Market shaping - adult carers
The Care Act sets out market shaping duties to ensure a diverse, high-quality market from which local people can choose. This should be based on locally identified needs, demographics, trends and aspirations. The statutory guidance expects local authorities to use ‘a wide range of approaches to meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways’. Local authorities need to ensure a variety of different service providers, including a variety of types of provider, and should always encourage innovation.
Rigid procurement approaches should not drive the agenda or obstruct the development of new, flexible choice-based provision.
The practice examples set out the richness and variety of approaches to breaks across England. A good approach to market shaping will include the following.
- Ensuring a genuine choice of breaks – a wide range of provision and types of provision available at different times. This may include residential respite, sitting services, through to holidays and support for shared activities. This range needs to address equalities and specific needs that may require particular approaches.
- Ensuring a sustainable market for breaks – moving beyond pilots and having contracts (where appropriate) and meaningful monitoring (including by carers) that facilitate wellbeing outcomes. Sustainability planning will need to address challenges in remote rural areas to ensure the viability of low volume services.
- An inclusive approach that checks that the market is responsive to the identified needs of different carer groups and communities.
- Investing in quality and developing what works. This may include encouraging quality providers to diversify to offer breaks. Staff skills and experience are key to quality so linking providers with workforce development plans to collaborate on training – including by carers – can help.
- Articulating to providers the likely demand and the types of services that people say they want, and a shared local understanding ‘what good looks like’.
- Ensuring carers (including self-funders and direct payment users) are aware of what is available and how much it costs.
- Fostering a climate that facilitates the development of flexible services that are truly personalised and strengths-based. This includes whole family and integrated approaches building on community assets and local business opportunities.
- Facilitating innovation, social enterprise and community-based models such as Shared Lives. Small charities and social enterprises may be put off by formal tendering processes but be able to offer tailored, innovative support. There are many ways that services can be engaged and funded. Commissioners should not limit choice by inappropriately applying rigid procurement approaches.
- Supporting carers’ organisations or direct payment organisations that can help carers to develop and organise individualised breaks.
- Getting on with it! Not delaying progressing support for what clearly works.
- Decommissioning services where there is not the need or demand or the service is unable to adapt to what is needed.
There is no ‘one size fits all’ carers’ breaks service. To meet diverse needs and preferences, areas need a range of options which could include a combination of more traditional services such as regular sitting service together with more creative options such as a relationship-centred short break for the carer and the person they care for to enjoy shared activities. The practice examples and table below set out a range of models of breaks and approaches.
Types of carers’ breaks
Below we set out some of the many ways of taking a break. This list is in no way exhaustive.
Short breaks in residential or nursing care
The person who is cared for stays overnight in a care home or nursing home.
Complex needs and specialist support – accommodation-based breaks
Short breaks away from home for the person who is cared for. Services may have skills in supporting people with particular health conditions, or enabling people with learning disabilities or complex behaviours to gain independent living skills, for example. Services may offer wider support to the family enabling shared visits and peer support.
There are numerous types of holiday: for the carer while the person is cared for at home or a residential setting; a supported holiday for the person who requires care; a shared holiday for the carer and the person they care for or a family holiday, but with support available for the caring tasks.
Support to care for the person at home
Support workers or personal assistants care for the person at home while the carer has a break. Sometimes called replacement care or a sitting service, this could be for a few hours on a regular basis, for occasional breaks or for longer periods while the carer goes away for a holiday, to visit family etc.
Befriending services / buddy schemes
A volunteer spends time with the person with care and support needs. This enables the carer to take a break, to go out and do something they want to do. Matching can based on shared interests, or around cultural identity, for example. This could be in the person’s home – having a coffee and a chat, or out and about – visiting galleries, going to the match for example.
Support is offered through Shared Lives carers who share their own homes and family life. Short breaks can be anything from a few hours a day on a regular basis to overnight stays for an agreed length of time.
