• EIJB Strategic Plan 2019-2022
• Edinburgh Joint Strategic Needs Assessment (JSNA) – 2015
• National Records of Scotland (NRS) population projections for local authority areas
• Audit Scotland Report on Health and Social Care Integration

Edinburgh Population Profile: (current size 487,500 people)

Estimates of future numbers of older people are sourced from National Records of Scotland (NRS) population projections for local authority areas. Of particular interest in terms of anticipated needs for support is the population aged 85 years and over. The number of people aged over 85 is expected to double by 2032 to 19,294. Within 20 years the number of people living with dementia could rise by 61.7 % to 11,548 people.

• Projections envisage a 28% growth in those aged 85+ between 2012 and 2022, a group that makes more intensive use of care services. The number of people aged 85+ is projected to more than double in Edinburgh by 2037 (110% increase from 10,100 to 21,300).
• North West locality has the highest one-third (33.5%) of the very elderly population aged 85+.
• The population of Edinburgh is projected to grow by almost 30% over the next 25 years. The number of older people over 75 living in the city is expected to grow by over 75% and the number of people requiring intensive levels of support, including those with complex physical and mental health needs, is expected to increase by 61% during the same period.
• Social isolation and loneliness can have significant adverse effects on people’s health and well-being, and age and living alone increase the risk of social isolation and loneliness (evidence from Scottish Parliament’s Inquiry into Age and Isolation, 2015).
• At any one time, around one in four people (over 120,000 people) in Edinburgh experience a mental health problem. Anxiety and depression are the most common mental health problems, but others include schizophrenia, personality disorders, eating disorders and dementia.
• The Scottish Government report, the ‘Same as You’ indicated that 2% of the population have a learning disability with the vast majority being unknown to services. NHS Lothian Community Learning Disability teams within Edinburgh are in contact with 1,520 people. The City of Edinburgh Council knows of 3,405 people with learning disabilities in the city.
• Edinburgh is estimated to have 30,735 adults aged 16-64 with moderate to severe disabilities.
• Around 20% of Edinburgh’s population experience either hearing loss or significant sight loss. The majority of those with a sensory impairment have hearing loss.
• There are estimated to be 65,084 carers in Edinburgh, or 13.7% of the population. One in five of these carers provides over 50 hours of care a week. Carers can, for example, prevent avoidable hospital admissions and contribute to people’s overall health and wellbeing. Therefore, as well as there being a strong case for supporting carers based on human rights and quality of care, there is also a compelling economic case. By providing appropriate and timely support to carers resources are saved in the long term.
  • More flexible short breaks tailored to individual needs and more breaks for carers from their caring role.

The results from the National Censuses between 1971 and 2011 tell us that:

• In 2011, 7.8% of Edinburgh’s population was “White other” (non-British or Irish) – the fifth highest proportion in the UK
• At 2011, among non-White ethnic groups, Chinese was the most common (around 8,000 people), followed by Indian (just under 6,500), Pakistani (just under 6,000) with other Asian and Black African both having around 4,500
• Censuses since 1971 show an increasing proportion of single person households (from 23% to 39%)

The size of the LGBT community in Edinburgh is not known but estimated to be at least 5% to 7% of the population.

Support services for those with particular needs:

• ‘Adequate care and support, and making better use of modern technology, can help people to remain independent at home or in a homely setting in the community and reduce the need for high cost formal care and unplanned hospital admissions.

Workforce:

• The health sector is a major source of labour demand and accounts for 45,700 jobs or 15% of total employment In Edinburgh. The sector is expected to grow by 13,000 in Edinburgh, Fife and Lothian regions from 2012 to 2022. This is a higher rate of growth than any other sector. Skill shortages and hard to fill vacancies are persisting and growing within the health sector. This presents a number of challenges in this growing and sizable area of employment in Edinburgh.

Empowering the workforce and streamlining the day to day could help with staff retention and autonomy in their roles.

