Carers

We have adopted a national initiative called the ‘Triangle of Care’ which is a therapeutic alliance between service users, staff and carers that promotes safety, supports recovery and sustains wellbeing.

The concept of a triangle has been suggested by many carers and professionals who want to ensure that carers are active and equal partners within the care team. It represents partnership working between the physical or mental health professional, service user and carer. The Triangle of Care brings together many years of research with carers about what they feel will benefit them when involved with physical/mental health and learning disability services.

If the Triangle of Care is used properly and a partnership is developed, it helps to promote safety, support on-going recovery and improve the wellbeing of both the carer and the person they care for. We are working to ensure that the six key elements or standards are embedded into clinical practice. The six standards are:

1. Carers and the essential role they play are identified at first contact or as soon as possible afterwards
2. Staff are ‘carer aware’ and trained in the best way to engage with you as a carer
3. Policy and practice protocols regarding confidentiality and sharing information are in place
4. Defined posts responsible for carers are in place
5. A carer introduction to the service and staff is available, with a relevant range of information across the care pathway. 
6. A range of carer support services is available. 

For more information about Triangle of Care please email triangleofcare@cpft.nhs.uk.

Carer assessments for adults caring for adults

• All carers are entitled to a carers assessment. If the cared for person is currently accessing Cambridgeshire and Peterborough Foundation Trust services please speak to their key worker or care co orindator who will be able to referr  you to who is responsible for completing a carers assessment.  
• If the cared for person isnt accessing Cambridgeshire and Peterborough Foundation services the care can self referr or be referred to: 
• Peterborough, adultsocialcare@peterborough.gov.uk /  01733 747474 option 4 
• Referral form link Adult Services contact form - What information are you looking for? - Self (achieveservice.com) 
• Tick "looking after somebody" 
• If you are a professional referring somebody click Yes for  Are you completing the form on behalf of somebody.
• If you are self referring  click No for Are you completing the form on behalf of somebody.   

 

• Cambridgeshire Adult.EarlyHelp@cambridgeshire.gov.uk / 01480 373440   Self-referrals to 0345 045 5202 / careinfo@cambridgeshire.gov.uk 
• Referral form link Adult Services contact form - What information are you looking for? - Contact details - Section 1 - Self (achieveservice.com) 
• Tick "looking after somebody" 
• If you are a professional referring somebody click yes for  "Are you completing the form on behalf of somebody".
• If you are self referring  click No for "Are you completing the form on behalf of somebody".   

Carer assessments for young carers

• All young carers (up to the age of 18) should be  referred for a statutory young carers needs assessment using the on line referral form Young Carers online referral form - Centre 33 or by contacting  03334141809 / youngcarers@centre33.org 

Support for carers

For further information about organisations supporting  carers can be found by following these links: 

Adult carers

Parent carers

Young carers

The Department for Health and Social Care have recently published and updated their consensus statement on Information sharing and suicide prevention (August 2021). Details of this consensus statement can be found here

Inaddition to this statement the Zero Suicide Alliance, on behalf of DHSC, has also published guidance for frontline staff on how to use the consensus statement, which aims to support staff regarding when and how to share information about patients where this may help prevent suicide.

Consent and confidentiality 
At CPFT we believe that carers and family members should be seen as working in partnership with those who provide clinical services. They provide important information that may help doctors, nurses, social workers and therapists to have a better understanding of the needs of service users. In order to be effective, partners, carers and family members need clear information about the service user’s care and treatment, their medication, potential side effects and any circumstances that may put the service user at risk. Confidential health-related personal information is shared between health and social care professionals, involved in a service user’s care, so that they get the safest and highest possible quality clinical care. Inaddition, staff need to include carers in the extended care and support team. A carer’s role requires them to be well informed so they can provide the essential support that service users need. Effective care and better clinical outcomes rely on this three-way partnership (Triangle of Care) between people who experience physical or mental health problems, their families and carers, and our staff. 

Who is a carer?

