Adult social care support and community health - learning and improvement framework: equality impact assessment

Key Findings

The research was conducted to identify the outcomes that various population groups seek to achieve when engaging in and with adult social care support services, alongside the barriers and enablers to achieving these. As part of the analysis, protected characteristics were examined such as age, race, sex, and gender reassignment. The potential impact of the framework on these protected characteristics in relation to three Public Sector Equality Duties (PSED) needs were considered. An overview of the findings for each of the protected characteristics can be found below:

Age

PSED need 1: Eliminating unlawful discrimination, harassment, and victimisation

• The SLIF has been developed to focus and track improvement across the outcomes that matter to people. Ensuring that the SLIF considers the needs of older people has been vital, particularly due to the growing ageing population across Scotland.
• An examination into existing research on older people accessing social care support services emphasised the importance of the workforce having improved professional knowledge for example in areas such as supporting specific care needs, or care planning such as self-directed support options. The framework’s workforce development pathway aims to support staff to develop knowledge, skills, and competencies in order to deliver safe, effective, high-quality care and support.
• The framework has been developed to support improvements in adult services and the outcomes for adult groups who engage with these services.

PSED need 2: Advancing equality of opportunity

• Having improved choice and control over their care was viewed as one of the main outcomes that older people seek to achieve when engaging with and using adult social care support services. The SLIF’s supporting people pathway has been designed to be used by service managers seeking to self-evaluate and improve support for people which includes aspects such as people’s involvement in decisions.
• The framework has been developed to support improvements in adult social care support and community health services and the outcomes for adult groups who engage with these services.

PSED need 3: Promoting good relations among and between different age groups

• Developing relationships with people involved in their care to support with transitions and information was identified by older people as an enabler to achieving their desired outcomes when engaging with services. The SLIF’s supporting people pathway seeks to support the development of quality relationships between people who use social care support and community health services, unpaid carers, families, and the workforce.
• The framework has been developed to support improvements in adult services and the outcomes for adult groups who engage with these services.

To help mitigate any potential negative impacts for children and young people, there is an intention to explore the inclusion of a transitions pathway within the SLIF in future phases. This would support smoother transitions between children’s and adult services. Work in this area will build on learning from the CYPIC - Children and Young People Improvement Collaborative

Disabled People

PSED need 1: Eliminating unlawful discrimination, harassment, and victimisation

• The evidence considered for the EQIA suggested that some disabled people with sensory loss impairments felt that there was a lack of staff training on sensory loss impairments. The SLIF’s workforce development pathway seeks to improve workforce development i.e. by ensuring that staff develop the knowledge, skills, and competencies to support the delivery of high-quality care and support.
• Some people with learning disabilities reported not being given sufficient support to make informed choices about their support and care. The framework’s supporting people pathway seeks to enhance the choice and control that the service user has over their care and support.

PSED need 2: Advancing equality of opportunity

• Accessibility in terms of being able to access information and clear communication, was a recurring enabler identified across disabled groups with different types of impairments. The SLIF’s supporting people pathway prioritises a focus on the provision of timely information and advice for the service user.

PSED need 3: Promoting good relations among and between disabled and non-disabled people

• Developing strong relationships with their care worker was viewed as an important enabler for all disabled groups when using adult social care support services. The SLIF’s supporting people pathway focuses on developing strong relationships between people who use social care support, community health services, and the workforce.

Sex

PSED need 1: Eliminating unlawful discrimination

• Both men and women who are survivors of domestic abuse reported barriers when attempting to access services, such as a lack information about services, and stigma. The SLIF’s supporting people pathway aims to improve the provision of person-led care where the service user is respected and is able to access information and advice in a timely manner.

PSED need 2: Advancing equality of opportunity

• The greater adverse effect on women (e.g., greater risk of death compared to men) indicates the need to provide more services and support for female survivors of domestic abuse. Continuous improvement of services and the range of support that is provided to people who use social care support/community health service is embedded in the SLIF’s providing support to people pathway.

PSED need 3: Promoting good relations between men and women

• The SLIF’s supporting people pathway aims to support the development of respectful and supportive relationships between people who use social care support and community health services, the workforce, unpaid carers, and families, covering both men and women.

Pregnancy and maternity

PSED need 1: Eliminating unlawful discrimination

• Pregnant women with multiple complex needs and health issues mentioned specific barriers when engaging with services in relation to trauma, experiences of racism and fears about prejudice and stereotyping. This was of particular concern for pregnant people under the age of 20, those with a learning disability and migrants, asylum applicants, or refugees. The SLIF’s supporting pathway seeks to improve outcomes for people using services through the provision of human rights-based care and support.

PSED need 2: Advancing equality of opportunity

• Research conducted with pregnant women with multiple complex needs highlighted the importance of having services that are accessible to all. The SLIF’s supporting people pathway seeks to enhance people’s access to care and support.

PSED need 3: Promoting good relations

• The provision of person-centred services that are person-centred (treats all pregnant people with dignity and respect) was identified as a key enabler for pregnant women experiencing complex social factors. The SLIF’s supporting people pathway seeks to ensure that people are respected, supported and safe when accessing services.

