Many NHS Trusts are now doing more to value carers in the healthcare setting, and there are an exciting number of initiatives around carers.
During a pilot at the Central Manchester University Hospitals NHS Foundation Trust, which trialled open visiting as part of a Carer Passport, nearly two thirds (59%) of staff felt it had improved communication between staff, patients and their relatives.
Prior to the pilot, only 23.5% of carers and patients thought that staff were available to discuss care and treatment, which rose to 100% at the end of the pilot. The pilot also saw a reduction in the number of falls compared to the same time in the previous year, which the Ward Manager felt was contributed to by open visiting.
John’s Campaign has resulted in a drive to get hospitals and more recently residential care settings to sign up and implement measures so that carers of patients living with dementia can have the right to stay with them in hospital if they wish and to be treated as partners in care. Health service experts consulted as part of this project report the impact of this at local level. This was included as one of 29 indicators for the NHS England’s Commissioning for Quality and Innovation (CQUIN) payment framework in 2016/17.
The expectation is that this would see a wider take-up of the principles which underpin John’s Campaign, whereby hospitals will be implementing a policy on welcoming carers and family members according to patient need and not restricted by visiting hours. These policies can be extended to all carers in different settings across the UK.
Through the use of Carer Prescriptions, Clinical Commissioning Groups are already implementing a joined-up approach between hospitals, GP practices and other healthcare services. Again, this has been given extra leverage by the NHS England Commitment to Carers and the Carers Memorandum of Understanding toolkit.
The Carer Prescription is a mechanism for identifying and referring carers for support. This started at primary care level in response to GP interest in offering more to carers (including referral for carers breaks). It was soon extended more widely and every provider in Surrey is now signed up. Once completed, a copy of the prescription is added to the patient notes – though some Trusts simply use a Carer Friendly sticker in recognition of the carer role.
This initiative sits alongside the use of Carer Passports in Surrey’s hospitals, which are described as both ‘permission to be involved in care’ and an acknowledgement of the value of carers by providing specific concessions. The Passport is seen as fostering a culture of Carer Friendly practices in local hospitals, and a useful tool for hospital staff to recognise the Partnerships In Care model. In Surrey and Sussex NHS Healthcare Trust, the Passport is used throughout the Trust and aimed at in-patients.
The wider package for the Passport includes instructions to staff (with a flowchart of what staff can do) and a poster signposting carers to Carers Support. Offers include staff discounts in the restaurant, use of refreshment rounds on the wards, and specific car parking arrangements. The Passport ‘sanctions carers to get involved in all aspects of the patient’s time in hospital’, including involvement in washing, dressing and feeding the patient, attending team meetings and providing support for investigations.
At Pinderfields Hospital, part of Mid Yorkshire Hospitals NHS Trust, a Carer Passport was introduced following feedback from carers of patients living with dementia, and recognition that involving carers in dementia patient care eases the anxiety felt by those living with the condition in a busy hospital setting. One of the most innovative features of the Passport is a special password which allows nurses to share detailed information about a patient over the phone. The hospital also built six family support suites to enable families to spend the night with their loved one. The Carer Passport has been given out to over 900 carers, with positive outcomes reported including carers feeling valued and able to communicate the patient’s needs to hospital staff.
At Lister Hospital in Hertfordshire, the benefits of their existing Passport scheme are clear. There are an estimated 100,000 unidentified carers in Hertfordshire. Reaching them is a priority, with this shaping the way in which the scheme is delivered. ‘Keeping it simple’ is the mantra, with carers issued with a bright yellow badge on a yellow lanyard which they can wear throughout the hospital.
They are not named on the card, and can pass it to another family member where the caring role is being shared. The badge makes them easily recognisable as a carer to ward staff, and in the canteen and pharmacy where it entitles them to discounts. In the first 6 months of 2017, 135 carers were identified for the first time.
One of the key benefits of the Lister scheme is reported to be the culture change which it has brought about on the wards. Carers now have 24 hour access for visiting if appropriate and this is credited with contributing to more open communications with staff, less of a ‘grid- lock’ at peak visiting times, less staff time spent on phones, and a ‘generally calmer atmosphere’ which is widely welcomed.
There is also early evidence of reduced falls when carers are present, with one of the scheme’s pilot wards reporting 92 days of no falls. This is one of many initiatives introduced to reduce falls. Staff also see other benefits for patients, including improved eating and drinking, and the stimulation provided by the company of a loved one. A new computer system in the hospital help identify and share information about patients and carers, and should enable more data gathering around the differences made by the presence of carers.
North Bristol NHS Trust and University Hospitals Bristol NHS Foundation Trust
In Bristol, the Carers Support Scheme presents patients and carers with a Carers Charter signed by NHS Trust Chief Executives, the Director of Nursing, and Chief Nurse. On admission, a patient is asked whether they have someone who supports them. If they do, staff will speak to the carer and consider a referral to the Hospital Liaison Worker. A conversation also takes place to see if the carer would like to be involved in providing care for the patient while in hospital.
Carers are given a badge allowing open visiting, a swipe card enabling access to the staff canteen for low-cost meals, and significant car parking concessions. The value of the scheme has been calculated using Social Return on Investment (SROI) methodology and found to save the equivalent of £3.6 million a year, including £239,000 in health services costs avoided. These gains have been attributed as £1.9 million for the state and £1.7 million for individuals.