Key statistics

• the average life expectancy gap between the most and least deprived wards in Plymouth is 7.5 years.

Key messages

• families experience difficulties securing care packages that meet needs, particularly in rural and low income areas
• limited support to arrange GP, district nurse and palliative care home visits restricts access to timely care
• lack of clarity about who provides care and what support is available at different stages makes services hard to navigate
• family carers face significant emotional and physical strain, with limited respite and low awareness of mental health support.

Policy implications

• access to coordinated community palliative care may need to be strengthened in rural and low income areas
• clearer communication about roles, responsibilities and care pathways could support families to navigate services
• greater involvement of voluntary and community sector provision may help address unmet emotional support needs
• improved coordination between NHS and voluntary sector services may reduce fragmentation.

Gaps

• limited evidence on the availability and impact of respite and mental health support for family carers
• lack of evaluation of models that improve coordination across statutory and voluntary services
• limited understanding of how access barriers differ across rural, coastal and low income settings.

Commentary
This study highlights inequities in access to palliative care for people living in rural, coastal and low income communities. Fragmented services and limited local capacity make it difficult for families to secure care that meets the needs of the person they support, particularly when home-based care is required.

A lack of clear information about who provides care and what support is available at different stages contributes to confusion and stress for families. From a care equity perspective, this uncertainty creates unequal experiences, with those in resource-limited areas facing greater challenges in navigating services.

The findings also draw attention to the impact on family carers. Emotional and physical strain is intensified by limited respite and low awareness of mental health support, increasing the risk of burnout and unmet need.

The paper points to the potential role of voluntary and community sector organisations in addressing gaps, particularly around emotional support. However, without stronger coordination between NHS and community provision, inequities in access and experience are likely to persist for families in these communities.

Key messages

• the framework centres dignity as a core principle in service delivery for people facing crisis
• person-centred care is emphasised, including psychosocial support and cash assistance to help maintain dignity
• collaborative, cross-sector working and community engagement are central to effective delivery
• training and practical tools for frontline staff are essential to applying dignity principles
• governments and organisations have a key role in reducing stigma and promoting inclusive, respectful services.

Policy implications

• service models may need to explicitly embed dignity as a core outcome
• workforce development should support frontline staff to apply dignity principles in practice
• collaboration across statutory, voluntary and community sectors may improve consistency of support
• organisational culture and leadership are likely to shape whether dignity-focused approaches are sustained.

Gaps

• limited intersectional research on experiences of specific subgroups
• lack of evidence on disabled or LGBTQI+ asylum seekers’ experiences of dignity in crisis support
• challenges in engaging marginalised populations continue to restrict the evidence base.

Commentary
This framework positions dignity as central to equitable service delivery, particularly for people experiencing crisis and marginalisation. By focusing on respect, person-centred care and psychosocial support, it highlights how inequities can be reinforced when services prioritise efficiency over lived experience.

The emphasis on collaboration and community engagement reflects an equity-led approach to care. Involving people and communities in planning and delivery can help services respond more effectively to diverse needs and reduce exclusion linked to stigma or misunderstanding.

Training for frontline staff is identified as a critical enabler of dignity in practice. Without adequate support and tools, principles of dignity risk remaining aspirational rather than embedded in everyday service delivery.

From a care equity perspective, the framework draws attention to the role of organisations and government in shaping inclusive systems. However, gaps in intersectional evidence limit understanding of how dignity is experienced by specific groups, underlining the need for further research to ensure dignity-focused approaches benefit those facing multiple forms of disadvantage.

Key statistics

• 52,731 detentions under the Mental Health Act were recorded in 2024–25, a 0.5% increase compared with 2023–24
• detention rates per 100,000 population (age and sex adjusted):
  • white: 65.8
  • Black/Black British: 262.4
  • Mixed: 187.5
  • Asian: 88.5
  • Other: 136.9
• Black people were four times as likely to be detained under the Act as white people
• 6,575 new Community Treatment Orders were made in 2024–25, up from 5,618 in 2023–24
• Community Treatment Order rates per 100,000: white 7.5; Black 61.3
• Black people were 8.5 times as likely to be placed on a Community Treatment Order as white people
• most detentions were under section 2 for assessment (37,012 cases).

