Underserved Populations
What do we mean by 'underserved populations'?
We are using the term 'underserved' here to mean populations that face inequities in accessing and receiving care, resulting in poorer health outcomes compared to the general population.
We have broken this down into groups by:Demographic Factors (age, sex, ethnicity, education), Social and economic factors and Health status.
The definition of ‘underserved’ is context-specific, shaped by the specific circumstances, needs, and characteristics of the population. It highlights the importance of recognising and addressing the disparities in care provision to ensure equitable health outcomes for all individuals.
Key Statistics
Pathway (2020)
Stonewall (2024)
FFT (2020)
Reference
McFadden et al. (2018). Gypsy, Roma and Traveller access to and engagement with
health services: a systematic review. The European Journal of Public Health
Key Messages
- Gypsy, Roma, and Traveller (GRT) communities face significant barriers in accessing healthcare, including:
- Organisational challenges within health systems.
- Experiences of discrimination and negative attitudes from healthcare staff.
- Cultural misunderstandings and language barriers.
- Low levels of health literacy.
- Economic constraints limiting access to services.
- Promising strategies to enhance engagement include:
- Establishing specialist liaison roles between communities and healthcare providers.
- Implementing outreach and dedicated services tailored to GRT needs.
- Raising health awareness within GRT communities.
- Utilising handheld health records to improve continuity of care.
- Providing cultural awareness training for healthcare staff.
- Fostering collaborative working relationships between health services and GRT community members.
- Despite identifying potential strategies, there is a lack of rigorous evaluations to determine their effectiveness in improving healthcare access for GRT populations.
Commentary
This systematic review highlights the multifaceted barriers that Gypsy, Roma, and Traveller communities encounter in accessing health and social care services across Europe. The identified challenges—ranging from systemic organisational issues to personal experiences of discrimination—underscore the urgent need for targeted interventions to promote equitable healthcare access.
The review suggests several engagement strategies, such as specialist liaison roles and outreach services, which show promise in bridging the gap between GRT communities and health and social care providers. However, the effectiveness of these interventions remains uncertain due to a lack of rigorous evaluations. This gap in evidence points to a critical area for future research to develop and validate approaches that can effectively reduce healthcare disparities for GRT populations.
Addressing these barriers is essential for promoting social care equity, as the current inequities contribute to poorer health outcomes among GRT communities. Policymakers and healthcare providers must prioritise culturally sensitive and inclusive practices to ensure that GRT individuals can exercise their right to healthcare without facing systemic obstacles.
Reference
Housing LIN (2015). Issues faced by people who are homeless in accessing
health and social care
Key Messages
- Individuals experiencing homelessness often face fragmented health and social care services, which complicates access and continuity of care. The lack of coordinated support among agencies creates barriers to meeting individuals' needs effectively.
- Stigma and misconceptions about homeless people’s circumstances and needs persist within health and social care systems. This stigma can lead to inadequate service provision and discourage homeless individuals from seeking necessary support.
- This report highlights the importance of trauma-informed and person-centred care as strategies to improve service engagement and outcomes for homeless individuals. Such approaches foster a supportive environment that can build trust and better meet the complex needs of this population.
Reference
Cossar & Belderson (2024). Policy and Practice with Lesbian, Gay, Bisexual,
Trans and Queer (LGBTQ+) Care-Experienced Young People—A National Survey of
Local Authorities in England
Key Messages
- Limited Policy and Data Collection: Local authorities generally lack specific policies or centralised systems for recording sexual orientation and gender identity (SOGI) data, although individual case records often contain this information.
- Support Gaps for LGBTQ+ Youth: While authorities employ various methods to support LGBTQ+ youth, there are notable gaps in staff knowledge and confidence in addressing these needs.
- Unequal Training Provision: Social workers more frequently receive training on LGBTQ+ issues than foster carers or residential staff, highlighting a need for broader, inclusive training across all roles.
