Consultation to amend the Civil Contingencies Act 2004 to include Integration Joint Boards: EQIA

We have good evidence across a range of services and needs in health and social care (H&SC) by age group from a range of sources, including official and national statistics, administrative data and surveys with the public. These show that use of delegated services is patterned by age. Older people, in particular, are highly reliant on H&SC, especially towards the end of life.

Specific age groups are also more likely to provide a relative or friend with care.

Integration Joint Boards do not directly employ staff, the relevant Health Board and Local Authority continue to be the employers. The Integration Joint Board workforce is therefore already factored into the planning assumptions for those organisations. As at end September 2020, 15.8% of the NHS Scotland workforce (whole time equivalent) were aged under 30 years, whilst just under half (45.9%) were aged between 30 and 49 years, and 38.3% were aged 50 years and over. At end August 2020, the median age of the social care workforce ranged from 33 to 51 depending on the sub-sector. Care home staff had a median age of 45.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Population level data

The Scottish Health Survey includes self-reported health status, conditions which impact on daily life and caring responsibilities; social care and a range of health statistics are published by Public Health Scotland; report on Scotland's Carers.

The Care Experience Surveys are the Scottish Government's main national data source about individuals' interactions with general practice, cancer care, as an inpatient and or maternity services. Results are broken done by age and gender. However, detailed breakdown by other ethnicity, disability, religion, sexual orientation are not included in regular reports. The last time such analysis was undertaken was in 2011 for general practice – "Scottish Patient Experience Survey of GP and Local NHS Services 2011/12 Volume 3: Variation in the Experiences of Primary Care Patients."

Workforce data

NHS Workforce Statistics (Last updated: September 2020, NHS Education for Scotland)

Scottish Social Service Sector: Report on 2019 Workforce Data, SSSC, August 2020

N/A for the Scottish Government in the context of this specific policy.

(Statutory responses to emergencies are likely to have unequal impacts on different groups which should be taken into account in impact and risk assessments and in monitoring of any measures taken. Integration Joint Boards should already consider whether they have the data they need at the local level.)

People with a disability use more H&SC services and have significantly poorer health outcomes and behaviours, on a wide range of measures, than the general population.

Many carers also have a disability.

We have good statistics for many policy areas at a general level.

At end March 2020, 1.1% of the staff employed by NHSScotland declared a disability. (Information on disability, ethnicity, religion, sexual orientation and transgender status is based on data from a self-reported questionnaire. As this is not mandatory, response rates and completion are variable across NHSScotland.) In August 2020, the proportion of social care staff declaring a disability ranged from 0 to 4% depending on the sub-sector.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Population level data: see entry at 'Age'.

Workforce data

NHS Workforce Statistics Equality and Diversity table (Last updated: March 2020, NHS Education for Scotland)

Scottish Social Service Sector: Report on 2019 Workforce Data, SSSC, August 2020

As for age.

We have good evidence across a range of services and needs in H&SC by sex (for those self-identifying as male or female) from a range of sources, including official and national statistics, drawn from administrative data and surveys with the public. We know that some services are used more by women and there are various reasons for this (e.g. most unpaid care is provided by women, higher life expectancy, pregnancy and maternity).

The H&SC workforce is predominantly female. At end September 2020, 77.2% of the staff employed by NHSScotland were female, while 22.8% were male. At end August 2020, 83% of social care staff were female, with 15% male and 2% unknown.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Population level data: see entry at 'Age'.

Workforce data

NHS Workforce Statistics (Last updated: September 2020, NHS Education for Scotland)

Scottish Social Service Sector: Report on 2019 Workforce Data, SSSC, August 2020

As for age.

Pregnant women and new mothers use specific services in H&SC and are part of the workforce.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Population level data:

Information on the use of specific health services by pregnant women and recent mothers are included in NHS data published by PHS.

The Scottish Government's Maternity Care Survey has run three time and asks 2,000 women about their most recent experiences.

As for age.

At end March 2020, 0.1% of the staff employed by NHSScotland declared that they were transgender. (Information on disability, ethnicity, religion, sexual orientation and transgender status is based on data from a self-reported questionnaire. As this is not mandatory, response rates and completion are variable across NHSScotland.) We do not have reliable data on the numbers of transgender individuals working in social care; rates of use of health and social care service use or needs; or health outcomes. Any figures would be likely to be inaccurate for a number of reasons.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Workforce data

NHS Workforce Statistics Equality and Diversity table (Last updated: March 2020, NHS Education for Scotland)

N/A for the Scottish Government in the context of this specific policy.

Survey data indicates that LGBT people often have poorer health behaviours and poorer self-reported health than other groups which may mean they need more services.

Non-response in surveys often makes it difficult to analyse responses. However, this may be changing as social attitudes evolve and people become more comfortable in sharing information about sexual orientation.

There is research literature indicating that gay and bisexual people have more negative experiences of health and care services.

At end March 2020, 55.4% of the staff employed by NHSScotland declared their orientation as heterosexual, 0.7% as gay, 0.4% as lesbian, 0.5% as bisexual and 0.2% responded 'other'. (Information on disability, ethnicity, religion, sexual orientation and transgender status is based on data from a self-reported questionnaire. As this is not mandatory, response rates and completion are variable across NHSScotland.)

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Workforce data

NHS Workforce Statistics Equality and Diversity table (Last updated: March 2020, NHS Education for Scotland)

N/A for the Scottish Government in the context of this specific policy.

