A Carer Passport scheme can enable a conversation, its very existence providing a practical prompt to talk about caring. It needs to be a conversation which recognises that carers and those they care for don’t necessarily label themselves and their situation in this way.
At their most effective, Carer Passports are delivered as part of a package of Carer Friendly practices. These practices become a thread running through the hospital setting, which normalises the role of carers.
As part of a Carer Passport scheme, access to face-to-face, knowledgeable and calm support is also important – the chance to actually speak to someone who can give practical advice. It may be provided in a more informal setting, such as a drop-in cafe for carers. This ongoing dialogue is essential. Carers’ circumstances will change over time, and the use of the Carer Passport needs to embrace this.
Hospital-wide communications should ensure that all staff are aware of these policies and practices, and how to use them. Carer Passports are often championed by Carers Leads, with evidence that these roles are now being funded by a small number of Clinical Commissioning Groups in some hospitals.
At Board level, there could be a Carers Lead, in the same way that they exist within local authorities. So where the Passport and other carer initiatives are being championed within a hospital, they are proactively offered to carers by hospital staff who understand their purpose and value.
Health professionals should consider the whole family when identifying carers, recognising that children and young people may also undertake caring responsibilities. Young carers have specific needs as a vulnerable group..
Where Passports work effectively, they embrace Partnerships In Care principles, fostering the Carer Friendly practices of identifying, engaging and involving. The aims and principles of the Carer Passport in different hospitals across an NHS Trust will be similar, but the delivery mechanisms may differ.
Challenges to overcome
A Hospital Carer Passport scheme needs to be promoted and offered consistently across all wards. So while it may be effectively championed by dementia nurses and patient experience staff, its reach needs to be wider. With hospitals affected by the use of agency and temporary staff, getting the message out there in a consistent way can be a challenge.
Systems may not be in place to record the take-up of Carer Passports in hospitals, and to monitor how they are being used.
There are often barriers to young carers getting support within the NHS, partly through staff uncertainty about how to respond to them, including concerns about safeguarding and neglect. As a result, progress in this area is slow. It is important to develop support for young carers through or alongside a Carer Passport scheme
The majority of healthcare happens outside hospitals, and this needs to be acknowledged in improving support to carers via a model such as a Passport. If Carer Passport schemes are to be part of a wider approach to delivering Carer Friendly practices, they become ‘one tool in the box’, so there needs to be a wider action plan connecting health and social care providers.
There may be some hesitation around the cost implications of taking a ‘whole systems’ approach - or of an offer which reaches a large and loosely defined number of individuals. Hospitals need to be clear about definitions, the offer they are making, and how they will resource it.
It can be challenge to overcome the perception that an initiative such as this will lead to an increased workload, The benefits of Carer Passport schemes should be presented, captured as they unfold, and clearly communicated to staff. The In Action pages contain some measurable benefits from existing schemes.
Promoting Carer Passport schemes in hospitals
Within hospitals themselves, Carer Passports need to be promoted and offered consistently across all wards. One carer has described in detail the difficulties she faced when she attempted to mention her husband’s long-term mental health needs to ward staff. She was treated with hostility and repeatedly had to justify her presence. The hospital had a carers policy, but staff would not recognise it. A Passport could have made a difference here, but the carer acknowledges that it could simply have been met with annoyance by staff if its purpose was not fully understood and embraced.
At Lister hospital, the scheme is promoted to all staff on the wards, to staff and visitors via an education stand staffed in public areas, through local carers organisations and Carer Champions in GP surgeries, and via local libraries. It is delivered by the Trust’s designated Carers Lead, who is line managed by the Deputy Director of Nursing and has the active support of senior staff across the hospital.
When championed at the highest levels of the hospital, staff are aware that this is the right thing for patients and their carers. The wider benefits of such a scheme are that they enable a shaping of services which respond to the needs of the patient and carer, improve their experiences, and reflect the Trust’s values and NHS Constitution..
So carers, and Carer Passports, need to be given status within the hospital setting. The policy to embed the use of Passports needs to be in place, with high levels of staff awareness of it, and training provided to ensure its effective implementation. Carers need to see the Passport more proactively promoted in hospitals, with clearer communications and information available. They report that it is of value once they have it, but that it sometimes takes a while to be offered.
Carers often acknowledge that a Passport will be most effective when it is used across the range of health and social care settings. For this to work, such schemes need to be introduced with formal support and promotion from these statutory agencies.