Resource Spending Review: Equality and Fairer Scotland Statement

Opportunity/Challenge 3: Ensure that inequalities in physical and mental health are tackled through the effective delivery of health and social care services as well as broader public health interventions

What does the evidence tell us?

• People experiencing socio-economic disadvantage have poorer physical and mental health, a shorter life expectancy, lower life satisfaction, and are more likely to experience feelings of loneliness.^[37] Age-standardised death rates for COVID-19 have been over twice as high for people living in the most-deprived areas compared to the least deprived areas.^[38],[39]
• People living in the most deprived areas were 18 times as likely to have a drug-related death as those in the least deprived areas. That ratio has almost doubled in 20 years, from around 10 times in the early 2000s.^[40]
• Younger people have poorer mental health than older people, particularly young women who are more likely to report mental health problems than other age and sex groupings.^[41],[42]
• Older people face disproportionate health, frailty, and multi-morbidity effects. Increasing proportions of those aged 75 and above are living with long-term conditions in comparison to younger age groups.^{[43],[44],[45]}
• Many disabled people have higher than average needs for health and social care services.^[46] The COVID-19 mortality risk for disabled people remains high^[47] and they are more likely to have comorbidities, suffer greater negative outcomes from Covid, particularly when admitted to hospital.^[48]
• There is continued evidence of increased risk of COVID-19 hospitalisations and severe outcomes in most minority ethnic groups relative to the White group.^[49] Compared to people identifying as White Scottish, deaths among people with Pakistani ethnicity were 3.7 times as likely to involve COVID-19. ^[50]
• Prevalence of some health conditions is higher among certain ethnic groups. For example, type 2 diabetes is up to six times more likely in people of South Asian descent and is up to three times more likely in African and Afro Caribbean people.^[51]
• Women are experiencing significant mental health impacts from the pandemic and women in the UK continue to be lonelier than men.^[52]
• In every year since 1985, 70% of all people dying from suicide have been men. Younger men are particularly affected. In 2020, suicide rates were highest for men between the ages of 35-39 who accounted for 12% of all suicide deaths.^[53]
• Lesbian, gay, bisexual, and people of other sexual orientations are more likely to report poor mental health. A 2021-22 survey by LGBT Youth Scotland found that 88% of those who responded to their LGBTI young people survey had experienced at least one mental health condition or related behaviour.^[54]
• Around 60% of Scotland's carers are women, who have therefore been disproportionally affected emotionally, financially, and physically due to their caring role particularly during the pandemic. Around 47% of carers in the most deprived areas care for 35 hours per week or more – almost double the level in least deprived areas.^[55]

What are we doing to address this?

In the period ahead, the focus will be to build on the response of our health and social care sector to the COVID‑19 pandemic, reforming services, prioritising population health, and tackling underlying health and wellbeing inequalities. This will include implementation of the NHS Recovery Plan^[56], work to tackle health inequalities through the Mental Health Strategy 2017-2027, the delivery of more effective social care, and the establishment of the National Care Service.^[57] We are developing a new strategy for older people's health and social care in Scotland, to be published later in 2022.

Investment in our health and social care services is central to Scotland's recovery from COVID-19 - and to ensuring we properly recognise and reward the hardworking staff and carers who have gone over and above to make sure we are all cared for when we need it most. It is essential that we drive up standards and quality in social care support. We previously confirmed our support for this agenda in the 2022-23 Budget with more than £1.6 billion of investment for social care and health integration. We will take forward establishment of the National Care Service, bringing social care into parity of esteem with healthcare and transforming the provision of this essential service. This will be backed by a 25% increase in social care investment – equivalent to more than £840 million.

We are committed to establishing the National Care Service by the end of the current Parliamentary term to ensure consistent, fair, high quality social care and support for everyone who needs it in Scotland regardless of where they live. The National Care Service is to fundamentally reimagine social care in Scotland and presents an opportunity to change the way support and services are designed and delivered, placing human rights at the centre of our decision making. We will shift our emphasis to prevention; empowering people to engage positively with their own care; embedding fair work and ethical commissioning; and strengthening the commitment to integrating social care with community healthcare.

We have invested an additional £20.4 million for local carer support in 2022-23, bringing our total investment in the Carers Act to £88.4 million per year. We have consulted on legislation to establish a right to breaks from caring and are working on legislative proposals in the light of this feedback. We are acting now to expand short breaks support, ahead of any legislation. We have allocated an extra £5 million for short breaks in the 2022-23 budget, on top of the annual £3 million voluntary sector Short Breaks Fund.

To help reduce inequality associated with problem drug use we are investing an additional £250 million over the life of the current parliament. This funding underpins our National Mission on drugs – to save and improve lives. As well as funding for local alcohol and drugs services in our most deprived communities, this resource also provides direct grant funding to local community groups and third sector partners operating at grass-roots level to provide community support in areas of deprivation. Although the main aims of the mission are to get more people into the protective treatment and recovery that is right for them, and at the right time for them, the National Mission also includes initiatives to protect the families and children of those impacted by drugs. The National Mission is also closely linked to services for mental health, primary care, and homelessness.

We are developing a population health response to the issues affecting the mental health and wellbeing of children, young people, and their families. Our direct programme budget for mental health will be used to develop and enhance services and support for children and young people. This includes providing up to £40 million for Child and Adolescent Mental Health Services (CAMHS), £5 million to implement the recommendations of the Eating Disorders Review, £3 million for distress and crisis services with a focus on support for under-16s. We will also provide at least £15 million for community mental health services for children and young people in 2022-23. We will continue to build on our response through the period of the spending review.

Our £15 million Communities Mental Health and Wellbeing Fund for adults will promote wellbeing, mitigate and protect against the impact of distress and help tackle the impacts of social isolation, loneliness, and mental health inequalities on adults in 2022-23. Among the groups that could benefit are women, older people from a minority ethnic background, people facing socio-economic disadvantage, people with a long term health condition or disability, people disadvantaged by geographical location (particularly remote and rural areas) and Lesbian, Gay, Bisexual and Transgender and Intersex (LGBTI) communities.

We are developing a self-harm strategy and action plan, involving stakeholders and people with lived experience from different groups and we will ensure transgender people are actively engaged, involved and considered as part of this work. A key element of developing our strategy will be filling gaps in data and gaining a deeper understanding of how self-harm affects different groups, including the transgender community, so that we can design the most effective pathways and types of support that meets their needs.

The Scottish Government has committed to three years of funding to improve access to, and delivery of, NHS gender identity services and in December 2021 published a NHS gender identity services: strategic action framework^[58]. This set out work which will be progressed to improve these clinical services from 2022 until the end of 2024. £2 million has been allocated to support this work in 2022-23.

As set out in the Scottish Government's 2021 Race Equality Immediate Priorities Plan^[59], we are developing plans to reinvigorate efforts on culturally competent health promotion and disease prevention of diabetes for people from minority ethnic communities. Work is also underway across Government, and with a range of key partners, to ensure we improve the collection and use of ethnicity data to evidence and address inequities in health access and outcomes. For example, we are improving the collection and recording of ethnicity information at the time of GP registration, and as part of our vaccination programme. We will continue to prioritise funding to deliver a world-class public health system; strengthen our investment in primary and community health care services; continue to support the social care sector; improve population health through tackling obesity, increasing physical activity, and reducing the harmful use of drugs, alcohol and tobacco; and improve the mental health and wellbeing of the population.