Supporting Carers to Care

Executive Summary

National Audit Office Report - Supporting Carers to Care

1. There are six million unpaid carers in the UK who look after relatives, friends, children or older people who are sick or disabled. The number of carers is growing and the Department for Work and Pensions (the Department) estimates that the number of carers it supports will increase by about a quarter by 2014-15. The nature of care obligations varies. Care may be provided throughout life, during a chronic condition, over distinct periods, or towards the end of a person's life. Appendix One provides examples of caring responsibilities from our survey of carers.
2. The Department is responsible for providing two main forms of support to carers – payment of carers' benefits and provision of employment support, through Jobcentre Plus offices. The Department provides Carer's Allowance at £50.55 per week to 481,000 carers. To be paid this benefit, carers must earn no more than £95 per week after allowable expenses, care for at least 35 hours a week for a person receiving Disability Living Allowance Care Component at the middle or highest rate, Attendance Allowance or Constant Attendance Allowance, and not be in receipt of certain other benefits that overlap. Appendix Two gives further details about the eligibility criteria for Carer's Allowance, and its interaction with other benefits. The Glossary gives a definition of selected terms.
3. Carers on low incomes who satisfy the Carer's Allowance entitlement rules, whether or not they are
   paid Carer's Allowance, can receive an additional payment of £27.75 a week, known as a 'Carer Premium' or 'Additional Amount', in their income-related benefits. The Department estimates the total number of people who receive these payments to be about 469,200. In this report we refer to all these payments as carers' benefits.
4. The Department is also responsible through Jobcentre Plus offices for providing employment services to carers who want to combine paid work and caring, or who want to return to work after a period of caring has ended.
5. We estimate the total cost to the Department of providing support to carers through benefits and employment services is up to £2 billion a year. This report assesses the efficiency and effectiveness of the way in which the Department discharges these responsibilities. The report examines the effectiveness of the Department's delivery of Carer's Allowance, and Jobcentre Plus employment support that carers receive. In addition, we have reviewed how well the Department works with others to make its policies as effective as possible. This report follows the launch of the Government's revised National Strategy for Carers in June 2008, to provide a review of value for money and make recommendations for improving services at a point when the Department is considering and starting to implement changes in carers' policy.

    

   Carer's Allowance

    

6. Carer's Allowance is administered by the Carer's Allowance Unit, a part of the Department's Pension, Disability and Carers Service which itself was created by the recent merger of The Pension Service and the Disability and Carers Service. In May 2008, 883,000 carers satisfied the Carer's Allowance entitlement rules. People who are entitled to more than one non-means tested, 'income replacement' benefit are paid only the one that is worth the most to them (Appendix Two). For this reason, 402,000 people who are theoretically entitled to Carer's Allowance received another benefit instead, while the remaining 481,000 received Carer's Allowance, at a cost of around £1.3 billion in 2007-08. Carers who satisfy the entitlement rules, whether or not they are paid Carer's Allowance, can receive an addition to their income-related benefits. In May 2008, 469,200 received this amount, known as the Carer Premium or the Carer's Additional Amount at an estimated cost of no more than £677 million. As an indicative figure, those carers supported by the Department provide social care whose cost, if paid by the state, we estimate to be approximately £23 billion a year.
7. The Department does not have an estimate for the take-up of the Allowance. It is difficult to determine what proportion of the eligible population of carers applies for the Allowance because of limitations with the available data. We found that some carers who may be eligible do not apply because they do not see themselves as carers, or　because the Department's publicity is not fully effective so they do not know the Allowance is available. Receipt of Carer's Allowance can affect the benefit entitlement of the person cared for. It is not known how many eligible carers do not apply because they want to avoid this impact.
8. Our survey of recipients showed that the large majority did not have problems with the service, but about a fifth found it difficult to apply for Carer’s Allowance. Of this group:
   • just over half of respondents with difficulties found it hard to understand the Allowance's eligibility criteria and to understand and complete the application form;
   • half of those expressing difficulties were unhappy about the length of time it took to process their Carer's Allowance claim; and
   • of the carers who reported changes of circumstances to the Carer's Allowance Unit ten per cent had difficulties, leaving them unsure of their financial position.
9. The interactions between Carer's Allowance and other benefits (for example, Pension Credit and Income Support) are complex, can delay payments and some customers find them confusing. The complexities result primarily from the way legislation is framed and also from the way it is implemented. For example, customers who do not qualify for the full payment of Carer's Allowance still have to apply for it in order to be 'passported' on to other premiums or additional payments.
10. The Department has given priority to improving the efficiency of the delivery of Carer's Allowance over the last few years. Performance targets for processing times for new claims have been met for each of the last three years. Whilst average processing times have increased by two working days since 2006-07, that is because claims are now dealt with on a more equitable, first come first served basis, rather than dealing first with the simpler claims, which tended to be the straightforward rejections.
11. Recent initiatives, carried out as part of the Department's wider Change Programme, and involving the use of 'Lean' management techniques, designed to improve performance at a reduced cost, have enabled the Carer's Allowance Unit to maintain performance while reducing staff numbers significantly. There may be scope for further efficiencies by reviewing the processes where Carer's Allowance interacts with other benefits.

