Carers Strategy 2023-26

East Dunbartonshire Health and Social Care Partnership (HSCP) recognises the enormous contribution that informal carers make to the safety, health and wellbeing of the most vulnerable members of our community.

This new Carers Strategy is designed to set out the priorities to support carers themselves. It forms a wider commitment by the HSCP and its partners to engage with carers individually and collectively, to meet their own needs and help them to balance the demands of their caring role with their other obligations, personal hopes and aspirations. There are around 17,000 carers in our community who are not employed to care; they do so voluntarily to support a family member or friend. Every caring role is unique and may range from supporting someone for a few hours a week, to providing full time care. The impact of caring can be rewarding but it can also impact very heavily on the health and wellbeing of carers themselves. It can affect their own family, work life and relationships. The Covid-19 pandemic has been particularly impactful for carers, with formal support services being suspended for long periods in line with Government direction, with the responsibility then falling to carers to replace these essential lifelines. As we move through and out of the pandemic we understand that more needs to be done to improve support for carers, particularly at a time when communities are feeling the added pressure of a cost of living crisis. This strategy sets out a commitment to improve and develop services in the following ways:

• Better information and advice on formal and informal supports
• Better and earlier identification of carers
• Carers should be involved in planning for their support and that of the cared for person, including hospital discharge
• Carers should be supported to continue to care, building on their strengths and assets
• The choice of support available should be increased to enable Carers to have a balance with life outside of caring
• Carer Support Plans and Young Carer Statements uptake should be increased
• Carers health and wellbeing should be prioritised
• The impact of financial hardship and inequality should be recognised
• Earlier engagement and prevention of crisis should be prioritised;
  Carer-friendly communities should be promoted
• Adult and Young Carers should be involved in the planning of new services and supports
• The impact of the Covid-19 pandemic for carers should be recognised and prioritised.

In East Dunbartonshire we have a strong track record of effective partnership working, with carers, our staff, people who use our services, local communities and our partners in the Council, NHS and third and independent sectors. We have well established mechanisms that allow carers to be involved in a meaningful way to inform the planning and development of services at all levels. This strong collaboration will continue to be instrumental in delivering this new Carers Strategy effectively.

We will continue to involve and listen to carers and will be as innovative and responsive as possible, to ensure that carers feel properly respected, understood and supported. We would also wish to place on record our enormous appreciation for the contribution that carers make to the lives of the people they support and to their wider communities.

Jacqui Forbes
Chair
East Dunbartonshire HSCP Board

Caroline Sinclair
Chief Officer
East Dunbartonshire HSCP

The Carers (Scotland) Act 2016 defines a carer as "an individual who provides or intends to provide care for another individual (the 'cared for person').

Carers (sometimes called informal carers) are not employed to care, they do so voluntarily to support a family member or friend.

People may become carers at almost any stage in their lives, including when they are young, and may be from all walks of life. Carers may be in employment, in education, retired, or they may provide care full time. Care may be provided a few times a week or for more significant periods. Caring for someone can be short term, perhaps because of a new condition or illness, or long term for someone with a lifelong or degenerative condition. A caring role can range from providing essential supervision or supporting someone with specific tasks through to providing intensive support with everyday life such as bathing, eating and drinking.

Each carer, and their caring role, is unique. Carers report that their role can have many positive features and rewards, but it is recognised that caring can have a significant impact upon a carer’s health, wellbeing and relationships.

Many people who provide care may not see themselves as a ‘carer’, but rather that they are providing a natural supporting role for their loved one that may increase over time.

The Act defines a “Young Carer” as a carer who is under the age of 18, or over 18 and still in education. Young carers are young people and children first, and whilst they may value and enjoy aspects of the caring role they fulfil within their families, they may experience fewer opportunities to access social, recreational or educational opportunities. They may also experience greater disruption to their lives and about the person they care for.

The Carers Act requires each Health and Social Care Partnership (HSCP) to prepare a local carer strategy and review that strategy every three years. The East Dunbartonshire HSCP brings together the Council and Health Board through a number of strategic planning groups, to jointly plan health and social care services, together with a range of stakeholder representatives, including carers.

The Carers Act sets out what a Carers Strategy needs to contain, as a minimum, so the contents of a Carers Strategy might look and feel a bit different to other strategies produced by the Health and Social Care Partnership. In essence though, the strategy is designed to set out what arrangements are in place now for carers and what the HSCP aims to put in place over the period of the strategy, through engagement with local carers themselves.

The East Dunbartonshire Carers Strategy forms part of a family of plans and strategies that sit under the overarching umbrella of the HSCP Strategic Plan. The Strategic Plan sets out the HSCP’s vision and values, its strategic priorities and enablers and its programme of action over the period 2022-25.