How race interacts with health and social care is complex and there are very wide variations in outcomes and experiences for different groups within 'Race' as a characteristic. In Scotland, BAME groups have better population health outcomes and behaviours than White population across many measures (e.g. lower level of smoking, healthier diet); other conditions are more prevalent in certain groups (e.g. Type 2 diabetes on South East Asian populations). It is well established that Gypsy Travellers have by far the worst outcomes of any ethnic groups and face multiple compounding disadvantages.

Reliable data by ethnicity is often not available for specific services or conditions.

One reason is the relatively low proportion of the overall population who are not White Scottish/British which means that response numbers in population surveys with a representative sample of the population will be small and numbers from administrative data sources too small to report, especially if there is a risk of identify disclosure.

Scottish Surveys Core Questions Analysis:

Data for core questions across the SG's main general population surveys are combined in an annual Official Statistics publication which allows breakdowns by ethnicity for relevant measures. This results in an annual sample of around 20,000 respondents, providing unprecedented precision of estimates at national level. This size enables the detailed and reliable analysis of national indicators by protected equalities characteristics such as ethnic group, religion, country of birth, sexual orientation, age, and gender. Further variables are education level, economic activity, tenure, car access and household type. The analysis employs age-standardised rates to compare people of similar age, which avoids the often misleading direct comparisons between populations with very different age structures.

SSCQ also enables more detailed analysis of sub-national geographies than source surveys allow (Local Authorities, Health Boards, Police Divisions and some smaller geographies - see Supplementary Tables).

Recording of ethnicity in secondary care is patchy and almost non-existent in primary care. Service use data may not be disagreggable to sub-national levels at all or on a regular basis.

At end March 2020, 69.8% of staff employed by NHSScotland declared their ethnicity as White, 0.4% as Mixed, 2.3% as Asian, 0.7% as Black and 0.3% as Other. Ethnicity is unknown or not declared for 26.5% of staff. (Information on disability, ethnicity, religion, sexual orientation and transgender status is based on data from a self-reported questionnaire. As this is not mandatory, response rates and completion are variable across NHSScotland.) The proportions for social care staff in August 2020 were 74% White, 1% Asian, 1% Black, and 22% unknown.

Interactions with other protected characteristics and socio-economic status (SES) create compounded inequalities for individuals.

Population level data

See Scottish surveys Core Questions for detailed results by ethnicity for a number of questions:

https://www.gov.scot/publications/scottish-surveys-core-questions-2017/

• "White: Other British", "White: Other" and "All other ethnic groups" reported higher good/very good general health than the "White: Scottish" reference group.
• Since 2012, levels of good/very good general health have increased by 3.0 percentage points for the "White: Other British" group.

The Scottish Government (2015) "Which ethnic groups have the poorest health?" report based on analysis of 2011 Census data. Key findings:

• Most ethnic groups in Scotland reported better health than the 'White: Scottish' ethnic group;
• Across most ethnic groups, older men reported better health than older women. Older Indian, Pakistani and Bangladeshi women reported poor health, and considerably worse health than older men in these ethnic groups;
• Gypsy/Travellers in Scotland had by far the worst health, reporting twice the 'White: Scottish' rate of 'health problem or disability' and over three and a half times the 'White: Scottish' rate of 'poor general health';
• 'White: Polish' people aged under 65 reported relatively good health, whereas those aged 65 or over reported relatively poor health;
• The age-standardised rates of 'health problem or disability' by ethnic group in Scotland followed a similar pattern to the results for England and Wales.

Workforce data

NHS Workforce Statistics Equality and Diversity table (Last updated: March 2020, NHS Education for Scotland)

Scottish Social Service Sector: Report on 2019 Workforce Data, SSSC, August 2020

N/A for the Scottish Government in the context of this specific policy.

The Scottish Government recognises the need to improve the recording of ethnicity in health and social care datasets based on administrative and clinical and is currently exploring options for this. Covid-19 has made this issue all the more important.

Different BAME groups are not evenly distributed across Scotland, so ensuring they have good quality data on BAME populations in their area will be more pressing for some Integration Joint Boards than for others.

Religion sometimes interacts/aligns with ethnicity in health behaviour and outcomes.

As at end March 2020, 30.8% of staff employed by NHSScotland declared their religion as Christian. 4.0% of staff declared their religion as belonging to another faith group (Buddhist, Hindu, Jewish, Muslim, Sikh or Other). 25.7% declared they follow no religion, and religion is unknown or was not declared for 39.5% of staff. (Information on disability, ethnicity, religion, sexual orientation and transgender status is based on data from a self-reported questionnaire. As this is not mandatory, response rates and completion are variable across NHSScotland.)

Population level data

https://www.gov.scot/publications/scottish-surveys-core-questions-2017/pages/5/

• In comparison to those with no religious affiliation:
• A lower proportion of "other" religious groups reported good/very good general health and a higher proportion reported having a limiting long-term condition.
• "Other Christians" reported a higher level of good/very good general health than the 'no religion' reference group.

Workforce data

NHS Workforce Statistics Equality and Diversity table (Last updated: March 2020, NHS Education for Scotland)

N/A for the Scottish Government in the context of this specific policy.

The Scottish Government does not require assessment against this protected characteristic unless the policy or practices relates to work, for example HR policies and or practices. This policy amendment relates to the planning of services and not to work policies, therefore we have not considered it for this EQIA.