We can see differences in people’s health across NHS Greater Glasgow and Clyde and there is a widening gap in health between the richest and poorest. Men in the least deprived areas can expect to live 13-14 years longer than those in the most deprived areas of the city. The gap for women is 8-9 years.
Social class is a major cause of these differences in health, or ‘health inequality’. Discrimination because of someone’s sex, race, disability, age and sexual orientation, combined with a person’s social class can have a harmful effect on health. People also experience a decrease in health as their social position decreases. This is called the health gradient.
What can the NHS do to tackle the Health Gap?
NHSGGC has an important role to play in reducing health inequalities by the way that it provides its services and gives out its resources. The NHS has worked in communities with the worst health and helped people find ways to become healthier. However, this has not affected the size of the health gap because more wealthy communities have been improving their health as quickly, or more quickly than poorer communities.
Those who need health care the most often have the least access to it (sometimes called the ‘Inverse Care Law’).In Glasgow, GP practices are evenly spread throughout the city – which does not reflect the distribution of poor health. Also, the way health care is organised favours people who:
have knowledge of the health care system and the confidence and assertiveness to use it;
can communicate and can be communicated with at several levels i.e. have spoken English as their first language, who can read and who have no sensory impairments such as blindness;
can travel easily to hospitals, health centres etc or for whom there are no physical barriers (such as difficulties walking); and
have health problems which are largely unrelated to their life circumstances or discrimination
NHSGGC’s work on inequalities is designed to deal with these issues and find ways of sharing resources in a fairer manner. It also works with its partners to improve the underlying causes of differences in health, such as education, employment, housing, transport and other public services.
Scottish Child Payment is now open for applications
Scottish Child Payment is a new payment for families on tax credits or certain benefits to help towards the costs of looking after a child. It is £40 paid every four weeks for each child under six.
The payment starts on Monday 15 February 2021, with first payments made from the end of February onwards, but Social Security Scotland is taking applications now to help manage demand.
You can apply if your child will be under six on 15 February 2021.
The qualifying benefits are:
* Child Tax Credit * Income Support * Pension Credit * Working Tax Credit * Universal Credit * Income-based Jobseeker’s Allowance (JSA) * Income-related Employment and Support Allowance (ESA)
Social Security Scotland will ask for evidence that the person applying is responsible for a child under six, usually through the child being named on a benefit claim form. If more than one person applies for the same child, there’s a process for deciding who gets the payment – prioritising the person who the child lives with most of the time.
Scottish Child Payment will not be taken into account for UK benefit and tax credit assessments and there is no cap on the amount of children this payment can support.
First payments will be made from late February onwards. When someone gets paid will depend on how many applications we get and the process each individual application goes through. If someone applied before Monday 15 February 2021, this will be the date that their payment will be calculated from. If they apply after this date, it will be calculated from the date that they applied.
Payments will be made every four weeks following the first payment.
Find out more information and apply at mygov.scot/scottish-child-payment or call Social Security Scotland on 0800 182 2222.
PIP is a new benefit for people aged 16-64 who have a disability, physical impairment or mental health condition.
It will replace Disability Living Allowance (DLA) but more people will qualify for PIP than DLA.
PIP aims to support people that are experiencing difficulties with daily activities and mobility that are likely to last for 12 months or more.
We want to ensure that patients who have problems with daily living, such as eating or preparing food, taking medication, moving around or managing money, are aware of this benefit and how to claim it.
Posters and leaflets promoting PIP have been produced by NHSGGC and are being distributed throughout our services.
NHS Greater Glasgow & Clyde have put in place a range of initiatives on money worries and employment which can make a substantial difference to vulnerable patients and families. For more information click here.
The COVID-19 pandemic, Brexit, welfare reform, austerity and the recession have created extreme poverty in Scotland and the UK. The Scottish Social Renewal Advisory Board and the Marmot Build Back Fairer reports argue for radical action to tackle the long term humanitarian crisis.
People’s human rights to food, fuel, income and shelter are often breached in the humanitarian crisis that has arisen. Poverty, child poverty, stress and social isolation with the long term associated impacts on mental and physical health are public health emergencies. This is due to low economic growth rising unemployment levels; stagnant wages; social security cuts; higher food and fuel prices.
Over 50% of people living in poverty are in work and often claim benefits such a working tax credits. However, often people are unaware of what is their right to social security with around £20 billion unclaimed in the UK every year. In 2020, the Scottish Human Rights Commission developed this short film clip about right to Scotland’s devolved social security powers.