Increased need for homecare, reablement or outreach services:

• Advances in health care and standards of living means more of us are living longer
• More of us are living with frailty and multi-morbidity, placing more pressure on carers and the traditional approach to publicly funded health and social care services.
• In addition, society and government are becoming increasingly aware and taking account of the effect of mental illness, living with disabilities and a range of long-term conditions.
• As overall demand increases, the supply and related costs of health and social care come under increasing pressure.
• Within cities this is further heightened by the gradual effect of urbanisation and a rise in inequality.
• Audit Scotland: recent report reviewed the changes being introduced through the integration of health and social care. The report sets out the challenge of increasing demand for services and growth over the next 15 years in Scotland. Among the pressures identified were:

1. 12% increase expected in GP consultations
2. 33% increase in the number of people needing homecare
3. 31% increase in those requiring ‘intensive’ homecare (defined as 10 + hrs pw.)
4. 35% increase in demand for long-stay care home places
5. 28% increase in acute emergency bed days and
6. 16% increase in acute emergency admissions.

Service information:

• Combined care at home (externally commissioned) and homebased care (internally supported) deliver over. 5 million hours of care and support every year
• Externally commissioned care and support is delivered to 4,443 people on average a week (108,000 hrs pw) by 90+ care providers of varying sizes and scale across the city through spot contracts and individual service funds (ISF).
• Internal services unsustainable in current form deliver a higher amount of long-term care support than reablement. We support on average 900 people a week (7000 hrs pw). The breakdown of this support is;
  • Average of 800 hours pw supporting adults (under 65)
  • 6000+ hrs pw support older people (over 65)
• Unmet need currently indicates on average of 500 people at any one time currently waiting for support to remain independent in their own homes (acknowledging data quality issues with time lapse since initial referral). Maximising capacity in our workforce could help to support more individuals in need.

• Edinburgh Joint Strategic Needs Assessment (JSNA)
• Christie Commission (2011)
• EIJB Strategic

• Mental ill health is not evenly distributed across society and is more common in socio-economically deprived areas.
• Being old is also a risk factor for poor mental health with depression affecting one in five older people living in the community and two in five living in care homes.
• Dementia is far more prevalent in people over 60 with the incidence increasing further with age.
• Research shows that people living in areas with higher levels of deprivation also have poorer physical and mental health throughout their lives. However, health inequalities are not restricted to areas of multiple deprivation – up to 50% of people experiencing poor health do not live in the most deprived communities.
• Social isolation and loneliness which are associated with higher mortality rates among older people – we know that the number of single households in Edinburgh is increasing, and that a substantial proportion (around 38%) of older people live alone.
• The Christie Commission highlighted that the greatest challenge facing public services is to combat the negative outcomes for individuals and communities arising from deep-rooted inequalities
• EHSCP will embrace the Three Conversations approach as a combined cultural reorientation and delivery philosophy, which will produce a deeper understanding of how to support communities. This approach is particularly important in areas of multiple economic disadvantage, where individuals and families can experience multiple needs being met with well intentioned, but uncoordinated public services.

We need our workforce to have the tools to enable them to communicate and effectively engage in the 3 conversations approach to supporting individuals and delivering quality of care in their own homes and to signpost to wider activity and support in their community.

• Making information accessible
• Equality /SIMD
• Aware of those who do not have a voice
• Fairness
• Meaningful consultation (allowing time to respond)

We would like to explore solutions for data to be shared with individuals and carers and to move toward the longer-term goal of paperless care plans and having immediate interactions with those we support, to ensure needs are met in a responsive and timely way and can change as per need.

EHSCP IIA Strategic Plan 2019-22:

There is considerable data available on health inequalities showing significant inequalities throughout all parts of Edinburgh as well as inequalities for some nongeographic groups.

