National Care Service Charter of Rights: equality impact assessment

Methodology

A range of activities were carried out to develop the Charter and to inform this EQIA:

• a framing exercise, carried out at an early stage informed the scope and focus of the EQIA
• a review of existing qualitative and quantitative evidence, including national surveys, official statistics and relevant literature
• a comprehensive co-design process, involving people who access care and support, unpaid carers, and key stakeholder organisations. This collaborative approach was central to ensuring that potential equality impacts were identified and addressed. Activities included one‑to‑one discussions, group discussions, survey‑style engagement and stakeholder events involving people with all protected characteristics and with intersecting characteristics
• commissioning of specific work to fill any gaps in participation; for example Healthcare Improvement Scotland were commissioned to seek feedback from specific equality groups

Key Findings

Age

• Age is associated with increased likelihood of needing care and support. Public Health Scotland figures in 2023/24 show that just over three quarters of people receiving social care support were aged over 65^[1]
• Audit Scotland reported in 2024 that older people are less likely to be digitally connected than other age groups increasing social isolation and reducing the level of support available to them^[2]
• Co-design insights told us that different information may be required at each life stage and information may be required in different formats to meet the needs of these age groups - for example young people expressed a preference for information to be summarised or presented in videos

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of age for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people of all age groups by providing information on rights, and clear routes for feedback or making a complaint about care and support. The availability of paper copies helps address barriers faced by people who have limited digital access, including some older people, while a summary version supports younger people to engage with information about their rights in a clear and accessible way. The Charter also links to age appropriate materials and resources as well as support services and advice.

The impact of the Charter on promoting good relations between different age groups is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Age can intersect with other characteristics such as disability, increasing the risk that some individuals may experience barriers to accessing information about their rights. By offering the Charter in a range of formats and clearly setting out the rights and expectations of those accessing care, the Charter will better support these people to realise their rights and understand what they mean in practice to them.

Disability

• Some disabled people want to be more involved in decisions made about their social care support. We heard from some disabled people that decisions about their care are made “behind closed doors” and that it is sometimes assumed that they will be unable to understand the options available to them
• Audit Scotland report that 51% of people in the UK who do not use the internet at home or elsewhere report having a disability^[3]
• People with learning disabilities said they have additional needs that make it more difficult to claim their rights
• Engagement with Deaf British Sign Language (BSL) users highlighted an overall lack of accessible information about social care and people’s rights. People require better support, as well as information being made available to them in BSL so that they can access the same information as others

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of disability for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for disabled people by providing information on rights, and clear routes for feedback or making a complaint about care and support. Various formats of the Charter are available and inclusive for people with sensory impairment and learning disabilities, for example a British Sign Language translation of the Charter, large font version and an Easy Read version.

The Charter advances equality further by providing clarity about some duties placed on authorities, helping individuals to better understand who is responsible for providing care and meeting standards. Including this information promotes increased transparency and accountability. Removing references to ‘responsibilities’ from the Charter’s title and content reinforces that rights are not contingent on an individual’s ability to meet prescribed responsibilities.

The impact of the Charter on promoting good relations for disabled people is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Gender Reassignment

• It is reported that LGBT+ people experience physical and mental inequalities across their lifespan including poorer access to health and social care services^[4]
• During co-design some transgender people expressed anxieties around the workforce and their understanding of how care should be given to transgender people. Having more control over choosing who is providing support would help people to feel more confident when getting social care support
• We also heard about the importance of language around gender identity and expression, including use of language and pronouns that transgender people wish to use for themselves

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of gender reassignment for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of gender reassignment by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. Inclusive language, imagery and clear signposting to advice and support services further helps to reduce barriers and promote equitable access.

The impact of the Charter on promoting good relations for people with the protected characteristic of gender reassignment is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Marriage/ Civil Partnership

The protected characteristic of Marriage / Civil Partnership is not relevant to this policy initiative.

Pregnancy and Maternity

• A report from Engender and the ALLIANCE about women’s experiences of accessing pregnancy and maternity services during the COVID pandemic recommended that tailored information and advice for pregnant women is clear, timely, inclusive, accessible, and consistent, and that human-rights based practice should be embedded across services, through co-design and co-production with service users and practitioners^[5]
• There is some evidence that intersectionality with other characteristics such as disability and race may impact on pregnant women’s ability to access safe and supportive maternity care^[6]
• Co-design told us that people accessing pregnancy and maternity services felt there was a disconnect between staff and services and that there needs to be more focus on integrated, joined-up and person-centred care^[7]

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having a positive impact on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of pregnancy and maternity for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of pregnancy and maternity by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. Accessible formats, translations and summary versions help reduce barriers for people who may be navigating services during periods of increased vulnerability or time constraint such as those who are pregnant or accessing maternity services.