Even before the pandemic, the UN rapporteur on human rights had two visits to Scotland – one on extreme poverty and one on the right to food. The reports cited the UK governments economic and welfare reform policies as a key factor in why these are live public health emergency issues in Scotland (see Human Rights page).
NHSGGC Public Health Strategy post pandemic firmly sets out to tackle poverty, child poverty and mental wellbeing with NHSGGC a partner in the legally required Local Child Poverty Action Plans.
ScotPHN Impact of Welfare Reform on Health (Literature search indertaken by NHS Highland in preparation for Parliamentary Finance Committee in June 2012 and interim guidance for NHS boards on mitigating impact)
The Fairer Scotland Duty came into force in April 2018 with the aim of ensuring that public sector bodies consider how they can reduce socio-economic disadvantage when making key strategic decisions.
Food Insecurity/Poverty – NHSGGC’s hospital based services assess for malnutrition and diet on admission. Our Financial Inclusion Group shares information on good practice around food poverty issues, highlighting the negative impact on health and stress and promoting community food initiatives.
Home Energy Advice – NHSGGC has a partnership with Home Energy Scotland. This means patient and staff struggling to pay with for fuel and requiring improvements to equipment receive the support they need. The service is promoted in hospitals and communities.
Person centred care is at the heart of the National Quality Strategy and aims to deliver effective, safe, non-discriminatory and efficient health and social care.
Being sensitive to inequalities and human rights within person-centred care means working in a way which responds to the life circumstances that affect people’s health. Evidence shows that if these issues are not taken into account by the health service, opportunities are missed to improve health and to reduce health inequalities.
Developing Person Centred Care that is Sensitive to Inequalities
NHSGGC has a number of programmes of work which aim to ensure that our services understand how to recognise and respond to the life circumstances that are affecting someone’s health.
For example, the Healthier Wealthier Children Project focuses on identifying and responding to the needs of people who have worries about money. While the Gender-based Violence Programme is developing the practice of sensitively asking service users about their experience of abuse.
Actions such as providing communication support, routinely asking about social issues such as money worries and stress and referring on as appropriate are key to delivering inequalities sensitive person centred care.
The current issues around Extreme Poverty and Destitution are likely to have a profound effect on NHSGGC patients. We are anticipating an increase in diseases relating to poverty and we can expect increased demand for mental health and primary care services and a negative impact on carers.
There are also a number of initiatives around workforce training and development.
NHSGGC wants to work in partnership with patients, learning from patients’ lived experiences.
We want to ensure that all voices are heard. The Equalities & Human Rights Team’s patient involvement activities therefore specifically engage with people with protected characteristics and other groups that experience discrimination.
People’s experience of inequalities and discrimination impact upon their health, how they engage with health services and manage their health problems. By engaging with communities and responding to feedback we can improve everyone’s experience of NHSGGC services. This work will also inform our equality outcomes and actions for the future. The Equality and Human Rights Team also work closely with the Patient Experience Public Involvement Team to help reach and engage with all our communities.
Involving Patients and Members of the Public
We consult with a variety of patient groups depending on the area of work. For example –
Disability Access – our Disability Access Patient Group, help us investigate and audit the factors affecting disabled people’s access to our buildings and services
Learning Disability – we work in partnership with a number of organisations supporting people with a learning disability and are members of The Life I Want Health Group, a partnership forum made up of 3rd sector services.
Black and Minority Ethnic Communities – our engagement is constantly being developed and delivered with a range of 3rd sector organisations working with BME communities. This has informed our work to ensure communities have access to health information and that our services are delivered in ways which ensure access for all communities.
The Deaf Community – feedback is sought from the deaf community on a range of issues, including the BSL National Plan, our Interpreting services and access to NHSGGC services. The BSL Health Champions – volunteers from the Deaf BSL community – work with us to achieve this and group meetings are open to any Deaf BSL user who lives in the NHSGGC area. The group also has a Facebook page which is used to share information and to get feedback from the BSL community.
The role of Peer Workers
Peer workers are people who draw on their own experiences to help and support others in similar circumstances. Their lived experience enables them to connect in a meaningful way with those they are supporting.
The role of Engagement and Educational Peer Workers was introduced in NHSGGC in 2022. Our current work focuses on Immunisation, Screening, Poverty and aims to –
Support the ongoing patient engagement within the vaccination programme; identify barriers to vaccine take-up and provide information on vaccines, poverty assistance and access to NHSGGC services.