Short breaks based on activities of interest to the person
Activities outside the home on a regular basis such as walks, cinema, sports, fitness and social groups. This offers the person who is cared for the chance to make social links, stay connected with faith groups, learn new skills or share peer support such as through mental health walks.
Short breaks based on activities of interest to the carer
Some carers may want to take breaks where they link with other carers. This may be around skills or employment training, peer support, regular coffee mornings or lunches, fun activities and socials. Other carers will have things that they want to do during the breaks that are important to them.
Hospitality and leisure services offer complimentary breaks or offers for carers and usually a guest too. The offer may include restaurants, theatres, hotels, universities, leisure and tourism, football clubs.
Breaks at end of life or for people with life-limiting conditions. Hospices often offer wrap-around support and advice for the person and their family.
Holistic breaks service
A holistic breaks service will usually offer, or help to organise a wide variety of breaks and coordinated support. This could include outreach, overnight support, residential stays, emergency back-up arrangements as well as leisure trips and holidays.
A GP or primary care professional refers to community-based support. This could be a break or support to design a break and make it happen.
Ideally breaks are planned, but knowing there is access to a break in case of emergency or crisis can be reassuring and also avoid the person who is cared for going in to unfamiliar residential care, for example.
Direct payments and carers’ personal budgets
The person with care needs and the carer can use direct payments (if eligible) to plan breaks that work for them. Carers’ personal budgets (whilst not for the cost of replacement care) could be used for the cost of a course, driving lessons, towards the cost of time away and so on.
Support to organise breaks
Having help to organise breaks is really important for many carers. Some carers organisations do this as part of their wider support and advice services. Finding out from other carers how they get a break is also important.
Opportunities for people not eligible for council budgets
There are a range of grants or schemes targeted at people who don’t receive other help.
Day services / day opportunities
Day services can offer a break during the day to many carers. Day services may also offer extended services at weekends or evenings, or organise holidays and trips.
Young adult carers
Services targeted at young adult carers may offer support for breaks, holidays, events – either individually or bringing young carers together.
Getting help with other tasks
Support for a range of tasks, such as around the home or with childcare, so the carer can spend more quality time with the person they care for.
Support from family and friends
Friends and family often provide the support that enables a carer to take a break. Services that support wider family to be confident to do this, perhaps through training, and services that provide emotional support to enable carers to accept help, are important in helping carers get the breaks they need.
For some carers (though not all), access to technology that helps keep the person safe, or provides back up support if needed, can provide the reassurance they need to take a break.
Carers Holiday Lodges – Council-owned lodges in Bournemouth and Poole
Provider: Bournemouth Borough Council and Borough of Poole (Council-owned service) Open
This is a local authority-led project. Carers in the two boroughs were asked if they would be interested in having a break in a lodge at a holiday park. Following positive feedback, the councils purchased lodges with money from what was then the primary care trust. They involved a carer in the selection of the first lodge in the seaside town of Brixham in Devon. The second lodge was in Weymouth in Dorset as some carers could not travel to Devon. This lodge was specifically designed to be more accessible and dementia-friendly, as carers usually took the person they cared for.
Between 2016 and 2018, over 300 carers had breaks at the two lodges. The services receive regular, positive feedback from carers describing it as 'a breath of fresh air', 'a chance to renew my batteries'. Holiday park staff are seen as especially helpful. Both parks have bus stops near to the entrances so that there is easy access to local leisure facilities.
As part of the project design, carers agreed to a highly reduced 'booking fee' of £10 per night, as a way of contributing to the cost.
Funding: c £25,000 p.a. to run both lodges.
See: Market shaping
Mytime – Breaks in partnership with hotels, leisure services, restaurants etc in Liverpool
Liverpool Carers Centre, Local Solutions (not for profit) Open
Evidence from carers accessing the Liverpool Carers Centre showed that the most requested type of support was a respite break. Demand in the city was outweighing supply so the Centre looked at how best to respond this request. Contact was made with a hotel and it offered complimentary bed and breakfast for a carer and a guest.
