Building a Carer Friendly Organisation

Nottinghamshire Healthcare NHS Foundation Trust

Contact: Paul Sanguinazzi -


Nottinghamshire Healthcare is a major provider of mental health, intellectual disability and community healthcare services for the people of Nottinghamshire. These services are provided from community settings through to acute wards as well as low, medium and high secure settings. It employs 9000 staff from over 100 sites. It has an income of over £400 million.

General Summary

We have developed and implemented an ambitious, transformational
and comprehensive programme in partnership with our carers to build a carer friendly trust. With the collective commitment of Trust staff, carers and local organisations we have:
 changed culture and practice through staff induction and development programmes
 raised awareness through innovative films, the carers section on our website and increased social media presence
 tackled issues that carers raised (e.g. information sharing)
 supported and informed carers through guides, information, support groups and forums
 ensured that all our 100 plus mental health teams have evidenced that they have improved their involvement of, support for and communication with carers. This was backed by Trust leaders who proactively enabled the aim of supporting and involving carers.

As a result we were awarded two gold stars from the Carers Trust as part of their national Triangle of Care (ToC) programme in recognition of our work, which we have shared widely. One of our carers said: “The impact of the work Notts Healthcare has done and continues to do is immense and has made a huge difference to the way carers’ needs are recognised and addressed. It has made me, as a carer feel valued. Thank you.”


The Trust has a history of working with carers. However, through listening to what carers said and complaints it was clear that many felt that sometimes we weren’t involving them in the care of their loved ones or communicating or supporting them well. Collectively we felt we needed a step change.
In addition, carers were asking us to sign up to the Triangle of Care (ToC). This is a national scheme run by the Carers Trust to promote shared working between carers, professionals and staff and includes six standards for all teams to meet to include and support carers. This was discussed with the Trust’s Executive Team and they were very supportive. They asked the Trust’s Head of Involvement and Experience to lead the initiative across the Trust. Our aim was to lead an ambitious and comprehensive culture change programme across the organisation to build a carer friendly organisation so that we improved support for and communication with carers, the information we provided for them and staff and also to have every single team in the organisation involve and support carers.


We launched our second Carers’ Strategy in July 2015 at our Carers, Families and Friends Conference on 7th July 2015. The Strategy included the implementation of
the Triangle of Care. The event was attended by 192 people including carers, carer organisations, Trust staff and people from the Local Authorities and
Commissioners. It was launched by our Chief Executive, and Ruth Hannan, Carers Trust.

The strategy/Triangle of Care was developed and implemented by the Carers Strategy Implementation Group (CSIG). This group was led by the Trust’s Involvement and Experience Team and included carers, carer organisations, our Directorate Carer Leads and staff from Local Authorities and commissioners. This group oversaw Stage 1 of the Triangle of Care during which all 74 ward and crisis teams completed self-assessments. In addition, we had a network of Directorate Carer Leads who worked with services to implement it.

On April 27th 2016 we held a day event to review all the self-assessments from across the Trust. The Trust’s Leadership Council held an event focused on carers, ‘Building a Carer Friendly Trust’ in June 2016. This meeting involves 100 managerial and clinical leaders as well as service user and carer volunteers. In addition, we invited local authorities, carers and carer organisations. We also launched our Carers and Confidentiality Guide. In September 2016 we presented to the Regional Meeting our Triangle of Care submission report on our work one along with 64 team self assessments showing how our teams met the six Triangle of Care standards. We were awarded our first gold star for the successful completion of phase 1 of the Triangle of Care.

In November 2016 our Carers’, Families and Friends film was launched by our Director of Nursing at an event with carers and Trust Carer Leads. This is used to raise staff awareness of how staff can work better in partnership with carers and their families. (see Supporting Evidence – Guides, Films and Information for Carers). The Carers Strategy Implementation Group (CSIG) met in November 2016 to plan the implementation of Stage 2. In order to monitor progress of the Stage 1 teams we
introduced a monitoring form so we could see progress at a glance.
As part of our approach in Stage 2 we wanted to work as a group to resolve issues and to look at how we could tackle them. We particularly focused on cross-Trust issues:
1. Information sharing and confidentiality. We reprinted the guide as it was in demand across the organisation and updated our policy in line with this.
2. Carer awareness training. We agreed to develop carer awareness training across the organisation, to publicise and use the carers film and to improve carer awareness for all new staff at Trust induction.
3. Information about carer support and carer assessments. We agreed to continue to improve the carer information on the Trust website.

In December 2016 we presented to the Trust’s Leadership Council to launch Stage 2 to the Trust’s leaders. In March 2017 we undertook two review days with carers and staff to look at all the Triangle of Care self-assessments (Stage 1 updates and the Stage 2 self-assessments) and to look at where they could be improved before submission to the Carers Trust. This helped with sharing of good practice and finding solutions to particular issues. During Carers Week in June 2017 we held events,
made a Trust pledge and used social media to raise awareness of carers via tweets and blogs. During 2017 all community mental health teams had completed their self-assessments and all ward and crisis teams had updated their self-assessments
and completed their monitoring forms. In March 2018 the Trust was awarded a second gold star for successfully completing the Stage 2 of the Triangle of Care. Since then we have developed and launched in September 2018 a ‘Quick Guide for Carers, Families and Friends’ to provide carers with easy to find support and information.


We have measured the impact of this initiative in several ways.
 The Triangle of Care self -assessments that our 115 mental health teams completed showed how each team was meeting the six standards. These evidenced how teams had made progress including how they ensured they had identified and supported carers, produced information about their service for carers and had trained their staff.
 Changes reported every six months by each directorate that they made as a result of carer feedback/involvement in their quarterly involvement and experience report.
 Our Carers Survey has had 869 responses during 2018 and of those 97% said they were extremely likely or likely to tell friends and family that the service was helpful to carers.

Below are some of the 618 responses we got to the question ‘What did we do well?’
“Dementia team are excellent & the courses are brilliant. Information giving, support for my husband & me, as carer – brilliant all round!”
“Support me through very difficult times … The staff are so easy to communicate with and support us all with a variety of issues”

In response to issues raised by carers we produced an easy to use guide to sharing information with carers, carer awareness training for staff and a variety of information on our website and in printed form to support carers.

The simple guide to Carers and Confidentiality was widely circulated across the Trust and has gone down really well. We wanted all staff to understand that sharing of information between staff and carers is vital to the care of our service users and to the support of carers.

We worked with carers and the Learning and Development Department to develop Carer Awareness Training for staff. This was first delivered in 2017 and we run four sessions a year. We co-present a session with carers at the start of the induction day for all new staff who are also given our simple guide to Carers and Confidentiality/
Information Sharing. As part of the Trust’s Learning and Organisational Development Programme we deliver carer awareness sessions twice yearly for clinical Bands 2-4 staff and the Band 5 Nurse Preceptorship Programme. The Trust’s Recovery College developed carer courses co-produced with carers and partners with the aim of supporting carers through self-management.

 Improved information for carers on the Trust website
 Our quick guide for carers
 Rampton Hospital has produced a film to help carers understand the Hospital, the treatment available and how to keep in touch with and visit patients.

Carers, carer organisations and staff who have been involved in the initiative tell us that it has been a significant culture and operational change in the organisation. Below are some of the quotes we have collected:
Carer: “The Triangle of Care has led to a change in staff attitudes to carers – a result of training and leadership. It has led to new networks for staff and interaction with carer groups.”

Carer Organisations: “I represent some one hundred and ninety untrained, unpaid. My rewards come in the introduction of new initiatives that I have been able to work on (and there are many) with the Trust. Our members may not see improvements immediately, but they do tell me of their good and bad experiences and right now good seems to be in the ascendance.”

Staff: ‘We have developed Carer Champions on all our wards. They now regularly attend our quarterly Carer events and add value to the relationships that are built with families and friends who visit our patients.”

Standing Out

This initiative stands out due to its ambition and commitment to changing the Trusts’ culture so we work in partnership with and support carers at every level of our Trust. The comprehensive nature and scale of the work is, we believe, unique. It has taken a strategic approach to culture change via training, films, guides and working with the Trust’s leadership. It has also made sure that changes happened operationally by ensuring that every mental health team improves how it works with carers. We believe that this has also been special because of the great partnerships we developed with carers, carer organisations and staff and the leadership at every level of the organisation.

Carer: “The Triangle of Care has led to a change in staff attitudes to carers – a result of training and leadership. It has led to new networks for staff and interaction with carer groups.”

Carer organisation: “As the CEO of an independent Carers support organisation I have been heartened to see the enthusiasm and energy staff have shown in implementing the Triangle of Care with carers across so many differing teams in a large Healthcare Trust.”

“The Triangle of Care has been hugely positive in terms of carer/family engagement. The support of the Trust to recognise the importance of using the expertise and skills of carers to work together in partnership has enabled services to make improvements.”

Key Learning Points

Set a clear expectation that all teams and staff should work with and support carers if we are to deliver effective, compassionate care for our service users
 Work with and listen to carers to understand what would make a difference for them
 Active and visible support from the leadership of the organisation and effective communications and support for frontline teams

We have been planning the rollout of Stage 3 of the Triangle of Care to over 100 community physical healthcare teams. This will begin in April 2019. In July 2019 we will review with carers the progress of all 115 Stage 1 and Stage 2 teams as they submit updated self-assessments. We will hold a Carers Champions Day in March 2019 to bring together carer champions from across the organisation to share good practice and ideas. The Carers Strategy Implementation Group will continue to meet
quarterly to develop and review our work and initiate new projects.

Watch the Presentation Here: