The Social Services and Well-being Act defines a carer as “a person who provides or intends to provide care for an adult or child”.
The Act further states that “in general, professional carers who receive payment should not be regarded as carers for the purpose of the act, nor should people who provide care as voluntary work. However, a local authority can treat a person as a carer even if they would not otherwise be regarded as a carer if they consider that, in the context of the caring relationship, it would be appropriate to do so. A local authority can treat a person as a carer in cases where the caring relationship is not principally a commercial one”
This definition includes carers of all ages, young carers are carers who are under the age of 18 and young adult carers are aged 18 to 25. Unpaid carers often do not see themselves as carers. They will describe themselves as parent, husband, wife, partner, son, daughter, brother, sister, friend or neighbour, but not always as a carer. A carer is someone who provides unpaid support and/or care to one or more people because they are older, ill, vulnerable or have a disability, Unpaid care is commonly provided by family members, friends or neighbours, it can be provided at home, at someone else’s home or from a distance. Unpaid carers may provide care on a temporary or permanent basis and caring can include physical, practical, emotional and mental health support.
Unpaid carers are the single largest provider of care to people with support needs in our communities, and they save the NHS and social services millions of pounds a year. One estimate puts the value of unpaid care in the UK at £132 billion per year – almost twice what it was in 2001, and close to the annual UK health spend. 
In recent decades the number and proportion of people born with disabilities and surviving into adulthood and later life has increased significantly. Improvements in health care and general health also mean more people are surviving serious illnesses like cancer or stroke. The increase in the number of people living with long-term conditions creates new and more complex demands on our health and social care services which are under pressure from already stretched NHS and social care budgets. Unpaid care provided by family, friends and neighbours is increasingly helping to meet growing demand and plugging gaps in services.
However, the UK’s rapidly ageing population structure and longer life expectancies mean that the numbers of those in need of care and support is beginning to exceed the numbers of working age family members able to provide it. The high proportion of elderly residents in the area has led to the two counties having some of the highest dependency ratios in Wales. Conwy County Borough in particular has a dependency ratio that is one of the highest in the UK, comparable only to seaside retirement areas such as those found on the south coast of England. Though a dependency ratio is not a direct measure of care need or provision (it is mainly an economic measure), it can, when coupled with information about the age structure of our population, be a useful indicator of the requirement for unpaid care amongst older age groups.
Caring for someone else can be demanding, and can lead to physical health problems for carers themselves (from physical exertion such as lifting or carrying, and from general fatigue). Carers can also be faced with pressures on their mental health such as dealing with stress and worry about the person being cared for and the impact of their illness; social isolation and lack time to focus on themselves; money worries due to reduced household income and/or increasing care costs; and feelings of frustration and anger with the person they are caring for and with the situation they find themselves in.
Until such time the 2021 Census is available we continue to use 2011 Census data. According to the 2011 Census, over 13,600 people in Conwy County Borough (11.8% of the County’s population) and over 11,600 people in Denbighshire (12.4% of the County’s population) provide unpaid care. Almost 30% of these carers (nearly 4,000 people in Conwy County Borough and 3,400 in Denbighshire) provide 50 or more hours of care a week. Such high levels of unpaid care provision will have a huge impact on the economic and social well-being of the carers as well as those being cared for. There will also be a toll on both carers’ physical and mental health. Those providing over 50 hours of care each week are twice as likely to be in bad health as non-carers. About two thirds of all unpaid carers are aged 50 or over – in Conwy County Borough 30% are aged 65+; 27% in Denbighshire.
Generally speaking, the proportion of people providing unpaid care increases with age until the 65 and over age group. In the 65 and over age group 14% of people provide unpaid care, which is the same proportion as in the 35 to 49 age group. The majority of the of carers who are in employment work full time and around 30% of carers are retired.
