Scottish Government

CHAPTER FOUR NEIGHBOURHOOD AND QUALITY OF LIFE

Introduction

4.1 This chapter continues the analysis of SHS data to explore key aspects of the day-to-day lived experience of adults with long-term conditions. It considers aspects of their neighbourhood, physical access to a range of services, transport use, internet access, difficulty with daily activities and care needs.

Attitudes towards neighbourhood

4.2 Overall 92.6% of adults rated their neighbourhood as 'very good' or 'fairly good'. Adults with disability and long-term illnesses were, however, least likely to rate their neighbourhood positively: 89.7% rated their neighbourhood fairly good or very good. Although younger adults were less likely than those in the older age groups to rate their neighbourhood positively, for all age groups adults with long-term health conditions were less likely than those without disability/illness to rate their neighbourhood positively.

4.3 The SHS investigated the aspects of the neighbourhood that were particularly disliked. The items most often mentioned by all adults were: young people hanging about (15.2%); vandalism and graffiti (7.8%); fast or speeding traffic (6.7%); parking problems (6.7%); litter and rubbish (6.6%); drug abuse and dealing (5.6%); too much traffic (5.0%); poor public transport (4.8%); problems with neighbours (4.3%); alcohol abuse (4.3%); and nowhere for children to play (4.3%). Adults with a long-term health condition were less likely to mention traffic-related dislikes (speeding traffic, parking problems or too much traffic) but were more likely to mention trouble with neighbours, vandalism or graffiti, drug and alcohol abuse (there were no significant differences in relation to other aspects). The numbers were too small to conduct further analysis by age.

Safety

4.4 Adults with long-term health conditions, especially those with disabilities, were more likely than adults without long-term health conditions to feel unsafe walking in their neighbourhood after dark and feel unsafe in their homes at night (Table 4.1). This difference could reflect the fact that adults with long-term conditions were more likely to live in more deprived areas (paragraph 3.10). Although older adults were more likely to report feeling unsafe walking in their neighbourhood after dark (numbers feeling unsafe in their homes were too small to analyse by age), the proportions feeling unsafe were higher amongst those with long-term health conditions in all age groups. The proportions of adults with long-term health conditions who felt unsafe walking in the neighbourhood decreased since 2001-2002, when around 36% of adults with long-term health conditions felt unsafe. Figures from 2005-2006 showed that 32.2% of adults with disabilities and 31.3% of those with long-term illness felt unsafe when walking in their neighbourhood after dark.

Table 4.1: Perceptions of neighbourhood safety

Row percentages

Source: Scottish Household Survey 2005-2006

4.5 A further question ²² asked respondents to rate the extent to which the quality of their lives was affected by fear of crime. This was measured on a scale from 1 to 10. In line with coding adopted by Social Focus on Disability (2004: 35), a score of between 6 and 10 was taken to indicate that a fear of crime had some effect on individual quality of life. Individuals with long-term health conditions were twice as likely (12.7% of each group) as those with no illness or disability (6.2%) to report that their lives were affected by fear of crime (Figure 4.1). Women were markedly more likely than men to report some effect - this gender difference existed amongst those with and those without long-term conditions. Numbers were too small to analyse differences between those with long-term conditions and those without across age groups but, overall, fear of crime was constant with age, suggesting that age was not a factor in the differences seen in Figure 4.1. As with perception of neighbourhood safety, fear of crime could have been influenced by adults with long-term conditions being more likely to live in more deprived areas.

Figure 4.1: Effect of fear of crime on quality of life

4.6 Fear of crime appeared to have decreased slightly from levels in 2001-2002. In 2001-2002, 15% of adults with long-term conditions and 8% of adults without long-term illness or disability reported that fear of crime had 'some effect' on their quality of life. The corresponding figures for 2005 were 12.7% and 6.2%.

Reliance on friends or relatives in the neighbourhood

4.7 A new question added to SHS in July 2005 asked respondents about the extent to which they could rely on friends or relatives in their neighbourhood. Generally, responses were very positive, with no substantive differences between adults with long-term conditions and those without. Thus, 88.9% of adults with a long-term illness or disability agreed that they could rely on friends or relatives in their neighbourhood for help, as compared to 89.5% of adults without a long-term condition. The figures for relying on friends or neighbours to look after the home (91.3% for adults with a long-term condition; 92.2% without) and relying on friends or relatives in their neighbourhood for advice or support (86.5%; 86.3%) were similarly high.

