This area provides details about the way in which the Clinical Commissioning Group (the CCG) will work with providers of wellbeing and prevention services to secure the support that carers of North East Lincolnshire need over the next 5 years and beyond.

A carer is someone of any age who looks after a child, relative, partner or friend in need of help because they have an illness, disability, frailty or a substance misuse problem. Carers may provide personal, emotional or supervisory care and are unpaid.

Financial Context
The carers' agenda locally is supported with a total budget of around £3,4000,000. This is made up of children’s services, adult services and health funding.

Adult carers funding across health and social care accounts for an estimated total of £1,7000,000. The funding is utilised within adult social care to support the provision of carers' support services, as a result of a carer’s/ joint assessment of need, and to deliver a range of contracts in the voluntary sector, for example the delivery of the NEL Carers' Support Services, the Alzheimer’s Society Carers’ Support and the Carers' Support Worker Services.

Underpinning principles
Within the refreshed National Carers Strategy (‘Recognised, Valued and Supported: Next steps for the carers strategy’ (2010)), the Government identified four priorities:
1. Supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages.
2. Enabling those with caring responsibilities to fulfill their educational and employment potential.
3. Encouraging personalised support both for carers and those they support, enabling them to have a family and community life.
4. Supporting carers to remain mentally and physically well.

The Care Act 2014 has also provided new rights for carers and has placed carers on an equal footing to service users. In summary, the Care Act is really positive for carers and focuses on:
• Carer wellbeing and support outcomes, ensuring these are at the centre of every decision
• Preventing and delaying carer support needs; integration and partnership working is reinforced
• Placing Carers on the same footing as those they care for, i.e. providing them with new rights, for example to assessments of need
• Embedding the right to choice through support planning and personal budgets
• A new national eligibility criteria for carers
• Carer involvement and need in adult safeguarding situations
• Greater opportunities for access to independent advocacy

The Care Act (2014) and the Children and Families Act (2014) also provide greater opportunities for identification, recognition and support for all carers, including young and parent carers.

CCG Responsibilities
Within N. E. Lincolnshire we recognise that carers are the lynchpin of care in our communities. Without them we would not be able to meet the needs of some of our most vulnerable people. However, the contribution carers make can expose them to a wide range of health, wellbeing, social, employment and financial inequalities.

The Council and NHS have a history of working in partnership around carers' support and services and have been implementing local carers’ strategies and plans since 2007. As an integrated health and social care organisation, the CCG has a history of developing and commissioning services to improve outcomes for carers, including working in partnership with other local organisations and agencies.  The current three year multi-agency local carers strategy, ‘Caring for our Carers 2013-2016’, sets out a framework for the delivery of local priorities that are consistent with national priorities and expectations.

The implementation of the local carers strategy is overseen by the well-established multi-agency Carers Strategy Group, which has representation across statutory and voluntary sectors as well as representation from local Carers' Forums. The Service Lead for Carers and Communities, based within the CCG, coordinates and leads the carer agenda across all partner agencies.

Current supply
There are a range of services commissioned by the CCG to support carers, including:
1) N.E. Lincolnshire Carers’ Support Service
The N.E.L Carers' Support Service provides support to all carers across North East Lincolnshire, including specialist advice and information, carer support groups, counseling /one-to-one support, befriending, holistic therapies, carers' training and social activities.

2) Carers' Emergency Alert Card
The Carers' Emergency Alert Card has been specifically designed to support carers in an emergency or crisis situation. Once registered, a carer will have peace of mind that they can contact an emergency 24/7 phone line if required, to activate an emergency plan. This will ensure that named contacts are contacted and support is put in place for the person cared for in the Carer’s absence. The service is provided by Carelink.

3) Support for carers of those with organic and functional mental health concerns through NAViGO
The Admiral Nurse and Carers' Support Worker service provides individual support to carers of those with Alzheimer’s/Dementia through the provision of advice, information and signposting, as well as an assessment of need and support services such as emotional and practical support and carers training. In addition there are a range of support mechanisms for all carers of those with functional mental health problems, including a monthly carers group, a carer drop in service at Your Place and a range of social activities/outings which are provided once per month.

