Equality impact assessment: health and social care statutory guidance refresh

3. Stage 2: Data and evidence gathering, involvement and consultation

Include here the results of your evidence gathering (including framing exercise), including qualitative and quantitative data and the source of that information, whether national statistics, surveys or consultations with relevant equality groups.

Characteristic

Age

Evidence gathered and Strength/quality of evidence

Use of health and social care services is patterned by age with higher use in older people, with the proportion of people describing health as ‘good’ or ‘very good’ declining with age.

Prevalence of adults that report living with long-term conditions increases with age.

Alcohol consumption, which negatively impacts health outcomes, increases with age.

Due to Scotland’s ageing population, demand for – and use of – health and social care services are projected to increase.

On the whole, there appears to be a clear link between worsening health outcomes and age.

Evidence suggests that the Social Care Workforce has a relatively high median age, when compared to the age profile of Scotland’s working age profile, which may represent a risk to the future delivery of services. Recruitment challenges also exist within the sector.

Likewise, for unpaid carers – who represent 20% of the Scottish population – caring prevalence varies by age, ranging from 12% of those aged 16-44, 28% of those aged 45-64, and 18% of those aged 65 and over.

Source

Scottish Government (2021), Scottish Health Survey – Telephone Survey August/September 2020: main report

Public Health Scotland (2022), Insights in social care: statistics for Scotland

Scottish Social Services Council (2020), Scottish Social Service Sector: Report on 2020 Workforce Data

Scottish Government (2022), National Care Service – adult social care: equality evidence review

Data gaps identified and action taken

A specific breakdown of the age of people using the breadth of services commissioned by IAs is not available. Given the likely difficulties in collecting such information, this is a data gap that is unlikely to be filled.

However, from the data available, it can be inferred that older people are more likely to require and use IA services.

Characteristic

Disability

Evidence gathered and Strength/quality of evidence

Just under half of adults (47%) report living with a long-term health condition, with 31% reporting a limiting long-term condition.

The prevalence of disability increases with age.

There is little variation in prevalence of long term health conditions by sex.

(Note: low response rates from deprived areas in the Scottish Health Survey data, cited above, may have impacted the accuracy of the prevalence in the above statistics)

In 2019, there were 23,584 adults known to local authorities across Scotland, which equates to 5.2 people with learning disabilities per 1000 people in the general population. 18.2% of these adults known to local authorities attended a day centre.

The data indicates that significant proportion of the public in Scotland report having a long-term health condition. Therefore, it is highly likely that individuals with long-term conditions will utilise IA services, which in turn means they may be indirectly impacted by the proposed programme of work.

Data also indicates that unpaid carers are more likely to have long-term conditions that non-carers. Although, this data is from 2011.

Source

Scottish Government (2019), Scotland’s Wellbeing: national outcomes for disabled people

Scottish Government (2021), Scottish Health Survey – Telephone Survey August/September 2020: main report

Scottish Government (2022), National Care Service – adult social care: equality evidence review

Scottish Commission for People with Learning Disabilities (SCLD) (2019), Learning Disability Statistics Scotland 2019

Characteristic

Sex

Evidence gathered and Strength/quality of evidence

Higher proportions of males report having health issues, such as high blood pressure, any cardiovascular disease, diabetes, ischaemic heart disease and strokes.

Females are more likely to provide regular, unpaid care, which is a role that can have a negative impact on physical and mental health and wellbeing.

The latest data shows that there is no significant variation by sex in the proportion of people that assess their health as ‘good’ or ‘very good’.

Alcohol consumption and smoking is higher among males than females.

Data covering 2020/21 highlights that there are more female users of social care than male, although though this varies by age group with younger age groups consisting of more males.

Overall, the data on health inequalities based on sex offers a mixed picture. Yet, qualitative research shows the impact of male bias within healthcare settings, which those designing and implementing service should be mindful of in order to address and mitigate the negative impacts on women’s health. Again, this is an area where strategic commissioning guidance could perhaps add value in promoting equality to mitigate structural bias.