Access to services

4.8 Perception of convenience of services has been measured since 2000. It has been consistently shown that adults with disabilities and/or long-term illnesses were less likely to find services convenient. This was also the case in 2005-2006. A new question for 2005-2006 asked respondents how often they used each of the services. For most services there was a positive correlation between the frequency of use and perception of convenience, i.e. those who used the service most were also those most likely to rate the service as convenient. However, when access to services associated with health were considered (doctors, chemists and hospital outpatients), there was a negative association between frequency of use and perception of convenience. Thus, adults with disabilities and/or long-term illnesses were more likely to visit doctors, chemists and hospital outpatients, but were also more likely to find these less convenient (Table 4.2).

Table 4.2: Access to services

Percentages

Source: Scottish Household Survey 2005-2006

Access to the internet

4.9 In 2005-2006, just under half of all households (49.6%) had home access to the internet. Households containing anyone with a long-term condition were less likely to have internet access (33.0% as compared to 58.2%). Analysis by age group showed that these differences existed across all age groups. Household access to the internet was also related to household income, with higher income households being more likely to have internet access. The difference in access between those with long-term conditions and those without was greatest at lower income levels and disappeared at the higher bands (Figure 4.2).

Figure 4.2: Proportion of households in each income band with home internet access

4.10 The analysis of random adult data showed similar discrepancies. While 63.3% of adults without long-term illness or disability could access the internet from home, just 34.8% of those with disability, 35.1 of those with a long-term illness, and 27.5% of those with both disability and illness could do so.

Transport

4.11 Data from SHS show that adults with long-term conditions were less likely to hold a driving licence, either currently or ever (Figure 4.3). These differences were seen amongst men and women and across all age groups.

Figure 4.3: Possession of current UK driving licence

4.12 Amongst those who had a full driving licence, the incidence of driving was lower for those with long-term conditions than for those without. For example, 41.7% of those with a disability and almost half (49.8%) of those with a long-term illness drove every day, compared to three-fifths (60.5%) of adults without a long-term condition. While only 9.4% of adults without long-term conditions who had a full driving licence said they 'never' drove, the corresponding figures were much higher for those with disabilities (18.9%) and long-term conditions (16.9%). Analysis by age shows that frequency of driving was lower amongst those with a long-term condition across all age groups (table not shown). Improved Public Transport for Disabled People (2006), which conducted detailed analysis of the travel diary information from the SHS, similarly showed that adults with long-term conditions were much less likely than adults without long-term conditions to make trips out of the house by car or any other means.

4.13 Two-thirds of all households had at least one car normally available for their private use. However, only 53.5% of households where someone had a long-term condition had a car as compared to 75.3% of households where no-one had a long-term condition. These differences were seen across each age group (table not shown). Although overall prevalence of car ownership/use was higher in rural communities, access to cars was still lower in households where someone was disabled, whatever type of community they lived in (Figure 4.4).

Figure 4.4: Percentage of households which have access to one or more cars

4.14 In terms of public transport, frequency of bus use was higher amongst adults with long-term conditions, especially those with long-term illnesses. 30.3% of adults without long-term conditions had used a bus at least once a week during the month prior to the survey. This compared to 33.5% of those with a disability and 38.0% of those with a long-term illness. The overall frequency of train use was much lower - just 19.4% of all adults had used a train in the month prior to the survey. Numbers were therefore too low to compare usage across groups.

Activities found difficult

4.15 The SHS asked all those respondents with a long-term health condition which, if any, of a list of day-to-day activities they found difficult to manage on their own. Adults with a disability were more likely than those with a long-term illness only to find day-to-day activities difficult (Table 4.3).

Table 4.3: Activities found difficult

Column percentages

Source: Scottish Household Survey 2005-2006
Notes: Column percentages may not add up to 100 as multiple responses were allowed.
¹. This item was added in July 2005. Therefore the bases are smaller (3024; 2775; 5799)

4.16 Analysis over time of activities found difficult revealed few fluctuations between survey periods. The only change of note was a decline in the proportion of adults with long-term health conditions who found difficulty using a bus. This declined from 28.0% in 1999-2000 to 23.8% in 2005-2006.

