Wirral’s Adult Carers Strategy 2023 to 2026

Improving support for Carers

Wirral Council appreciates and respects the contribution that Carers make in our community.

People who give their time and energy to provide support and care to someone else is amongst one of the most selfless gestures and actions someone can make, whether the care they provide is out of love, because of care and concern, or because they have a sense of duty to provide an individual with support. Each person’s caring situation and their role is different; caring for someone can be for an intense short period of time if you are caring for someone who has acute ill-health, or it can be for many years if the person’s condition remains the same or they have a slowly degenerating condition.

Many people with caring responsibilities do not identify themselves as a Carer, and for some people it can take several years to realise they are a Carer and that there is support and services that they can access.

Whatever the caring situation is, it is most important that Carers are recognised in our society, at an early stage in their caring role, and offered information, advice, and support to ensure that they are well informed. Implementation of this strategy will assist Carers to overcome barriers to access the right support and at the right time, to avoid the challenge of seeking support when there is a crisis or Carer breakdown, or not knowing where or who to turn to or being overwhelmed by the prospect of having to wade through a maze of information about services and support.

The Wirral Carers Strategy has been co-produced with groups of Wirral Carers, who gave their time to identify what is important to them and share their experiences and knowledge. Carers were able to tell us about the times they felt they had to navigate the health, social care, and education system, and they provided examples of where they had received the support that they needed and when they had not.

The Carers Co-production events took place in various venues across the Wirral and were primarily face to face, however, a few sessions took place virtually through Microsoft Teams meetings.

Your contribution has been valuable to help to shape the Wirral Carers Strategy.

Carers told us they want to feel they are being supported, listened to, and involved in the care and support of the person they care for.

This strategy will assist us to achieve the recognition that Carers deserve and to improve support and services for Carers of all ages in Wirral.

Introduction

The previous Wirral’s Strategy for Carers 2014 to 2017 was due to be updated in 2018. There has been a delay in drafting a new Wirral Strategy for Carers because:

• the government planned to update the national Carers Strategy; and although a new strategy was not launched, the government did produce the Action Plan for Carers 2018 to 2020
• the strategic Carers Partnership Board, which monitored the strategy implementation was under review prior to the COVID-19 pandemic, the Carers Partnership Board ceased to operate during 2020

The impact of COVID-19 has had a significant effect on people in the community, particularly Carers. People were caring in extremely testing circumstances where meeting up with family and friends was either prohibited, limited or very difficult. People were not able to access support to help them in their caring role, take a break using services such as short-break beds or day care support as many of these services could not operate throughout the pandemic. Some Carers who relied on care and support at home to help with personal care needs of the cared for, opted to temporarily cease the service to protect against catching COVID-19.

Health and care services within the community have resumed their service offer, with the community adapting to live with COVID-19, it is an appropriate time to start pulling together a new Wirral Carers Strategy.

The new Wirral Adult Carers Strategy will incorporate what people with caring responsibilities have told us about what is important to them, as well as input from providers who work closely with Carers. The Strategy has been coproduced with Carers. We will establish a new Carers Partnership Board to monitor the progress of the delivery of the priorities set out and an Action Plan put in place.

The Wirral Adult Carers Strategy will draw on some of the national directives and good practice examples to provide a foundation for improving identification, recognition, and support for local Carers.

Carers in Wirral

For the purpose of this strategy the term Carer is defined as someone who provides, unpaid, physical and/ or emotional support to a family member or friend who has a physical or learning disability, ill health, frailty due to age, a mental health or substance misuse problem and without help they would find it difficult to manage or unable to cope. A Carer can be under or over 18 years of age.

The Census 2021 data, released 19 January 2023 on unpaid Carers indicates a reduction in the overall number of people identifying themselves as a Carer. The Census Bulletin included a statement on this about the Census taking place during the COVID-19 pandemic, that this may have influenced how people perceived and managed their provision of unpaid care, and therefore may have affected how people choose to respond.