Scotland’s carers make a huge contribution to the people they care for and to our communities.

The Scottish Government estimates that there are more people providing significant amounts of care for relatives or friends than staff working either in the NHS or in social care. The actual number of carers is not exactly known but it was estimated that there were 700,000 to 800,000 unpaid carers in Scotland before the COVID-19 pandemic, which equates to around 16,000 carers in East Dunbartonshire.

The 2020 Scottish Health telephone survey results reported there were 839,000 adult carers living in Scotland in August – September 2020, equating to nearly 17,000 carers in East Dunbartonshire. These different sources provide very similar results on the number of people caring, which gives us increased confidence on the accuracy of the prevalence rates.

There are around 16,000-17,000 unpaid carers in East Dunbartonshire.

The Scottish Government estimates that there are around 93,000 young carers and young adult carers in Scotland.

Although people can become carers at any stage, they are most likely to be caring between the ages of 45-54. In this age group, over a quarter of all women and around a sixth of all men are carers.

There are over 2,660 carers aged 16+ caring for 35 hours a week or more in East Dunbartonshire. Around a quarter of older carers (aged 65 and over) provide 35 hours of care a week or more compared with just under a tenth of carers aged under 24.

Overall, 59% of carers are women and 41% are men. Throughout the working years, women are more likely to be carers than men. With gender stereotypes surrounding caring still present in our society, there is a risk that women feel more pressured to undertake caring roles. This pressure can negatively impact on a woman’s career path and be a key contributor to the gender pay gap.

59% of carers are women, 41% are men.

Scotland’s population is ageing, with numbers of very old people predicted to continue growing alongside a proportionately smaller and shrinking working age population. In East Dunbartonshire, the numbers of older people aged 85+ has increased faster than any other HSCP area in Scotland, and this is expected to continue for the next 10 years. This is a success story in terms of improved health and wellbeing and longer life expectancy, but it has significant implications for the future of care and support in Scotland.

With demand for health and social care services predicted to increase 25% by 2031, the role and contribution of carers will be even more critical in the future.

Some 29% of carers in the most deprived areas care for 35 hours a week or more this is double the level in the least deprived areas. The impact of caring may be exacerbated by existing inequalities of low incomes and poor health in these areas.

Demographic factors, culturally held beliefs and practices, a recent history of migration and settlement, and social, economic and material disadvantage shape the demand for and supply of unpaid care in minority ethnic groups.

In the most deprived areas, 29% of carers care for 35 hours a week or more.

At the time of preparing this strategy, there were 1402 carers known to the HSCP’s Social Work Services. The number of carers known to services remains at around 8% of the estimated number of people undertaking informal care in East Dunbartonshire. This is likely to be a consequence of eligibility criteria that generally limits formal social work support to individuals at critical or substantial risk. Around 270 new carers are identified by the HSCP each year, with around 225 supported to complete an Adult Carer Support Plan. More than half of the carers known to services are over 65 years old, with the gender split almost exactly that of the national balance with 61% being female.

Carers Link is a local voluntary organisation that offers a range of personalised supports to adult carers and young carers across East Dunbartonshire. In 2021, Carers Link provided 2042 carers with at least one form of direct support from staff or volunteers, involving a wide range of service supports. Each year Carers Link attracts an average of 400 new carer referrals. Since its establishment, Carers Link has supported over 6,000 carers.

A total of 529 carers under the age of 24 are registered with Carers Link, although not all are active cases. Notably, 383 are under the age of 15. More than 14% come from the most deprived areas and 51% are contributing to the care of a sibling. Some 227 young carers received one-to-one or group support from the service in the last year. At the time of preparing this strategy, there were 110 pupils with caring responsibilities known to Education Services in East Dunbartonshire. Those are all pupils whose caring responsibilities result in them receiving additional support from the school. This is only a subset of a much larger number of young carers who are not in receipt of additional support.

A growing number of people fulfil a dual role balancing employment with caring responsibilities. The challenges people can face in combining work and care may be stressful and debilitating. Any changes to care needs and support arrangements may bring additional uncertainty to their working lives. At present we do not hold consistent data on the numbers or proportion of carers who are in employment, which is something we would like to remedy.

Most of our health and wellbeing needs will be common to most other HSCP areas, but there are particular issues for every area. It is important that we understand the needs and priorities of our population. We have recently updated our Joint Strategic Needs Assessments, which provide a detailed analysis of our population’s health and social care circumstances. The following information sets out some of the headlines from this work. These trends will inevitably impact on families and carers now and in the future.

