IIA – Edinburgh Integration Joint Board (EIJB’s) Savings Programme 2021/22

Edinburgh Integration Joint Boards (EIJBs) Savings Programme 2021/22 – Cumulative Integrated Impact Assessment

To support the delivery of a balanced budget for the 2021/22 financial year the EHSCP has developed a Savings Programme with a range of savings proposals.

The proposals have been developed, to where possible help:

  • Achieve a balanced budget
  • Improve efficiencies in service delivery
  • Allow for continuous improvement of services
  • Move forward and support the principles of the Strategic Plan
  • More effectively target resources

Every effort has been made to ensure the alignment of proposals to the EIJBs Strategic Plan, in order to minimise negative impacts and to help support the sustainable delivery of services, now and in the future. However, it is recognised that the need to deliver a significant savings programme in 2021/22, may lead to an impact on services, people and staff.

This Cumulative IIA provides an opportunity to review collectively, the equality impact of the proposals on the population of Edinburgh . It provides a level of assurance that a robust consideration of potential impacts has taken place. As well as providing  an overarching strategic perspective of how projects link together, this process is helping to ensure that  work is not progressing in  silos.  The IIA also highlights any interdependencies between projects and work streams, within the savings programme and the EHSCPs wider transformation schemes of work.

Summaries of the proposals will available on the City of Edinburgh Council website from the 16th March 2021when papers will be published in advance of the EIJB meeting on the 24th March 2021: https://democracy.edinburgh.gov.uk/ieListDocuments.aspx?CId=160&MId=5569&Ver=4

There has been no overarching public engagement around the EIJBs savings proposals for 2021-22.  Several budget workshops involving IJB members, including elected members and non-executive NHS Board members have taken place.

Project specific engagement which has taken place to date is noted in each IIA report.

The proposals align as far as possible with the intentions of the strategic direction laid out within the EIJB Strategic Plan.  Extensive engagement was integral to the Plan’s development including significant public and stakeholder engagement, consultation and feedback.

1 March 2021

Name IIA role Job Title Date of IIA training
Moira Pringle Lead Officer Chief Finance Officer
Jenny McCann Facilitator & Report writer Programme Manager – Savings March 2020
Colin Beck Savings Proposal Lead Rep Strategy and Quality Manager Mental Health and Substance Misuse
Deborah Mackle Savings Proposal Lead Rep Locality Manager – South West Edinburgh
Mark Grierson Savings Proposal Lead Rep Disability Support and Strategy Manager
Sarah Bryson Notes Strategic Planning & Commissioning Officer Nov 2017

The purpose of the cumulative IIA is to consider potential cumulative impacts arising from the various budget proposals.  The individual IIAs have considered and noted the appropriate evidence in relation to the corresponding budget proposal.  The table below only notes the overarching evidence.

Evidence Available? Comments: what does the evidence tell you?
Data on populations in need:
Strategic needs Assessment City of Edinburgh HSCP (2015) Yes Provides supporting information for understanding the demographics of the wider population in the City of Edinburgh (https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Joint_Strategic_Needs_Assessment.pdf
Edinburgh HSCP

Joint Strategic Needs Assessment:

Health and Care Needs of People from Minority Ethnic Communities

(April 2018)

Yes 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.


Edinburgh Integration Joint Board Strategic Plan (2019-2022) Yes Details the Strategic direction of the EHSCP https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Strategic-Plan-2019-2022-1.pdf
Data on service uptake/access No See individual IIAs
Data on equality outcomes: Yes Completed/Interim IIAs and IIA statements for the  2021/22 savings programme proposals (will be available here:
Individual Savings Proposals IIAs https://www.edinburghhsc.scot/the-ijb/integrated-impact-assessments/ ) and provide details of identified impacts that may come from the implementation of the proposed changes:

  1. External Housing Support (IIA)
  2. Day Centres & Be Able (IIA)
  3. LD Services (B) (IIA)
  4. Review Rehabilitation Services (IIA)
  5. Review Sexual Health Services (IIA)
  6. Community Equipment (IIA)
  7. Purchasing (IIA)
  8. Mental Health Whole System Review: Positive Steps (IIA Statement)
  9. Mental Health Whole System Review: Review the Works (IIA Statement)
  10. Prescribing (IIA Statement)
  11. Substance Misuse (IIA Statement)
  12. Interim Older People Day Opportunities Contract (IIA)
  13. Hosted Services & Set Aside(IIA Statement)
  14. (There are currently no published IIAs under the Transformation Programme)
  15. Blood Bourne Virus Services (IIA)
  16. LD Overnight Services (IIA)
  17. Policy Development & Implementation (IIA)
Research/literature evidence No See individual IIAs
Public/patient/client  experience information No See individual IIAs
Evidence of inclusive engagement of service users and  involvement findings

