Edinburgh Integration Joint Board Equality Outcomes and Mainstreaming Progress Report 2019 – 2021

Introduction

In December 2019, the Edinburgh Integration Joint Board (EIJB) published its second Mainstreaming Equality and Outcomes Report. This stated how the EIJB proposed to mainstream equality into its day to day working and set out its Equality Outcomes. This document now provides an overview of progress made in embedding its equalities duties and sets out highlights of progress made in achieving the Equality Outcomes.

Under the Equality Act 2010, the EIJB is required by the Public Sector Equality Duty (PSED) to have due regard to the need to:

  • eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by the Equality Act
  • advance equality of opportunity between people who share a protected characteristic and those who do not
  • foster good relations between different people who share a protected characteristic and people who do not.

In Scotland, the PSED is underpinned by specific duties which require the EIJB to:

  • publish equality outcomes every four years
  • report progress on the outcomes and mainstreaming every two years.

The protected characteristics are given in Appendix 2.

Mainstreaming equality simply means integrating equality into the day-to-day working of the Edinburgh Health and Social Care Partnership to help ensure a fair and more equal society. The ways which the Partnership does this are outlined below.

Board Structure and staff

The Edinburgh Integration Joint Board (EIJB) is responsible for the planning and oversight of the health and social care services which it has been delegated.

The Scottish Government outlines who the members of the Edinburgh Integration Joint Board should be. Membership of the EIJB includes residents with experience of using health and care services alongside local councillors, NHS Board members, staff from the Health and Social Care Partnership and a representative from voluntary organisations.  The current membership of the board consists of 10 voting members (nine male and one female) and 16 non-voting members (5 male and 11 female).   Five of the members are people who use adult health and social care services/have unpaid carer experience. These members help ensure that the perspective of people who use adult health and social care services is heard in the deliberations of the Integration Joint Board. The current Board membership is set out in Appendix 1.

The Board meets every eight weeks and meetings are open to the public. Before COVID-19 restrictions were put in place, the meetings were held at different locations around the city and webcast to improve ease of access.   Since the COVID-19 restrictions began, the meetings have been held online via MS Teams and continue to be webcast.  All EIJB papers are available online.

Staff

The EIJB only employs 2 members of staff – the Chief Officer and the Chief Finance Officer.  The vast majority of staff are employed by either City of Edinburgh Council or NHS Lothian. The EIJB continues to work alongside its partners to ensure a diverse workforce which reflects the residents of Edinburgh and promotes fairness. As the EIJB employs only 2 staff, it is not required to produce or publish staff equality information.

Our Values

The Board has a legal duty to produce a Strategic Plan every three years which sets out its plans, vision and long-term outcomes. The current plan was produced in August 2019 and covers the period 2019 to 2022.

The EIJB ensured equality and rights considerations were embedded into the current Plan and has the wellbeing of people living in Edinburgh are at the heart of what it does.  The EIJB continues to be inclusive, transparent and compassionate, and places an emphasis on:

  • quality
  • dignity and respect
  • putting people first through empowerment
  • honesty and transparency
  • working together.

The next Strategic Plan is currently being developed and will be finalised in 2022.

City Vision 2050

The EIJB has signed up to the City Vision 2050 Charter which was developed through a steering group of city partners.  The vison has equalities at its core and commits to creating a more inclusive, affordable and connected city where opportunities are available to all and support is given to those who need it most.

Edinburgh Poverty Commission

The EHSCP supports the work of the independent Edinburgh Poverty Commission, which published its final report – A Just Capital: Actions to End Poverty in Edinburgh – in September 2020.  The report identified six broad areas for action and one cultural challenge to serve as a lens through which each action should be approached to end poverty in Edinburgh.

Staff training, awareness and understanding

The EIJB continues to work with staff to raise awareness of all aspects of equality and diversity.   Mandatory equality and diversity training is provided which gives an understanding of the Equality Act and an awareness of the physical and cultural barriers which many people face.

A number of NHS and Council colleague networks have been established which provide opportunities for peer support, act as a voice for members, share information and help build productive working relationships.  Networks include women’s network, Lesbian, Gay, Bisexual and Transgender + (LGBT+) network, Black and Minority Ethnic (BME) Networks – one of which is specifically for Health & Social Care colleagues, Carer’s Network, disability and long-term health conditions network and Armed Forces.

Integrated Impact Assessments

Integrated Impact Assessments (IIAs) continue to be carried out on new policies and proposals.  These help ensure that any impacts which a proposal may have on equality, human rights, environment and sustainability are considered and that actions are taken to mitigate any negative impacts and opportunities for improvements are considered.  The findings of the IIAs are included in EIJB’s committee reports to ensure that committee members consider any impacts which the proposal may have on equalities, human rights and sustainability in the decisions which they take.   IIIAs are published on the Partnership’s website.

The value and necessity of carrying out IIAs is regularly relayed to managers.   IIA Training sessions (held in partnership with local authority and NHS Lothian partners) is available to all staff and provided quarterly.  Templates, guidance and supporting information are available online.  Before the pandemic, training was held in person however when the COVID-19 restrictions were introduced the training was quickly adapted and held on-line, via MS Teams.  Attendance at the training sessions is high with 262 participants attending since August 2020.  Feedback gathered through the evaluation has been extremely positive.  An IIA training session was also carried out for new lay EIJB board members.

IIAs are signed off by the relevant Head of Service however quality assurance is also provided through the IIA Steering Group.  The IIA Steering Group consists of equality representatives from NHS Lothian, Lothian local authorities and other Health and Social Care Partnerships who regularly quality check a sample of completed assessments.  The IIA Steering Group also regularly reviews and updates the IIA Guidance and Supporting Information documents as required, providing a consistent approach across Lothian.

Procurement

Procurement is undertaken on behalf of the EIJB by either the City of Edinburgh Council or NHS Lothian. NHS Lothian have a specific Equality & Diversity Procurement policy for procurement officers to refer to when letting contracts. This policy helps ensure that any supplier of goods or services chosen to supply NHS Lothian meet the same values of Equality and Diversity held by NHS Lothian.  NHS Lothian Procurement also have a policy on Fair Work practices in addition to a well embedded Community Benefits in Procurement policy.

The Council, in addition to compliance with Equality and diversity regulation, expects contractors to take a positive approach to fair work practices, and reflect this in contract documents, which includes the expectation that contractors commit to:

  • a fair and equal pay policy that includes a commitment to supporting the Living Wage
  • promoting equality of opportunity and developing a workforce which reflects the population of Scotland in terms of protected characteristics
  • flexible working and support for family friendly working and wider work life balance
  • support measures to give staff an effective voice.

The Council’s approach to community benefit (contractual clauses which are used to build a range of economic, social or environmental conditions into the delivery of contracts) has been further developed to help ensure that those with protected characteristics benefit.  Development of the ‘Cenefits’ system now provides enhanced monitoring of community benefits with reference to promoting protected characteristics or to other priority groups such as those living in poverty.

In 2020, THE EIJB agreed to implement a contract uplift for adult social care contracts to allow an uplift of 3.3% for carers hourly rates.  This reflected the board’s recognition of the work health and social care staff make towards keeping vulnerable people in the city safe, to recognise their efforts in the COVID-19 response and to ensure that the workforce receive payment for the Living Wage.

Communications and Engagement Strategy

The current EHSCP Communications and Engagement Strategy (C&E Strategy) was developed and approved in June 2021.  This revised Strategy has been developed in response to the EIJB and the Edinburgh Health and Social Care Partnership’s (EHSCP) ambition to engage and communicate with the widest range of audiences to increase visibility and awareness.

