Embedding ‘No Wrong Doors for young carers’ - working together to support young carers and their families: Leeds City Council

In 2023, we asked Carers Trust to undertake a review and refresh of “No Wrong Doors for Young Carers" is a template Memorandum of Understanding (MoU) designed to embed a whole-system approach to identifying and supporting young carers, young adult carers and their families, and improve joint working between adult and children's social care services, integrated care boards and other key partners. This fourth iteration of "No Wrong Doors for Young Carers" was launched in February 2024, alongside a set of supporting resources which can be found on a dedicated Carers Trust webpage. This updating is timely for councils, as the template MoU is referenced by the Care Quality Commission (CQC) in the ‘best practice and guidance’ section of their assessment framework and CQC say they will wish to hear from young carers about their experience of the local health and care system.

At the launch event in February 2024, participants heard from Leeds City Council, Leeds Community Healthcare NHS Trust and Family Action (who provide young carer support services in the city) about their city-wide approach to embedding their ‘No Wrong Doors for Young Carers’ MoU. This briefing sets out in more detail the approach taken in Leeds, shares some of the resources developed by system partners to support implementation and identifies some of the key factors which need to be in place to successfully embed a fully joined-up approach at local level.

We would like to thank Leeds City Council, Leeds Community Healthcare NHS Trust and Family Action for sharing their time, resources and learning so generously. For more information you can contact Amanda Bradley at [email protected] or Sophie Parker at [email protected]

The Leeds Carers Partnership champions the needs of carers and young carers in Leeds and aims to influence the way that services are planned and delivered in response to their needs and aspirations. The partnership developed an all-age carers strategy so that anyone looking for support as a carer can find all the information they need in one place. A fundamental element of the Leeds all-age carers strategy is a series of ‘I’ statements against which any unpaid carer, including young carers, can judge how well they are being supported by their local system (See 'I' statements' below). Partners in Leeds wanted to demonstrate through their strategy that they understood that caring has impacts across all age groups and that for young carers, an all-age carers strategy supports a smooth transition for young carers into adulthood.

The 'I' statements

The Leeds commitment to carers

As part of its commitment to carers, Leeds City Council has said that they want to make Leeds “the best city for carers” and they invite individuals and organisations to commit to this using a pledge form. The pledge sets out 10 outcomes and asks for three commitments to action against these outcomes. They also host a list of organisations who have signed up to this approach.

Young carers strategic objectives

As part of its all-age carers strategy, the Leeds Carers Partnership set out a series of six strategic objectives, one of which is ‘The right support at the right time for young carers.’ This objective is underpinned by five operational objectives identified by the Leeds young carers working group:

1. Ensure an ‘early-help’ offer is available for all young carers and their families using whole family approaches.
2. Ensure enhanced support is available for young carers where the impact of caring on their lives is significant.
3. Ensure that young carers are supported at key transition points in their lives (for example, to adulthood).
4. Develop a young carers in schools programme.
5. Safeguard the most vulnerable young carers.

Challenges and the role of the young carers working group

In 2019, Leeds City Council set up a young carers working group with a view to recommissioning their young carers service. The council had listened to the views of young carers at a one-off engagement event in 2018 and this informed the development of a new service specification.

The specification was informed by the Leeds commitment to carers, the ‘I’ statements and the Leeds practice model. Following a bidding process, the contract was awarded in April 2020 to Family Action, a national charity which has been working with families for over 150 years.

The Leeds Practice Model

• Always working WITH – creating a context of high support and high challenge with children, young people and families and each other. 
• Relationship based – assuming that engagement and best outcomes are achieved through trusting and respectful relationships with each other, taking responsibility for creating and maintaining effective relationships at all levels. 
• Enabling the utility of the family – putting the family at the heart of everything we do; recognising and enabling the networks and skills within the family; and wherever possible, families determine the direction of care and intervention. 
• Early in the life of a problem - engaging families in appropriate and effective support immediately when an issue is identified and maintaining a persistent offer to engage in support. 
• One family, one lead worker, one plan - wherever possible, working to reduce numbers of practitioners involved with a single family and defining one lead practitioner to coordinate a single comprehensive family plan. Where agencies are also involved with the adults in the family, a ‘Think Family, Work Family’ approach should be adopted . 
• Systemic, formulation-driven and evidence based - all plans consider the whole system around a family, information is effectively analysed, and plans are created using the best available evidence. 
• Transparent - children, young people and families are as fully informed as possible and are always involved in and understand decisions that concern themselves and their families. 
• Strength focussed - all interactions, interventions and plans are seeking, affirming and utilising existing knowledge, skills and abilities; and adopt an evidence-based approach to assessing needs and managing risk. 
• Recognising that engagement with education is a protective factor – seeking to maximise attendance, attainment and achievement. 
• Accountability, evaluation and sustainability - always working to continually understand a situation, improve plans and find ways to enable independence and reduce reliability on services.

