Integrated Impact Assessments – External commissioning

External Commissioning Framework (interim)

Our ambition is to implement a ‘One Edinburgh’ approach for all homebased support services, to ensure equity of access to quality support across the city for people and their carers. This includes commissioning improved integrated support options for adults living at home which are sustainable, well-coordinated, accessible, and appropriate at point of need, supporting improved outcomes and maximising independence.

Similarly, for providers, it is our ambition to shift from competitive, shorter term commissioning models to long term collaboration and partnership commissioning instead. The commissioning of these services will define a modern Edinburgh Offer between health and social care providers, support organisations and our citizens.

We are making the commitment to work closely with providers, people who are supported by our services, carers and communities, to co-produce a new contract that is fair and equitable, whilst enabling us to meet the existing and projected demand.

Assuming successful implementation of our internal reablement model, the key elements of the proposed external commissioning framework will include: 50,000 hours commissioned alongside our internal reablement model; a locality-based framework; modelling to agree a sustainable rate; and a transitioning plan to get us there.

A full integrated impact assessment took place following two sessions in July and August 2022, considering the proposed changes within the entirety of the One Edinburgh Programme, including an increased reablement offer, more flexibility in visits, and optimisation work taking place with providers to ensure our shared capacity is maximised.

This IIA is an update of that work, to specifically focus on the external commissioning framework. We have also scheduled an additional session specifically with carers and people who use our services.

Co-production has also continued with our external providers throughout this process.

22 June 2023

Name Job Title Date of IIA training
Rachael Docking

IIA facilitator

Programme Manager, EHSCP January 2020
Caroline Todd

IIA facilitator

Programme Manager, EHSCP April 2022
Denise McInerney

Note taker

Executive Assistant, CEC
Susan Robertson Strategic Planning and Commissioning Officer, EHSCP
Steph Craig North East Hub Manager, EHSCP
Paula Deegan Category Delivery Lead, CEC
Jayne Kemp Planning and Commissioning Officer, EHSCP
Lisa Forbes Hub Services Manager, EHSCP
Chelsea Silk Contracts officer, EHSCP
Peter Lloyd Data Analyst, EHSCP
Rene Rigby Independent Sector Lead, Scottish Care
David Walker Principal Accountant, CEC
Linda Irvine-Fitzpatrick Strategic Programme Manager, Thrive Edinburgh, Substance Use and Homelessness

SRO, Edinburgh Wellbeing Pact and Community Mobilisation, EHSCP

Anna Duff North West Locality Manager, EHSCP
Lynn Forrest Hub Service Manager, EHSCP
Catherine Mathieson Cluster Manager, EHSCP
Evidence Available – detail source Comments: what does the evidence tell you with regard to different groups who may be affected and to the environmental impacts of your proposal
Data on populations in need EIJB Strategic Plan 2019-2022

Edinburgh Joint Strategic Needs Assessment (JSNA)

National Records of Scotland (NRS) population projections for local authority areas

Audit Scotland Report on Health and Social Care Integration

The average age of the population of City of Edinburgh is projected to increase as the baby boomer generation ages and more people are expected to live longer. In 2020 the 75+ age group comprised 6.9% of Edinburgh’s population, and during the period 2018-2028 this group is projected to see the largest percentage increase (+24.8%).

Edinburgh will also see an increase of those with complex and long-term care needs within the adult population, notably those in the higher age groups who are considered more at risk from social isolation which can affect health and wellbeing, and the rise in conditions such as dementia.

Edinburgh’s population is expected to increase from 527,620 (mid-2020) to 575,576 by 2037.

Estimates of future numbers of older people are sourced from National Records of Scotland (NRS) population projections for local authority areas. Of particular interest in terms of anticipated needs for support is the population aged 85 years and over. The number of people aged 85+ living in Edinburgh is projected to increase by 80% between 2018 and 2043.

Within 20 years the number of people living with dementia could rise by 61.7 % to 11,548 people.

The number of older people over 75 living in the city is expected to grow by over 75% and the number of people requiring intensive levels of support, including those with complex physical and mental health needs, is expected to increase by 61% during the same period.

Social isolation and loneliness can have significant adverse effects on people’s health and well-being, and age and living alone increase the risk of social isolation and loneliness (evidence from Scottish Parliament’s Inquiry into Age and Isolation, 2015).

At any one time, around one in four people (over 120,000 people) in Edinburgh experience a mental health problem. Anxiety and depression are the most common mental health problems, but others include schizophrenia, personality disorders, eating disorders and dementia.