The C&E Strategy includes communications and engagement objectives, approaches and an action plan for both the EIJB and the EHSCP.  The EIJB Public Facing Working Group will lead on the EIJB Event planning and continue to monitor the C&E Strategy implementation and further development as it affects the EIJB     The strategy will be reviewed and updated yearly, and formally refreshed in line with the EHSCP Strategic Plan on a three-year cycle.  The Communication and Engagement team will adhere to a principle of clear and accessible information whereby:

  • information and publications will be made widely accessible to audiences (where appropriate).
  • language and images used will reflect diversity and differing levels of engagement.
  • Staff will be open and honest.

The EIJB Equality Outcomes and Mainstreaming Report identified 5 Equality Outcomes:

  • Equality Outcome 1: People know what support and services are available and know how to access them
  • Equality Outcome 2: People are treated with respect and provided with the best advice and support
  • Equality Outcome 3: People are supported to lead an independent life
  • Equality Outcome 4: Services ae available fairly across the city
  • Equality Outcome 5: Health Inequalities are reduced.

The table below provides an update on progress in implementing the actions listed in the Mainstreaming Equality and Outcomes Report. While this is not an exhaustive list of actions which the EHSCP has taken to reduce inequality, it highlights progress across a diverse range of activities.

Where there is an indication of slippage or inability to take the action forward, the rationale has been indicated in the progress section.

RAG key

Actions in category
1 Action is up and running and ongoing 11
2 Action is on target to be complete by 2023 23
3 Timescale for action has slipped 12
4 Action will no longer be carried out 2

Equality Outcome 1:  People know what support and services are available and know how to access them.

Duty:  Advance equality of opportunity among those who share a protected characteristic and those who do not.

What you said

  • Plain English should be used and not “Council speak” which is often not easy to understand.
  • We do not all absorb information in the same way. One size does not fit all.
  • Not everyone has access to on-line engagement and communications and it should not be relied on.
  • We should be able to access groups and advocacy to help us find out information.
  • Consider ensuring that all digital information (i.e. on-line) is accessible to all.
  • Ethnic minority services are very difficult to source. We don’t have specific ethnic services anymore. Huge area of un-met need.
  • Self-directed support can work well however it is complex and difficult to navigate. More accessible information should be available about how the system works.
  • Why can’t you keep it simple, we do not want to keep filling in lots of forms.
What we will do Progress to date RAG Date due for completion Lead or partner
1.1 The annual EIJB communications and engagement action plan will use a wide range of channels to reach multiple audiences. Over the last year, the communications and engagement team have been focused on ensuring that the content they create – events, website, social media, blogs – are fully accessible.

The website was published before the communications and engagement team was established, and so the team is now retrospectively ensuring that this channel, and all future communications, are accessible.

The Consultation and Engagement Strategy outlines the various communications channels used to engage internally and externally. Although most of the channels detailed are already in place, the communication team are continuing to work towards implementing them all by the end of the next Strategic Planning cycle.  EHSCP Communications and Engagement Strategy

2 April 2022 Lead
1.2 We will work with our partners in the community to make people with protected characteristics more aware of what is available to them locally and how to access services. The Connect Here Initiative has been developed to help make community resources visible and accessible and outlines self-management resources for citizens.  The current, 6th edition of Connect Here Directory reflects the changes in service delivery of Edinburgh’s community resources following the pandemic.   The 7th edition will be released in October 2021.

The Partnership also supports The EVOC Red Book – Directory of third sector organisations and their services

1 Complete Directory will be regularly updated and evaluated Lead
1.3 Inclusive communication will be used throughout the development of the Edinburgh Offer. Materials will be tailored to engage with specific audiences including those with specific communication needs. Work on developing the Edinburgh Pact (formerly the Edinburgh Offer) is continuing.  A range of different approaches were used to find out what health and care means to the people of Edinburgh and our partners.

Between June to September of 2020, colleagues:

  • interviewed 23 city leaders from the third sector, public sector, elected members, Board members, academia and private sector
  • held 12 focus groups with 84 frontline colleagues and practitioners
  • ran a public survey which received 356 responses
  • held 11 diverse community of interest groups, including Black Asian Minority Ethnic, faith groups and people with specific health conditions
  • joined eight voluntary sector forum meetings with 191 participants.

The Edinburgh Pact webpage is now live and shares information in a variety of different media for example the site hosts audio podcasts and Picturing Health – a photography exhibition which reflects what health and social care means to individuals.

Development of the Pact has faced challenges which may see the completion date go beyond December 2021.  Challenges included the restrictions and competing pressures arising from Covid-19 and Capacity challenges in our communications team.

The Edinburgh Wellbeing Pact – Edinburgh Health & Social Care Partnership (edinburghhsc.scot)

3 December 2021 Lead
1.4 The Community Investment strategy will recognise the need for additional ethnic minority services, in particular translation services.

(This has been reframed as community mobilisation reflecting the themes identified by the Edinburgh Wellbeing Pact dialogue.)

To help inform Community Mobilisation, a series of Edinburgh Wellbeing Pact Summer Season conversations are currently taking place across a range of communities (geographical, intertest and identity) including engagement and activities with ethnic minority groups.  The conversations with local communities will ask:

  • what wellbeing means to you
  • how are you connected in your community (or not) and
  • what kind of things are important in your communities.

The findings will help inform to help inform areas of need and priority.

Spending through Community Mobilisation has been pushed back for 1 year and activities will now begin in April 2023.  The existing grants have been extended by one year to end of March 2023.

3 April 2023 Lead
1.5 The new directory/self-help site will be developed with individuals to make any technology as accessible as possible for citizens. The Connect Here Initiative, led by HSCP, outlines a range of self-management resources for citizens.  For ease of use, the main directory of community resources is supported by a series of smaller thematic Connect Here guides covering topics within the main directory. These guides cover a wide range of topics from cycling to mental health apps and can be printed out as A5 double sided booklets.

Performance and evaluation data is currently being explored to determine how readily it is accessed and who is accessing the information, professional or citizen.

1 Lead
1.6 When new policies or service changes are introduced, care will be taken to ensure that changes are communicated to those that may be affected, in a manner which they can understand. New policies or service changes which are proposed are subject to an Integrated Impact Assessment (IIA).  An IIA considers any potential impacts on equality, the environment, the economy and sustainability.  Within the IIA process, consideration is given to how the changes will be communicated to those affected by the proposals particularly those affected by sensory impairment, speech impairment, low level literacy or numeracy, learning difficulties or English as a second language.

IIA training sessions are held every 2 months and in the last year 262 staff members (85 H&SC) have attended training.

1 Ongoing – action is mainstreamed Lead
1.7 Implementation of the health and social care, mental health and wellbeing actions of the British Sign Language Plan will continue. A range of actions from the British Sign Language Plan have been carried out, including:

  • BSL videos describing a range of key EHSCP services have been made and embedded on the Partnership’s website, and further videos are planned.
  • Edinburgh Health and Social Care Partnership’s mental health and wellbeing strategic programmes under the “Thrive” initiative (Thrive Welcome Hubs, Thrive Community and Thrive Collective) have recently undergone an Integrated Impact Assessment (IIA). This highlighted the need for the teams to be aware of the needs of Deaf BSL users and the particular services and supports required to provide the help they need. This will be actioned once staff are recruited and may involve staff training.
  • BSL in care settings project autumn/winter 2019 involved issue scoping, provision of funding for BSL training for care home staff, presentation of a paper about high value care packages for Deaf BSL users at the Hub and Cluster Managers’ meeting
  • Lyrics for Life EHSCP project on suicide prevention included BSL videos
  • EIJB strategic plan easy read version was translated into BSL to assist engagement exercises.

Further actions to be carried out as per the plan which runs to 2024.

