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Systemic safety inequities for people with learning disabilities

A study examining safety inequities experienced by people with learning disabilities in English health and social care, drawing on lived experiences from focus groups and patient feedback narratives.

Key statistics 

  • people with learning disabilities in the UK experience substantially reduced life expectancy, with earlier mortality linked to avoidable or preventable conditions 
  • prior evidence cited in the study shows deaths occurring on average 22 years earlier for men and 27 years earlier for women compared with the general population 

Key messages 

  • people with learning disabilities experience systemic safety inequities when accessing health and social care services 
  • health and social care systems are often rigid and poorly adapted to the complex needs and communication requirements of people with learning disabilities 
  • failures in communication, information accessibility and reasonable adjustments increase risks to patient safety 
  • discontinuities in care, staff shortages and poor interoperability between services contribute to avoidable safety risks 
  • family members, carers and advocates frequently act as informal safety buffers within the system 
  • reliance on social support networks creates additional inequities for individuals who lack strong advocacy or family support 
  • improving safety requires system-level change, including better service design, staffing, training and coordination across health and social care 

Policy implications 

  • improve implementation of reasonable adjustments for people with learning disabilities across health and social care services 
  • increase specialist learning disability roles such as liaison nurses across care settings 
  • strengthen continuity of care and coordination between services, including better information sharing systems 
  • invest in accessible communication methods such as easy-read materials and personalised care plans 
  • develop stronger advocacy provision to support people with learning disabilities when interacting with services 
  • address workforce shortages and training gaps affecting safe care delivery 

Gaps 

  • demographic characteristics of participants were not extensively collected, limiting analysis of how inequities vary by factors such as ethnicity or socioeconomic status 
  • qualitative findings provide strong insight into experiences but cannot quantify the prevalence of specific safety issues 
  • more research is needed on interventions that effectively reduce systemic safety inequities 

Commentary 
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.

Solutions to reduce inequities in dementia diagnosis and care

A systematic review examining interventions designed to reduce inequities in dementia diagnosis and post-diagnostic care across multiple countries, focusing on individual, community and health system solutions.

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. 

Key messages 

  • people living with dementia and their carers face barriers to diagnosis and care that lead to avoidable inequities in health and social care outcomes 
  • solutions identified in the literature operate at three levels: individual factors, community support, and health and social care system infrastructure 
  • system-level interventions, such as dementia link workers, integrated care networks and memory clinic networks, show the strongest evidence for improving access to care 
  • culturally and linguistically tailored interventions can improve dementia awareness, service navigation and carer confidence in underserved communities 
  • community-based initiatives, including dementia-friendly communities and peer networks, can help reduce stigma and improve understanding of dementia 
  • digital tools and telehealth services may improve access to support but can also create barriers for people with limited digital literacy or access to technology 
  • evidence on cost-effectiveness and long-term impact of interventions remains limited 

Policy implications 

  • develop dementia link worker or care navigator roles to help individuals and carers access services following diagnosis 
  • strengthen integration between health and social care services to improve coordination of dementia care 
  • invest in culturally appropriate information and support programmes for underserved communities 
  • support community-based initiatives that raise awareness and reduce stigma around dementia 
  • improve workforce training to increase knowledge and confidence in dementia care across health and social care settings 
  • ensure digital dementia support services are accessible and accompanied by non-digital alternatives 
    • increase research and policy attention on dementia care in lower- and middle-income countries 

Gaps 

  • the majority of studies were conducted in high-income countries, with very limited evidence from lower- and middle-income settings 
  • many interventions were evaluated only once, limiting the strength of evidence for their effectiveness 
  • there is limited evidence on the cost-effectiveness of interventions designed to reduce inequities in dementia care 
  • few studies examine long-term outcomes or large-scale implementation of interventions 
  • more research is needed on how different interventions affect health and social care utilisation and outcomes 

Commentary 
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.