Maximise the contact with communities who find it hard to engage with NHSGGC’s routine patient involvement activities and support them to do so.
The Peer Workers run discussion sessions with their groups on issues relating to healthcare and people’s experience of using NHS services. They also provide information on the advice and support available to NHSGGC patients, particularly around help with financial hardship.
The Fairer Scotland Duty came into force on 1 April 2018. It places a legal responsibility on named public bodies in Scotland to actively consider how they can reduce inequalities caused by socio-economic disadvantage when making strategic decisions.
Scottish Government guidance (2021) Fairer Scotland Duty: guidance for public bodies provides a comprehensive explanation of the Duty together with useful tools to assess decision making processes.
Addressing socio-economic issues in NHSGGC
NHS Greater Glasgow and Clyde is involved in a range of work to tackle inequality as a result of income inequality, poverty and social issues.
Home Energy Advice – NHSGGC has a partnership with Home Energy Scotland. This means patient and staff struggling to pay with for fuel and requiring improvements to equipment receive the support they need. The service is promoted in hospitals and communities.
NHSGGC’s hospital based services assess for malnutrition and diet on admission. Our Financial Inclusion Group shares information on good practice around food poverty issues, highlighting the negative impact on health and stress and promoting community food initiatives.
Food insecurity – worrying about accessing enough food, making compromises to quality or quantity or just going without – is becoming much more of an issue for our communities.
People experiencing food insecurity face not only a lack of sufficient food, but also negative impacts on their health and the stress of being able to feed their family from one day to the next. This can also come with feelings of shame and helplessness, social stigma and isolation. Community food initiatives have a really important role to play here, as they can provide emotional and practical support as well as places for people to access food.
Find your local foodbank
For more information on how to access a foodbank, donate or help out, click on the links below.
Domestic abuse, rape and sexual assault, prostitution, child sexual abuse and other forms of gender-based violence cause immense pain and suffering and are a major public health issue. The emotional, psychological and physical consequences of gender-based violence can be profound and include fatal injury, physical health problems, chronic conditions, mental health problems and negative health behaviours.
Many people affected by gender-based violence are reluctant to disclose this experience, often through fear or shame. However, they do present across the whole range of primary and acute health settings. Health workers are therefore in a unique position to provide help and support. If we do not ask about or respond to gender-based violence there is a danger that the health issue won’t be treated properly and could increase the risk of long-term and chronic ill-health and even death.
Health workers across the whole of the health service need to know about gender-based violence, what to look for and how to respond. This is fundamental to our duty of care to patients and part of our role to promote gender equality.
The prevention of gender-based violence and the care of people experiencing it is a key priority for public protection within NHS Greater Glasgow and Clyde.
Imagine your child is sick. You take them to hospital but you can’t find a way to let the staff there know what is wrong.They ask you questions, but you don’t understand what they are saying.
This is just one of the frightening scenarios which people can find themselves in if they have difficulties with the types of communication many of us take for granted. There are many reasons why someone might find themselves in this situation:
English is not their first language
They have a visual impairment, are Deaf or hard of hearing
A condition such as a stroke or having learning difficulties is making communication difficult
They have difficulty reading
Health staff not being able to communicate effectively with patients can have real consequences for their health and the services they receive. Many patients miss appointments or are unable to access services because of the language barrier. It is also frustrating for staff who find themselves unable to communicate with their patients.
NHSGGC aims to ensure that we providing effective communication support for all those who need it.
Accessible Information Policy
NHSGGC’s ‘Clear to All’ Accessible Information Policy is designed to make sure there is a consistent, accurate and clear approach in providing information to patients and members of the public in a range of formats and languages. Translated versions of any NHSGGC resource or information relating to individual clinical care can be obtained via the Clear to All web page.
Providing interpreting services is a vital part of the ongoing work to ensure that everyone receives the best possible care. NHSGGC has an in-house interpreting service. Find out more about the Interpreting Service.
For a range of language resources currently available for NHS staff, please go to Staff Resources.
What is Social Class
What is social class?
Social Class can be defined by:
economic factors (wealth, income, occupation)
political factors (status, power)
cultural factors (lifestyle, education, values, beliefs).
Despite arguments that the class system has changed over the past 50 years it is still the case that important differences in shared beliefs and values relate more obviously to class than any other social category.
Social class leads to inequalities of resources, whether that is income, education, housing or health.
