Carers’ Week is the opportunity to think about the millions of family members and friends looking – unpaid – after people who couldn’t manage without their support. Although their efforts are often taken for granted, or completely unnoticed, if their help had to be replaced by the state, analysis1 in 2015 suggests the bill would be more than £132 billion – basically the cost of a second NHS! The pandemic and lockdowns have increased the pressures on carers: Carers UK’s second Covid survey, in October 2020, showed that 4 in 5 carers (81%) were providing more care than before lockdown. Most (64%) had had no breaks in six months. Unsurprising then, that more than half (58%) said their physical health had declined and 64% that their mental health had worsened.

If only 1% of them chose to cease caring tomorrow, it would cost the state well over £1bn.

So it’s only common sense that in my role as Head of Community Resilience for the NHS in Hertfordshire, I work closely with the County Council and voluntary sector on how we can identify carers earlier to prevent some of the health impacts caring can bring.

Before COVID-19, we’d reached 12,000 carers registered with primary care – still only about 22% of the total number of carers in West Herts (2011 Census). We have offered carer health checks (837 accepted last year) and flu jabs (more carers took them up last winter than ever before). Most practices already had carers’ champions within the reception team. And now all Primary Care Networks have social prescribing link workers too, who have more time to listen and find out what really ‘matters to them’.

This is where social prescribing fits in. Hertfordshire has always had a vast range of voluntary organisations, some countywide, some very local. But before social prescribing people couldn’t always find the way to the right help for them. Carers in Herts (our county carers’ organisation) demonstrated, even before they became one of the local charities employing link workers for PCNs, how focusing on what mattered to the carer (giving time and listening) could create low cost interventions that reduced the risk of carer depression by over 20%2. Sometimes it was the provision of a laptop or tablet, sometimes a gardening course, an adult learning class, a massage, or a weekend away. It just had to be something the carer would value, not what someone else thought was best for them. A link worker can focus on what matters to the person in front of them, explain the benefits of local carers’ support groups and benefits, of course, but also find other support through counselling, mindfulness, stress-busting arts and crafts activities as well as carer-specific services.

When it was essential to reach out to the clinically vulnerable, some link workers also rang carers on the registers to make sure they were all right. Carers in Herts also had carers volunteering to support other carers. As so often in social prescribing, volunteering was good for the wellbeing of the locked down carer volunteering, as well as those supported by them.

Each caring situation is different. Factors like age, trying to stay in work, raising children, additional carer roles, poverty, housing problems, loneliness – and of course COVID-19- all increase stress and anxiety. 81% of carers feel they don’t do as much exercise as they should. Here Covid has actually been helpful. Virtual exercise groups are now commonplace and hugely beneficial to carers who find it hard to leave the person. Based on the national GP survey (135,000 carers responded in 2020) a fifth are caring for more than 50 hours per week. While their health is probably the most vulnerable, early intervention can help with the creeping anxiety, depression and joint pain which the survey shows carers acquire much earlier and more often than their peers – and can undermine the ability to care. In March 2021 Public Health England published a key document Caring as a social determinant of health, as well as acknowledging carers’ huge contribution to the NHS, it shows how important non-clinical interventions like social prescribing and the peer support and activities provided by the voluntary and community sector can be.

As we move out of the pandemic, the impact on exhausted carers will continue to be heavy. But there are 1500 link workers in primary care in England now working to make sure people find the help they need, whether from carers’ groups or other community support. It’s never been more important to join it all up and make sure support to carers is part of the local social prescribing plans all PCNs are required to have.

1 Valuing Carers 2015 – the rising value of carers’ support [2015] University of Sheffield, University of Leeds and CIRCLE, published by Carers UK
2 Carers in Herts, based on 10 years’ SF12 data (2009-2019)


Tim Anfilogoff

Head of Community Resilience, Herts CCGs                                       

NHSE Regional Associate, Social Prescribing, East of England 

Tim Anfilogoff