National carers strategy: executive summary

Introduction

Unpaid care is vital to how social care is provided in Scotland, and the value of the dedication and expertise of carers cannot be overstated. This strategy recognises the diverse experiences of carers and sets out a range of actions to ensure they are supported fully in a joined up and cohesive way. It brings together existing initiatives and new approaches, and proposes new and better ways to support carers. It seeks to reflect both the diversity of careers' experiences and their lives beyond caring to avoid pigeonholing people as carers and nothing else.

For many people, caring is a positive experience. Those with the least intensive caring roles can experience better than average mental health and wellbeing. For many carers, the time spent with the person they are caring for can be a positive and rewarding experience, if supported appropriately.

Every caring situation is unique. Carers' individual needs and the impact of caring depend on all sorts of factors such as their age, health and ethnicity, and their support networks of family and friends. For example, minority ethnic carers face the same challenges as all carers, but also face additional barriers, for instance cultural barriers, stereotypes and language which can increase the chances of poorer health, poverty and social exclusion. The level and type of care provided is also a major factor. There are very different physical and emotional pressures from supporting someone with addiction, a mental illness, a physical disability or learning disability, or a progressive condition or terminal illness.

People in more intensive and stressful caring roles can often experience negative impacts on their health and wellbeing. Without the right kind of support and recognition, unpaid carers can face difficult challenges. The approach set out in this strategy seeks to ensure that unpaid carers can provide the best possible care, supported by a system that recognises and values their contribution, allowing them to lead a full life in addition to their caring role.

Without proper support and the ability to lead a full life beyond caring, a carer's health and wellbeing suffers. This has an impact on the cared-for person often resulting in greater need for health and care support, particularly for older people, such as admission to a care home or hospital or delays to hospital discharge.^[1] Where the caring role leads to a carer leaving employment, this will affect their financial situation, their employer and the wider economy.

People who provide care to loved ones must be supported to do so in the most effective way and in a way that allows them to lead a balanced and varied life. The Carers (Scotland) Act 2016 aims to ensure that carers have choice and control, and can access preventative support to keep caring situations manageable. It puts in place a system of carers' rights designed to listen to carers, improve consistency of support and prevent problems – helping sustain caring relationships and protect carers' health and wellbeing.

Despite this, we know that unpaid carers can have too many burdens placed on them. To address this, the strategy will drive long-term, sustainable systemic change to how carers are valued and supported. This will help to recognise and mitigate the potential wellbeing, economic and social risks of caring. This will need immediate action as well as change over an extended period.

It is also important to build a wider understanding and recognition of caring across society. Unpaid carers are a diverse range of people covering all parts of society, but they can often be marginalised. We must ensure that unpaid care is visible, understood and valued across society, not regarded as peripheral or something that affects only particular people.

The broader policy landscape

As part of the development of the National Care Service (NCS), we are proposing changes to how people access care and support in Scotland. People have told us that the current system of eligibility criteria often does not work for them. Eligibility criteria are focused on deficits, not outcomes, and do not necessarily put a person's human rights at the centre of decisions. We have committed to overhaul the current mechanism of eligibility criteria and set out proposals for doing this in the NCS consultation.

This will mean changing the way care and support services are designed and delivered. We want the focus to be on the support people need, not on eligibility. Prevention will be prioritised, and we will make sure that people can move easily between different types of care and support as their needs change. We will continue to actively engage with stakeholders, including carers, to develop this work. Improving access to social care cannot wait for the NCS, and we are putting in place measures to strengthen the implementation of Self-Directed Support (SDS) and improve prevention and early intervention.

The issues that affect carers go beyond health and social care. This strategy sits within a wider reform agenda, with carers at its heart. In order to achieve lasting change both for carers and the people they care for, we will drive forward a range of policy developments, such as actions to tackle health inequalities and household income. Carers' own rights and needs are impacted by the service, support or budgets available to the person they care for. This strategy will help to bring about sustainable improvements in this wider context.

We also welcome the European Care Strategy^[2] published in September 2022which reflects the ambition to improve support and recognition for unpaid carers that Scotland and the European Union both share.

The impact of COVID-19

We have learned lessons from the COVID-19 pandemic and the strategy reflects that. We know that we need to be able to support carers better whilst also enabling them to live as fully as possible.

The Scottish Government's and COSLA's jointly chaired Pandemic Response in Adult Social Care Group provided a multi-stakeholder focal point for work to support the effective delivery of adult social care during the COVID-19 pandemic. The group had a strong focus on issues that unpaid carers are experiencing, with valuable contributions from carer representatives. While the group has been superseded by new approaches to addressing social care pressures, it is vital that we continue to recognise carers and support them as we move into a new phase of living with COVID-19.

Our approach

The strategy will cover activity during the current Scottish Parliament to spring 2026, but will be reviewed annually to monitor progress and ensure it is focussed on the most important issues.

The key themes of the strategy intend to put the individual carer at the centre and focus on five different aspects of unpaid carer support:

• Living with COVID-19
• Recognising, valuing and involving carers
• Health and social care support
• Social and financial inclusion
• Young carers

Developing this strategy

We have consulted with carers with lived and living experience to ensure that in developing this strategy we have had meaningful engagement with those who know what it is like to devote a significant proportion of their time to caring for a loved one or friend. We have also engaged with carer organisations and a range of delivery partners to make sure that those who have responsibilities to support carers have also shaped this strategy.

Scottish Government policy works in a variety of ways to help protect carers' health and wellbeing and to sustain caring relationships. It is based on a human rights approach to supporting carers, in line with other government policies and legislation.

Our policies contribute to a number of outcomes from our National Performance Framework^[3] and these principles underpin the strategy.

Carers in Scotland^[4]

Scotland's carers make a huge contribution to the people they care for and our communities. There are more people caring full time for relatives or friends than staff working in either the NHS or in social care.^[5] The actual number of carers is not known but it was estimated that there were 700,000 to 800,000 unpaid carers in Scotland before the COVID-19 pandemic.

Age and gender

Of the 696,000 carers in Scotland, 28,000 are under 18.^[6] Although people can become carers at any stage, they are most likely to be caring between the ages of 45-54. In this age group, over a quarter of all women and around a sixth of all men are carers.

There are over 133,000 carers aged 16+ caring for 35 hours a week or more. Around a quarter of older carers (aged 65 and over) provide 35 hours of care a week or more compared with just under a tenth of carers under 24.

Overall, 59% of carers are women and 41% are men. Throughout their working years, women are more likely to be carers than men. With gender stereotypes surrounding caring still present in our society, there is a risk that women feel more pressurised to undertake caring roles. This pressure can negatively impact on a woman's career path and be a key driver of the gender pay gap.

Demographic pressures

Scotland's population is ageing, with numbers of very old people predicted to continue growing and a proportionately smaller working age population. This is a success story in terms of improved health and wellbeing and longer life expectancy, but it has significant implications for the future of care and support in Scotland. With demand for health and social care services predicted to grow by 25% by 2031^[7], the role and contribution of carers will be even more critical in the future.

Intensive caring and deprivation

29% of carers in the most deprived areas care for 35 hours a week or more – more than double the level in the least deprived areas. Caring may therefore stem from lack of choice and may be exacerbated by existing inequalities of low incomes and poor health in these areas.^[8]

Impacts of caring

Unpaid carers make a huge contribution to the people they care for and our communities. It is estimated that the economic value of the contribution made by