Healthcare Associated Infection strategy - second phase deliverables impact assessment: progress report - March 2025

Annex C

Summary of Evidence Data and Evidence to Support Impact Assessment Screening

Data was available across protected groups and social economic status, however, in some groups the data available to policy officials was limited. For example, there was no published data in certain categories, these include gender reassignment, the socio-economic status of patients, visitors and residents. For social care workers we have used data from the Scottish Social Services Council (SSSC) who report data and intelligence on the registered social services workforce (this includes the social work, social care and the children and young people workforce but excludes the unregistered workforce e.g. Personal Assistants). Where there is no data, we have used Scottish general population data from the 2022 Census^[3] for the purpose of supporting the impact assessments.

Age

Due to Scotland’s ageing population, demand for, and use of, health and social care services is projected to increase. The current data showed that 22.8% of the NHS Scotland workforce is 55 years of age and over, and the overall median age of the workforce is 44 years^[4]. Age distribution across the registered social services workforce shows the largest group to be those aged 30-39, making up 23.4% of the total. The youngest (20 years or less) and oldest (65 years) age groups are the least represented, making up 2.1% and 4.0% respectively^[5]. Recipients of social care services are more likely to be older than the general population (80% of social care recipients are aged 65 or older). The largest age group of patients is the 65 to 74 age group (26% of patients)^[6].

Babies are vulnerable to acquiring infection and the current data shows us that approximately 50,000 of the population are babies^[7].

Disability

Disabled people are more likely to use health and social care services, they are also more likely than those with no disability to report fewer positive experiences with health services, particularly involving decision making about their care^[8]. Healthcare workforce have confirmed that 3% have a disability. This data is limited with a total of 35% participants reporting ‘not known’ or declining to comment^[9]. We have used general population data for the purpose of supporting this EQIA for healthcare patients and visitors. This general population data shows that 47% people self-reported as doing ‘very well’ in looking after their own health, 44% quite well, 8% not very well and 2% not well at all^[10]. A small percentage 5.4% of the registered social services workforce report having a disability^[11].

In the Health and Care Experience 2024 survey, which is sent to a random sample of people who were registered with a GP in Scotland, 28% of people reported that they have a long-term illness disease or condition and 16% have deafness or partial hearing loss, 38% stated they have no condition. Other disabilities were less than 15% including learning disabilities (2%) and mental health conditions (11%)^[12].

As one of the deliverables (a) is to highlight IPC week internally within Scottish Government we reviewed published equality information on Scottish Government staff. For example, in 2023, 812 core Scottish Government staff reported a disability however, there were a high number (3455) unknown responses^[13]. It should be noted that not all disabled staff will require information in accessible formats and some staff who do not identify as disabled will require information in accessible formats.

Sex

The adult healthcare and social care workforce are predominantly female. This includes an overall split in the healthcare workforce of 77.1% female and 22.9% male^[14]. The social services workforce has a high proportion of female staff with only around one in six being male. Including 82% and 77% of staff working in adult care homes and adult day care services, respectively. The percentage split of patients is females are slightly higher at 56% than male at 44%^[15]. Public Health Scotland’s Insights in Social Care publication reports that around three-fifths (61%) of people being supported by social care services in 2020/21 were female^[16].

Gender Reassignment

The 2022 Scottish Census found that 19,990 people were trans or had a trans history^[17]. This is 0.44% of people aged 16 years and over. With regards to NHS Scotland workforce, the data shows between 1-2% is trans^[18]. There is no data available on trans patients and visitors accessing healthcare settings or staff and users of social care services.

Sexual Orientation

The healthcare and social care workforce, patients, service users and visitors largely class themselves as heterosexual with all other categories having a significantly lower percentage. The data on the healthcare workforce shows that 65% identify as heterosexual, smaller percentages of less than 5% identify as bisexual, gay/lesbian or other^[19]. In the data used for healthcare patients, 96% identified as heterosexual or straight^[20]. The data on the registered social services workforce shows that 88.3% of registrants (when not reported is excluded) identify as straight or heterosexual. Smaller percentages identify as bisexual (2%) and gay or lesbian (2.2%)^[21]. There is little information on the number of gay, lesbian, or bisexual health and social care patients or service users however the 2022 census found that there were 183,860 LGB+ people in Scotland, 4.0% of people aged 16 and over^[22].

Pregnancy and Maternity

Infections during pregnancy can carry an increased risk of serious illness, The data used for NHS Scotland workforce was based on staff being on maternity/parental or shared parental leave. Overall, 3% reported that they have been on parental leave^[23]. The regulator for the social services workforce the Scottish Social Services Council do not collect data on pregnancy and maternity therefore it is unknown what percentage of the workforce are pregnant or on maternity/parental or shared parental leave. There is also a lack of data on the general population regarding the number of patients, visitors or social care users who are pregnant or visiting maternity services in healthcare settings. However, we have used the number of live births to support this EQIA screening. This data shows the number of live births from March 2022 to March 2023 in hospitals by age. 11.8% of births were from women aged 20-24, 26% from women aged 25-29, 35% from women aged 30-34, 20.2% from women aged 35-39 and 4.7% in women aged 40 years or over^[24].