The Scottish Government report, the ‘Same as You’ indicated that 2% of the population have a learning disability with the vast majority being unknown to services. NHS Lothian Community Learning Disability teams within Edinburgh are in contact with 1,520 people. The City of Edinburgh Council knows of 3,405 people with learning disabilities in the city.

Edinburgh is estimated to have 30,735 adults aged 16-64 with moderate to severe disabilities.

Around 20% of Edinburgh’s population experience either hearing loss or significant sight loss. The majority of those with a sensory impairment have hearing loss.

There are estimated to be 65,084 carers in Edinburgh, or 13.7% of the population. One in five of these carers provides over 50 hours of care a week. Carers can, for example, prevent avoidable hospital admissions and contribute to people’s overall health and wellbeing. Therefore, as well as there being a strong case for supporting carers based on human rights and quality of care, there is also a compelling economic case. By providing appropriate and timely support to carers resources are saved in the long term.

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

In 2011, 7.8% of Edinburgh’s population was “White other” (non-British or Irish) – the fifth highest proportion in the UK

At 2011, among non-White ethnic groups, Chinese was the most common (around 8,000 people), followed by Indian (just under 6,500), Pakistani (just under 6,000) with other Asian and Black African both having around 4,500

Censuses since 1971 show an increasing proportion of single person households (from 23% to 39%)

Data on service uptake/access EIJB Strategic Plan 2019-2022

Internal Service Reports

Care Inspectorate: Inspection of adult social work and social care services (March 2023)

EIJB Strategic Plan:

Increased need for homecare, reablement or outreach services:

Advances in health care and standards of living means more of us are living longer

More of us are living with frailty and multi-morbidity, placing more pressure on carers and the traditional approach to publicly funded health and social care services.

In addition, society and government are becoming increasingly aware and taking account of the effect of mental illness, living with disabilities and a range of long-term conditions.

As overall demand increases, the supply and related costs of health and social care come under increasing pressure.

Within cities this is further heightened by the gradual effect of urbanisation and a rise in inequality.

Audit Scotland’s recent report reviewed the changes being introduced through the integration of health and social care. The report sets out the challenge of increasing demand for services and growth over the next 15 years in Scotland. Among the pressures identified were:

12% increase expected in GP consultations

33% increase in the number of people needing homecare

31% increase in those requiring ‘intensive’ homecare (defined as 10 + hrs pw.)

35% increase in demand for long-stay care home places

28% increase in acute emergency bed days and

16% increase in acute emergency admissions.

Homecare and Reablement Support Information:

Combined care at home (externally commissioned) and home based care (internally supported) deliver over. 6 million hours of care and support every year.

Externally commissioned care and support is delivered to 5,340 people on average a week (119,000 hrs pw) by 70+ care providers of varying sizes and scale across the city through spot contracts and individual service funds (ISF).

Internal services unsustainable in current form deliver a higher amount of long-term care support than reablement. We support on average 783 people a week (6329 hrs pw). The breakdown of this support is;

Average of 513 hours pw supporting adults (under 65)

5817+ hrs pw support older people (over 65)

Unmet need 31 May 2023 127 older people waiting for care at home support totalling 967.75 hours per week to remain independent in their own homes (acknowledging data quality issues with time lapse since initial referral) and an additional 57 older adults totalling 448.75 hours had interim EHSCP support team arrangements in place meeting assessed needs i.e. Reablement, but who still require a long term provider to transition support to. Maximising capacity in our workforce could help to support more individuals in need.

Care Inspectorate: Inspection of adult social work and social care services

The inspection of adult social work and social care (March 2023) identified a number of areas for improvement, some of these included:

  • There were significant weaknesses in the design, structure, implementation and oversight of key processes, including the assessment of people’s needs and in their case management
  • Approaches to early intervention and prevention were uncoordinated and inconsistent
  • Long standing significant delays in discharging people from hospital, people waiting for assessment of their care needs and meeting vulnerable peoples’ unmet needs had recently begun to improve
  • Self-directed support had not been implemented effectively
  • There was insufficient support for unpaid carers
  • Prioritised actions will be required to ensure the needs of people and carers are met, and their wellbeing improved, more consistently
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Edinburgh Joint Strategic Needs Assessment (JSNA)

Christie Commission (2011)

EIJB Strategic Plan 2019 – 2022


·       Mental ill health is not evenly distributed across society and is more common in socio-economically deprived areas.

Being old is also a risk factor for poor mental health with depression affecting one in five older people living in the community and two in five living in care homes.

