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This chapter analyses how social policy structures in England and Wales contribute to persistent inequities experienced by autistic adults, particularly within health and social care systems. The authors frame these issues through the concept of epistemic injustice, arguing that autistic perspectives are frequently excluded or marginalised in policy development. 

Within healthcare systems, autistic people face barriers at multiple stages of access. Diagnostic pathways are often slow, confusing and difficult to navigate, meaning many autistic individuals remain undiagnosed and therefore unable to access services that require formal diagnosis. Even when a diagnosis is obtained, adjustments within healthcare settings are inconsistent, and many autistic patients report that clinicians do not adapt communication styles or appointment structures to meet their needs. 

Healthcare accessibility is further limited by structural features of service delivery. For example, many services rely heavily on telephone communication for booking appointments, which presents a significant barrier for autistic people who experience communication challenges in this format. Sensory environments in clinical settings, such as bright lighting, noise and crowded waiting areas, also create barriers to accessing care. 

In the social care system, autistic adults may receive personal budgets to organise their own support. However, the administrative and organisational demands associated with managing care can be particularly difficult for individuals who already experience executive functioning challenges. As a result, the system may inadvertently disadvantage those with the greatest support needs. 

The chapter argues that these barriers reflect structural inequities embedded in policy design rather than individual shortcomings. Policies are frequently developed without meaningful involvement of autistic people, which leads to services that do not reflect lived experience or accessibility needs. The authors therefore emphasise the importance of co-produced policy development, where autistic individuals contribute directly to the design of services and social policies that affect them. 

From a health and social care equity perspective, the chapter highlights how systemic barriers across diagnosis, healthcare access and social care support contribute to poorer outcomes for autistic adults. Addressing these inequities requires structural reform, including accessible service design, improved professional understanding of autism and stronger inclusion of autistic voices in policy development.

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This study explores systemic safety inequities experienced by people with learning disabilities when interacting with health and social care services. Rather than focusing solely on mortality data or adverse events, the research examines lived experiences of care to identify structural factors that contribute to unsafe or inequitable care. 

The analysis identified three overarching themes: health and care system rigidity, systemic gaps and traps within services, and the reliance on ‘dependency work’ undertaken by families, carers and advocates. These findings suggest that inequities are often produced by structural features of health and social care systems rather than by individual-level factors. 

System rigidity was a key issue. Health and social care services often required people with learning disabilities to adapt to standardised systems rather than adapting care to individual needs. Participants reported difficulties with communication, inaccessible information, insufficient time during appointments and environments that could be overwhelming or distressing. These barriers increased risks to patient safety and reduced the ability of individuals to participate fully in their care. 

The study also highlighted systemic gaps within services. Participants described inconsistencies in support provision, limited staffing capacity, poor coordination between services and failures in information sharing across organisations. These issues often led to fragmented care and repeated retelling of medical histories, which created additional burdens for individuals and families. 

A particularly important finding concerns the role of family members, carers and advocates in compensating for systemic weaknesses. Family members, carers and advocates frequently acted as informal safeguards by interpreting information, advocating for reasonable adjustments and ensuring that care needs were understood. While this support was valued, the study emphasises that reliance on social capital can create additional inequities for individuals without strong support networks. 

In terms of care equity, the study shows how structural barriers within service design, staffing and coordination contribute to poorer safety outcomes for people with learning disabilities. Addressing these inequities therefore requires system-level change rather than relying solely on individual staff training or local adjustments. 

Overall, the findings suggest that improving safety for people with learning disabilities requires more flexible service design, better communication practices, stronger advocacy support and improved integration across health and social care services. These changes would help reduce systemic safety inequities and improve care experiences for this population.

This paper uses the term inequalities. In this Evidence Hub, inequities is used where differences in access or outcomes reflect avoidable and unfair structural barriers in health and social care. 

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This systematic review examines interventions designed to reduce inequalities in dementia diagnosis and care. The review highlights that people living with dementia and their carers often face barriers when trying to access services, which can lead to avoidable differences in health outcomes. 

Many of these barriers occur at several levels. Some relate to individual circumstances such as language, cultural background or socioeconomic status. Others occur at community level, for example where stigma around dementia discourages people from seeking help. Structural barriers within health and social care systems also play an important role, particularly where services are fragmented or poorly coordinated. 

The review finds that system-level solutions appear to have the strongest evidence. These include models such as dementia link workers, integrated care networks and memory clinic collaborations. These approaches can improve coordination between services and help individuals and carers access appropriate support more easily. In some studies, link worker roles also improved quality of life for people living with dementia and reduced pressure on carers. 

Community-level initiatives can also play an important role. Programmes that raise awareness about dementia, reduce stigma and build dementia-friendly communities may encourage earlier help-seeking and improve understanding of the condition. Culturally tailored information and support programmes can also help address barriers faced by minority ethnic communities. 

The review also identifies increasing use of digital tools to support dementia care. Online information platforms, telehealth services and digital care planning tools can help some people access support more easily. However, the authors note that digital solutions can also create new barriers where people lack digital skills, access to technology or reliable internet connections. 