Social Class and Discrimination
People’s experience of class and poverty can lead to their views not being heard, being left out when decisions are being made, isolation and humiliation.
A recent poll showed that poor people in particular think that class, not ability, greatly affects the way they are seen.
In the last 25 years the number of people in the top two social classes has doubled in Glasgow. However while the city’s middle class has grown and prospered, other parts have seen little improvement. Many people are dependent on sickness or unemployment benefits or low paid work. This has led to growing inequality.
Social class discrimination can affect many areas of people lives; access to education, housing, social mobility and job opportunities and pay. Numerous studies have been carried out into the effect being working class might have on an individual’s working life. In 2017, the Social Mobility Commission found there was a class pay gap where professionals from working class backgrounds earn an average of £6,800 less than professionals from higher classes.
There is currently no specific protection within the Equality Act 2010 on the grounds of class; although the Fairer Scotland Duty does offer some protection.
Social Class and Other Protected Characteristics
There is a strong link between social class and groups with other protected characteristics, as they are often denied access to power, wealth, status, resources and opportunities.
For example:
Employment among all black/minority ethnic groups in Glasgow is 10% lower than for white Glaswegians
68% of disabled people have an income of less than £10,000
Women are more likely to be poor than men due to lower paid jobs, part-time jobs and the fact that 90% of lone parents are women
In Scotland today the pay gap between women and men can translate to a loss of over £330,000 in a woman’s working life – just because she is a woman.
Social class is not a protected characteristic in the Equality Act 2010 however it has close links to poor health and other forms of inequality.
The Fairer Scotland Duty came into force on 1 April 2018. It places a legal responsibility on named public bodies in Scotland to actively consider how they can reduce inequalities caused by socio-economic disadvantage when making strategic decisions.
Scottish Government guidance (2021) Fairer Scotland Duty: guidance for public bodies provides a comprehensive explanation of the Duty together with useful tools to assess decision making processes.
Why social class matters to Health
Social class leads inequalities of resources, whether that is income, education, housing or health. This has led to widely varying but predictable life chances and health outcomes across Greater Glasgow and Clyde.
The link between social class and health was identified almost 40 years ago. In 1980, there was found to be a clear inequality in life expectancy between men in social class 1 (managers and professionals) and social class 5 (unskilled workers).
The reasons for the link between social class and health includes things such as health risks in low paid, unsafe jobs and stress caused by having low status and lack of power.
Upward and downward social mobility can improve or decrease people’s life chances. Certain events such as such as leaving home, becoming a parent, losing your job or bereavement can make us vulnerable to falling into a low income or low status in society.
Social class inequality has an impact on the whole of society. Research shows that more equal societies have better health rather than richer societies where there is a bigger gap between rich and poor.
How are we addressing social class issues
NHS Greater Glasgow and Clyde is carrying out a range of work to tackle inequality as a result of income inequality, poverty and social issues.
These include:
Monitoring the impact of the recession and welfare reform on health
Increasing referrals to employability and money advice services
Measuring the health gap so that we know that specific programmes of work are making the gap better or worse
In ‘Turning the Tide through Prevention’, the Public Health Strategy 2018-2022, we can see that the determinants of health are well documented and many of them lie outside the direct influence of the NHS, such as relieving poverty, improving housing or education. A crucial element of this strategy is therefore the effectiveness of our influence on these factors through community planning partnerships and the way we work with Scottish and UK governments and the people who use our services.
Local health and social care partnerships mean that staff work together to give people support with health and social issues to reduce health inequality.
Tina lives with her husband and two children. Two years ago she suffered a serious brain haemorrhage. The consequences of her illness, which was completely unexpected, were devastating.
In order to care for Tina and the children her husband had to leave his job. But when he tried to claim benefits he was told that he wasn’t entitled and would have to wait 10-16 weeks before they would be given any money at all. They said he had made himself voluntarily unemployed. This advice was wrong.
For four months the family had no income at all except for a small amount of Child Benefit and Tax Credit. They didn’t receive Housing Benefit, although entitled to it, and their rent wasn’t being paid. They sunk deeper and deeper into debt.
The family were struggling to survive on less than £50 a week. Through social services they were put in touch with the Family Support Unit (FSU) who helped with food parcels and Home Start, who were able to offer some support.
Tina’s situation has improved now. Her husband is back in work and they still receive support from Home Start, but the debt is still a major concern and the family still has some way to go before it’s back on track.