Potential explanations for changes in the provision of unpaid care could include:

• COVID-19 guidance on reducing travel and limiting visits to people from other households
• unpaid carers who previously shared caring responsibilities may have taken on all aspects of unpaid care because of rules on household mixing during the COVID-19 pandemic.
• there were a higher number of deaths than expected in the older population at the beginning of 2021 due to COVID-19 and other causes; this could have led to a reduction in the need for unpaid care
• changes in the question wording between 2011 and 2021 may have had an impact on the number of people who self-reported as unpaid carers

Comparing the 2011 and 2021 Census data:

Number of Carers

	2011	2021
Wirral	40,340	33,499
England and Wales	6,506,457	Estimated 4,989,002 (19/01/2023)

Hours providing unpaid care Wirral 2011 and 2021

Number of hours care provided	Up to 20 hours	Between 20 – 49 hours	50 + Hours
2011	23,879 (59.2%)	5,768 (14.3%)	10,693 (26.5%)
2021	15,297 (45.7%)	7,330 (21.9%)	10,872 (32.5%)

In 2011 Census, the number of people who self-identified as a Carer was 40,340 (12% of the Wirral population). This compares to 33,499 (10.5%) of a resident population of 320,200 in the 2021 Census, this is a 1.5% decrease in terms of population proportion. The largest decrease is the number of people providing unpaid care up to 20 hours a week, while the number of people providing between 20 – 49 hours and over 50 hours have increased.

For more details please see Wirral JSNA – Carers and for local population information go to Local Insight

Research shows that the impact on a Carers health and wellbeing is greater for those who spend a significant amount of time providing care, their age and people who are caring alone who do not have wider circles of support - family and friends.

 The 2011 Census found that Carers providing round the clock care are more than twice as likely to be in poor health than non-Carers.

• 6 out of 10 Carers (61%) said their physical health has worsened as a result of caring,
• 7 out of 10 (72%) said they have experienced mental ill health. 

These findings are reinforced in the 2021 GP Patient Survey, which found that Carers are more likely to be in poor health than the general population

•  with 6 in 10 (60%) of Carers having a long-term condition, disability or illness compared to 50% of those who were not caring. [1]

Between 2010-2020, people aged 46-65 were the largest age group to become unpaid carers. 41% of people who became unpaid carers were in this age group [2]

Of the 40,340 Carers, the 2018 projections estimated that 17,723 of the Carers will be aged 65+ with 75% of them providing 50+ hours of care

Carers recorded as known to health and social care services:

There will be Carers who appear on one or more of the electronic record systems in health and social care, other voluntary, community and faith sector organisations that have their own databases of Carers that they support. The table below shows a snapshot in December 2022, of the number of Carers recorded in adult social care, GP’s, and the commissioned Wired Carers service.

Carers registers	December 2022	Category
Local Authority	5,060	Total recorded as the main Carer: of these 3,312 identified as female and 1,686 male
	2,757	providing informal support
	3,128	adult Carers (over 18 years)
	1,932	older Carers (0ver 65 years)
	10,221	people known to Adult Social Care
GP Carers Register	12,837
Wired Carers Register	6,295

In 2015 the economic value of the contribution that was made by Carers in the UK was £132 billion, recent research carried out by Carers UK, (Unseen and Undervalued) November 2020, estimated the value of care provided between March and November 2020 was £530 million per day and estimated as £193 billion per year during the pandemic.

The development of electronic recording systems, across health and care services should help to improve the identification of Carers to provide more accurate records. This will assist in health and social care services to provide information to Carers, for example the new NHS England SNOMED CT codes for GP identification of unpaid Carers (2023) at practice level. SNOMED is defined as Systemised Nomenclature of Medicine, which are codes used to record clinical information about patients’ electronic health records.

Carers receiving COVID vaccinations

In February 2021, the Joint Committee on Vaccinations and Immunisation (JCVI), categorised Carers as priority group, for the roll-out of the COVID vaccinations. This provided a real opportunity for GP practices to update their own Carer register records and identify Carers known to their practice for the first time and enabled Carers to be identified earlier to receive their vaccinations and booster injections. 

GP’s will use the new SNOMED codes and, in the future, we will be able to report from the codes.

NHS England identified the following benefits for Carers:

• supporting the sharing of appropriate information with others involved in delivering care
• opportunity for the practice to identify patients for priority interventions such as vaccinations
• all unpaid carers are eligible for an Annual Wellbeing Check. The purpose of this check is to ensure that the information recorded on the Practice Carers Register is accurate and to provide a space where the mental, physical, and social aspects of the carer’s life can be discussed

NHS England identified some of the benefits for GPs as enabling accurate and targeted access to relevant information, reducing costly duplications and errors. As well as preparedness for CQC inspections: how practices support carers: carers registers; holistic support needs; in-practice support; appointments and access; information for carers; awareness and culture. 