From a health and social care equity perspective, the findings show that inequities in dementia care often arise from structural barriers within systems rather than individual choices. Access to diagnosis, information and support can vary depending on geography, service availability and socioeconomic circumstances.

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This study examines how newly qualified social workers experience and respond to racism in practice during the early stages of their careers. Through focus groups with 67 practitioners, the authors identify significant gaps in training and organisational support for addressing racism within social work and related health and social care contexts. 

Participants widely recognised that racism exists within social work systems, including in interactions between professionals, in organisational decision-making and in experiences from people who draw on care and support. However, many reported feeling unprepared to challenge racism due to limited training during their degree programmes and early employment support programmes such as the Assessed and Supported Year in Employment. 

The research highlights structural barriers within organisations that limit practitioners’ ability to challenge racism. These include fear of professional consequences, lack of managerial support and workplace cultures where discussions about race are avoided. Some participants reported witnessing discriminatory treatment of people who draw on care and support or colleagues but feeling unable to intervene effectively due to uncertainty about organisational procedures or fear of repercussions. 

For practitioners from minoritised ethnic backgrounds, racism directed at them personally was a common concern. Several participants reported that cases were sometimes reassigned when people who draw on care and support refused to work with a Black or Asian social worker, without the behaviour being challenged. This approach prioritised service delivery but left practitioners feeling unsupported and exposed to further discriminatory behaviour. 

The authors also describe a “layering” of barriers across the professional pathway. As illustrated in the framework presented in the paper, obstacles can emerge from multiple sources, including limited exposure to diversity during upbringing, training programmes that lack focus on race, placements with limited diversity, and organisational cultures that discourage discussion of racism. These combined factors reduce practitioners’ confidence and capability to address racism in practice. 

From a health and social care equity perspective, the findings suggest that failure to address racism within professional training and organisational structures may affect both the wellbeing of practitioners and the quality of services delivered to racialised communities. Strengthening anti-racist education, improving organisational accountability and supporting practitioners to challenge discrimination are therefore important steps toward more equitable health and social care practice. 

This study uses the term inequalities. In this Evidence Hub, inequities is used where differences in access or outcomes reflect avoidable and unfair structural barriers in health and social care. 

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This study explores practical ways to address inequalities in dementia diagnosis and care through a national consultation involving people with dementia, carers, professionals and community organisations. The consultation involved 131 stakeholders who participated in workshops across England to discuss the barriers people face and identify possible solutions. 

The findings show that inequalities in dementia care arise from multiple interacting factors. These include individual circumstances such as income or ethnicity, community-level influences such as stigma or limited social support, and wider structural issues such as service availability and coordination between health and social care systems. 

Many of the proposed solutions focused on improving support after diagnosis. Stakeholders highlighted the potential role of dementia link workers or care navigators who could help people and their families understand their diagnosis, navigate services and access appropriate support. These roles could help address some of the structural barriers that currently create inequities in access to care. 

Community engagement was also identified as important. Participants emphasised the role of dementia-friendly communities, peer networks and local organisations in raising awareness and reducing stigma. Improving understanding of dementia within communities may encourage earlier help-seeking and improve access to support. 

Workforce development was another key theme. Stakeholders identified the need for better training for health and social care professionals, as well as clearer career pathways within the social care workforce. Improving workforce knowledge and stability may help reduce inequities in the quality and availability of dementia services. 

From a care equity perspective, the study highlights that inequalities in dementia care often reflect avoidable structural barriers within systems and services. These inequities can affect who receives a diagnosis, how quickly support is provided and the quality of care available after diagnosis. 

Overall, the study suggests that reducing inequities in dementia care requires coordinated action across multiple levels. Interventions targeting individuals, communities and health and social care systems need to work together to ensure that people living with dementia can access timely diagnosis and appropriate support regardless of their background or location. 

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This paper examines how dementia services in the UK fail to meet the needs of Black and minoritised communities, despite longstanding policy commitments to inclusion. It shows a clear gap between national ambitions and what is delivered locally. 

A key issue is late access to care. Many individuals from these communities only engage with services at crisis point, which limits access to early diagnosis, treatment and support that could improve quality of life. 

Barriers are multiple and intersecting. These include limited awareness of dementia, language and literacy challenges, and difficulty navigating complex health and social care systems. Cultural expectations around family care also shape help-seeking, particularly where services are not seen as culturally appropriate. 

The study also highlights the role of structural factors. Experiences of racism and discrimination, alongside a lack of culturally competent services, contribute to mistrust and disengagement. At the same time, people from these communities are more likely to experience wider socio-economic disadvantage, which increases dementia risk over the life course. 

Policy frameworks such as the National Dementia Strategy emphasise inclusive and person-centred care. However, the decentralised nature of commissioning means that implementation varies widely. This creates geographical inequities, with some areas offering tailored services while others provide little targeted support. 

