Scottish Government

REPORT OF THE JPIAF SUB-GROUP ON SINGLE SHARED ASSESSMENT PERFORMANCE MEASURES
PERFORMANCE MEASURES FOR CARERS' ASSESSMENTS - CONSULTATION PAPER

Carers' PI-3: Carers in contact with the Council in the year by ethnicity

Use "-" for cells with less than 5 people

The availability of Census 2001 counts of the number of carers (by age group) in each Council's population provides an opportunity to consider an indicator to measure the proportion in contact with the Council in the year. The Census data on carers is discussed in Annex 1.

Carers' PI-4: Percentage of carers in the resident population who are in contact with the Council for assessment

Clearly, PI-4 will become less useful as we move away in time from the 2001 Census. Nevertheless for a few years it will give a crude but reasonable measure of the proportion of the carer population in contact with the Council for assessment purposes. Moreover, there is no additional collection burden over and above Carers' PI-1. Definitions are given in section 4.7.

Carers' PI-5: Time in days/weeks between first contact and the end of the Carers' assessment

3.4 Consultation questions

The following questions concern fitness for purpose. Questions about definitions are in the next section. Readers may wish to return to these questions after they have read the definitions that explain the terms used in the PI tables.

4. DEFINITIONS

4.1 " The Council"

The responsibility for offering and undertaking Carers' assessments rests with the local authority, unless delegated to a joint body or to a partner agency or voluntary body. References in this paper to the Council or Local Authority are intended to cover all assessment arrangements, whether or not delegated to other agencies.

4.2 Carers, Adult Carers, Young Carers

The definition of a carer, amalgamating a number of UK sources, is as follows:

Young carers are carers aged under 18 years; adult carers are aged 18 and over.

4.3 Carer's Assessments and Completed Assessments

Carers' Assessments are defined in the Scottish Executive guidance. We summarise this in the box below:

The number of carers who are assessed in the year is the number of carers who have at least one completed Carers' assessment in that year. This means that "Not assessed" (PI-1, rows 4-6 and 11-13) will include some assessments started but not completed in the reporting period. " Completed assessment" is defined in the English RAP system and has been amended below to apply to Carers' assessments:

4.4 " Assessed separately"

Defining "Assessed separately" is not straightforward. Clearly, the term refers to an assessment of the Carers' ability to provide or to continue to provide care that is undertaken separately from any assessment of the needs of the care-for person for community care or children's services. But what does " separately" mean? The narrow sense is where no assessment of the cared-for person is taking place at the same time, either because they have refused an assessment or perhaps because their assessment has already taken place, or is yet to take place. A wider sense is where carers take up an opportunity to discuss their needs individually without the cared-for person being present, whether or not the person they care for is being assessed at the same time.

The Scottish Executive guidance states:

Local authorities will need to decide whether to assess the carer in conjunction with an assessment of the cared-for person, or in a separate assessment. They should decide this on the basis of the individual circumstances, and the wishes of the carer and the cared-for person. In all cases, the carer and cared-for person must be given the opportunity to discuss their needs and views without the other person being present. (CCD 2/2003, para 6.10.1)

While all carers should be given the opportunity to discuss their needs and views separately, only if the opportunity is taken up and thereafter results in a separate statement is the assessment a separate assessment. The Guidance states that carers should be given "a permanent record of the final assessment in an accessible format" (ibid, para 6.14) which should:

• record the overall needs identified in the assessment, either on the care plan of the cared-for person if they and the carer consent, or separately on the Carers' assessment form.
• record the resources or other services provided, and any needs that are not met by these.
• record the Carers' role and the level and type of care provided so that changes in the Carers' situation and needs are identified when the care/support plan is reviewed.
• record any decisions around sharing of information and consents given or refused (para 6.15).

We therefore propose defining a separate Carers' assessment as follows:

In practice, Councils may operationalise the distinction in terms of the assessment paperwork: a separate assessment may be one requiring a Carers' Assessment Form to be completed, while joint assessments may be simply those recorded via the assessment forms used for the cared-for person. This raises some problems. The current Carenap form, for example, allows for Carers' views to be recorded but does not provide for Carers' needs for support to be recorded. ( We recommend that this issue be referred to the Carenap User's Group). The "forms" solution to the distinction definition problem can only work locally if the relevant paperwork supports the solution.

4.4 " Not Assessed"

Not assessed - offered assessment. Rows 4 and 11 in Carers' PI-1 and PI-3 count the number of people who were offered an assessment in the year but did not receive one because:

• the assessment was either not started or not completed in the reporting period;
• the carer declined the offer of an assessment; or
• the carer, went away, died, or for some other reason were not available.

