Our comments below in red relate to the following suggested Indicators for inclusion
Domain 2 – Enhancing quality of life for carers
2.19 Carers identified on practice registers
2.21 Number of information prescriptions for carers
Rationale for inclusion
Improvement area: Enhancing quality of life for carers
Carers 2.19 Carers identified on practice registers
2.21 Number of information prescriptions for carers
Indicator 2.19 measures the proportion of people who are carers that have been identified and recorded on GP practice registers.
Indicator 2.21 measures the number of carers provided with information prescriptions on caring effectively and the support available as a carer. Providing appropriate information and support to carers of people with long term conditions can be beneficial for people with long term conditions and their carers.
Stakeholders are asked to submit comments in the table below for all indicators based on the following set of questions:
1. Which of the care processes or health outcomes measured by the indicators have the greatest potential to deliver against the domain objectives and improvement areas of the NHS Outcomes Framework?
The inclusion of a carer indicator in the framework is a massive step forward. The inclusion of the indicator under the Domain of Long Term Conditions is not entirely appropriate however it does pose some interesting questions about whether being a carer is considered a ‘condition’ an d in the rationale for inclusion it still puts the focus on the patient being helped by providing support to the carer rather than them benefiting in their own right.
However irrespective of placement or emphasis we believe that inclusion of a carer indicator has huge potential to help improve long term health, quality of life and other improvement areas also. Carers make up at least 10% of a practice population and if they are not recognised and supported early on in their role they are likely to a.) become patients in their own right with physical and mental health problems and b.) become unable to provide the same levels of care this is therefore a double effect on health services, costs etc. It also affects quality of life of two (or more) people immediately.
2. To what extent do you think the care processes or health outcomes measured by the indicators can be influenced by the actions of clinical commissioning groups (CCGs)?
Again this is why it is crucial to have a carer indicator in the CCGOIS because currently there is very little emphasis given to carer support through health and at this time of massive change it is very possible that carers could disappear off the agenda of primary health care professionals altogether if it is not included here. There is talk currently of major change to the QOF (consultation just closed) which threatens to remove all aspects of carer QOF points (including the holding of a register of carers and having a process to signpost for assessment – which is already inadequate but at least it exists) and only having carer support measures listed for QOF points under specific conditions e.g. Dementia and Mental Health – this move would mean that support for all other non ‘in-favour currently’ condition specific carers would not be of interest under the QOF system.
Carers are at the heart of our communities, without their input the country would need to find another £19billion and CCGs must recognise and play their part in providing low level intervention and preventative/supportive services and hold hospitals, community and secondary care services to account to do the same.
3. To what extent do you think the care processes or health outcomes measured by the indicators reflect aspects of care with unacceptable variations?
Carer support is seen as a ‘cross cutting’ theme by many which usually means it is ‘somebody else’s’ business or concern. With the major changes currently taking place some areas are debating whether carer support services should be considered a public health issue and therefore passed into local authority control – whilst this in itself may not be a n issue (dependent entirely on each Local Authority’s attitude and approach to carer support – which in itself is widely variable across the country) it does mean that primary and secondary health care is being relieved of it’s duties around carers and this is critical in terms of early identification. Many carers are not known to local authorities however almost everyone will be known to their local health services albeit perhaps not known as a carer – and this is likely to increase if changes to the QOF continue and the suggestions here to include the carer indicator are not taken forward.
4. What, if any, are the barriers to implementing the care processes measured by any of these indicators?
Some thought needs to be given to what exactly is meant by ‘an information prescription’ for carers as this is not something in common practice at present and if it were going to be included and implemented wholescale there may need to be guidance about what is expected and acceptable. Providing information explicitly to carers is a specialist activity. It is not the same information that is given to patients as it should focus on them IN THEIR OWN RIGHT.