Key messages

• racial disparities in detentions and Community Treatment Orders have widened compared with previous years
• white people were the only ethnic group to experience a fall in detention rates
• all other ethnic groups saw increases in detention rates
• concerns have been raised that the Mental Health Bill does not adequately address entrenched racial inequalities
• official statistics do not capture people waiting for admission or preventative work by approved mental health professionals.

Policy implications

• monitoring and action on racial disparities may need to be strengthened within Mental Health Act implementation
• better data on assessments, diversions and preventative work could support more equitable crisis responses
• expansion of early and community-based mental health support may reduce reliance on detention for racialised groups
• legislation may require clearer duties to address disproportionality.

Gaps

• lack of data on people waiting for admission to inpatient care
• limited visibility of preventative and diversionary work carried out by approved mental health professionals
• limited evidence on which policy or service changes reduce detention disparities.

Commentary
These figures show a clear and worsening inequity in how the Mental Health Act is applied across ethnic groups. Although overall detentions increased only slightly, Black people remain far more likely to be detained or placed on a Community Treatment Order than white people, indicating persistent disproportionality.

The data also highlight divergent trends. Detention rates fell for white people but increased for all other ethnic groups, widening existing gaps in experience and outcomes. This suggests that improvements in crisis care are not being experienced equitably.

Concerns raised about the Mental Health Bill point to a gap between principles and practice. While the Bill emphasises autonomy and least restriction, warnings that it lacks enforceable duties to address racial inequalities raise questions about its potential impact on long-standing disparities.

From a care equity perspective, the absence of data on waiting lists and preventative work limits understanding of the full system pressures shaping detention. Without recognising both unmet need and avoided detentions, policy and service responses risk overlooking opportunities to invest in culturally informed, community-based alternatives that could reduce inequitable use of compulsory powers.

Key messages

• limited proficiency in English restricts communication with service providers and understanding of available support
• gaps in cultural competence within mainstream services reduce trust and accessibility
• unfamiliarity with UK health and social care systems limits engagement, even at a local level
• mistrust of formal institutions discourages some older migrants from seeking help.

Policy implications

• interpretation and language support are likely to be central to equitable access
• services may need to better recognise cultural practices and preferences
• locally tailored information could improve understanding of care and support systems
• trust-building approaches may support engagement with formal services.

Gaps

• limited representation of less-studied migrant groups
• lack of comparative analysis across different migrant communities
• limited evidence on the effectiveness of culturally tailored interventions.

Commentary
This study highlights how inequities in access to care and support for older migrants are shaped by language barriers, cultural mismatch and limited familiarity with UK systems. These factors contribute to exclusion and isolation, reducing opportunities to engage with services.

The findings also emphasise the role of trust. Cultural competency gaps and prior experiences of institutions shape expectations and willingness to seek support, particularly where services are perceived as unresponsive or inaccessible.

From a care equity perspective, the evidence shows how mainstream service models can disadvantage people who do not share dominant linguistic or cultural norms. Without adaptation, systems risk reinforcing unequal access and outcomes.

The study also points to important evidence gaps. Limited representation of less-studied migrant groups restricts understanding of variation in need, underlining the value of locally driven and culturally sensitive research to inform more equitable service design.

Key messages

• minority language users face communication barriers that contribute to misdiagnosis, inadequate care and exclusion
• lack of cultural and linguistic competence among professionals exacerbates disparities
• minority language users are underrepresented in health and social care research
• language and cultural barriers directly affect care equity and outcomes
• improved training, interpretation services and inclusive research practices are recommended.

Policy implications

• health and social care systems may need to strengthen interpretation and translation provision
• professional training should address both linguistic and cultural competence
• research funding and design should support inclusion of minority language users
• service design should consider language access as a core equity issue.

Gaps

• limited evidence on the effectiveness of different language support models
• lack of data on experiences across specific language groups
• limited evaluation of culturally competent training interventions.