Race

Data indicates that the health workforce predominantly describe their 'race or ethnicity' as white Scottish (55%) with all other categories being significantly lower (15% is not known and all other categories were less than 10% each in healthcare workforce)^[25]. 95% identify as ‘White’, 3% were ‘Asian, Scottish Asian or British Asian’ and all other categories were 1% or less of Respondents to the Health and Care experience survey ^[26].

7.1% of the registered social service workforce report their ethnicity to be Scottish African or British African. 3.8% report their ethnicity to be Asian, Scottish Asian or British Asian (84.2% define themselves as white). These figures vary for different parts of the SSSC register. For example, 17.3% Registrants who are support workers in a care home service for adults define themselves as African, Scottish African or British African with 8.3% defining themselves as Asian, Scottish Asian or British Asian is 8.3%. 66.8% of support workers in a care home service define themselves as white^[27]. For comparison in the 2022 census 12.9% of people in Scotland reported that they had a minority ethnic background^[28]. Where ethnicity is known 98% of people receiving social care services funded by their Local Authority during 2022/23 were white.^[29]

Religion or Belief

The healthcare workforce has reported that 33% of the workforce have ‘no religion’, 19% of the workforce is ‘not known’ and all other religion or beliefs were less than 15% each^[30]. Data shows that 42% of the participants in the 2023 to 2024 Scottish Health and Care Experience Survey have no religion, 32% are Church of Scotland, 7 % Roman Catholic and all other religions and bodies were 2% or less^[31]. From the latest SSSC data 37.4% of social services workers indicate that they have no religion. The next most common response (23.5% of all registrants) is other Christian^[32].

Socioeconomic status

Socioeconomic factors play a critical role in influencing health and health inequalities^[33]. Low socioeconomic status is shown to be an important risk factor for infectious disease, part of which may be mediated by poor lifestyle and chronic comorbidities^[34]. With over 1.3 million staff working for the NHS in the UK, and in-work poverty affecting one in eight workers before the current cost of living crisis emerged, healthcare staff are being affected^[35]. There is no NHS Scotland specific data available.

The Scottish Index of Multiple Deprivation (SIMD) is the Scottish Government's standard approach to identify areas of multiple deprivation in Scotland. However, as there is no available data on SIMD and the social care workforce, information on pay and conditions in the adult social care workforce was used in the impact assessment for the National Care Service. This found that almost half (47%) of the adult social care workforce were employed on a part-time basis in 2020. In 2023, 212,780 people were employed in the social services sector in Scotland. The majority of adult social care workers were employed on a permanent basis, with 5.5% being on zero-hour contracts^[36] . However, it should be noted that part-time work and zero-hour contracts are not proxies for deprivation or poverty.

In their 2019 report on ‘Fair Work in Scotland’s Social Care Sector’, the Fair Work Convention highlighted poor terms and conditions and a lack of security for social care staff, although they acknowledged that progress was being made to address issues of low pay with the implementation of the Living Wage^[37].

There was a lack of data identified around socioeconomic status of healthcare patients, visitors, and the users of care services. However, the Scottish Government’s Equalities Evidence Review found that overall, substantially higher proportions of people in the most deprived areas in Scotland receive home care support; 26% of people receiving home care lived in the most deprived areas, compared to 13.9% in the least deprived^[38]. This varies by age with minor difference in the age 85 and over age group.

Demographic location including Islands

The data was limited in specifically providing data in each NHS Board to equality assess the impact on the health and social care workforce and patients, users or visitors depending on their demographic location. The data available showed that healthcare staff in island Boards have similar scores to mainland Boards on their overall experience of working in their organisation (mean scores as follows: NHS Shetland 7.3, NHS Western Isles 6.7 and NHS Orkney 6.4)^[39]. Other NHS Boards such as NHS Ayrshire and Arran and NHS Highland have island populations, however the data for these groups will be considered as part of the overall Board population. There are consistently a higher level of negative scores (when compared to other NHS Boards across the following categories in the iMatters survey for NHS Western Isles (Na h-Eileanan Siar): individual, line manager/ team/ organisation^[40]. Data for overall experience of working in their organisation is not available by geography for social care staff however overall, Local Authority staff score their experience higher (7.1) (for those working in adult services this is 7.0) than NHS Scotland staff (6.9)^[41].

A lot of information on social care is only available at local authority or health and social care partnership (HSCP) level. Orkney, Shetland and Western Isles local authorities/HSCPs encompass islands only. However, Highland, Argyll and Bute and North Ayrshire local authorities/HSCPs include mainland areas as well as islands. Therefore, their data may not truly reflect the experiences of island communities as it may be skewed by larger proportions of their population living on mainland Scotland.

Compared to Scotland as a whole, the rate of people receiving social care services was higher in all but one health and social care partnership with islands^[42]. Experiences of health and social care were generally more positive in islands areas. Apart from North Ayrshire, more people in the health and social care partnerships with islands rated their overall experience of care and support services positively, than in Scotland as a whole^[43].