Integration needs to take better account of women’s lives and rights

• Written by: Emma Ritch — Engender — Executive Director
• Published: 17th June 2018

Emma explains what is uncovered when you look at health and social care integration through a gender lens.

Care continues to be a profoundly gendered issue, resounding along women’s lives in Scotland.  Women take on the major share of responsibility for caring as either unpaid or paid carers, caring formally or informally.

Caring has a significant economic cost to those who provide it, reducing the capacity of informal carers to participate in paid employment.  The role of caring for children and adult dependents often limits the extent to which carers can financially provide for themselves and their families.  As women make up the majority of formal carers, childcare workers and workers in other care services, the low pay and status of care work is a matter of concern to Engender and to gender equality advocates.  The economic impact of caring has an immediate impact on current household income, but also has a future impact on women’s earning and pension income potential.

The social care system is failing many older people and disabled people, as well as their families and carers.  Many disabled people are living without essential support beyond basic washing and dressing, or ‘life and limb’ care.  Scotland is lacking in a social care system which provides people with the opportunity to take control over their own lives.  Though the existing social care system is currently straining under pressure, demographics suggest that demand for care will only increase.  Public sector funding is diminishing, and projections show that the number of people aged 75 and over in Scotland will increase by 85% over the next 25 years, a rate faster than the rest of the UK.  It is expected that by 2026, the number of adults in need of care will have increased by 30%.

Adequately funded social care supports people in Scotland to participate fully in society – to attend work, to pursue an education, to engage with family and friends, to take part in community activities, and to stay in their own home.  Furthermore, an appropriately funded social care system can prevent isolation, exclusion, illness, and poverty.  Experts in Scotland have noted that ‘the whole system of funding social care is broken, [and] addressing one issue at a time will not fix it’.  Scotland is in need of a system that sees social care support as an infrastructure investment in the social and economic wellbeing of society as a whole.

For those of us who advocate for policies and practices to be reflective of women’s experiences and perspectives, it is hardly surprising to find another example of social policy developed without gender at its heart.  We are concerned about the extent to which health and social care integration is not taking cognizance of the impact of its implementation on women’s equality and rights, and particularly the rights of carers.

To succeed for women, integration boards need to have gender-competent governance that is not undermined by conflicts of interest.  Strategic plans need to explicitly include equality outcomes for women, including care workers, health workers, and carers, and enable action that will realise them.  Locality and workforce planning must engage with the question of gender equality, including occupational segregation and women’s propensity to engage in unpaid care.  Failing to count can mean failing to plan for or manage, and we are concerned both at the lack of gender-disaggregation in the core suite of indicators, and in the content of the indicator around unpaid care.  We have greater ambitions for carers than that they “feel supported to continue in their caring role”.

Engender has spent two years talking to organisations and individual women about what women want in Scotland.  This was collaborative thinking for the purpose of envisioning how we might get from where we are to where we want to be.

We want a social care system that reflects social justice, human rights, and gender equality ambitions.  We need a modern, nationwide infrastructure of social care support that is underpinned by a sustainable funding model.  Carers should have minimum entitlements to breaks from caring, should ‘consent to care’, and be able to access an independent social care tribunal to protect the rights of carers and those to whom they provide care.

We want a good life for carers and cared for people in Scotland, and we know that policymakers’ failure to consider gender plays a significant part in preventing that from happening.  The implementation of health and social care integration needs to take better account of women’s lives and experiences if it is to succeed in improving outcomes for Scotland’s people.

Emma can be found on Twitter at: @EmmaRitch (this link will take you away from our website).

Emma’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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