2 BSL Plan runs to 2024 Partner of plan and lead for H&SC actions
1.8 People will have access to good quality independent advocacy, if they feel it is required. Over the last twelve months, a co-production group with Independent Advocacy providers and health and social care staff was established which meets regularly to develop a new, improved service specification for the provision of quality independent advocacy services in the city.

Extensive consultation has also taken place to help understand what’s working well and what’s not working so well; to gather suggestions for improvements; and to identify any gaps. Following a procurement process, new independent advocacy contracts are planned to be issued in summer 2022.

An integrated impact assessment was undertaken for the commissioning of independent advocacy services. It highlighted several actions in relation to the development of the service model and specification including the following:

  • Look at how advocacy services engage earlier with children and young people who need independent advocacy before a crisis happens or they are detained.
  • Improve access to advocacy service for people who have substance misuse issues.
  • Explore how collective advocacy can meet the needs of specific groups, including people from LGBT plus communities and older people or people with a physical disability.
  • Consider the need for improved access to advocacy for women who are unpaid carers.
  • Look at how to improve access for people with disabilities and carers of people with a physical disability.
  • Ensure that staff have training to provide a better service to advocacy partners with a range of disabilities. This could include training in BSL awareness, Makaton, Talking Mats and other alternative communications. Consider requirement of BSL interpretation in service specification.
  • Look at how to improve access for people with non-statutory issues or self-referrals from older people.
2 Summer 2022 Lead
1.9 We will build the capacity for more peer led self-help groups. The capacity to deliver peer led self-help groups continues to develop across a range of programmes and services including Thrive, the Rehabilitation and Support Services and a number of grant funded organisations.

Thrive

Peer support has been supported by the peer collaborative as part of the Edinburgh Wellbeing Public Social Partnership (PSP) and more recently through the Thrive Collective commissioning. Thrive commissioning supports:

  • Paid peer workers are paid as part of the Thrive Welcome Teams. They bring their unique contributions which have been highly valued especially over the last year.
  • As part of the Thrive Locality Teams, the Connect Partnership have been supporting a number of peer-led groups. These have been delivered online through the pandemic and have seen a growth in numbers attended. Now that restrictions are being eased, they are looking to develop a blended approach to give people choice and control around how they engage.
  • How a peer led self-help group for people who have sought support from the Thrive Welcome Teams is currently being tested. This was an output of the learning labs where people’s stories were shared. This will be supported by the Connect Partnership.
  • As part of the Thrive Collective the Thrive Peer Community of Practice – delivered by Health in Mind and Consultation Advocacy Promotion Service (CAPS) advocacy – has been commissioned. It will have a remit to build capacity around peer support, provide training and information, and raise awareness of its value. As part of the community of Practice they are already working closely with over 10 organisations all delivering peer support.
  • CAPS Advocacy and Media Education have been commissioned to carry out service user research. The service user research is focused on: BME populations, people with eating disorders, young parents all of which have experienced particularly hard times over the last year.

In addition, Bi-Polar Scotland are supported to host frequent groups for both young people and adults and provide them not only with a space to connect but also bring in people who can help or share things that might help.

A recent meeting with the Scottish Recovery Network looked at developing peer support opportunities and peer working roles across the mental health system. It is hoped to work in partnership to build capacity in Edinburgh.

Edinburgh Community Rehabilitation and Support Services (ECRSS)

The ECRSS have facilitated a Peer Support group for people returning to work following Stroke, MS, Parkinson’s or any physical disabilities.  The Group was created because people told highlighted that there was a gap in the service offered in terms of returning to work support.   The Group continued online throughout the pandemic using MS Teams.   There are currently have 8 – 12 people attending this group every 2nd week.

Hosted by The Ripple Project and supported by the British Lung Foundation and the EHSCP’s Long Term Conditions Programme, the North East Edinburgh Breathe Easy Support Group is currently being established for people who have a lung condition, or anyone affected by a lung condition.  The group aims to provide a holistic response to the emotional, practical and physical issues people can face on a day to day basis. By bringing people together with similar conditions and experiences, the group will facilitate peer support, provide opportunities to become more physically active, support healthy living and provide advice on condition management.

Planned start date: October 2021, weekly group for 10-20 people.

1 Peer groups have been established and are up and running Lead for some, partner on others
1.10 We will prepare and make available, easily understood, good quality information and advice regarding Self Directed Support. The EHSCP has been invited by Social Work Scotland’s Self-directed Support Team (the SDS Team) to test and develop the national Self-directed Support (SDS) standards.  Working with our colleagues in Communities and Families, the City of Edinburgh Council is one of three local authorities engaging in this project over the next six months.  The SDS Team, hosted in Social Work Scotland have been sponsored by the Scottish Government to develop a national framework for Self-directed Support.

There are eleven national SDS standards which have been developed to ensure good practice in assessment, planning and provision of care and support resources.  For example, ensuring that everyone has access to relevant information and that the administration involved in accessing support is minimised are key components of Standard 2 – Early Help & Support.  Over the next six months testing of the standards will be carried out, key learnings will be shared and an action plan developed.  The EHSCP will focus on testing Standard 8 – Worker Autonomy.

2 Summer 2022 Partners in National work and Lead for  implementation of findings locally
1.11 We will redesign the “front door access” to improve accessibility to services and reduce the need for multiple assessments and form filling. The EHSCP transformation programme was revised and re-phased in July 2020 to take account of the ongoing effects of the COVID-19 -19 pandemic.

A decision was taken to disaggregate the planned “Front Door Access” project and to progress elements of that work in other existing projects.

Work to streamline and improve access and pathways into and out of acute services are being taken forward as part of the Home First programme. Plans are being developed for a review and redesign of the Social Care Direct front door as part of the Three Conversations project.

This work will be taken forward in early 2022, informed by the learning from locality based Three Conversations innovation sites. Three Conversations is already having significant impact in terms of providing meaningful support to people more quickly and reducing the number of hand-offs.

Maximising the use of digital technology to improve our “online front door” will form part of our digital transformation plans, however this work is currently paused due to lack of capacity and system pressures.

4 Lead
1.12 We will work to ensure unpaid carers are made aware of the support that is available through active promotion of the service. Following co-production, contracts were issued for carer support services starting in January 2021.  The contract was split into 8 lots with lot 1 having a focus on identifying carers and awareness.  The length of the contract is 5 years, with the option to extend for 3 years.  This is seen as a real positive, providing longer term sustainability, and a strong foundation for growth and development.

A national campaign to raise awareness of services and support available to carers was delayed due to COVID-19 but took place in November 2020.  This did not prove particularly successful in reaching many new hidden carers. As part of the new contract, a local campaign will be run which will promote the carer support available locally.

Publicity and promotions have been affected by the pandemic however during this time, information was circulated about the services via newsletters, partnership e-mails etc.

2 Contract ends 2026 (with option up to 2029) Lead

RAG key

Actions in category
1 Action is up and running and ongoing 11
2 Action is on target to be complete by 2023 23
3 Timescale for action has slipped 12
4 Action will no longer be carried out 2

Equality Outcome 2:  People are treated with respect and provided with the best advice and support.

Duty:

  • Eliminate unlawful discrimination, harassment and victimisation and other conduct that is prohibited by the Equality Act 2010.
  • Foster good relations between people who share a relevant protected characteristic and those who do not.