Source

Scottish Government (2021), Scottish Health Survey – Telephone Survey August/September 2020: main report

Scottish Government (2015), Scotland’s Carers

Public Health Scotland (2022), Insights in social care: statistics for Scotland

Scottish Government (2022), Health and Care Experience Survey 2021/22: National Results

Scottish Government (2022), National Care Service – adult social care: equality evidence review

Young, K., Fisher, J. & Kirkman, M. (2020), Partners instead of patients: Women negotiating power and knowledge within medical encounters for endometriosis

Scottish Government (2021), Women’s Health Plan

Characteristic

Pregnancy And Maternity

Evidence gathered and Strength/quality of evidence

IAs will provide services to people who are pregnant or mothers, therefore changes to commissioning guidance may impact this group.

It is known that there are health risks to mothers and babies during and after pregnancy. Research also indicates that this risk varies based on race, with significant disparities in the maternal mortality rate between white women and black, Asian and mixed ethnic women.

Qualitative research also highlights negative experiences of women in healthcare settings, which can include male bias, male-centric power dynamics and a lack of knowledge of women’s health that can negatively impact women’s experiences. Through education, it is possible that revised commissioning guidance can play a small role in reducing the broader structural inequalities that play out within healthcare settings.

Source

Oxford University et al. (2021), Saving Lives, Improving Mothers’ Care

Young, K., Fisher, J. & Kirkman, M. (2020), Partners instead of patients: Women negotiating power and knowledge within medical encounters for endometriosis

Characteristic

Gender Reassignment

Evidence gathered and Strength/quality of evidence

IAs will likely provide services to people who have or are undergoing gender reassignment, therefore changes to commissioning guidance may impact this group.

People reported feeling uncomfortable being open about their non-binary identity when using various public services. This was particularly true of general NHS services, where 60% of respondents ‘never’ felt comfortable (n 824), as well as with GPs where 50% of respondents said they ‘never’ felt comfortable (n 846). Survey respondents reported that they will often avoid using a variety of public services, due to embarrassing or uncomfortable situations arising, many of which were attributed to people being uneducated about non-binary people.

At end March 2021, 0.1% of the staff employed by NHSScotland declared that they were transgender.

Source

Scottish Trans Alliance and Equality Network (2016), Survey of Non-binary People’s Experiences in the UK

NHS Education Scotland (2021), NHS Workforce Statistics Equality and

Diversity table

Data gaps identified and action taken

Very limited Scotland-specific data.

Characteristic

Sexual Orientation

Evidence gathered and Strength/quality of evidence

Data suggests that lesbian, gay and bisexual people in Scotland face a range of health issues arising from prejudice and discrimination. Levels of smoking, substance use and mental health are likely to be poorer.

IAs will provide services to people of all sexual orientations, therefore changes to commissioning guidance may impact these groups.

Source

The Scottish Public Health Observatory (2010), Dimensions of Diversity: Population differences and health improvement opportunities

Scottish Government (2012), Scottish Health Survey – topic report: equality groups

Data gaps identified and action taken

The data identified is over 10 years old and therefore may be outdated.

It is difficult to find Scotland-specific data on this topic.

Characteristic

Race

Evidence gathered and Strength/quality of evidence

The last census indicated that 16% of the Scottish population were minority ethnic and 4% of the population were black and minority ethnic.

Data covering 2020/21 highlights that the vast majority of social care clients identify as white.

Given the vast majority of social care users identify as white, there is a risk that other racial and ethnic minority groups may not be fully considered in the commissioning and design of services.

However, data suggests that minority ethnic groups, excluding Gypsy/Travellers, have better general health than the majority white population.

In Scotland, the mortality rate is also higher in the majority ethnic (white) population than in the black and minority ethnic population.

Nonetheless, revised commissioning guidance could contribute to this area by promoting consideration of diversity and equality duties when commissioning services.

Source

Public Health Scotland (2022), Insights in social care: statistics for Scotland

Public Health Scotland (2022), Ethnic groups and migrants

Characteristic

Religion Or Belief

Evidence gathered and Strength/quality of evidence

There is variation in how different religious groups self-report their health and mental wellbeing.

It is likely that IAs will commission services for people who hold a range of beliefs and religions. The proposed work programme may therefore indirectly impact people with a wide range of religions and beliefs. Refreshed guidance could promote greater equality, in the design of services, for those from minority religious groups.

Source

Scottish Government (2012), Scottish Health Survey – topic report: equality groups

Data gaps identified and action taken

There is limited data on this topic.

The data identified is 10 years old and therefore may be outdated.

Characteristic

Marriage And Civil Partnership

Evidence gathered and Strength/quality of evidence

N/A

Source

N/A

Data gaps identified and action taken

N/A