Survey of Adult Carers in England 2021 to 2022

The council is required to undertake an Adult Carers Survey every two years. The survey was sent out to approximately 1,000 Carers known to Adult Social Care, who were randomly selected from the social care records. All personal details remain confidential as participants are provided with a unique personal number.

The Carers Survey gathers information from Carers about access to support, information and advice and asks Carers about their quality of life, the impact of services on their quality of life, and their general health and well-being.

The Carers Survey issued in 2021 also contained questions about the Carers experience of support during COVID-19. Many services were restricted during the pandemic and therefore, 53% of Wirral respondents reported not receiving support or services during the pandemic, while the England average of 45.5%

Other important findings from the Carers Survey, which were reflected in our conversations with Carers, was on accessibility to information and advice, services, and benefits, where 47% of Wirral Carers found it very or fairly easy to access against the England average of 58%, but 53% of Wirral Carers found access fairly or very difficult. Carers accessing training or support from Carers Groups or having someone to talk to in confidence were also lower than the England average.

However, 35% of Wirral Carers said that they have as much social contact they want with people, compared to England average of 28%. The Carer reported Quality of Life experienced by Wirral Carers scores 7.9, this is against a North West and England average score of 7.3. The Quality of Life score for Carers is calculated on the health condition of the cared for person.

The results from the 2021 to 2022 Social Adult Carers Survey will be used to benchmark Wirral against other comparator local authorities and any progress made will be monitored as part of the Action Plan.

Some of the Wirral results compared to England average

		Wirral %	England %
Finding information and advice on support, services and benefits.	Very of Fairly Easy to access	47%	58%
Social contact with people you want?	I have as much time as I want	35%	28%
I have little social contact and feel socially isolated	14%	21%
Encouragement and support in your caring role?	Yes	39.9%	31.5%
No	24%	23%
Finding information and advice on support, services and benefits	Fairly or very difficult	53%	42%
Accessing training for Carers in the last 12 months?	2.4%	4%
Support from Carer groups or someone to talk to in confidence	Yes	21%	32%

What has been achieved since the Wirral Carers Strategy 2014 to 2017?

• online Carers Assessment – the Carers Assessment has been made available electronically on the local authority website. This enables Carers to complete an assessment in their own home, without having to wait for a social care worker to contact them. Carers can save and complete their assessment in their own time.
• increased number of Carers known to GP practices as a result of the COVID-19 vaccination programme.
• re-commission of the Early Intervention and Prevention and Carers services, delivered by Wirral Health and Wellbeing Community Interest Company.
• Age UK Wirral distributed tablet computers to over 100 older people and their Carers during COVID-19 lockdown, to provide them digital access to family, friends, and online information
• during the COVID-19 lockdown periods, the third sector organisations adapted in the way that services were delivered. Wired and Age UK Wirral Carers Services offered support to prevent Carers from feeling isolated due to the restrictions, support was provided through a range of offers, including welfare phone calls, Teams or Zoom meetings, safe distancing face to face meetings as well as support provided from the Council and third sector helplines.
• Carers Direct Payments are available to eligible adult Carers following a Carers Assessment.
• Local Authority funding was provided to Wired to offer free Personal Protective Equipment (PPE) for Carers from 2021

The national picture

There are a number of national directives that have set key priorities. The key priorities will be incorporated into the strategy and will include reference to the national directives and good practice guides for improved Carers support:

• DHSC Carers Action Plan 2018 – 2020
• NICE Quality Standards 2021
• Adult Social Care Reform December 2021
• NHS Long-term plan 2019
• NHS Commitment to Carers 2015
• Supporting carers in general practice: a framework of quality markers
• Caring as a social determinant of health

The Carers Action Plan produced by the Department of Health and Social Care followed one of the largest consultations they had undertaken. The following national key priorities were identified as:

1. services and systems that work for Carers
2. employment and financial wellbeing
3. supporting Young Carers
4. recognising and supporting Carers in the wider community and society
5. building research – evidence to improve outcomes for Carers

The NICE Quality Standards focused on adult Carers over 18 years and identified the following priorities:

1. identification of Carers
2. working with Carers
3. assessing Carers needs
4. Carers' breaks
5. helping Carers to stay in work