Edinburgh Integration Joint Board Strategic Plan (2019-2022)

Yes See individual IIAs

Details consultation completed with stakeholders about the EIJB Strategic Plan: https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Strategic-Plan-2019-2022-1.pdf

Evidence of unmet need Yes See individual IIAs
Edinburgh Integration Joint Board Strategic Plan (2019-2022) Details the health needs and priorities for the people of Edinburgh https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Strategic-Plan-2019-2022-1.pdf
Good practice guidelines No See individual IIAs
Environmental data No See individual IIAs
Risk from cumulative impacts

Savings Programme Cumulative IIA Evidence Document

Impacts due to the restrictions imposed due to the Coronavirus

Yes Impacts identified within each budget proposal IIA have been considered to undertake this cumulative impact assessment.

Due to the restrictions imposed to control the coronavirus pandemic:

  • the number of unpaid carers in the city and nationally has risen.
  • there is a likelihood that some people may now present with a higher level of need as some services have been restricted for an ongoing period
Other (please specify) The Independent Review of Adult Social Care https://www.gov.scot/groups/independent-review-of-adult-social-care/
Additional evidence required

All evidence and data relevant to specific budget proposals are listed in corresponding IIAs and used as the basis for this Cumulative Integrated Impact Assessment:

  • Proposal 12: Interim Older People Day Opportunities Contract (IIA)
  • Proposal 16: Blood Bourne Virus Services (IIA)
  • Proposal 17: LD Overnight Services (IIA)
  • Proposal 18: Policy Development & Implementation (IIA)
Equality, Health and Wellbeing and Human Rights Affected populations
An overview of the individual IIAs highlights that the main groups of people who may be impacted by the proposals, both positively and negatively, are older people, people with disabilities and carers.

Where possible/ appropriate proposals are focused on providing alternative ways in which people’s needs can be met to help ensure services are provided in the right place, at the right time and in the right way.



The savings proposals take a person-centred/human rights and assets based approach, and are guided by the values, priorities and guiding principles of the EIJB’s Strategic Plan

They will be an opportunity to help ensure positive choice, control and equality of outcomes for people.

In order to deliver savings and improvements required, all services cannot continue to be delivered as they currently are.  Those effected (either positively or negatively) will more likely be older people, people with disabilities and carers due to the inherent demographics of service users.

Service provision will be based on needs rather than people’s expectations, with priority given to the most vulnerable.

Links with community facilities, specialist support and advice services will continue, and opportunities will be maximised through connections with other workstreams including 3 conversations, the Edinburgh Pact and Transformation.

A move to more locality/ community-based models has the potential to align with the 20-minute neighbourhoods concept, with opportunities to receive care and support in locations that are easier and quicker to get to.

There is an opportunity to incorporate technological solutions to aid and provide flexible access to service delivery

Changes will provide a level of support which we can afford and so increase sustainability

All people who receive services – more of which are older people, people with disabilities and carers

Savings will be made through efficiencies and improved effectiveness, which may result in some people not receiving the same support to that which they currently receive or would expect to. Some services may also be delivered through a different approach.

Any change may cause anxiety, disruption and stress, particularly to those most vulnerable (including their unpaid carers), and a perceived sense of loss. This must be recognised and alleviated through considered planning and good communication.

There may be an increased ask of families, friends and unpaid carers (in particular women as a higher proportion of carers are women)  – links with the Carers Strategy will be established.  People’s support networks vary considerably and cognisance of this will be taken using a person-centred approach

Those with poor health literacy skills,  language difficulties and those with limited or no digital skills or with less online access will be considered whilst developing any technology enabled services or any move to a more self-managed care approach

All people who receive services – more of which are older people, people with disabilities and carers

Unpaid carers and women

Those with poor literacy skills; those for whom English is not as a first language, and those with less access to digital technology


There are likely to be positive and negative impacts for staff.


Clear policies and procedures will help support staff in their roles and provide a level of confidence.