Most of our health and wellbeing needs will be common to most other HSCP areas, but there are particular issues for every area– It is important that we understand the needs and priorities of our population. We have recently updated our Joint Strategic Needs Assessments, which provide a detailed analysis of our population’s health and social care circumstances. The list below sets out some of the headlines from this work. These trends will inevitably impact on families and carers now and in the future.

• Age 85+ population is increasing by 5% per year – highest in Scotland
• Care at home and care home service demand is increasing by 5% per year (pre-Covid)
• East Dunbartonshire has higher proportion of some long-term conditions such as cancer, arthritis and coronary heart disease. This contributes to an elective hospital admissions rate around 20% higher than Greater Glasgow and Clyde and 50% higher compared with Scotland
• East Dunbartonshire outpatient attendance rate is around 10% higher than Greater Glasgow and Clyde and Scotland, although our unscheduled attendance at emergency departments is generally lower
• Mental health in younger people is a growing area of concern with high numbers of CAMHS referrals and waiting times, and increasing prescribing for depression and anxiety for young people
• East Dunbartonshire has the highest rate of falls resulting in hospital admission, in Greater Glasgow and Clyde
• 8% of East Dunbartonshire adults identified at increasing risk of alcohol related harm
• Hospital-related pressures
• 162% increase in Hospital Assessment Team referrals 2008-2018
• Demand pressures and complexity increases: 40% increase in unscheduled older people care projected to 2025 (from 2018) Orthopaedics of 31%.

Age 85+ population is increasing by 5% per year, the highest in Scotland.

The Carers (Scotland) Act 2016 was implemented on 1st April 2018 and is designed to support carers’ health and wellbeing and help make caring more sustainable. The Act seeks to consolidate carers existing rights and recognises carers as equal partners. The Act includes duties for Councils and Health Boards (and consequently for Health and Social Care Partnerships) to provide support to carers, based on carers’ identified needs, which meet local eligibility criteria. Funding is currently provided by the Scottish Government to support the
implementation of the Carers (Scotland) Act 2016.
Many carers have legal powers in place which authorise them to act and make decisions on behalf of the person they care for. These are known as Powers of Attorney or Guardianship.Both legal frameworks come with a range of duties and responsibilities that must be adhered to and are supervised by the Office of The Public Guardian and the Health and Social Care Partnership.

There has been a number of important policies over recent years, which have sought to empower and develop choice for carers. Through Self Directed Support, for example, carers have greater choice and control of the services they receive and their involvement in the management of their support.

The box below sets out what we consider to be the key policy drivers over the period covered by this Carers Strategy 2023-26. This list does not include everything that the HSCP does on a daily basis; that would be a much longer list. Rather, we wanted to identify what we think would be the main drivers for change over the medium term that will affect carers and the support they receive.

• The Carers (Scotland) Act 2016
• The Carers Charter (2016)
• The National Carers Strategy 2022
• United Nations Convention on the Rights of the Child
• Human Rights Act 1998
• A Fairer Healthier Scotland (June 2012)
• Public Bodies (Joint Working) (Scotland) Act 2014
• National Clinical Strategy for Scotland (2016)
• A Fairer Scotland for Disabled People: Delivery Plan (Dec 2016)
• Health and Social Care Delivery Plan (Dec 2016)
• The National Care Service (Scotland) Bill 2022
• Healthcare Improvement Scotland: Making Care Better - Better Quality Health and Social Care for Everyone in Scotland: A strategy for supporting better care in Scotland: 2017–2022
• Social Care (Self Directed Support) (Scotland) Act 2013
• National Mental Health Strategy 2017-2027 (March 2017)
• Rights, Respect and Recovery: Alcohol and Drug Treatment Strategy
• National Learning Disability Strategy: The Keys to Life.
• Coming home: complex care needs and out of area placements 2018
• The Fairer Scotland Duty (April 2018)
• Best Value: revised statutory guidance 2020
• A Scotland Where Everybody Thrives: Public Health Scotland’s Strategic Plan 2020–23 (Dec 2020)
• Re-mobilise, Recover, Re-design: the framework for NHS Scotland
• Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 Pandemic
• Audit Scotland: Health and Social Care Integration - Update on progress (Nov 2018)
• Digital Strategy for Scotland (2021)
• Ministerial Strategic Group for Health and Community Care: Review of Progress with Integration of Health and Social Care (Feb 2019)
• Scottish Govt: Framework for Community Health and Social Care Integrated Services (Nov 2019)
• The Promise: action to take forward the findings of the independent care review for care experienced children and young people (Oct 2020)
• Coronavirus (COVID-19): Strategic Framework
• The Independent Review of Adult Social Care (March 2021)
• Community Mental Health and Wellbeing Supports and Services Framework (Children and Young People)
• Transforming nursing, midwifery and health professions roles
• Suicide Prevention Action Plan: Every Life Matters.