Commentary
This systematic review highlights how language functions as a structural barrier within health and social care systems. Minority language users experience exclusion through communication failures that affect diagnosis, treatment and overall quality of care.

The findings also point to gaps in professional capacity. Without adequate training or resources, services struggle to meet linguistic and cultural needs, reinforcing inequities in access and experience.

From a care equity perspective, underrepresentation of minority language users in research further compounds disadvantage. When lived experience is absent from the evidence base, policy and practice risk reproducing assumptions that do not reflect diverse needs.

The review underscores the need for system-level change. Embedding language access and cultural competence into service delivery and research practice is central to reducing inequities and supporting fairer outcomes for minority language users.

Key messages

• significant gaps exist in out-of-hours care, particularly during evenings, weekends and bank holidays
• limited out-of-hours support increases stress, burnout and isolation for informal carers
• availability and quality of out-of-hours care vary by region, creating inequities
• a national framework is recommended to ensure equitable access to high-quality out-of-hours care
• improved coordination and communication between providers are needed to better support patients and carers.

Policy implications

• national oversight may be needed to reduce regional variation in out-of-hours care
• better coordination across services could improve continuity and responsiveness
• planning should explicitly consider the needs of informal carers alongside patients
• proactive approaches to out-of-hours care may reduce crisis-driven service use.

Gaps

• limited evidence on the impact of out-of-hours gaps on longer-term outcomes for carers
• lack of comparative evaluation of different regional models
• limited insight into how unmet need varies across population groups.

Commentary
This report highlights clear inequities in access to out-of-hours care for people with advanced illness and their informal carers. Gaps in provision during evenings, weekends and bank holidays leave many individuals without timely support, with impacts felt most acutely by carers.

Regional variation in service availability contributes to unequal experiences of care. People in some areas receive consistent out-of-hours support, while others face fragmented or limited provision, reinforcing place-based inequities.

Unpaid carers are particularly affected by these gaps. Insufficient professional support during out-of-hours periods increases stress and isolation, placing additional pressure on individuals who are already providing substantial care.

From a care equity perspective, the report points to the need for a coordinated national approach. Improved planning, communication and integration across providers could help ensure that access to out-of-hours care is based on need rather than location or time, supporting fairer outcomes for both those who draw on care and support and carers.

Key statistics

• adults with a registered carer had 27% higher combined health and social care costs than those without a carer
• social care accounted for 39% of the cost difference between people with and without carers.

Key messages

• having a carer is associated with higher use of health and social care services across all settings
• carers often act as advocates, supporting access rather than substituting formal care
• assumptions that carers reduce demand on services are challenged by the findings
• people without carers may face barriers to accessing services, raising equity concerns
• the study highlights variation in carer roles, though available data could not fully differentiate these differences.

Policy implications

• policies that assume carers reduce reliance on formal care may need to be reconsidered
• carers could be more effectively supported through training and inclusion within formal care systems
• services may need to identify and support people without carers who are at risk of unmet need
• care coordination and navigation support could help address access gaps.

Gaps

• limited differentiation between types and intensity of caring roles
• reliance on primary care records to identify carers may undercount caring relationships
• lack of longitudinal analysis to assess longer-term impacts on service use and outcomes.

Commentary
This study challenges common assumptions about the role of informal (unpaid) carers in health and social care systems. Rather than reducing service use, the presence of a carer is associated with higher costs and increased access across care settings, particularly within social care.

The findings suggest that carers play an enabling role, acting as advocates and coordinators who help individuals navigate complex systems and access support. In this sense, carers often address unmet needs rather than replacing professional care.

From a care equity perspective, the study raises concerns about individuals without carers. Lower service use among this group may reflect barriers to access rather than lower need, pointing to potential inequities in how support is reached and received.

The evidence highlights the need for policy approaches that recognise carers as part of the wider care system while also addressing gaps for people without informal support. Better integration, support and identification of caring relationships may help reduce inequities in access, experience and outcomes.