Any shift in service provision/service re-prioritisation will require a degree of investment in skills development and support for staff which will may help increase staff morale.

Flexible approaches to working are likely to lead to digital investment to support the workface, enabling them to deliver services in a different way, providing opportunities for innovation and skills development.


The changes may bring additional stress and a sense of loss if they feel that they are not able to give the services which they think people are entitled to.

It is important that the rationale behind any service changes are clearly communicated to staff and that the required support, training, skills, policies and procedures are put in place.

Any change of service provision may also lead to increased levels of stress and anxiety for staff as they undertake challenging conversations with citizen (including people in receipt of services, families and carers).  Changes to service provision may lead to a rise in the number of complaints which can place a considerable time burden on staff.

All staff
Environment and Sustainability Affected  populations
The Strategic Plan 2019-22 commits EHSCP to working with its partners to support the development of the city’s new sustainability strategy for 2030 – pg 21 – https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Strategic-Plan-2019-2022-1.pdf

The creation of more locality/community-based models aligns with the 20-minute neighbourhoods concept. There will be potentially less travel to a central location by people who can instead access services in the localities (leading to reduced emissions).

Staff are encouraged to travel sustainably, and where appropriate engage with people through Near Me, etc and other technological and digital options

Any changes proposed should support the NHS Lothian Sustainable Development Framework, CEC Sustainability Strategies and the Edinburgh 2030 net-zero carbon target.

Any changes in practice will provide an opportunity to implement change to culture and working practices and help support the Edinburgh 2030 net-zero carbon target

All populations

There could be an increase in staff travelling (leading to increased emissions) as they deliver more community-based support to people in their own homes instead of centrally.  Staff should be encouraged to travel sustainably

All populations
Economic Affected populations

Changes will help ensure the long-term sustainability of services.

All those that access services

Any reduction in external commissioning may lead to a reduction in third sector and independent staffing. This impact should be limited as there is a recognised shortage of care staff across most organisations.

All those that access services and staff in third/ independent sector

Yes, a number of the proposals cover services that will be delivered by contractors.

Procurement processes and contract documents will consider how potential contractors will address equality, human rights, environmental and sustainability issues including how contractors will support the implementation of relevant sustainability strategies referred to in this document.

See individual IIAs for communication proposals.

All communications plans/  strategies will include specific information for patients, unpaid carers, staff and wider stakeholders and will include consideration of easy read and dementia friendly versions, BSL, Braille, hearing loop, information on screens, audio signage, and use of Happy to Translate. Consideration will also be given to health literacy and the use of different mediums and channels for sharing information.

Feedback from ongoing communication with stakeholders will inform the wider Savings Programme as well as the transformation programme (in particular the Edinburgh Pact).

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.

Several budget proposals are not yet at a stage in their development at which an IIA can be undertaken and these will be carried out when appropriate. The Savings Programme 2021-22 Cumulative IIA will be updated to reflect any identified impacts as appropriate.

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 contact details) Deadline for progressing Review date
Relevant leads for savings proposals should progress any specific actions identified in individual IIAs Savings proposal leads Ongoing Ongoing
Overarching report re delivery of the savings programme to be provided to Savings and Governance Board (SGB) monthly Jenny McCann/ Finance Programme Manager Monthly July 2021
Ongoing reporting to EIJB bi-monthly Moira Pringle (with support from Jenny McCann) Bi-monthly June 2021
Training and support for staff is provided. Savings proposal leads – where pertinent to their proposal Ongoing Ongoing
Procedures and policies should be clearly set out and available Savings proposal leads – where pertinent to their proposal Ongoing Ongoing
The rationale for the changes should be clearly communicated to staff including the over-riding financial position Savings proposal leads Ongoing Ongoing
Proposals to be implemented in line with appropriate strategies and relevant workstreams Savings proposal leads Ongoing Ongoing

An overarching view on delivery of the savings programme, including monitoring of activity and spend, will be provided at the monthly Savings Governance Board, chaired by EHSCPs Chief Officer. Bi-monthly reports will also be provided to the EIJB and quarterly reports provided to the Performance and Delivery Committee.

Existing NHS Lothian & CEC finance reporting processes will also be utilised as appropriate.

Where appropriate there will be ongoing consultation with staff, patients, and carers about any changes

Name: Moira Pringle (Chief Finance Officer, EIJB)

Date: 10/03/21

Send completed IIA for publication on the relevant website for your organisation. See Section 5 for contacts.