What you said

  • A workforce which reflects the diversity of the people it serves is likely to improve institutional awareness of barriers, lead to improvement in services for people with diverse characteristics and instil confidence in users with diverse characteristics.
  • A firmer focus on people with multiple intersecting characteristics is needed.
  • Providers of older people’s services, need to make specific efforts to ensure that older LGBTQI people are recognised.
  • I feel pressure is placed on patients in hospital and their representatives to make choices about their long-term future within unacceptable timescales.
  • It is important to make sure that we are safe in the community and that if we come out of hospital we will not face discrimination.
  • We should educate people to raise awareness and acceptance.
  • Improved training in equality issues to raise cultural awareness and sensitivity should be compulsory for front line staff.
  • It is important that all people are treated with respect and given the same opportunities as everyone else.
  • Recognition of LGBTQI older adults is needed.
What we will do Progress to date RAG Date due for completion Lead or partner
2.1 Staff training and awareness raising of all aspects of equality and rights including intersectionality, socio-economic, cultural and physical barriers will be further prioritised. The EIJB continues to work with staff to raise awareness of equality and diversity.   Mandatory equality and diversity training is provided which gives an understanding of the Equality Act and an awareness of the physical and cultural barriers which many people with protected characteristics face. 1 Ongoing Partner
2.1 Staff training and awareness raising of all aspects of equality and rights including intersectionality, socio-economic, cultural and physical barriers will be further prioritised. We continue to roll out the Three Conversations model as a strategic and cultural framework to working with the people who approach us for support. Three Conversations takes a more personal approach and is based on the principle that we should focus on what matters to people, working collaboratively with them as the experts in their own lives.

An understanding of the barriers which people face is imperative to the principle however the he impact of COVID-19 -19 in early 2020 caused a period of uncertainty and slowed progress as adjustments to accommodate pandemic restrictions were made and staff were redeployed to care homes or other teams to help with the crisis situation.  A 3C roll-out plan has been approved and will be implemented by the end of the financial year.

A Transformation-wide Training Pack is being considered for development with Learning and Development colleagues as part of the roll-out of Three Conversations.

2 March 2022
2.1 Staff training and awareness raising of all aspects of equality and rights including intersectionality, socio-economic, cultural and physical barriers will be further prioritised. As part of the Thrive – Rights in Mind priority, a stakeholder group has been established, the ‘Rights in Mind Partnership’ to progress a range of actions to help embed human rights in mental health service provision. Some of the key actions being progressed include the following:

  • A roll out of a new human rights awareness education programme to staff using people with lived experience as facilitators.
  • Dissemination to staff of the Mental Welfare Commission’s booklet – “Rights in Mind Pathway”.
  • Establishing a new Human Rights Based Approaches Steering Group to include overseeing an audit of human rights in mental health services.
  • A literature review of human rights based approaches and supported decision making.
  • Involvement of people with lived experience in mental health officer training programme.
  • Group established to look into improvements in rights for people with mental health issues in hospital discharge planning.
  • Undertake a report into the use of emergency detention in Edinburgh.
2.2 We will carry out staff training across the public, third and independent sectors aimed at equipping staff with the skills to work and communicate more effectively with people with sensory impairment. The “Sensory Impairment Awareness and Skills” training programme commenced delivery in December 2019, and six full days of face-to-face training were delivered to a total of 73 participants from EHSCP teams and the third, independent and community sectors before the final two days were cancelled due to the COVID-19 pandemic. The training covered working and communicating with people with acquired hearing loss, Deaf BSL users, and people with sight loss.

Online MS Teams training entitled “Working with people with sight loss in your locality” was delivered to 150 locality staff between January and March 2021 (social workers, occupational therapists, physiotherapists, community care assistants, social care workers, home care co-ordinators and managers etc.) to support the move from RNIB’s delivery of specialist sight loss social work to delivery by locality teams from April 2021.

Twenty face to face workers within EHSCP were offered a place on the only Scottish pilot of RNIB’s “Vision Friends” training course. Staff were recruited from ATEC24 sheltered housing support teams, homecare teams, care home teams and older people’s day services. Our Vision Friends are specially trained to identify hidden sight loss in the people they support, understand their needs in terms of eye care and communication, and support people with sight loss by implementing simple adaptations to Vision Friends’ practice to help empower the people they support who have sight loss to maintain their independence and improve their quality of life.

Lothian-wide Deafness and Dementia course organised by Lothian See Hear leads and delivered by British Deaf Association February 2020.

Public Health Scotland’s BSL e-learning module and NHS Education for Scotland’s 3 sensory e-learning modules are mandated as essential pre-course learning for all EHSCP sensory training, and now form part of “Essential Learning for Care” staff training.

1 Complete Lead
2.3 Specialist training will be encouraged, for example in Stroke Education. Stroke is the most common cause of severe physical disability amongst adults in Scotland.  Training in Stroke Education is currently a Scottish government priority and as such Stroke Education training is being delivered across the city to HSCP staff in partnership with NHS Lothian and audited by the Scottish Stroke Quality Improvement Board. Data is available on what types of Stroke training for staff is being delivered in the City. 2 Ongoing Partner (Lead is NHS and Scottish Government)
2.4 An increased number of training courses and suicide prevention initiatives targeting specific high-risk groups, will be provided The Every Life Matters co-ordinator (suicide prevention co-ordinator) sources and provides training to a number of internal and external participants, in line with the Every Life Matters national strategy. Based on data sharing and discussion with the Edinburgh Steering Group this is, at times, targeted at particular groups who are more at risk of suicide. For instance, there has been a focus on men, and on people living in areas of multiple deprivation in recent months. The United to Prevent Suicide movement (the communications arm of the national Suicide Prevention Leads Group) is about to launch a campaign focusing on men in the workplace which the co-ordinator would intend to support as far as possible with targeted local training.

There is a plan to conduct a mapping exercise over the next months which would include capacity building within the steering group and to introduce use of NHS Education for Scotland resources for training. This this will likely improve our ability to identify particular groups at risk of health and wellbeing inequalities with our training.

The pandemic meant that some models had to be stopped as they cannot be safely provided on-line and a proportion of our budget was spent on e-licences for alternatives. These licences are likely to be prioritised to frontline council staff, first responders, those working with men in the workplace and women and girls at risk of violence. However, data may change these priorities as time goes on.

Numbers are below for those trained since 2019
A further 200 training licences are being rolled out at present for an online programme ‘Living Works Start’.

  • ZERO Suicide Alliance Training with Pre & Post Training Facilitated Discussion – 146
  • SafeTALK Suicide Prevention – 165
  • ASIST Suicide Prevention (numbers impacted greatly by pandemic) – 32
2 Ongoing Lead
2.5 Collaboration with University of Edinburgh to develop care home training and research centre of excellence. The collaborative work with the University of Edinburgh on the development of care home training and an Edinburgh Training Research Centre is currently paused.

This may be considered as part of future bed-based reviews.

4 Partner
2.6 The Workforce Strategy will consider how best it can achieve a workforce which reflects the diversity of the population of Edinburgh. The Workforce Strategy is currently under development and includes strong links to the issues of fairness and equality at work.

There are 4 key Strategic Priorities that have been identified, these being:

  • Health & Wellbeing
  • Culture & Identity
  • Capacity and Transformation
  • Leadership & Development

Under Culture & Identity, reference is made to a number of commitments regarding parity and equity; addressing inequalities; developing a fair and equal working culture and championing equality and fairness at the heart of everything we do.

Some possible action to support the above include training and awareness on cultural awareness; reviewing representation on groups/panels to ensure we have equitable representation etc.

We will be linking with key groups for BAME, LGBT, Disabilities and Youth.

2 February 2021 Lead
2.7 Develop and train staff in the Three Conversation approach which will focus on what matters to the individual. It recognises the value of a person-centred way of working and recognises that everyone is different and requires different types and levels of support We continue to roll out the Three Conversations model as a strategic and cultural framework to working with the people who approach us for support. This approach aims to achieve improved outcomes for people and families, working in a more preventative and personal way. Three Conversations is based on the principle that we should focus on what matters to people, working collaboratively with them as the experts in their own lives. It recognises the power of connecting people to the strengths and assets of community networks, and the necessity to work dynamically with people in crisis. Staff are encouraged to think creatively about how to support people to deliver improved outcomes.