Number of activities found difficult

4.17 In line with the classifications used in Social Focus on Disability (2004: 84) the numbers of activities found difficult were calculated (Table 4.4) ²³. Adults with disability and long-term illness were particularly likely to find difficulty with day-to-day activities: only 13.2% reported no difficulties, while 33.5% found more than five of the activities difficult. In terms of trends over time, in 1999-2000 65% of all adults with long-term conditions had difficulty with at least one activity. This proportion was higher in 2001-2002 and 2003-2004, but returned to 65% in 2005-2006 (Table 4.5).

Table 4.4: Number of activities found difficult to manage on own

Column percentages

Source: Scottish Household Survey 2005-2006

Table 4.5: Number of activities found difficult to manage on own, 1999-2006

Column percentages

Source: Scottish Household Surveys 1999-2006

Care needs

4.18 SHS asked those who reported a long-term condition if they had a home help. In 2005-2006 only 11.5% of adults with a long-term condition had a home help. Adults with a disability and a long-term illness were more likely to have a home help. The numbers of adults who had a home help declined from 15.1% in 1999-2000 to 11.5% in 2005-2006 (Table 4.6).

Table 4.6: Proportion of adults with a long-term condition who have a home help

Percentages

Source: Scottish Household Surveys 1999-2006
Note: high proportion of missing values because of non-response

4.19 In 2005-2006, only negligible proportions of those who found 0 to 2 activities difficult had a home help, compared to 15.6% of those who found 3 to 5 activities difficult and nearly one-third (32.0%) of those who found 6 or more activities difficult. Numbers were too small to explore whether any particular activity or sets of activities were related to greater likelihood of having a home help. As regards household type, 'single pensioner' households were the most likely to have a home help.

4.20 One third (33.2%) of households containing at least one person with a long-term health condition said they needed regular help or care ²⁴. In line with analysis presented in the SHS 2003-2004 Annual Report (Chapter 6), care requirements varied by household type and tenure. Over half of the households who said they required care belonged to either the 'older smaller' (25.1%) or 'single pensioner' (28.8%) categories. Those living in accommodation rented from either a local authority or housing association were more likely than those in owned accommodation to require care.

4.21 Analysis was conducted of the need for care by impairment type. This showed the highest requirements for care where the person or people in the household had a long-term condition relating to a speech impairment, dyslexia or learning difficulties. These are all more likely to be associated with children/young people.

4.22 Detailed analysis of the levels and patterns of care can be found in Characteristics and Experience of Unpaid Carers in Scotland (2006) ²⁵, which was based on SHS data from 1999-2004. Analysis of 2005-2006 data showed that the most common patterns of caring were either one carer from outwith the household (45.1%) or a sole carer from within the household (32.2%). Care from outside the household was most likely to be provided by relatives - they provided care in nearly half (49.7%) of households who reported care from non-household members. The majority of care undertaken by household members was on a continuous basis, while most care provided by people outwith the household was for less than 20 hours per week. Taken together, these findings support the findings from Characteristics and Experience of Unpaid Carers in Scotland (2006), and illustrate the importance of unpaid carers in terms of both the overall proportion of carers and the total number of hours spent caring.

4.23 In line with findings from Characteristics and Experience of Unpaid Carers in Scotland (2006), in 2005-2006 a fifth (20.1%) of adults with a long-term health condition were themselves providing regular help or care for a sick, disabled or elderly person who was not living with them.

Summary of key points

4.24 Although overall perceptions of neighbourhood and neighbourhood safety were high, adults with long-term conditions, especially those with disabilities, were less likely to rate their neighbourhood positively, and were more likely to feel unsafe in their neighbourhood or home.

4.25 Adults with long-term illness and/or disabilities experienced restricted physical and technical access to services. They reported difficulty in accessing a range of day-to-day services, including public transport and medically-related services such as GP or chemist; they were less likely than adults without a long-term condition to have a car or to drive; and were less likely to have home internet access.

4.26 Adults with long-term conditions faced difficulty with a range of daily activities. Despite little variation since 1999 in the number of activities found difficult, the analysis noted a decline in the proportion of adults having access to a home help. Most care was undertaken on an unpaid basis by relatives.