Commentary
Without dedicated policies or centralised recording of SOGI data, local authorities lack critical insights into the needs and experiences of LGBTQ+ individuals, making it harder to allocate resources effectively or address disparities. The gaps in staff knowledge and confidence, especially among foster carers and residential staff, further risk inconsistent support for these young people. Training disparities mean that while some youth might receive informed care, others may face misunderstandings or neglect due to staff unpreparedness. Addressing these gaps is essential to ensure that LGBTQ+ individuals can access care that is responsive, inclusive, and equitable, ultimately creating a safer and more supportive environment within social services.
Reference
CarersUK (2023). Supporting Black, Asian and minority ethnic carers: A good practice briefing.
Key Messages
- Many BAME carers do not identify themselves as carers due to cultural nuances and language barriers, which limits their access to support.
- The report suggests to better engage people from different cultural backgrounds with more outreach to ensure carers get the help they need.
- BAME carers are more likely to report financial anxiety, and Covid-19 has worsened these challenges which has led to more barriers in accessing services.
- Organisations are recommended to develop ways to cater to the specific needs of BAME carers.
- Case studies in the report include organisations adapting their outreach materials, partnering with local community and faith-based organisations, frontline staff undergoing cultural competence training, and also targeted financial support to cope with the financial challenges that people face.
Commentary
This evidence highlights the challenges BAME carers face, particularly in identifying as carers and accessing support due to cultural and language barriers. Financial pressures, worsened by Covid-19, compound these difficulties, making it harder for carers to engage with services. The report offers practical recommendations, including culturally competent training for staff, targeted financial support, and outreach partnerships with community and faith-based organisations. These approaches can help address the specific needs of BAME carers and improve equity in service delivery. However, the evidence is largely qualitative, limiting its ability to generalise findings or measure the effectiveness of proposed interventions. More robust data collection is needed to evaluate these strategies and ensure they deliver meaningful improvements for BAME carers.
Reference
Barnardo's (2019). Caring alone: Why Black, Asian and Minority Ethnic young carers continue to struggle to access support. Barnardo's.
Key Stats
- Young carers are 1.5 times more likely to be from ethnic minority communities.
- Under 20% of the young carers that Barnardo’s supports are ethnic minorities.
- Approximately 7% of all young people in England have a caring role for a family member.
Key Messages
- Young BAME carers experience cultural barriers in trying to access support services, as many have reported that services are not culturally sensitive to their unique needs.
- A considerable number of young carers from the South Asian community are unaware of the services available to them, which is a barrier to seeking help.
- Many young carers from BAME communities do not report their caregiving roles due to cultural norms and expectations and fear of stigma. This leads to a lack of support and recognition of their roles and responsibilities.
- The report calls for targeted approaches to better support BAME young carers by increased funding, better cultural competency training for service providers, and inclusive and accessible services.
Commentary
This evidence highlights the inequities faced by Black, Asian, and Minority Ethnic (BAME) young carers in accessing support. Despite being 1.5 times more likely to have caring responsibilities, less than 20% of the young carers supported by Barnardo’s are from ethnic minority backgrounds. Cultural barriers, lack of awareness about available services, and fears of stigma often prevent these young carers from seeking help, leaving many unsupported and unrecognised.
The findings point to the need for targeted approaches, such as funding for culturally competent services, training for providers, and inclusive outreach efforts. However, the evidence is limited in scope. It does not fully address structural factors like socio-economic disparities or systemic policies that worsen these barriers. Expanding research in this area would offer a more complete picture of the challenges and help inform strategies to achieve equity in supporting BAME young carers.
Reference
Yip et al. (2024). Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: An umbrella review and findings from healthcare, education and criminal justice.
Key Messages
- Community health worker programmes and participatory care pathway design showed significant promise in improving healthcare outcomes.
- Culturally tailored education programmes, multilingual tools, and peer-supported skills-building interventions were particularly impactful for managing chronic conditions like diabetes and cardiovascular diseases.
- Integrating mental health and primary care enhanced both access and outcomes, while generic quality improvement strategies also benefitted ethnic minority populations.
- Structural interventions, such as minimum wage policies and linking healthcare with housing or financial support, addressed social determinants of health and improved access to services for minority groups.
Commentary
This evidence highlights the importance of equity-driven approaches in health and social care, focusing on interventions that address the distinct barriers faced by ethnic minority populations. Despite the breadth of research, only a small number of studies explore structural interventions or the broader socioeconomic conditions that shape both health and social care outcomes. This gap shows the urgency of strategies that prioritise systemic change to support equitable access and outcomes.
