The Triangle of Care scheme is making a difference for unpaid carers at CNWL

This week CNWL has received its second Triangle of Care ‘star’. 

The Triangle of Care is a national initiative that NHS Trusts sign up to, to improve how they involve and support unpaid carers. Teams are rated against six key standards to show how they are identifying unpaid carers, involving them in decisions, giving them appropriate information and signposting them to unpaid carer support.

At least nine per cent of the UK population are unpaid carers, playing a vital role alongside health and social care professionals. Research shows that unpaid carers function best when NHS teams treat them as partners in care, involve them in decisions, keep them updated, respect their expertise and look out for their wellbeing. 

In 2021 CNWL was awarded its first Triangle of Care ‘star’ for involving unpaid carers in inpatient and urgent mental health services. 

On 15 June 2023, an external peer review team, including the national Triangle of Care lead from the Carers Trust, assessed the Trust's community-based mental health services.

The reviewers were impressed by numerous examples of good practice at CNWL, including

• the Carer Dashboard on SystmOne which is making it much easier for staff to identify and support carers, and the welcome pack and information leaflets are now being widely used in many areas.
• work supporting and educating families in Eating Disorder Services where a Carer Peer Support Worker uses her lived experience to encourage individuals and families to work together – empowering carers to support the patient to maintain a healthy weight, reducing the risk of relapse and readmission. By contributing to team discussions, Janet is also able to ensure that carer views are fully included in treatment plans. Janet’s role is directly improving both patient outcomes and carer wellbeing and is an excellent example of how peer roles can help bridge the gap between those who use and those who provide services. 
• work providing mentalisation training to families of people with complex emotional needs. Jarka Hinksman, a carer representative and mental health recovery trainer, provides psychoeducational training to families of people with complex emotional needs which received outstanding feedback, with attendees reporting that this training equipped them to keep their loved one safe in times of crisis, helping to prevent self-harm and suicide. The programme’s format, and the research behind it, helps carers to find their strengths and shows that if carers broaden their knowledge, skills, and understanding of their loved one’s difficulties their own wellbeing and quality of life as well as that of their loved one can considerably improve. Thus, the whole family can benefit.   

• Jarka also spoke about how she and Veronica Kamerling, carer and trainer, who co-chairs the CNWL ToC Steering Group, are being trained in Open Dialogue, an innovative approach to people experiencing a mental health crisis and their social networks (e.g., family, friends, partners) that CNWL has been currently developing. There is certainly an affinity between ToC and Open Dialogue as they both value and emphasise a partnership between the person, their social network and mental health professionals.

• excellent carer involvement work taking place in Brent, where a concerted effort to recruit Carers Champions to each team and train all staff in carer awareness is leading to positive outcomes.

Ann Smith, who Chairs the CNWL Carers’ Council, also spoke about the importance of services giving 1:1 time to carers and Janet Seale, Carer Lead on the CNWL Improvement Academy Board spoke of her work delivering Carer Awareness Training to staff and what an impact this is having, with staff rating their confidence much higher after the training. Janet has also helped to significantly increase the number of carers involved in Quality Improvement projects.

The Trust also has a Governor for Carers. Phillip Perkins, who has been involved in projects to help reduce falls and pressure ulcers. Capturing the carer perspective in improvement projects is an excellent way to make our services more carer friendly, as is having carers on staff recruitment panels, another role that Phillip and other carers excel at.

After the review the national team said:

“We saw good practice around the carer recording on SystmOne, including the addition of a “Borough Tab” to link carers to wider support.

“The Check in and Chat service and the clinical messages of the week reflected well the ‘think carer’ approach across the Trust.”

“There is clear executive and board engagement, an Involvement Strategy and partnership action plan and this was supported by hearing from a Carer Governor and the Chief Operating Officer who we thought really encapsulated the Triangle of Care ethos when pointing out the Trust cannot be assured about quality and safety if we are not gathering feedback from staff, patients and carers and learning from that feedback.”

“There is clear involvement of carers in the training development and delivery and also support to train carers in specialisms, including in Open Dialogue to offer wider support.  This and the Carers’ Council shows great evidence of carer involvement and the passion that surrounds it.

“It was great hearing of your work and having an opportunity to discuss your progress and plans.  We congratulate the efforts of all those involved.”  

Grace Levy, CNWL's Carers Lead, said:

“We are extremely proud to now be accredited for all of our mental health teams across the Trust – this is a huge achievement and we will continue to work closely with these teams to ensure that the good work continues and that carers and families are increasingly involved and supported across all of our services. I would like to thank all of the carers and services users who have supported our team with the roll-out of this scheme, and shared their experiences and feedback with us to help us improve. I would also like to thank our Carer Champions, and all staff working across these teams for their continued hard work and dedication during an extremely busy time with existing pressures. We hope to continue with the momentum that we have built up for the scheme as we enter our stage 3.”