Carer’s Triage Service – Qualitative
evaluation of the impact on District
teams
January 2014
Version
Date
Authors /
Contributors
Version Control
6
26th February 2014
Joanna Cooper
Penny Spice
Reablement Monitoring and
Commissioning Manager
Evaluation Officer
Adult Social Care, Health and Public
Public Health Nottinghamshire
Protection
County and Nottingham City
Sven Watmore
F2 Doctor
Public Health Nottinghamshire
County
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Kate Whittaker
Commissioning Officer
Adult Social Care, Health and Public
Protection
Contents
Contents .................................................................................................................................................. 2
Executive Summary................................................................................................................................. 3
1 Introduction .................................................................................................................................... 4
Service Description ............................................................................................................................. 4
Evaluation ........................................................................................................................................... 5
2 Method ........................................................................................................................................... 6
Methods.............................................................................................................................................. 6
Reflexivity ........................................................................................................................................... 7
3 Results ............................................................................................................................................. 8
Communication between departments/team members ................................................................... 9
Uptake of the service.......................................................................................................................... 9
Pressure on District teams.................................................................................................................. 9
Unfamiliarity with the carer’s assessment service ............................................................................. 9
Benefits to district teams ................................................................................................................... 9
Benefits of the service for carers........................................................................................................ 9
Desire to improve standards ............................................................................................................ 10
Quality of Referral pathway ............................................................................................................. 10
Scepticism about the service ............................................................................................................ 10
Limitations of the carer’s triage service ........................................................................................... 10
Limitations of service provision ........................................................................................................ 10
4 Limitations of the evaluation ........................................................................................................ 11
5 Conclusion ..................................................................................................................................... 11
6 Appendices:................................................................................................................................... 12
Information sheet ............................................................................................................................. 12
Consent form .................................................................................................................................... 14
Interview questions .......................................................................................................................... 15
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Executive Summary
An evaluation plan for the Carer’s Triage Service was agreed during development of the service to
answer a number of evaluation questions. This report concerns the questions relating to the impact
on the District teams. This part of the evaluation was led by officers from Public Health
Nottinghamshire County and Nottingham City.1
A qualitative interview methodology was used to conduct interviews with the district team
managers from the Broxtowe and Gedling teams. The data gained from these interviews was
analysed using thematic analysis. The resulting themes suggest that the service was positively
received. The main themes identified from the interviews were the benefits of the service (both to
the district teams and carers), the service relieving pressure on the district teams and positive
relationships between the district teams and Carers triage service. To develop the response to this
evaluation question, the views of other district team managers should be sought once the service
has been rolled out to other districts.
In the development of the service it should be recognised that there is an overlap between the
Carer’s Triage Service and the services offered by other teams within NCC. There is a need for the
Carer’s Triage Service to proactively collaborate with different NCC services (district teams, START
etc) to both support carers holistically, and for better coordination between service user and carer
assessments.
1
Independent from commissioning/procurement of the services
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1
Introduction
Service Description
The aim of the carer triage system is to ensure that carers contacting the Department can access
timely and accurate information to support them in their caring role. Whilst people requesting social
care support were ‘triaged’ through the Adult Access Team (AAT), carers were not. Previously they
were either provided with brief advice/information from Customer Service Advisors or referred to
district teams for a carer assessment. The implementation of a carer triage process has enabled an
initial professional judgement to be made regarding the level of care provided by the carer, the
impact of the caring role and the likelihood of eligibility for services (primarily the carers’ personal
budget) if referred on to a district team. The triage system also ensures that carers receive
information regarding services that they can access directly themselves, for example the Carers’
Federation and the carers’ crisis prevention service.
When appropriate, the triage system enables a full carer assessment and/or review to be completed
and a carers’ personal budget to be commissioned on the telephone. However, if the case is already
open to a district team, or if particular communication issues/other complexities are identified, the
carer will be referred on.
Objectives








Ensure that carers contacting the Customer Service Centre (CSC) receive accurate and timely
advice/information through direct (telephone) contact with a qualified social worker.
Complete part A of the carer assessment, with a view to making an initial professional
judgement regarding the caring role and eligibility for the carers’ personal budget.
When appropriate, complete part B of the carer assessment and commission a carers’ personal
budget, and complete a carer review
Ensure that carers are aware of universal services available to them, regardless of Fair Access to
Care Services (FACS) eligibility, for example the carers’ emergency card and the Carers’
Federation.