In November 2020, there were 18,250 people in North Wales claiming Carers’ Allowance. This has increased from 15,750 in February 2011. This number is much lower than the estimated 73,000 who provide unpaid care reported in the 2011 Census. However, this allowance is only available for those under pension age, unpaid carers may be eligible for Pension Credit once they are in receipt of their State Retirement Pension.
It will not be available to the majority of people in employment who make up about 50% of unpaid carers. The increase in the numbers claiming is probably due to a combination of an increase in the total number of carers and better awareness of the allowance. These numbers still suggest that there is an issue of carers not claiming the benefits they are entitled to and highlights the importance of welfare rights services for carers. There is also a drive from the Welsh Government to get carers to register with their local authorities. North Wales LA’s work closely with Citizens Advice and NEWCIS to support unpaid carers, specifically those in rural areas who can be more isolated, to maximise income and check entitlements for welfare.
What do we know about the young carer population
The identified number of young carers in North Wales has grown in the last few years due to an increase in referrals through successful awareness raising and positive relationships with partner agencies. At time of writing 1,752 young carers are being supported across North Wales (November 2021). The 2011 census identified 1,500 young carers aged 0 to 15 and 4,000 aged 16 to 24 in North Wales. The 2021 census data will be published in 2022 and reviewed.
Funding for young carers only allows organisations such as Action for Children to support young carers who have a moderate to high caring role / impact of caring. This means that there are a number of young carers in North Wales that will not be captured in the data above and therefore the data should be treated as a conservative estimate.
Young carers in particular are more likely to achieve poorer educational outcomes – which is a key determinant of later well-being – missing an average of 48 school days per year due to caring responsibilities (Welsh NHS Confederation, 2018). Carers aged 16–18 are twice as likely not to be in education, employment or training (NEET) compared to their peers.
As with adult carers, a number of factors influences the relationship between being a young carer and well-being outcomes. In addition to the type, frequency and duration of the care being provided, mediating factors include the family’s socioeconomic situation and the extent of support being provided. Other intersectional factors also have an effect – for example, while nearly half (45%) of young adult carers report having suffered from mental health problems, this increases to 88% for lesbian, gay, bisexual and transgender carers.
Equality and caring
The Equality Act 2010 gives protection for unpaid carers in relation to disability discrimination. For example, carers of a disabled person are protected due to being associated with a disabled person. They are also protected under the Act if they experience prohibited conduct such as victimisation. Carers can also experience significant multi-layer disadvantages due to intersectionality (the overlap of social identities such as carer status, race, sex and socio-economic status). This can affect confidence in accessing services wellbeing and impacting on the outcomes of carers and those they provide care for.
There are still often societal expectations of women as caregivers. The 2011 census showed that women make up the majority of unpaid carers – 57% of carers in Wales are women and women of working age (25 to 64) are significantly more likely than men to be providing unpaid care to someone with a disability or illness or who is older. A higher percentage of unpaid carers than non-carers reported that they were disable (32%) compared with 23%, with unpaid carers aged 16 to 34 years and 45 to 54 years more likely to be disabled than non-carers of the same age groups (ONS, 2021).
As our society ages, the number of people living with complex needs is increasing. It is therefore inevitable that older people will take on a caring role. Most older carers live alone with the person they care for and many also live with life limiting conditions. There is also likely to be an increase in mutual carers as older couples provide care and support for each other.
We know from the 2011 Census that the majority of all unpaid carers are of working age and surveys and consultations completed by third sector carer organisations show that the majority wish to work, but many are unable to because of caring. Financial hardship can also disproportionately affect women because they are more likely to be providing care and providing more hours of care while at the same time balancing work or their own health conditions.
An Oxfam report states that prior to the pandemic more than one in three unpaid carers of people with additional needs providing over 20 hours of care per week were in poverty (Care, Poverty and Coronavirus Across Britain, 2020). The report states that it is often the case that unpaid cares can lose income due to leaving or reducing paid work to undertake their caring duties. Research by Carers UK (State of Caring, 2019) stated that 12% of unpaid carers took a less qualified role or turned down promotion at work. 11% of carers retired early to become a carer.