Newly qualified social workers and anti-racist practice in England

A qualitative study examining how newly qualified social workers in England experience and respond to racism in practice, and how social work education prepares them to challenge racism in health and social care contexts.

Key statistics 

  • the study included 67 newly qualified social workers within two years of completing their social work degree in England 
  • participants were drawn from multiple routes into social work: bachelor’s degree (31), postgraduate programmes (22), and fast-track routes such as Frontline, Think Ahead and Step-Up 
  • the majority were employed in local authorities (58 participants), with others working in the NHS or other settings 
  • the sample included 28 white participants and 24 Black participants, with others identifying as mixed race, Asian or other ethnic backgrounds 

Key messages 

  • newly qualified social workers report limited preparation during training for dealing with racism in practice 
  • racism occurs in multiple parts of the system, including interactions with colleagues, people who draw on care and support and partner agencies 
  • social workers from minoritised ethnic groups experience racism from people who draw on care and support and colleagues but often feel unsupported by management 
  • fear of being labelled “angry”, “problematic”, or “unprofessional” discourages practitioners from raising concerns about racism 
  • organisational cultures sometimes prioritise maintaining service delivery over addressing racist behaviour directed at staff 
  • the absence of practical frameworks or guidance leaves newly qualified practitioners uncertain about how to challenge racism 
  • barriers to anti-racist practice occur across several stages of the professional pathway, including education, placements and early employment 

Policy implications  

  • social work education programmes should provide explicit training on recognising and challenging racism 
  • employers should create organisational policies that clearly support staff who challenge racism 
  • managers should provide supervision and support for practitioners experiencing racial abuse from people who draw on care and support 
  • greater representation of ethnic minorities in leadership and academia may improve organisational awareness of racism 
  • organisations should facilitate open discussions about racism in supervision, training and team meetings 

Commentary 

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. 

Addressing inequalities in dementia diagnosis and care 

A national study exploring practical solutions to reduce inequalities in dementia diagnosis and care across England, drawing on workshops with people with dementia, carers, professionals and third sector organisations.

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. 

Key messages 

  • people with dementia and their carers experience multiple inequalities affecting diagnosis, access to care and support 
  • these inequalities arise across three levels: individual characteristics, community and social networks, and wider societal and system factors 
  • stakeholders identified a range of potential solutions focused on strengthening community support and improving health and social care services 
  • proposed interventions included dementia link workers, improved workforce training, community awareness programmes and culturally appropriate services 
  • stakeholders emphasised that no single intervention can address inequalities in dementia care and that coordinated actions are needed across multiple levels 
  • improving integration between health and social care services is essential to support people after diagnosis 
  • increasing public awareness and reducing stigma were identified as priorities for improving help-seeking and earlier diagnosis 

Policy implications 

  • develop link worker or care navigator roles to help individuals and carers navigate services and support after diagnosis 
  • improve integration and communication between health and social care services 
  • increase workforce training to improve dementia knowledge across health and social care settings 
  • create clearer career pathways within the social care workforce to support recruitment and retention 
  • expand community awareness programmes and dementia-friendly initiatives 
  • improve culturally appropriate services and accessible information for diverse communities 
  • strengthen national coordination and accountability to reduce regional variation in dementia care 

Gaps 

  • the proposed solutions were identified through consultation and require further evaluation to assess effectiveness 
  • people living with dementia were less represented than carers and professionals in the workshops 
  • some demographic groups were under-represented in the consultation process 
  • there is limited evidence on the long-term impact of many proposed interventions 
  • further research is needed to evaluate the cost-effectiveness and scalability of suggested solutions 

Commentary 
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. 

Shaping the future of digital technology in health and social care

An evidence review examining digital technology developments in health and social care, the barriers to adoption, and actions needed to support effective and inclusive use.