It now has 30 hotels and 32 other organisations providing offers to carers. This includes overnight stays in hotels, and access to restaurants, theatres, universities, leisure and tourism, football clubs, watersports centre and Aintree Racecourse. Some carers are unable to leave the cared-for overnight so Mtime worked with organisations such as theatres/restaurants who could offer a few hours during the day. There are 1,300 carers now registered with Mytime, which is run by 1.5 paid members of staff plus a manager and two volunteers who were themselves carers. Carers chose the name and design of Mytime. They are also involved in the development of offers. This project was recently recognised by Nesta and the Observer as one of their ‘New Radicals’.
Mytime supports the whole family. Examples include breaks that are family orientated, to allow parents who are carers to be able to take their children on the break. This could be family concerts at theatres where children are encouraged to come and try the instruments, or using tickets provided by CBBC (Children’s BBC) to see their roadshow. Many families that have young carers enjoy pantomime tickets, something that they can enjoy together. There is support available for families who are caring for someone with dementia to take them to the event and help to make a memory.
Evaluation gained from the project shows an increase in carers health and wellbeing. This is evidenced by the Warwick and Edinburgh Mental Wellbeing Scale. They also use the carers outcome star to assess the carer pre and post activity. Carers are reporting back that the services have helped them to remain in their caring role.
One of the key lessons they learned, was that some carers are unable to leave the person they care for overnight so they worked with organisations such as theatres and restaurants that could offer a few hours of activity to carers during the day, such as Barista training.
Budget: Approx £80k per annum. At present the service is funded through the Big Lottery Fund and other charitable trusts.
For meals, everyone is asked if there are any food requirements to be aware of.
There is a carer who has been supported via the project volunteering for us. She is able to speak several languages and last week used this to support a carer whose first language was Punjabi access a break. The volunteer is keen to provide more of this type of support for carers.
The aim is to make Mytime as inclusive as possible and work on an individual basis to reduce any potential barrier to a carer being able to access a break.
Shared Lives – short breaks with Shared Lives carers who share their own home
Shared Lives Plus Open
Shared Lives offers adults the opportunity to use small-scale, family and community-based support to meet their care and support needs. Shared Lives is used by people of all ages from 16 onwards, with a wide range of difficulties. Support is offered through Shared Lives carers, who share their own homes and family life offering long-term live-in arrangements, short breaks or day care. Short breaks can be anything from a few hours a day on a regular basis to overnight stays for an agreed length of time. Time is spent making sure that the match between the service user and the Shared Lives carer is a positive one. At the heart of Shared Lives is the relationship between the person using the service and the Shared Lives carer and their family.
Shared Lives is funded in the same way as other forms of short breaks. The local authority will undertake an assessment for the person being cared for and their carer. This will look at the needs of the person being cared for and consider what services they may be able to provide bearing in mind local priorities and availability of services. They will also do a financial assessment which means that the family carers or the person being cared for may be charged for the services according to means. Charges vary according to the area and the support needs of the person using Shared Lives.
In 2015–16 Shared Lives participated in the Carers Social Action Support Fund project funded by the Cabinet Office which explored different way to support family carers. The evaluation of the project, undertaken by TSIP, showed that using Shared Lives for short breaks provided a reduction in caring stress and in the likelihood of breakdown and an improvement in wellbeing. (TSIP 2016)
Commissioner, be brave and commission innovative solutions.Carers’ Breaks Reference Group discussion, February 2019
Ensure choices reflect your community diversity. Don’t leave groups or communities isolated. Services should be accessible to all – adapt them if necessary. Otherwise it is lazy commissioning.Carers’ Breaks Reference Group discussion, February 2019
Look carefully at the care market for everyone – including self-funders.Carers’ Breaks Reference Group discussion, February 2019
Use the wider voluntary and community sectors as they are trusted by local citizens.Carers’ Breaks Reference Group discussion, February 2019
Use a wide range of local assets including the private sector.Carers’ Breaks Reference Group discussion, February 2019
Providers can have great ideas as well. How do new providers in an area link in?Carers’ Breaks Reference Group discussion, February 2019