Key messages from the year

As with all areas of society the coronavirus pandemic had a huge impact on our delivery of services. While we continued to deliver vital support to the most vulnerable, initial analysis highlights that the pandemic has exacerbated existing health and social inequalities[1].

Employment and social impacts from the pandemic adversely affected many of the people who use our services, including those with disabilities and their carers. Unpaid carers were particularly affected by the restrictions on the services that support their caring role, such as respite care. Early research also suggests that loneliness and anxiety may have risen during the pandemic but the impact on heath and wellbeing in Edinburgh is not yet clear[2].

The covid-19 pandemic is likely to continue to affect health and wellbeing and how we deliver our services for the immediate future. We continue to monitor and prepare for this longer-term impact by learning lessons from our experiences over 2020/21.

[1] Edinburgh Joint Strategic Needs Assessment

[2] Personal well-being in the UK, quarterly – Office for National Statistics (ons.gov.uk)

As part of our covid-19 response, we developed a mobilisation plan setting out the actions we were taking to ensure the health and care system was prepared for the impact of the virus. To protect our staff and service users, we had to make the very difficult decision to pause some of our services, including day centres and respite care. Many other services, including community resources, were disrupted, offering reduced delivery or changing the way they deliver support. Care provision was also reduced during this time, with supported people prioritised so that care continued to be provided to the most vulnerable in our society. Incoming demand dropped for much of the year.

Our hospital-based services were also impacted by the pandemic. Wards where covid-19 was present were closed to new admissions and social distancing measures were introduced across other wards. This meant some beds had to be closed to allow enough circulation space, reducing the capacity available. As a result, there was a nationwide focus at the start of the pandemic on creating capacity in hospitals by ensuring only those that needed to be in a hospital setting occupied beds. We utilised temporary ‘Safe Haven’ beds and assessment of long-term needs at home (Discharge to Assess) to ensure fewer people were delayed in hospital and were able to move home, or if their needs required it, move to a care home.

Demand for hospital services decreased during the pandemic as hospitals shifted focus and the public were asked to adjust their behaviour to protect the NHS. This saw a notable drop in elective procedures and a reduced number of people attending accident and emergency. As services begin to increase capacity and reintroduce regular procedures, and as people return to their usual activities, we expect to see a rise in hospital attendances and ongoing treatment.

In May 2020, we set up a Route Map Project Board to ensure we could implement the Scottish Government’s Route Map through and out of the covid-19 Crisis across our services. This work was paused as restrictions returned later in 2020 but restarted in early 2021 to support the remobilisation of our services into 2021-22.

Throughout the pandemic, our care homes, home care and reablement workforce and our external providers continued to deliver care and support to people across Edinburgh. These services faced significant challenges during the initial wave of covid-19, with high levels of staff absence due to covid-19 or self-isolation requirements, and periodic outbreaks of covid-19 within care homes.

Early in the pandemic we mobilised a Care Home Support team to provide ongoing support to the care homes for older adults in Edinburgh. The service was made up of staff from services which were temporarily halted due to the pandemic. In line with Scottish Government guidance, assurance visits took place in all care homes for older adults focusing on infection control measures, use of PPE, resident wellbeing and supporting staff with additional reporting and testing regimes. After the initial few months of forming this new service, staff were asked to return to their substantive posts as services opened back up. Recognising the value of this service as a consistent support to care homes, we recruited a team of 12 nurses at the end of 2020 to continue this valuable service.

In May 2020, the Scottish Government issued an update to the National Clinical and Practice Guidance for Adult Care Homes in Scotland in response to the Covid-19 pandemic. A multi-disciplinary team, including our Chief Nurse, key clinical leads and the Chief Social Work Officer was put in place. This team provided assurance to the health board and Scottish Government that the care homes within our remit had the support they needed to provide the highest standards of care to residents.