Gender reassignment

PSED need 1: Eliminating unlawful discrimination

Some Trans people reported experiencing direct discrimination when accessing transgender services for example, having referrals being refused. The SLIF’s supporting people pathway seeks to ensure that people are respected, supported and safe when accessing services.

PSED need 2: Advancing equality of opportunity

• Some Trans people emphasised the importance of integrated services which includes having access to a range of alternative sources of support, such as transgender support groups, gender specialists, mental health services and services that offer holistic care for future plans, and support with societal and familial conflict, social isolation, and discrimination. People having greater choice and control over their care and support is embedded throughout the framework, especially in the supporting people pathway.

PSED need 3: Promoting good relations

• The research conducted with Trans people identified a lack of information on their experiences of health and wellbeing in educational materials. Specific workforce training that focused on gender dysphoria and identified areas of good practice, including referral services for Trans people and their rights would enable the workforce to enhance their awareness and understanding of this group and their needs.

Sexual orientation

PSED need 1: Eliminating unlawful discrimination

• Older LGBTQI+ people reported experiencing prejudice, stigma and discrimination when engaging with services. The provision of human rights- based care and support in a respectful manner is embedded throughout the SLIF from both a workforce and service user perspective, notably in the supporting people pathway.

PSED need 2: Advancing equality of opportunity

• LGBTQI+ people emphasised the importance of having targeted support and information for LGBTQI+ people. The SLIF seeks to provide the service user with greater choice and control over their care and support through the use of its supporting people pathway.

PSED need 3: Promoting good relations

• Regular specialist training on LGBTQI+ inclusion and the use of inclusive language were identified as key areas for development to improve the experiences of LGBTQI+ people accessing services. The SLIF’s workforce development pathway strives to improve staff support and workforce development through learning and development so that staff develop the knowledge, skills, and competencies to deliver high quality care and support.
• Some older LGBTQI+ people reported a lack of support networks and social isolation, with the group more likely to live alone, to be single, to not have support networks or children, and/or to not be in touch with biological family. This increases the risk of feeling disconnected and can also affect the mental wellbeing and confidence needed to reach out to services. The SLIF’s supporting people pathway seeks to improve people’s health and wellbeing through seeking to understand the outcomes that matter to people.

Race

PSED need 1: Eliminating unlawful discrimination

• Some people from ethnic minority backgrounds reported experiencing racial stereotyping when engaging with social care services, especially with care-related decisions, with it sometimes being assumed that family networks are available to provide unpaid care. The SLIF’s providing support to people pathway focuses on the provision of person-led care where the service user and unpaid carers feel valued, respected, supported, and listened to.

PSED need 2: Advancing equality of opportunity

• People from ethnic minority backgrounds have communicated the importance of being provided with a full range of care services which enables person-centred, rights-based care. The provision of quality, safe and human rights-based care, and having choice over care and support are integral aspects of the SLIF’s providing support to people pathway.

PSED need 3: Promoting good race relations

• When engaging with services, some people from minority ethnic backgrounds mentioned feeling rushed and a lack of time spent with the professional. They noted the importance of the professionals taking the time to listen to and familiarise themselves with their needs. The SLIF, through its supporting people pathway, seeks to enhance the delivery of care through the development of quality relationships.

Religion or belief

PSED need 1: Eliminating unlawful discrimination

• Some women from minority communities have reported a lack of understanding around multi-generational households, which are more common in some communities. This can mean women do not always feel able to speak openly at home about personal challenges. The framework’s workforce development aims to ensure staff build the cultural awareness and knowledge needed to deliver effective, high-quality care and support.

PSED need 2: Advancing equality of opportunity

• Women from minority communities can often face barriers in accessing appropriate and culturally sensitive mental health services. The SLIF’s supporting people pathway seeks to embed a person-led approach whereby people have access to integrated safe, reliable, and responsive care and support to meet their needs, provided through quality relationships.

PSED need 3: Promoting good relations

• Women from minority communities have expressed that at times professionals can lack understanding of their cultural context, which could be improved through cultural awareness training. The SLIF’s workforce development pathway aims to support workforce development in various ways i.e. training to ensure that they develop the knowledge and skills to deliver effective, high-quality care and support.

Intersectionality

The experiences of population groups who possess multiple protected characteristics when engaging with services were examined during both the qualitative and quantitative research conducted. A summary of the key findings is as follows:

Age and sexual orientation:

The findings from the research demonstrate how multiple protected characteristics, such as age and sexual orientation, intersect to exacerbate the barriers faced by specific population groups when engaging with adult social care support and community health services. These groups are more likely to experience instances of discrimination and prejudice when engaging with services, which can negatively impact their ability to receive human rights-based care. Through the use of the supporting people pathway, the SLIF seeks to ensure a focus on greater choice and control for people’s care and support.

Sex and religion:

It is evident that the intersectionality between sex and religion can compound the barriers faced by specific population groups who possess both of these protected characteristics, especially when attempting to access human rights-based care that incorporates awareness of both their individual, and cultural needs.

When examining the existing research, gaps were identified for population groups including minority ethnic carers/women and disabled people. To address the gaps, in-person workshops were subsequently held with different groups, including Pakistani and Sikh women and disabled people.