4) Carer Support Worker Service provided by Care Plus Group
The service supports carers of older people, and people with a learning or physical disability who have an identified need for the service following a carers assessment. The service provides regular contact via telephone or a home visit as required, emotional and practical support, a quarterly mailshot and social and peer support activities.

5) Carers' support provided through the Alzheimer’s Society
Carers' support is provided through various services including the Dementia Advisor service, the Dementia Support Worker service, The CRISP (Carers Information and Support programme) training, Memory Cafes and social events. There are also an extensive range of advice, support and carers services available, to meet the needs of parent and young carers.

Future demands and needs
Within N.E. Lincolnshire, just under 10% of the population are carers (15,993 carers). The current numbers are likely to be greater, as this statistic dates back to the 2011 Census and we know that many carers do not identify themselves as carers.

It is well documented that the number of carers will inevitably increase, since we have an aging population and people with life limiting conditions are living longer; this will increase the need both for the number of carers and for the amount of care provided. Nationally, it is said that the number of carers will rise by 60% in the next 30 years (Carers Trust 2012).

In North East Lincolnshire we have already seen an increase in the number of carers between the 2001 and the 2011 Census (4%), and of those carers there is a 27% increase in the number providing over 50 hours of care per week. There was also an increase in the number of carers providing 20-49 hours of care per week.
Strategic direction

The CCG will deliver the carers agenda locally as defined in  NEL Carers Strategy, ‘Caring for our Carers 2017-2020’. These priorities fall within 6 headings -

1. Carers are identified at the most appropriate time
2. Carers have access to appropriate advice & information throughout their caring role
3. Carers are recognised for their knowledge, understanding and skills
4. Carers are involved in care & support planning for the cared for
5. Carers’ needs are identified & responded to appropriately
6. Carers must be involved in the service design, delivery & monitoring

Progress against the strategy is monitored at the NEL Carers' Strategy Group meetings and internally via management boards/forums.

Commissioning principles and aims, including timings for any significant developments in commissioning
Our commissioning principles with respect to carers are to ensure that carers' services continue, are innovative and of good quality, are efficient and cost effective and that they are delivered in a personalised manner that is responsive to carer needs. This will ensure that carers across North East Lincolnshire remain in a position to want to continue caring; it will sustain their caring role and allow them the opportunity to have a life of their own, as well as aiding them to keep in good health.

Following re- tendering of the NEL Carers' Support Service, the new service was launched on 1st April 2014.   The Carers' Support Service retender date is expected to be 2019. All carer services will continue to be carer led wherever possible and will be reviewed quarterly (as a minimum) to ensure they are continuing to meet local carers’ needs, are delivering the required outcomes and demonstrating continual service improvement

Provider implications – how the CCG expects the market to respond
The CCG expects that the health, social care and voluntary sector will -
• Maintain robust attendance at NEL Carers' Strategy meetings
• Including themselves in all public consultation with respect to carers services
• Keep abreast of all national, regional and local legislation, policy and practice guidance with respect to carers
• Ensure all service developments include consideration of carers and caring
• Work together with other local providers in partnership
• Deliver any organisational support specific to carers in line with the Local Carers Priorities, and strive to be innovative and responsive to meeting local carer needs

Quality and performance monitoring
All carers contracts have clear quantitative and qualitative information requirements as well as a specific focus on delivering carer outcomes. Overall, the main outcomes to be achieved are as follows:
• Increased carer recognition
• Improved access to up to date, timely and accessible information
• Improved knowledge and understanding of what carers services are available locally
• Improved access to and range of universal carers support services
• Increased take up of carers/ joint assessments of need
• Improved access to and range of commissioned carers support services to meet need
• Improved carer specific outcomes including -
o Reduction in carer stress
o Improved carer physical and mental well being
o Reduction in social isolation
o Increased sense of control
o Increased decision making

Tendering procedures
The CCG aims to continue to strive, to ensure all commissioning relating to carers is carer led and that carers are part of wider CCG commissioning mechanisms.