The findings emphasise the value of participatory and tailored approaches in advancing equity. Community health worker programmes and participatory design of care pathways have been effective in improving outcomes by involving marginalised groups in shaping the services they receive. In social care, this participatory approach ensures that services reflect the cultural, linguistic, and social contexts of the people who rely on them.
Culturally tailored education programmes, multilingual tools, and peer-supported interventions are particularly impactful in addressing chronic conditions such as diabetes and cardiovascular diseases. In social care, similar strategies can improve access to support services, especially for those navigating complex care needs in unfamiliar systems. These interventions show how equity-driven solutions align services with the lived experiences of ethnic minority communities.
Integrating mental health and primary care services improves both access and outcomes, addressing gaps that disproportionately affect marginalised populations. In social care, integrating mental health support within community services provides a holistic approach that can reduce stigma and improve the wellbeing of service users. General quality improvement strategies, though broad, also benefit minority groups by creating more inclusive and responsive systems.
Structural interventions, such as linking care with housing or financial support and implementing minimum wage policies, address the social determinants of health and social care. These initiatives create conditions that allow individuals to access services without being hindered by poverty, unstable housing, or financial insecurity. By addressing these root causes, structural interventions provide the foundation for equity in health and social care.
By focusing on these diverse interventions, this evidence highlights practical steps toward equity in health and social care. Tailoring services to the specific needs of ethnic minority communities and addressing systemic barriers ensures that resources and opportunities are distributed based on need, not uniformity. This equity-driven approach is essential for creating a fairer, more effective system that works for everyone.
Reference
Memon et al. (2016).
Perceived barriers to accessing mental health services
among black and minority ethnic communities: a qualitative study in southeast England
Key Messages
- Personal and environmental factors such as stigma, cultural identity, reluctance to discuss distress, and financial challenges hinder individuals from recognising and accepting mental health problems and seeking help.
- Long waiting times, language barriers, and poor communication negatively affect the relationship between service users and healthcare providers, leading to inadequate recognition of mental health needs.
- There is a significant imbalance of power and authority in healthcare interactions, compounded by cultural naivety and discrimination, particularly affecting BAME service users, alongside a lack of awareness about available services.
Commentary
These factors highlight the critical importance of care equity in mental health services. When personal barriers, communication issues, and cultural insensitivity prevent individuals from receiving the support they need, it creates disparities in health outcomes. Care equity ensures that all individuals, regardless of their background or circumstances, can access appropriate mental health care.
Reference
Allen, D., & Hulmes, A. (2021). Aversive Racism and Child Protection Practice with Gypsy, Roma, and Traveller Children and Families. Seen and Heard, 31 (2). ISSN 1744-1072.
Key Messages
- Aversive Racism: Subtle biases in child protection practice affect GRT children, even among well-intentioned professionals.
- Cultural Stereotypes: An “objective” approach often marginalises the distinct needs of these communities.
- Need for Cultural Competence: Child protection professionals require better cultural competence and awareness to address biases and provide more inclusive support.
Commentary
This evidence underscores the significance of recognising unconscious biases in child protection practice. It highlights that while professionals may explicitly reject prejudice, their actions often reinforce harmful stereotypes. The study stresses the importance of cultural competence training in child protection. However, as the study is based on interviews with practitioners, its findings may not fully capture the lived experiences of GRT families themselves.
Reference
Hansford et al. (2024). Lessons from a research partnership in southwest England to understand community palliative care needs in rural, coastal and low income communities. Public Health Res.
Key Stats
- The average life expectancy between the most and least deprived wards in Plymouth is 7.5 years.
Key Messages
- People have reported facing difficulties in trying to receive a care package that meets the needs of their family member. Barriers include the lack of support available to book GP, district nurse and palliative care visits at home, particularly in rural and low-income areas where resources are already limited.
- There is a lack of clarity and information given to family members around who would be providing care and what type of support could be offered at different stages of care, making it difficult for families to navigate care options effectively.