Key messages

  • The potential of digital technology to transform the health and social care system has still not been realised, though the Covid-19 pandemic has caused a rapid shift towards the remote delivery of care through online technologies.
  • digital technology adoption in health and social care is shaped by funding, infrastructure and organisational culture
  • digital exclusion remains a significant risk where support and alternative access routes are limited
  • user-centred design is essential to ensure technology meets real needs
  • data sharing challenges constrain the effective use of digital tools
  • leadership and strategic direction strongly influence digital progress.

Policy implications

  • investment in digital infrastructure and workforce skills is required to support adoption including changes in how new tools are evaluated and supported during implementation
  • user-centred and inclusive design should be embedded across digital programmes
  • clearer leadership and system-wide direction can reduce fragmentation
  • addressing digital exclusion should be a core consideration in digital strategy.

Gaps

  • evidence largely reflects the pre-Covid context
  • limited empirical evaluation of outcomes linked to specific technologies
  • uncertainty about how recommendations have been implemented across systems.
  • More evidence is needed on a range of factors, including the cost-effectiveness of such tools, the groups best suited to using these interventions, the effects of digital inequalities on access, and the impact of tools that use digital technologies on outcomes.

Commentary
This review provides a system-level view of why digital transformation in health and social care often falls short of its potential. Rather than focusing solely on technology, it highlights the importance of leadership, culture and investment in shaping how digital tools are adopted.

Barriers such as inconsistent strategic direction, digital skills gaps and weak data infrastructure are shown to limit progress. These constraints mean that even well-designed technologies may fail to deliver benefits in practice.

The review also draws attention to the consequences of neglecting inclusion. Without adequate support, digital change can exacerbate existing disparities, particularly for people with limited access, skills or confidence.

Overall, the report reinforces that effective use of technology in care depends on system readiness as much as innovation. Aligning leadership, funding and user-centred design is critical if digital technologies are to improve care without widening inequities.

The economic impact of digital inclusion in the UK

Economic analysis examining the costs and benefits of improving digital skills and reducing digital exclusion in the UK, including implications for public services such as health and care.

Key statistics

  • around 11.5 million people in the UK lacked basic digital skills in 2021, falling from 12.4 million in 2019
  • without intervention, 5.8 million people may remain digitally excluded by 2032
  • around 508,000 people per year would require digital skills training to achieve full inclusion by 2032
  • every £1 invested in digital skills training is estimated to generate £9.48 in economic benefits
  • digital inclusion could generate around £899 million in NHS savings between 2023 and 2032

Key messages

  • digital skills are increasingly essential for participation in everyday life, employment and access to services
  • large numbers of people remain digitally excluded, particularly older adults and those with lower skills levels
  • improving digital inclusion can generate economic and public service benefits
  • digital skills support programmes are required to reach people who are not yet online
  • digital inclusion requires coordinated investment in skills, devices and connectivity

Policy implications

  • sustained national investment in digital skills training is needed
  • programmes should target groups most likely to remain excluded, including older adults
  • digital inclusion strategies may reduce pressure on public services
  • digital skills should be treated as core infrastructure supporting access to services

Gaps

  • the report focuses mainly on economic modelling rather than direct health or social care outcomes
  • there is limited analysis of how digital inclusion programmes affect different groups
  • behavioural impacts on service use are assumed rather than directly measured
  • more research is needed on links between digital inclusion and care access

Commentary
This report provides an economic assessment of digital inclusion in the UK, focusing on the potential benefits of improving digital skills across the population. The analysis frames digital inclusion as a key component of economic participation, with implications for productivity, employment and the use of public services.

The findings suggest that improving digital skills could also generate savings for the NHS, partly through increased use of online services and reduced demand for in-person appointments. This reflects the growing role of digital channels in accessing health information, services and administrative processes.

From a care equity perspective, the report highlights the risk that digitalisation of services may disadvantage people without access to digital skills, devices or connectivity. Older adults and individuals with lower digital literacy are projected to make up a significant proportion of those who remain digitally excluded in the future. Without targeted support, these groups may face increasing barriers to accessing health and social care services that are delivered or coordinated through digital systems.

