Carer Support Payment: island communities impact assessment

Key Findings

This section provides an overview of issues for Scottish island and remote rural communities which are relevant for Carer Support Payment policy and regulations.

Rural Scotland accounts for 98% of the land mass of Scotland, and 17% of the population are resident there.

Scotland has 93 inhabited islands, of which only five are connected to the Scottish mainland by bridge or causeway.

The Islands Act identifies 6 local authorities representing island communities in Part 4 of the Act (Section 20 (2)), which are Argyll and Bute Council, Comhairle nan Eilean Siar/Western Isles, Highland Council, North Ayrshire Council, Orkney Islands Council, Shetland Islands Council. Amongst them, Orkney, Shetland and Western Isles are entirely island authorities, while Highland, Argyll and Bute and North Ayrshire local authorities cover island regions as well as mainland regions.

Respondents to the National Islands Plan Survey^[13] described a lack of employment, training and higher education opportunities and a lack of childcare options to fit with residents' working patterns; a poor variety of housing types, sizes and tenures to meet people's needs, and a lack of affordable housing. Respondents also had mixed experiences of accessing healthcare services, and of speed and reliability of internet connections.

Island stakeholders have emphasised the importance of understanding the island experience. Each island has its own specific considerations and constraints. The National Islands Plan highlighted that experiences of island life vary considerably by island group. Differences were particularly striking between residents of Orkney Mainland and Outer Isles, and Shetland Mainland and Outer Isles, with "mainland" islanders generally more positive about a range of measures. These differences may be attributable to proximity to a small town (associated with access to services and more diverse economies) and direct access to mainland Scotland from the "mainland" islands, unlike in the outer islands. Different age groups, too, have distinct experiences of island life, and a young person's views can contrast with those of an older person living in the same island group.^[14]

Stakeholders noted that issues of limited available services and the costs of accessing those services are not specific solely to island communities, but that mainland rural and remote communities suffer from many of the same issues and challenges, although reliance on ferries was an extra barrier to accessing services.

Demography

Scotland has 93 inhabited islands with a total population of 103,700 (2% of Scotland’s population) as per the 2011 Census^[15]. The population of the islands increased by 4% (3,963) between 2001 and 2011.

Remote rural areas have a higher (23%) proportion of older people (65+) than the rest of Scotland (17%)^[16]. Scotland’s population is projected to age, with the population of people aged 75 years and older projected to increase in all areas. In the Highlands and Islands, the population overall is also projected to decline.^[17]

Older adults are far more likely to be impacted by the effects of caring. This was highlighted in the Carers Trust - Experiences of Older Adult Carers in Scotland^[18] report, which noted that respondents aged 70 and above reported higher levels of being physically impacted by their caring role.

87% of all respondents agreed that their mental health and wellbeing had been affected by their caring role, of which 32% reported that it had been affected greatly. This trend was similar between male and female older adult unpaid carers, and, similarly to physical health, respondents aged 80 and above reported the highest levels of being affected greatly. Additionally, due to the cost of living crisis, 25% reported they felt financially worse off now when compared to their financial situation 12 months before.

For males, the life expectancy in remote rural and accessible rural areas is around 79 years, nearly 2 years more than life expectancy in the rest of Scotland. For females, the life expectancy in rural areas is around 83 years, nearly 2 years more than in the rest of Scotland.

According to the 2011 Census, 83% of island residents reported their health as being ‘very good’ or ‘good’ compared with 82% for Scotland as a whole. The proportion of island residents with a long-term (lasting 12 months or more) health problem or disability that limited their day-to-day activities was just under 20%, including 9% who reported their daily activities were limited ‘a lot’. The corresponding proportions for Scotland as a whole were very similar^[19]. 17% of island residents are under the age of 16, which is the same proportion as per Scotland as a whole^[20].

Based on StatXplore information to the end of February 2023, the proportion of men and women in receipt of Carer’s Allowance does not differ substantially between island communities and Scotland as a whole. A lower proportion of the population is below 55 on the islands, with a substantially higher 65+ group (40% of all entitled are over 65, whereas this figure is only 29% in Scotland as a whole). The over 65 group mostly have underlying entitlement to the benefit, due to receipt of the State Pension which is an overlapping benefit.

