Interim Integrated Impact Assessments – Housing support services

A briefing note was issued to the Edinburgh Integration Joint Board (EIJB) on 22nd December 2023 which highlighted the deterioration in the 2023/24 financial position for social care services which are delegated to the Edinburgh Integration Joint Board (IJB).  Specifically, that the projected year end shortfall had increased to £20.7m.  Taking into account the total additional contributions agreed by the City of Edinburgh Council (the Council) of £14.5m, reduced this to £6.2m. There are limited mitigations against this and an urgent need to develop proposals to bring this back into balance by the end of March 2024. One area of service provision where there is potential for greater efficiency of use of resources is Housing Based Support.

The proposal is that the HSCP continues with the programme of reviews but to assist in the acceleration of this process that there is a senior review of Housing-Based Support currently delivered on a case-by-case basis over a concentrated time-frame. This will identify where there is the necessary available evidence within assessments and case file recording that the provision of this service is disproportionate to the level of assessed need and the ability to immediately determine an interim alternative level of provision pending further review.  This is to ensure that decision-making regarding eligibility criteria and service provision levels are proportionate to need and can be corrected where necessary.  All cases subject to such an interim decision will be followed-up by a full review process to ensure proportionate provision is secured for the future.

Any interim decision will take into account the views and needs of individuals that have been previously recorded.  Any decisions regarding permanent future provision will be made following a full review that includes the views of service users and others such as their carers will follow any adjustment to service provision.

There has not been any public involvement in this proposal to date. The EIJB has been informally engaged on this matter and a report is due to be presented to the EIJB on Friday 9th February.

5 February 2024

Name Job Title Date of IIA training
Mike Massaro-Mallinson Service Director Operations
Deborah Mackle Locality Manager SW
Nikki Conway Locality Manager SE
Katie Bryce NW MH SM Manager
Anna Duff Locality Manager NW
Matt Kennedy PSWO
Jane Perry Independent Providers rep
Hannah Cairns Chief AHP
Sarah Bryson Strategic Planning and Commissioning Officer
Jayne Kemp Strategic Planning and Commissioning Officer
Rene Rigby Independent Sector Lead
Rhiannon Virgo Project Manager Innovation & Sustainability
Gosia Szymczak Project Manager Innovation & Sustainability
Jessica Brown Innovation & Sustainability Senior Manager
Emma Gunter Contracts Officer
Bridie Ashrowan EVOC
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 1. Joint Strategic needs Assessment City of Edinburgh HSCP (2020)

2. Edinburgh HSCP Joint Strategic Needs Assessment: Health and Care Needs of People from Minority Ethnic Communities (April 2018)

3. Edinburgh Integration Joint Board Strategic Plan (2019-2022)

4. Public Health Scotland Data

1. Provides current and projected data on the wider population in the City of Edinburgh

(Population and demographics – Edinburgh Health & Social Care Partnership (

2. Provides an understanding of what contributes to poor health and wellbeing and the barriers and challenges to seeking and obtaining support (many being interrelated).

Actions highlighted as needed to address these include:

  • Staff training including cultural sensitivity
  • Recognition of the role of the Third Sector
  • Effective community engagement
  • Developing effective approaches to prevention including overcoming isolation.

3. Details the Strategic direction of the EHSCP

4. Public Health Scotland – demand for care at home services across Scotland

Social care – Demand for Care at Home Services 25 April 2023 – Social care – Demand for Care at Home Services – Publications – Public Health Scotland

Data on service uptake/access Internal data Table 1: provides examples of housing support tasks and personal care tasks

Examples of Housing Support Examples of Personal Care
  • Housework / Hoovering and Dusting
  • Financial Management / Paying Bills / Sorting Mail
  • Shopping
  • Organising and Decluttering
  • Running errands
  • Changing beds where there is no incontinence
  • Day services
  • Gardening
  • Transport
  • Psychological and emotional support
  • Maintaining a tenancy
  • Accessing community resources and activities
  • Reducing social isolation
  • Support and supervision
  • Help with personal hygiene/support to wash at the sink.
  • Toileting / Continence management.
  • Dry shaving
  • Hair washing
  • Bathing / Showering
  • Assistance with meal preparation
  • Assistance with eating
  • Changing bed if incontinent
  • Washing dishes after a meal
  • Cleaning shower / bath after personal care has taken place
  • Assistance with medication
  • Assistance getting in/out of bed
  • Help with dressing /undressing
  • Applying / removing Ted stockings
  • Stoma care
  • Oxygen care

Table 2, below, sets out the current hours of housing based support provided, the number of individuals receiving it, and the associated cost. It also shows information about the proportion of service delivery across different groups.  21,047 hours are provided weekly to 1,736 service users which amounts to £445k/week of financial commitment.  Approximately 60% of those people receiving HBS also receive a care at home service for personal care.  Some may be receiving additional services such as day service supports and overnight care.

