Published: June 2021
The focus of this rapid review from SCIE is on the barriers and enablers to accessing carers’ needs assessments in Wales. Commissioned by Social Care Wales, it is part of the continued work to understand how to improve the quality and consistency of support for unpaid carers as identified in the Strategy for Unpaid Carers (Welsh Government, 2021).
Introduction
The Social Services and Well-being (Wales) Act 2014 enshrined a number of rights for unpaid carers in Wales. Since the Act came into force in 2016, work has continued to improve the lives of carers in Wales. The Act was ground-breaking in creating a legal duty on local authorities to carry out needs assessments for carers and to meet their eligible needs. However, local authority data suggests that many carers are not getting their needs assessed or getting the support needed. Of those that are invited for an assessment, just under 50 per cent refuse that assessment (Welsh Government, StatsWales, 2019).
This review will therefore focus on the barriers and enablers to accessing a carers’ needs assessment as well as the experiences of those who have had an assessment. The review covers the period from 2016 and whilst there is some information in relation to the period since the 2020 COVID-19 lockdown. It should be noted that most of the literature and information predates the pandemic so there is a specific COVID-19 section that reports evidence from this period.
Review questions
The following research questions have been used to guide this review:
- What does the evidence tell us about barriers and enablers for unpaid carers in accessing support?
- What does the evidence tell us about why unpaid carers in Wales are not accessing carers’ needs assessments when they are eligible to do so?
- For unpaid carers in Wales who do access assessments, what is their experience of that assessment? What went well and what could be improved?
Key findings
- Most of the literature and evidence in relation to carers’ needs assessments relates to adults rather than young carers. Additionally, there is little evidence in relation to COVID-19 and assessment processes, but rather more general information about support for unpaid carers.
- Barriers to accessing assessments includes unpaid carers not identifying themselves as such, because they see caring as part of their familial/spousal role or because they, or the person they care for, feels shame or stigma. Individuals may not be identified as carers by services and professionals that should signpost them to services or assessments.
- Some groups are more at risk of not accessing information that would be relevant to them. This includes people caring for children with additional support needs, carers not in employment and/or seeking employment, young carers and carers of people living with dementia. Language barriers, sensory impairments and limited internet access are also identified as potential barriers to accessing information.
- Enablers to accessing assessment include an effective first point of contact with highly-trained staff, well-designed online resources, and carers’ groups where carers can get peer support to navigate the system.
- Third sector organisations play an essential role in identifying and providing support to carers. Their role in providing and sharing information and making information accessible to specific groups is highlighted, as is their pivotal role during the pandemic.
- COVID-19 has resulted in an increase in the number of carers and they have found it difficult to access assessments. Information has had to be provided remotely, but any direct contact from professionals was appreciated by carers.
- It is essential the carers feel heard and are treated with respect during the assessment process, and doing so can help take down barriers created by previous negative experiences. Conversations have not always occurred in private spaces, making carers unwilling to be open.
Further key messages are available in the full version of the review – which you can download below.
Conclusions
- Most of the literature and evidence in relation to carers’ needs assessments relates to adults rather than young carers. Additionally, there is little evidence in relation to COVID-19 and assessment processes, but rather more general information about support for carers.
- The impact of COVID-19 on services and research poses a significant challenge for understanding what worked well and what lessons and interventions should continue into the future. During the pandemic there has been less co-production of services, individual support plans and of research/evidence.
- Many carers and professionals still do not know or fully understand the rights of carers to have an assessment or what the outcomes of such an assessment could be. This additionally relates to confusion around terminology, especially regarding ‘what matters’ conversations and carers’ needs assessments.
- Managing expectations is important so that carers understand what services may be available or what the outcomes of an assessment could be (including not being eligible for support at that current time). If carers see no obvious benefit to assessments however, they will not seek them out for an initial or re-assessment.
- There are positive examples of assessment and contact with professionals both before and during COVID-19 where carers have felt listened to, respected and supported. In some cases, people with very low expectations of an assessment or with a poor previous experience of the process were reassured.
- It is clear from this review that there is considerable consensus in the literature about some of the barriers and enablers of accessing assessments or wider support, but less consensus about successful interventions and approaches, especially during the pandemic.
Further conclusions are available in the full version of the review – which you can download below.