Policy responses and statements

Name of organisation:

Academy of Medical Royal Colleges

Name of policy document:

Involving and supporting carers in hospital and community health settings: discussion paper

Deadline for response:

31 May 2012

Background: At a recent meeting of the Academy's Patient and Lay Group Meeting, consideration was given to a report from the Department of Health Carer Policy Team about ways that clinicians could take a fuller leadership role in the support of carers.

The Department is keen to engage with Colleges and it was agreed that this should be done in the first instance through College patient and lay groups.

The College's PLGs were asked to consider -

• Following discussion with your College, in what ways does each PLG believe that their College and clinicians in their specialty could promote and facilitate a clinical leadership role on the involvement and support of carers?
• how might robust evaluation of good practice be further encouraged
• how examples of good practice can be effectively disseminated.

There may be an opportunity for Colleges and PLGs to be involved in taking forward these discussions with DoH and ministers as part of the National Carers week in June.

Royal College of Physicians of Edinburgh
Lay Advisory Committee
Comments on ‘Involving and supporting carers in hospital and community health settings: discussion paper’

Introduction

The Royal College of Physicians of Edinburgh Lay Advisory Committee consider that the involvement and support of carers in hospital and community health settings is an extremely relevant and important issue. They, therefore, welcome the steps that have already been taken to give credence to the importance of carers in the provision of care to those who are ill especially those with long-term conditions and who have increasing dependency needs.

The Committee has considered the specific points highlighted by the Academy of Medical Royal Colleges (AoMRC) and would comment as follows:

Clinical leadership role:
Clinicians need to be aware of the potential contribution of carers and to understand how they can help facilitate such involvement and support it. It is anticipated that their leadership role would be one of fostering a culture of encouraging involvement and providing support of carers together with a commitment to two-way communication. The commendation and enthusiasm at national and local level from high profile clinicians would help promote the value of carer involvement and support.

Clinicians are often relatively inaccessible to carers. Therefore, ways in which they can make themselves available to provide information to, and receive feedback from, carers, either in hospital or in the community, would be positive.

It is recognised that the issue of involvement and support of carers may be higher on the agenda of some clinicians, eg geriatricians and paediatricians, and less in single organ specialities; also that there are a substantial number of priorities on the current NHS agenda for which clinical leadership is essential. There will be a crucial role, therefore, for other medical staff in ensuring the involvement and support of carers.

Evaluation of good practice:
It is important that robust evaluation of good practice is encouraged in order to demonstrate the benefits for patients of the involvement and support of carers. There should also be evaluation of the benefits for staff in the NHS, eg to assess the improvement in the delivery of care and avoidance of inappropriate treatment or discharge arrangements, as well as potential savings to the public purse. This would be in line with the philosophy of early intervention and prevention policies that should reduce the risks of problems arising in the first place.

Dissemination of good practice:
Clearly it is essential that examples of good practice are disseminated so that lessons can be learned and the delivery of health services and the care of patients can be improved. Mechanisms for providing feedback and sharing good practice examples need to be established both within and between hospitals and communities. However, it is necessary to include such questions in assessment systems in a meaningful way rather than through a tick-box exercise.

Existing or dedicated websites could be use as both a repository, and dissemination, of good/bad practice.

Good practice in neonatal was cited as an area where lessons could be learned in the delivery of care. In this example parents are encouraged to stay for one or two nights with their baby to gain confidence as carers and to have the chance to practise newly learned skills with immediate access to help and advice if needed. This approach has been described by parents as a key step to ‘independent caring with confidence’. During their resident nights the parents both learn the reality of what their role will entail – sometimes only then accepting that they need help at home. A similar approach for carers for an elderly person might be well worth exploring; also for adults with disabilities (both physical and learning) where the presence of their familiar carer could aid recovery and support nursing staff.

Other points raised by Lay Advisory Committee members:

There is need for a frank debate about the responsibilities of staff and carers when an individual who depends on carers is admitted to hospital. It is a delicate balance between involving carers and expecting carers to provide much of the care.

Consultants and senior doctors should recognise the key role of the carer in aiding treatment and recovery. For example, discharge of a patient into the community should not be determined by his/her medical condition alone but by recovery and care status with the carer involved in discharge planning. Including carers in ward rounds or MDT discussion about their relative could enhance care planning and discharge arrangements.

Young carers should be specifically mentioned as a particularly vulnerable group with little or no experience of accessing services or identifying their own health and support needs. Ethnic minority carers especially in communities where they are in a minority are also vulnerable to exclusion from community and statutory support.

In the first instance, a combination of dedicated liaison nurses in collaboration with local/specialty lay support groups may be better able to tailor education/information/support to circumstances than generic nationally produced education material. However, the nurses/lay groups could then go on to suggest what kinds of generic material will be most useful.

Colleges should work with local authorities and voluntary organisations to achieve the best effects for carers and patients in a cost-effective manner. This could take place within the context of the development of personal care budgets for individuals.

Much can be learned from involvement of carers but a lot of rich learning experience is not captured anywhere. In hospitals it should be possible for carers to have a place to record their experiences in a candid way and clinicians should be encouraged to take on board the learning from such comments on a routine basis. In the community, it would perhaps be good to ask carers – perhaps through groups/associations – to record their experiences of interventions/support from clinicians.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[1 June 2012]