  All >=60 <=20 All others
Clients 1,736.00 70.00 1,491.00 175.00
Cost/week 445,091.66 122,228.85 199,267.34 123,595.47
Hours/week 21,047.68 5,950.00 9,171.00 5,926.68
Average cost/week 256.39 1,746.13 133.65 706.26
Average hours/week 12.12 85.00 6.15 33.87
Average rate/hour 21.15 20.54 21.73 20.85
50% reduction saving/week 222,545.83 61,114.42 99,633.67 61,797.74
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Joint Strategic needs Assessment City of Edinburgh HSCP (2020) Provides current and projected data on the demographics within Edinburgh

(Population and demographics – Edinburgh Health & Social Care Partnership (

Data on equality outcomes
Research/literature evidence People receiving Care at Home per population

  • North Ayrshire – 35.7
  • Shetland Islands – 25.7
  • West Dunbartonshire – 25.7
  • Inverclyde – 23.7
  • Argyll and Bute – 23.3
  • Clackmannanshire – 23.1
  • East Ayrshire – 22.5
  • East Dunbartonshire – 22.5
  • Falkirk – 21.4
  • Comhairle nan Eilian Siar – 21.2
  • Angus – 19.8
  • Perth and Kinross – 19.8
  • Stirling – 18.2
  • Dumfries and Galloway – 18
  • Renfrewshire – 17.8
  • East Renfrewshire – 17.7
  • South Lanarkshire – 17.2
  • South Ayrshire – 16.9
  • Scotland (estimated) – 16.4
  • East Lothian – 16.2
  • Aberdeenshire – 16
  • Dundee City – 15.7
  • Glasgow City – 15.6
  • North Lanarkshire – 15.4
  • City of Edinburgh 15.2
  • West Lothian – 14.6
  • Scottish Borders – 14.4
  • Midlothian – 13.7
  • Aberdeen City – 12.4
  • Moray – 12.1
  • Highland – 12
  • Fife – 11.7
  • Orkney Islands – 9.5

A graph showing the information in the list above

Hours of Care at Home per population

  • Dumfries and Galloway – 18.38
  • Clackmannanshire – 13.93
  • Argyll and Bute – 13.52
  • Perth and Kinross – 12.02
  • North Ayrshire – 11.91
  • Stirling – 10.32
  • Shetland Islands – 10.18
  • Falkirk – 9.97
  • Aberdeenshire – 9.39
  • City of Edinburgh 9.15
  • Midlothian – 8.65
  • South Ayrshire – 8.44
  • Moray – 8.40
  • East Lothian – 8.37
  • West Lothian – 7.78
  • East Ayrshire – 7.66
  • South Lanarkshire – 7.26
  • Renfrewshire – 6.98
  • Scotland (estimated) – 6.94
  • Aberdeen City – 6.30
  • Dundee City – 6.12
  • Angus – 5.85
  • East Renfrewshire – 5.80
  • East Dunbartonshire – 5.35
  • West Dunbartonshire – 5.04
  • Fife – 4.62
  • Scottish Borders – 4.22
  • Inverclyde – 4.20
  • North Lanarkshire – 4.06
  • Glasgow City – 3.78
  • Highland – 3.11
  • Comhairle nan Eilian Siar – 2.95
  • Orkney Islands – 2.82

A graph showing the data listed above

Average hours of Care at Home provided (census week)