The impact of COVID-19 in early 2020 caused a period of uncertainty and slowed progress as we adjusted to pandemic restrictions and staff were redeployed to care homes or other teams to help with the crisis.

Our Three Conversation approach remains a key strategic priority for the EIJB Work is underway to permanently embed the Three conversation approach into the way we do business. This roll-out will include developing a training pack through ongoing engagement with our learning and development colleagues.

3
2.8 Support further development of the Dementia Friendly Edinburgh programme. Dementia Friendly Edinburgh activities continue to be run by partners across the city however many have been significantly impacted by the COVID-19 pandemic restrictions.

The promotion of the Herbert Protocol (a scheme which helps find individuals, mainly those with dementia, if they go missing) to increase awareness and uptake has continued since its implementation in 2019. Edinburgh has also been influential and proactively involved in the national rollout of the Herbert Protocol in Scotland which was publicly launched on 21 September 2021

2 Ongoing Partner
2.9 Revise the Edinburgh Autism Plan. A short-term period of consultation was carried out in May 2021 with autistic adults, autistic children and their carers to further inform a refreshed Edinburgh Autism Strategy. The feedback from this consultation is currently being evaluated and the intention is to develop the refreshed Edinburgh Autism Strategy by October 2022. 2 October 2022 Lead
2.10 We will develop and implement a model to ensure that people return “home first” from hospital, wherever possible, before decisions on longer term care and support are made. The Home First (HF) principles are now firmly embedded within many areas across the Health & Social Care system in Edinburgh. A dedicated HF team is now progressing a programme of work to plan and implement various aspects of improvement work in conjunction with Locality Teams and Acute Services. These workstreams primarily focus on the prevention of hospital admission and the facilitation of discharge home, or to a homely environment in a timely manner.

The EHSCP HF team are at the forefront of ongoing work with NHS Lothian, other partner IJB’s and the Scottish Government in relation to the implementation of two major workstreams, the Redesign of Urgent Care (RUC) and Planned Date of Discharge (PDD).

It is anticipated that the HF team moves away from project status and be permanently structured and embedded within Business as Usual in EHSCP. Work is underway to consider a longer-term, stabilised model for the HF team and the workforce established to implement and embed the approach across the health and social care system in Edinburgh. It is crucial that improvement methodology is utilised as a way of working for the HF team to ensure that there is a continuous cycle of improvement on an ongoing basis and the workforce will be upskilled accordingly.

1
2.11 We will evaluate Good Conversation Training and take forward lessons learnt. Discussions have been held with colleagues in Learning and Development about building 3C principles into the induction for new staff.  This has however paused temporarily as other pieces of training are being discussed.  This will be picked up again and progressed as part of one coherent plan which will capture all the training needs. 3

RAG key

Actions in category
1 Action is up and running and ongoing 11
2 Action is on target to be complete by 2023 23
3 Timescale for action has slipped 12
4 Action will no longer be carried out 2

Equality Outcome 3: Individuals are supported to lead an independent life.

Independent living means all people having the same freedom, choice, dignity and control as other citizens at home, at work, and in the community. It does not mean living by yourself or fending for yourself. It means having rights to practical assistance and support to participate in society and live an ordinary life. This is the definition of independent living adopted in the strategic approach to independent living, by the Scottish Government, COSLA, the NHS and the Disabled People‘s Independent Living Movement. Without care and support and the opportunity to direct their support, many people would not be able to participate in society and live an ordinary life.

Duty: Advance equality of opportunity between those who share a relevant protected characteristic and those who do not

What you said

  • It should be easier to access Personal Assistants and supporters, who are essential to independence and quality of life, including support to communicate if required, while out and about
  • Disabled people should be supported to be part of life in Edinburgh, not just disability things.
  • We would like equality of access to services via different channels to support those who can self-help and drive their own care and wellbeing either individually or by support from friends and family and third sector.
  • Changing Places toilets should become mainstream. The lack of accessible toilets with a hoist etc is limiting our access to the community.
  • We need more accessible, affordable houses for young disabled people.
  • The Council should fund job opportunities and support for people with learning disabilities to get jobs.
What we will do Progress to date RAG Date due for completion Lead or partner
3.1 We will roll out the plan for Self Directed Support including trialling and feedback mechanism. As noted above, the EHSCP has been invited by Social Work Scotland’s Self-directed Support Team to test and develop the national Self-directed Support (SDS) standards.  The standards have been developed to ensure consistency of outcomes and approaches in SDS practice across Scotland.

Over the next six months, the EHSCP’s work will centre on testing Standard 8 – Worker Autonomy.  Learning from this will be shared across Scotland and the learning gained from the other test sites will be heard.

2 Summer 2022 Partner
3.2 We will redesign our approach to providing support for individuals with learning disabilities. This will include the redesign of policies, staffing models and support service models. We participated in Health Improvement Scotland’s New Models of Day Support Collaborative from October 2020 – March 2021. This process supported us to define and consider approaches to day support that best meets the needs of individuals who have a learning disability (LD) and their carers. We now want to further develop a menu of choices that reflect the vision of support for people with learning disabilities.

From October 2022 to April 2024 we will engage with a wide range of stakeholder to develop and implement this menu of choices to ensure people who have a learning disability have equal opportunities to live life to its fullest potential.

2 April 2024 Lead
3.3 We will develop and roll out an overarching Technology Enable Care strategy and plan to maximise the benefits and usage of technology to support individuals and their families There is recognition that all aspects of technology enabled care and digital innovation require to be at the forefront of service delivery for the EHSCP now and in the future.

The COVID-19 -19 pandemic has rapidly accelerated the use of digital support and technology and has altered the way we support those who need our help to include a much higher level of virtual support where appropriate. This blended approach of face-to-face and virtual support has now become an established way of working for many teams.

The concepts of digital poverty and digital inequity are at the forefront of the service delivery and post-pandemic redesign and services are considering how they meet the needs of everyone including those who are unable or find it difficult to access technology and digital support. The digital and technology projects within the Transformation Programme have been collated and co-ordinated and now encompass a single Digital, Technology and Equipment project.

The Analogue to Digital Transition within the Technology Enabled Care (Telecare) services is underway with dedicated project support and direction from the Digital Office within the SG. Going forward this will require substantial financial and workforce resource to achieve the full ambitions of this transition.

An initial mapping exercise of the Digital Technology and Equipment Services within the EHSCP has been carried out to establish initial areas of priority and opportunity. Work is ongoing to improve the Community Equipment Service to include partner organisations across the Lothians.

A TEC Reference Group has been established across services within Edinburgh including third sector and independent organisations in an effort to improve the services we provide to service users, reduce duplication and maximise our limited resources.

The national strategy, A changing nation: how Scotland will thrive in a digital world  was published by the Scottish Government in March 2021 and outlines the factors critical for local and national government, and also people, place and the economy to progress digitally. In addition to this, a revised and updated version of Scotland’s Digital Health & Care Strategy (originally published in April 2018), is due to be published imminently following the recent elections. Both strategies will require a more coordinated action and dedicated resource within EHSCP to implement.

In anticipation of this support, a digital readiness survey across all aspects of the service requires to be carried out to identify further areas of focus and priority action.

It is acknowledged that delays have occurred in relation to the digital/tech work due to lack of Project management resources and impact of Covid-19.

3 Ongoing work Lead
3.4 We will develop ‘new types’ of befriending leading to provision of city-wide service to work with befriending organisations to co-ordinate activity in service delivery. The Health and Social Care Grant Programme and the EADP (Edinburgh Alcohol and Drugs Partnership) currently fund organisations to provide Befriending services.  The restrictions imposed due to COVID-19 also saw a number of organisations implement additional befriending telephone services in lieu of face to face activities.

