·       Given the current scale of delivery it is determined that the service is not currently accessible by everyone and recognising the team size, however with high levels of resource required to deliver service at home and considering waiting lists, noting that to scale up service would not be financially viable

·       Opportunity to consolidate prevention offer by bringing skills to other services that need them to advance prevention on a larger scale, whilst acknowledging that other services do not utilise the specific specialist skills such as Otago and CST

·       Opportunity to continue to provide a general offer digitally

·       Financial sustainability crucial in being able to provide core services to those considered high risk within the wider population who also rely on essential care and support services

·       Opportunity to consolidate and strengthen offer in prevention services that are currently disparate

·       Opportunity to work with teams to collaborate, take stock and create a stronger and sustainable model of prevention, consolidating and bringing together strengths and experience from small teams – prevention and therapy team, Be Able, reablement.

·       Opportunity to redirect resources to support vulnerable adults in other prevention services on a larger scale, albeit a different prevention offer

·       Financial sustainability will mean stability of services for all across the partnership

·       Opportunity to deliver a more general offer through digital means to support continuation of health promotion – learning from experience during the pandemic when services were adapted whilst noting for some this may not be accessible

All those in receipt of services from the EHSCP, particularly older people and disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems)

·       Reduced service will impact older people given the demographic who access the service

·       Emphasise stigma often associated with falls – worry around fear of falls within families and communities

·       Emphasise stigma associated with ageing which this change may exaggerate

·       Reducing socialisation and opportunities for people to engage in their communities for inclusion and potentially increasing isolation or dependency

·       Reduced quality of service offer with Be Able holding a good reputation given its unique offer

·       Removing access to a long-standing service with good reputation established in 2002

·       Reducing quality of service increasing demand on formal care and support

·       Reduced opportunities for the right support at the right time

·       Reducing community connections for individuals who may not be currently accessing other support

·       Reducing opportunity for those receiving or waiting for the service for independent living and community connections

·       Reducing opportunities for those receiving and waiting for the service to participate in activities that promote independence

·       Vulnerability perception of individual ‘becoming a target’, receiving support ensures the person feels safe

·       Some individuals have experienced financial fraud, staff intervention can support fraud avoidance

·       Reduction of outdoor mobility that promotes physical activity and wellbeing.

·       Reduced offer for those with dementia Cognitive Stimulation Therapy supporting people to be more independent in their own homes and offering motivation and confidence and to remain in contact with others

·       Reduced offer for those experiencing mental health issues

·       Risk of increased medication use for those living with long term conditions or disability

·       Context of perceived decreased funding for community initiatives could reduce capacity further

·       Reduced offer of support in the home may increase risk in relation to safe environments in the home – security, fire, and trip hazard risks

·       Potential deterioration of condition

·       Safety considerations – people don’t necessarily receive other services, this could be first contact/point of support

·       Reducing physical activity may increase a person’s vulnerability and safety

·       Reduced support could reduce opportunities to identify trip hazards in the home linked to falls and increase accidental injury leading to hospital admissions

Whilst some in the group felt that these impacts for service users could be mitigated to some extent through the provision of alternative services such as falls prevention, reablement, therapy and the Steady Steps programme, there were others in attendance who believed that the Be Able service is unique and specialist and is supporting people with a high level of need and that existing alternate services could not replace this or deliver the same outcomes for people.

·       Reduce resilience of unpaid carers some of which access services designed to support this group, including an information cognitive stimulation therapy carers group

·       Reduced reassurance for unpaid carers of their loved one at risk of falls or without support, may put pressure on relationships

·       Impact on community capacity if need shifted elsewhere or people at risk of being unsupported

·       Closure of the service would see staff redeployed into other roles. Some staff who feel they are unable to utilise their specialist skills may choose to leave the organisation, with a consequent loss of skills and knowledge.

·       The Be Able team have been through changes to the service post pandemic moving from building based to in the home, so this further change may result in a sense of feeling out of control

·       Be Able team work in a Three Conversations approach which requires time which may be less available in other services, but noting the benefits to working in this way including reducing demand and need for paid services and connecting people in their communities

These impacts on staff may be mitigated to some extent by ensuring that staff are well supported throughout the process and that the agreed policies and procedures of the City of Edinburgh Council are followed in any service closure.

·       Reduced access for those in more rural/remote locations of the city where alternative services may be harder to reach

Unpaid carers

Business community, particularly third sector and community organisations

Staff

Rural communities

·        Reduced need for staff to travel – recognising majority staff use public transport not car users

·        Reduced travel would reduce air pollution (note limited predominantly already use public transport as opposed to cars)

Negative

·       Reduced support to individuals in the home with wider environmental support including energy efficiency

·       Cross referral to fire service working in a multi-disciplinary team way

·       Reduced opportunities to address housing quality observations and issues and referrals to wider support services

·       A more general continued digital offer may be possible to maintain some level of access, to be scoped

·       Possible links to community organisations to support with digital improvements in the home – acknowledging funding challenges, whilst acknowledging the potential barriers to access for some including those living with dementia

·

·       Reduced potential to support those receiving the service with benefits maximisation and access to food banks for those in most need

·       Literacy/numeracy – Three Conversations approach helps to ensure exercise regimes are accessible through different visual ways – outcome-based person-centred approach

·       Reduced ability to signpost to Social Security Scotland

·       Reduced potential to support local businesses through outdoor mobility support and confidence building activities that involve local community groups (church groups/lunch clubs)

Business community, third and community sector organisations