Ensure that all main carers identified by the Adult Access Team are linked to the person that
they care for on Frameworki
Deliver training to the Adult Access Team and CSC staff regarding carer support services
Develop up-to-date knowledge of services supporting carers in all districts of the county
Provide a contact point for GPs and other primary care staff to offer advice and information
regarding carer support
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Evaluation
An evaluation plan was agreed during development of the service between Adult Social Care, Health
and Public Protection, and Public Health to include the following:
Evaluation measure
Highlight reports
Lead person
Bob Saul
Timescale
Monthly (first
report due July
19th)
Summary report re initial pilot in Gedling (summary Bob Saul/Yasmin September
of quantitative/qualitative outcome data above and Raza
2013
recommendations for phase three)
Focus group (Gedling teams) analysis
Joanna Cooper
December 2013
Summary report re phase two (data as above and Bob Saul/Yasmin February 2014
recommendations for phase four and beyond-funding Raza
implications beyond May 2014?)
This report provides detailed information on the methodology employed and analysis of the impact
on District teams. The methods and analysis are presented below.
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2
Method
Aim: to understand the impact that the carer triage service is having on
district teams.
Reason for selection: members of the district teams where the carer triage
service has been rolled out
Methods
In order to answer the evaluation question outlined above, data was collected using interviews with
District Team Managers from Gelding and Broxtowe. Since development of the evaluation plan, the
approach to this question has been amended.
Initially, a focus group was suggested with the Gedling Team, however, it was highlighted that only
the Team Manager had contact with the Carer’s Triage Service. Consequently, a focus group with the
managers from Gedling and Broxtowe was decided upon to explore the differences between areas,
however, this was not feasible due to time constraints of the Team Managers and interviews with
each manager took place separately.
Questions for the focus group were developed by Public Health and circulated to the commissioners
for comment to agree a final set of questions (see appendices). These questions were used for the
interviews.
Questions were open and the format was semi-structured. Deviation from the questions to explore
and further understand participant’s comments was permissible: all areas were covered according to
their appropriateness to the interviewees’ unique personalities, and interviewees were given the
space to go off topic if required.
The interviews were conducted and analysed by:
 Joanna Cooper (interviews and analysis)
 Sven Watmore (analysis)
(Public Health Nottinghamshire County and Nottingham City – both independent of service
delivery).
Kate Whittaker and Joanna Cooper, with support from the Public Health admin team, liaised with
the Team Managers to identify suitable participants to take part in the focus group. This is a whole
population sample of the areas of Nottinghamshire that the Carer’s Triage Service was operational in
at the time of the interviews.2
The interviews took place at County Hall with the officer named above. Each interview was
audiotaped using a handheld Dictaphone and later transcribed for analysis.
In order to answer the evaluation questions ethically and with sensitivity to the cohort, an
information sheet was provided with details about the focus group/interview and a form to obtain
informed consent (see appendices for Participant Information Sheet and Consent Form). This
2
The service is now operational in other districts of Nottinghamshire
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information was circulated prior to the interview and reviewed again before starting, participants
were:
 told what the interview was about
 given time to read the information and ask questions they had
 asked to sign the consent form
 given the opportunity to withdraw from the process at any time
 assured that confidentiality would be maintained as far as possible
 not offered any incentives for participation
Participants were encouraged to feedback their comments or questions after the interview and were
given contact details on the Participant Information Sheet.
Thematic content analysis was used to analyse the qualitative data collected. This method of analysis
allows data to be simplified into initial ‘themes’, which reflect participants’ experiences. Similarities,
patterns and inconsistencies are identified, the coding framework is refined and developed, and the
process repeated until no new themes emerge from the data. Themes are then synthesised into
broader conceptual ‘categories’ that account for participants’ experiences of the services, and from
which generalisable statements can be made. This process was completed collaboratively.
Data reported will not be identifiable to any particular participant.
Reflexivity
When reviewing the method/results, it should be noted that the interviews, development of
questions and analysis have been conducted by people with characteristics that may differ from that
of the cohort; public health / health background rather than social care, and from outside of the
Nottinghamshire area.