• In Edinburgh, by 2041, compared with 2016, there will be 32% more people aged 65 and older and 78% more people aged 75 years and over. The implication of this for health and social care is significant because as people age, they are more likely to need the support of statutory services.
• The EHSCP knows of 25,510 people with a physical disability, of which 1,540 are in receipt of services from the Partnership. This population is estimated to rise annually by 1.4%.
• It also knows of 8,684 people with a learning disability and supports 1,335. The national population of adults with a learning disability is predicted to increase by 2% each year.  People with learning difficulties often have poorer health outcomes compared to the general population and are at risk of dying from causes that are preventable.
• In 2010/2011, there were twice as many GP consultations for anxiety in areas of deprivation than in more affluent areas in Scotland. People with mental health problems are more likely to have serious debt problems, increased social isolation, poor physical health and live in areas of deprivation.
• The Scottish Household Survey (2011) estimates there are 65,084 carers living in Edinburgh, this equates to 13.7% of the population. Those who provide 50+ hours per week, amount to 13,761 people.

Mobile devices would enable social care workers to be able to apply the three conversations good practice approach to check information online for individuals and to support improved communication through use of mobile apps where English is not first language. From the people we support around 2% are from black, minority ethnic backgrounds. Workers will have the ability to research culturally specific support requirements or to make identify and share community resource information through signposting.

Taken from a statement provided by the BME Equality Workers Forum regarding equality issues within the workforce:

According to the records gathered by SSSC (2019), in the City of Edinburgh Council local authority, within the public sector care at home and housing support services, 79% of staff are female and at least 60% of staff are over 45 years old. Unfortunately, SSSC has not yet gathered ethnic origin data. However, according to the data held by Scottish Government gathered through Annual Population Survey (2018), the majority of workers from ethnic minority backgrounds are employed in health, public admin and education sector (inclusive of social care) with 43% of Black workers holding employment in this sector. Other estimates of Scottish workforce within health and social care suggest 20% of social care workforce to be from European Union.

These figures indicate that a large proportion of home care staff are people from ethnic minority backgrounds, largely female and older than the general working population. The council is not able to verify this data, as again the newly implemented campaign to gather equality data relies on employees’ access to the MyHr System. The lack of access to the systems of the employees characterized as above who are in one of the lowest paid jobs within Edinburgh Heath and Social Care Partnership, contributes to the digital inequality experienced elsewhere in their lives, again exacerbated by the Covid-19 pandemic. The digital inequality is associated with socioeconomic status, age and disability (UK Parliament Data, 2021). The current conditions of their work within Health and Social care partnership through lack of digital tools is evident in this context.   As stated in Carnegie report on Social Justice and Digital Access (Whyte, 2016), the digital means can be ‘a driver to greater socioeconomic equality but just as surely can be a great barrier to such equality too’.

Priorities within the Digital Health and Care Strategy outlines that:

• technology has the potential to have a positive impact on workforce demand, but we need our workforce to have the necessary digital skills to take advantage of these opportunities. Workforce development is an important part of the Digital Health and Care Strategy and focusses on four key areas of skill development:
• Digital Leadership: The skills required by all staff at all levels to champion digital as an enabler in transforming health and care;
• Workforce Skills: The digital skills required by the general workforce to effectively deliver services to meet patients’ and service users’ expectations;
• Workforce Skills (specialist): The skills and development of those in specialist digital roles (ICT staff) to deliver digital solutions in health and care;
• Future Workforce: The skills that will be required and shaped by our ongoing transformation of services, in line with patient and service user demand.
• identifying solutions that bring the most modern of technologies to our business and administrative requirements, freeing up staff to focus on frontline services
• providing productivity and collaboration services and tools, such as shared calendars, email, video and instant messaging, to support effective, efficient and secure ways for working across organisational boundaries.

https://www.gov.scot/publications/national-health-social-care-integrated-workforce-plan/pages/6/

Efficient Use of the Workforce

• Alongside growth and retention, we need to make more efficient use of existing resources. This will involve a range of approaches, including improvements in rostering.

We understand from our frontline workers that in order to pick up information for their working day ahead, they often must communicate on their days off or for those who use their personal devices they have not separation for work life balance.

Having adequate access to information on the day of their work will support workers to be off on their 4 days downtime and not have to be available to take a call each Friday for their next week’s rota or at other points when Rota’s change both on days off or on shift breaks in the middle of the day.

