Letter to Dr P Russell, Chair of the Standing Commission on Carers
9 May 2008
Dear Dr Russell
British Medical Association’s (BMA) response to the questions posed by Lord Darzi for the NHS Next Stage Review
Thank you for seeking the British Medical Association’s comments on the above consultation.
Please find our response enclosed.
Yours sincerely
Rachel Craine
Executive Officer
BMA House
Tavistock Square
WC1H 9JP
British Medical Association’s (BMA) response to the questions posed by Lord Darzi for the final paper on the NHS Next Stage Review
The following is a response from the BMA Committee on Community Care (Chaired by Dr Helena McKeown) to the questions posed by Lord Darzi for the final paper on the NHS Next Stage Review.
1. How can the NHS best contribute to improving carers’ experience of the NHS & support the role of family carers?
(i) Recognition-Systematically asking patients when they register with a practice; by poster; practice leaflets and opportunistically.
(ii) Directing carers to sources of help and information and advocacy at the time of diagnosis.
(iii) Integrating and re-integrating social workers into existing primary care teams and attaching community nurses to existing GP surgeries would help practitioners to identify carers and discuss their needs from a holistic approach. These social workers and community nurses should be moved from primary care into secondary care to bridge the primary-secondary care interface and to facilitate the arrangement of early discharge packages. These roles could also be fulfilled by physiotherapists, occupational therapists, midwives, dieticians, specialist nurses, for example diabetes and psychiatry nurses, all being attached to one or perhaps two (smaller) practices linking primary care teams to the local hospital.
Consultants could hold some of their surgeries in existing surgeries with GPs acting as clinical assistants in outpatient departments. This would not require new polyclinics in all places but would require the implementation of improvement grants or premises funding for a few existing practices.
(iv) Integration based on existing primary care teams would make the service appear more seamless for the carer and would also enable them to talk to any one member of the team. This in turn would make it easier for members of the team to share this communication and to provide a single package of answers.
(v) It is essential that the needs of the carer are considered as part of the package of care for an individual. The needs of carers are directly relevant to the care needs of the patient. Carers and those being cared for benefit from having funded, planned and emergency care breaks.
2. How can primary care services help to maximise mental and physical health and well-being of carers?
Primary care services need to have easy access to high quality services to assist the individual being cared for and the carer. Without this, there is a risk that providers of primary care services may become disillusioned and may not actively search out the needs of carers.
Many GPs are pragmatic problem solvers. They need to be able to help those identified by supporting services such as carers lifting courses and subsidised packages of leisure and exercise facilities. In addition support is required from an attached worker who can arrange high quality planned and emergency care breaks, social care funding and benefits advice. Providing different forms of care breaks and providing information and support will enable carers to access work, study, socialise and stay fit. Such activities are essential to their health and wellbeing and will help save the economy money in the longer term.
3. How should the NHS work with social care, third sector and other partners to explore different ways of working and in particular to gather sound evidence jointly on cost effectiveness and “spend to save” solutions?
Businesses should be encouraged to be innovative in employing carers. This may involve implementing statutory right similar to maternity right and adoptive parents’ rights, for example, enabling flexible working for carers. Businesses who are already leading the way, for example Natwest, should be talked to about their benefits.
NHS and local authority employers should lead by example offering flexible working to carers, and in the same way as many provide crèches, they might invest in local day centres to offer care and carer tax vouchers for the individual who is cared for, to be spent in addition to personal budgets.
4. How can we ensure that carers’ experience and expertise is utilised in NHS leadership development – among clinicians and managers in primary and community care services as well as acute services?
By the NHS and local authorities employing carers in the way described they will be integrated into the NHS and be an integral resource for development for existing and future leaders. It will change the whole culture of the organisation; because there are many carers at any one time, and the turnover of carers is rapid.
5. What are the key priorities for the development of the healthcare workforce from the carers’ perspectives?
The healthcare workforce needs to understand the professionalism of carers and address how best to make use of this, for example, in information about medication and conditions.
6. How can the NHS best contribute to the development of comprehensive information resources for carers and the people they support?
With the third sector, many organisations already produce very good, condition specific information, which should be shared widely across the NHS. The BMA, as part of the Annual BMA Medical Book Competition, offers an award for patient information. This scheme was established to encourage and recognise the production and dissemination of accessible, well designed and clinically balanced materials that enhance patients’ understanding of health issues and their ability to participate in decisions about their care.
It is important that Doctors are able to signpost carers and patients to reliable, locally relevant and up-to date information. This information could perhaps be made available via the web.
The NHS can contribute to the development of proactive and positive partnerships through a number of channels. They include; - linking one social care individual to a practice, linking a school (s) to a practice population, perhaps using the practice patient group, enabling local elderly residents with transport to go and eat lunch in a school-this would be beneficial for their nutrition and their social well-being and would also offer additional benefit to the pupils perhaps through reading schemes or teaching table manners and social interaction. Having NHS activities on school buildings or sharing facilities, will improve communications and health. Schools could also give pupils projects to involve them in health and learning about carers and to generate ideas and enthusiasm. Partnerships between leisure centre and staff at a surgery (and school) could be created. Corporate discounts for employees and patients and their carers would encourage participation and re-enforce a sense of community. Representatives from the voluntary sector should be asked to join existing patient participating groups and to help set them up where they do not exist.
8. Should we consider making clear the expectations, roles and responsibilities of both family carers and professionals in support service users?
Only when question 7 has been tried should you consider making clear the expectation, roles and responsibilities of both family carers and professionals in support of service users.