Although the interviews were conducted in an environment known to the attendees and convenient
for them, interviews are artificial and inevitably certain dynamics, such as power relations and
authority, can play a role. In order to mitigate against these competing dynamics, efforts were made
to:
 appear formal yet relaxed, both in dress and delivery
 utilise a semi-structured interview schedule so that the interviewer was able to reduce any
potential bias
 involve more than one person in formulating the questions and data analysis thereby
increasing the validity of the results
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3
Results
The following data sources were included in analysis:
 two interviews with Team Managers for Gelding and Broxtowe
All potential participants gave their consent and no participants withdrew from the interview either
during or at a later date.
The following themes emerged from the data:
Categories
Service Provision
Carer Focus
Theme
Communication between departments/
team members
Uptake of the service
Pressure on District teams
Unfamiliarity with the carer’s assessment
service
Benefits to district teams
Quality of Referral pathway
Scepticism about the service
Limitations of the carer’s triage service
Limitations of service provision
Benefits of the service for carers
Desire to improve standards
Sources
2
References
8
1
2
1
1
13
3
2
2
1
1
1
2
2
12
3
1
1
1
9
10
The majority of themes emerged from both interviews, with slight variation between the two (which
is highlighted).
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Communication between departments/team members
The team managers often talked of the importance of good communication with the carer’s triage
service and individuals. A majority of the comments reflected positively on their working
relationship. For example, team managers expressed that the carer’s triage service allowed
appropriate allocation of service users to the respective teams, and communication between teams
prevented duplication of work and allowed for timely intervention.
Uptake of the service
From the interviews conducted it would seem that the carer’s triage service was embraced and that
a reasonable number of cases were assessed by the service. This was reflected in the fact that the
team managers were getting substantially fewer referrals through to them (from double figures per
week to “single figures per week”), because they were being picked up by the carer’s triage service.
Pressure on District teams
A recurring theme throughout the interviews was the sense of pressure that staff felt in terms of
delivering prompt and effective assessments. The team managers were keen to emphasise that they
had a substantial workload and that prioritisation was difficult. They also highlighted that they did
not have a particularly large department and that delivering a prompt high quality service was very
challenging. Although their workload was substantial the team managers generally felt that the
carer’s triage service actually provided an effective tool for reducing and effectively directing their
caseload in relation to carers and ensuring that carers in crisis were seen quickly.
Unfamiliarity with the carer’s assessment service
The carers’ triage service was recently implemented in these two districts, and it was clear from the
interviews that not all staff members felt confident using it initially. One of the team managers was
keen to point out that with any changes you will have staff members that take it on quickly, and
others who take a bit longer to get used to new systems.
Benefits to district teams
The team managers were generally quite positive about the carer’s triage service, and were keen to
point out some of the benefits that it has brought to the district teams. For example they
emphasised the fact that in a team with a heavy workload and substantial time pressures, any
scheme that saves you time (such as the carer’s triage service) would be positively received. They
also go on to state that the carer’s triage service has allowed them to reduce the backlog of
referrals.
Benefits of the service for carers
The team managers interviewed were keen to highlight a range of advantages for carers. Team
managers pointed out that due to the carer’s triage service people were being assessed in a timelier
manner (especially those in greatest need). Another advantage which frequently came up was that
carers did not have to leave their homes for the assessment, so it was more convenient for them.
The Team managers also felt that it was beneficial for the carers to be assessed completely
independently of the cared for, and that a huge amount of useful information was collected during
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the triage process. This information was then being used, where possible, to offer carer’s the
support that they need.
Desire to improve standards
Something which was encouraging to see from the interviewees was an acknowledgement that the
current system is not infallible and that there is a clear desire to build and improve on the current
system in terms of care provision for those who need it. One of the areas that the team managers
felt was in need of improvement was communication between individuals and teams to avoid
duplication and improve efficiency. The other idea was to publicise the service more heavily to make
other departments more aware of what the carer’s triage service has to offer, and improve the links
between all ASCH&PP services.
Quality of Referral pathway
There were reports of the referral pathway for the service needing development to account for
carers who need to be seen with the cared for.
Scepticism about the service
One of the team managers reflected on the opinions of staff when they initially heard about the
carer’s triage service. Pointing out that staff members were sceptical about offering a service that
did not allow for face to face contact with carers, as they believed that it would not be personal, and
therefore not well received by carers. However they then go on to say that the initial scepticism was
probably unfounded based on the positive response from carers.