• East Dunbartonshire HSCP Strategic Plan 2022-25
• The East Dunbartonshire Local Outcome Improvement Plan (2017-27)
• NHSGG&C Health and Social Care Strategy: Moving Forward Together (July 2019)
• Turning the Tide through Prevention: NHSGG&C Public Health Strategy 2018-28
• Fair Access to Community Care (Adults) Policy (March 2019) NHSGG&C and East Dunbartonshire Council Covid-19 Recovery and Remobilisation Plans
• East Dunbartonshire HSCP Recovery and Transition Plan
• NHSGG&C Board-wide strategies
• Mental Health, Learning Disability, Unscheduled Care, Health Visiting, School Nursing, District Nursing, Rehabilitation
• Joint Inspection of HSCP Adult Services in East Dunbartonshire (July 2019).

As acknowledged above, carers do not always self-identify or associate with the term ‘carer’. If carers do not identify as a carer, then they are unlikely to consider asking for access to carer support through the formal route, via an Adult Carers Support Plan or Young Carer Statement. Indeed, they may not know where to go to seek support or know what support may be available.

According to research, many carers take years to recognise their role, missing out on crucial financial, practical and emotional support in the meantime. The research demonstrated that, by not receiving support at an early stage, the negative impacts of caring are intensified with many carers missing out on benefits and entitlements and others forced to give up work altogether, with a significant long-term effect on personal and family finances. On a personal level, a lack of practical help can have a huge impact on health and wellbeing, from long-term physical health effects such as back pain, to mental ill health and social isolation as a result of caring without a supportive network. The longer it takes to identify as a carer the more likely it is that carers will struggle without the support and advice they need.

People become carers when a family member or friend cannot manage without help because of an illness, frailty, disability or other health and wellbeing concern. The caring journey may start in a doctor’s surgery, with a nurse specialist, at a hospital outpatient clinic or at hospital discharge when the cared for person receives their diagnosis.

Key to supporting carers is identifying them as early as possible. By identifying carers earlier, we can provide advice and/or support to ensure they remain healthy but also to help prevent a breakdown of the caring role.

In 2021/22 around 1402 carers were known to the HSCP, 2042 carers were receiving at least one form of direct support from Carers Link and 110 young carers were known to Education services. These numbers are much less than the 16,000 carers that the Scottish Government estimates live in East Dunbartonshire.

This strategy recognises the need for all organisations working in support of carers to act together to help identify more carers that live in East Dunbartonshire, so it forms one of our key strategic priorities. This support might not always require structured formal support for everyone, but it is essential that people who provide informal care know that there is advice available to them and the opportunity to have their own needs understood. The HSCP also recognises the importance of identifying and supporting carers of people from ethnic minority backgrounds, Gypsy/Travellers communities, and ensuring that carers of people with all forms of disability or other debilitating health issue are identified and supported by the right organisations.

This is not the East Dunbartonshire HSCP’s first Carers Strategy. The Carers (Scotland) Act 2016 requires that HSCPs prepare a local Carer Strategy and review that strategy every three years. Since our last Carers Strategy was published in 2019, we have worked with partners, carers and communities to improve support to carers in many ways, including:

• Increasing identification of adult and young carers
• Increasing levels of short break provision, at home, centre based, community based and residential, for a higher number of carers. For example, in 2021/22 an equivalent of 13,384 weeks of direct or indirect carer support was provided for 2067 cared for people (aged 18+), with an additional equivalent of 188 weeks of short breaks provided to carers of 29 children with disabilities. Indirect carer support is when a service is provided to meet the needs of a cared for person, but which also brings breaks for carers, such as day services
• Training and awareness provided to health, social work, social care and education service including training to refresh knowledge of the Carers Act in 2022 and over 60 sessions per year provided by Carers Link
• Continued involvement of carers in the planning of services at a strategic level through their representation on various HSCP strategic groups, most particularly through the Public Service User and Carer Group
• Well-developed Carer Partnership Group operating in East Dunbartonshire that was instrumental in the development of this new Strategy
• Information has been provided to carers in a range of languages
• A formal review of the Adult Carer Support Plan template has been undertaken and addition of a template for reviewing the Adult Carer Support Plan. These focus on identifying and reporting on formal (HSCP funded) and informal (asset based) outcomes achieved with carers
• Around 225 carers have been supported to complete an Adult Carer Support Plan, each year; with around 90 Young Carer Statements completed since 2019 and 18 completed since April 2022
• Better information has been developed on short breaks, personalised to meet individual needs
• Better ways to identify and engage with young carers have been established, with 280 young carers referred to Carers Link since April 2018
• Since April 2018, 140 young carers regularly attend group and holiday period activities run by Carers Link
• A Short Breaks Statement was developed in 2018 and is being reviewed in conjunction with this new Carers Strategy
• Carers continue to be encouraged to access all Self Directed Support options to maximise the level of flexibility and choice that is right for them
• Carers Link providing grants for carers to access short breaks through the Time to Live Fund. During the pandemic, this fund almost trebled to just over £34,000 with over 100 carers benefitting.