- Family caregivers face emotional and physical challenges, often feeling overwhelmed by managing complex daily tasks for the person they are caring for. With little to no respite and no awareness of available mental health support, caregivers undergo high periods of stress.
Commentary
This evidence highlights important insights into the inequities faced by rural and low-income communities in accessing palliative care, especially the fragmentation of services, confusion about available support, and the emotional, physical, and psychological burdens on caregivers.
The report underscores the need for more accessible voluntary and community sector support, particularly for emotional care. Family members expressed the need for someone to sit with them or their loved ones being cared for, to provide emotional respite, but this support is often unmet.
Additionally, the paper discusses the need for better coordination between the NHS and voluntary and community sectors to address gaps in access and ensure more consistent service delivery in these communities.
Reference
Giuntoli & Cattan. (2017). The experiences and expectations of care and support among older migrants in the UK. In Older People and Migration (pp. 141-158). Routledge.
Key Messages
- Language barriers: Limited proficiency in English restricts older migrants' ability to communicate effectively with service providers and understand the support available. This can exacerbate feelings of exclusion and isolation.
- Cultural competency gaps: Mainstream services often fail to accommodate cultural practices and preferences. This reduces trust and makes services less accessible for migrant populations.
- Unfamiliarity with services: Older migrants frequently lack awareness of health and social care systems in the UK, even at a local level, limiting their engagement with available support.
- Historical mistrust: A legacy of mistrust towards formal institutions discourages older migrants from seeking help, further marginalising them from accessing necessary services.
Commentary
This evidence sheds light on critical issues faced by older migrants in the UK when navigating health and social care systems. Its emphasis on language barriers, cultural competency, and mistrust of institutions aligns with broader findings in social care equity research.
However, it highlights gaps in existing studies, particularly the limited representation of less-studied migrant groups. This is a significant weakness, as it prevents a full understanding of the heterogeneity in needs across communities. The authors’ call for locally driven and individualised research underscores the importance of tailored, culturally sensitive interventions to improve service access and trust.
Reference
British Red Cross (2024). Delivering with dignity.
Key Messages
- Dignity in service delivery: The framework focuses on embedding dignity into service delivery for individuals facing crises, such as those impacted by homelessness, health crises, or other emergencies.
- Person-centred care: It emphasises person-centred care, recognising individual and community needs, particularly the importance of psychosocial support and cash assistance to maintain dignity during crises.
- Collaborative practices: The framework advocates for integrating efforts from various sectors and actively engaging communities in the planning, delivery, and evaluation of support services.
- Training for frontline staff: Training and tools for frontline staff are highlighted as essential for understanding and applying dignity principles effectively.
- Role of government and organisations: The report stresses the role of government and organisations in creating a culture of respect and understanding to reduce stigma and ensure inclusive, accessible service delivery.
Commentary
The "Delivering with Dignity" framework plays a key role in advancing social care equity by promoting inclusive, person-centred care approaches. It addresses the structural barriers and stigma often faced by marginalised groups, including asylum seekers. The framework's focus on dignity is critical in reducing disparities caused by systemic inequities, especially in contexts where discrimination or cultural misunderstandings limit access to appropriate care.
By emphasising the importance of training for frontline staff, collaborative practices across sectors, and community engagement, the framework offers actionable strategies to reshape care environments. These recommendations aim to ensure equitable access to dignified support, aligning with broader social care equity goals. The integration of dignity principles into service delivery fosters an environment where all individuals, regardless of their background, can receive respectful and effective care.
Gaps: There is a lack of intersectional research on the experiences of subgroups, such as disabled or LGBTQI+ (lesbian, gay, bisexual, transgender, and queer or questioning) asylum seekers. These groups’ specific barriers and enablers remain under-researched, often due to challenges in engaging such populations in research, leaving gaps in the evidence base.
Reference
Tucker et al. (2022). Supporting People with Social Care Needs on Release from Prison.
Key Messages
- Limited data: There is insufficient data on the number of individuals needing social care post-release, though existing literature highlights challenges in providing adequate support.
- Promising initiatives: Initiatives like pre-release training and buddy systems show potential but lack long-term evidence on their effectiveness.
- Need for evaluation: Policy and research should focus on assessing the effectiveness of these interventions to improve support for individuals leaving prison.