The treatment of covid-19 also presented challenges to our teams as they sought to continue care in the community in the face of a rapidly spreading new virus. To support our community nursing teams to reduce the suffering for those requiring palliative care due to covid-19, clear guidance and resources were developed, including ‘grab bags’ and exceptional use guidelines for the administration of covid-19 medicine.

Adapting our services – provision of PPE

We host the Southeast Mobility and Rehabilitation Technology (SMART) team, which provides a range of rehabilitation technology services. To meet the demands of the pandemic, the team adapted their services and redeployed staff. Routine services were paused, with only urgent and essential repairs and maintenance undertaken.

Instead, the service shifted their attention to the creation and distribution of Personal Protective Equipment (PPE) and other support to frontline services. The SMART team managed a PPE advice line and PPE distribution for all our services, with 8.4 million items issued. The team also utilised their resources to manufacture over 34,000 face shields (visors), with 1,875 made on the biggest day.

This incredible flexibility was representative of many of our teams during the pandemic.

Supporting the most vulnerable through the pandemic

Throughout the pandemic front-line mental health and substance misuse services remained operational in the statutory and third sector. Face-to-face contact was kept at a minimum and PPE used as required. Special arrangements were made to drop off medicines, with telephone and digital contact used to assess and support people in recovery. A thriving Edinburgh recovery community put on a programme of digital events to support people and their families. As restrictions eased, walk and talk sessions were arranged and group work was resumed in line with the Scottish Government’s Route Map.

Remarkable work was carried out with the homeless community during the early part of lockdown. People were accommodated in city centre hotels and this provided opportunities for better care, including access to health and psychosocial interventions. A significant number of people were started on substitute prescribing to reduce harmful drug use.

The work of the public protection committee continued, with adult protection case conferences being held through digital means.

Throughout the year, we worked with partners to innovate and improve our collective services within the restrictions in place. Digital technology and the redeployment of staff allowed us all to work in new ways that provided greater flexibility to our service delivery.

As with many other organisations, we had to rapidly switch much of our work to digital channels last year. Where possible, our staff moved to working from home and many of our services moved to online delivery. This technology provided increased flexibility to both our service delivery and the people that use our services. We will work with our partners to consider where it is appropriate to continue these ways of working into the future.

Wellbeing calls

Over 46,000 outbound calls were made through the partnership’s ATEC24 (Assistive Technology Enabled Care 24) service. These calls provided an opportunity to check on individuals’ wellbeing, provide companionship and offer advice and support on coping with lockdown. Of those participating in a customer satisfaction survey, 96% felt the wellbeing phone calls during the pandemic had been helpful and enabled them to feel well-supported.

Wellbeing calls were also made to 457 people identified with dementia who were not receiving formal service involvement. These calls allowed a focus on wellbeing, including food/medication/shopping check, daily living activities, general wellbeing, and carer support, with advice and onward referrals provided as required.

Supporting people to stay active (long term conditions programme)

During the early stages of the Covid-19 pandemic, it was recognised that care home residents had reduced physical activity levels, leading to deconditioning and increased risk of falls. In response, a multi-disciplinary care home falls prevention support service was tested between May – October 2020 using the video-consulting platform ‘Near Me’. The aim was to support care home staff to reduce the risk of falls and increase physical activity during the pandemic. Nine care homes received support, resulting in a 61% reduction in reported falls.

We also continued to support people living with long term conditions, many of whom were shielding, through the Fit for Health physical activity programme, run in partnership with Edinburgh Leisure. While sports and leisure venues were closed, we used a pre-recorded Fit for Health class, coupled with motivational and wellbeing calls, to support people with long term conditions to stay active at home. The pre-recorded Fit for Health class was viewed over 4,000 times. A further two Fit for Health pre-recorded classes were made available to all participants in November 2020, with over 170 views in the first month. During December, we launched twice weekly live-streamed Fit for Health classes, which increased to three classes a week from January 2021. Live streaming allows for up to 24 people per week to access Fit for Health on a supported video platform where instructors provide live feedback to participants.

