This thesis contributes evidence to support the implementation of UK national policy commitments for unpaid carers into practice, specifically, the commitment to support a life alongside caring through meaningful short breaks.

Aim:
This research aimed to generate evidence to enrich the development, commissioning, and delivery of meaningful short breaks for spousal carers (aged 65 years and over) for persons living with dementia.

Method:
Underpinned by a constructivist collaborative approach to knowledge generation, the research progressed through four phases of inquiry. The first three phases involved extensive stakeholder engagement with a diverse range of social care professionals and unpaid spousal carers. The Developing Evidence Enriched Practice approach guided the delivery of a knowledge exchange event that integrated stakeholder perspectives and consolidated learning. The data collected in the first three phases of study, along with insights from a recent seminal scoping review on short break outcomes (Seddon & Prendergast, 2019) identifying knowledge gaps, played a crucial role in shaping and justifying the focus and placement of the scoping review in Chapter Eight.

Findings:
Collectively, the four phases of study contributed a holistic understanding of short breaks provision, underpinned by a whole systems approach to supporting interdependent well-being through short breaks.

A dynamic descriptive model of the short break landscape in north Wales was produced, describing factors shaping local and regional decision-making. The model interprets key challenges and opportunities that shape the planning, commissioning, and delivery of short breaks.

A collective narrative of the caregiving career was constructed to explore how unpaid carers’ short break needs evolved in response to the degenerative course of dementia.

Consensus was reached on the features that contribute towards a meaningful short break and social care policy and practice recommendations were co-created with stakeholders.

A review and synthesis of developmental temporal models of dementia caregiving informed thinking around the need for a new conceptual model for breaks across the caregiving career, reasserting the value of short breaks that are regular and help preserve unpaid carers’ sense of identity and purpose as an essential resource to support a life alongside, and beyond caregiving.

Recommendations:
Practice and policy recommendations have relevance to assessment and support planning processes and to the conceptualisation, design, and delivery of short breaks.

Identifying and understanding of short break needs and outcomes necessitates genuine dialogue and practitioner support to identify solutions, negotiate options, and balance priorities. This is complex, interpersonal work that requires confidence to think about breaks in their broadest sense., e.g., as a service, an activity, or an item. Proactively supporting short breaks throughout the caregiving career must be underpinned by a temporal understanding of short break needs in dementia caregiving and requires ongoing practitioner engagement to aid and smooth transitions to breaks of mutual value for the unpaid carer and the person with dementia.

Commissioning for sustainable short breaks necessitates a multi-agency and multi-sector response. Partnerships, underpinned by long-term secure funding arrangements, that enable coordination and collaboration between organisations and sectors is vital to achieve this. Processes that help coordinate and collate information about unpaid carer short break needs and desired outcomes are needed to drive service improvements, at a local and regional level. This research spotlights the need for a drastic shift in the cultural orientation and structural underpinnings of the social care system, to reassert what best supports adult social care to deliver sustainable short breaks, namely, the nurturing of long-term continually evolving relationships.

A better understanding of the developmental changes in short break needs and preferences could help unpaid carers in their thinking around breaks as circumstances change, as well as serve as an indicative guide for practitioners to aid the proactive and responsive planning for breaks. This work has the potential to support commissioners to proportionately deploy resources to ensure an appropriate range and balance of short breaks throughout the caregiving career.