Evaluating the Caring with Confidence Programme

Background

Caring with Confidence  was an important measure introduced as part of the 'New Deal for Carers' initiative, first proposed in the 2006 White Paper Our Health, Our Care, Our Say. Previously referred to as the expert carers programme (ECP) it offered carers new opportunities to gain the knowledge, skills and expertise they require to look after both themselves, and those they care for, in a safe, efficient and effective manner, and to access the information and support they need. The Programme was available to carers aged 18 years and above living in England. Carers who participated in the Caring with Confidence would be better placed to exercise greater choice and control in important areas of their lives, for instance in relation to health care, social care support and paid work. In the longer term, this had the potential to lead to carers' increased wellbeing, choice and independence, and to benefit those they care for, enabling both carers and those they support to participate in society according to their own wishes. 

Aims

Working alongside the Caring with Confidence national team responsible for administering the Caring with Confidence Programme, training providers and carers, the research team assessed the extent to which Caring with Confidence meets its objectives to support carers to sustain their own quality of life, and the quality of life of those they care for, in a more effective partnership with health and social care services. 

This study aimed: 

• to evaluate the national team's management of the programme 
• to understand what worked, where and for which groups of carers 
• to identify longer term impacts on carers' lives. 

Methodology

The evaluation combined both quantitative and qualitative research methods. To assess the quality of the programme's implementation, the research team  tracked the national team's relationship with training providers using qualitative interviewing, documentary analysis and observational techniques. In addition, providers were surveyed to determine whether the commissioning process meets the Caring with Confidence objectives and target groups.

A case study approach (involving up to 12 training providers) will be adopted to understand what design, styles and delivery of training work best for which groups of carers, in what circumstances. Training providers were purposively selected to represent a range of organisation types, types of training focus and geographical spread. In each case study site, interviews were conducted with the manager and trainers, and a group training session was observed. Carers from each study site were asked to complete a survey questionnaire, including a validated assessment tool designed to measure changes in the effects of caring, at the start and finish of the training. They were also  asked additional questions about their perception of the course and its impact on them and their caring situation. Follow-up telephone interviews with carers who took part in the evaluation were held four months later, designed to collect information about the longer term effects of Caring with Confidence; the assessment tool was also administered for a third time, by post. Where appropriate, carers were asked to forward a self-completion questionnaire to those they care for, to collect any views they may have about their carer's involvement in the programme.

Carers' involvement

Carers were involved in the research in a variety of ways, over and above being a key study participant group. 

An advisory group was established by the Department of Health to support the project, and carers are amongst the members. 

Carers recruited to a project run by a local carers resource were asked to help pilot data collection instruments, such as questionnaires and interview topic guides.

A consultation group, established to support the Adults, Older People and Carers' team in the Social Policy Research Unit (SPRU), were also invited to comment on different aspects of the evaluation process, where appropriate. 

Researchers in both CIRCLE (University of Leeds) and SPRU worked closely with a wide range of relevant organisations working with or supporting carers, to ensure that user, carer, professional and practitioner perspectives inform all aspects of the work.

Key findings

The programme was designed to provide training and support to carers, thereby giving them greater choice and control in different aspects of their lives. The evaluation found that the carers who participated in the programme were very positive about it and benefited in a number of ways, including: greater confidence in their caring roles; learning new skills; improved health and well-being; better knowledge of support services; and improvements affecting those they cared for. 

A prescriptive and centrally planned approach to the programme design was taken, focussing on high quality, standardised training, comprising a flexible, modular training programme delivered by trained facilitators, based in local training providers. Ambitious targets were set relating to carer numbers, which individual providers and the programme overall had difficulty meeting. Although target number of carers were not met, the programme succeeded in registering almost 14,000 carers, well over 10,238 of whom attended at least one CwC module, with many of these (59%) being fully trained. These carers were reasonably representative of the wider population of carers, and some success was achieved in meeting targets for some particularly hard-to-reach groups.

There was no specific target cost per carer trained or number of modules attended but lower than expected carer numbers led to a relatively high cost per filled carer place. Initial high delivery costs became more manageable for some providers once they had established the programme, and a revised funding regime had the potential to deliver CwC more cost effectively than the initial model used. The report concludes with eight recommendations arising out of the CwC programme evaluation that were identified for future training and support programmes for carers.