supporting informal carers

Policy documents on the future of the Scottish NHS; highlight the needs of carers and explicitly state that carers' health is a public health issue.

A carer is "Someone who, without payment, provides help and support to a partner, child, relative, friend, or neighbour, who could not manage without their help. This could be due to age, physical or mental illness, addiction or disability."1 Recent estimates suggest that almost 10% of the Scottish population are carers at some point during the week. Population projections show that Scotland's population is ageing rapidly. So the requirement for care is likely to be even greater in future. Scottish Executive policy is that older people should receive free personal and health care. However, health and social care policy is also focused on providing care and support to allow people to live in their own homes whenever possible, therefore much of this personal care is likely to be provided by informal carers.

In some respects the phrase "informal" masks the potential burden of being a carer. Data from Scotland as a whole shows that many informal carers are providing what is - in effect - full time care (see table).

Recent government legislation has recognised the demands being placed on carers. The 2004 Carers (Equal Opportunities) Act2 ensures that:

How bodies such as NHS Lothian can support such legislation was considered by the working group that produced the Care 21: the future of unpaid care in Scotland report1. This was commissioned by the Scottish Executive in 2004 to provide:

One of the major themes that emerges from recent research is the requirement to support carers both in terms of respite but also to provide training to enable them to be more effective carers. There is some research that suggests basic skills training can enhance the quality of life of both the patient and care-giver markedly1. Care provided outside hospital tends to be less costly. Training care-givers meant that average cost/patient was significantly lower (approximately 4000) than comparable hospital care1.

The report has 22 recommendations, almost all of which have been accepted by the Scottish Executive (see Box 1) The Scottish Executive has set as priorities support for young carers, provision of respite, carer health, the NHS Carer Information Stratgies and 'expert' carer training.

National directives, government reports and research and evidence are all necessary but changes and new services are required to turn these priorities into action on the ground. Fortunately, there is already some new support for carers. Students in health and social care will receive training about issues relating to unpaid care as part of their courses. The 2006 GP contract asks GP practices to produce a register of carers. GP practices are also expected to nominate a person to liaise with local carer agencies. There is also work underway to strengthen the referral process to support organisations.

At a strategic level, all NHS Boards are producing carer information strategies. This is a major piece of work and NHS Lothian expects to produce its strategy in the next year.


1. Care21 (2006). The future of unpaid care in Scotland. Edinburgh Scottish Executive

2. Carers (Equal Opportunities) ad 2004 Scottish Parliament