‘Carers are people who provide help and (unpaid) support to a family member, friend or neighbour who would otherwise not be able to manage. We use the term ‘carer’ in its broadest sense to include the most significant people in the life of the service user, including spouses, parents and young carers. It is also important to note that the carer is not always the “nearest relative”. The term “nearest relative” is defined in the Mental Health Act. The person they care for may have a physical or learning disability, dementia, mental health problems, may misuse drugs or alcohol or may be ill or frail.’

Young carers are children and young people who often take on practical and/or emotional caring responsibilities that would normally be expected of an adult. Informal carers must be given enough knowledge to enable them to provide effective care from an early stage. Carers should be given the opportunity to talk to staff about any difficulties they are experiencing in their caring role.

Duty of confidentiality

Service users have a right to expect that information about them will be held in confidence. Carers can also expect that the information they provide will be held in confidence by the professional care team. However there may be times where there is a statutory duty to share information. For example, if there are safe guarding concerns, for the protection of the public or another individual such as the carer, service user / patient or staff member and if a service user is considered to be at significant and immient risk of suicide or serious self harm to themselves. Crucial to this process is the building and maintaining of trust between service users, professionals and carers. This is the foundation of good care.

Duty to share information

Doctors, nurses and other members of the care team have a duty to share information about the care, treatment, medication and other important information about a person’s health, in order to provide the safest and best clinical care possible. This means that sharing information must be discussed with service users early on in their care. If there are difficulties in sharing information that is crucial to care, this should be seen as a major problem that requires intensive work. Even when there are problems with confidentiality, this should not be used as a reason for not listening to carers or for not discussing fully with patients the need for their carers to receive information and support. Furthermore, this must be done when service users do give consent for information to be shared.

Consent to share information

Confidential information about a service user should only be shared with their explicit permission. If the service user doesn’t give permission, confidential information can only be disclosed in exceptional situations, such as where the service user is at serious and imminent risk of suicide or serious harm to themselves risk. Confidential information might also be disclosed for the protection of the public or another individual such as a carer, service user or staff member or where there is a public interest or legal reason for disclosure without consent. In the absence of consent, it is best practice to share non-confidential information with carers. The care team should cregularly review a service user’s refusal to share information with their carers. The support carers can offer is invaluable in supporting an individual’s recovery.

The care team should seek to understand the reasons why a service user may be declining to share information. The best outcome is almost always that they do agree to share at least some information.  Detailed documentation of any conversation relating to consent and family or carers is imperative. Many service users often agree to share information with carers when their condition improves. Any decision made must always be in the best interest of the service user and to achieve the best possible outcome for them. The provision of general information about mental illness, emotional and practical support does not breach confidentiality. General information can include information about the condition and behaviour it may cause, advice on managing it, particularly in a crisis, and contact details of the team responsible for the service user / patient’s care.

Principles of Best Practice

Staff should seek a service user's views on sharing information with informal carers / family as early as possible. This will usually be during assessment or admission.  This is the time when it is most likely the service user will refuse permission. This may be because they are very unwell, feel betrayed by their carer, or are angry about the carer’s role in their assessment or possible detention.

There needs to be a clear understanding that sharing information will need to be re-visited during the care episode. Regular review of the situation by the care team is essential. The care team should always seek to understand the reasons why a service user may be declining to share information.

Even if permission to share information is refused at this point, staff must still give general information about mental illness and treatment options, discuss the carer’s concerns or fears and signpost them to carer support services. If permission is given to share information with the carer, it is essential that it is shared.

Any decision made must be in the best interest of the service user and to achieve the best possible outcome for them. It is essential that staff explain how and why the decision to breach consent is in their best interest.

The carer may need help and support to understand their relative’s decision to exclude them. Deciding what information is general and what is personal will be a clinical judgement in each case.

The same principle of confidentiality applies to information given by carers. Staff must clarify the carer’s expectations as to who the information can be shared with.

Where the service user withholds consent or lacks capacity and cannot express their wishes clearly, personal information will only be shared on a strictly ‘need to know’ basis.