User research for Carer Support Payment highlighted a lack of understanding of underlying entitlement among carers which could prevent older carers from accessing associated support.

Access

The Scottish Government published its first Benefit Take-up Strategy in 2019, setting out the ongoing work of the Scottish Government and Social Security Scotland to address barriers to benefit uptake.^[21] Costly or complex access to services was identified as one of the key accessibility barriers, particularly pertinent to those in island communities. User research for Carer Support Payment found that living remotely often translates into limited services, whether health care, government services, or limited access to specialised knowledge and skilled workers.

Only a third of island residents say that it is easy to connect between different forms of transport when making journeys to or from their home.^[22] Bus services can be unreliable and are often community run, and taxis are not often available. Even where buses are available, they often run rarely, and timetables do not always meet the needs of people living in the community. This leads to a reliance on neighbours, friends and families driving as primary transport.

Island stakeholders have described the extra complexity and expense of travelling to access medical treatment on the mainland. Specialist services may only be available in cities a great distance from islands, which can mean extra travel and accommodation costs for patients and carers. Travel infrastructure was also cited as a frequent issue, particularly the reliance on ferries which are often subject to disruption, and can delay both islanders accessing treatment on the mainland, and professionals coming to the island to provide support.

Carers interviewed for Carer Support Payment user research in the Highlands and Islands also described the difficulties of accessing healthcare, especially specialist appointments or support. Often, they have to travel extensive distances to see a specialist, some of them having to take several ferries, flights and spend a few nights away to reach a hospital. This is particularly challenging for those who have to organise travel to accommodate complex needs, for example, travelling with an oxygen tank. In more acute cases, clients and the cared-for person may need to take be airlifted to the nearest hospital. However, those in more critical conditions may not be able to travel by air and they are often not diagnosed or lack medical attention, actions that may lead to worsened conditions and higher pressure on the carer. GPs and local hospitals in remote areas are often understaffed or are staffed with seasonal doctors, which may lead to a lack of trust, and fatigue in having to repeat their medical histories and needs.

There are striking differences in reported levels of access to health, social care and wellbeing services between the island groups. Almost all residents of Orkney Mainland and Shetland Mainland report that they can easily access a hospital, a dentist and a pharmacy. However, substantially fewer residents of Orkney Outer Isles and Shetland Outer Isles report this.

Carers interviewed as part of user research for Carer Support Payment described the increased pressure on carers due to limited or non-existent support groups. It can also be challenging to access respite care or paid care, to allow carers to access employment or short breaks: due to a limited population and low workforce migration, the Highland and Islands have a large number of vacancies, especially in the care sector. Third-sector organisations provide vital support, but they are often overstretched due to budget constraints or lack of staff, meaning that carers have to wait for long periods to receive the support they need.

Connectivity

Digital exclusion and unreliable broadband services were cited by respondents to the consultation as being an issue for island communities, although it was also noted that direct face-to-face communication can be a challenge due to geographical distance.

In addition, carers may be “digitally excluded” – limited in accessing the internet, either because they lack digital skills or confidence in using a computer and online services and/or because they do not have access to the internet.^[23] Digitally excluded groups^[24] are more likely to be:

• Those over 65 years of age
• Economically inactive working age adults, lower income households, lone adult households, people in communal establishments or other non-private housing
• Disabled people
• People on lower incomes and households in locations without fibre broadband internet access.

It is therefore likely that island carers will be disproportionately impacted by digital exclusion, due to the overlap in demographic trends between carers and digitally excluded groups.

Digital exclusion was felt to be a significant barrier among carers interviewed for Carer Support Payment user research. Factors included age, with older carers less likely to use digital services, and lack of skills and confidence. For some who lacked digital confidence before becoming carers, taking on caring responsibilities compounded the issue and meant that they lacked the time and capacity to learn the skills they needed to get online. Digital exclusion was identified as a barrier to carers accessing information about benefits, negatively impacting benefit uptake.