When Family Action took up their contract, Leeds was facing long waiting lists for both young carers assessments and transition assessments, sometimes needing to close the waiting list altogether. Historically, the approach taken was that as soon as a school or other agency identified a young carer, they would refer them to the young carers service, with no real understanding of the caring role they were undertaking, its impact, the level of support or the type of assessment which may be needed. This could result in multiple referrals from different agencies and young carers having to tell their stories multiple times.

A ‘resilience-based’ approach to support for young carers had also been taken, meaning the focus tended to be on supporting young carers to continue caring, rather than enabling them to reduce or limit their caring responsibilities by providing better, more timely help to those they support. The aim of the new service from Family Action was to make the proactive identification of young carers everyone’s business, and to develop a single initial assessment which could be carried out by any setting, service or partner organisation in the city, recognising that not every young carer needs specialist support or intervention at the point they are identified.

This new approach has proved highly effective in reducing waiting lists for assessment and works towards ensuring that young carers in Leeds are not providing inappropriate or excessive amounts of care. It also ensures that young carers are not experiencing multiple assessments or having to repeat their stories many times to different professionals.

The original young carers working group was made up of colleagues from council commissioning, adults and children’s services, alongside NHS representatives. The working group has evolved and now includes 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. Strategic oversight of the young carers working group sits with the Leeds Health and Wellbeing Board.

This multi-agency approach, alongside joint funding from children’s, adults’ and health services, has been critical to securing agreement and commitment to the co-produced Leeds single referral pathway and brief assessment tool, alignment to the Leeds Practice Model and all-age carers strategy, and sign-up to the Leeds ‘No Wrong Doors for Young Carers’ MoU.

The response to the challenges faced by partners working with young carers in the city came in the form of a single ‘No Wrong Door for Young Carers’ Leeds single referral pathway (see diagram below) (closely aligned to the template Memorandum of Understanding) which all system partners in the city signed up to. This Leeds pathway is a graduated response to how young carers and their families are supported in the city, and is used by any service which first becomes aware that a child or young person may be providing care for a family member. The identifying service explores this further, using a brief assessment tool, to arrive at a judgement about what further support, if any, is required by the family, which may include a referral to Family Action for a young carer or transition assessment. 

One of the key benefits of this single pathway is that frontline workers in all settings are more confident about the approach to take city-wide, and everyone is aware of the steps to follow using the same pathway.

‘A Day in the Life’ - a brief assessment tool to identify and support young carers in Leeds assessment 

The Leeds Young Carers brief assessment tool is called “A Day in the Life of …” and was developed to support professionals to better understand a child or young person and their family situation. An early help approach to identifying and supporting young carers in Leeds is crucial so the first service to become aware that a child or young person under 18 may be providing care for a family member is responsible for exploring this further, establishing who is providing care, at what level, the impact this is having and what support could be offered to the family. The brief assessment helps decide which service is best placed to provide appropriate support in line with the Leeds single referral pathway. At any point, Family Action can be contacted for information and advice, even if the outcome of the brief assessment concludes a referral to their service is not required.

There are four potential outcomes from the brief assessment:

1. No care is being provided by the child or young person. Where other adults in the household are providing care, they can be signposted to Carers Leeds who support adult unpaid carers.
2. The child or young person is providing a certain level of care but considering age, capacity and impact, this is appropriate, and no additional support is required. This should be regularly reviewed to ensure a speedy response should things change.
3. The child or young person is providing care, and the child, young person and/or family requires some additional support. The additional support can be provided by existing services or by referring to universal and/or targeted services which could include family support or early help services.
4. The child is providing inappropriate and/or excessive care. The child or young person should be referred to Family Action and a full young carer needs assessment completed with the child or young person and their family. The young carer needs assessment includes transition and support planning where appropriate.

The Leeds single referral pathway

The pathway recognises that existing universal and targeted services will often meet the needs of families, however for those young carers who are undertaking inappropriate or excessive caring tasks, a referral to Family Action should be made. A referral to Family Action will include the brief assessment and a completed ‘Understanding me and my family’ form.

Children’s social work services do not need to complete ‘Understanding me and my family’ if a completed child and family assessment and most recent plan can be supplied in its place.