  • Dumfries and Galloway – 26.56
  • Midlothian – 22.51
  • Renfrewshire – 20.41
  • Clackmannanshire – 18.57
  • Perth and Kinross – 18.34
  • Moray – 18.31
  • Aberdeenshire – 17.43
  • City of Edinburgh 16.74
  • Stirling – 16.28
  • Argyll and Bute – 15.99
  • West Lothian – 14.95
  • East Lothian – 14.76
  • Aberdeen City – 14.67
  • Falkirk – 14.46
  • South Lanarkshire – 13.42
  • Scotland (estimated) – 13.18
  • South Ayrshire – 12.61
  • Scottish Borders – 10.97
  • East Ayrshire – 10.82
  • Fife – 10.80
  • Dundee City – 10.72
  • North Ayrshire – 10.26
  • Shetland Islands – 10.09
  • East Renfrewshire – 9.38
  • Angus – 9.10
  • North Lanarkshire – 8.88
  • Orkney Islands – 8.65
  • East Dunbartonshire – 8.55
  • Glasgow City – 8.35
  • Highland – 7.56
  • West Dunbartonshire – 5.84
  • Inverclyde – 5.39
  • Comhairle nan Eilian Siar – 3.83

A graph showing the information listed above

Public/patient/client experience information VOCAL Carer’s Survey 2021 VOCAL carer’s survey 2021 – full data set(

Views of carers within Edinburgh and Midlothian

Evidence of inclusive engagement of people who use the service and involvement findings Care Inspectorate inspections for individual providers – available on Care Inspectorate website
Evidence of unmet need To be added.
Good practice guidelines 1. Legislation governing the provision of housing based support services

2. Local and national policies

1. The following legislation is relevant to the provision of such support:

  • Social Work (Scotland) Act 1968
  • Chronically Sick and Disabled Persons Act 1970
  • NHS and Community Care Act 1990
  • Human Rights Act 1998
  • Adults with Incapacity (Scotland) Act 2000
  • Regulation of Care (Scotland) Act 2001
  • Community Health and Care (Scotland) Act 2002
  • Mental Health (Care and Treatment) (Scotland) Act 2003
  • Adult Support and Protection (Scotland) Act 2007
  • Equality Act 2010
  • Social Care (Self-directed Support)(Scotland) Act 2013
  • The Carer’s (Scotland) Act 2016

2. National policies and frameworks:

  • Self-Directed Support: framework of standards
  • National Health & Social Care Standards
  • Mental health and wellbeing strategy: delivery plan 2023-2025

Local policies:

  • Eligibility criteria
  • Transitions policy & associated policy

Registered and Regulated Services – National Care Standards

Carbon emissions generated/reduced data Not available
Environmental data Not available
Risk from cumulative impacts 23/24 Savings and Recovery Programme IIA report Sets out the cumulative impacts of the existing in-year savings & recovery programme.

Other (please specify)
Additional evidence required Additional evidence was suggested during the session which may provide further insight. It was agreed that this would be pulled together for the final IIA. This may include:

  • Engagement from One Edinburgh in particular homecare service surveys
  • Evidence of unmet need.
  • Edinburgh Learning Disability Advisory Group insight
  • IIAs from One Edinburgh
  • LGBT housing report (RR to forward)
  • 24/25 savings IIA – scheduled for 4th Mar 2024 to be added in once available.
  • Unmet need lists, although it was acknowledged that it might not be possible to distinguish  between those awaiting personal care and those awaiting housing support.
Equality, Health and Wellbeing and Human Rights  Affected populations

  • It was noted that people are initially likely to see this proposal very negatively, but where there has been an overprescription  of this type of care, we need to correct this. As a consequence, people may be able to gain more independence in the longer term, which would have positive impacts on outcomes for individuals.
  •  A fairer distribution of housing-based support, right-sized according to need will free up capacity to address unmet need in the longer term.


Older people; Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems); young people (particularly those in transition from children’s to adults services)



