Overview
Introduction
The Edinburgh Integration Joint Board (EIJB) was established in 2016 to bring together planning and operational oversight for a range of NHS and Local Authority services. This was intended to improve overall health and wellbeing through the delivery of more efficient and effective health and social care services.
This performance report sets out our progress against the strategic priorities within the EIJB Strategic Plan 2019-22, which remains extant and is available online. The content in this report covers the financial year April 2023 to March 2024 unless otherwise stated. An update to the EIJB Strategic Plan was delayed as we responded to post-pandemic systems pressures and our response to recent inspections. The refreshed EIJB Strategic Plan is expected to be published in late 2024.
The Edinburgh Health and Social Care Partnership (EHSCP) is responsible for providing integrated services through the operational delivery of the EIJB’s strategic plan. Its workforce is made up of staff employed by both the City of Edinburgh Council and NHS Lothian, and our Chief Officer is accountable to the Chief Executives of both the City of Edinburgh Council and NHS Lothian.
The health and social care services we deliver and commission include:
- carers support services to a subset of the 45,000 and 70,000 adult carers estimated in Edinburgh
- social care assessment and other social work services provided to around 10-12,000 people a year
- care at home services provided to around 8,000 adults and older people over the course of the year
- technology enabled care provided to around 9-10,000 people a year
- around 2,000 people supported through learning disability services
- dementia services to support the estimated 8-9,000 people in Edinburgh with dementia
- primary care services including pharmaceutical services, district nursing and GP services and enhanced primary care services across around 70 GP practices
- mental health and wellbeing services and services that support people with substance misuse
- services to prevent admission to and support discharge from hospital, such as hospital at home services, with about 5,000 discharges supported each year
- around 3,500 people supported in care homes and nursing homes across each year
- adult support and protection services, with around 3,000 duty to inquire assessments completed each year.
We organise our community health and social care services in Edinburgh around four localities: South East, South West, North East and North West. The management of most community health and social care services is carried out in these localities, including assessment and care management, home care, day centres for older people and care homes in Edinburgh. Throughout 2023/24 we undertook a review of these delivery arrangements, with structural changes to move to the delivery of citywide services to be implemented throughout 2024/25. These changes will allow us to streamline delivery of services across the city, while continuing to have a focus on shaping services that are responsive to the different characteristics and needs of our distinct Edinburgh communities.
Our major strategic change projects include some of the key pieces of work that were previously part of the transformation programme, including some of those outlined in this report. However, it also focuses on ensuring that services are sustainable in the longer term. To be sustainable, we need to deliver services within our budget, but we also need to address the challenge of increasing demand for health and social care services and ensure that we can continue to attract and retain a skilled and capable workforce.
- Edinburgh is one of the largest health and social care partnerships in Scotland, with a population of 512,700 as of March 2022.
- 82,100 residents were aged 65 or over, with this age group projected to increase the most over the coming years1.
- Edinburgh is also the wealthiest city in Scotland, with 82.8% of the working age population in employment.
- 49.6% of the economically inactive population within the city are students, and 14.5% look after others.4
- However, 15% of the population, and as many as 20% of children, live in relative poverty5.
- This poverty is spread throughout the city, with two thirds of those living in poverty not living in areas described as deprived. The majority of those in poverty are in employment.
An overview of our localities is provided here and our joint strategic needs assessment (JSNA) provides more detail on the population and demographics of Edinburgh.
North East
- 125,188 people live in the North East locality2
- 50.8% are female and 49.2% are male2
- 51.1% are aged under 18, 71.6% are 18-64 and 13.2% are over 652
- 21.2% of people lived in the least deprived SIMD quintile, and 18.2% lived in the most deprived quintile2
- Life expectancy at birth is 80.6 years for women and 76 for men2
- 35,573 average home care hours per week between January and March 2024
- 1,566 were receiving home care at the end of March 2024
- 18 GP practices3
North West
- 148,992 people live in the North West locality2
- 51.6% are female and 48.4% are male2
- 19.7% are aged under 18, 62.6% are 18-64 and 17.7% are over 652
- 50.3% of people lived in the least deprived SIMD quintile, and 9.1% lived in the most deprived quintile2
- Life expectancy at birth is 83.4 years for women and 79.6 for men2
- 29,083 average home care hours per week between January and March 2024
- 1,524 people receive were receiving home care at the end of March 2024
- 18 GP practices3
South East
- 138,730 people live in the South East locality2
- 52.4% are female and 47.6% are male2
- 14% are aged under 18, 71.5% are 18-64 and 14.5% are over 652
- 49.5% of people lived in the least deprived SIMD quintile, and 8.8% lived in the most deprived quintile2
- Life expectancy at birth is 82.5 years for women and 78.1 for men2
- 27,122 average home care hours per week between January and March 2024
- 1,345 people were receiving home care at the end of March 2024
- 18 GP practices3
South West
- 113,560 people live in the South West locality2
- 49.7% are female and 50.3% are male2
- 17.6% are aged under 18, 66.4% are 18-64 and 16% are over 652
- 40.8% of people lived in the least deprived SIMD quintile, and 12.9% lived in the most deprived quintile2
- Life expectancy at birth is 83.2 years for women and 78.8 for men2
- 31,664 average home care hours per week between January and March 2024
- 1,320 people were receiving home care at the end of March 2024
- 16 GP practices3
2 PHS LIST Locality Profiles
3 National Primary Care Clinicians Database (NPCCD), Public Health Scotland (Jan 2024)
4 NOMIS Official Census and Labour Market Statistics (Oct 2022 – Sept 2023 release)
In the Performance section of this Annual Performance Report, we report progress against the National Indicators set by the Scottish Government and Ministerial Strategic Group (MSG) for Health and Community Care indicators.