What Wirral Carers told us is important to them

The Carers who have helped to shape the strategy came from a range of backgrounds and ages. Some were Parent Carers of children with disabilities, adults caring for other adults or older people with ill health, or disability. Some were Young Carers and some working Carers. We met Carers who were caring for more than one person and Carers caring for a young dependent person under 18 years as well as an older person, known as ‘Sandwich Carers[3]’. The focus groups that we met with have identified the following areas or issues that they wish to improve:

• valuing Carers and their contribution as partners in providing care
• Carers health and wellbeing, physical and emotional support
• identification of Carers, particularly in primary care and hospital settings
• skills training for Carers, and the cared for
• flexible working to improve ability to work around caring role
• digital Inclusion support
• issues relating to isolation and loneliness
• access to good quality information and advice or CADT referrals for assessments
• contingency planning for emergencies and crisis
• flexible and personalised support, for example, Direct Payments, outcomes from assessments
• access to Carers Groups
• access to short breaks from caring
• improved understanding of issues faced by Carers of people with dementia
• improved knowledge by professionals supporting people with dementia
• parent Carers support
• transition of young people from children to adult services
• information sharing across agencies
• Adult and Young Carer pathways from identification, advice and information, assessment, and support to involvement
• support for Young Carers and Young Adult Carers
• greater Carer involved in co-production and co-design.
• the impact of the cost-of-living crisis on finances and caring
• support for former Carers when their caring ends

What Carers identified as being important to them:

The list above covers the wide variety of subjects covered by each Carer co-production group and provided the basis to the emerging key themes that were identified. At the final Carers Co-production group we agreed the following themes that would be included in the priorities:

1. improving Carers health and wellbeing, including physical and emotional support
2. early identification of Carers, particularly in health and care services, and the wider community and society
3. addressing Carers isolation and loneliness
4. improved access to comprehensive information and advice including practical, emotional, and financial issues
5. services and systems that work for Carers
6. improved access to Carers Assessment, including contingency / emergency planning
7. developing Carer activities, short breaks, and support where there are identified gaps
8. support for working Carers

What you told us and what we have prioritised

Combining the national directives alongside what local Carers have identified, we are proposing the following six priorities for Wirral:

• Priority 1 - Information and advice
• Priority 2 - Carers Health and Social Care support
• Priority 3 - Carers health and wellbeing
• Priority 4 - Finance and benefits
• Priority 5 - Carers short breaks
• Priority 6 - Communication with professionals

Priority 1 - Information and advice

Ensure that Carers can find information and advice to support them in their caring role and when caring ends:

• we will work with Carers to produce the right information and advice in new and accessible ways. We will continue to provide the digital information platforms and will explore alternative ways of providing information
• create a Carers Toolbox
• we will ensure that training and learning for Carers is available for them to carry out their caring role safely and with confidence
• we will ensure that Carers Assessments are offered, personalised, proportionate, and timely
• we will equip and support partners with the skills and knowledge to provide accurate information that supports Carers
• we will work to develop a single point of contact for Carers Information and Advice
• we will work to support digital inclusion

"Not all people can access digital information. We need support with this." Carer.

"Professionals can support Carers by providing and directing them to reliable sources for information and advice." Carer.

Priority 2 - Carers health and Social Care support

We will work with all health and social care sector organisations to improve access to support to address the Carers own health as well as the person they care for:

• to raise awareness of Carers, promote best practice across all health and social care professionals to identify, value and support Carers effectively
• we will support and promote the Primary Care Carers Quality Standards to include:
  • Carers Health Checks
  • Carers vaccinations
  • flexible appointments
  • Mental Health support
  • contingency and emergency planning
• we will promote improved ways to support Carers in Primary Care and other health settings
• review availability and access to Carers Short Breaks
• support people to access Carers Support groups and networks for specific health conditions

"We want all Health and Social Care professionals to identify Carers, and recognise them as experts by experience." Carer.

"My husband has dementia, I love him dearly, but I need the support of others to help me get through some of the bad days." Carer.

Priority 3 - Carers health and wellbeing

Strive to improve the health and wellbeing of Carers of all ages to reduce health inequalities in Carers:

• ensure that there is a range of training available for Carers such as:
  • understanding Carers Rights and Carers Assessments
  • manual handling techniques
  • managing medications
  • managing health conditions
  • health and safety
  • Lasting Power of Attorney, Wills, and Trusts
• ensure people are informed about technology to support the Carer and cared for
• support to maintain contact with family and friends, and enjoy activities outside the caring role
• Carers want to be recognised and valued to promote emotional wellbeing
• support to access Carers and Peer support groups, with the person I care for attending, if they want to
• provide Carer awareness training for professionals

"This Carers group is so important to me. I am with people who understand what it is like to be a Carer and they are so supportive." Carer.