Carers also expressed that their concerns around digital security limited their use of online services, with third sector organisations playing an important role in supporting carers with advice around online security. The prevalence of conflicting information, and the experience of information overload, made it difficult to find information. As a result, carers often didn’t trust information accessed online.

Issues with rural mobile phone reception and broadband connection were compounded by limited public services, with some rural areas lacking local libraries or hubs with public computer facilities. Where these services do exist, limited public transport can prevent carers from accessing them. Reliable internet solutions, such as satellite internet, can be prohibitively expensive for carers.

Research undertaken by the Scottish Government^[25]and stakeholders in 2020 found that a lack of connectivity in rural or remote communities has been compounded by the impacts of the Covid-19 pandemic. An absence of good quality internet connection can significantly impact on an individual’s ability to socialise and partake in cultural activities, particularly where people already have mobility restrictions as a result of a disability or health condition.

Research from the National Islands Plan Survey^[26] showed that islanders are generally confident in using the internet for most tasks, but slightly less confident in using the internet to attend online health and social care appointments. The majority of respondents could access the internet from home. However, speed and reliability of internet connections are an issue for many, particularly in Orkney and Shetland Outer Isles. Mobile signals vary, with particularly poor reports from Orkney Outer Isles. There is a difference^[27] in coverage between rural and urban areas. Rural areas tend to have poorer coverage and slower speeds. Connectivity varies between islands and island groups. While 62% of island residents agree that their internet connection at home is reliable, there is significantly lower agreement in Shetland Outer Isles (30%) and Orkney Outer Isles (35%).^[28]

Stigma

Stakeholders have identified potential cultural barriers to applying for social security benefits, particularly in rural and island communities.

User research for Carer Support Payment, as well as previous user research and experience panels conducted for Best Start Grant, Funeral Support Payment and Young Carer Grant, identified a risk of stigma hindering applications for benefits.

Young carers identified the close-knit nature of island communities as a potential barrier to claiming Young Carer Grant^[29], emphasising the sensitive nature of disclosing caring responsibilities and the receipt of disability benefits, and the need for privacy and dignity.

User research for Carer Support Payment found cultural barriers to accessing support and information, with a perception that Highland and Island communities tend to ‘look after their own’ and do not feel they should claim benefits for this. The perception of care as a duty can act as a barrier to carers seeking support, and carers may end up seeking support only in extreme circumstances. Another barrier identified was the potential reluctance from the cared for person to apply for benefits or acknowledge a need for help. Carers emphasised the private nature of island communities, which could prevent care from becoming visible.

Levels of stigma can vary between islands and island groups. Stakeholders^[30] said that the proportion of incomers in island communities and the size of those communities could impact the level of stigma, and also that stigma was more prevalent in smaller communities, where people living with financial hardship are living close to those with relative wealth.

User research for Carer Support Payment found that benefit stigma translated into a lack of awareness of benefits and support, preventing carers from accessing necessary support. The Highlands and Islands were perceived to have a higher degree of benefit stigma than elsewhere in Scotland. Carers identified a reluctance to ask for help in island communities, particularly from older carers who may refuse to apply, perceiving this to be taking money away from others in need of assistance. Benefit stigma was found to negatively impact carer’s mental health and self-identity.

The recent Carers Week Report on unpaid carer identification ^[31] noted over two-third (68%) of people who currently provide unpaid care or have provided care in the past have never identified or called themselves a carer. Over a third (34%) of carers with experience of providing care saw their health and wellbeing suffer as a result and over a fifth (23%) said it had affected their job or ability to work.

Poverty

On average, rates of poverty tend to be lower in rural areas. However, the barriers to leaving poverty may be greater for those in rural areas.^[32] For example, poor public transport networks mean that people may not have good access to opportunities for education and employment, particularly if they rely on bus networks.

Issues with access to employment were also noted by carers interviewed for Carer Support Payment user research, who reported that, due to the needs of the cared for person, they found it hard to find employers who could accommodate their caring needs. Some island carers reported that they would like to work, but were unable to due to a lack of available paid carers.