Not assessed - Requested but not offered assessment. Rows 5 and 12 count the number of people who had no assessment completed in the year, but had requested an assessment in that year but were not offered one. Reasons will include:

• the request was refused because the frequency and volume of care was judged insufficient to merit assessment;
• the request was refused because the person cared for is not eligible for community care services or children's services under the 1968 and 1995 Acts (as amended);
• the carer had changed their mind, went away, or died;
• the decision whether to offer assessment had not yet been made (eg because the carer requested an assessment too near the end of the year to trigger actions that year)

Requests are not defined in the guidance. As Carers' become more aware of their new rights under the 2002 Act, requests for assessment are likely to increase, either made directly to Councils or through GPs or NHS staff. However, the 2002 Act also requires Councils to take account of the views of carers when assessing people cared-for. The seeking of such views should itself lead to Carers' assessments, with the agreement of the carers but without a formal "request". The definition of "requests" should be wide enough to cover all such cases. We propose:

The Total not assessed (Rows 6 and 13 in Carers' PI-1 and PI-3) is simply the total of the two categories above (Rows 4 and 5 for adult carers; and 11 and 12 for young carers). It only counts carers in contact with the Council by virtue having made a request for assessment or having been offered an assessment, excluding those assessed in the year. It excludes other carers known to the Council.

Apart from double-counting issues (discussed later), that completes the definition of the rows in the proposed Carers' PI1 and PI3; we believe that the columns for PI1 are self-explanatory. The next sections consider the additional definitions required for the proposed Carers' PIs 2-5.

4.5 Client-group

Carers' PI-2 would enable the number of completed Carers' assessments in each year to be analysed by the client-group of the person they are caring for.

"Children with a disability" are children and young people aged 0-17 with learning disabilities, physical disabilities or mental health problems.

The community care client-groups referred to in the rows would be defined as per the Accounts Commission statutory PI on community care assessments, except that AIDS/HIV is not a separate category but is included under the "other" category above. Further definitions of client-group, with consultation questions, are contained in Consultation Paper 1: Counting Single Shared Assessments (available on the JFU website at www.scotland.gov.uk/health/jointfutureunit).

4.7 Ethnicity

The ethnicity categories in the columns are based on the 2001 Census. 'White' categories have been grouped together, and 'Other' has been grouped with 'Mixed'. An extra category 'Not known or refused' has been added.

The numbers of carers in the different ethnic groups in some Councils may be too small to support the full PI-3 table. Where this is the case, Councils may wish to consider grouping some of the categories (for example, 2-4: Indian Subcontinent; 5-6: Chinese/other Asian; 7-9: Black). The data on carers in contact with the Council needs to be related to the Census 2001 data on the ethnicity of residents and carers.

4.7 " Carers in the resident population"

For ease of reference, we repeat the proposed Carers' PI-4:

Carers' PI-4: Percentage of carers in the resident population who are in contact with the Council for assessment

Column 1 is defined in the same way as for PI-1: " carers in contact for assessment" are carers with a completed assessment in the year (either separately or jointly with the cared-for person), or who were not assessed but were offered an assessment or had requested an assessment. The Adults Carers count should be the same as the Total column for PI-1 row 7, and for Young Carers the same as the total column for PI-1 row 14.

Column 2 is defined in terms of the 2001 Census table S25 data. There are two options: count all carers in the Council's resident population or only those providing 20 or more hours per week (often used in research as a very rough approximation for "substantial and regular" care). Table S25 provides age-groups capable of aggregation into the under 17s (for Young Carers) and those aged 18 and over (for Adult Carers).

Column 3 is column1 as a percentage of column 2.

4.8 Definitions for the time intervals PI

Consultation Paper 3 - Waiting times for community care assessments and services - considers the following time interval PIs for all community care assessments:

CC-WT1 Time in days/weeks between first contact and first service start.
CC-WT2 Time in days/weeks weeks between first contact and the end of the assessment.
CC-WT3 Time in days/weeks weeks between assessment start and end.
CC-WT4 Time in days/weeks weeks between first contact and the date by which all services specified in the care plan are in place.

The relevant definitions are considered in more detail in Consultation Paper 3 (available on the JFU website at www.scotland.gov.uk/health/jointfutureunit).

For Carers' assessments we propose a Carers' version of CC-WT2: "Time in days/weeks between first contact and the end of the Carer's assessment".

" First contact" means the date on which the carer requested a Carers' assessment or, if no request has been made, accepted the offer of an assessment. For practical reasons (drawing upon experience in England), the time intervals paper recommends restricting the PI to "new clients". If we were to follow this position for carers then "first contact" would have to defined as the date on which a carer not currently "on the books" requested a Carers' assessment or, if no request has been made, accepted the offer of an assessment. Carers "on the books" are carers currently receiving support directly or through a programme of respite care provided to the person they care for.

The " end of the Carers' assessment" is the date on which the carer has been informed of the outcome of the separate or joint assessment, and has been given a permanent record in an accessible format with an offer to discuss or explain it if required (see CCD Circular 2/2003 para 6.14)

4.9 Consultation Questions