"I make sure I take time out to do something that I enjoy. I have family that will step in to give me a break." Carer.

Priority 4 - Finances and benefits

We will work to ensure that the systems and organisations improve access to information in relation to finance and benefits:

• identify what information and organisations are available to advise on benefit claims and other financial advice
• support Carers to break out of the ‘benefits trap’ where Carers are looking for employment or training
• provide Carers and the cared for with accurate information about charging for services
• support for ‘self-funders’ and help them to understand what support is available to them
• assist to understand Continuing Health Care (CHC) funding
• Improve Direct Payments Services for the cared for
  • clearer process for Direct Payments
  • a register for Personal Assistants (PA)
  • assistance with CVs and training PAs
• greater understanding of Personal Health Budgets

"The cost of living crisis is worrying; it is having a real impact on Carers and the people we care for." Carers.

"My wife and I are self-funders because we are over the upper limit in savings. But I still need someone I can trust to advise me." Self-funding Carer.

Priority 5 - Short Breaks for Carers

We will work to ensure that there are community support services to enable Carers to take a break from their caring role:

• good quality, reliable Short Break services through residential settings and day care opportunities
• promote taking breaks through a Direct Payment option
• work with providers to encourage Carer confidence to access, or where possible to trial, a short break offer in advance, for example in a day care setting
• include Carers in the design and development of short break services and support
• raise awareness of disability accessible community services  
• offering Carers Assessments to ensure that Carers needs for a break are identified
• improve the Primary care role in identifying Carers whose health and wellbeing would benefit from Short Breaks

"I need a break to recharge my energy levels so that I can continue to provide the best care that I can when they return home." Carer.

"I want to carry on caring for my mum but I just need a break every so often." Carer.

Priority 6 - Communication with professionals

To improve the sharing of data across professionals, as well as, between professional and Carers.

• health and social care professionals should respect carers
• improve the training offer for social care professionals regarding Carers Assessments and referrals to alternative support
• Carers do not want to repeatedly tell different professionals about their situation. We will look to improve communications and sharing of information between departments
• improve hospital staff identification and communication with Carers and family members that may be about to take on caring responsibilities
• support Domiciliary care agencies to work proactively with Carers and improve communication
• encourage agencies to improve dementia awareness, and training when working with people with dementia and their Carers

"I want to be involved in the plans for my sister, so that she can enjoy an independent life with my support." Carer.

"I sometimes feel like I'm invisible! I just want my voice to be heard." Carer.

"Please help me to understand what your role is, how to contact you and what help you are going to offer." Carers.

Parent Carers caring for children with additional needs

Many of the same issues, obstacles and barriers faced by adult Carers caring for another adult over 18 years, can apply to a Parent Carer, however, there are some areas that Parent Carers told us that need highlighting.

We will work to address and improve support in the following areas.

Transition from Children’s to Adult Services

To ensure that young people and their families understand the transition process:

• embedding a Whole Family Approach when working with families
• ensure the family understand what to expect from the transition from children to adult services
• children and young people with health conditions (both diagnosed and undiagnosed) will understand what is available to them once they turn 18 years
• raise awareness of issues encountered by children and young people with health and cognitive issues who are considered be high functioning or have neuro-diverse conditions

Recognition as a Parent Carer

Work with health, social care, and educational professionals to recognise and respond to Parent Carers issues and needs, and how a child’s disability, or additional needs, impacts on the Parent Carer:

• recognition as a Parent, who has a child with additional needs
• improved communication between Children’s and NHS services
• Direct Payments (See Priority 4)
  • listening to what Parent Carers want, PA training needs to meet a diverse range of people with unique needs
  • confidence to leave a child with someone else

"Finding a way to get a break for my son and for me was so frustrating, because of his medical and social care needs he was turned away from services. One service would not take him because they weren’t trained around his medical needs, and another couldn’t meet his social care needs. The manager at the Centre found the ‘solution’ he arranged for the staff to receive managing diabetes and learning disability training.

Now we both get to take part in things that we both enjoy. It just took one professional to look at our situation and make it happen." Parent Carer.