Last Wednesday the new Care Act came into force. It overhauls social care legislation in England for the first time in 60 years and has implications for people working in the NHS, including GPs. It places statutory obligations upon Local Authorities to afford carers the same legal right to a needs assessment, practical or emotional support and information as those they care for. The guidance recommends that health care professionals should identify carers and direct them towards support from the third sector or Local Authorities, so they can get the support they need. Having met and worked with many people who are caring for someone with cancer, I know that they really do need this support.
Identifying and supporting carers falls naturally into the remit of GPs, given our daily contact with them. Well supported, with information and practical or emotional help, carers will be better able to both look after themselves and the person they’re caring for. It could reduce unexpected, and potentially avoidable, hospital admissions which may occur when care arrangements break down.
There are over 1 million carers in the UK who are looking after friends or family members with cancer.1 The wide-ranging care they provide is undoubtedly important, but can have a big impact on their own physical health and mental wellbeing. Just under half of cancer carers (46%) report an impact on their emotional wellbeing and mental health. Some also report physical problems, including exhaustion, sleep problems and back pain.
Despite this, half of cancer carers currently report not receiving any support. This is partly because they may not seek help putting the needs of the person they’re caring for first. This may endanger their own health and diminish their capacity to care for their loved one.
It is also because identifying carers is not always straightforward. Research shows that GPs currently identify only one in seven carers.2 Our demanding schedules and heavy workload put pressure on our time with patients, leaving little time for the needs carers, but also less than half of people caring for someone with cancer identify themselves as carers, preferring to see themselves as, for example a wife or son of the patient. Many assume that the term ‘carer’ only refers to a paid care assistant.
Raising awareness in primary care teams of the important part that carers play in the lives of patients with cancer, but also the potential impact on their psychological and physical health is a useful starting point. Asking our cancer patients about who supports them may identify many more people who have important roles but may not be thought of by the patient or themselves as a “carer”.
Having identified people in caring roles, we have the opportunity to provide support. The most common support carers of patients with cancer want is information, so directing them to Macmillan’s website and phone line is a simple and quick first step to help carers get the support they need.
With the number of people living with cancer set to increase from 2.5 million today to 4 million in 2030, the number of people caring is also increasing. Evidence of the impact of caring is clear and carers need support.3 The new Act seeks to address this need. I’m hopeful that with extra support, from government, health bodies, local authorities and the third sector, GPs can play a lead role in identifying cancer carers and ultimately improve cancer patients’ outcomes as well as those of their carers’.
Dr Rosie Loftus is joint chief medical officer at Macmillan Cancer Support and a practising GP in Kent. Macmillan’s website is http://www.macmillan.org.uk/ and its phone line (0808 808 00 00) is open Monday-Friday, 9am-8pm.
1 Macmillan Cancer Support/Ipsos MORI, More than a Million: Understanding the UK’s carers of people with cancer. 2012. http://www.macmillan.org.uk/Documents/Cancerinfo/Ifsomeoneelsehascancer/More_than_a_million.pdf
2 Carers Week, Prepared to care? Exploring the impact of caring on people’s lives. 2013
3 Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107: 1195-1202. (Projections scenario 1).
Macmillan analysis based on extrapolation of 2010 and 2020 projections that the number of people living with cancer will hit an estimated 2.5 million in 2015.