• Preference for fixed timing and visit length over flexibility but need to accommodate both options –
  • at the same time and for the same length each time? 42 (64.62%)
  • at different times so it can change when you need it to? 23 (35.38%)
• Consistency of carers supporting – 16.92%
• Good communication with provider – 6.15%
• Social isolation – 6.15%
• Gender preferences of carers supporting – 4.62%

The dynamic scheduling will enable us to set constraints and preferences for individuals and their carers around their specific needs and provide more tailored and flexible quality of care and support. Greater access to information on the move will equip social care workers with the information they need and greater confidence to best support the individual.

Family testimonial regarding how they currently value technology for their parents care and support, delivered by their care providers;

…’my care provider invited me to join, so I could read the carers report and also see the bookings for the week ahead. Having access to their system allows me to see what time they arrived and what they did. It’s really useful as I can also leave feedback on their report that is then emailed to them. I’ve had a phone call fairly quickly after I questioned the time spent on site by one of the carers which they then clarified to me. I do check it every day, as I can see from everyone’s notes how my parents have been’.

Edinburgh ‘Offer’ Pact Consultation 2019:

Themes of feedback relevant to this proposal include:

• ‘Culture’ key. Requires focus and energy.  Require to empower staff.  Build infrastructure. Value and develop workforce.
• Supporting carers and families
• Skilled and equipped workforce to implement community-based support
• Building networks/support and relationships in the local community

• Culture shift values human rights, lived experience, co-production, mutuality and common good
• Shift attitude towards technology and data sharing to improve people’s experience of social care to help them live independently
• Focus on improving performance through greater transparency, innovation and use of digital technology
• Implementation of the Fair Work principles to improve workers’ working conditions; peer support and supervision; and a more consistent approach to providing high quality training for staff
• Greater integration at a local level driven by better partnerships, collaboration and local delivery
• People must be able to access support at the point they feel they need it
• Move away from time and task and defined services to commissioning based on quality and purpose of care – focused upon supporting people to achieve their outcomes, to have a good life and reach their potential, including taking part in civic life as they themselves determine

• Evidence of unmet need

• Internal Service Reports Data
• Internal Engagement with Workforce Focus Groups and Interviews
• Independent Review of Adult Social Care (IRASC)

Evidence of unmet need and capacity

• Around 500 people at any one time waiting in the community for support equating to approximately 4000-5000 unmet need hours across the city
• Actual support ‘contact time’ when a social care worker or assistant is delivering support, is averaging at 40% with the remaining time admin or travel. This is the makeup of a normal day, not including other ad hoc admin or training time.

Increased route optimisation, reduction in paper-based admin and maximising on the capacity potential in real time as needs change, will enable us to meet the needs of more people needing support to live independently in their own home.

IRASC:

As the older population has increased and resources have been focused increasingly on those in greatest need, a smaller proportion of the adult population is in receipt of social care support than was before austerity, with the result that the needs of a number of people are probably not being met and for others they are being met in a crisis response rather than to anticipate or avoid such interventions.

Examples of the kind of improvements that people are trying to make include:

• Reducing use of institutional/residential care – increased opportunity for support at home
• Making better use of adaptations and technology
• Involving people and their families more in decisions
• Including wider community supports in care
• Professionals working together better across traditional boundaries of health, social care support and other services such as housing.

There is wider relevance potentially for the dynamic scheduling tool within district nursing, hospital at home and a potentially for visibility of scheduling across groups and to support teams to reduce their inefficiencies, collate more real time data and spot opportunities for joint supportive working.

• Fair Work principles to improve workers’ working conditions; peer support and supervision; and a more consistent approach to providing high quality training for staff

Adequate smartphones and e-mail access will enable social care workers and assistants to have access to the information they need for online training and development and for equality of access for internal opportunities. It is also necessary for lone working to improve working conditions.