     

    Jobcentre Plus employment support for carers

     

12. The Department does not have specific employment support programmes for carers as a group, since carers are not required by law to be available for work. Within its limited resources overall, the Department has prioritised those benefit recipients who are obliged by law to be available for work or to meet other requirements as a condition of receipt of benefit. Carers who do wish to work can access all mainstream Jobcentre Plus services, but there is considerable variation across the country in the level of support provided by Jobcentre Plus offices. Some Jobcentre Plus Personal Advisers, for example,
    are not aware that carers are exempt from mandatory Work Focused Interviews.
13. Jobcentre Plus staff we surveyed believe that services currently provided to carers are not well-suited to carers' needs. Only one third of Jobcentre Plus Personal Advisers believe carers get the support they might reasonably expect to help them combine caring and paid employment. Personal Advisers identified ways in which the service to carers could be improved within their existing day-to-day responsibilities, and some Advisers provide these services already. For example, Jobcentre Plus does not have a consistent method of identifying and promoting flexible work opportunities that would be helpful for carers who wish to seek short hours or less conventional working patterns. But the Department's capacity for developing and sustaining enhanced services is constrained by the workload resulting from current labour market conditions.
14. Jobcentre Plus is carers' main source of employment support, but our findings show that the service is not accessed by all interested carers. Just over half of carers who used Jobcentre Plus services were satisfied with them. About a quarter of carers who access Jobcentre Plus services however are dissatisfied with the service they receive, primarily because they find staff are not sufficiently helpful, approachable or aware of carers' circumstances.
15. There are gaps in Jobcentre Plus management information about their support for carers, as they are not identified by Jobcentre Plus as a specific customer group. Jobcentre Plus does not know therefore how many carers use their employment support or the cost of providing this support to carers. Neither do they have accurate figures for the costs to Jobcentre Plus of providing additional payments to carers who have an underlying entitlement to Carer's Allowance, though they estimate the cost (excluding administration) of these payments to be no more than £330 million.
16. The Department has made some significant commitments, as part of the revised National Strategy for Carers, to improve employment services for carers. These include up to £38 million of existing departmental allocations to enable carers to combine paid employment and caring through provision of, for example: new Care Partnership Managers who will work with care providers and coordinate Jobcentre Plus programmes and strategies for carers; specialist training; and information about flexible job opportunities.

     

    Working with partner organisations

     

17. Carers benefit from services provided by a range of bodies. The Department recognises that partnerships can help align the services provided and improve carers' experiences of support. It has a range of relationships with other organisations in national and local Government and with national charities which have helped in implementing its policies as effectively as possible. The recent work to produce the revised National Strategy for Carers benefited from the Department's successful relationships with others.
18. The Department of Health is the lead department for the National Strategy for Carers. It leads the new Carers Cross Government Programme Board which will oversee implementation of the commitments from the National Strategy. The Department for Work and Pensions has two representatives at this Board, covering their responsibilities regarding income and employment.

     

    Conclusion on value for money

     

19. The Department currently provides support to approaching 900,000 carers through payment of carers' benefits and provision of employment support at an estimated cost of up to £2 billion a year. This support provides a means for society to share in the responsibility assumed by those who care for people who are sick or disabled. We found that in pursuing this objective the Department is largely successful in delivering carers' benefits efficiently and there have been cost-effective improvements in processing claims in the last few years. The majority of carers who receive support from the Department are positive about their experiences. Around a fifth of Carer's Allowance applicants however experience difficulties to do with understanding the information required and provided by the Department. Furthermore, not all eligible carers are accessing Carer's Allowance or Jobcentre Plus employment services.
20. The Department's help to carers who wish to support themselves through combining paid work with their caring responsibilities is not sufficiently effective for carers. The Department does not consistently identify which job opportunities are flexible and there is a potential disincentive to provide part-time work because it is not part of the Jobcentre Plus target regime. Most people receiving carers' benefits who seek employment support from the Department feel the services do not fully meet their needs as carers. The Department has generally worked well with others in designing and implementing its policies for carers.