From a care equity perspective, the findings show that inequities are present across the entire dementia pathway, from prevention and diagnosis through to end-of-life care. Without stronger accountability and culturally appropriate service design, these disparities are likely to persist.

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This study highlights how homelessness intersects with inequities in access to health and social care. People experiencing homelessness face multiple barriers, including mistrust of institutions, fragmented services and limited access to information that is relevant to their circumstances.

Reliance on informal networks plays a dual role. These networks provide vital routes to information and support, but they can also limit access to preventative or coordinated care when connections to formal systems are weak.

The findings underline the importance of outreach approaches that are culturally sensitive and rooted in trusted local organisations. Delivering support through community-based providers can help overcome barriers linked to trust and engagement.

From a care equity perspective, the study points to the need for more integrated systems that recognise how people experiencing homelessness access information and support. Aligning health and social care services with trusted community organisations may reduce exclusion and improve access for people living in vulnerable situations.

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This review highlights the importance of equity-driven approaches that explicitly address barriers faced by ethnic minority populations. While a wide range of interventions is covered, the evidence base remains weighted towards service-level change rather than structural action.

Participatory approaches, including community health worker programmes and co-designed care pathways, are identified as particularly promising. These approaches centre lived experience and help ensure that services reflect the cultural, linguistic and social contexts of the people they aim to support.

Culturally tailored education, multilingual tools and peer-supported interventions are shown to improve outcomes for people managing long-term conditions. In social care, similar approaches may help people navigate complex systems and reduce exclusion linked to language or cultural mismatch.

The review also highlights the benefits of integrating mental health and primary care. From a care equity perspective, joined-up provision may reduce fragmentation that disproportionately affects marginalised groups and improve continuity of support.

However, the limited focus on structural interventions points to an important gap. Addressing inequities in health and social care is likely to require action beyond services alone, including policies that tackle poverty, housing insecurity and financial stress, which shape people’s ability to access and benefit from care.

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This article highlights how inequities in child protection can arise through subtle and often unintentional forms of racism. Even where professionals explicitly reject prejudice, practice may still reflect assumptions and stereotypes that disadvantage Gypsy, Roma and Traveller children.

The findings suggest that approaches framed as neutral or objective can obscure cultural context and reinforce unequal power dynamics. This has implications for how risk, parenting and need are interpreted within child protection systems.

From a care equity perspective, the study points to the importance of recognising how institutional norms and professional judgement can produce unequal experiences for racialised groups. Addressing inequity requires more than individual goodwill and depends on critical reflection within systems.

However, the evidence is based on practitioner interviews and does not include direct accounts from Gypsy, Roma and Traveller families. This limits understanding of lived experience and highlights the need for further research that centres the voices of children and families affected by child protection interventions.

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This study highlights how inequities in mental health care are shaped by a combination of personal, cultural and service-level barriers. Stigma, cultural identity and reluctance to discuss distress limit help-seeking, while financial pressures further restrict access to support.

Service-level factors compound these inequities. Long waiting times, language barriers and poor communication weaken relationships between service users and providers, increasing the risk that mental health needs go unrecognised or unsupported.

The findings also point to unequal power dynamics within care interactions. Experiences of cultural naivety and discrimination, alongside limited awareness of available services, place Black and minority ethnic service users at a particular disadvantage.

From a care equity perspective, these barriers contribute to uneven access, experience and outcomes in mental health services. Addressing them requires changes to how services communicate, recognise need and share power with the people they support, rather than relying solely on individual help-seeking.

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This study highlights inequities in access to social care and carers’ needs assessments for people with dementia and unpaid carers. Lack of awareness about entitlements and complex systems mean that support needs often go unidentified or unmet.

Barriers are reinforced by system pressures. Professionals conducting assessments face time and resource constraints, which can limit the depth and effectiveness of assessment processes.

The persistence of unmet needs after assessment points to wider structural issues. Fragmented coordination between health and social care services reduces the likelihood that identified needs translate into practical support.

From a care equity perspective, improving awareness, accessibility and integration is central to ensuring that carers and people with dementia receive support based on need rather than ability to navigate complex systems. Without addressing these barriers, existing inequalities in access and outcomes are likely to continue.

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This report highlights clear inequities in access to support for Black, Asian and minority ethnic young carers. Although young carers from ethnic minority communities are more likely to have caring responsibilities, they are under-represented within formal support services, suggesting unmet need and barriers to access.

Cultural factors play a central role in shaping these inequities. Lack of awareness of services, concerns about stigma and expectations around family responsibility contribute to under-reporting of caring roles, reducing opportunities for assessment and support.

The evidence points to the importance of targeted and culturally competent approaches. Without services that reflect cultural context and address awareness and trust, existing systems risk continuing to exclude some young carers.

However, the report provides limited insight into wider structural drivers, such as poverty or policy design, that may further compound disadvantage. From a care equity perspective, addressing both cultural and structural barriers is likely to be necessary to improve access, experience and outcomes for Black, Asian and minority ethnic young carers.