No Wrong Doors for young carers: maturity assessment

1.1 As a minimum, signatories to the MOU will be Directors of Adults and Children’s Services and the chair of the ICB. You could also consider signatories from local carers organisations, primary and secondary care, schools, other council departments such as housing, and institutions of further and higher education.

1.2 We’ve heard that without senior level buy-in and sponsorship, the MOU is unlikely to gain traction, so it’s important that each individual partner in the MOU has a senior level sponsor who will champion the MOU and troubleshoot where necessary on behalf of the group implementing the local action plan; in Leeds, strategic oversight of the young carers working group sits with the Leeds Health and Wellbeing Board which builds in high level oversight and ownership of the MOU.

1.3 The MOU will work best when there is a detailed action plan for ensuring its implementation. Ideally, there will be a working group involving all partners,as well as young and young adult carers, who can operationalise the implementation of the MOU and report on progress. In Leeds this was achieved through a young carers working group with representation from several council services, mental health services, carers Leeds, NHS colleagues, 0-19 public health integrated nurses, Leeds teaching hospital, children’s safeguarding, and primary health care.

1.4 Building in a robust process for auditing progress with the action plan for embedding the MOU will provide signatories to the MOU with the assurance they need that the MOU is working, and an opportunity to address any barriers. The use of this maturity assessment would be a useful audit and assurance tool. In Leeds, Family Action developed a ‘We are young carer friendly Leeds’ quality mark which is awarded to settings who can demonstrate how they consistently meet an agreed set of standards. You can also read about how Waltham Forest Council used the NICE QS200 Standard to develop a local reporting framework to ensure accountability and support for the priorities and projects that are being delivered.

1.5 It’s important that Safeguarding Boards for both adult’s and children’s services are aware of the signed MOU and there is clarity across the local system about when the impacts of caring for young carers and young adult carers become a safeguarding concern. It’s also important that frontline staff in all settings which may identify a young carer have awareness of the circumstances in which they should raise a concern about a young carer or young adult carer. You can find a helpful resource from The Children’s Society which explores safeguarding in the context of young carers and relevant legislation, and also references the MOU and whole family approaches. Adopting the MOU will also support compliance with the Department for Education’s Working Together to Safeguard Children 2023 statutory guidance which says that “ Adult social care services should liaise with children’s social care services to ensure that there is a joined-up approach when both carrying out such assessments and in the provision of support to families where there are young carers or parent carers.”

SOURCES OF EVIDENCE - we suggest you use this section to provide evidence in support of your assessment of where your stand on the leadership and oversight domain of the maturity assessment; this will also be useful to share with CQC as part of their evidence and assessment process.

2.1 It’s important that partners in the MOU have as accurate a picture of all young carers in their area as possible, not just those who are ‘known’ to services. There is, however, no single definitive source of data about young carers in a local area, apart from the 2021 census. You can find census data showing numbers of young carers and hours of care provided by young carers (age 5-17) and young adult carers (age 18-24) for each council. Numbers of young carers have risen since the 2011 census. National carers organisations think that the latest census numbers for young carers are likely to be under-reported. A frequently cited BBC survey in 2018 identified much higher numbers nationally than the census. Since January 2023, schools are required to collect data about numbers of young carers. You can find the latest data release. Government say this data should be treated with caution as it’s a new data item, but reliability should improve over time. Carers Trust say there is likely to be significant under-reporting. GP Practices can contribute to the recording of young carers within primary care by routinely using relevant SNOMED codes for young carers but it’s unclear the extent to which this is happening or how reliable the data is. Councils will also hold some data on young carers, as will local carers organisations, but it’s likely this will be patchy and inconsistent.

2.2 It’s helpful to show how partners in the MOU use the data available to them to inform their strategic planning to meet future demand for young carers services, transition assessments, support, advice and information, including any gaps in provision; this should be clearly set out in public facing strategies and plans (see 2.5 below); we know CQC will look at as these published strategies and plans as part of their information gathering for their assessments.

2.3 As a minimum, partners in the MOU will have a data sharing agreement in place to share anonymised information about young carers who are known to them; this can be quantitative and/or qualitative.

2.4 Ideally, anonymised data about young carers will also be shared based on mutual trust and confidence between wider partners in the local area; this could include other council departments, carers organisations (commissioned and non-commissioned), primary and secondary care, schools, colleges, and universities.

2.5 Arrangements for identifying, assessing and supporting young carers and their families both now, and in the future, should be set out in public facing strategies including carers strategies, commissioning strategies, Health and Well Being Strategies, Joint Strategic Needs Assessments, Integrated Care Strategies and Market Position Statements.

2.6 MOU partners should be able to evidence how their strategic priorities for young carers and their families have been directly shaped and influenced by insights gathered from them; CQC are very likely to look at this; ideally, young carers and young adult carers will be a core part of the action planning group for embedding the MOU, with continuous opportunities for young carers and their families to contribute to the planning and direction of support for young carers, rather than being asked to join one-off consultation events.

SOURCES OF EVIDENCE - we suggest you use this section to provide evidence in support of your assessment of where your stand on the young carers and local context domain of the maturity assessment; this will also be useful to share with CQC as part of their evidence and assessment process.