  • Younger adults and those in middle years may see more of an impact than older people as older people are more likely to receive higher volumes of personal care and lower volumes of housing support, with the opposite applying to younger adults.
  • The potential impacts of a reduction in housing support will depend on the kind of tasks being provided. Where support is focused more in emotional and wellbeing support, there may be risk of increased social isolation however we would seek to mitigate this by connecting people into local community resources and alternatives. This in turn could lead to increased pressure on these services.
  • Potential increased risk of people struggling to maintain a tenancy, it will be important to ensure that any follow up reviews seek to ensure people are accessing universal supports and also accessing any benefits they may be entitled to.
  • There may be an increased risk of hoarding, although the proposed approach would identify those at particular risk of this and ensure appropriate mitigation is in place (which may include removing them from the scope of any proposed reductions).
  • Where housing support is focused on helping people to develop skills, there may be a risk that this will be compromised because the time available to devote to this will be limited. This may have a particular impact on older people or those with a learning disability.
  • It is possible that those with mental health issues  may become more unstable.
  • There is a risk of knock-on impacts or increased demand for other services such as hospital admissions due to the changes proposed.
  • We will need to consider how these changes are communicated to particular groups, for example, those with learning disability or non-English speaker. A clear communication plan will be needed, including consideration of information in accessible formats. This includes communications for families and carers as well as for those who are directly receiving a service. This challenge also includes family or carers.
  • There may be particular impacts on minority ethnic staff, as a significant proportion of the provider workforce is made up of international staff.
  • Some risk to people with different religion or beliefs if the housing support service is partly based on supporting them to attend places of worship, although this may be mitigated by the fact that those within religious communities may be more likely to have access to informal support from their community.  
  • There may be an increased impact on those who have less family support around them to help where formal support is reduced, which may include those who are unmarried or childless. These people may also be at greater risk of social isolation as a result.
  • Potential for greater impact on unpaid carers, who may have to absorb additional responsibilities as a result of any reduction.  Greater risk into carers crisis and break down in care arrangements. Decisions may be made without considering carers input and it will be important to be aware of any carer vulnerability, including where a carer support plan is in place.
  • Complaints might increase and we need to ensure we support staff to deal with them. We need to ensure they have skills to do that and that they are being supported by their managers. There might be a need to do realignment of work.

All negative impacts can be mitigated to a large extent by the implementation approach set out – cases will be considered by a senior assessor before any decision to reduce service is taken. An individual assessment of risk and need (desktop assessment) will be applied to each case.


Older people; Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems); young people (particularly those in transition from children’s to adults services)

Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers); AND Refugees and asylum seekers

People with different religions or beliefs 

People who are unmarried, married or in a civil partnership 



Environment and Sustainability including climate change emissions and impacts Affected populations

No specific impacts were identified.


No specific impacts were identified.

Economic Affected populations

  • There could be significant impacts on some providers of commissioned housing-based support services. Reductions in commissioned hours will reduce the income these providers receive and this could lead to viability risks for their business. Some providers may not be able to continue to operate, leading to a loss of capacity within the market. We are aware of a small number of providers who have focused primarily on housing-based support rather than personal care, and the impacts for these businesses will be greater.
  • There are risks for the staff who work for affected providers. If providers do not have sufficient income, they may be unable to continue to pay their staff and jobs may be at risk as a result.
  • Staff who work via the Home Office visa scheme may be particularly at risk. There is a risk that even a temporary reduction in hours could lead to the loss of staff, which would make it difficult to recruit up to the required numbers again once the need for service increases.
  • Communication with providers throughout this period is very important.
Business community, specifically providers of housing based support and their staff.

If yes, it is likely that a Strategic Environmental Assessment (SEA) will be required and the impacts identified in the IIA should be included in this.


If further evidence is required, please note how it will be gathered. If appropriate, mark this report as interim and submit updated final report once further evidence has been gathered.

This is an interim report. A number of items of additional evidence are detailed within the evidence table. This IIA report will be updated once those have been gathered.

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
Gather additional evidence as outlined in the evidence table above and update IIA report. Mike Massaro-Mallinson 19/02/24 12/02/24
Continue to engage with EVOC regarding potential impacts on third sector and options for mitigating risks posed to individuals who may see their support reduced. Mike Massaro-Mallinson 31/03/24
Develop detailed communications plan which sets out how we will keep service users and providers informed, with particular reference to those who may require accessible communications and for non-English speakers. Mike Massaro-Mallinson 19/02/24 12/02/24
Additional data analysis to ensure we understand as much as possible about the circumstances of those receiving housing-based support and their protected characteristics ahead of any decision-making about potential reductions in service. Mike Massaro-Mallinson 19/02/24 12/02/24
Continue to monitor the total cumulative impact of this change along with existing programmes. Mike Massaro-Mallinson 31/03/24

Monitoring of this proposal will rest with the Executive Management Team and may include (though is not restricted to):

  • Monitoring complaints and challenges to decisions to reduce support
  • Monitoring any cases where support is reduced but the decision subsequently needs to be reversed.
  • Monitoring impacts on the provider market and sustainability of individual providers.
  • Monitoring impacts on our own staff.

Mike Massaro-Mallinson's signature

Name: Mike Massaro-Mallinson

Date: 5 February 2024