Commentary
This review highlights ongoing gaps in social care for individuals transitioning from prison to community life, particularly in relation to post-release care. Despite some promising initiatives, there is a clear need for structured, evidence-based approaches to improve outcomes for this vulnerable group. Policymakers and researchers must shift focus to refining and evaluating these interventions to address the unique challenges faced by individuals leaving prison effectively.
Reference
Healthcare Improvement Scotland (2020). Homelessness, Access to Services and COVID-19: Learning during the Pandemic to Inform Our Future.
Key Messages
- Vulnerability of homeless individuals: The COVID-19 pandemic has highlighted the extreme vulnerability of people experiencing homelessness and the urgent need for more flexible, responsive services.
- Adapted services: Key learning points include the necessity of adapting services to meet the immediate needs of homeless individuals, including flexible accommodation, healthcare, and social support.
- Digital healthcare shift: A notable shift towards digital healthcare services occurred, but access remains uneven, with people experiencing homelessness continuing to face significant barriers, including digital exclusion.
Commentary
The report provides a comprehensive overview of the impact of COVID-19 on homelessness services, revealing both strengths and gaps. It advocates for more innovative solutions and stresses the importance of holistic care, integrating housing and health and social care more effectively. While the increased use of digital health tools is beneficial, it risks excluding already marginalised individuals, making more equitable solutions necessary.
Reference
Heaslip et al. (2022). How do people who are homeless find out about local
health and social care services: A mixed method study. International
Journal of Environmental Research and Public Health, 19(1), 46.
3 x
more likely to use emergency health services than the general population
45%
of respondents reported they are self-medicating with drugs or alcohol to help them cope with their mental health
43-46
average age at death for people experiencing homelessness
Key Findings
- Reliance on informal networks: Homeless people often rely on friends, family, or other individuals within their community to learn about available services, as they may not trust or have access to formal healthcare systems like hospitals or clinics.
- Barriers to access: Barriers such as mistrust of formal institutions, lack of information, and a fragmented healthcare system prevent homeless individuals from engaging with health services.
- Outreach efforts: Effective outreach must be culturally sensitive and leverage trusted community resources to reach homeless individuals.
- Cultural sensitivity: Outreach programs must understand the unique needs of the homeless population and collaborate with community-based organisations that already have the trust of this group.
Data showing confidence of people experiencing homelessness using the internet to access information and support
Commentary
This study is crucial in understanding how homelessness intersects with access to health and social care. It shows that homeless people, who are already at a disadvantage due to their living situation, face additional barriers to accessing health and social services. These barriers often include lack of trust in formal institutions, inadequate information, and limited access to services that are not designed with their needs in mind.
The reliance on informal networks is both a strength and a challenge. On one hand, these networks provide vital support and information, but on the other, they may perpetuate cycles of disadvantage as they are not always connected to the formal healthcare system, limiting access to more comprehensive or preventative services.
To address these barriers and move toward equitable care, the study suggests the need for outreach that is not only culturally sensitive but also delivered through trusted local organisations. This type of community-based outreach is a practical approach to overcoming the gap in access and trust, ensuring that homeless individuals can access the health and social care they need.
This research highlights the importance of integrating health and social services with community organisations that the homeless population trusts. Additionally, it calls attention to the need for systemic changes that make health services more accessible and relevant to those living in vulnerable situations.
Further reading
Reference
Magwood, O., et al. (2019). Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness. PLoS ONE, 14(12), e0226306.
Key Messages
- Trust issues: Homeless individuals face significant barriers to accessing healthcare services due to mistrust and concerns about personal safety, often linked to past negative experiences with institutions.
- Tailored interventions: Successful interventions must address cultural and personal safety concerns, building trust and ensuring inclusivity.
- Co-design with lived experience: Involving people with lived experience of homelessness in the design and delivery of services is critical for increasing their acceptability and effectiveness.
Commentary
This systematic review highlights the foundational role of trust-building and personal safety in health and social care interventions for the homeless population. The findings underline that interventions must be tailored to address the unique concerns and past experiences of homeless individuals. Such approaches, informed by lived experiences, are essential to improving service access and outcomes.