A 3-year community mobilisation and commissioning plan is currently being developed which will see the development of more collaborative, partnership approaches to supporting community sector organisations.  The timetable for this has been pushed back one year with new projects now anticipated to begin in April 2024.

3 April 2024 Lead
3.5 We will work with public and community services to use tools e.g. Lifecurve that identify those who would most benefit from a self-enablement approach The EHSCP’s Long Term Condition’s Programme works together with Lothian Centre for Inclusive Living, to provide support for people living with a long term condition to better understand their condition and develop skills to be better prepared and supported with their everyday challenges. Support is provided by a Self-Management Support Worker to explore ‘what matters’ to people and make decisions that are right for them.

To enable health, social care and third sector practitioners to have a shared approach to supporting people with self-management, the EHSCP’s Long Term Condition Programme has formed the Edinburgh Management Network. Practitioners come together in a community of practice, facilitated through an online platform to connect with partners, share good practice, find out about services, activities and events, and innovate self-management approaches.

The Edinburgh Self-Management Network for practitioners was launched during Self-Management week (28th September-2nd October 2020) and hosted a series of online workshops, sharing good practice as a springboard for developing shared initiatives. Practitioners have since worked together to develop:

  • a shared outcomes framework to direct, plan and evaluate self-management support across Edinburgh;
  • an Integrated Facilitation Team to increase skills and capacity to deliver lifestyle management courses across Edinburgh, aiming to improve access to valued self-management support;
  • a self-management toolkit for practitioners to provide a more formal self-management infrastructure to enable the self-management ethos, principles and methods to be applied in a competent and consistent way by practitioners.
1 Lead
3.6 We will support developments for timely dementia diagnosis and quality post-diagnostic support for people who have a dementia diagnosis, and those who give support. The EHSCP has extended the contract with Alzheimer Scotland to provide Post Diagnostic Support (PDS) until 31 March 2023.  The locality-based service provides support to 330 people newly diagnosed with dementia, at any one time.   PDS is also provided by community mental health staff.  PDS development continues to be taken forward through a range of activities in Edinburgh on a co-production partnership basis.

It is acknowledged however that there have been impacts on services and delays to diagnosis during COVID-19 pandemic.  A blended approach to service delivery is now being taken, dependant on the current COVID-19 restrictions in place.

In addition, the Scottish Government announced on 7 September 2021, in their programme for Government, that they will be providing additional funding for dementia Post Diagnostic Support, to expand access to front line services and to strengthen wider support which benefits people with dementia and their families after a diagnosis.   The EHSCP will be considering how best to take this forward in Edinburgh.

2 31 March 2023 Lead
3.7 We will continue to work with 21st Century homes to provide accessible properties that can meet people’s support needs and maximise the use of assistive technology to enhance people’s independence Workshops have taken place in 2020 with the 21st Century Homes team to seek views of multiple disciplines, both operationally and strategically, across the EHSCP about key elements to consider for accessibility and ensuring digital literacy/access to associated tools is a key priority.

We have continued to work closely with partners in 21st century homes to work on new housing developments across Edinburgh, this is delivering on our key strategy of 4,500 homes for people with additional support needs.

A commissioning exercise, ‘Thrive – A Place to Live’, has been undertaken recently for the provision of supported living and visiting support services for people with complex mental health issues. An associated integrated impact assessment outlined a range of actions associated with accommodation with support services including the following:

  • Future strategic planning and design of accommodation is required to take account of the needs of people growing old in supported accommodation with physical comorbidity as it can negatively impact on where they can live.
  • Work with providers and housing associations to explore options of future proofing supported accommodation to address the issues of current older properties which are not suitable for people who use wheelchairs or people with sensory impairment and have limited options for adaptation. Also explore issues around suitable location of accommodation and accessibility to community resources.
  • At a strategic level, a planning discussion is required on the needs of people over 65 years old with functional mental health issues, and the different supported accommodation provision options available.
  • In the service specification include that providers where possible ensure that their shared accommodation is suitable to meet the needs of lesbian, gay, bisexual and heterosexual people if they wish to bring their partner to visit.
  • At a strategic level, consideration should be given to provide training to different staff groups to help ensure that staff in mental health services have an understanding of physical needs, especially in people who are growing old and will have changing needs.
2 2024 Partner – CEC Lead
3.8 We will provide training and employment opportunities for young people who have disabilities through the Project SEARCH programme. The Project SEARCH programme provides employment and learning opportunities for young people with a disability and is managed through colleagues in City of Edinburgh Council in partnership with NHS, Edinburgh College and Into Work. 2 Ongoing work by CEC Shouldn’t be in now as is run by CEC
3.9 We will work with partners to make changing place toilets more available. The awareness of the need for Changing Places toilets has improved greatly in recent times however the challenge continues to be with retrofitting older buildings.  Work with partners to identify potential suitable locations for changing place toilets is continuing. 3 Ongoing Advocacy

RAG key

Actions in category
1 Action is up and running and ongoing 11
2 Action is on target to be complete by 2023 23
3 Timescale for action has slipped 12
4 Action will no longer be carried out 2

Equality Outcome 5: Health inequalities are reduced

Duty:

  • Advance equality of opportunity between people who share a relevant protective characteristic and those who do not.
  • Reduce inequalities of outcome caused by socio-economic disadvantage.

What you said

  • How can we close/narrow the inequality gap?
  • Need to appreciate social factors – poverty as a barrier to taking responsibility for own health. I think wealthier people with more resources are much more likely to be able to manage their own health.
  • How are you how going to influence housing/place and employability?
  • Target resources at communities and citizens who are already adversely impacted by inequality in their day to day lives; people in poverty, single parents, BMD communities, communities with high crime rates, levels of drugs and alcohol deaths etc.
What we will do Progress to date RAG Date due for completion Lead or partner
5.1 Increase opportunities for vulnerable people, of supporting, sustaining and achieving paid employment, volunteering and education. Earlier in 2021, The EIJB agreed to extend its contract with Volunteer Edinburgh for a further 3 years to provide support to people with long term conditions, disabilities & other support needs to secure and sustain volunteering opportunities.  In addition to working with individuals, support and guidance is also given to volunteer involving organisations.

The Edinburgh Community Stroke Service provides access to a multidisciplinary team to support rehabilitation, based on individual needs, in the community following a stroke.  The service also provides a Peer Support group for people returning to work following Stroke, MS, Parkinson’s or any physical disabilities.

2 Ongoing – contract until March 2024 Lead
5.2 Inclusive Edinburgh homeless service will provide an integrated response to homeless people with complex needs including a housing first option and open its new Centre in 2020. ‘The Access Place’ will open on 1st November 2021, offering homeless people with complex needs a one stop shop where they can access integrated primary care, housing and social work support. The facility will be run by the Edinburgh Health and Social Care Partnership and will allow homeless people who have complex needs to seek advice and support with medical, housing and social care issues.  People who use services have been involved in the redesign with the physical environment and social spaces within the building developed to create a psychological environment where those accessing care and support can feel safe. 1 Centre open Nov 2021 Lead
5.3 Continue with and review independent advocacy support for mitigating against Universal Credit. A service level agreement with Advocard is in place which provides individual and collective advocacy services for Edinburgh residents who use mental health services and are claiming benefits, including (but not limited to) Employment Support Allowance, Personal Independence Payment and Universal Credit.

Regular monitoring of activities is carried out and reports produced on activity levels and compliance, twice a year.

2 Ongoing Lead
5.4 Improve the pathway for students with caring responsibilities, across colleges and universities to access care and support statutory services. Following co-production, contracts were issued for carers support starting in January 2021.  The contract was split into 8 lots with lot 6 focussing on young adult carers (aged 16 to 25 and no longer at school). The services delivering on Lot 6 have made good progress, particularly around their work with further education.

