Integrated Impact Assessments – EHSCP restructure phase one
EHSCP Restructure
The current organisational staffing structure within the Edinburgh Health and Social Care Partnership (EHSCP) is not best configured to meet the challenges and opportunities ahead. Within our operational services, the four localities have led to lack of clarity on accountability and duplication of effort. There are too many hand-offs which has led to inconsistency of approach. In addition, because of this, our strategic planning function currently cannot relate clearly to our operational structure.
The problems with the current structure attracted negative comments in the two most recent Care Inspectorate Reports on the HSCP (February and March 2023). In particular a lack of management oversight of key processes, lack of assurance on consistency and quality of practice, variation between localities, lack of effective professional governance.
The proposed new structure is designed with deletion of existing locality manager and direct report posts and creating city wide functions led by Head of Services posts supported by Service Managers. The Heads of Service and Service Managers will have clear accountability for specific services across the city. The structure will also strengthen professional leadership and visibility and support stronger planning links between Operations and Strategy.
As the legislation for locality working still applies, the partnership will ensure that working at locality level continues in a number of ways.
N/A, this is an internal management review, engagement sessions held with internal colleagues.
3 April 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 |
|---|---|---|
| David Small | SRO – Lead officer | |
| Gosia Szymczak | Project Manager – facilitator | January 2020 |
| Mike Massaro-Mallinson | Service Director – Operations | |
| Helen Fitzgerald | Partnership Lead | |
| Fiona Jolly | RCN Accredited Representative | |
| Avril Mackay | Strategic Programme Manager Public Health | |
| Karen McErlean | ||
| Siobhan Murtagh | Senior HR Consultant (Council) | 28 October 2021 |
| Louise Morgan | Senior Employee Relations Practitioner (NHS) | |
| Danni Burgess | Accountant (Council) | |
| Sara MacDonald | Senior Accountant (Council) | |
| Eleonora Ho | Finance Manager (NHS) |
| 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 City of Edinburgh HSCP (2020) Edinburgh HSCP Joint Strategic Needs Assessment: Edinburgh Integration Joint Board Strategic Plan (2019-2022) |
Provides current and projected data on the wider population in the City of Edinburgh (Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot) 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:
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 | Service uptake/access reports
EIJB Performance annual reports Performance report for Whole System Delivery Oversight Group |
The performance and evaluation team have access to various data sets on service uptake/access.
This performance report sets out our progress against the strategic priorities within The performance and evaluation team produce this report for the Whole System Delivery Oversight Group. HSC surveys and service users reports National waiting times targets and standards |
| Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. | Joint Strategic needs Assessment City of Edinburgh HSCP (2020)
Director Public Health annual report Edinburgh Poverty Commission |
Provides current and projected data on the demographics within Edinburgh (Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot) Provides details on the experience of poverty in Edinburgh |
| Data on equality outcomes | Scottish Government – Scottish Health Survey
Locality profiles |
https://www.gov.scot/collections/scottish-health-survey/
Our Localities profile tool gives you facts and statistics about smaller areas within Edinburgh. It covers all 17 wards, the 4 localities, Edinburgh and Scotland and allows you to do a side-by-side comparison on subjects such as
Scottish Index of Multiple Deprivation. |
| Research/literature evidence | Care Inspectorate SW SC Inspection Report
SWSC IP plan |
Edinburgh was inspected in relation to adult social work and social care in Edinburgh – City of Edinburgh inspection report March 2023.pdf (careinspectorate.com) |
| Public/patient/client experience information | Scottish Government – Scottish Health Survey | https://www.gov.scot/collections/scottish-health-survey/
HSC surveys and service users reports |
| Evidence of inclusive engagement of people who use the service and involvement findings | N/a | |
| Evidence of unmet need | Unmet Need Data | The performance and evaluation team have access to the unmet need list of those awaiting assessments & packages of care and delayed discharges, access to MH, LD and SU services. |
| Good practice guidelines | Legislation governing the provision of EHSCP services
Local and national policies |
The following legislation is relevant to the provision of such support:
Social Work (Scotland) Act 1968 Public Sector Joint working (Scotland) Act 2014 National policies and frameworks: Local policies: ASP Policy |
| Carbon emissions generated/reduced data | N/a | |
| Environmental data | N/a | |
| 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. https://www.edinburghhsc.scot/wp-content/uploads/2023/06/Cumulative-IIA-Savings-Programme-23-24_Phase-2_final.pdf |
| Other (please specify) | Local workforce data
LEZ |
The EIJB Workforce strategy provides information on partnership workforce numbers and profile, use of HSC services, projected demand and sets out workforce priorities.