3.1 To be compliant with the Care Act 2014, accessible information and advice for young carers and young adult carers in the local area, regardless of whether they are ‘known’ to services needs to be available in a diversity of formats and age-appropriate; we know from the census that children as young as five are providing care and staff need to feel equipped to have these conversations and signpost young carers to reliable sources of support, advice and information. “Young Carers in Bunnyland” supplies free e-books and resources for work with primary school-aged children who may be carers. Carers Trust also have resources for working with younger carers.

3.2 Partners in the MOU will have committed to promote the wellbeing of young carers locally, including through the provision of support which helps prevent, reduce, or delay adverse impacts on young people from caring. Staff will need to be aware of the impacts caring can have on young people and how they can help improve the wellbeing of young carers.

3.3 Being proactive in identifying young carers means that any staff member who has first contact with a family, regardless of setting or service, takes time to establish whether there is a young carer in a family or household. This may mean reviewing assessment conversations to ensure they consistently include questions designed to check this out. Carers Trust have a set of training resources to help improve the identification and support of young carers by professionals.

3.4 Where a young carer is identified in a family, staff then know what the next step to take is, ideally using an integrated referral pathway agreed by all partners in the MOU.

3.5 Its important to consider a proactive strategy for reaching out to young people least likely to identify as a young carer, or take up advice, information, or support. This Literature Review from the Children’s Society makes a number of recommendations in Part E about improving the identification of young carers from groups that are particularly ‘hidden’, ‘seldom heard’ or ‘hard to reach.

4.1 To ensure there are ‘no wrong doors’ for young carers, staff in all settings and services will need to be clear where responsibility for assessing the needs of young carers lies. This is best achieved through an integrated referral pathway agreed by all partners in the MOU which clearly sets this out. Care Act statutory guidance (6.68) is clear that ‘Local authorities should ensure that adults’ and children’s care and support services work together to ensure the assessment is effective – for example by sharing expertise and linking processes.’

4.2 As per the Care Act 2014, young carer needs assessments are available on request, or on the appearance of need. Carers Trust have developed a checklist covering the statutory basis underpinning this requirement which would be a helpful aide memoire for staff.

4.3 CQC frequently ask councils about waiting lists for assessment and this could include how many young people are waiting for a young carer or young carer transition assessment. Partners in the MOU will need reliable data about their waiting lists for assessment, and be able to describe what actions they are taking to mitigate risks to a young person’s wellbeing associated with a long wait for an assessment. Young carers have said that they don’t want to have to tell their story multiple times to multiple professionals. By introducing their integrated referral pathway, Leeds significantly reduced their waiting list for assessments.

4.5 Its important that partners in the MOU have a shared understanding of what is meant by inappropriate or excessive care by young carers as set out under Care Act 2014 and the Children and Families Act 2014 and that staff, regardless of service or setting, can identify this, and understand what the next steps to take are. Carers Trust have developed a helpful briefing covering the definitions of inappropriate or excessive care.

4.6 Where staff have concerns about a young person’s safety, or that of the adult they support, its important they understand what steps they need to take next in line with local safeguarding arrangements for both adult and children’s services. You can find a helpful resource from The Children’s Society which explores safeguarding in the context of young carers and relevant legislation.

5.1 An integrated approach to supporting young carers as they move into adulthood is the best way to ensure young carers are not lost or forgotten by the local system. The Children’s Society report Shaping our future Improving Assessment and Support for Young Carers’ Transition into Adulthood takes a detailed look at young carer transition assessments and makes a number of recommendations for improvement. They have also published Young Carers’ Transition to Adulthood - A pathway for all practitioners designed to help practitioners from all setting to implement their responsibilities as outlined in The Care Act 2014 and the Children’s and Families Act 2014.

5.2 There is a duty on councils to make a young carers transition assessment available to young carers as they approach the age of 18. You can find a useful checklist from Carers Trust detailing the relevant principles and requirements.

5.3 Signatories to the MOU will only have access to so much information about young carers approaching the age of 18. It will be essential to work with local partners including schools, colleges, training providers and employers to identify as many young carers approaching adulthood as possible. Carers Trust have a set of training resources to help improve the identification and support of young carers by teaching professionals.

5.4 Age-appropriate information and advice for young carers approaching adulthood in the local area, regardless of whether they are ‘known’ to services, will be needed in line with the Care Act 2014. Young carer resources for professionals from the Children’s Society is a useful resource

5.5 Staff supporting young adult carers will need training and knowledge to properly support young carers as they move between the children’s and adult’s social care system. Carers Trust have a set of training resources to help improve the identification and support of young carers by professionals. You can also read about Durham County Council’s Young Adult Carer Support Service.

6.1 The Care Act 2014 statutory guidance (6.65-6.79) is clear that councils need to take a whole family approach to identifying and supporting young carers and young adult carers. Frontline staff will need to understand the concept of a ‘whole family approach’ and how it applies in their day to day practice. They will also need to be legally literate about the council’s duties towards young carers and young adult carers under the Care Act, and its interplay with children’s legislation and guidance. Councils will find the training resources and briefings one and two from Carers Trust very helpful in this context.

6.2 The Care Quality Commission (CQC) in the ‘best practice and guidance’ section of their assessment framework reference both ‘No Wrong Doors for Young carers’ MOU and ‘The Care Act and Whole Family Approaches. They have also said they will wish to hear from young carers about their experience of the local care system. It’s very possible that CQC will ask frontline staff about support for young carers in the context of the Care Act 2014 so this should be built into preparation work for frontline staff as part of readiness for CQC assessment.