Working with staff and students directly around the issue of carer identification, how to refer for support and to who/where. For example, one agency is having meetings over lunch with young adult carers, giving free space and time to talk about their respective situations and how/where to go for help. They have also run sessions with guest speakers for both students and college staff including for example reception staff.

Work with Universities has been slower however due to factors including exam times and pandemic restrictions. There is also an understanding that Young Adult Carers tend to seek advice when, for example the nature of their study becomes “harder” and during times of heightened stress such as exam time. The consensus is that the work going forwards shall seek to identify them before these times to ensure the carers are supported throughout the year.

2 Lead
5.5 Review health screening programmes that people have access to but are not engaging with. Over the last 2 years there has been significant disruption to cancer screening services, including pauses whilst staff were deployed to support the COVID-19 pandemic response.

Before March 2020 and after restart, much work is being done across screening services to help eliminate barriers which may prevent people groups of people from attending screening. For example:

  • in long term residential mental health units, on site cervical sampling is being further developed together with training of MH staff in cervical sampling and signs and symptoms awareness training.
  • Through MEHIS, LD groups and primary care, the use of health tracker (patient held record) is being encouraged to prepare for health appointments including screening. Easy read literature and storyboards are now used to increase informed decision making. Learning events have been coproduced with people with learning disabilities and from BAME communities and screening is now included in annual primary care review for people with LD.
  • A GP good practice guide, informed by successful pilots in areas of greatest deprivation to address barriers, has been shared across primary care
  • Health check appts in primary care for those in deprived areas and marginalised vulnerable groups to discuss bowel health and screening before invitation to screening to improve uptake with informed consent and symptom awareness
3 Ongoing Support
5.6 The link worker network, which supports GPs in areas of economic deprivation, will be augmented with a strengthened welfare rights capacity through third sector partners. The Community Link Worker network has continued to develop across Edinburgh and there are now 21 link workers covering 37 GP practices, employed by 11 voluntary sector organisations.

The network focusses on areas of Edinburgh with high levels of deprivation.  There have been positive impacts on clients of all ages, with significant, measured increase in health and wellbeing and increased number of patient engagements.   People experiencing mental health issues (50%) or social isolation/loneliness (23%) are the main reasons for referrals with onward links made to over 150 services, projects and activities 84% of which are delivered by Edinburgh’s vibrant voluntary sector.

Service delivery has been impacted by COVID-19 restrictions however Community Link Workers were quick to adapt and continue to offer a blended approach to their service delivery.

There are several new developments proposed in the coming months for the CLW network.  Several new GP practices will be joining the Network and there is a new opportunity to work alongside the on-site student population at Heriot Watt University.  Operational support and line management will also be provided to Edinburgh’s six ‘Improving the Cancer Journey’ Link Workers (Macmillan), which is a new departure and experience for the CLW Network. This programme has funding for five years.

The consortium delivering welfare rights in Edinburgh consists of Citizens Advice Edinburgh, Community Help & Advice Initiative and Granton Information Centre and continues to deliver in GP practices and health centres, community mental health hubs and drug and addiction recovery hubs. The welfare rights advisors work closely with the community link workers, primary care staff and the locality community mental health and addiction teams. The welfare rights services continue to be strengthened in all settings including GP practices.

2 Ongoing Lead
5.7 Edinburgh Access GP Practice will work with housing colleagues to support and promote the Housing First model. Since August 2018, Edinburgh has been one of 5 areas across Scotland who have worked alongside partner agencies to implement the Housing First Pathfinder Project.  Housing First offers people experiencing homelessness with complex needs access to permanent secure housing (which they would previously have been bypassed for) with extensive wrap around support for as long as they need it.  Since August 2018, 120 of Edinburgh’s most vulnerable citizens have been offered Housing First. The high tenancy sustainment rate demonstrates that  when people have the foundation of a home and stability they are able  take advantage of support services which can help build a platform to pursue personal goals and improve quality of life  thus ending their homelessness. 1 Project established and work is ongoing Partner
5.8 The Inclusion Health group will seek to improve care and support for the most vulnerable population groups in the city. Edinburgh Health and Social Care Partnership is a member of The Centre for Homelessness and Inclusion Health – a collaboration between the University of Edinburgh and local partners in Scotland to improve the health and wellbeing of people who experience homelessness. It brings together people with lived experience of homelessness, those working in the NHS, third sector, policy, local government and academia to work together to develop learning, teaching and research to improve the health and wellbeing of people who experience the worst health outcomes in society. The Centre for Homelessness and Inclusion Health was established in 2017 and since then, have built up strong partnerships working across a range of different homelessness organisation in the city. We have increased our understanding of different perspectives – including those of people with lived experience of homelessness – and developed a clear vision of how we can work together to make a difference. 1 Centre and partnership working established. Partner
5.9 Through the Future Focussed Infrastructure (FFI) Project, continue joint work to identify need for and ensure provision of affordable, warm, adaptable, accessible and connected homes to meet needs within the city (short, medium and long term). Investment in existing homes to improve health through improving housing quality. Implementation and mainstreaming of Housing First approach. The FFI project has been delayed due to resource and capacity challenges however, joint work is underway with colleagues in CEC Housing to identify the needs of the Partnership to inform future housing development opportunities. A number of development opportunities are ongoing where the Partnership have outlined the requirements for housing provision for older people, learning and physical disabilities and mental health. 3 Delayed due to resource and capacity challenges Lead

RAG key

Actions in category
1 Action is up and running and ongoing 11
2 Action is on target to be complete by 2023 23
3 Timescale for action has slipped 12
4 Action will no longer be carried out 2

Equality Outcome 5: Health inequalities are reduced

Duty:

  • Advance equality of opportunity between people who share a relevant protective characteristic and those who do not.
  • Reduce inequalities of outcome caused by socio-economic disadvantage.

What you said

  • How can we close/narrow the inequality gap?
  • Need to appreciate social factors – poverty as a barrier to taking responsibility for own health. I think wealthier people with more resources are much more likely to be able to manage their own health.
  • How are you how going to influence housing/place and employability?
  • Target resources at communities and citizens who are already adversely impacted by inequality in their day to day lives; people in poverty, single parents, BMD communities, communities with high crime rates, levels of drugs and alcohol deaths etc.
What we will do Progress to date RAG Date due for completion Lead or partner
5.1 Increase opportunities for vulnerable people, of supporting, sustaining and achieving paid employment, volunteering and education. Earlier in 2021, The EIJB agreed to extend its contract with Volunteer Edinburgh for a further 3 years to provide support to people with long term conditions, disabilities & other support needs to secure and sustain volunteering opportunities.  In addition to working with individuals, support and guidance is also given to volunteer involving organisations.

The Edinburgh Community Stroke Service provides access to a multidisciplinary team to support rehabilitation, based on individual needs, in the community following a stroke.  The service also provides a Peer Support group for people returning to work following Stroke, MS, Parkinson’s or any physical disabilities.

2 Ongoing – contract until March 2024 Lead
5.2 Inclusive Edinburgh homeless service will provide an integrated response to homeless people with complex needs including a housing first option and open its new Centre in 2020. ‘The Access Place’ will open on 1st November 2021, offering homeless people with complex needs a one stop shop where they can access integrated primary care, housing and social work support. The facility will be run by the Edinburgh Health and Social Care Partnership and will allow homeless people who have complex needs to seek advice and support with medical, housing and social care issues.  People who use services have been involved in the redesign with the physical environment and social spaces within the building developed to create a psychological environment where those accessing care and support can feel safe. 1 Centre open Nov 2021 Lead
5.3 Continue with and review independent advocacy support for mitigating against Universal Credit. A service level agreement with Advocard is in place which provides individual and collective advocacy services for Edinburgh residents who use mental health services and are claiming benefits, including (but not limited to) Employment Support Allowance, Personal Independence Payment and Universal Credit.