Web pages on EHSCP Workforce: https://www.edinburghhsc.scot/whoweare/ NHS and Council staffing data MTFS – Medium Term Financial Strategy Carbon emissions generated/reduced data – City Vision 2050 consultation – Policy and Sustainability Committee agreed a ‘Short Window Improvement Plan’ (SWIP) in October 2019 |
| Additional evidence required | N/a |
| Equality, Health and Wellbeing and Human Rights | Affected populations |
|---|---|
| Positive The aim of the restructure is to provide more stability, improve stress level and wellbeing of staff by reducing the number of interim posts. There will be clearer lines of accountability and role definitions. Job Descriptions will be reflective of roles and ensure accountability and improved governance, there will be clear lines of management including professional. An agreement has been reached for consideration of colleagues who have been acting up or seconded into roles within the scope of this review as an exception to the standard 4 years required per the Council Managing Change Policy & Guidelines, to ensure equity between NHS Lothian and City of Edinburgh Council employees within this review. By bringing together community mobilisation and public health practitioners there may be more opportunities for a coordinated response and strengthened equalities agenda. Mental Health and Substance Use services will be standardised and this should be more positive and less restrictive experience for people. The proposal is to also reduce variance across services and localities and improve links across services. This restructure aims to impact positively on people as they will be able to access the right service at the right time, changes should lead to reduced waiting times, improved communications and flexibility of staff to move across the city. Process between Social Care Direct and localities will be streamlined. The aim is to provide more opportunities for holistic care and person centered care. The proposed restructure aims to strengthen the governance arrangement for transition services which should improve outcomes for people transitioning from children to adults. Improving professional governance can strengthen quality and safe care. |
EHSCP employees
Edinburgh citizens |
| Negative Policies of both organisations provide a level of protection but it is causing uncertainty and stress amongst staff and colleagues who are directly and indirectly impacted. Change is difficult for people and we aim to reduce this through providing clear and timely communications, line manager support and signposting to appropriate supports, e.g., the Council’s EAP provider PAM Assist. With the introduction of the new Low Emissions Zone potential for increased cost and or mileage if colleagues use their own transport to travel across the city. Moving to city wide approach may impact on local knowledge, relationships and focus on locality working. |
EHSCP employees
Edinburgh citizens |
| Environment and Sustainability including climate change emissions and impacts | Affected populations |
|---|---|
| While the restructure might provide opportunity for consideration of existing buildings/resources these are not going to be directly impacted at this stage. |
| Economic | Affected populations |
|---|---|
| Positive Access to services will be improved by effective operational management. Job Descriptions will be developed to ensure staff are paid appropriately for their work. Working conditions and stability of services will improve by reduced interim posts. |
EHSCP employees |
| Negative Reducing management posts will be necessary reduce management costs. Loss of experienced staff and knowledge. |
EHSCP finances |
A detailed comms plan has been developed for the Restructure with set timescales, methods of communication and list of who needs to be engaged.
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
| 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 |
|---|---|---|---|
| Continue to ensure that the NHS and Council policies are followed. Continue to work closely together across the Council and NHS. | EHSCP Restructure Project team. | Throughout the process. | |
| More work is needed to define the locality working within the context of city wide services.
New Hos and Ops Director to ensure local knowledge is not lost. |
It is proposed that this will be done by the new HoS once appointed and Ops Director. | It is proposed that this will be done by the new HoS are in posts they will take ownership to develop that further. | |
| Continue to strengthen professional leadership including collaboration with general managers. | It is proposed that this will be done by the Professional leads and new HoS. | It is proposed that this will be done by the new HoS are in posts they will take ownership to develop that further. |
This will be monitored throughout the consultation process, normal management channels and through regular engagement with the Trade Unions. We will also carry out a post review feedback exercise to ensure we identify any lessons learned.
Name: Tony Duncan, Head of Strategic Planning
Date: 3 September 20201