This report explores barriers to accessing health and social care services for older people from visible ethnic minority backgrounds living in the south of Glasgow. The report is a synthesis between three strands of research:
- Firstly, direct contact with older people from ethnic minority backgrounds in the area, specifically aimed at exploring their experience of accessing services (1)
- Secondly, semi-structured interviews with professional staff and people in leadership positions working in services in the area, conducted separately and by different personnel;
- Thirdly, a review of relevant literature on access to services for older people from Black and Minority Ethnic (BME) backgrounds.
The analytical framework used in this report uses the concept of “Candidacy”. This framework is emerging from recent academic work and empirical research studies on service access issues, particularly in the field of health, where the concept was initially developed. Its use in this report provides further experience of the Candidacy framework as a tool for analysis in the field, beyond solely health services. As a means of analysing issues relating to service access, the concept was found to be effective. This research was undertaken in partnership with a service delivery agency working in the field of advocacy in Glasgow (The Advocacy Project) and this dynamic uncovered clear potential for wider use of the Candidacy model as a means of re-framing dialogue with service-users and as a framework for internal review of client journeys within services.
The area of south Glasgow stretches from the Gorbals, just south of the city centre, south to Pollok, east to Polmadie and Kings Park and west to Pollokshields. Within this area, the proportion of people from ethnic minority backgrounds compared to others is significantly higher than in other parts of Glasgow – and Scotland. Glasgow City Council estimates (2) the population of people from ethnic minorities living in the south of Glasgow in 2010 was just over 25% of the total population in the area, compared to 8.6% for the whole of Glasgow. Between 2001 and 2010, Glasgow has seen a 38% increase in its ethnic minority population, to nearly 51,000 people (3). Govanhill, one of the wards at the heart of this geographical area, has seen a 14.1% drop in the population of people of white Scottish, British or Irish origin and a 10.4% increase in people from BME backgrounds in the period 2001 – 08 according to Glasgow City Council estimates.
Understanding how this population breaks down by age group is difficult as little data exists. The 2001 census indicated that just over 5% of Glasgow’s ethnic minority population was over the age of 65. Given the estimated increases in the BME population since 2001 and the increase in the age profile of this population during this period (4), a rough Glasgow-wide estimate is likely to be in the region of 4,000 – 5,500 older people from ethnic minorities, excluding the “other white” category.
This study was able to compare findings with research conducted with similar demographic groups in similar geographical locations over the last 25 years, because a significant volume of research exists which is specific to the groups and locations studied in the present report. Nevertheless, comparisons are based on broad themes emerging from the studies, from which general impressions are drawn.
A key finding from this comparison shows that the level of awareness of services among older people from BME communities is low and appears to have barely changed in 25 years. The present study found that older people maintained that they did not know how to go about accessing social services and lamented a general lack of information about services, often relying on intermediary organisations like day centres, or word of mouth from others, to gather information they wanted about services. Studying a population of older south Asian people living in a part of the area covered in the present study, McFarland et al, in 1989, found a low level of expectation with regard to social services, “coupled with an even lower awareness of what services were on offer” (5). Other studies since have had similar findings. The intransigence of this issue over such a long period, in the face of major policy initiatives and against a background of increasing awareness of and resource for equalities based work between 1990 and the present, raises questions about the efficacy of prevailing approaches to improving equality, specifically with regard to south Asians living in the area.
Another seemingly intransigent issue is the perception among older people from ethnic minorities that the services on offer to them have very little cultural congruence with their own lives. Not only do people think they will not be understood through basic communication difficulties, they also feel there is very little sensitivity within services to other cultural norms such as religious observance, food consumption differences and even correct pronunciation of names. This is a consistent finding from studies focussing on Glasgow ethnic minority populations spanning a 25 year period and evidence from the present study suggests no change in this perception. The view from the service provision perspective tends to corroborate these perceptions, with social work management able to point to many initiatives generated from within their organisation aimed at increasing service uptake, such as language-specific leaflets and targeting of locations known to be used by high numbers of people from ethnic minorities, but not able to show that any of these has had a positive impact on numbers using services. The commonest route for older people from ethnic minorities onto social work client lists was via medical emergency. It is when people reach crisis point in terms of health needs that they finally appear on social service radars; rarely before.
One obvious measure to counter this trend has been the appointment of people from the ethnic minorities themselves in key roles within the services on offer. This study found no evidence of people from ethnic minorities working in key roles in social services, or their mainstream satellite agencies, in the south of Glasgow, despite suggestions in the literature that various attempts have been made to introduce this measure within Glasgow City Council and its predecessor with social service responsibility, Strathclyde Regional Council. The 2013 Mainstreaming Report for this local authority shows 13 people from BME backgrounds employed from a total of 696 in the higher post gradings (8 – 15); just 1.86%. Within health services, this issue was much more diluted in terms of initial access. People were generally able to find GPs locally who shared their ethnic origin and this made a difference to both their identification of themselves as candidates for these services and in how they were able to present themselves for that service.
