Priority 2: Tackling inequalities

We have a key role to play in addressing inequality, in particular the health inequalities that represent thousands of unnecessary premature deaths every year in Scotland. The fundamental causes of health inequalities are an unequal distribution of income, power and wealth which can lead to poverty and the marginalisation of individuals and groups. These fundamental causes also influence the distribution of wider social determinants of health, such as the availability of good quality affordable housing; green space; work, education and learning opportunities; access to services; and social and cultural opportunities. These also have strong links to mental and physical health.

In April 2022, our grant programme was extended by a further three years to March 2025. This extension was provided to allow third sector organisations to consolidate and continue to develop and redesign their services following the pandemic. The programme aims to address two key priorities of our Strategic Plan – to tackle inequalities and promote prevention and early intervention.

In 2022/23, 71 projects, including two successful projects from our Innovation programme, received funding through the EIJB Grant Programme. In total, we provided £5,161,802 for the continued provision of preventative and early intervention services across the city. The grants awarded through the programme included grants ranging from £300k for citywide provision of specialist income maximisation services, to very small grants of £8k for small scale volunteer-led services.

In general, the return to normal service provision is progressing well, with many organisations continuing to redesign their services to incorporate lessons learnt from the pandemic and develop new ways to deliver services to a wider group of service users.

Throughout 2022/23, it is estimated that services funded through the grant programme will benefit approximately 44,000 people across the programme’s priority outcomes for reducing health inequalities, with 80-85% of the targets set either met or exceeded. The user satisfaction of services provided through the grant programme remains high with an average satisfaction score of 93%. In addition to this, the effectiveness of the programme is further augmented through the additional benefit of funding leverage, which is estimated at around £13m across the programme; the inclusion of volunteer hours provides an additional financial value of £1.9m to this total.

Overall, the programme has helped progress against the National Health and Wellbeing Outcomes, with activities targeted at disadvantaged communities, and it has addressed factors such as community resilience and improved physical and mental health and wellbeing. As such it has contributed to the mitigation and resolving of the causes of health inequalities.

Our third Thrive Edinburgh Conference took place on 25 November 2022, chaired by the Lord Provost and attended by over 140 people. It focused on how we continue to change the conversation, change the culture around our city’s mental health and wellbeing.

Our Community Commissioning process aims to bring organisations together to explore local community needs, challenges and aspirations, and we allocated all our Communities Mental Health and Wellbeing funding, supporting over 120 organisations and partnerships in delivering a wide range of support across the city.

In terms of our Redesign Urgent Care Plan, we increased capacity in the Mental Health Assessment Services by three WTE Mental Health Nurses; introduced senior clinical makers; employed navigators for wider community support and community connection; and progressed work with the TRAK team to develop a more effective mental health triaging and referral system.

Four Thrive Welcome Teams are based in Edinburgh’s localities. The multi- agency and multi-professional teams were prototyped from February 2020 through to August 2021, with teams augmented through formal organisational review transferring the Primary Care Liaison Team members into the Thrive Welcome Teams. As part of the Big Lottery-funded Living Well UK programme, an external independent evaluation was conducted and published in July 2022. The recommendations of the evaluation were considered by the Thrive Welcome Teams and wider Thrive Collective.

In February 2022 the Scottish Government announced their intention to allocate £3.2 million over 3 years to support the development of the Primary Care Mental Health and Wellbeing Teams in Edinburgh. This allocation is being reviewed as part of the Scottish Government’s budget deliberations following the UK budget settlement. Following the announcement of this new funding, it was agreed to combine all current and planned funding to form eight Thrive Welcome (PCMHWBTs) Teams across the city. These teams would be built up from the current Thrive Welcome Teams in line with the values and practice model, serve local communities (20-minute neighbourhoods) and the GP clusters across the city, and include a local GP mental health lead, working with the local team lead. These changes will embed a ‘no wrong door’ and value-based approach, helping us to achieve the Thrive/PCMHWBT aspirations of open access and no upper age limit services. The Thrive Welcome Teams Locality co-design and co-production groups were established, and the co-design process commenced on 8 December 2022.

Some other key highlights of the year include:

  • Phase two of the development of the iThrive website was completed, enabling real time referrals into the Thrive Collective services and support.
  • Out of Sight, Out of Mind celebrated its tenth birthday with an inspiring exhibition presenting over 100 artworks made by people who have lived experience of mental health issues.
  • We embarked on a new partnership with the Scottish Storytelling Centre in creating a space for people and families to come together on the third Sunday of every month for fun activities including storytelling, family ceilidhs and arts and craft activities.
  • Our City (E)Scaping Community of Practice was established, with spaces transformed into green and public art sites to foster collaboration and boost mental health and wellbeing.
  • The third edition of Coorie In was produced, which highlights useful tips and advice for supporting people’s mental health and wellbeing over the winter months. Eight thousand booklets were distributed across the city. The related small grants scheme supported 115 programmes providing 39,000 opportunities for people to connect over the winter months.
  • The Royal Edinburgh Hospital’s Volunteer Hub supported 43 inpatients, generating 54 volunteer hours; and 68 members of the public volunteered 2,078 hours.
  • The New Era Programme was established to accelerate community developments and housing with support to enable more people to be discharged from the Royal Edinburgh Hospital

Further funding was secured from the Armed Forces Covenant Fund to develop the Scottish Veterans Wellbeing Alliance and to develop interventions for veterans at high risk of attempting suicide. This programme will be delivered in partnership with the Centre for Military Research, Education and Public Engagement, Edinburgh Napier University.

