Integrated Impact Assessments – Older people’s day opportunities

10% reduction to Older Peoples Day Opportunities (OPDO) Contracts for 2025/26 from 880 places to circa 792 places.

A reduction of 10% was made in 24/25 and a further 10% reduction will be made in 25/26 to each providers’ contract value. Some providers may choose to move to a new business model incorporating private clients and Self-Directed Support (SDS) payments if they so wish.
At August 2024 659 people accessed places with some attending more than once a week with overall occupancy being 85% average.
Further reductions may be required in order to achieve financial balance.

  • Coproduction with providers has been established and ongoing since summer 2023.
  • Current OPDOs providers have regularly been made aware of the reduction in contract value as part of the contract review process.
  • The reductions were published in the prior interest notice, issued on Public Contracts Scotland portal.
  • Open book exercise has been completed to inform a fair unit price for OPDOs with providers.
  • As well as group meetings, individual organisation meetings took place to understand risks and mitigations associated with the reduction.
  • EMT members aware through briefings and papers and procurement strategy at Commissioning, Contracts & Procurement Board.
  • Chief Officer has signed off procurement strategy for new Framework Agreement, April 2025 & beyond.

Yes

Tuesday 10 December 2024 as a follow on from original IIA, 8 February 2024.

Identify facilitator, Lead Officer, report writer and any partnership representative present and main stakeholder (e.g. NHS, Council)

Name Job Title Date of IIA training
Andrew Farr External Provider – Libertus – Comments provided
Fiona Johnston Senior Accountant
Katie McWilliam Strategic Programme Manager
Karen Thom Planning & Commissioning Officer – Comments provided
Kellie Mercer External OPDO Provider – Caring in Craigmillar – Comments provided
Kyle Oram Planning and Commissioning Officer
Lewis Huntson Older People Enquiry Team Manager – Comments provided
Paula Deegan Procurement Category Lead
Rene Rigby Scottish Care – Independent Sector Lead – Comments provided
Ryan Watson Project Support Officer
Sarah Bryson Planning and Commissioning Officer – Comments provided November 2017
Susan McMillan Performance and Evaluation Manager – Comments provided
Vivienne Kennedy Contracts Officer
Vivienne Robertson Acting Accountant

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 Joint strategic needs assessment – Edinburgh Health & Social Care Partnership

Population and demographics – Edinburgh Health & Social Care Partnership

Between 2024 and 2030 the following population increases will occur:
65-74 -13% increase to 51,644
75-84 – 13% increase to 33,365
85+ – 8% increase to 13,405

 The JSNA breaks down on population and demographics, poverty, dementia, population health and inequalities in Edinburgh, Mental Health and Carers.
Data on service uptake/access Provider Capacity Work. Info on providers capacity is available and recorded via the Contracts Team. The information tells us the capacity of 14 providers and what locality the service is provided in. 2024/25 baseline provides 880 places and from April 2025 place will circa 792.
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. State of Caring in Scotland 2022: A cost-of-living crisis for unpaid carers in Scotland | Carers UK

https://www.gov.scot/collections/scottish-health-survey/

 State of Caring In Scotland 2022 –
Scottish Government – Scottish Health Survey
Data on equality outcomes https://www.gov.scot/collections/scottish-health-survey/

https://www.edinburghhsc.scot/the-ijb/joint-strategic-needs-assessment/carers/

 Scottish Government – Scottish Health Survey

The JSNA breaks down on the number of carers by age and sex and indicates there are more female carers than male.
Carer census https://www.gov.scot/publications/carers-census-scotland-2023-24/
Public/patient/client experience information Providers have complaints procedures
Carer Outcomes software paperwork
Care Package review records on AIS
Evidence of inclusive engagement of people who use the service and involvement findings Providers attend core group to discuss implementation of reduction.