Health and Social Care Integration and Standards

As part of the integration of health and social care we have a requirement and duty of care to work with our local communities and providers of care to ensure care is responsive to people’s needs and that we follow the guidance for the national health and wellbeing outcomes to ensure;

• people who use health and social care services have positive experiences of those services, and have their dignity respected
• people, including those with disabilities or long-term conditions, or who are frail, can live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

In addition, the health and social care standards, considered by the Care Inspectorate, Healthcare Improvement Scotland and other scrutiny bodies in relation to regulation and inspection of health and social care services, cover the following areas that are directly relevant to our consultation and outline the standard of care a person can expect;

1. I experience high quality care and support that is right for me.
2. I am fully involved in all decisions about my care and support.
3. I have confidence in the people who support and care for me.
4. I have confidence in the organisation providing my care and support.

Enabling our workforce with the tools to better communicate and have access to preference and important information pertaining to the individuals they care will enable us to provide greater quality of care and support.

EIJB Strategic Plan identifies the vision:

Where do we want to be?

• A sustainable, well performing and trusted health and social care system
• A clearly understood and supported Edinburgh health and social care Offer, which is fair, proportionate and consistent
• A person-centred, patient first and Home First approach
• A motivated, skilled and representative workforce
• An optimised partnership with the voluntary and independent sectors care supported by the latest technology
• A culture of continuous improvement and innovation

How are we going to get there?

• Roll out the Three Conversations approach across the city over time
• Work towards shifting the balance of care from acute services to the community through Home First supported by our transformation programme
• Generate a unity of purpose and build momentum
• Technology – identification of emerging and proven solutions –implementing commercial off the shelf and spend to save initiatives
• Learn from others; across Scotland, the wider UK and internationally

The Digital and Smart City Strategy sets out the City of Edinburgh Council’s approach to the sustainable development and delivery of technology to support the Council and enable Edinburgh to become a Smart City, covering the period 2020- 2023.

• This Strategy describes how we will embrace innovative technical solutions to meet rapidly evolving and changing business needs, respond to the changing shape of the organisation, provide value for money and enable us to respond to opportunities and demands for joint working with our partners.
• The principles within this Strategy provide a framework for how our future technology services will be designed, sourced and delivered enabling us to support new, safe and secure collaborative ways of working.
• The Strategy will support the Council in the delivery of the Council’s Business Plan and the commitments within this and adopts the principles of the Edinburgh 2050 City Vision.

Key principles of the strategy relevant to this validation piece and full business case to build in technology into the heart of home-based care and support services:

• Re-use, Before Buy, Before Build – We will leverage existing capability where appropriate, seeking to simplify the ICT estate.
• Focus on citizen and customer centric requirements first;
  • Person centred approach and outcomes for people at the heart – preferences and needs information access, fewer missed care visits, consistency of care.

• City vision is to be net zero on carbon emissions by 2030. More sustainable routes for our outreach mobile workforce could help to impact on reducing carbon emissions from the 32% of our workforce who are registered car users for delivery of homecare services.
• The SWIP plan looked across the work of the Council and identified a set of actions which the Council could initiate within a short timeframe, in order to immediately improve the organisation’s approach to sustainability.
  • High Impact Action: (T4) ‘Expand and accelerate measures to reduce pollution and improve air quality’. Increasing optimisation of routes within the 32% of our social care workers who are drivers could impact on emissions and air quality, respecting ‘low emission zones’ and better monitor footprint from our service.
  • Moving toward ‘car free’ society and reducing ‘single car occupancy use’.

We know from staff that they visit the office at least once a week to drop off paperwork for filing, to submit expenses forms and to pick up resources. Having greater access to information digitally would help to reduce the amount of travel that frontline workers must undertake and reducing the environmental impact.

O30. Deliver an accelerated reduction in the use of paper and scope the sustainability impacts of further shifts towards paperless working

• The Council has set up a Paperless Strategy Working Group, which is supporting services to reduce print volumes and accelerate the shift to paperless working, for example through increasing the use of digital alternative to physical posting.

