juggling work with care In Surrey 60,000 people combine work with caring. 1:8 of the workforce are caring. 1:5 give up work to take on a caring role. Recent report from the Alzheimer's Society states that 9:10 business say dementia caring is a growing issue for workforce. On average, carers retire 8 years early, missing out on years of income and pensions contributions

Better Care Fund – NHS Contribution GP Carers Breaks - £1,300,000.00 End of Life Carers Support - £300,000 Crossroads Care – Waiting lists - £300,000 Crossroads Care – Home based care - £156,000 Additional Carers Support Services - £205,263 Total- £2,261,263 Overall Total - £8m Contribution to Surrey wide Joint carers contracts

Carers Health Caring can have a huge impact on the carers own health In Sickness and Health Report (Carers UK 2012) 83 % of carers stated their physical health had been impacted 87% of carers said their mental health had been impacted with 40% being at risk of depression 80% of young carers experience mental health problems due to their caring role The Surrey Adult Carers Health Survey 2011 and the Surrey Young Carers Survey 2013 provides a detailed analysis

Royal College of Psychiatry Report September 2014 Carers had poorer mental health and higher psychiatric symptom scores than non- caregivers. There was an observable decline in mental health above 10 h per week. A twofold increase in psychiatric symptom scores in the clinical range was recorded in those providing care for more than 20 h per week

Carers UK – Carers A Breaking Point Report 10th September 2014 6 in 10 are at Breaking Point A quarter of those who had reached breaking point required medical treatment as a result. 46% said despite being seriously ill they had no choice but to continue caring 1 in 9 said the person they cared for had to be rushed into hospital, emergency care or that social services had to step in to look after them while the carer recovered. 1in 5 were forced to give up their jobs because they were in crisis

Carers of People with Dementia Family carers of people with dementia have difficulty managing their medication and lack the knowledge to weigh up risks and benefits of different drugs. In July 2014 The Pharmaceutical Journal published an article revealing that Carers feel overburdened with the responsibility of administering medicines and think health professionals fail to understand the problems around managing medicines when caring for someone with dementia. Practical problems were often associated with drugs not linked to dementia. For example, the laxative Fybogel can set too quickly in a glass to be taken by a person with dementia. http://www.pharmaceutical-journal.com/news-and- analysis/news/carers-of-dementia-patients-reveal-burden-of- managing-medicines/20066024.fullarticle?amp;amp;amp The issues of medicine management are not emotionally neutral for carers.

End of Life Care – Advanced Care Planning And what about the Carers? Top 3 Concerns for Carers managing EOL at home Managing Pain Relief 2. Not having Access to 24:7 Support 3. Strain on finances End of Life Care

Legal Eagle Spot: No adult is obliged to care for another adult, not even a spouse. Parent carers have a duty to care for their own children under 18. The right to a separate Carers Needs Assessment. The right to have their views taken into account. The right to services and support from the Local Authority if they have been assessed to have their own eligible needs as a carer The right to be involved in the process of hospital discharge The right to be supported to get back into employment or remain in employment. Young carers have a right to services that supports them and enables them to live a full life, as well as protecting them from excessive or inappropriate caring responsibilities (Children's and Families Act) And finally although not a right RCGP best practice is for carers to be registered with their GPs. National Assistance Act 1948 Carers (Recognition & Services) Act 1995 Carers and Disabled Children’s Act 2000 Discharge from Hospital: Pathway, process and practice, Department of Health Jan 2003 Ready to Go 2010: Good practice guidance update All supported by NHS Mandate and NHS Constitution All supported by The Surrey NHS Carers Care Pathway NHS and Community Care Act 1990 Community Care Directions 2004 Mental Capacity Act 2005 Employment Relations Act 1999 Carers Equal Opportunities Act 2004 Work & Families Act 2006 The Equality Act 2010

Why Carers are so important to NHS Health Services? They help us: Reduce admissions to hospital and residential care. Reduce the costs of delays in transfers of care. Reduce carers’ need to access primary care as a result of their caring role. Reduce overall spending on care

What do Carers want from the NHS? Identification and Recognition Involvement in Care Planning Accessible Information Referral to Carers Support Services A whole family approach Training Protection Choice Key components of the National Carers Strategy 2010 Carers know the ‘cared for’ person far better than any health practitioners Carers need to be treated as expert partners Surrey Carers Care Pathway

Surrey Carers Care Pathway Co-designed ‘Carers Care Pathway’ linked to patient care pathways and hospital discharge procedures. The aim is to support heath staff in identifying, recognising and supporting carers (including young carers). Training resources and a practitioners check list have been developed to work alongside the model. A new fast track referral process is being developed for launch 2014. Website: http://carersworldradio.ihoststudio.com/resourcenhs.html

Refer Carers for Carers Assessment and other Carers Support Services Identify Carer/s Recognise carers needs and refer them for their own support needs and to validate including young carers. Think Families! Provide Carers information about Surrey including Young Carers Service Use carers pathway (Parental consent required for those under the age of 16 years) www.carerspathway.co.uk Refer Carers for Carers Assessment and other Carers Support Services If person using services gives consent then involve the carer in care planning

What is a Carers Assessment? A Carers Assessment is the legal right for the carers to have an assessment of their own needs. It is a chance for the carer to discuss with the social care team, what help they and/or their family need in their caring role. Here is a list of things that might be discussed: Is the Carer willing to care?  Is the Carer struggling to find any/enough time for themselves, Are they able to get out and about, The affect caring is having on their health, how caring is affecting their relationships with others, whether the person they're caring for is getting enough help, sources for additional help via local or national support organisations, and any employment concerns they may have