Overall, the analysis reinforces the argument that digital inclusion should be treated as a core public infrastructure issue. Investments in digital skills, connectivity and support services may help reduce exclusion from digital health and care services while improving the efficiency of public service delivery.

Care home staff experiences of delivering heart failure care

A grounded theory study exploring how care home staff deliver and make decisions about heart failure care for residents.

Key Messages 

  • training for heart failure is often designed for acute settings rather than care homes 
  • care home staff navigate complex clinical decision-making with limited tailored guidance 
  • communication with residents and families is a central part of managing heart failure care 
  • staff described both barriers and facilitators to delivering appropriate care 
  • role clarity and access to support influenced confidence in practice. 

Policy implications

  • training for long-term health conditions should be adapted to care home contexts 
  • clearer pathways between health services and care homes could improve care continuity 
  • communication skills training may support discussions with residents and families. 

Gaps

  • findings are based on qualitative accounts 
  • recruitment through an independent network may limit representativeness 
  • the study focuses on heart failure and may not transfer to other conditions 
  • limited insight into organisational and system-level variation. 

Commentary 

  • This study provides insight into the everyday realities of delivering heart failure care in care homes. It shows that staff are required to make complex judgements in settings that differ significantly from the acute environments where most clinical training is focused. 
  • Participants described the challenge of adapting condition-specific knowledge to residents with multiple needs, alongside the emotional labour of communicating with families about changing health and care requirements. These responsibilities often sit outside formal role definitions or training expectations. 
  • From a care equity standpoint, the findings highlight how gaps in training and support can lead to uneven care experiences for residents. Where staff lack access to appropriate education or specialist input, residents with heart failure may receive variable levels of care depending on the confidence and experience of individual workers or teams. These inconsistencies reflect broader inequities in how clinical expertise is distributed across care settings. 
  • Overall, the study underscores the importance of recognising care homes as complex clinical environments. Supporting the workforce with tailored training and clearer integration with health services is essential for delivering equitable, high-quality care to residents living with long-term conditions such as heart failure. 

Creating an adult social care workforce strategy for Cornwall

A rapid evidence review informing the development of a regional adult social care workforce strategy for Cornwall.

Key messages

  • adult social care makes a significant economic contribution to Cornwall 
  • workforce data show variation in pay trends by role since 2021 
  • turnover rates remain a challenge across parts of the sector 
  • the workforce is shaped by demographic factors including gender, age, nationality, ethnicity and disability 
  • skills gaps exist across training, qualifications and digital capability 
  • workforce characteristics vary across different areas of Cornwall. 

Policy implications

  • regional workforce strategies need to reflect local labour markets and demographics 
  • targeted action on pay, retention and progression could improve stability 
  • investment in training and qualifications supports workforce sustainability 
  • equality, diversity and inclusion should be embedded within workforce planning 
  • digital skills development is increasingly relevant to care delivery. 

Gaps

  • evidence reflects a specific regional context 
  • limited insight into longer-term workforce outcomes 
  • variation between local areas suggests need for more granular analysis 
  • rapid review methodology limits depth in some areas. 

Commentary

This review provides a detailed picture of the adult social care workforce in Cornwall, linking workforce conditions to the wider local economy. By bringing together data on pay, turnover, skills and demographics, it highlights the complexity of sustaining care provision in a geographically diverse area. 

The findings show how workforce challenges are unevenly distributed. Differences in demographics, skills and turnover across Cornwall point to the limits of one-size-fits-all approaches to workforce planning and the importance of place-based strategies. 

From a care equity perspective, the review draws attention to who makes up the workforce and how their experiences vary. Gender, age, nationality, ethnicity and disability all shape access to employment, training and progression within adult social care. Where skills gaps or low pay persist, these patterns risk reinforcing inequities within the workforce and, in turn, affecting the quality and continuity of care. 