With staff currently not on e-mail, information is relayed over the phone, through texts, postal and photocopying activities unless the individual has agreed to use their personal e-mail address. This is costly, time consuming and often information errors occur in the relay and confirmation of receipt. HR related requests for annual leave, mileage expenses and overtime claims are all currently paper based. Staff only receive organisational information if these are printed and posted out to the worker and training materials are all hosted on The Orb. Policies and procedures need to be printed and posted and are often large documents which could be e-mailed more effectively with a read receipt confirmation requested.

In addition, care plans are paper based and printed at cost, care plan printing with 4,500 service users across the city at any one time constitutes a significant environmental impact and cost. In the long term it is envisaged that this could be digitised with individual and carer access to online records and real time updates. This also reduces the potential for information loss or human error in relaying information.

• an overarching sense of feeling devalued and unsupported
• disengaged with the possibility that better ways of working are possible
• inequality with their allied health professional peers who have now all received devices and are exploring technology in support of their work – examples such as Near Me which could be explored within social care
• performance is measured on things they cannot influence

• ‘we have requirements from Care Inspectorate to fulfil – some things not within gift – i.e. mobile technology and the use of’
• Comparison made to agency staff – ‘they are so far ahead in terms of tech’ – their workers have phones with apps installed – we are paper based
• Currently achieving grade 4/5 with the Care Inspectorate with no tech (and existing systems/ processes) – Agencies score less and have the tech – imagine the score if we had the technology
• Existing performance is based on contact time
• There is a clear appetite to use digital, but a limit to what they can do with what we have (even for patient care)
• Mindful that the workforce is ageing too (has an impact)
• Many staff don’t have emails (that’s not equitable when organisational wide messaging goes out)
• HCR have basic Nokia’s often with poor reception/battery life
• Text Essendex costs £1000 p month. No CEC email address/ no smart phone.  Have to use own computers at home to receive information
• A huge amount of communications but homebased care staff don’t get them – they get texts and phone calls – not a great experience – message gets relayed differently and information is fragmented.

Workforce

• The workforce: the health sector is a major source of labour demand and the sector is expected to grow faster than any other sector. However, there are skill shortages and unfilled vacancies, even at present.
• Testimonials from staff regarding the need to have the necessary tools to do their job as social care workers and assistants who are in most cases lone working.

IASCR:

• ‘foundation that needs nurturing and strengthening is the social care workforce. For us to achieve the improvements we seek, they need to feel engaged, valued and rewarded for the vitally important work that they do’.

Skills for Care:

• Caseload management tools that help to match people to the workers with the right skills, knowledge and similar interests
• Include time for travel, handovers and record keeping
• Accessibility and location of where people live
• Sharing rotas early – provide workers with easy ways to access the rota and keep up to date with any changes
• Develop a contingency plan to maintain safe staffing levels, for example:
  • work with other local services whose workers could cover shifts
  • have a team of bank lone workers
  • use agency staff to cover emergencies

“We have a rota app – it works well – if the rota is updated, I get a notification.”

“The app (that the agency utilised) used geo-tagging which enabled the service to monitor that the care worker had arrived safely at the property and their time of arrival. The application monitored when the care worker left and enabled the service to monitor the time that had been spent with the person.”

CQC inspection report, homecare agency rated ‘outstanding’ for ‘safe’

In the research, lone workers said that there were some key challenges or risks in relation to their personal safety, including:

• travelling to different locations alone, especially at night
• poor mobile phone signals in some areas, meaning that lone workers may be unable to contact managers or colleagues in the event of an emergency or when they need prompt advice or assistance
• not having colleagues on hand to assist should they be exposed to unexpected or unpredictable behaviour or situations.

Supporting personal safety tips:

• issuing mobile phones including, where required, a function that provides access to specialist support in case of an emergency
• having a process and system for lone workers to regularly clock in and out, for example, of each home or service visit – this could be, for example, via an app
• using GPS tracking devices so employers know the location of lone workers
• offering a help/advice line for lone workers during working hours, including out of hours

Staff have reported that our existing handsets have poor battery, often experience poor signal and cannot link to their car for handsfree/navigation – some workers are using their personal phones.