Several national and local initiatives are focused on ensuring that the design and delivery of services are informed by the lived and living experience of those who rely on them, as this can have a significant impact on how people respond to support, and influences the culture and insight of the system.

In 2023, the ADP commissioned EVOC to support the Lived Experience panel reach its potential and ensure that the voice of lived experience is central to the planning, monitoring and evaluation of current and future service provision. Amongst other things, a Recovery Community Development specialist has been employed to recruit people to the panel, to engage the recovery communities in its work, and to work with Edinburgh Recovery Activities (ERA), EADP, Advo Card, Scottish Recovery Consortium (SRC), and other key stakeholders. A report with recommendations on the future shape of the panel and its work will be produced.

The use of experiential evidence in the development of plans and services is a requirement of the Medication Assisted Treatment (MAT) standards. In 2023 the EADP developed a network of peer researchers – people with lived experience of substance use and recovery who have been trained by SRC – to interview others with a focus on their experience of treatment and support. Over 50 interviews were completed and the results informed and continue to inform the MAT standards reporting and planning.

The newly designed Access Place experienced a successful first year of operation in its new premises. People experiencing homelessness face many health and social inequalities, and we created Edinburgh’s Access Place with integration at its heart, offering a multi-agency, trauma-informed service under one roof. Everyone working at the Access Place has been trained in trauma-informed practice, recognising the impact that trauma has had on many of those accessing the service. People experiencing homelessness who have multiple and complex needs receive high quality, co-ordinated care and support to access permanent accommodation and improve their mental and physical health.

The service offers access to primary care; vaccination programmes; women’s only clinics; temporary and permanent accommodation; social work and social care support; welfare benefits advice; veterinary support; support with mental health and substance use; occupational therapy; peer support; community linking; outreach support; and employment support. Anyone using the service has choice and flexibility in how they do so, and for those supported the service is a single point of access; our teams work together across citywide partnerships and networks, learning together, co-ordinating and co-designing each person’s pathway to better wellbeing and independence.

Case Study 2: Rowan Alba CARDS Befriending Service

Elisabeth is a 56-year-old female who had been made homeless during the Covid-19 pandemic due to her excessive drinking and had been placed in elderly sheltered accommodation. Initially contact was made by telephone; Elisabeth explained she was in a very bad way and was extremely reluctant to have a home visit as she was embarrassed about her living conditions. She was assured by the service provider that she would not be judged and that it was her wellbeing that was important. Elisabeth agreed to a visit, and indeed her living conditions were bad. Elisabeth was in poor physical condition, her house was messy and infested with cockroaches, she was lying on a mattress on the floor surrounded by discarded cigarette ends, food containers and empty vodka bottles, and she admitted she had given up.

A trusting relationship was built up over a number of visits and after several weeks Elisabeth agreed to accept help with her situation. She was helped to move into supported accommodation in the Grassmarket. Elisabeth has become very houseproud of her new accommodation. She has vastly reduced her alcohol intake and following a reassessment of her circumstances has been prioritised for Edinburgh’s Detox Clinic services. Elisabeth has been attending alcohol recovery meetings and meeting new people. Initially, Elisabeth was adamant that she didn’t want a volunteer assistance, however, she is now looking forward to meeting her new volunteer and attending outings or events run by CARDS.
Personal Outcomes:
· Improved mental and physical health

· Improved self-management of long-term alcohol condition including reduced addiction

· Reduced isolation and more opportunities to connect to the community

· Improved confidence and self-esteem

· Increased support to maintain a home
Wider Impacts:
Our support has reduced reliance on crisis services such as. A&E, emergency housing and social work. Long term, through being supported to volunteer, clients contribute to strong and inclusive communities.

Edinburgh Alcohol and Drug Partnership (EADP)

Several national and local initiatives are focused on ensuring that the design and delivery of services are informed by the lived and living experience of those who rely on them, as this can have a significant impact on how people respond to support, and influences the culture and insight of the system.

In 2023, the ADP commissioned EVOC to support the Lived Experience panel reach its potential and ensure that the voice of lived experience is central to the planning, monitoring and evaluation of current and future service provision. Amongst other things, a Recovery Community Development specialist has been employed to recruit people to the panel, to engage the recovery communities in its work, and to work with Edinburgh Recovery Activities (ERA), EADP, Advo Card, Scottish Recovery Consortium (SRC), and other key stakeholders. A report with recommendations on the future shape of the panel and its work will be produced.

The use of experiential evidence in the development of plans and services is a requirement of the Medication Assisted Treatment (MAT) standards. In 2023 the EADP developed a network of peer researchers – people with lived experience of substance use and recovery who have been trained by SRC – to interview others with a focus on their experience of treatment and support. Over 50 interviews were completed and the results informed and continue to inform the MAT standards reporting and planning.