Limitations of the carer’s triage service
The team managers acknowledge that the carer’s triage service has some limitations in its current
form. One issue which was highlighted by one of the team managers was that in a small number of
cases, carers can be assessed once and then be assessed again by another ASCH&PP service, which
can leave the service user / carer frustrated and can present problems for the assessing teams.
Limitations of service provision
The team managers acknowledge that there are gaps that need to be filled in the current level of
service provision. The main limitations currently relate to the provision of emergency and night
responses, and that one of the key areas for development in the future would be to improve the
response times for both carers and the cared for.
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4
Limitations of the evaluation
Whilst the evaluation only focuses on the responses of two team managers, this represents the
entire population (at the time of the interviews). Once the service has been rolled out to further
districts within the County, it would be worthwhile to interview these team managers and revisit the
themes developed here to examine how applicable they are.
Another limitation is the introduction of bias on two levels. The first is on behalf of the interviewees
who would have been aware that the interviewer was associated with the carer’s triage service, and
therefore may have been reluctant to openly criticise the service, especially given the face-to-face
nature of the interviews. The second is confirmation bias in both the themes identified, and the
interpretation of those themes. The use of paraphrasing confounds the conformational bias, but is
unfortunately difficult to escape in this type of review without the use of direct quotes.
5
Conclusion
In summary, an evaluation plan for the Carer’s Triage Service was agreed during development of the
service to answer a number of evaluation questions. This report concerns the questions relating to
the impact on the District teams.
The findings suggest that the service was positively received and the two team managers who were
interviewed in the districts of Broxtowe and Gedling were keen to give feedback on the service. The
main themes identified from the interviews were the benefits of the service (both to the district
teams and carers), the service relieving pressure on the district teams and positive relationships
between the district teams and Carers Triage Service.
In the development of the service it should be recognised that there is an overlap between the
Carer’s Triage Service and the services offered by other teams within NCC. There is a need for the
Carer’s Triage Service to proactively collaborate with different NCC services (district teams, START
etc) to both support carers holistically, and for better coordination between service user and carer
assessments.
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6
Appendices:
Information sheet
Implementation of Carer Triage within the Adult Access Team Evaluation
You are being invited to take part in an evaluation of the Carer Triage Service. Before you
decide whether or not to take part it is important for you to understand why the service is
being evaluated and what it will involve. Please read the following information sheet
carefully. Talk to others about the evaluation if you wish. If you would like more information
please ask Joanna Cooper (contact details are at the bottom of the next page). Please take
time to decide whether or not you wish to take part.
What is the purpose of the evaluation?
Nottinghamshire County Council commissions a range of services for carers provided by the public,
private and voluntary sectors. Earlier in 2013 a new service for carers was set-up, the Carer Triage
Service, to ensure that carers contacting Nottinghamshire County Council can access timely and
accurate information to support them in their caring role.
As this service is new, it is important to find out how the service is working, what difference it has
made and what kinds of things seem to make the service work (or not). As part of this process, we
would like to gather the views of workers from the Broxtowe and Gedling District teams through a
group interview with one representative from each team. This information is vital to planning and
providing effective and quality services, and the findings from the interview will help to develop
future services.
Who is organising the evaluation?
The evaluation is being led by the Reablement Evaluation and Monitoring Officer, from Public Health
Nottinghamshire County.
Why am I being asked to take part?
Gathering the views of staff/service-providers is an important part of the evaluation. As someone
involved with the service you are being invited to tell us about your experience of using this service
and to feedback your views.
Do I have to take part?
No. Your involvement is entirely voluntary and you can withdraw at any time. If you decide that you
do not want to take part, it will not affect your employment or legal rights in any way. You are free
to choose to take part or not, and you may withdraw at a later date.
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What is involved?
You are being asked to take part in a group interview in order to gain your views (two participants).
The interview will consist of around 15 questions about your experience of the service and will take
place at a convenient time and place for you with the Reablement Evaluation and Monitoring
Officer. Before we start, we will discuss “ground rules” which will include maintaining confidentiality
of staff members’ comments made during the session. The interview should take no more than an
hour. During the interview you can give as much or as little information as you feel comfortable
sharing.
The interview will be audio-taped. If you do not want to be recorded this can be arranged and the
interview can still take place. Similarly, if you want the tape recorder to be turned off at any point
during the course of the interview you can ask for this.
