National Care Service - adult social care: equality evidence review

4. Disability

Disability is defined in the Equality Act 2010 as ‘a long-term limiting mental or physical health condition, that has a substantial negative effect on your ability to do normal daily activities that has lasted, or is expected to last, more than 12 months^[44]. The Scottish Health Survey found that just under half of adults (47%) reported that they were living with a long-term health condition, with 31% reporting that they lived with a limiting long-term condition, with no significant variations by sex. The prevalence of any long-term condition (limiting and/or non-limiting) increased with age, from 32% among those aged 16-44 to 68% among those aged 75 and over. This pattern by age was similar among men and women^[45].

This section brings together data and evidence on social care and disability. Evidence is presented here in relation to the experiences of people who access social care, unpaid carers, and social care workers.

4.1 People who access social care

Public Health Scotland’s Insights in Social Care publication includes a breakdown by client group. The client group category is determined by a Social Worker or Social Care Professional and is used as a means of grouping individuals with similar care needs. Whilst this is not the same as disability, it provides some insight into the needs of different groups. A person can be assigned to more than one client group. In 2020/21, the most common client group was “Elderly/frail” (99,015 people) followed “Physical or sensory disability” (76,605)^[46]. Further data on the profile of the population of people accessing social care support can be found in People who Access Social Care and Unpaid Carers in Scotland.

The Scottish Commission for People with Learning Disabilities’ (SCLD) report data for adults with learning disabilities who are known to local authorities in Scotland. Many of this group will be accessing social care, but others will not be receiving formal support. In 2019, there were 23,584 adults with learning disabilities known to local authorities - equivalent to 5.2 people per 1000 people in the general population. Many of this group lived in mainstream accommodation (61.8%), with or without formal support. Just under a third (31.3%) lived with a family carer, mainly a parent (77.5%). A further 14.7% of people lived in supported accommodation, and 7.8% lived in registered adult care homes. SCLD data show that 18.2% of adults with learning disabilities known to local authorities attended a day centre^[47] in 2019^[48]. However, the data does not report how many adults with learning disabilities known to local authorities receive support at home or in their communities. Furthermore, the number of people attending day centres is likely to have reduced since this data was collected as a result of broader shifts in service provision, as well as the suspension of many day services during the pandemic^{[49] [50]}.

Research by the ALLIANCE and Self Directed Support Scotland (SDSS) explored people's experience of Self-directed Support and social care in Scotland. This research highlighted particular barriers to accessing information, advice and support experienced by many participants, including people with mental health problems, people with learning disabilities, and blind and partially sighted people. This research also found some evidence of gendered assumptions in social care assessments, for example, support with childcare and housework was considered appropriate for a disabled mother, but neglected for a disabled father as it was assumed that housework and childcare would be undertaken by their female partner^[51].

4.2 Unpaid carers

Whilst there is limited available data about disability and unpaid carers, there is considerable evidence about carers’ health and wellbeing. However, given the prevalence of unpaid care and disability within the population of Scotland, discussed earlier in this paper, it is likely that there is a substantial population of unpaid carers who would meet the definition of disability, as set out in the Equality Act 2010.

Analysis of Scotland’s Census data has shown that adult and young carers are more likely to have a long-term condition or illness than non-carers, although this is based on 2011 data^[52]. According to the 2011 Census, young carers and young adult carers are twice as likely as young people generally to report a mental health condition: 3.7% of young carers compared to 1.4% young people without caring responsibilities. However, it is unknown from the Census data if and how this may be related to their caring role^[53].

UK wide surveys carried out by Carers UK found that unpaid carers were more likely to experience anxiety and feel lonely, and to have lower levels of life satisfaction than the general population^[54]. Recent research carried out by Carers Trust Scotland suggests that unpaid carers’ mental and physical health may have been particularly affected during the pandemic. Carers Trust Scotland reported that many unpaid carers were spending more time caring and had fewer opportunities to get a break from caring^[55]. Research carried out by the Care Inspectorate found that isolation, anxiety and disruption had impacted unpaid carers’ mental and physical wellbeing^[56]. In addition, evidence from a nationally representative UK survey found that the mental health of unpaid carers deteriorated more during lockdown than non-carers^[57].

4.3 Social care workers

There is limited available data about disability and social care workers, which relies on individual workers to disclose this information. Whilst Scottish Social Services Council (SSSC) data show that at least 2% of the overall social care workforce reported having a disability, this is likely to be an undercount, because disability information was unknown for a further 17% of the social care workforce^[58].