We remain in the top half of partnerships for 58% of the indicators (14 out of 24) with an update this year. 11 out of 18 indicators (61%) with trend data this year have seen an improved or steady ranking on benchmarked performance compared to last year, with improvements also seen in other areas. Our benchmarked performance is shown in the table below, including our quartile position and the change in our ranking compared to last year.
In particular, we continued to see positive movement in our levels of bed days spent in delay for over 75s this year. Edinburgh has moved out of the bottom quartile, with a 17% reduction over 2023/24 compared to a 2% decrease nationally, although challenges remain to reduce our level of delays to sustainable levels. We also have the lowest rate in the country for emergency admissions and fifth lowest on emergency bed days.
While we have seen a decline in ranking in some indicators this year, there are also indications of positive directions of travel for many of these indicators that we will continue to build on:
- NI-8 Carers who feel supported to continue – We increased our positive response slightly from 30.4% to 31.3%, though recognise we have a long way to go to improve this measure.
- NI-11 Premature mortality – We remained below than the Scottish rate and our per population rate was within 1% of the previous year.
- NI-14 Emergency readmissions – We remain below the Scottish average and lower than our rate between 2019 and 2022.
- NI-16 Falls rate – We remain lower than our rate between 2019 and 2022.
- MSG1.a A&E Attendances – We remained better than the Scottish rate and our per population rate was within 7% of the previous year.
- MSG3.a Acute emergency bed days – We remained within the top 5 best performing partnerships and our per population rate was within 3% of the previous year.
- MSG3.c Mental health emergency bed days – While we remained in the bottom quartile, our per population rate improved by 4% on the previous year.
| Core Indicator | Time Period | Quartile | Change in rank from previous year | |
| NI – 1 | Percentage of adults able to look after their health very well or quite well | 2023/24 | 2 | |
| NI – 2 | Percentage of adults supported at home who agree that they are supported to live as independently as possible | 2023/24 | 2 | – |
| NI – 3 | Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided | 2023/24 | 3 | – |
| NI – 4 | Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated | 2023/24 | 3 | – |
| NI – 5 | Total percentage of adults receiving any care or support who rated it as excellent or good | 2023/24 | 2 | – |
| NI – 6 | Percentage of people with a positive experience of the care provided by their GP practice | 2023/24 | 2 | |
| NI – 7 | Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life | 2023/24 | 2 | – |
| NI – 8 | Total combined % carers who feel supported to continue in their caring role | 2023/24 | 3 | |
| NI – 9 | Percentage of adults supported at home who agreed they felt safe | 2023/24 | 1 | – |
| NI-11 | Premature mortality rate (per 100,000 population) | 2023 | 2 | |
| NI – 12 | Emergency admission rate (per 100,000 population) | 2023 | 1 | |
| NI – 13 | Emergency bed day rate (per 100,000 population) | 2023 | 1 | |
| NI – 14 | Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) | 2023 | 3 | |
| NI – 15 | Proportion of last 6 months of life spent at home or in a community setting | 2023 | 3 | |
| NI – 16 | Falls rate per 1,000 population aged 65+ | 2023 | 4 | |
| NI-17 | Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections | 2023/24 | 2 | |
| NI – 18 | Percentage of adults with intensive care needs receiving care at home | 2023 | 2 | |
| NI – 19 | Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) | 2023/24 | 3 | |
| MSG1.a | Rate of A&E Attendances (lowest rate = Quartile 1) |
2023/24 | 2 | |
| MSG1.b | 4-hour Performance | 2023/24 | 4 | |
| MSG2 | Rate of Emergency Admissions (lowest rate = Quartile 1) |
2023 | 1 | |
| MSG3a. | Unscheduled Bed Days (Acute): | 2023 | 1 | |
| MSG3c. | Unscheduled Bed Days (MH): | 2023 | 4 | |
| MSG4 | Delayed Discharge Bed Days: | 2023/24 | 3 | |
Source: Public Health Scotland Notes: Quartile and Trend: The Quartile shown denotes which quartile the City of Edinburgh partnership was in during the time period noted. The arrows indicate the change in the City of Edinburgh’s position relative to the other partnerships, between the 12-month time period noted and the previous 12 months. Dashes indicator that we do not have previous comparative data for the indicator. Only indicators with an update for 2023 or 2023/24 are included. MSG3b not included due to SMR completeness issue.