     

    Recommendations

     

21. The following recommendations are designed to help the Department improve its services to carers:

Improving the experience of carers

1. The Department does not know the take-up rate of Carer's Allowance. There is currently no reliable estimate of the total population of potential recipients of Carer's Allowance. Estimating the take-up rate is complex because it is based on the take-up rate of other benefits, in particular Disability Living Allowance. The Department has however made some progress in estimating the take-up of Disability Living Allowance. It should extend that work to estimate the take-up rate of Carer's Allowance, in order to understand the reasons for lack of take-up, where it exists, and identify what action would most cost-effectively encourage those carers who are eligible to receive benefits to do so.
2. The majority of carers are positive about their experiences with the Carer's Allowance Unit, but a minority experience problems, mainly with understanding what the Department provides and what information it requests of carers. Carers need clarity about what benefits are available and to whom. The Pension, Disability and Carers Service should consult further with their Advisory Forum to understand better how improvements could be made to information about the availability of and eligibility criteria for benefits for carers. The Pension, Disability and Carers Service should draw up a plan and timetable for improving communications with customers and their carer networks about the application process, eligibility criteria and interaction with other benefits, with the aim of reducing the number of manual checks that are necessary.
3. Having flexibility in their paid employment is key to enabling many carers to combine paid work with their caring responsibilities, but Jobcentre Plus does not have a consistent method for providing information about flexible work opportunities. The Department is committed to improving information about flexible job vacancies in Jobcentre Plus job banks. In line with the revised National Strategy for Carers and as part of its aim to make it easier for carers to combine caring with paid work, the Department should assess the impact of this new facility on carers in terms of job outcomes and customer satisfaction.

    

   Improving support for carers to have a life outside caring

    

4. There is a lack of clarity amongst carers and Jobcentre Plus staff about the extent of employment support services available for carers and the scope to make referrals to other agencies. As a result, not all carers receive a service in line with national policy. Jobcentre Plus should identify where services do not adhere to national policy, and make it clearer to staff and customers what support it does and does not provide to carers. Jobcentre Plus should assess the effectiveness of the new Care Partnership Managers in ensuring adherence to this policy amongst Jobcentre Plus offices across the country.
5. Jobcentre Plus is not consistent in its service to carers. For example, some but not all Jobcentre Plus offices aim to ensure that carers are always seen by Personal Advisers who have experience of assisting similar or related groups, such as lone parents or disabled customers, or who have personal experience of being a carer. The differences may partly reflect the different size and capacity of individual offices. But for a given level of capacity, Jobcentre Plus offices should adopt best practice in the use of staff knowledge and experience and of the new Carers Portal (an intranet site about entitlements of and support for carers) to improve the service provided and customer satisfaction.
6. About 70 per cent of carers and a third of Jobcentre Plus Personal Advisers we surveyed believe services are not as well-suited to carers' circumstances as they could be. Carers share some similarities with lone parents as a group and the Department should make it easier for carers to benefit from services more suited to their needs, such as those currently offered to lone parents, for example funding replacement care whilst attending interviews.

    

   Improving efficiency of support for carers

    

7. Carer's Allowance has complex interactions with other benefits, primarily because of the way legislation is framed, but also because of the way it is implemented. The Department has recognised that there are administrative inefficiencies in its interaction with Pension Credit, affecting up to nearly a quarter of a million carers. As a part of an initiative to encourage staff suggestions for service improvement, the Pension, Disability and Carers Service is currently piloting a new service and procedures under the Carer's Addition State Pension Efficiency Review (CASPER) to improve the administrative efficiency of providing Carer's Additional Amounts to carers who receive Pension Credit. The Pension, Disability and Carers Service should also use the findings from the evaluation to draw up a plan for improving efficiency and customer experience of the process across the system as a whole.
8. There is a potential disincentive for Jobcentre Plus to provide employment support to carers because the Department's targets do not'count' part-time work. The Department and Jobcentre Plus should reinforce their communication about part-time work being a valuable and valued outcome and incorporate this message into objectives for Personal Advisers.
9. The Department has generally worked well with partners to improve alignment of services to carers, but some organisations report they are not always able to make contributions as effectively as they might. The Department should keep other organisations informed of progress by circulating material such as meeting minutes more widely and extending timescales for comment on proposals.