Dementia is far more prevalent in people over 60 with the incidence increasing further with age.

Research shows that people living in areas with higher levels of deprivation also have poorer physical and mental health throughout their lives. However, health inequalities are not restricted to areas of multiple deprivation – up to 50% of people experiencing poor health do not live in the most deprived communities.

Social isolation and loneliness which are associated with higher mortality rates among older people – we know that the number of single households in Edinburgh is increasing, and that a substantial proportion (around 38%) of older people live alone.

The Christie Commission highlighted that the greatest challenge facing public services is to combat the negative outcomes for individuals and communities arising from deep-rooted inequalities.

EHSCP will embrace the Three Conversations approach as a combined cultural reorientation and delivery philosophy, which will produce a deeper understanding of how to support communities. This approach is particularly important in areas of multiple economic disadvantages, where individuals and families can experience multiple needs being met with well intentioned, but uncoordinated public services.

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

Data on equality outcomes EHSCP Edinburgh ‘Offer’ Pact Consultation 2019

EHSCP IIA Strategic Plan 2019-22

BME Equality Workers Forum Statement

Edinburgh Offer Pact Consultation raised themes for the citizens of Edinburgh around:

Making information accessible

Equality /SIMD;
Aware of those who do not have a voice;

Meaningful consultation (allowing time to respond)

EHSCP IIA Strategic Plan 2019-22:

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

In Edinburgh, by 2041, compared with 2016, there will be 32% more people aged 65 and older and 78% more people aged 75 years and over. The implication of this for health and social care is significant because as people age, they are more likely to need the support of statutory services.

The EHSCP knows of 25,510 people with a physical disability, of which 1,540 are in receipt of services from the Partnership. This population is estimated to rise annually by 1.4%.

It also knows of 8,684 people with a learning disability and supports 1,335. The national population of adults with a learning disability is predicted to increase by 2% each year.  People with learning difficulties often have poorer health outcomes compared to the general population and are at risk of dying from causes that are preventable.

In 2010/2011, there were twice as many GP consultations for anxiety in areas of deprivation than in more affluent areas in Scotland. People with mental health problems are more likely to have serious debt problems, increased social isolation, poor physical health and live in areas of deprivation.

The Scottish Household Survey (2011) estimates there are 65,084 carers living in Edinburgh, this equates to 13.7% of the population.

Those who provide 50+ hours per week, amount to 13,761 people.

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

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

literature evidence
NICE: Overview | Intermediate care including reablement | Guidance | NICE

Reablement outcomes references:

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Role and principles of reablement | SCIE


Scottish Government – National Health and Social Care Integrated Workforce

In Scotland improving workforce planning is vital to sustaining our high quality and safe services into the future. National comparisons of healthcare workforce planning have underlined the need for a range of responses to global supply and demand challenges.

Future Workforce: The skills that will be required and shaped by our ongoing transformation of services, in line with patient and service user demand.

Efficient Use of the Workforce

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

client experience information
EHSCP Satisfaction Consultation Feedback March 2021

Feedback example from family to locality team – on importance of access to information

Edinburgh Pact consultation 2019

EHSCP Satisfaction Consultation Feedback early findings indicate areas of support individuals and carers value the most for the care and support they receive through external care providers – 1057 respondents.

Preference for fixed timing and visit length over flexibility but need to accommodate both options:

·    at the same time and for the same length each time? 42 (64.62%)

·    at different times so it can change when you need it to? 23 (35.38%)

·    Consistency of carers supporting – 16.92%

·    Good communication with provider – 6.15%

·    Social isolation – 6.15%

·    Gender preferences of carers supporting – 4.62%

Edinburgh Wellbeing Pact Coproduction:

Themes of feedback relevant to this proposal include:

·     Shared Purpose – to achieve and maximise the wellbeing of all our citizens.

·     Relationships

·     Community Mobilisation

·     Agility

·     Radical transformation

·     Measuring and evidencing change

·     Supporting unpaid carers and families

·     Skilled and equipped workforce to implement community-based support

Evidence of inclusive engagement of people who use the service and involvement findings Independent Review of Adult Social Care (2021) Independent Review of Adult Social Care in Scotland recommendations:

Culture shift values human rights, lived experience, co-production, mutuality and common good

Shift attitude towards technology and data sharing to improve people’s experience of social care to help them live independently

Focus on improving performance through greater transparency, innovation and use of digital technology

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

Greater integration at a local level driven by better partnerships, collaboration and effective local delivery

People must be able to access support at the point they feel they need it

Move away from time and task and defined services to commissioning based on quality and purpose of care – focused upon supporting people to achieve their outcomes, to have a good life and reach their potential, including taking part in civic life as they themselves determine.