Key messages

• most local authorities do not have specific policies or centralised systems for recording sexual orientation and gender identity data
• information on sexual orientation and gender identity is often held only within individual case records
• gaps remain in staff knowledge and confidence when supporting LGBTQ+ care-experienced young people
• training on LGBTQ+ issues is more common for social workers than for foster carers or residential staff.

Policy implications

• local authorities may need clearer policies and consistent systems for recording sexual orientation and gender identity data
• workforce development strategies should extend beyond social workers to include foster carers and residential staff
• training should focus on building confidence as well as awareness to support inclusive and affirming care practice.

Gaps

• limited evidence on the experiences of LGBTQ+ care-experienced young people themselves
• lack of evaluation of how different recording practices affect care planning and outcomes
• minimal evidence on effective training models for non-social work roles.

Commentary

This study highlights how limitations in policy and data infrastructure can contribute to inequities in care for LGBTQ+ care-experienced young people. Without consistent approaches to recording sexual orientation and gender identity, local authorities lack a system-level understanding of need, making it harder to identify disparities or plan targeted support.

The findings also point to inequities in care experience linked to workforce capacity. Variations in staff knowledge and confidence increase the risk that LGBTQ+ young people receive inconsistent or inappropriate responses depending on who supports them and in which setting. This raises concerns about fairness and reliability across the care system.

Unequal access to training further compounds these issues. When foster carers and residential staff are less likely to receive LGBTQ+-specific training, young people in these settings may face greater risks of misunderstanding, exclusion or harm, compared with those supported by trained social workers.

Taken together, the evidence suggests that equity in care for LGBTQ+ young people depends not only on individual practice, but on system-wide policy, data and workforce approaches. Addressing these structural gaps is likely to be necessary to improve access to inclusive support and reduce inequities in care experiences and outcomes.

Key messages

• data on the number of people released from prison with social care needs is extremely limited, with almost no quantified information available
• most literature is descriptive rather than evaluative, with relatively few studies focusing directly on social care following release
• several promising initiatives exist, including pre-release training and buddy or self-referral schemes, but long-term evidence on effectiveness is lacking
• barriers remain around continuity of care, screening and information-sharing between prison and community settings
• policy and research should prioritise evaluation of interventions to improve social care outcomes after release.

Policy implications

• more consistent approaches may be needed to identifying and assessing social care needs before and after release
• stronger continuity of care and information-sharing could reduce gaps during transition
• promising interventions may warrant further development and evaluation before wider adoption.

Gaps

• absence of population-level data on social care needs following prison release
• lack of robust evaluation of interventions and pathways
• limited evidence on specific subgroups, including disabled people, older people and those with complex needs.

Commentary
This review highlights persistent gaps in understanding social care needs among people leaving prison. The lack of reliable data on how many individuals require support, and what that support looks like, limits the ability of systems to plan and commission services equitably at a critical transition point.

The available evidence is largely descriptive, offering limited insight into whether existing approaches improve outcomes. From an equity perspective, this makes it difficult to know which interventions reduce disadvantage and which risk reproducing gaps in access and experience.

Several initiatives, including pre-release skills training and buddy schemes, suggest potential for more person-centred and continuity-focused models of care. These approaches aim to bridge the divide between custodial and community settings, but their long-term impact remains unclear.

Barriers around continuity of care and information-sharing reflect wider structural challenges. These disproportionately affect people with overlapping needs, including physical disabilities or long-term conditions, increasing the risk of unmet need after release.

Improving equity in this area will require stronger evidence on need, outcomes and effectiveness. This includes better data collection, evaluation of interventions and research that reflects the experiences of people leaving prison, to support more responsive and equitable social care pathways.

Key messages

• young carers experience unequal access to resources, support and recognition compared to adult carers
• gaps in social policy limit access to appropriate support, financial assistance and links with education
• caring responsibilities contribute to school absence, lower academic attainment and reduced social participation
• stigma discourages some young carers from seeking help and contributes to their needs being overlooked
• more inclusive policies are needed to address the specific challenges faced by young carers.