Overall, the report underlines that workforce strategy is inseparable from equity considerations. Addressing disparities in pay, skills and opportunity is not only central to supporting workers, but also to ensuring that adult social care can meet the needs of communities across Cornwall in a fair and sustainable way. 

Identity and experiences of minority ethnic dementia care workers during COVID-19

A qualitative study exploring how identity shaped the experiences of dementia care workers from minority ethnic backgrounds during the COVID-19 pandemic.

Key messages 

  • participants described experiences of racism and discrimination in the workplace 
  • care workers reported feelings of injustice and being undervalued 
  • strong senses of personal and collective responsibility shaped care delivery during the pandemic 
  • workplace support structures influenced how workers coped with pressures 
  • identity intersected with pandemic conditions to shape everyday working experiences. 

Policy implications 

  • employers need to address racism and discrimination within dementia care settings 
  • culturally responsive support structures are needed for minority ethnic staff 
  • recognition and valuing of care work are central to workforce wellbeing 
  • inclusive leadership and clear reporting mechanisms may improve staff experiences. 

Gaps 

  • online recruitment may have excluded workers with limited access to technology 
  • participants had limited exposure to COVID-related deaths, affecting transferability 
  • findings are based on self-selected qualitative accounts 
  • future research should include randomly selected samples. 

Commentary 

This study highlights how identity influenced the working lives of minority ethnic dementia care workers during the COVID-19 pandemic. Participants’ accounts show how experiences of racism and exclusion sat alongside strong professional commitment and a sense of responsibility to those they supported. 

The findings underline the emotional labour involved in dementia care, particularly under crisis conditions. Where workplace support was limited or inconsistent, feelings of being undervalued were intensified, shaping how workers understood their role and status within care settings. 

From a care equity perspective, the study exposes how structural inequities within the workforce affect both staff wellbeing and the delivery of care. Minority ethnic workers faced additional burdens linked to discrimination and lack of recognition, reflecting wider inequities in the social care sector. These conditions risk reinforcing disparities in retention, progression and workforce stability. 

Overall, the paper demonstrates that equitable dementia care depends on equitable treatment of the workforce. Addressing racism, strengthening support structures and recognising the contributions of minority ethnic care workers are essential steps toward a fairer and more resilient care system. 

Digital skills and learning in the social care workforce

A survey study examining the digital skills, experiences and attitudes of the Northern Ireland social care workforce towards technology for learning and development.

Key messages 

  • many social care workers preferred face-to-face training over digital formats 
  • digital skills varied widely across the workforce 
  • older age was associated with lower digital skills and confidence 
  • higher confidence with technology was linked to greater engagement with e-learning 
  • lower digital skills were associated with reduced interest in online learning tools. 

Policy implications 

  • basic digital skills training is needed across the social care workforce 
  • blended learning approaches may support engagement across age groups 
  • workforce development strategies should address confidence as well as skills 
  • digital capability is increasingly important for learning and service delivery. 

Gaps 

  • findings are specific to Northern Ireland 
  • survey data may not capture depth of lived experience 
  • limited exploration of organisational support for digital learning 
  • changes in technology use since 2020 are not reflected. 

Commentary 
This study highlights the uneven distribution of digital skills within the social care workforce and how this shapes engagement with learning and development. Preferences for face-to-face training suggest that digital learning cannot be assumed to be universally accessible or acceptable. 

The relationship between age, confidence and digital skill points to the need for targeted support rather than uniform approaches. Where workers lack confidence, digital learning tools may become barriers rather than enablers of professional development. 

From a care equity perspective, disparities in digital capability within the workforce risk reinforcing inequities in access to training, progression and job security. Workers with lower digital skills may be excluded from development opportunities as learning increasingly moves online, affecting retention and workforce resilience. 

Overall, the study stresses that digital transformation in care depends on investing in people as much as platforms. Supporting equitable access to skills and training is essential if technology is to strengthen, rather than fragment, the social care workforce.