The report further found that 21% of unpaid carers are or have been in debt as a result of their caring responsibilities, 8% cannot afford utility costs and 4% are struggling with housing payments.
Covid-19 has had a significant impact on carers, this is represented in the consultation responses highlighted in the North Wales Population Needs Assessment. One of the most significant impacts has been the effect on the mental health and wellbeing of unpaid carers. Services closed completely or offered a reduced service leaving unpaid carers to cope. Unpaid carers have told us how stressed they were about keeping the person they care for safe and also worrying about what would happen if they were unable to continue caring Friends neighbours, communities and Third Sector all helped to avert crisis. Key issues reported across the region were the availability of PPE, access to GP and medical appointments and hospital discharge procedures, and being separated from family and friends.
Since the start of the pandemic there has been an increase in the numbers of carers in Wales, the National Survey for Wales found that that by June 2020 35% of people looked after or provided help and support to family, friends or neighbours. This had increased from 29% in the 2019 -2020 full year survey (Unpaid Carers Strategy Wales, 2021). The Office for National Statistics collated key statistics relating to the impact the coronavirus pandemic has had on unpaid carers:
A larger number of unpaid carers than non-carers were worried about the effects that the coronavirus pandemic was having on their life (63% of unpaid carers compared with 56% of non-carers)
Unpaid carers were more likely to avoid physical contact with others when outside their household (92% compared with 88%)
Unpaid carers indicated that the pandemic impacted life events such as work, access to healthcare and treatment, their overall health, access to groceries, medications and essentials
 Valuing carers 2015; the rising values of carers’ support, CareUK
 Wales Centre for Public Policy (2021). Well-being and equalities briefing.
 Wales Centre for Public Policy (2021). Well-being and equalities briefing.
The number and proportion of people providing unpaid care has increased since the 2001 Census – an increase of about 1,350 in Conwy County Borough and 950 in Denbighshire. More than half of that increase (56% of the overall increase in Conwy County Borough and 65% in Denbighshire) has been in people providing 50+ hours of unpaid care a week.
The increase has been mainly in the number of people aged 65+ who provide unpaid care, which increased by over 1,050 in Conwy County Borough and over 850 in Denbighshire. This was an increase from 12.6% to 14.4% of all people aged 65+ in Conwy County Borough and from 12.9% to 15.9% in Denbighshire.
The increase in need for social care identified by the North Wales Population Needs Assessment report is likely to lead to greater numbers of people providing unpaid care and providing care for longer. Changes in working patterns and the increasing retirement age may reduce the capacity of people to provide unpaid care. People moving to the area to retire may also have moved away from the family and social networks that could have provided support.
It is difficult to make a reasonable prediction about future provision of unpaid care, as it is influenced by a complex interaction of factors such as changes in social care provision, long term trends in health and well-being, housing policy, and friendship and family networks. However, a straightforward application of current rates to predicted future populations suggest that by 2035 the numbers of people providing 50+ hours of unpaid care could increase to about 4,300 in Conwy County Borough and 3,950 in Denbighshire – a percentage increase since 2011 of about 8.4% in Conwy County Borough and 16.4% in Denbighshire.
The number of people aged 65+ providing unpaid care is expected to rise by about 1,400 in both Conwy County Borough and Denbighshire – a percentage increase since 2011 of about 35.3% in Conwy County Borough and 45.0% in Denbighshire. An increasing reliance on older carers – who may have age related well-being needs of their own – could be precarious. National population and health condition trends indicate that the greater volume of carers are likely to be caring for older people, and particularly older people with dementia.
These predictions have significant implications for the public sector in Conwy and Denbighshire. Supporting carers by providing respite care and other services is a key priority for helping people maintain their independence in their own home and reducing the longer term burden on the NHS and council services.
