EurWORK European Observatory of Working Life

Case Study: Care-related Supports – 5 Boroughs Partnership, UK


United Kingdom
Organisation Size: 
Large (250+)
Public sector
Initiative Types: 
Leave-relatedHours reductionWork adjustmentsHealth/wellbeingCare-related supportsawareness raisingCo-operation with external agencies

Company / organisation name

5 Boroughs Partnership

Initiative name

Carers Inside Out

About the company / organisation

5 Boroughs Partnership (5BPT) is a foundation trust within the National Health Service (NHS), the publicly funded healthcare system of the United Kingdom (UK). The NHS is one of the largest employers in the UK (1,368,000 as of September 2009). It has a work–life balance policy that recognises employees as the company’s most important resource. It states that employees should be encouraged to remain within the health service, despite caring or family commitments. The NHS also hosts ‘NHS Employers’ which monitors and promotes NHS organisations that demonstrate good practice, such as 5BPT.

The trust covers Halton, Knowsley, Warrington, St Helens, and Wigan, in the North West of England. It provides treatment and support for people affected by mental health problems and learning disabilities. Their services encompass: children and young people; learning disabilities; adults; older people; and forensic science.

The trust 5BPT employs 2,099 people, comprising 490 men and 1,036 women working full-time, and 55 men and 518 women working on a part-time basis.

The initiative

The ‘Carers Inside Out’ (2005) policy was implemented by 5BPT to address the needs their employees (inside) and their clients (out) who care for others. It states that carers should:

  • Feel valued and supported;
  • Be introduced to the member of staff working with the person they care for;
  • Be contacted regularly by professionals;
  • Receive services in a safe environment with the consent of the person they care for;
  • Feel encouraged to ask questions;
  • Be invited to meetings about the person they care for, with their agreement;
  • Be invited to take part in organisational development;
  • Have their needs taken into account when agreeing visiting arrangements;
  • Have the opportunity to apply for flexible working arrangements (applies to carers employed by the Trust);
  • Have access to quiet, private and safe visiting areas aimed at developing a family friendly environment;
  • Be consulted and given sufficient notice of day/weekend leave.

It also states that carers should be given information, when appropriate on a range of issues, including carers’ rights, assessment and carers’ breaks; benefits and concessions; diagnosis and medication; care and treatment options; available services in the community; advocacy and support groups; contacts for emergencies; hospital admission and discharge procedures; as well as the Mental Health Act and other relevant legislation.

For operational purposes, a carer is defined as someone who looks ‘after family, partner and friends in need of help because they are ill, frail or have a disability’ on an unpaid basis. Within 5BPT, this includes unpaid carers among their staff and service users.

A staff survey conducted in November 2007 showed that 166 employees (138 women and 28 men) were carers. This comprised 7.9% of the total workforce, and made up 8.9% of female employees men and 5.1% of male staff. It included 55 employees who cared for somebody else for more than 50 hours per week, above their paid employment.

Staff training events are held six times a year. One of the areas they cover is that of carers within the organisation; this is run by working carers employed by 5BPT. Additionally, 5BPT is developing a ‘carers’ champion’ initiative across the trust foundation. A rolling programme of workshops will focus on carers’ issues, and will involve working with other agencies to support local carers’ strategies. It will also monitor the progress of the ‘Carers Inside Out’ charter.

Consultations about carers within the workforce are ongoing. They also form part of ‘away days’ for management. In addition, feedback is sought from individual staff accessing the ‘work–life balance unit’, the equality and diversity unit, and from carers inside and outside 5BPT. All of this forms part of the ‘Carers Inside Out’ project.

Flexible working has been in place as part of the work–life balance policy for employees with or without caring responsibilities. Employees can also request changes to their working patterns on a long-term, short-term, temporary, and permanent basis. Additionally, the timing of meetings or interviews can be adjusted to accommodate working carers. All carers are offered a ‘carer's assessment’ which gathers information about each employees’ specific responsibilities and any gaps in their benefits.

All managers within 5BPT have to undertake ‘essentials for managers’ training. This is provided by the equality and diversity unit, and incorporates the trust’s policy on work–life balance and carers. A range of guides are also available for employees.

The carer’s assessment is a means to explore the impact of caring on employees. For example, caring may impact upon their sleep. It may result in health concerns for the carer, or an inability to leave the person being cared for. It could lead to associated worries about giving up work to care for somebody, and crucially, finding enough time for the carer. The age of a carer can also contribute to the impact of caring, and other commitments may be curtailed. An assessment may highlight a number of needs, such as a break from caring, help with housework, changes to equipment or adaptations to the home, and emotional support. 

Rationale and background of the initiative

Legislation provides a context for5BPT policies around caring. Relevant acts are briefly outlined here.