Evidence of unmet need Internal Service Reports Data

Internal Engagement with Workforce Focus Groups and Interviews

Independent Review of Adult Social Care (IRASC)

Internal Service Reports

Evidence of unmet need and capacity

On 31 May 2023 Unmet Need list 278 people (all adults, not just older) were waiting for support totalling 1,714 hours in the community and an additional 78 people (all adults, not just older) totalling 826.75 hours had interim EHSCP support team arrangements in place meeting assessed needs i.e. Reablement, but who still require a long term provider to transition support to


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

Good practice guidelines Independent Review Adult Social Care

Health and Social Care Standards (2018)

Health and Social Care Integration (2016)

Guidance framework on the national health and wellbeing outcomes and indicator measures (February and April 2015)

Digital health and social care strategy (2018)

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 – Person Centred Care


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

Reducing use of institutional/residential care – increased opportunity for support at home

Making better use of adaptations and technology

Involving people and their families more in decisions

Including wider community supports in care

Professionals working together better across traditional boundaries of health, social care support and other services such as housing.

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

Health and Social Care Integration and Standards

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

People who use health and social care services have positive experiences of those services, and have their dignity respected;

People, including those with disabilities or long-term conditions, or who are frail, can live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

EIJB Strategic Plan identifies the vision:

Where do we want to be?

A sustainable, well performing and trusted health and social care system

A clearly understood and supported Edinburgh health and social care Offer, which is fair, proportionate and consistent

A person-centred, patient first and Home First approach

A motivated, skilled and representative workforce

An optimised partnership with the voluntary and independent sectors care supported by the latest technology

A culture of continuous improvement and innovation

How are we going to get there?

Roll out the Three Conversations approach across the city over time

Work towards shifting the balance of care from acute services to the community through Home First supported by our transformation programme

Generate a unity of purpose and build momentum

Technology – identification of emerging and proven solutionsimplementing commercial off the shelf and spend to save initiatives

Learn from others; across Scotland, the wider UK and internationally

the principles of the Edinburgh 2050 City Vision.

Carbon emissions generated/

reduced data

City Vision 2050 consultation – Policy and Sustainability Committee agreed a ‘Short Window Improvement Plan’ (SWIP) in October 2019. City vision is to be net zero on carbon emissions by 2030. More sustainable routes for our outreach mobile workforce could help to impact on reducing carbon emissions from the 32% of our workforce who are registered car users for delivery of homecare services.

The SWIP plan looked across the work of the Council and identified a set of actions which the Council could initiate within a short timeframe, in order to immediately improve the organisation’s approach to sustainability.

High Impact Action: (T4) ‘Expand and accelerate measures to reduce pollution and improve air quality’. Increasing optimisation of routes within the 32% of our social care workers who are drivers could impact on emissions and air quality, respecting ‘low emission zones’ and better monitor footprint from our service.

Moving toward ‘car free’ society and reducing ‘single car occupancy use’.

Environmental data City Vision 2050 consultation – Policy and Sustainability Committee agreed a ‘Short Window Improvement Plan’ (SWIP) in October 2019. The continued move to provision of services at locality level should reduce CO2 emissions for residents, but health care professionals will need to make a greater number of vehicle trips which may increase emissions.
Risk from cumulative impacts None identified None identified.
Other (please specify) Independent Adult Social Care Review (IASCR) 2021 ‘(A)…foundation that needs nurturing and strengthening is the social care workforce. For us to achieve the improvements we seek, they need to feel engaged, valued and rewarded for the vitally important work that they do’.
Additional evidence required Health and Safety Executive (HSE) “It is the employer’s duty to take every reasonable precaution to ensure the safety of lone workers and to carefully consider and deal with any health and safety risks for people working alone.”
Equality, Health and Wellbeing and Human Rights


Affected populations

There is a potential positive impact with community wealth building, and opportunities for employment for people in these locality areas.


Positive impact is the Home Office Visa Scheme providers are using now.


For staff, there might be more consistency with a sustainable rate across providers.

The framework should have a positive impact on advancing equality of opportunity. The framework will build those links with providers to be another point of direction for individuals who may identify other supports they need and open up other avenues to link with other services.

Positive impact will be that staff will have a shared understanding of cultural differences.

