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How system change can improve carers’ health

10 April 2026

Across Scotland, thousands of people provide unpaid care for family members, friends, or neighbours. They do this out of love, but it often comes at a cost to their own health.

Research shows that unpaid carers often experience poorer physical and mental health than people who do not provide care.

That’s why we’ve reopened our Supporting Change – Carers programme. The programme funds projects that help reduce health inequalities for unpaid carers by changing the systems around them – not just offering short-term fixes.

But what do we mean by systems change? Let’s break it down.

Three adults sitting closely together indoors, two looking down at something in front of them, with a mug visible in the foreground

Why unpaid carers need better support

Research shows that unpaid carers often have poorer physical and mental health than people who do not provide care. Many experience loneliness, long-term pain or illness, and money worries caused by juggling work and caring.

These problems do not happen by accident. They’re caused by the way our society, services, and attitudes are set up. To make things better, we need to look deeper than what we can see on the surface. That’s why it’s vital to address these barriers and make changes to the systems around carers, to improve their health.

Thinking about systems change

To help us better understand systems change, we worked with Jennifer Wallace, a Senior Strategic Improvement Coach. She has lots of experience in public service innovation and policy development, with a focus on wellbeing and putting people at the centre of adult social care. Jennifer brings a deep understanding of how to make lasting changes in complex systems - helping us find ways to reduce health inequalities for unpaid carers.

Jennifer introduced us to and helped us use the iceberg model to explain systems change. The iceberg helps to visualise issues affecting unpaid carers by displaying factors "above the water" (what you can see) and those “below the water” (what you can not see).

Illustration of an iceberg showing visible and hidden issues linked to unpaid care, with labelled sections on outcomes, contributing factors, structures and attitudes
Unpaid care visualised as an iceberg

This model helps us to understand what drives health outcomes for unpaid carers and where change can make the biggest impact.

The iceberg model has 4 levels:

The tip (above water)

  1. What we see when we look at unpaid carers and health outcomes?

  2. What is happening to cause these outcomes?   

The submerged (below the water)

  1. What structures are influencing these patterns and outcomes? 

  2. What attitudes and beliefs shape these structures and outcomes?

Systems change means looking “below the water". What we see (health outcomes) is supported by what we don’t see (structures and beliefs). 

We want to fund projects that focus on influencing what is below the water, and the attitudes and beliefs that shape these structures. 

Level 1: The visible - what we see

These are the health problems unpaid carers often face, such as:

  • more care needs due to an ageing population

  • different challenges at different ages (for example, young carers missing school or friends, older carers dealing with their own health issues)

  • trying to balance caring with inflexible jobs, which can lead to financial insecurity and poverty

Level 2: The patterns - what is happening

These are the things that repeat themselves and lead to poor health outcomes. Such as:

  • cuts to public funding mean unpaid carers are doing more, with some communities unable to access the right support

  • carers are often treated as an extension of the healthcare system instead of being recognised as equal partners with valuable lived experience

Level 3: The structures - why is it happening?

These are the rules and systems that make life harder for carers.

Barriers that influence their health outcomes include:

  • workplace norms, prioritising continuous full-time work, making it more difficult for those with care duties

  • fragmented systems, including health, social care, and welfare services that don’t always work well together leading to inconsistent support 

  • caring slowly being seen as a private family issue, rather than something society should share responsibility for

Level 4: The mental models - what beliefs shape this?

These are the attitudes and beliefs that help to shape health inequalities, including:

  • the belief that caring is “natural” for women

  • how race, sexuality, and disability compound the impact

  • how women with ME (chronic fatigue syndrome) are often caring for others, but still do not get the support they need

  • how care is excluded from economic indicators like Gross Domestic Product (GDP), so it’s easy for decision-makers to overlook when planning services and support

What we want to fund

Though Supporting Change Carers, we want to fund projects that do not just help carers cope – but help change the system itself.

This means funding community-led initiatives that:

  • tackle the root causes of challenges

  • create long-term health benefits for unpaid carers

  • reduce the inequalities they face

Ideas we will consider include those that:

  • challenge unfair structures

  • shift attitudes and beliefs

  • create long-term improvements to carers’ health

  • reduce the inequalities unpaid carers face

Find out more