The impact of the Charter on promoting good relations for people with the protected characteristic of pregnancy and maternity is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Race

• The Equalities and Human Rights Commission recommends providing information in different languages to support people for whom English is not their first language. Cultural, as well as language barriers, can negatively affect access to social care services for people from ethnic minority backgrounds^[8]
• Language barriers can also make it more difficult for people from ethnic minority communities to access online services. This can affect trust between people accessing care and public services delivering it^[9]
• There may be specific challenges for ethnic minority communities where there is stigma around seeking support, which can reduce uptake of services. Evidence shows that people from Gypsy and Traveller communities are likely to have experienced discrimination or stigma in health and/or social care settings. This makes it important to build trust with these communities^[10]
• During co-design, participants from ethnic minority backgrounds described some experiences of racism, judgement and power imbalances faced in care settings, which can discourage them from making complaints or realising their rights. Participants expressed a need for clear and accessible information on complaints, including a visual representation of these processes, to help them navigate the system more easily. They also wanted reassurances that making a complaint would not affect future treatment or level of service provided

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of race for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of race by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. Translations of the Charter into different languages will advance equality for ethnic minority communities who are less likely to have English as their first language. To support ethnic minority communities to navigate complaints more easily, a visual representation outlining complaints processes is included in the Charter. Inclusive images are included in the Charter, including people with a range of different ethnicities. The Charter will raise awareness of rights for all, reducing the impact of lack of awareness of rights for any specific groups, including those from ethnic minority communities.

The impact of the Charter on promoting good relations for people with the protected characteristic of race is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Religion

• Scottish research related to the experiences of Sikh women in healthcare settings identified barriers to accessing healthcare including fear of judgement and lack of culturally appropriate or culturally aware support^[11]
• International research also identified potential barriers to accessing healthcare for Muslim women, including modesty and privacy, gender preference for providers, health literacy and language proficiency^[12]
• Co-design participants told us it was important to understand how their beliefs will be supported when accessing care services. They felt it was important that the Charter covered religion, customs and traditions when talking about people’s rights and that respect for these things should be prioritised

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of religion for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of religion by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. It makes it clear that individuals should be supported to observe religious, spiritual or cultural practices and that their backgrounds and beliefs should be respected. By raising awareness of rights for all, the Charter helps reduce inequalities that can arise from differing levels or awareness in asserting those rights across different religious and faiths.

The impact of the Charter on promoting good relations for people with the protected characteristic of religion is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Sex

• Co-design told us that some people felt there are assumptions about gender roles within social care, particularly that women are expected to provide unpaid care for family members and that this is even the case where females may also have their own disabilities that require support
• Co-design participants highlighted that people who experience domestic abuse are often engaged in care services through no choice of their own and with limited knowledge of systems. For them, it was vital to have support and guidance that was consistent throughout. Language within the Charter should be trauma-informed to ensure it is not overwhelming. Discussion of abusive behaviour should be handled with care and framed in a way that makes clear that respect is mutual, rather than placing unbalanced expectations on those accessing services
• Sex can intersect with a number of other protected characteristics, such as race and religion. This was highlighted in co-design where participants told us that some minority ethnic women are unlikely to give feedback or make a complaint as they don’t see the point and they don’t want to be seen as trouble-maker. This can reduce opportunities for their experiences to inform service improvement and fully realise their rights when accessing care

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of sex for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of sex by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. Imagery and language used challenges norms and stereotypes around gender roles, for example showing men in caring roles. Language is inclusive with a focus on an expectation of mutual respect to help ensure women accessing services are not unfairly disadvantaged because of their sex and assumed expectations placed on them as a result. Rights and expectations within the Charter apply equally, regardless of sex, helping to promote equality within care settings.

The Charter includes specific rights for unpaid carers, the majority of whom are women. Where rights exist for a specific group, the Charter explains these rights clearly so that people understand to whom they apply.

The impact of the Charter on promoting good relations for people with the protected characteristic of sex is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.

Sexual Orientation

• LGB+ individuals experience physical and mental inequalities across their lifespan, including poorer access to health and social care services. Analysis of the Health and Care Experience survey 2021/22 suggests that there may be higher levels of unmet care needs for LGB+ individuals than heterosexual individuals^[13]
• Co-design told us that feeling safe and building trust with carers was essential, particularly for LGB+ people. Some people highlighted that frequent changes in carers and past experiences of homophobic comments can make people feel unsafe or reluctant to engage with social care support
• People told us that staff training is critical to improving care for LGB+ people. They stressed that understanding people’s community and support networks can reduce anxiety, support mental health, and improve experiences of care

Summary of positive, neutral, and negative impacts identified

The Charter is assessed as having positive impacts on eliminating unlawful discrimination, harassment and victimisation for people with the protected characteristic of sexual orientation for the following reasons:

• it clearly sets out what individuals should expect from their care and support, provides information on rights, and enables people to challenge instances where their rights are not being met due to discrimination or other factors
• it includes specific information on equality and discrimination, including rights and duties under the Equality Act 2010
• it identifies protected characteristics and provides examples of how people should expect to be treated fairly

The Charter advances equality of opportunity for people with the protected characteristic of sexual orientation by providing clear, consistent and accessible information about rights and what people should expect when accessing social care and community health services. The Charter will raise awareness of rights for all, reducing the impact of lack of awareness of rights for any specific groups.

The impact of the Charter on promoting good relations for people with the protected characteristic of sexual orientation is assessed as neutral. Publishing the Charter alone is unlikely to directly affect relations between groups however it will provide consistent information for all.