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To support the implementation of the Leeds referral pathway, Family Action developed the ‘We are young carers friendly Leeds’ programme, an offer to all settings in Leeds working with children and young people, aged five to 18. The aim of the programme is to ensure that all settings are ‘young carer friendly’ and operate to the same quality standards, ensuring that regardless of the setting or service which has first contact with a potential young carer, they can expect a consistent, timely and appropriate response. Achieving this means that the whole frontline workforce, whether in health, education, children’s or adult services, or in commissioned and non-commissioned services, is equipped to identify young carers, support young carers and their families, understand the Leeds pathway, the brief assessment, and when to refer to Family Action.

In support of this ambition, Family Action has developed a ‘We are young carer friendly Leeds’ quality mark which is awarded to settings who can demonstrate how they meet an agreed set of standards. These standards were co-produced with young carers, who also designed the logo. The aim of the quality mark is to embed systemic change and to ensure support for young carers is not just a ‘bolt on’ but is embedded throughout all settings which may have contact with young carers.

The quality standards for young carer friendly settings

A designated lead for young carers 

A named, visible lead who has oversight of young carers in their setting, who actively champions them, and joins quarterly meetings for designated leads locally; the role involves sharing good practice, current policy and other developments, sharing case examples, promoting the needs of young carers in local communities, and supporting their organisation to embed good practice in the identification and support of young carers and their families.

Staff training 

Providing a core training package and practice development sessions which support all staff to identify and support young carers and their families and to understand the whole system, whole council, whole family approach to providing support for young carers and their families in Leeds, including the Leeds single assessment and referral pathway.

Safe space for young carers

On-site facilities for young carers which are safe, quiet, confidential, and have IT equipment and WiFi access; young carers know who they can speak to or how to access support when they need it.

A positive, professionally curious culture

An organisational culture which fosters and embeds awareness of young carers, and in which the needs of young carers and their families are actively discussed; professional curiosity is a feature of discussion, enabling a holistic view of what life is like for a young carer and the risks and impacts caring can have on their life choices and opportunities.

Identifying young carers

Robust systems, policies and procedures are in place which support the identification and support of young carers.

Reporting and monitoring 

Young carers are identified and recorded on data monitoring and safeguarding systems which support the reporting and oversight of young carers as they journey through a setting.

Support and signposting

Young carers are signposted to the help and support they may need to reduce their caring role where possible. There is engagement with other organisations and services to ensure the whole family has the appropriate support in place. Information about being ‘Young Carer Friendly’ is shared both internally and externally with other settings and with families. Information on the Leeds single referral pathway and other useful information is accessible for young carers, their families and professionals through the Family Action Leeds website, alongside other national resources.

‘We are young carer friendly Leeds’ support package from Family Action

Family Action provide support to settings who wish to achieve the ‘We are young carer friendly Leeds’ quality mark. This package includes:

• bespoke support to settings wishing to achieve the quality mark
• a set of quality standards co-produced with young carers (see above)
• an action plan agreed with a setting as they implement the quality standard, and which is reviewed and updated at least every six months
• a certificate and templates which settings can display once accredited
• a network of designated young carer leads who come together to share good practice and champion young carers
• community engagement practitioners who deliver practice development, training information and resources to children, family and adult services in Leeds and enable settings to review their current young carer identification and support mechanisms and establish a robust action plan to improve outcomes for children and young people. The programme is designed to ensure that settings have a designated lead for young carers and staff are trained and skilled to be able to identify, support and appropriately refer young carers in Leeds.

The 0-19 public health integrated nursing service (PHINS) within the trust is uniquely placed to raise awareness and identify young carers as part of their day-to-day role, including in schools where they raise awareness about young carers and the support available to them as part of the national child measurement programme (NCMP) which weighs and measures reception age children and those in Year 6 (10 to11 years old).

All staff within the 0-19 public health integrated nursing service undertake enquiries with young people and family members during core visits, such as antenatal, birth visit and development reviews, as well as part of other health assessments with young people. PHINS review the support needs of the young carer and their family, discuss strategies that may minimise the impact of caring, and signpost and liaise with other professionals where needed.

Family Action and the 0-19 young carer lead in the trust offered joint training to the entire service as the single referral pathway was being developed. This training focused on why it’s important to identify young carers, the impact of being a young carer, and understanding the pathway and how and when to refer. The 0-19 service in the trust participates in the Young Carer working group and is a signatory to the MoU. Family Action and the young carer lead in the trust continue to offer training and each team within the 0-19 service has a young carer champion who shares information and updates with their team, and act as a point of contact if practitioners have questions, alongside the 0-19 young carer lead. These champions join the designated young carer leads’ meetings set up by Family Action.