The HSCP’s Public, Service User and Carer Representative Group exists to strengthen accountability and help influence the strategic planning of services. The group has also been very active in providing information and support to carers directly, including:

• Development of regular Covid information leaflets
• Planning, creation and delivery of four short covid awareness films
• Leading a Power of Attorney (PoA) Awareness Campaign
• Encouraging the participation of carers in the work of the group.

‘Coalition of Carers - Equal, Expert and Valued’ - HSCP Evaluation Report.

In September 2022, the HSCP carried out an evaluation on carers’ involvement in the HSCP decision-making processes and what improvements the HSCP could make to enhance this. A report was approved with recommendations for action that are currently being implemented.

The early development of ‘Compassionate Communities’, an approach aimed at supporting East Dunbartonshire to be recognised as a compassionate authority and to support individuals and families at times of greatest need.

The Carers (Scotland) Act 2016 came into effect on 1st April 2018 and is designed to support carers’ health and wellbeing, helping them to remain in their caring roles and be able to manage their own life alongside their caring responsibilities. The Act places a number of duties on Health and Social Care Partnerships, including the following:

• To offer an assessment of the support needs of a carer to every carer we identify or for any carer who requests one. These assessments are called “Support Plans” for adults or “Statements” for young people. These Plans/Statements are the gateway to formal carer support. Without completion of these we cannot determine eligibility
• To discuss with the carer what plans need to be put in place in circumstances where the carer may unexpectedly be unable to support the cared for person, ensuring that these emergency plans are recorded in order that they can be enacted when required
• To provide formal support to the carer where their identified needs meet local Eligibility Criteria, firstly exploring informal support opportunities for example, community, personal and financial assets. The eligibility criteria provide the route to formal support to address ‘critical’ or ‘substantial’ risks for adults and include ‘moderate’ risks for young people
• To involve carers in service design and delivery
• To involve carers in the discussion and decisions regarding the support arrangements for the cared for person, managing conflict between the carer and the cared for person when disagreements regarding support arise
• To provide signposting: information, advice and support has to be readily available for carers. Ensure that carers are signposted to all relevant organisations
• To involve carers in hospital discharge arrangements for the cared for person
• To follow national timescales for Support Plans where the cared for person is terminally ill
• To publish a Short Breaks Statement - this is available on the HSCP Carers’ page on East Dunbartonshire Council’s website
• To prepare a Carers’ Strategy.

Information and Services

Information and advice to both existing and new carers is currently provided from a range of resources. Some of the available services are outlined here:

Social Work Services are delivered through the Health and Social Care Partnership. Social Work operates under wide-ranging duties to assess circumstances of people who may be in need of personal care, support and/or protection. As part of undertaking these duties to adults or children with disabilities or other health or wellbeing concerns, informal carers very often become known to Social Work. Social Work can arrange for carers to be offered Adult Carer Support Plans or Young Carer Statements that set out their support needs. The national standard is to operate within a six week period from assessment to service delivery, where services are required by carers within those timescales.

Carers Link is a local voluntary organisation established through efforts of local carers and the Health and Social Care Partnership. Carers Link is a ‘onestop shop’ for carers and is often the first point of contact for carers to access information, advice and support. Carers Link provide a range of one-to-one supports, including a dedicated support service for young carers, providing some one -to- one support, groups and activities. Carers Link can also help to complete Adult Carer Support Plans and Young Carer Statements and liaise with Social Work and Education on the carer’s behalf.

Children’s Education Services provided by the Council are responsible for ensuring that young carers who attend school are aware of their entitlement to support and can work with them to review their support needs via a Young Carer Statement. They can also refer young carers on to Social Work Services.

GP services are often the first point of contact for many carers. GPs provide access to condition-specific information and advice and can signpost the carer to other support services.

The OPAL Advice Line is delivered in partnership between Citizen Advice Bureau, Carers Link and Ceartas Advocacy Service and provides a single point of contact for all adult service users and carers (16+) living in East Dunbartonshire. The dedicated OPAL telephone line puts people in contact with a wide variety of information, advice and support services, from social and leisure activities through to voluntary sector, social work and social care support services.

Community Health Services provide a wide range of care, to support patients and carers to manage long-term conditions at home.