What's Available in Surrey? 10 Carers Support Organisations that are borough and district based. They provide advice, advocacy, information and support. Surrey Crossroads – Generic Home Based Care and EOL Carers Support Surrey Welfare Rights – Benefits Advice Action for Carers Surrey – Young Carers, Back Care, Work and Training, GP Carers Awareness Advice, Giving Carers a Voice In all last year we supported 22,000 carers here in Surrey

Surrey GP Carers Registration 2015 Approx 20% of adult carers are now registered with their GP Less than 0.1% of young carers are registered

Carers Health Checks in Partnership with Carers Support 425 checks have been offered 338 health checks to carers: Take up rate is 79.5%.

Surrey Carers Emergency Card Surrey County Council has an Emergency Carer’s Card which Carers carry with them at all times. If they are taken ill or are in an accident, this can alert the emergency services to their caring responsibilities. Linked to this Carers can register details with Surrey County Council about who they care for and what measures need to be taken if they are suddenly unable to continue in your caring role so that emergency provision can be made. These cards are available as part of the Carers Prescription.

Surrey Young Carers (SYC) has been supporting young carers, under the age of 18, across Surrey since 1996.  They offer free impartial information and support to young carers and their families on minimising the impact of their caring role. They provide workshops, forums, activities and groups.  SYC gives young carers timeout from their caring role and helps them to achieve their full potential.  They promote the needs of young carers in all child care and adult settings, they offer training to Health, Social Care and Educational professionals. SYC is currently working with 1600 young carers. Surrey Young Carers Astolat, Coniers Way Burpham, Guildford, GU4 7HL Contact 01483 568 269 or Visit www.surrey-youngcarers.org.uk

Surrey Facts About Carers 108,000 Carers (9.6% of population). Breakdown: 78,920 provide 1 -19 hrs 11,039 provide 20 – 49 hrs 18,474 provide 50+ hrs (18.23%) Young Carers – 3 in every room class Every day 6,000 people take on caring responsibilities i.e. 2.3 million every year 6.5 million Carers -including 700,000 Young Carers Takes on average 5 years for a carer to be identified Over the next 30 years the number of carers will increase by 60% due to demographical changes and a rising older population. National Surrey

Partnership working with Carer support groups Acute Trusts Patient and carer Information boards. Partnership working with Carer support groups NHS Providers have a key part to play in supporting carers. A CCG can ensure this by referencing carers in all commissioning intentions and contracts. A Surrey Wide Carers and NHS providers network meet quarterly to share best practice and monitor the implementation of the Surrey Carers Strategies. Training Documentation 3

Carers and Pharmacy Week 2015 Aim is: To increase the identification and support of unpaid carers (including young carers)within a community pharmacy setting so that carers receive support before they reach crisis point. To improve pharmacists awareness of carers To work in partnership with carers to support medicine management and reduce waste. To evaluate the impact the promotion week has had and report back to commissioners Approx 50 Pharmacists took part

Carers and Pharmacy Week 2015 Pharmacies hold a unique position in terms of their accessibility, the frequency with which many carers visit their local pharmacy and the supportive and professional relationship they develop with regular customers.  This position puts them in a strong position to support carers – not only for their ability to provide a range of advice and healthcare services, but also to be able to identify carers and refer them on to GPs and local carers services

Carers and Pharmacy Week 2016? Date to be determined In Partnership with Crossroads Care Service Posters Carers Information Leaflets Carers Postcards Carers Emergency Cards Carers Prescription In 2013 we mailed out resources to every pharmacy In 2015 we invited pharmacy to opt in 2016…..?

Steps to become a Carer Friendly Pharmacist Ensure all staff are trained to be carer aware, sensitive to carers’ needs and the challenges they face and understand the best way to engage effectively with carers. Ensure all staff are pro-active in identifying, referring and supporting carers. Identify a member of the team to take on the role of ‘Carers Champion’, to lead and facilitate carer referrals and act as a contact point for the local carers services.  Display posters and leaflets to encourage carers to self- identify Safe guard young carers

Want more? Carer Awareness Training There are lots of choices to staff: Basic E Learning is available: http://surreycc.elumos.net/public/ There are also half day courses provided by Action for Carers Surrey. http://carersworldradio.ihoststudio.com/trainstaff.html Carers Trust Training and Resources https://professionals.carers.org/pharmacy-pilot-resources Action for Carers Surrey – BCC count training and whole family assessments

Here for Carers – Welsh Pharmacy The campaign ran throughout October online and in pharmacies across Wales Carers are often required to administer medicines, and to order and collect prescriptions on behalf of the person they care for. To ensure carers take advantage of the support offered by pharmacists A free bilingual booklet ‘A Carer’s Guide to Managing Medicines’ http://www.carers.org/news/her e-carers-campaign-raises- awareness-carers-amongst- pharmacists

Next Steps: How can we support you Next Steps: How can we support you? - Piloting Carers Prescription - Crossroads Care Surrey – Carers Information Week 2016

And always remember it could be you! Prepared Debbie Hustings Partnership Manager for Carers Email: debbie.hustings@nhs.net Mob: 07917158971 (Mon – Wed) Ron Critcher Carers Lead – Surrey County Council Email: ron.critcher@surreycc.gov.uk Telephone: 01483 519146