National Care Service - adult social care: equality evidence review

11. Socio-economic status

The impact of socio-economic disadvantage on people’s outcomes is recognised by the Fairer Scotland Duty. The Duty seeks to tackle socio-economic disadvantage and reduce the inequalities that are associated with being disadvantaged. This is a complex, multidimensional problem, closely related to poverty. Having less access to resources can mean that individuals fare worse on outcomes including health, housing, education or opportunities to work or train, and these negative outcomes can reinforce each other^[117]. The Scottish Index of Multiple Deprivation (SIMD) is the Scottish Government's standard approach to identify areas of multiple deprivation in Scotland^[118].

11.1 People who access social care

Overall, substantially higher proportions of people in the most deprived areas in Scotland receive home care support; 26% of people receiving home care lived in the most deprived areas, compared to 13.9% in the least deprived. However, this varies by age; 36.2% of those aged 16-64 receiving home care lived in the most deprived areas, compared to 7.5% in the least deprived, while there was little difference in the age 85 and over age group^[119].

Analysis of the Health and Care Experience Survey data found that people living in the most deprived areas were amongst those most likely to be not receiving support but feeling they needed it in 2021-22^[120]. Analysis of social care data in England found that people living in deprived areas or low income households were much more likely to need help with one or more Activities of Daily Living. This research also found an association between unmet need and deprivation for older people in England, and reported that people aged 65 and over living in the most deprived neighbourhoods were more than twice as likely to experience unmet need than those living in the least deprived areas. This report draws parallels with social care need and the social determinants of health, and suggests that people’s need for care is influenced by the same factors that influence health (e.g. employment, housing, education as well as social and community factors)^[121].

11.2 Unpaid carers

The Scotland’s Carers Report found little difference between the overall proportion of people who are unpaid carers living in the most and least deprived areas. However, it did find differences in the number of hours spent caring, with unpaid carers living in the most deprived areas much more likely to be caring for 35 hours a week or more than those in the least deprived areas (47% and 24% respectively). Furthermore, despite there being little difference in the overall proportion of people who are unpaid carers between the most and least deprived areas, there were notable differences for younger age groups. People aged under 25 living in the most deprived areas were more likely to be unpaid carers than those in the least deprived areas (3.1% and 1.7% respectively). In addition, young carers in the most deprived areas were more likely to be caring for 35 hours a week or more than those in the least deprived areas (28% and 17% respectively)^[122]. Whilst this was based on Scotland’s 2011 Population Census data, the findings are consistent with the more recent Carers Census (2020-21), which includes all unpaid carers being supported by local services across Scotland. The Carers Census also found little difference in the number of adult unpaid carers by deprivation, but substantial differences for young carers; 14% of young carers being supported by local services lived in the most deprived Scottish Index of Multiple Deprivation (SIMD) decile compared to 5% who lived in the least deprived SIMD decile^[123].

11.3 Social care workers

As there is no available data on SIMD and the social care workforce, this section focuses instead on pay and conditions in the adult social care workforce. Almost half (47%) of the adult social care workforce were employed on a part-time basis in 2020. On average, adult social care workers in Scotland worked for 31 hours per week in 2020. The majority of adult social care workers were employed on a permanent basis, with 5.5% being on zero-hour contracts^[124]. However, it should be noted that part-time work and zero-hour contracts are not proxies for deprivation or poverty.

In their 2019 report on ‘Fair Work in Scotland’s Social Care Sector’, the Fair Work Convention highlighted poor terms and conditions and a lack of security for social care staff, although they acknowledged that progress was being made to address issues of low pay with the implementation of the Living Wage^[125].