Post Diagnostic Support Services can provide condition-specific information, advice and support for carers following diagnosis. Post-diagnostic services are provided for people diagnosed with dementia and autism.

CEARTAS provides Independent Advocacy to adults (aged 16 or over) who are normally resident in East Dunbartonshire. Independent Advocacy is independent of any other service provider, like Social Work or Health, and works on the adult’s behalf to make their voice stronger.

Citizens Advice Bureau (CAB) provides information, advice and support to adults on a variety of issues including; money and debt advice, employment rights, access to welfare benefits and support with housing issues.

Take Control East Dunbartonshire provide a one-to-one support service on all aspects of setting up a Self-Directed Support package in order to be able to live more independently in the community. This includes assistance in preparing for assessments, liaising with funders, and all aspects of successfully managing a
support package.

East Dunbartonshire Association for Mental Health (EDAMH) offers one to one support to adults (aged 16 and over) experiencing mild to moderate mental ill health and their family and carers.

East Dunbartonshire Community Assets Map provides an online list of over 400 places, resources, activities and businesses in the area. Users can browse and add to the community assets by town or by categories such as outdoor, physical exercise, health and wellbeing.

National Carer Support Organisations provide carer specific information, advice and support usually through web-based information and phone helplines, for example: Carers Scotland and the Scottish Young Carers Service Alliance.

Shared Care Scotland offer services including events, publications and research reports, and an online directory of short break services. As one of six national carers organisations they also contribute to the development of policy and best practice for carers. They also operate the Short Breaks Fund on behalf of the Scottish Government, providing grants to third-sector organisations that support unpaid carers to take a break.

Health and Social Care Partnerships are collaborative at heart; they include Councils and Health Boards, plus representatives of service users, informal carers, professionals and clinicians, trade unions and third and independent sector service providers. When preparing any new strategy, an HSCP must ensure that all of these stakeholders and partners are fully engaged in the process and have regard to the Health and Social Care Delivery Principles . This ensures that a shared approach is taken to the planning of services to deliver the National Outcomes for Health and Wellbeing and to achieve the core aims of integration, which are:

• To improve the quality and consistency of services for patients, carers, service users and their families
• To provide seamless, integrated, quality health and social care services in order to care for people in their homes, or a homely setting, where it is safe to do so; and
• To ensure resources are used effectively and efficiently to deliver services that meet the needs of the increasing number of people with long term conditions and often complex needs, many of whom are older.

Many of these principles and outcomes described above clearly go wider than the delivery of support to carers, but how well care and support is provided to patients and service users impacts enormously on the well-being of family and friends that provide day to day care for them. It is essential therefore that we consider the whole system of health and social care when thinking about the needs of carers. That is why the Carers Strategy should be seen as part of a wider programme of improvement and development that is set out in the HSCP Strategic Plan 2022-25.

The COVID-19 pandemic has posed significant challenges regarding participation, engagement and consultation. Whilst wishing to ensure that our engagement to develop and shape the new Carers Strategy was as robust and effective as possible, we prioritised people’s health, safety and welfare. In order to do this, the HSCP adopted a blended approach to communication, engagement and consultation that included online as well as in-person elements.

In November 2022, the HSCP Board approved the commencement of a period of consultation on the initial summary report that set out its proposed areas for priority action, supported by a Communication, Engagement and Participation Plan.

The consultation exercise commenced in November 2022 and concluded in January 2023. The general responses indicated support with the areas identified for priority development, but with quite detailed commentary on the importance of making improvements happen. It will be the work of the East Dunbartonshire Carers Partnership Group to coordinate improvement activity in support of this strategy.

Set out below is a summary of the consultative comments received:

• The very challenging nature of caring and the difficulty in obtaining all the support to meet carers’ needs properly
• The critical importance of short breaks for carers to recharge and catch up with other things
• The high regard for the work of Carers Link
• Recognition of the support and contribution of social work
• The impact of the reduction of formal support levels during Covid lockdown periods, which have not fully recovered, leaving carers significantly impacted
• The importance of “checking in” on carer wellbeing regularly, to ensure they are coping
• The need for better signposting to respite services and eligibility
• The need for improved transition from childhood to adulthood
• The consequences of late cancellation of respite support are very impactful and must be avoided wherever possible
• The importance of carers being involved in their communities and playing a part in improving services.

On the strength of this consultative process, a draft Carers Strategy was prepared building around consensus on the proposed priorities and taking into account the comments received from carers during the engagement exercise. The HSCP Board then approved the commencement of a second round of consultation on this draft strategy at its meeting in March 2023, which generated detailed comments and suggestions that have been indispensable in the final drafting stages. A final Carers Strategy 2023-26 was then prepared for approval by the HSCP Board in June 2023.