Will my taking part in the study be kept confidential?
We endeavour to keep everything you say during the interview confidential in accordance with the
agreed ground rules and your name will not be used in any reports. However, maintaining your
anonymity within the interview will be difficult as you are identifiable to your colleagues that are
also participating. We hope that this will not inhibit you in what you say; should there be anything
that you do not want reported, you should feel free to inform us of this or alternatively ask for the
tape recorder to be switched off.
Under some circumstances, for instance if you told the facilitators that someone was at risk of harm,
this information may need to be passed on to an appropriate person (e.g. their doctor). If this is the
case it will be discussed with you prior to information being shared.
All the information you provide will be stored in an anonymous fashion either electronically, on a
secure computer server which requires a password to access, and/or in locked cabinets at
Nottinghamshire County Council. Stored information will be controlled by Joanna Cooper and only
accessible to selected members of the Public Health Nottinghamshire County team.
What will happen to the results?
Once the interview has been completed, a report will be produced describing the findings. This
report will not include personal details of the people who take part. It will only describe the results
as a whole, and you will not be identified. Anonymous quotes from the interview may be included in
the report. A summary of the findings will be available to all those people who are interviewed and
would like a copy.
If you wish to discuss your involvement in the evaluation at any time, including if you no longer wish
to take part, please contact;
Joanna Cooper, Reablement Evaluation and Monitoring Officer
Public Health Nottinghamshire County
CLASP Block, County Hall
Loughborough Road
West Bridgford
Nottingham NG2 7QP
Tel: 0115 9773577 E-mail: [email protected]
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Consent form
Carer Triage Service Evaluation CONSENT FORM
Please initial box
I confirm that I have read and understand the information sheet for
the above evaluation. I have had the opportunity to consider the
information, ask questions and have had these answered
satisfactorily.
I understand that my participation is voluntary and that I am free to
withdraw at any time, without giving any reason and without my
employment or legal rights being affected.
I agree to participate in the focus group.
I agree to the focus group being audio-taped and transcribed.
I agree that (anonymous) quotes from our group discussion may be
used in the write up of the evaluation.
I understand that any information given by me may be used in
future reports or presentations (anonymously).
I understand that my name will not appear in any reports, articles or
presentations.
I am satisfied that the information I give will be confidential and I
understand that all data will be stored securely and covered by the
Data Protection Act.
I accept that if I tell the facilitators about something that could lead
to someone being harmed, they may need to tell an appropriate
person about this.
I would like to receive a summary report of the findings and am
happy for my email/address details to be stored on a secure server
in order to email/post the report to me when it is available.
(Please provide contact details below)
Name of participant (please print)
Date
Signature
Address or email address (see question 10 above before providing this information)
Name of evaluator
Joanna Cooper
Reablement Monitoring and Evaluation Officer
Public Health Nottinghamshire County
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Date
Signature
Interview questions
Aim: to understand the impact that the carer triage service is having on district teams.
Reason for selection: members of the district teams where the carer triage service has been rolled
out
I would like to ask you about your experience of the Carer Triage Service; there are no right or wrong
answers so don’t worry if some questions appear not to apply to you. Please give as much or as little
information as you feel comfortable sharing and respect the confidentiality of your colleagues taking
part by not discussing what we talk about today with anyone else. A few ground rules:
 Be respectful to each other
 Talk one at a time
 Agree to disagree
Once the interview has been completed, a report will be produced describing the findings. This
report will not include personal details of the people who take part. It will only describe the findings
as a whole, and you will not be identified. Anonymous quotes from the interview may be included in
the report.
As you know, the interview is being audio-taped. If at any point you want the recorder to be turned
off, or anything that you don’t want to be reported please let me know.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Could you tell me what your job role is and what area you work in?
What’s your understanding of the carer triage service?
How does the service operate in your district?
How easy have you found referring to the service?
a. Is there anything that could be improved?
Have you had any difficulties with the service?
Does the service provide anything that sets it apart from other ASCH&PP services?
a. What is this?
How does the service fit with what is on offer in your district?
Do you feel that the current approach is working?
Do you think we are making progress using this approach?
Do you have any suggestions for improving or enhancing the service?
Are there any gaps in provision for carers that this service doesn’t meet?
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