Valuing and engaging carers

Aimee Danzi reflects on the practical steps Betsi Cadwaladr University Health Board has taken to improve its offer to carers

Carers Week provides a welcome opportunity to reflect on the dedication and value of carers and the importance of engaging and supporting them within healthcare settings.


Betsi Cadwaladr University Health Board is committed to delivering for carers, and this is in part evidenced by the existence of my role as Carers lead. In this blog, I would like to focus on one particular approach used by the Health Board to improve carer engagement within Mental Health Services.


In May 2017, we bought together a range of organisations to identify a way forward. Through discussion, it was agreed to develop a formal pilot of the Triangle of Care across North Wales. The Triangle of Care is an approach which was developed by staff and carers to improve carer engagement in acute inpatient and home treatment services.


The original guide was launched in July 2010, and emphasised the need for better local strategic involvement of carers and families in the care planning and treatment of people with mental ill-health.


Since its launch, the programme has been adapted for use across all mental health services, not only inpatient. The Triangle of Care best practice guides and audit tools aim to build upon existing good practice to recognise and include carers as partners in care. It offers key standards and resources to support mental health service providers that can be incorporated in their everyday practice, policies and procedures.


Betsi Cadwaladr University Health Board established a task and finish group, to undertake a range of tasks including:


  • Mapping what Triangle of Care provisions were currently in place throughout mental health services across the whole health board
  • Sourcing feedback from professionals and carers about how these services could be improved and built upon
  • Supporting, extending and standardising the provisions that the Health Board already had and looking at future opportunities to continue to build upon this
  • Presenting findings to Service User Experience and Mental Health Heads and ultimately help inform the work of the Patient Experience Group and the Mental Health Strategy


The Triangle of Care task and finish group brought together a range of professionals and experts from a number or organisations including: Betsi Cadwaladr Health Board, Carers Trust Wales, Hafal and Caniad (a commissioned service that aims to deliver better health and wellbeing for the users of alcohol, drug and mental health services, their carers and their communities).


Since its inception the group has completed audits with a multi-disciplinary approach including a health professional, carer and third sector representative, with very positive outcomes.


Themes and Trends identified to date.

Using the Triangle of Care self-assessment process, it was very clear from initial conversations with staff and carers that there was a need to improve awareness of carers, processes for engagement and training for staff.


As part of this, we were able to identify the need for a renewed focus on developing:

  • clear pathways for carer engagement and inclusion,
  • systems to follow once a carer had been identified to ensure they receive the right information and support
  • processes to ensure appropriate consents were obtained and confidentiality protected and
  • inclusive approaches to involving carers in the care and treatment planning process


Partnership Working

Hafal and Caniad were key partners in supporting the completion of the self-assessments which, in most instances, involved staff and carers.


There were a range of approaches used to help allay any staff fears in completing self-assessments honestly, which was crucial to ensuring that the right support and training is put in place. For example, one unit actively encouraged completion of the audit independently by carers to offset any power imbalance, this not only helped compare perspectives but proved extremely insightful.


My role has been central in the facilitation, training and support for all the pilot sites. This has included meetings with the Ward Manager and Carer Champion of each unit in turn. The meetings have been extremely productive and offered an opportunity to:

  • scrutinise the findings from the self-assessments
  • apply recommendations of how to improve on certain areas
  • discuss how best to make changes to policy and paperwork to forge a legitimate carer pathway


Regular support, advice and guidance were provided throughout by Carers Trust Wales in relation to the approach, audit reviews and additional Triangle of Care resources.


Achievements to date


Through commitment to the Triangle of Care approach, we have been able to deliver a range of outcomes which have had a positive impact on staff, carers and those they care for.

  • A unified carer pathway has been forged within rehabilitation services.  It is our intention to replicate this in other service areas.
  • Carers Champions have been identified in each rehabilitation unit
  • Ward managers are engaged with the initiative and involved at all levels
  • Multiple sessions of staff training have been undertaken around general carer awareness and the Triangle of Care
  • A Rehabilitation Unit Carer Champion Network has been established. This is led by the Modern Matron and the Carers Lead within the Health Board. This allows an opportunity for the carers champions to meet with their peers, share good practice examples and protected time to engage in support around this additional responsibility
  • There has been agreement from the units to adopt an amended consent form created by one of the Home Treatment Teams to capture more detailed information about carers
  • All Rehabilitation Units have taken ownership of the Triangle of Care action plan and are regularly updating with achievements. Ward managers have agreed that after six months of working on the action plan we can begin to sample dip in the case files to capture quantitative data and to see if there is a marked improvement for carers. We will, for example, be able to assess what percentage of the time carer information details are captured on admission
  • A Carer Welcome letter is being developed by the rehabilitation units that will include information on their rights as carers, how to access support and what carers they can expect from the service
  • A commitment has been made by the units to slightly adapt the admissions procedure to include separate carer and next of kin sections
  • A commitment has been made to record carer information within the continued Care and Treatment Plan notes and within part A of the Mental Health Measure Paperwork
  • Notice boards have been developed within the units with local and regional information for carers
  • The rehabilitation service is looking to alter the Care and Treatment Plan invitation letter to include encourage carers to submit their views on the return slip or via phone call if they cannot attend the meeting.  This will standardise the inclusions of a carers’ views in the plan even if they cannot physically attend.


Whilst further analysis is needed, early indications and anecdotal evidence suggests many staff and family carers have benefited from increased opportunities to have open and honest discussions. Additionally, raising awareness of who carers are and offering an insight into what carers can offer, has helped to build a rapport between carers and staff breaking down barriers.


Although some outcomes of the implementation of the Triangle of Care may take several years to evidence, it is already clear that staff are now actively identifying carers and ensuring that they comply with the carer pathway.  Staff are continuously developing their local carer pathway and sharing good practice examples.


Our investment in this approach has had a positive impact on all involved, demonstrating the many benefits of partnership working. Across the Health Board we are proud to have implemented a range of projects and processes aimed at ensuring that carers are recognised, listen to and supported.


This series of articles to mark Carers Week have been guest edited by Kate Cubbage


All articles published on Click on Wales are subject to IWA’s disclaimer.



Aimee Danzi is Carers Lead, Betsi Cadwaladr University Health Board

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