A lot of what the HSCP needs to do to support carers is already set out in national and local policy. But not all HSCP areas are the same. Different HSCP areas have different pressures an population needs. It is important that we ensure that our Carers Strategy reflects what all HSCPs need to do, but also emphasises the priorities that are right for local needs and aspirations.

In preparing this new Carers Strategy, we needed to consider whether our existing priorities are the same or have changed. Changes might be due to new policy or legislation, they might be due to feedback from carers, they might be to take account of successful work that has been done elsewhere, or it may be due to changed circumstances. Since the last Carers Strategy, the COVID-19 pandemic has had an enormous impact on carers, so it will be essential to ensure that these impacts are recognised in the new strategy and plans developed to support carers through and out of the pandemic.

The information below illustrates the process that we undertook. The five boxes at the top are the main influences that inform the context of the new Carers Strategy. By analysing these we were able identify what the priorities should be for us.

The content:

• National and Local Policy Drivers
• Joint Strategic Needs Assessment
• Partnership, Stakeholders and Public Views and Priorities
• Benchmarking and best practice
• HSCP vision and values.

Key Challenges

The Strategy:

• Priorities for Improvement and Development.

The Implementation:

• Carers Delivery Plan
• Monitoring Achievement.

The HSCP carried out initial work by looking at the main pressures (or “drivers”) for change and improvement. Analysis of carer numbers and circumstances has also been undertaken to ensure that the Carers Strategy identifies and reflects these local needs in the development of its priorities. We have also looked at what has been included in recent Carers Strategies elsewhere, to help to inform our own thoughts.

Crucially important, we have reviewed the expressed views of carers themselves over recent years, locally and nationally. We found that many of the issues and priorities that have been raised in the past remain really important for carers.

Evolving national policy on carer support and the development of the National Care Service are rapidly developing agendas at the time of writing. This makes it a bit more difficult to predict what the landscape will be like over the period of the strategy and how this may change the action plans and resources available to implement the agreed priorities. As it stands, we have to make plans based upon what we know and what finance has been made available to the HSCP at the time of writing the Carers Strategy. However, if the Scottish Government makes available additional resources to support carers, then this can then be targeted towards accelerating the priorities set out in our local Carers Strategy, which makes it all the more important to get it right.

After analysing the main policy drivers, the local needs analysis, the priority work being progressed elsewhere and taking into account feedback from the initial consultation survey, we think that the priorities for development and improvement over the next few years should be those set out below. Specific actions associated with these priorities are also set out.

We want to make it easier for people to recognise themselves as carers and to access support and advice. We aim to achieve this by:

• Developing and publicising clear signposting and pathways for all carers, as a means of navigating services
• Developing an accessible directory of carers support options and making this available via all partners
• Promoting Self Directed Support as a mechanism for ensuring choice for carers, the options available to them and how each will work for them.

By helping people to self-identify as an unpaid carer or by raising awareness so that others can recognise unpaid care, we can open up access to information and support at the earliest opportunity. We aim to achieve this by:

• Carers Link to produce a regular e-bulletin to promote awareness and information for all partners on carer issues
• Relaunching the Carers Partnership Network Group to maximise participation by all partners
• Developing closer links with GPs through the review and development of engagement strategies, to help identify carers at the earliest opportunity
• Delivering an ‘Awareness Raising Campaign’ led by Carers Link and supported by a communication strategy
• Continuing the implementation of carer awareness guidance and training for all partners.

There are duties placed on the HSCP to ensure that carers are involved in decisions that affect them and those they care for. We aim to achieve this by:

• Encouraging and supporting applications for legal powers where appropriate, to provide carers with the authority to act where necessary on behalf of an adult with incapacity
• Improving digital engagement options, including the use of digital apps, online support plans and digital access
• Promoting the use of advocacy, by all partners
• Embedding the ‘Discharge Without Delay Programme’, to improve pathways through hospital settings and ensure continued engagement and involvement with carers at the point of hospital discharge.

 Carers are invested in their caring role and wish in the main to continue to care but need support to do so. We recognise this substantial commitment and aim to support this by:

• Embedding Self Directed Support as the default approach for all carers, to enable them to arrange support at a time that sustains their other commitments, including employment
• Improving opportunities for carers to share information through peer support and by encouraging representation and involvement in community forums, such as ECHO (Every Carer has Opinions) and locality Carer Cafés
• Improving processes that support the identification of young carers, to ensure they have access to the same opportunities as their peers, with the arrangement of replacement care.