There are Carer & Citizen user representatives on the EIJB which are aware of the proposal
Evidence of unmet need Geographical gaps in service provision

Edinburgh Integration Joint Board Strategic Plan (2019-2022)

Unmet Need Data

MSP Survey – Day Opportunities and Respite

 There is ongoing piece of work re geographical service provision

Details the health needs and priorities for the people of Edinburgh Strategic-Plan-2019-2022-1.pdf (edinburghhsc.scot)

The performance and evaluation team have access to the unmet need list of those awaiting assessments & packages of care

A recent return has been submitted to an MSP which is an annual request and provides information on Day Services & Respite
Good practice guidelines Mental Health Law Review

New dementia strategy for Scotland: Everyone’s Story – gov.scot (www.gov.scot)

 Mental Health Law Review

Scottish Government Dementia Strategy Scotland 2023
Carbon emissions generated/reduced data N/a
Environmental data N/a
Risk from cumulative impacts EIJB Savings Proposals Other budget savings have interconnection and dependencies on the Day Opportunities and Respite proposal.
Other (please specify) Scottish Benchmark Data
Edinburgh is ranked 8 out of 27 local authorities, three places above the national rate, with a rate of 4.8 in Edinburgh compared to 2.4 nationally. Glasgow city, as one of our comparable authorities, has a ranking of 17 with a rate of 1 per 1000 population.

This data is taken from the Public Health Scotland Insights in Social Care report, which uses the Source national data return.

Source data definition of day care is “Day care involves attendance at a location other than the client/service users own home for personal, social, therapeutic, training or leisure purposes. Day care services can be registered or unregistered services.”

Why we are unable to use day care benchmarking data effectively and confidently:

This benchmarking covers day services for all client groups including MH, PD, LD over 65 years of age, therefore currently we can’t extrapolate solely on the Older People Category.

Specific definitions of day care provision and the individuals in this return may differ across partnerships. For instance:

Glasgow and Moray do not include people who receive day care as part of an option 1 (direct payment) package, but Edinburgh do include this. This can explain why Glasgow’s rate appears lower compared to Edinburgh and the national rate.
Additional evidence required N/a

Emissions Zone potential for increased cost and or mileage if colleagues use their own transport to travel across the city.

Equality, Health and Wellbeing and Human Rights Affected populations
Positive

  1. People will be able to use their SDS flexibly to enhance choice.
  2. 2. Continuation of service, recognising respite for unpaid carers required.
  3. 3. Proportion of available spaces exist across the city.
  1. Service user, Unpaid carers, Providers
  2. Service user, Unpaid carers, Providers
  3. Service user, Unpaid carers, Providers
Negative

  1. The use of SDS payments mean that users can change services whenever they wish, meaning staff requirements are more varied leading to a potential risk of job insecurity.
  2. The current wait time for the AllPay card to be received by the service user is extremely long. This therefore results in the user being unable to utilise the service when required, for a long period of time unless they pay up front. This would have a bigger negative impact on those people vulnerable to poverty. On the other hand, if the organisation decides to take the user on before receipt of the card then they run the risk of the individual moving to another service or no longer requiring the service prior to receipt of the card which results in a financial loss for the organisation.
  3. Some services offer men only days. A reduction in funding could lead to termination of such service.
  4. A potential reduction in staff due to savings could lead to additional demand on employees. This in turn could lead to those with additional support needs receiving a limited service.
  5. Our current Ethnic Minority provider could be affected as individuals within this service have been there for a long period of time. However, this should not be the case and periodic reviews should be taking place to stop this from occurring.
  6. Less supply could lead to increased waiting lists with a resulting negative impact on the service user & carer. (Positives of Day Opp will not be achieved) This may lead to a deterioration of physical and mental health for service user and carer. This may shift demand to more critical need across Health and Social Care systems.
  7. The potential of smaller organisations ceasing to operate can lead to additional travel times for service user resulting in stress and distress for individuals.
  8. Any change to service may lead to negative impacts for service users, in particular those that have neurological disorders.
  9. Proposals may impact on number of staff employed, many of whom are on a low pay bracket, leading to potential poverty.
  1. Provider Staff
  2. Service Users & OPDO Providers
  3. Male Service Users
  4. Service Users with Complex Needs
  5. Ethnic Minority Provider & Service User
  6. Service User & Carer
  7. Service Users
  8. Service User
  9. Staff
Environment and Sustainability including climate change emissions and impacts Affected populations
Positive

