Triangle of Care: Enhancing health care by bringing together unpaid carers with practitioners and patients

When patients are admitted to a mental health setting for treatment, the greatest source of knowledge and experience of their condition is often a family member or friend who is also the patient’s unpaid carer. But often that valuable knowledge isn’t harnessed effectively.

Carers Trust’s Triangle of Care programme is changing that, bringing the carer’s voice and knowledge into an innovative three-way partnership between patient, practitioner and carer. The result is enhanced treatment, as well as greater support and inclusion of unpaid carers throughout the treatment pathway.

Carers Trust’s Executive Director of Programmes, Policy and Impact, Rohati Chapman, reflects on the Triangle of Care story so far, and talks to Donna Bradford about the “transformative” effect Triangle of Care has made at the Lincolnshire Partnership NHS Foundation Trust, where she is Head of Carer and Relative Experience and Volunteers.

Carers Trust has delivered Triangle of Care since the original guide was launched in July 2010 by The Princess Royal Trust for Carers (rebranded as Carers Trust in 2012 following a merger with Crossroads Care) and the National Mental Health Development Unit and founding carers.

From the start, Triangle of Care aimed to highlight the need for better involvement of unpaid carers and families in the care, planning and treatment of people with mental ill-health. The programme was developed on the basis of clear evidence from unpaid carers that they need to be listened to and consulted more closely.

The Triangle of Care membership scheme is a three stage recognition process for services that commit to self-assessing their existing services. The purpose of self-assessment is to ensure the Triangle of Care standards are achieved.

Triangle of Care is not a kitemark scheme with an endpoint. Instead, the programme recognises long-term commitment from health and care providers who are working in an ongoing process towards cultural change within their trusts.

With the National Triangle of Care Steering Group, our strategy is to continue to ensure that unpaid carers receive full engagement from services, have involvement in health and social care improvements, and are given support to carry out their role. 

We also plan to expand the settings and organisations that can apply for Triangle of Care accreditation to all health and care settings.

Working together we want to continue to ensure unpaid carers receive quality support and involvement in health and social care. We also want health and care teams to be supported to deliver this support for unpaid carers and recognise its positive impact on treatment and outcomes. 

“The Triangle of Care has been absolutely transformative for our trust”

Rohati:

Donna, can you tell us why Lincolnshire Partnership NHS Foundation Trust decided to adopt Triangle of Care?

Donna:

We adopted Triangle of Care thanks to our former Director of Operations. He joined the Trust from another organisation that had already adopted Triangle of Care so he could see the potential of us joining Triangle of Care.

Rohati:

That is great to hear. What do you think has been the impact of Triangle of Care for unpaid carers, as well as patients and staff?

Donna:

The Triangle of Care has been absolutely transformative for our trust. Before we didn’t have a large support offer for carers but after adopting it and using its benchmark principles, that’s all changed. We now have 158 staff trained in  family therapy, which is something we never had previously.

Our Carer’s Council is incredible. It’s a group of 14 carers who meet monthly, together with staff within the Trust, and directly feed in to service development. They are very used to using our services and directly influence the Trust  to change practice.

Our Chief Executive sits on that too so it has real power to influence change. Thanks to them we now have a wide range of information leaflets on our website which are developed by carers for other carers on every subject you can think of.

Rohati:

What has been the benefit for staff and patients?

Donna:

There are obvious benefits for staff at the Trust. For instance, our family therapy is evidence-based and evidence suggests it can reduce relapse and readmission rates by 40%. We have four Carer Champion staff members on our acute wards who are dedicated to supporting carers, keeping them informed and making sure their views are heard.

At an individual level, there are so many cases where Triangle of Care has had an impact too and by involving carers that has a knock-on effect for patients too.

We used to do carer education sessions and one gentleman joined us whose family member had been in and out of services for many, many years and at the beginning he was quite frustrated because he just didn’t feel he was being listened to.

As time has gone on, and we started to work with him, he got really interested to the point where we put him up to be a governor for the trust.

After becoming a carer governor he got full-time employment within the Trust as a senior occupational therapy assistant, leading  on all the carer courses within the Lincolnshire Recovery College. That’s been a real journey for someone who started in one of our education sessions.

Rohati:

Could you explain a bit more about how Triangle of Care works across Lincolnshire Partnership NHS Foundation Trust?

Donna:

Triangle of Care is embedded throughout the trust. So much so that we have Carer Leads in every single team and ward. There are also dedicated Carer Champions on all four acute wards, as well as a Clinical Lead in our Older Adults division and a Carer Peer Support Worker.

The trust has made unpaid family carers one of the five key Trust priority areas for this year. This commitment is underpinned by a quality improvement project which we’ve put in place.

We have a Head of Carer and Relative Experience who leads the work across the trust and an Experienced Senior Mental Health Nurse offers crisis interventions with families. A part time Project Lead is now also in place.

Rohati:

Would Lincolnshire Partnership NHS Foundation Trust recommend Triangle of Care to other providers?

Donna:

Yes, absolutely! Triangle of Care has transformed our offer and service to carers within Lincolnshire Partnership NHS Foundation Trust and ensured that carers are supported and involved in service development.

It has also made a huge difference to our patients, with services that have arisen out of it and ensuring that carers have access to information and support through our services.

We also offer fortnightly education to carers online with a different topic each time to empower them and help them understand a variety of subjects. I would recommend Triangle of Care to every trust to ensure that the carer voice is embedded across all services.

The Triangle of Care programme has been made possible thanks to support from players of People’s Postcode Lottery. To find out more about Triangle of Care, including information on how to join.