Business communities


Advance equality of opportunity eg improve access / quality of services / digital access

Promote participation, inclusion, dignity and control over decisions


The biggest impact will primarily be felt by older people and people with disabilities (and their carers). This will be particularly felt during the transition period as we move to a new framework. This will need to be worked out in ongoing co-production with providers and conversations internally.

Older people may be digitally excluded as they may not be as technologically aware as others or have access to technology.

As our population continues to change, we need to ensure we have enough culturally competent providers on the framework, and that they are educated and trained to understand and support our LGBTQ community, those from minority ethnic groups, and those with different religions or beliefs. To ensure safety and comfort for all receiving home-based care support.


For lone parents and vulnerable families, we need to ensure that changes to the framework and providers fits with family life in a way that supports them to continue to receive the service.


There may be impact on looked after children and those leaving care settings, if they are in the process of transitioning to adult services. We need to engage closely with all parties involved at this transitioning stage, especially for those who are also going to experience a transition in provider.

There is difficulty in getting service provision to some areas and we need to ensure those circumstances are improved and not detrimentally impacted.

The business community may be affected, some who we currently have a commissioning relationship with may not move forward on the framework, this would also affect the people they support, and their carers.

There might be a number of negative impacts felt on various staff groups.

·     If we do not have a specific rate for staff, it may not worth their while working. The rate would have to be sustainable for those working, and the Edinburgh housing market and cost of living can have an impact on this.

·     Childcare might impact on workforce capacity, especially with a predominantly female workforce.

·     There is an aging workforce and need to encourage a new generation into this space.

·     If a provider does not remain on the framework staff may wish to stay with that employer.

Potential negative impact around the risk of modern slavery, which we know is a current concern with some providers.


Primarily older people with health and social care needs, people with disabilities (and their carers), who receive home-based care services.

Men (include trans men), Women (include trans women) and non-binary people. (Include issues relating to pregnancy and maternity including same sex parents)

Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers)

People with different religions or beliefs (includes people with no religion or belief)

Lesbian, gay, bisexual and heterosexual people

Lone parents and vulnerable families

Looked after children and young people

Those leaving care settings (including children and young people and those with illness)


Geographical communities

Business communities


Reduce crime and fear of crime including hate crime


Environment and Sustainability including climate change emissions and impacts


Affected populations

The ambition of the framework is to have providers and staff more geographically aligned so there is less travelling happening and improved local connections. We would therefore anticipate a positive impact on tackling the climate crisis and reducing the need to travel.


Address/respond to the climate crisis and reduce greenhouse gas (GHG) emissions


Reduce need to travel and promote sustainable forms of transport






Affected populations

We will see a positive impact on the support for local businesses for those providers on the framework.

We may also be able to support young people into positive destinations as part of the community benefits aspect, help to access jobs both, paid and unpaid.

We can further try and influence and improve working conditions and work practice, which will form part of the contract as standard, and something that is mandated.

Support local businesses

Income from employment


We could see a negative impact on the support for local businesses for those providers not on the framework.

Support local businesses

The purpose of co-producing an external commissioning framework with our providers, is to ensure equity of access to quality support across the city for people and their carers. This includes commissioning improved integrated support options for adults living at home which are sustainable, well-coordinated, accessible, and appropriate at point of need, supporting improved outcomes and maximising independence. All equality, human rights, environmental and sustainability issues will be covered by the Contractual or Framework Agreements, good practice guidance or the contracted terms and conditions.

This will involve collaboration with planning and commissioning colleagues and partners to ensure a wide range of communication tools, including easy read, large print, alternative language options and online access to information. We have also agreed for FAIR (Family Advice and Information Resource) to produce an easy-read version of the final IIA report once published.

Further evidence will be collated, in particular through engagement with carers and people who use our services and included for final version of IIA. Any additional mitigating actions will also be included. An additional IIA with people who use our services and carers is scheduled for 3 August and 4 August 2023.

Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) Who will take them forward (name and job title Deadline for progressing Review date
Engage with FAIR to create an easy-read version of IIA Rachael Docking

Caroline Todd

Jayne Kemp


This proposal has been developed as part of the work from the Partnership’s Innovation and Sustainability Programme and will continue to be monitored within the wider programme. The impacts on different groups, including those with protected characteristics will be monitored through the programme working group and ongoing review of progress and challenges.

Name:         Mike Massaro-Mallinson

Date:            20 July 2023

Completed and signed IIAs should be sent to:  to be published on the Council website

Edinburgh Integration Joint Board/Health and Social Care to be published at