However, a key limitation of the current evidence base is the lack of long-term studies assessing the sustained impact of these interventions. Addressing this gap with longitudinal research would provide a clearer understanding of their long-term effectiveness in fostering trust, enhancing safety, and improving health outcomes for homeless populations.
Reference
Alexander, C. (2021). Unequal conditions of care and the implications for social policies on young carers. Child and Adolescent Social Work Journal, 38(5), 505–518.
Key Messages
- Unequal access: Young carers often lack resources, support, and recognition compared to adult carers, affecting their educational, social, and mental well-being.
- Barriers to support: Current social policies do not adequately address the specific needs of young carers, such as providing accessible support services, financial aid, and integration with education.
- Educational impact: Caregiving responsibilities can lead to school absences, lower academic performance, and limited social development, putting young carers at a disadvantage.
- Social stigma: Young carers often face stigma that discourages them from seeking help and contributes to their needs being overlooked.
- Policy gaps: The paper advocates for inclusive policies that address the unique challenges faced by young carers and promote their well-being.
Commentary
This paper explores the disparities young carers face in accessing resources and support, highlighting the educational, social, and mental health challenges tied to their caregiving roles. Despite their significant contributions to family care, young carers are often excluded from policy frameworks designed to support carers, which predominantly focus on adults.
To ensure equity in social care, policies must recognise the distinct needs of young carers, offering targeted support that enables them to achieve educational and social milestones on par with their peers. The findings underline the long-term risks of neglecting young carers’ needs, including poorer educational outcomes and limited future opportunities. Addressing these gaps through inclusive and youth-centred policy changes is essential to mitigate the disadvantages they face and support their dual roles as students and caregivers.
Reference
Shand et al. (2023). The impact of having a carer on adult health and social care utilisation across five settings of care: A matched cohort study. Health Policy, 129(C), Article 104705.
Key Messages
- Higher costs for those with carers: Adults with a registered carer had 27% higher health and social care costs than those without, with social care accounting for the largest share of the difference (39%).
- Service use dynamics: Having a carer increased access to services across all settings, countering assumptions that carers substitute formal care. Carers often act as advocates, driving service use.
- Health inequalities: Individuals without carers may face barriers to accessing services, raising concerns about equity in health and social care.
- Variability in carer roles: The study highlights diverse carer roles and contributions, though the dataset lacked detailed differentiation between these variations.
- Policy implications: Current policies assume carers reduce formal care reliance. The study suggests a need for revised strategies, including training and education for carers as part of formal systems.
- Unmet needs and system gaps: Informal carers often address unmet needs, such as emotional support and care coordination, rather than substituting professional care.
Commentary
This study reveals that individuals with carers incur higher service costs, challenging the assumption that informal carers reduce the strain on health and social care systems. Instead, carers enable access to services by acting as advocates and addressing gaps in care. These findings call for rethinking policies to better integrate carers within formal care systems and provide them with appropriate support and training.
From an equity standpoint, the study points to systemic disparities in service access for those without carers. This highlights the need for targeted interventions, such as outreach programmes for socially isolated individuals and expanded care navigation services.
The study’s limitations, including its reliance on primary care records to identify carers and absence of longitudinal analysis, indicate areas for further research. Future studies should explore diverse carer groups and the interplay between informal and formal care to develop optimised, equitable care solutions.
Reference
Carers UK (2023) Supporting Black, Asian, and minority ethnic carers:
A good practice briefing. Carers UK.
626,985
UK unpaid carers are from Black, Asian, and minority ethnic backgrounds
21%
of BAME carers provide over 50 hours of unpaid care per week
32%
of BAME carers reported that the services in their local area did not meet their needs.
Key Messages
- Barriers to support: Many Black, Asian, and minority ethnic (BAME) carers face challenges such as cultural stigma, language barriers, and financial anxieties, which often prevent them from identifying as carers or accessing support services.
- Service gaps: Mainstream care services frequently lack cultural competence, leading to feelings of exclusion and misunderstanding among BAME carers.
- Good practices: Recommendations include cultural competence training for carers’ organisations, establishing community partnerships, and co-designing resources with input from ethnic minority groups.