One positive development in the area over the past 25 years is the increase in appropriate service provision for this group. A number of ethno-specific day centres and drop-in services exist in the south of Glasgow that are well used by older people. Most of these did not appear to exist as recently as 10 years ago. The study uncovered a pattern of usage of these services as gateways to mainstream services. People who knew of these services used them to negotiate access to other services, or simply presented themselves and their need for a service, confident that they would receive the necessary assistance to access the appropriate service for their need. Evidence from professionals working in the area suggests more of these services existed in recent years than do in 2013 and cite the recession as the culprit for the constriction in the number of these services. This report suggests that the replication of this model of small community based highly permeable but non-specialised services acting as gateways to other, less permeable and more specialised services for this community may be a useful development in addressing some of the issues above, alongside the effective penetration of mainstream services at professional level by people who come from ethnic minority backgrounds.
Older women from ethnic minorities are more excluded from services then their male counterparts. The exclusion issues are no different; they are as described above, but they apply more acutely to women because traditional cultural norms dictate they tend to be more home-based, engaged in rearing families and with far fewer opportunities open to them for independent behaviour. They therefore have less exposure to integrative experiences than men, leading in later life to lower levels of confidence in using English and in getting out and about in the wider community. Because of their traditional situations in their culture, many south Asian women are reliant on family members for transport when they do go out, having not had the opportunity to learn to drive or for car ownership, and finding significant barriers to their use of public transport. This further restricts their access – by independent means – to services.
The debate still exists within Glasgow policy and planning circles as to how best to facilitate the integration of people from ethnic minorities into the mainstream of society. One drop-in service in the area under study operates a fully integrated service, with no identifiable pre-determined cultural stance. It is well-used – mainly, but not exclusively, as a centre for social contact – by local people from many different ethnic backgrounds and is located within an area which has a high level of ethnic diversity. It offers sign-posting to other services where necessary, depending on the needs presented. Although this service is staffed by people from white backgrounds, it is used by significant numbers of people from non-white backgrounds. All of the other services identified in the area are ethno-specific, catering for the mainly social needs of older south Asian people. A debate was evident in the area among community activists about the allocation of ethno-specific funding at the expense of funding of services for indigenous white people who live in the area, although this centred on more recent immigrant groups from Romania than in did on the established BME community in the area. Block funding of ethno-specific services by the local authority is likely to change as a result of a move to a model of personalised services, although social work managers are currently looking to mitigate the impact of these changes. This study found that there is a real need for the existing day centres and drop-in centres as important engagement points for people from ethnic backgrounds, as well as for the health improving social contact they bring to these people. This does not mean that experimentation with other models that support integration should not be pursued – evidence was apparent that both approaches provide valuable opportunities for engagement with this community, in different ways.
The promotion of sustainable, self-advocating groups representing the needs and perspectives of populations of people from BME backgrounds is seen as an important development in improving access to services. Seen through the lens of the Candidacy model, such groups would be able to generate constructive dialogue with services over candidacy issues such as how people identify themselves – or, more accurately in the current circumstances, fail to identify themselves – as candidates for services; how they become aware of services; what specific difficulties they have in navigating their way to services and in presenting themselves as candidates; how professional “adjudication” impacts on them and what wider environmental, political and social factors impact on their candidacy. However, such overtly political group-forming behaviours are not necessarily as natural and logical to people whose ethnic origins are not rooted in western values, which traditionally favour competitive, campaigning and high visibility, extroverted approaches to problem solving. If 25 years of striving for better equality over service access for people from ethnic minority backgrounds has produced anything, it should be the realisation that new approaches need to be sought. Bridges may be in place, but they remain to be crossed. Listening, with care, to the fears of those who do not step out, rather than keep building more bridges, is a reasonable change to make.
(1) A separate report focusing only on these experiences is available (The experiences of accessing health and social care services for older people from Black and Minority Ethnic backgrounds in South Glasgow, Advocacy Connections, 2013 – The Advocacy Project, Glasgow)
(2) Population and Households by Ethnicity in Glasgow – Estimates of Changes 2001-2010, J. Freeke, Glasgow City Council, 2012
(3) These figures exclude the recently added “Other white” category, which consists mainly of white Europeans who have arrived in Glasgow in recent years and whose constituency contains few older people at this stage. The total estimated Glasgow-wide population of people from ethnic minorities including this group in 2010 was 75,708
(4) Ethnic Population Projections for Scotland, 2001 to 2051 -extracted for a 2011 Scottish Govt seminar series “Scotland’s People, Past, Present and Future” from Ethnic population projections for the UK, 2001-2051, P. Rees, University of Leeds, 2011
(5) Ethnic minority needs and service delivery: The barriers to access in a Glasgow inner‐city area, E McFarland, Mike Dalton & Dave Walsh (1989) , Journal of Ethnic Migration Studies 15:3