Because of the work already accomplished in embedding the Leeds single pathway, it was not difficult to secure partner buy-in to the MoU. The Leeds version of the MoU was signed in April 2022 by the council’s children and families directorate, the adults and health directorate, the NHS integrated care board and the Leeds Health and Wellbeing Board. Exactly as intended, Leeds adapted the MoU to take account of local requirements of system partners and governance arrangements. The council are happy to share their MoU with others, please email [email protected].

We asked colleagues in Leeds for their reflections on what have been the key factors enabling them to embed their single referral pathway and secure system-wide sign up to ‘No Wrong Doors for Young Carers’ template memorandum of understanding. 

These were the things which made a difference:

• an active and engaged young carer working group with a diverse, cross-sector membership able to make commitments on behalf of their respective organisations and with a clear action plan
• alignment of approaches to early help and young carers, making these ‘everyone’s business’
• a programme of awareness raising across all settings and sharing learning and insights through the designated leads forums
• making changes within the local system, especially sign-up to the brief assessment and embedding use of the Leeds pathway for referrals; there is now the expectation of a routine enquiry about young carers at all contacts with families and young people by all staff within any given setting
• relationship building across the city and growing a network of young carer-friendly settings
• a comprehensive support offer through the ‘We Are Young Carer Friendly Leeds’ programme which includes relationship building, training, staff updates, quality standards and designated young carer leads forums
• providing not just training to settings, but a quality standard which ensures good practice is fully embedded
• understanding the city’s needs and the system-wide landscape as it relates to young carers
• ensuring the referral pathway is fully aligned to the all-age carers strategy, national legislation and policy, the template memorandum of understanding, and the Leeds practice model
• the setting up of designated young carers leads meetings, a group to allow front line practitioners from universal and targeted services to come together and share good practice.

The support provided through the ‘We are young carer friendly Leeds’ package from Family Action has been essential to embedding the brief assessment and single referral pathway. As a result of implementing this approach, Leeds partners have observed a marked reduction in waiting times for a young carer’s assessment. Routine enquiries about young carers at all contacts with families and young people by staff within any setting have become the norm, and these staff are clear about next steps by following the single referral pathway. There has been an increase in staff awareness of the impacts of being a young carer, increases in young carers being identified and as a result, earlier interventions to reduce or limit the impact of caring on young people have been offered.

Despite the significant achievements to date, colleagues in Leeds tell us there is always more work to be done in achieving staff confidence and consistency in asking about young carers as part of their routine enquiries and offering appropriate support. There can also be pressures on specialist staff capacity when, for example, large numbers of young carers previously ‘not known’ to the local system are identified, for example, through the national child measurement programme and an assessment response is required. 

We hope that by sharing the great work happening in Leeds to support young carers and their families, councils and colleagues working in local systems will feel inspired to ensure that there really are no wrong doors for young carers to get the support they need when they need it, and can continue to live their best possible lives.  

Leeds resources

The Leeds Young Carers brief assessment tool “A Day in the Life of …” and ‘Understanding me and my family’ form

One minute guides

Leeds has developed a comprehensive list of One minute guides on a broad range of topics.

Useful guides include:

One minute guide: Early help

One minute guide: The Leeds Practice Model

One minute guide: young carers

One minute guide: child friendly Leeds

Family Action Young Carers Leeds webpages

Leeds Young Carers Support Service information leaflet for families

Leeds Young Carers Support Service information leaflet for professionals

Leeds Young Carers Service QR code with postcard

Leeds Young Carers Service poster 1

Leeds Young Carers Service poster 2

Leeds Young Carers Service poster 3

Leeds Young Carers Service poster 4

MindMate helps young people in Leeds find out more about being a young carer, how they can care for themselves and links to other emotional support available to them

West Yorkshire Carers Hospital Discharge Toolkit

Other resources

The Care Act and Whole Family Approaches

Carers Trust dedicated webpage for ‘No Wrong Doors for Young Carers’ MOU which includes Implementation Guidance, a briefing note, suggested to-do list, checklist for transition assessments and a young carers needs assessment checklist plus slides from the launch of the latest iteration of the MOU in February 2024.

Carers Trust (2020) has also published a set of training resources to support professionals identify and support young carers

Carers Trust (2023) Young Carer Mental Health Toolkit

Carers Trust (2019) Identification Practice of Young Carers in England – Review, Tips and Tools

Young Carer Support App for Android phones

Young Carer Support App for Apple phones