- Case studies: Local council initiatives have shown improvements in engaging with BAME carers through culturally tailored programmes.
Commentary
This briefing highlights the inequities faced by Black, Asian, and minority ethnic (BAME) carers within social care, driven by cultural, linguistic, and systemic barriers. These challenges highlight a failure to provide equitable access to support, as BAME carers are disproportionately excluded from services that should meet their needs.
The recommended practices—such as cultural competence training, community partnerships, and co-designed resources—are positive steps towards fostering inclusivity. However, the absence of robust quantitative evidence limits the ability to gauge how effectively these measures close the equity gap. Care equity requires not just good intentions but demonstrable improvements in outcomes for carers and care recipients alike.
The case studies are encouraging but insufficient to ensure systematic change. Research is essential to evaluate the scalability and impact of culturally tailored approaches. Without this, the risk remains that good practices stay isolated rather than transforming the broader social care landscape into one that genuinely supports all carers equitably.
Further reading
Reference
Marie Curie (2022) Mind the gaps: understanding and improving out-of-hours care for people with advanced illness and their informal carers.
Key Points
- Out-of-hours care gaps: Significant gaps exist in out-of-hours care, particularly during evenings, weekends, and bank holidays, leaving patients and informal carers unsupported during critical times.
- Impact on carers: Informal carers, often family members, face increased stress, burnout, and feelings of isolation due to insufficient professional support during out-of-hours periods.
- Inconsistent services: Regional disparities in the availability and quality of out-of-hours care create inequities, leaving some individuals better supported than others.
- Recommendations for improvement: A national framework is recommended to ensure equitable access to high-quality out-of-hours care. Improving coordination and communication among healthcare providers is also critical.
- Advocacy for policy change: The report urges a consistent, proactive approach to out-of-hours care across the UK, focusing on both patients’ and carers’ needs.
Commentary
This report highlights significant inequities in out-of-hours care for people with advanced illnesses and their informal carers. Regional disparities in service availability exacerbate care inequities, leaving many vulnerable individuals unsupported. Informal carers often bear the brunt of these gaps, facing heightened stress and isolation, which highlights the urgent need for systemic change.
A nationally coordinated framework could close these gaps, ensuring consistent care irrespective of time or location. Improved planning, communication, and integration between healthcare providers would enhance support for both patients and carers, reducing disparities and promoting equitable care.
By addressing these gaps, the report argues, the quality of life for patients and carers will significantly improve, with a fairer distribution of healthcare resources. The recommendations provide a clear pathway to achieve this, calling for urgent policy changes to prioritise out-of-hours care in national healthcare planning.
Reference
Shand et al. (2023). A matched analysis of the impact having a carer has on an individual’s health and social care utilisation across five settings of care for adult residents of Barking and Dagenham. Health Policy, 129, Article 104705.
Key Messages
- Increased service use: People with informal carers had 27% higher health and social care costs compared to those without carers, with social care accounting for 39% of the difference in service use.
- Challenging the care substitution hypothesis: Contrary to the assumption that carers substitute for formal care, individuals with carers accessed more services across all settings, suggesting that carers augment rather than replace professional care.
- Carer advocacy role: Informal carers often act as advocates, driving increased service use by facilitating access, hospital visits, and more active treatment.
Commentary
This study highlights a critical issue in healthcare equity: the differing experiences of individuals with and without carers. The findings challenge the assumption that informal care reduces reliance on formal health and social care services. Instead, carers appear to enhance access to care, resulting in higher utilisation and associated costs. This suggests that people without carers may face significant barriers, potentially leading to health inequities.
In an equitable system, the role of informal carers should be recognised and supported without creating disparities for those lacking this informal network. Policymakers should address the imbalance by ensuring that individuals without carers receive adequate support to access services. Meanwhile, carers should be better integrated into the healthcare system, with appropriate training, resources, and support to align their contributions with formal care provision.
This study calls for a nuanced approach to informal and formal care integration, ensuring equitable access to healthcare services regardless of an individual’s carer status.
Reference
Spencer et al. (2024). The experiences of minority language users in health and social care research: A systematic review. International Journal of Health Planning and Management. Advance online publication.