The Carers (Equal Opportunities) Act 2004: this act made three main changes to the existing law around carers’ services. It placed a duty on local authorities to inform carers, in certain circumstances, of their right to an assessment of their needs. It provided that when assessing a carer’s needs, local authorities must take into account whether the carer works or wishes to work, or undertakes or wishes to undertake education, training or leisure activities. Finally, it facilitated cooperation between authorities in relation to the provision of services that are relevant to carers.

The Work and Families Act 2006: this act extended the right to request flexible working to employees who care for adults. It built on the introduction (through the Employment Act 2002) of the right to request flexible working for parents of children under the age of six (or 18 if the child has a disability). Imelda Walsh’s independent review recommended that the right to request flexible working should be extended to cover parents of children aged 16 and under.

At the time of writing, the UK’s Equality Act (2006) included disability; gender; proposed, commenced or completed gender reassignment; race; religion or belief and sexual orientation. However, it did not mention protection against discrimination of working carers. Many experts in the UK have stressed that an opportunity has been missed here to define carers and to extend legal protection against discrimination to this particular target group.

Approximately seven years ago, the current director of 5BPT was appointed. As he has a disability and has been cared for by his wife and children, he was acutely aware of the problems associated with carers who work. He was also aware of the more global problems of caring for somebody within a family. At a National Health Service (NHS) conference, he challenged the chairman of the NHS who suggested six strands to equality, with a seventh strand, that of carers. Additionally, he has been involved nationally in campaigning for more rights for carers who work.

Within 5BP there was a very active work–life balance initiative (as part of the NHS) was already in place. Employees were encouraged to reflect upon their work levels and its impact upon themselves and their families. In addition, 5BPT supports inclusion and support for different groups, such as the black and minority ethnic (BME) community and the lesbian and gay community.

Results and assessment

As demonstrated by the staff survey, carers within 5BPT have been identified and given a care assessment.

Between April 2009 and March 2010 the work–life balance policy resulted in the following:

  • 26 employees requested ‘adult carer leave’, all of which were approved with paid leave;
  • two employees requested ‘employment breaks’ and this was granted as unpaid leave;
  • 32 employees requested ‘flexible working’, and all these requests were given, as paid work;
  • 43 employees requested ‘emergency domestic leave’, 41 of which were granted as paid leave, and two as unpaid leave;
  • three employees requested ‘terminal care’ leave, one of which was granted as paid leave, and two as unpaid leave;
  • 36 employees requested to ‘purchase additional annual leave’, which were all granted;
  • 45 employees requested ‘bereavement leave’ and all received this as paid leave;
  • 46 employees requested ‘parental leave’, 45 of whom received paid leave for this, with one being granted unpaid parental leave.

As a result of its activities in this field, 5BP has become relatively well-known as an employer providing opportunities for employees to have caring responsibilities. This is evidenced by individuals approaching 5BP at job fairs, specifically to discuss their carers’ policy.

Issues, challenges and lessons learned

The ‘Carers Inside Out’ policy was designed to include both service users of 5BPT and employees. In practice, however, advice provided to its working carers directly competed with that provided by local NGOs, as both were attempting to access the same funds. The local NGOs referred to here are UK charities who play a strong role in providing services for carers, such as free help and support. Examples include the Citizens Advice Bureau, Crossroads Care, Contact a Friend, the Family Fund, and MacIntyre Care. All of these depend on funding from the UK Government.

In response to this tension, 5BP have changed their approach by directing carers within their organisation to access this information from those NGOs. In effect, this means that 5BPT liaises and consults with local NGOs; this requires considerable efforts.

In practice, cooperation with local NGOs does not meet all of the entitlements of 5BPT’s working carers. For example, 5BPT’s employees who work full-time are often not able to access information about caring as many local agencies are only open during normal working hours. 5BPT employees have been allowed to make phone calls while at work in order to access services by telephone, wherever this is possible.

Carers within 5BPT are not currently recorded as working carers on their electronic staff record. Information about related issues is captured by the annual staff survey, and there are plans to incorporate carer-related questions in the survey in the future.

In 5BPT’s experience, there are different types of caring and each brings its own challenges. Caring for individuals with mental health issues can be extremely challenging; for example, non-compliance with medication and particular illnesses, such as psychoses, can provide complex presentations for carers.

Experience with the Carers Inside Out project also suggests that line managers need training in diversity and equality, so that they better understand the issues when approached by an employee. It would be a good idea to directly include contributions from carers within 5BPT in such training. This would send out a ‘cultural’ message to employees that carers are identified within 5BP and, critically, that they have a legitimate voice that is being addressed in policy and practice.


Case study author:

  • Dr Paula Byrne, Division Primary Care, University Liverpool


  • Dave Thompson, 5 Boroughs Partnership Foundation Trust, Director of inclusion and Partnership, Lead in Carer initiatives.

Online sources:

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