It is not unfathomable that some carers may themselves be at risk of, or indeed be living with, domestic abuse also. They may be survivors of historic domestic abuse perpetrated against them by a spouse, or those dependent on their care may also be inadvertently perpetrating abuse against caregivers due in part to illness and infirmity.
Whatever the case, it is essential that training is provided to enable care providers to identify the signs and symptoms of domestic abuse in Carers, to provide an assessment when required and to offer adequate care and support to enable Carers to better manage their situation. There is no specific dataset available either nationally or regionally that looks at carers as a specific population group, in terms of prevalence of domestic abuse.
Emerging trends for young carers
Young carers need to be identified as early as possible so that they can receive the support that they need. The introduction of the Young Carer ID Card aims to help with this. There also needs to be a focus on the mental health and well-being of children and young people with caring responsibilities as a result of the pandemic. Many young carers are worried about socialising in case they carry and transmit Covid-19 to the person they care for.
This means they miss out on opportunities negatively impacting their wellbeing. The Carers Trust undertook a survey with young carers and young adult carers which pointed to a decline in the mental health and wellbeing of hundreds of thousands of young people who provide care for family members. 40% of young carers and 59% of young adult carers said their mental health is worse since the pandemic (Carers Trust, 2020).
Safeguarding (young carers)
There can be a number of factors for young carers that mean safeguarding issues can arise. Young carers are often difficult to identify and this can mean their needs only come to light when there is a crisis. The extent of the child’s caring role and the impact that it has on their own development can be a safeguarding concern in itself, which is why it is vital that services quickly recognise and fully assess their needs to ensure the right support is in place at the right time.
Young carers are vulnerable to the impact of caring on their emotional and physical development, education and social networks and friendship (Becker et al., 2000). Very young carers, those under the age of eight, are at particular risk and have been excluded from some young carers’ assessments and services in the past on the grounds that a child under eight should not have any caring responsibilities. Commissioners need to make sure there is support in place for these young people whether through young carers’ services or other services for vulnerable children.
There may also be differences of view between children and parents about what constitute appropriate levels of care and parents can sometimes be reluctant to engage with services because of negative perceptions or fears relating to the action social services may take.
Young adult carers equally face safeguarding issues similar to young carers. The caring role can place a significant strain on young people, which can impact on their educational attainment, accesses to training and employment and their general health and wellbeing.
Being a young carer does not mean that a child or young person is automatically in need of protection. However, it highlights that services must put preventative processes in place to ensure families do not find themselves in crisis, resulting in child protection procedures being triggered.
Housing is an important part of unpaid carers’ well-being and housing services are a key partner when supporting carers. Carers may face housing issues such as fuel poverty due to a low income, for example, if they have had to give up work. Housing that is not suitable or needs adaptions can make caring more difficult and it can be more difficult for people living in rented property to make adaptations.
Location is also an issue for unpaid carers living in rural communities (See our ‘Living in isolation and access to services‘ topic for more information). Carers Trust has highlighted specific needs of unpaid carers living in remote or rural communities in Wales where social isolation, poverty, deprivation, lack of transport and long distances to travel to access health and carers services mean that rural unpaid carers face additional challenges in accessing services
Unpaid carers can also be concerned that they will be made homeless if the person they care for dies or goes into residential accommodation.
A priority within the Strategy for Unpaid Carers (Welsh Government, 2021) is the physical and mental wellbeing of carers. There is a focus on improving access for respite care to allow unpaid carers to take breaks from their caring roles. Additionally, psychological support is to be extended and should be identified during a carers’ needs assessment. Research by Carers Wales found that 74% of carers in Wales said they had suffered mental ill health and 61% said their physical health had worsened as a result of their caring role. This has been exacerbated by the coronavirus pandemic.
A significant data gap exists for carers at risk of domestic abuse.
This topic does not give consideration to climate and eco consideration needed (for mitigation and adaptation).
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