Key Points
- Barriers to access: Minority language speakers face communication challenges in health and social care settings, resulting in misdiagnosis, inadequate care, and feelings of exclusion.
- Lack of cultural competency: Healthcare professionals often lack the training or resources to address cultural and linguistic needs, worsening disparities in care delivery.
- Limited research inclusion: Minority language users are underrepresented in health and social care research, leading to gaps in understanding their needs and experiences.
- Impact on care equity: The findings call for systems to address language and cultural barriers, offering inclusive care for all communities.
- Recommendations: The review advocates for improved professional training, robust translation and interpretation services, and greater inclusion of minority language speakers in research.
Commentary
This systematic review sheds light on a critical care equity issue: the systemic exclusion and marginalisation of minority language users in health and social care systems. Language barriers and cultural insensitivity not only hinder access to quality care but also contribute to poorer health outcomes and heightened disparities for these groups. The findings highlight the dual challenges of inequitable care provision and inadequate representation in research.
For equitable care, health and social care systems must go beyond basic translation services, embedding cultural competence into every aspect of service design and delivery. Training healthcare professionals to understand and meet the needs of linguistically and culturally diverse populations is an essential step towards reducing these disparities. Additionally, the inclusion of minority language users in research is vital to ensure that their unique needs inform policy and practice development.
This paper serves as a call to action for more inclusive healthcare systems that actively work to eliminate barriers for minority language users, fostering greater equity and better outcomes for all.
References
van der Heide et al. (2021). “Nobody Seems to Know Where to Even Turn To”: Barriers in Accessing and Utilising Dementia Care Services in England and The Netherlands. International Journal of Environmental Research and Public Health, 18(22), 12233.
Giebel et al. (2024). The landscape of inequalities in dementia care across Europe: First insights from the INTERDEM taskforce. International Journal of Geriatric Psychiatry, 39(5), e6096.
Key Messages
- Individuals with dementia and their carers face significant barriers in accessing care services, including:
- Lack of awareness about available services.
- Complexity and fragmentation of care systems.
- Stigma associated with dementia.
- Financial constraints limiting access to private care options.
- Cultural factors and language barriers further hinder access, especially among minority ethnic groups.
- There is a need for integrated care approaches to improve service accessibility and coordination.
- Cross-country variations in service provision lead to inequalities in dementia care across Europe.
Commentary
These studies highlight the multifaceted challenges faced by individuals with dementia and their carers in accessing appropriate care services across Europe. The identified barriers, such as lack of awareness, system complexity, and cultural factors, underscore the need for tailored interventions to promote equitable access to dementia care. The research suggests that integrated care models and culturally sensitive approaches are essential to address these disparities. However, the effectiveness of such interventions requires further evaluation to ensure they meet the diverse needs of dementia patients and their carers across different European contexts. Addressing these barriers is crucial for promoting social care equity, as current inequities contribute to poorer health outcomes among individuals with dementia. Policymakers and health and social care providers must prioritise inclusive practices to ensure that all individuals can access the care they need without facing systemic obstacles.
Reference
Giebel et al. (2024). Socioeconomic determinants of access to dementia care in Europe: A systematic review. International Journal for Equity in Health, 23(1), 2245.
Key Messages
- Socioeconomic status significantly influences access to dementia care services, with lower-income individuals facing greater barriers.
- Financial constraints limit the ability to afford private care options, leading to reliance on often under-resourced public services.
- Educational disparities affect awareness and utilisation of available dementia care services.
- Policy interventions are needed to reduce socioeconomic inequalities and improve access to dementia care across Europe.
Commentary
This systematic review highlights the significant impact of socioeconomic factors on access to dementia care services across Europe. Individuals from lower socioeconomic backgrounds face substantial barriers, including financial constraints and limited awareness of available services, leading to disparities in care utilisation. The findings underscore the need for policy interventions aimed at reducing these inequalities, such as subsidising care costs and enhancing public awareness campaigns. Addressing these socioeconomic disparities is essential for ensuring equitable access to dementia care and improving health outcomes for all individuals, regardless of their economic status.
Further Analysis
Ethnic Disparities in Access to Care
Data showing disparities in access across different ethnic groups