  1. Larger providers may have capacity to increase if smaller providers struggle with the 10% contract reduction creating a more sustainable market.
  2. The Short Life Working Group have developed an SDS toolkit to support providers with this transition to a new business model if they so wish.
  3. The creation of a blended service model (Framework agreement/SDS/ Private Clients) for OPDO providers increases the variety on offer for individuals which may result in more uptake of the services.
  4. Prevent carer breakdown.
  5. Prevent or delay admission to long term care
  6. Promotes “right care, right place, right time” philosophy.
  1. OPDO providers
  2. OPDO Providers
  3. Service Users
  4. Service users/unpaid carers
  5. Service users
  6. All
  1. The reduction in funding may have a negative effect on some businesses and their sustainability which will cause uncertainty and stress amongst members of staff. This could also lead to highly qualified and knowledgeable staff members leaving the industry to find a more stable career. To mitigate this risk, providers may wish to improve marketing.
  2. Smaller organisations may struggle to sustain their business with a reduction in funding & the framework can be renegotiated with available providers.
  3. If larger organisations take on additional contracted work due to the breakdown of smaller organisations this may lead to stress and distress for service users & possible carer breakdown through both the natural change and the potential additional travel time required. This could then in turn increase the need and so the demand on the provider increases.
  4. There may be a loss through the reduction in service for community assets.
  1. Organisational Sustainability & Loss of Staff
  2. OPDO Providers, Cared for Person
  3. Cared for Person, Unpaid Carers, OPDO Provider
  4. Edinburgh Citizens

 

Economic Affected populations
Positive

  1. More sustainable business model for organisations remaining in the market.
  2. Contribution to EHSCP financial planning.
  3. Fixed unit cost will be applied from April 2025.
  4. Continuation of service within available budget will exist.
  5. Chargeable elements for Meals & Transport has been agreed to align with the City of Edinburgh Councils charging structure which is updated annually.
  1. Providers
  2. EHSCP & EIJB
  3. All
  5. Providers, service users
Negative

  1. As indicated above, financial pressures may shift to other services (as of November 2024, there was no additional SDS option 3 day care purchased or Spot Purchases as a result of the 2024/25 reduction).
  2. Unlike framework agreement places, SDS & Private Client contributions are not guaranteed therefore this may create challenges for providers to be flexible in staffing arrangements.
  3. The fixed unit price can only buy so many places within the available budget unless new business models are adopted.
  4. The recently added financial pressure on all services as a result of future EIJB grant funding cuts in addition to the EHSCP contract reductions could reduce any savings forecast, therefore calculations must be informed holistically to mitigate the risks of savings transforming into additional financial burdens to statutory services receiving additional referrals from vulnerable people and carers as a result of cumulative reductions in day service and respite service placements.
  1. EHSCP Finance
  2. Service Users, OPDO Provider
  3. Service Users, OPDO Provider
  4. Service Users, OPDO Providers

Yes, this will be addressed as part of the procurement process.

Providers will update their communications and links will be made available on the EHSCP & City of Edinburgh Council websites which will be accessible.

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. See section 2.10 in the Guidance for further information.

No

No

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
EHSCP to maintain communication with providers as the framework agreement progresses to be awarded April 2025. All
Draft IIA to be circulated to full group for comment by 20th December. Ryan Watson 20 December 2024
Once complete, will be incorporated into savings proposals for the EIJB to ratify as part of the Savings & Governance Plan. Signed off by director and published via Communications team. Katie McWilliam Mid January 2025

A reduction in funding may lead to the loss of some service provision, increased waiting times and potentially increased travel times for individuals. This will require mitigation on a case by case basis.

Through regular engagement with providers to understand any impact, regular meetings are scheduled.

Name: Andrew Hall – Service Director, Strategy

Date: 5 February 2025

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