Carers should be able to take breaks from their caring responsibilities in a way that best meets their needs. We aim to achieve this by:

• Continuing to deliver on our Short Break Statement, to ensure carers understand their rights to a break and have information on the breaks available in their area
• Developing innovative approaches to broaden the type and nature of available short breaks
• Continuing to work with Shared Care Scotland and other agencies to develop greater availability and choice of short breaks.

The Carers Act provides for each carer’s right to a personalised plan to identify what is important to them. We aim to achieve this by:

• Supporting local third sector organisations to promote and maximise the uptake of Young Carer Statements and Adult Carer Support Plans
• Increasing the completion of Young Carer Statements with Children’s Social Work, Education and Health Professionals
• Developing online systems to support the electronic updating of Young Carer Statements and Adult Carer Support Plans.

We want to prioritise and promote the welfare and wellbeing of carers through the implementation of this strategy. We aim to achieve this by:

• Engaging with third sector partners to grow and develop individual trauma informed services, including bereavement support, therapeutic and wellbeing based options
• Investing in carer access to resources such as the National Wellbeing Hub, East Dunbartonshire Asset Map, local leisure and health services
• Promoting the awareness and knowledge of suicide prevention and intervention amongst statutory and third sector health and social care professionals and carers
• Pursuing the development of Adult and Young Carer ID Cards, with associated reward schemes linked to carer-friendly community aspirations.

We want to ensure that carers can balance their caring responsibilities with the ability to work, attend education and have a meaningful quality of life beyond caring. We aim to achieve this by:

• Encouraging uptake of the Young Scot Young Carers Card (11+) and the Young Carers Grant (16-18)
• Increasing access to financial support, including the Scottish Carers Assistance payment by engaging with Citizens Advice Bureau (CAB), East Dunbartonshire Voluntary Action (EDVA) and Child Poverty Action Group (CPAG)
• Promoting unpaid carer access to eligible financial support, including by signposting to the Scottish Government Cost of Living Support Scotland website, in response to the current cost of living pressures.

We want to ensure that carers have choice and control and can access preventative support to keep caring situations manageable. We aim to achieve this by:

• Actively undertaking emergency planning with all carers in the development of the support plan and as part of review arrangements
• Ensuring that the needs of carers are recognised and developed within supporting locality strategies, such as our Dementia, Autism, Learning Disability and Mental Health Strategies, led by existing partnership arrangements
• Strengthening the implementation of Self Directed Support to improve early intervention.

We want to foster a profound culture shift to make caring visible, valued and supported by a connected approach across communities and networks. We aim to achieve this by:

• Developing Awareness Raising Campaigns to promote the profile of unpaid care within communities
• Promoting carer friendly workplaces, policies and Carer Positive Employer Accreditation Schemes aligned with Skills Development Scotland and Skills for Life Learning and Work
• Applying the East Dunbartonshire HSCP Compassionate Communities Approach, which is being progressed by statutory and third sector partners to advance carer friendly communities
• Working more collaboratively with housing providers to develop suitable housing options and adaptations which maximise independence, security and choice.

We will continue to work with partners and people with lived and living experience to make sure that services work for everyone and are accessible and consistent. We aim to achieve this by:

• Promoting access to and membership of the Public, Service User & Carer Representative Group and locality based strategic groups, to increase the direct involvement of carers in decision making
• Securing the views and experiences of carers to ensure that their voice directly influences decision making, service and strategic development
• Developing consistent approaches to measure and feedback on the experiences and outcomes of carers
• Improving analysis of carer data, including unmet need, engagement rates, and carer experience and satisfaction levels.

As we move into the new phase of living with COVID-19, we want to support carers to rebuild confidence and to re-engage with wider communities and services. We aim to achieve this by:

• Continuing to ensure that carers have access to the most current advice and guidance which takes account of their particular needs
• Recognising the impact of bereavement on carers and considering how we can provide opportunities to commemorate and reflect
• Promoting and encouraging access to wider services for support such as counselling provided by Carers Link and third sector partners.

The priorities for improvement and development set out above will provide the strategic framework for advancing carer support over the next three years. East Dunbartonshire Carers Partnership Group which has representation from social work, health, Carers Link, education, and carers themselves, will be tasked with taking these priorities and actions forward in collaboration with other organisations, groups and networks. Progress will be reported through the HSCP’s Public Service User and Carer Group and Strategic Planning Group. Cognisance will be taken each year to overarching Scottish Government policy and financial frameworks.

The Health & Social Care Partnership would like to thank all of the carers who have given their time over recent years to attend meetings and events and to those who have shared their experiences and offered their expertise.

In particular, we would like to thank those who have participated directly to the work of the HSCP and the Carers Partnership Group.

We would also like to thank all of our statutory and voluntary partners for their commitment and support to the implementation of the Carers (Scotland) Act 2016 within East Dunbartonshire.