In 2019, the fuel poverty rate for remote rural (43%) households was higher than for urban (24%) households or rural households (29%)^[33]. Higher living costs on islands, combined with higher fuel costs, can create the conditions for extreme fuel poverty for households on low incomes.

Local authority Comhairle Nan Eilean Siar have previously stated in their written evidence to a fuel poverty strategy consultation undertaken by the Scottish Government, “it is essential to factor in higher living costs to an understanding of poverty in remote and rural areas. Poorer households in the islands are likely to be significantly worse off financially than an equivalent-earning mainland household because of the higher cost of living”^[34].

Poverty in rural areas may be more isolating in its impact, due to the greater visibility of individuals within rural communities and a rural ideal of self-reliance. Poor adults in remote rural areas have been found to have particular problems with low levels of support.^[35] The majority of carers are in the bottom half of income deciles, and face additional costs related to caring including fuel, food and transport. Furthermore, research has shown that poverty disproportionately affects those with a disability, with disabled people experiencing higher poverty rates than the rest of the population.^[36]

A recent report on the experiences of older adult unpaid carers in Scotland^[37] found that 82% of all respondents agreed that their caring role had financially impacted them, of which 25% felt as though it had greatly impacted them.

Cost of living

There is widespread evidence that rural areas, and remote and island communities in particular, experience higher costs of living for some goods and services.

A lack of choice and accessibility for people living in island communities means that shopping, mobile phone services and broadband can be more expensive for carers living in island communities compared to those on the mainland. The greater distances mean that day to day travel, postage, fuel, daytrips and holidays are also more expensive for carers in remote communities. ^[38]

In rural and remote areas, the costs of travel to essential services are generally much higher. Those experiencing poverty may be unable to afford transport, which reduces their quality of life and increases social isolation. In circumstances where there is no public transport infrastructure, families may be forced to run a car, putting pressure on their finances.

Highlands and Islands Enterprise^[39] found that, typically, the minimum cost of living in remote rural Scotland ranged between 10% and 35% more than the equivalent in urban Britain in 2016. The additional costs are mainly from shopping, broadband, delivery costs, transport, childcare, and fuel costs. More recent research has shown that additional minimum living costs for a household in remote rural Scotland typically add 15-30% to a household budget, compared to urban areas of theUK.

Citizens Advice Scotland have identified issues of grid, utilities, digital and travel as key barriers for people in remote rural areas. Furthermore, a typical food basket can cost as much as 50% more on islands in Scotland, while transport can be up to £40 a week more expensive due to longer distances for commuting and a higher price for petrol.^[40]

On top of the increased cost of living for island and remote rural communities, carers have additional costs relating to care. Recent research by Carers UK^[41] found that carers face increased costs for equipment, travel and food. On top of reduced capacity to work to earn money, carers often have to spend a larger proportion of their income on energy costs to keep the person they care for warm and to manage their condition. They may have higher food bills, and higher transport costs because the person they care for needs support to travel or the carer has to travel to provide care.

Recent research on the impact of the cost-of-living crisis^[42] showed that a quarter of carers were cutting back on essentials such as food and heating to make ends meet, highlighting that those on the lowest incomes were struggling the most. The research showed that over a third (35%) of carers are spending 20% of their income or more on energy, with one in five (19%) of carers in the lowest income households spending 50% or more of their income on energy.

Even where one or more individual in the household is in employment, the same level of income secures a lower standard of living than it would for a household without someone with a disability or long-term health condition. This is because disabled people face higher costs than non-disabled people, such as the cost of specialist equipment, therapies and home adaptations to manage a condition.^[43] Disabled people living in island and remote rural communities may face higher costs, for example travel costs, as individuals may have to pay the cost of taxis if they need to travel to and from hospital where it is not possible to use public transport (and/or public transport may not be available).

The Joseph Rowntree Foundation reported that levels of poverty among disabled people are generally underestimated.^[44]Because disabled people’s needs are often greater than for those without a disability, the cost of living for disabled people is frequently higher. These costs are higher in island and remote communities due to an environment that is less accessible, with higher costs for reasonable adjustments to technology, housing and transport.