A recent report by Carers UK identified that up to 600 people a day need to leave their jobs to care for older, ill and disabled relatives (Carers UK, 2019). Estimates suggest there are 5 million people balancing the demands of work and caring for older people, a 12% increase since 2013. Add to this the numbers of carers beyond working age and young carers and the total estimates are of around 7 million carers in the UK. Three in five people in the UK will be carers at some point in their lives, and by 2030, the numbers of carers will increase by 3.4 million (60%) (Carers UK, 2019). What's worse, these numbers may be under-estimated given the hidden nature of many caring activities, particularly around the growing problems in mental health and addiction, where carers may not seek help because of stigma and embarrassment.
This definition of a carer (NHS England) exemplifies the breadth and scope of the role: a carer is anyone, including children and adults, who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they provide is unpaid, and unpaid carers are estimated to contribute the equivalent of £132 billion a year for the work they do. Evidence suggests they do so at considerable costs to their own physical and mental health, financial security and wellbeing (Carers UK, 2019).
Most district nurses would claim carer support as a key part of their work. However, there is limited research evidence about the impact of district nursing interventions on carers, and any existing research is mainly around palliative and end-of-life care. Care at the end of life at home is of course essential, and district nurses take pride in their contributions to ensure a good death. While there remains scope for improvement for care at the end of life at home, this is an area where the contribution of district nurses toward caring for carers is certainly visible.
So the question is: what about the other carers whose role is less clearly defined, not especially time limited and fairly invisible? Multimorbidity, frailty and enduring mental health problems are linked to ageing populations. Growing demands for support will increasingly overwhelm health and social care services. A key aim of district nursing practice is to deliver person-centred, coordinated and preventive care to reduce hospital admissions and keep people at home (Maybin et al, 2016), and this last aspect is often wholly dependent on carers ‘managing’.
Policymakers do recognise the contributions of carers, although guidance varies. The Care Act (2014) bestows responsibility onto councils to promote the wellbeing of carers. The challenge is what this actually means and what resources district nurses can access to help carers meet their own needs. The Carers (Scotland) Act (2016), enacted on 1 April 2018, goes much further and is the first to set in policy the requirement for adult carers to have a ‘carer support plan’ and for those under 18 years to have a ‘young carer statement’. Both health and social care providers need to prepare a local carer strategy.
It remains to be seen if the Carers (Scotland) Act improves carers' experiences. District nurses are in a key position to enhance carer wellbeing through this act. Impeccable assessment is a cornerstone of district nursing practice, and this needs to include an independent assessment of carers' needs. Involving the carers in joint decision-making and documenting this is crucial if this largely invisible aspect of district nursing work is to be recognised. District nurses need to understand the changing profile of carers and the challenges they face, alongside evolving demographic and societal challenges.