The purpose of this chapter is to reinforce the importance of the equalities dimension in identifying and supporting carers. It is important to recognise, and to respond to, the particular challenges for some groups of carers. People should be free from disadvantage or discrimination as a consequence of caring.
As discussed in chapter 3 on the profile of carers, the lack of data on hard-to-reach or hidden carers, including BME carers, should not imply that they do not exist. This chapter also links to chapter 4 on prioritising support to carers and to chapter 6 on carers rights. We also include within this equalities chapter support to carers in remote and rural areas which is an equalities issue in terms of the availability of, and access to, services and support in certain geographical areas.
5.1 The new cross-cutting legislative framework, The Equality Act 2010, 18 is intended to protect the rights of individuals and advance equality of opportunity for all; to update, simplify and strengthen the previous legislation; and to deliver a simple, modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society. Chapter 6 on carers' rights covers in more detail the provisions in the Equality Act 2010.
5.2 Ensuring equalities in race or ethnicity, disability, gender or sexual orientation, age or religion means ensuring opportunity for all carers to access suitable resources and support. Carers may be excluded from support because there is no recognition of their particular caring situation. The result may be lack of opportunity, difficulty in accessing provision or unresponsive services.
5.3 Support needs to be delivered in a sensitive way. So, for example, carer training might be delivered to BME female carers in their own right. In relation to gender issues, professionals have to recognise that daughters may not wish to carry out personal care for their fathers. Carers' centres should deliver support to partners and be careful about advertising themselves to families only, which might be off-putting to LGBT carers. Health and social care professionals need to be sensitive to caring relationships and the different forms these may take.
"We were treated differently to heterosexual couples who meet in a private space during visiting times whereas we had to meet in the dining room of the hospital ward. One day when I put my arm around Martin to comfort him I was told to stop by healthcare staff as they thought this may lead to 'other things.' As a very private person I was extremely upset and humiliated."
Brian, who cares for his partner, Martin who has mental health problems.
5.4 There should be greater awareness in delivering culturally competent services. Cultural competence 19 as a concept has evolved particularly in relation to BME groups but it applies equally to other equality groups and all forms of social care.
5.5 Cultural competence recognises that there are barriers which effectively prevent BME carers and service users accessing appropriate support and services. These barriers may be visible, such as producing information in English only, or invisible, such as the assumptions of individual workers which may lead to cultural stereotyping.
"I look after my wife myself. Our children have grown up and moved away. It is very difficult and tiring but I have to manage. I do not read or speak English so I did not know I could get any help until a Chinese worker told me. My life is easier now but there are still many Chinese who do not know they are a carer."
Mr Lim cares for his wife, who has had a stroke and is also frail elderly. (translated into English)
5.6 Problems in identifying BME carers can lead providers to believe that there is no need or demand for their services. Additionally, BME communities in different parts of Scotland can be relatively small, with an even smaller BME carer population. This may lead providers to believe that a 'critical mass' does not exist to justify the development of specific services. Whilst it may not be practical or appropriate to develop new services, providers must consider whether they are excluding people from support that other carers receive. The 'mainstreaming' agenda recognises that mainstream services have to change to accommodate the needs of a diverse population. 'Mainstreaming' is equally applicable to all equality groups.
5.7 There will be some carers who are themselves disabled. Their particular needs should be fully addressed by local authorities, Health Boards and other partners. This will be in line with the existing disability public sector equality duties.
5.8 Equality Impact Assessments can provide an important mechanism for increasing awareness of carers' needs and rights in the public sector. The public sector is required to ensure that equality duties on race, disability and gender are integrated into all the functions and policies of Scottish Government Directorates and Agencies and of local authorities and Health Boards. We all need to assess the impact of our policies to ensure that we do not inadvertently create a negative impact for equality groups.
ACTION POINT 5.1
The Scottish Government, with COSLA and partners, will ensure that all the Action Points in this strategy are taken forward in ways which fully address the equalities perspective.
Carers in Remote and Rural Areas
5.9 Providing support to carers in remote and rural areas has an equalities dimension to the extent that carers living in these areas may not have access to support that other carers have. We refer to the particular needs of carers in remote and rural areas throughout this strategy, especially in relation to the accessibility of services for the cared-for person, the provision of short breaks, carer training, carer health and income. The accessibility of healthcare services for the person with care needs is an issue.
5.10 Another key issue is transport. Many carers in remote and rural areas have to travel long distances and there are issues about the lack of adequate transport or the high costs of transportation. Appendix 7 sets out the full range of Scottish Government policies designed to improve transportation in remote and rural areas.
"Living in a rural area we rarely go out other than for medical appointments due to fuel and time costs. Shopping and seeingfriends is always squeezed into these travel arrangements.
Doctor 68 miles return (1 hour 30 minutes), hospital 140 miles return (3 hours)."
Ann, who cares for her husband with complex health problems and limited mobility.
5.11 Community transport services 20 are normally operated by voluntary organisations and can take different forms such as community minibuses, dial-a-bus, and voluntary car schemes. These types of service are very valuable in rural areas where there are no or very limited, public transport services and are of particular benefit to older and disabled people. Many services are demand led, providing a door-to-door service at the time requested by the passenger. This type of service may be of benefit to carers, particularly in rural areas.
5.12 There are other key issues relevant to caring in remote and rural areas. As a result of having to travel long distances, it can be difficult to keep hospital and GP appointments. Innovative solutions are needed to help make life more straightforward for carers in rural areas. Telehealthcare solutions are very relevant to caring situations in remote and rural areas. Telephone support in relation to health and well-being and carer training should be explored further. The development of rural co-ordinating networks, perhaps to facilitate respite, can help. The further development of community facilitators or co-ordinators of support in remote and rural areas can be explored too.
ACTION POINT 5.2
From 2010 onwards, the Scottish Government will work with the relevant local authorities, Health Boards and Third Sector organisations to develop plans to help address rural carer issues.