Regular monitoring of activities is carried out and reports produced on activity levels and compliance, twice a year.

2 Ongoing Lead
5.4 Improve the pathway for students with caring responsibilities, across colleges and universities to access care and support statutory services. Following co-production, contracts were issued for carers support starting in January 2021.  The contract was split into 8 lots with lot 6 focussing on young adult carers (aged 16 to 25 and no longer at school). The services delivering on Lot 6 have made good progress, particularly around their work with further education.

Working with staff and students directly around the issue of carer identification, how to refer for support and to who/where. For example, one agency is having meetings over lunch with young adult carers, giving free space and time to talk about their respective situations and how/where to go for help. They have also run sessions with guest speakers for both students and college staff including for example reception staff.

Work with Universities has been slower however due to factors including exam times and pandemic restrictions. There is also an understanding that Young Adult Carers tend to seek advice when, for example the nature of their study becomes “harder” and during times of heightened stress such as exam time. The consensus is that the work going forwards shall seek to identify them before these times to ensure the carers are supported throughout the year.

2 Lead
5.5 Review health screening programmes that people have access to but are not engaging with. Over the last 2 years there has been significant disruption to cancer screening services, including pauses whilst staff were deployed to support the COVID-19 pandemic response.

Before March 2020 and after restart, much work is being done across screening services to help eliminate barriers which may prevent people groups of people from attending screening. For example:

  • in long term residential mental health units, on site cervical sampling is being further developed together with training of MH staff in cervical sampling and signs and symptoms awareness training.
  • Through MEHIS, LD groups and primary care, the use of health tracker (patient held record) is being encouraged to prepare for health appointments including screening. Easy read literature and storyboards are now used to increase informed decision making. Learning events have been coproduced with people with learning disabilities and from BAME communities and screening is now included in annual primary care review for people with LD.
  • A GP good practice guide, informed by successful pilots in areas of greatest deprivation to address barriers, has been shared across primary care
  • Health check appts in primary care for those in deprived areas and marginalised vulnerable groups to discuss bowel health and screening before invitation to screening to improve uptake with informed consent and symptom awareness
3 Ongoing Support
5.6 The link worker network, which supports GPs in areas of economic deprivation, will be augmented with a strengthened welfare rights capacity through third sector partners. The Community Link Worker network has continued to develop across Edinburgh and there are now 21 link workers covering 37 GP practices, employed by 11 voluntary sector organisations.

The network focusses on areas of Edinburgh with high levels of deprivation.  There have been positive impacts on clients of all ages, with significant, measured increase in health and wellbeing and increased number of patient engagements.   People experiencing mental health issues (50%) or social isolation/loneliness (23%) are the main reasons for referrals with onward links made to over 150 services, projects and activities 84% of which are delivered by Edinburgh’s vibrant voluntary sector.

Service delivery has been impacted by COVID-19 restrictions however Community Link Workers were quick to adapt and continue to offer a blended approach to their service delivery.

There are several new developments proposed in the coming months for the CLW network.  Several new GP practices will be joining the Network and there is a new opportunity to work alongside the on-site student population at Heriot Watt University.  Operational support and line management will also be provided to Edinburgh’s six ‘Improving the Cancer Journey’ Link Workers (Macmillan), which is a new departure and experience for the CLW Network. This programme has funding for five years.

The consortium delivering welfare rights in Edinburgh consists of Citizens Advice Edinburgh, Community Help & Advice Initiative and Granton Information Centre and continues to deliver in GP practices and health centres, community mental health hubs and drug and addiction recovery hubs. The welfare rights advisors work closely with the community link workers, primary care staff and the locality community mental health and addiction teams. The welfare rights services continue to be strengthened in all settings including GP practices.

2 Ongoing Lead
5.7 Edinburgh Access GP Practice will work with housing colleagues to support and promote the Housing First model. Since August 2018, Edinburgh has been one of 5 areas across Scotland who have worked alongside partner agencies to implement the Housing First Pathfinder Project.  Housing First offers people experiencing homelessness with complex needs access to permanent secure housing (which they would previously have been bypassed for) with extensive wrap around support for as long as they need it.  Since August 2018, 120 of Edinburgh’s most vulnerable citizens have been offered Housing First. The high tenancy sustainment rate demonstrates that  when people have the foundation of a home and stability they are able  take advantage of support services which can help build a platform to pursue personal goals and improve quality of life  thus ending their homelessness. 1 Project established and work is ongoing Partner
5.8 The Inclusion Health group will seek to improve care and support for the most vulnerable population groups in the city. Edinburgh Health and Social Care Partnership is a member of The Centre for Homelessness and Inclusion Health – a collaboration between the University of Edinburgh and local partners in Scotland to improve the health and wellbeing of people who experience homelessness. It brings together people with lived experience of homelessness, those working in the NHS, third sector, policy, local government and academia to work together to develop learning, teaching and research to improve the health and wellbeing of people who experience the worst health outcomes in society. The Centre for Homelessness and Inclusion Health was established in 2017 and since then, have built up strong partnerships working across a range of different homelessness organisation in the city. We have increased our understanding of different perspectives – including those of people with lived experience of homelessness – and developed a clear vision of how we can work together to make a difference. 1 Centre and partnership working established. Partner
5.9 Through the Future Focussed Infrastructure (FFI) Project, continue joint work to identify need for and ensure provision of affordable, warm, adaptable, accessible and connected homes to meet needs within the city (short, medium and long term). Investment in existing homes to improve health through improving housing quality. Implementation and mainstreaming of Housing First approach. The FFI project has been delayed due to resource and capacity challenges however, joint work is underway with colleagues in CEC Housing to identify the needs of the Partnership to inform future housing development opportunities. A number of development opportunities are ongoing where the Partnership have outlined the requirements for housing provision for older people, learning and physical disabilities and mental health. 3 Delayed due to resource and capacity challenges Lead

Voting Members

Councillor Ricky Henderson (Chair), Council elected member

Angus McCann (Vice-Chair), NHS Lothian board member of the EIJB

Councillor Robert Aldridge, Council elected member

Councillor Phil Doggart, Council elected member

Councillor George Gordon, Council elected member

Councillor Melanie Main, Council elected member

Siddharthan Chandran, NHS Lothian board member of the EIJB

Martin Hill, NHS Lothian board member of the EIJB

Peter Murray, NHS Lothian board member of the EIJB

Richard Williams, NHS Lothian board member of the EIJB

Non-Voting Members

Bridie Ashrowan, Third Sector Rep

Colin Beck, Co-Chair Professional Advisory Group

Carl Bickler, Co-Chair Professional Advisory Group

Heather Cameron, Lead Allied Healthcare Professional

Christine Farquhar, Carer Rep

Helen FitzGerald, NHS Staff Side Rep

Ruth Hendery, Carer Rep

Kirsten Hey, CEC Staff Side Rep

Jackie Irvine, Chief Social Work Officer

Grant Macrae, Service User Rep

Jacqui Macrae, Chief Nurse

Ian McKay, Clinical Director

Allister McKillop, Service User Rep

Moira Pringle, Chief Finance Officer

Judith Proctor, Chief Officer

Emma Reynish, Registered medical practitioner not providing primary medical services

Rachel Gentleman (Secretary)

Matthew Bass (secretary)

  • age
  • disability
  • gender reassignment
  • marriage and civil partnership
  • pregnancy and maternity
  • race
  • religion or belief
  • sex
  • sexual orientation.
  • Under the Fairer Scotland Act, inequalities of outcome caused by socio-economic disadvantage must be considered in strategic decisions