IIA – Edinburgh Integration Joint Board (EIJB’s) Savings Programme 2022/23 – Cumulative Integrated Impact Assessment

Edinburgh Integration Joint Boards (EIJBs) Savings Programme 2022/23 – Cumulative Integrated Impact Assessment

To support the delivery of a balanced budget for the 2022/23 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 savings programme in 2022/23, may lead to an impact on services, people and staff. Throughout 2021/22 there has been ongoing dialogue about how to balance the current care, workforce and financial deficits whilst ensuring the sustainability of the Edinburgh Heath and Social Care system. The need to evolve and transition into a wider strategic programme encompassing the principles of innovation and sustainability, has been identified. As such, the 2022/23 Saving Programmed has been developed to support and ensure alignment with these principles.

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 14th March 2022 when papers will be published in advance of the EIJB meeting on the 22nd  March 2022:


While there has been no overarching public engagement around the EIJBs savings proposals for 2022-23, public engagement has been undertaken for agreed projects within the 2022-23 Saving Recovery Programme that are currently are currently undergoing option approval. Several budget workshops involving EIJB 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.

28 February 2022

Name IIA role Job title Date of IIA training
Moira Pringle Lead Officer Chief Finance Officer
Sarah Bryson Facilitator Planning & commissioning Officer Nov 2017
Kellie Smith Report writer Finance Programme Manager May 2021
Cat Young Contributor Assistant Strategic Programme Manager for Mental Health and Wellbeing with Thrive Edinburgh Aug 2018
Jenny McCann Contributor Finance Programme Manager March 2020
Sheena Muir Contributor Hospital and Hosted Services Manager
Deborah Mackle Contributor Locality Manager – South West
Nikki Conway Contributor Locality Manager – South East
Anna Duff Contributor Locality Manager – North West
Sylvia Latona Contributor Senior Manager Assistive Technology Enabled Care
Evidence Available? Comments: what does this evidence tell you?
Data on populations in need:
Joint Strategic needs Assessment City of Edinburgh HSCP (2020) Yes Provides current and projected data on the wider population in the City of Edinburgh

(Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot)

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:

Individual Savings Proposals IIAs

Yes Completed/Interim IIAs and IIA statements for the  2022/23 savings programme proposals (will be available here: 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. Review Rehabilitation Services (IIA)
  2. Review Sexual Health Services (IIA)
  3. LD Overnight Services (IIA)
  4. Mental Health Whole System Review: Review the Works (IIA Statement)
  5. Hosted Services & Set Aside (IIA Statement)
  6. Community Equipment (IIA)
  7. Prescribing (IIA Statement)
  8. Purchasing (IIA)
  9. Medical Day Hospital (IIA statement)
  10. Bed Based Review (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 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

Yes Impacts identified within each budget proposal IIA have been considered to undertake this cumulative impact assessment.
Impacts due to the restrictions imposed due to the Coronavirus Due to the restrictions imposed to control the coronavirus pandemic:

  • the number of unpaid carers, and associated stressors of unpaid carers has risen in the city, and nationally.
  • 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
  • staff absentee rates have significantly increased impacting service delivery and quality across all sectors
  • services have been working to critical criteria for several years
  • those with long term mental health and physical health conditions experienced elevated levels of anxiety compared to the wider population
  • There have been positive experiences of digital services and wider online supports and it is important we harness these.
  • There is need to ensure that all people in Scotland can be digitally connected through the removal of practical and financial barriers.
  • The role of community pharmacies has amplified during the pandemic
  • Outdoor activities and the value of green space has had a huge impact on public mental health and wellbeing – working more locally could allow us to use our spaces differently in the city
  • Financial concerns were high early in the pandemic but did subsid (potentially due to furlough schemes). However, there is a potential for this anxiety to re-emerge if unemployment rises and businesses struggle.
  • There has been positive uptake and engagement with online networks and support as a result of Covid-19.   There is a need throughout our public policy to maximise and invest in community-based supports to enable social networks to flourish (clubs, societies, neighbourhood schemes and peer supports). By enhancing individual wellbeing and community cohesion this will bring benefits to both mental and physical health
Other (please specify) The Independent Review of Adult Social Care


A National Care Service for Scotland: Consultation

A National Care Service for Scotland: consultation – gov.scot (www.gov.scot)

Additional evidence required
Equality, Health and Wellbeing and Human Rights

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.

Affected populations


The savings proposals take a person-centred/human right 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 and a focus on ensuring equity of access across the population.

Links with community facilities, specialist support and advice services will continue, and opportunities will be maximised through preventative and early intervention initiatives and workstreams and connections including 3 conversations, Thrive Edinburgh, Home First, One Edinburgh, the Edinburgh Pact and Transformation.

Where possible, 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 with less environmental impact. It is acknowledged that there may be a need, or a choice, for people to attend services or activities out of their local area to support their health and wellbeing.

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, that achieves current and future sustainability.

There will be a reduction in cost for people through not having to pay travel costs to receive help and support

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.

The ask of families, friends and unpaid carers (particularly women as a higher proportion of carers are women) has increased in the last 12 months due to another year of government restrictions associated with Covid 19 – 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

Anxiety and stress due to perceived or actual financial and/or safety concerns with obtaining and receiving care. Reduced capacity to travel to receive care without additional financial or personal support

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

People with long terms conditions, people experiencing mental health problems, and low income single-parent families

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

Staff are fully engaged and active in the organisational change process.

Clear performance measures to support expectations and understanding of roles and responsibilities within and across teams and individuals.

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 workforce, enabling them to deliver services in a different way, providing opportunities for innovation and skills development.

All staff

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

Staff may experience stress associated with the uncertainty leading up to decision or option approval once the intent to change has been communicated.

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. Additionally, plans to support staff through change will be modified, to address the concerns of ethnic minorities within the staffing cohort

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

Staff shortages, recruitment and retention issues has continued to impact the physical and mental health and wellbeing of the current workforce. With less personnel in posts, overall workloads have increased. This has resulted in increased anxiety and stress in staff associated with a lack of capacity to provide safe and optimal care services on an ongoing and sustained basis.

All staff
Environment and Sustainability

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

Affected  populations

The creation of more locality/community-based models aligns with the 20-minute neighbourhood 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

Reduction in travel using technology and digital staff scheduling solutions.

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

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


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.


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

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 compliant with;

  • UK Government guidance on Accessible Communication formats (2021); and
  • The Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018.

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).

Several budget proposals are currently undergoing activities to identify options for appraisal. Reviews of the services have taken longer than previously planned due to; the complexity of the service being reviewed, the number of stakeholders involved and/or the diversion of planned resources to address current system pressures. As such, activities to review, update and finalise the IIA’s for the individual projects has been aligned with the projected activities to approve options for implementation in the 2022/23 programme. The Savings Programme 2022-23 Cumulative IIA will be reviewed and updated to reflect any identified impacts as each of the individual IIA’s are finalised

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 Finance Programme Manager Monthly July 2022
Ongoing reporting to EIJB bi-monthly Chief Finance Officer (EIJB) (with support from Finance Programme Manager) Bi-monthly June 2022
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 EHSCP’s 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

Moira Pringle signature

Name: Moira Pringle

Date: 13/04/2022

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