Policy implications

• social care and education policy may need to better recognise young carers as a distinct group
• targeted, accessible support could reduce educational and wellbeing inequalities
• closer integration between social care and education systems may help identify and support young carers earlier
• stigma reduction should be considered within policy and practice responses.

Gaps

• limited evidence on how different policy approaches affect long-term outcomes for young carers
• lack of evaluation of youth-centred support models
• limited insight into how inequalities vary across different groups of young carers.

Commentary
This paper highlights clear inequities in how young carers are recognised and supported within social care and education systems. Despite their significant caring responsibilities, young carers often receive less support than adult carers, contributing to unequal experiences and outcomes.

Educational impacts are central to these inequities. Caring responsibilities can disrupt attendance, attainment and social development, placing young carers at a disadvantage compared with their peers and shaping longer-term opportunities.

The evidence also points to the role of stigma in reinforcing inequality. Fear of judgement or negative consequences can prevent young carers from seeking help, leaving needs hidden and unaddressed.

From a care equity perspective, the findings underline the importance of policies that explicitly recognise young carers and respond to their distinct needs. Without inclusive, youth-centred approaches, inequalities in education, wellbeing and life chances are likely to persist for this group.

Key messages

• carers often use multiple assistive technologies to support people with dementia at home
• reported benefits include improved safety and reduced stress for carers
• carers experience significant information gaps about available technologies
• affordability limits access and contributes to unequal use
• technologies are frequently abandoned as needs change over time.

Policy implications

• centralised information and advice services could improve awareness and appropriate use
• loan stores may support trialling technology before purchase
• assistive technology provision should anticipate changing needs rather than one-off solutions
• better integration with formal care services may support sustained use.

Gaps

• limited evidence on how assistive technology use affects formal care demand
• lack of research on incremental addition of technologies as dementia progresses
• insufficient understanding of long-term patterns of use and technological abandonment.

Commentary
This study highlights the complex role of assistive technology in home-based dementia care. Carers often assemble multiple technologies to manage safety and daily support, reflecting both the potential value and the burden of technology use.

From a care equity perspective, information and affordability barriers are central. Carers with less access to advice or financial resources may struggle to identify suitable technologies or sustain their use as needs evolve.

The frequent abandonment of technologies underscores the importance of adaptability. Static solutions are poorly suited to the progressive nature of dementia, placing additional emotional and practical strain on carers.

Overall, the findings reinforce that the use of technology in care must be supported by clear information, ongoing advice and flexible provision. Without this, assistive technology risks increasing burden rather than supporting carers and the people they care for.

Key statistics

• less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system
• about 25% (37/147) adopt digital self-assessment within their system. 

Key messages

• digital front doors are increasingly used by local authorities to manage access to social care
• associations were identified between the presence of digital front doors and patterns of social care uptake
• impacts varied across age groups
• findings suggest digital access routes may influence who engages with social care services
• evidence reflects early implementation rather than long-term effects.

Policy implications

• digital front doors should be implemented alongside non-digital access routes
• monitoring of service uptake by age and other characteristics is important
• local authorities may need to assess how digital access shapes demand and equity
• digital access strategies should be integrated with wider access and prevention planning.

Gaps

• lack of qualitative data explaining why digital front doors are effective or ineffective
• limited insight into user experiences and barriers
• most data relate to 2021 or within two years of implementation
• long-term impacts on access and outcomes are not yet evidenced.

Commentary
This study offers early quantitative insight into how digital front doors may shape access to social care. By analysing patterns of uptake across local authorities, it highlights that digital access points are not neutral tools and may influence who comes forward for support.

Variation by age group suggests that digital routes may work better for some populations than for  others. Without accompanying qualitative evidence, it remains unclear whether observed differences reflect convenience, exclusion, confidence or awareness.

The short timeframe is also important. Digital front doors were widely introduced during and shortly after the COVID-19 pandemic, a period of rapid service change. Their longer-term effects on access, prevention and unmet need remain uncertain.

Overall, the study highlights the importance of treating digital front doors as part of a broader access system. Understanding how different groups experience and navigate these tools will be essential if technology is to support fair and effective access to social care.