Case study – Steady Steps

Gwen and Arnold, both 91, were attending Steady Steps at the Craiglockhart Leisure Centre prior to lockdown in March 2020. Both were referred to Steady Steps by their physio after having serious falls around the home. During the pandemic, Gwen and Arnold continued their exercise through pre-recorded Steady Steps sessions initially, then live sessions over Zoom. They said:

“We believe the online videos have played an important role in maintaining our mobility, strength, and balance, it gave us structure to our week during the long months of isolation. The fact that we knew [the Steady Steps instructor] beforehand and having that continuity of seeing a familiar face made the online class so enjoyable. It was like having an old friend in the living room with us.” 

As a result of Steady Steps online support, Gwen and Arnold have continued to be active during lockdown. They are feeling physically and mentally stronger and the classes have provided an opportunity to socialise with others.

Digital connections

With many of our services, including older people’s day services, having to pause in-person support during the pandemic, our providers have continued to support as many people as possible using digital means to connect with service users. This included the use of virtual groups, where individuals could continue to meet and enjoy activities together online, and online events like presentations on various subjects.

Case Study – Online support from day service providers

Prior to the pandemic, Michael[1] was retired and providing care for his wife who was living with dementia and attending a day service once per week. At the start of lockdown, the day service provider offered a wellbeing call once a week, which Michael took as his wife was unable too. When the provider began offering virtual support groups, Michael signed himself and his wife up to three different groups. They both looked forward to the interaction with staff and other participants.

Unfortunately, Michael’s wife went into hospital and subsequently passed away. As the family were quite far away, the provider encouraged Michael to continue using the groups for socialisation and to help minimise his isolation and loneliness.

Michael has since been working with the provider to form a carers group, as he had enjoyed connecting with the other carers in the groups so much. This has kept him busy and provided a place where he can continue to talk about his wife.

For those without digital access, support was available from many of the organisations that we fund through our grants programme. These organisations were quick to assist those that needed help in making the transition to the use of digital technology.

Case Study – Golden Years digital inclusion service

Danny[1] is 66 years old. He recently moved into a new flat provided by City of Edinburgh Council. Before that, he lived in veterans housing but had lost contact with the residents of the veterans’ home and was feeling increasingly isolated. Due to the restrictions caused by the covid-19 pandemic he was unable to meet his social worker and his only daughter lives abroad. Danny spends all his time alone at home, only occasionally going to the local shop, but is not confident doing this due to the covid-19 situation.

Danny was referred to Golden Years digital inclusion service by Family Housing Support. The service provided him with a Chromebook and training to support him to set up and use the device. Danny feels less isolated now, enjoying weekly meetings with both his daughter and social worker. He is also able to access online shopping, banking and healthcare services, connect with his friends online and further develop his hobbies despite the restrictions brought on by the pandemic.

ATEC24’s Sheltered Housing Support Service have also recently purchased technological devices, tablets and keyboards for each of the Sheltered Housing schemes with community rooms, using community benefit funding from Utilita. These devices will enable citizens to interact with services online including ordering repeat prescriptions and attending medical appointments using the Near Me initiative. Building their confidence with these devices also allowed citizens to use social media, email or video calls as a means of maintaining connections with family or friends they are unable to see in person, reducing the negative impact of isolation from the pandemic restrictions.

[1] Name has been changed.

[1] Name has been changed.

Our transformation programme continued into 2020-21. After redeployment of resources due to the pandemic, the EIJB approved a rescheduled transformation programme in July 2020.

Our transformation programme is a wide-ranging and ambitious programme of change and innovation, aiming to deliver high-quality and sustainable health and social care services for our citizens. The programme has been structured around the Three Conversations model, with three main programmes of work aligned to conversation stages and a further element delivering cross-cutting, enabling change. The programme is scheduled to run until March 2022.

The key projects within the transformation programme progressed in 2020-21 are discussed under the most relevant strategic priority: