Savings programme 2024-25 – BeAble integrated impact assessment

Proposed closure of the Be Able Service as part of the 2024-25 savings programme.


The proposal will mean the Be Able service would close and represents a change to the way we deliver prevention support to older and vulnerable people, and this may be seen as an opportunity to reshape a more sustainable model of support. In the short term it is a reduction in the delivery of prevention activity to 358 people currently receiving care and support through Be Able and to 301 people on the waiting list, currently the service receive weekly referrals and managers’ report a flow through the service.

It represents an impact for staff in change of roles for the twenty people employed within the service, who would require redeployment to alternative roles to ensure skills and knowledge are retained in the partnership. There is a skill loss in relation to Otago and Cognitive Stimulation Therapy if alternative roles are unable to deliver this activity.

People who access the service are identified as individuals who may not currently access other forms of support and therefore could be considered harder to reach, therefore there is a risk of isolation or deterioration for these individuals, recognising the service is for a 6–12-week period and not long term and may need further alternative support to ensure continuation of health promotion, independent living support and for overall quality of life.

The potential cumulative impacts of reducing prevention services like Be Able could lead to an increase in demand within acute settings and pressure on other teams and services in the partnership or increasing waiting lists for support. It may mean more formalised care and support required sooner and/or pressure on community organisations.

In addition to the direct provision of the Be Able service, the managers within the team also carry out a further function in relation to the grip and control around access to registered day opportunities for older people. This involves triaging referrals, managing the waiting list and reducing spot purchase spend by ensuring that block contracts are fully utilised. the triage function has resulted in people being diverted from statutory services to wider community supports where appropriate

If the closure of the Be Able service is approved, then alternative arrangements would be required for this to ensure that this grip and control can be maintained.


For more information about the service: Be Able Service – Edinburgh Health & Social Care Partnership (

The proposal has been discussed as part of a number of proposals shared with the savings governance board in response to the financial challenges across the partnership.

An initial meeting has been held with the Be Able management team in order to gather information and evidence regarding the proposal and given the sensitive nature of the change the proposal is currently within a small group.

29 February 2024

Name Job Title Date of IIA training
Hannah Cairns

(lead officer)

Chief Allied Health Professional 26/8/2020
Jessica Brown Senior Manager, Innovation and Sustainability  
Claire Bennett (facilitator, report writer and evidence) Project Manager, Innovation and Sustainability 22/12/2020
Helen Elder (note taker) Executive Assistant
Catherine Mathieson Cluster Manager, South East Locality  
Tracy Lowe Be Able Manager (South)  
Lewis Hunston Be Able Manager (North)  
Siobhan Murtagh HR representative  
Bridie Ashrowan Chief Executive, EVOC  
Allister McKillop Service User Representative  


Contributions provided outwith formal IIA session:


David Harrold Union representative  
Katie McWilliam Strategic Programme Manager, Older People’s Services  



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 Chief AHP Lead Budget Savings Development Proposal

Joint Strategic needs Assessment City of Edinburgh HSCP (2020).

Edinburgh HSCP Joint Strategic Needs Assessment: Health and Care Needs of People from Minority Ethnic Communities (April 2018)

Predominantly older people over the age of 65 receive this service, eligibility for the service is 55 yrs. Be Able is targeted at those with long-term conditions, those who have a history of falls or are at risk of falling, those with poor balance and those who have lost confidence with their mobility. Also, those with a memory impairment or mild/moderate dementia. Referrals on based on critical and substantial eligibility criteria. Currently on average the service receives 15-20 referrals a week, noting that not all will be appropriate referrals.

Provides current and projected data on the wider population in the City of Edinburgh.

Provides an understanding of what contributes to poor health and wellbeing and the barriers and challenges to seeking and obtaining support (many being interrelated).

JSNA-Health-Needs-of-Minority-Ethnic-Communities-Edinburgh-April-2018.pdf (

Data on service uptake/access Chief AHP Lead Budget Savings Development Proposal In 2023 a total of 358 people received the Be Able service.

Be Able is delivered over 6 weeks, 2 X weekly, depending on the individual agreed goals and outcomes.

Out of 358 people that received the service during 2023. Out of this total under 10% (26) people didn’t complete the course; 4 people withdrew, 5 were admitted to hospital, others were discharged due to improved function during the delivery, so were linked into other support or given information on other community resources.

The current waiting list (at 22/01/24) is 301 people.

·       People are referred to the service via GPs, Dementia Link Workers, and GP Link Workers, CMH Teams, Hospital Staff, Practice Teams, relatives, or self.

·       All open case can be captured from AIS case management system.

·       Info on needs is captured on the referral form, available on AIS and our criteria is applied as part of screening.

·       OT’s carryout regular screening and will prioritise and engage with people to offer advice and possible OT assessment & equipment prior to engagement. By doing this, a few people have not needed direct support.

·       OT’s monitor and contact people on the waiting list and prioritise when needed.

Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. JSNA Demography Data – SIMD 2020 Scottish Government
Data on equality outcomes Chief AHP Lead Budget Savings Development Proposal The longest wait is 26 weeks, the average wait being 20 weeks. 96% of service activity delivered within people’s own homes.
Research/literature evidence Prevention and Early Intervention Strategy.

Otago Method /Cognitive Stimulation Therapy (CST) efficacy information.


Edinburgh Falls Report 2022-23 NHS Lothian Analytical Services (attachment)

The closure of this service potentially impacts the prevention and early intervention strategy unless alternative intervention can be identified for those receiving and waiting for the service.

Strategic priority one: Prevention and early intervention – Edinburgh Health & Social Care Partnership (

·       Does the ‘Otago exercise programme’ reduce mortality and falls in older adults?: a systematic review and meta-analysis | Age and Ageing | Oxford Academic (

·       Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial – PubMed (


Outcome measures are completed for everyone taking part in the programme which captures progress and setbacks. This includes what the person has linked into, when completing Be Able. Where appropriate an informal 12-week review takes place with people who completed Be Able which enables us to establish how things have been since completing and offer advice and information.

Showing data for residents in Edinburgh aged 50+ attending NHS Lothian A&E departments due to a fall. On average 478 falls related admissions per month following attendance at A&E.

Public/patient/client experience information Care Inspectorate (CI) Inspection Reports for Be Able North and South

Be Able Team Feedback

CI Inspection (Be Able North) undertaken in 2023. Be Able North is a registered service as a provider of reablement activities, active since 2002. InspectionReport-316718.pdf

Be Able South inspection report is published here Find care (

A service evaluation/impact report hasn’t been completed since the pandemic and since change of service delivery.

The team do carry out participants and/or their carers questionnaire. Be Able also offers carers/family members the opportunity to participate in a carers support group, facilitated by OT’s and staff where we offer advice and information to people facing the same challenges, such as supporting individuals with new behaviours linked to dementia or having a recent diagnosis.

Please see attached participant feedback evidence.

Evidence of inclusive engagement of people who use the service and involvement findings Care Inspectorate Inspection Report(s)

Individual satisfaction survey

Inspection report for Be Able North and South as above.

Individual questionnaires shared for some individuals receiving the service and including some feedback from unpaid carers/families.

Evidence of unmet need Chief AHP Lead Budget Savings Development Proposal.

Edinburgh Integration Joint Board Strategic Plan (2019-2022)

The current waiting list for the Be Able service (at 22/01/24) is 301 people.

Details the health needs and priorities for the people of Edinburgh

Strategic-Plan-2019-2022-1.pdf (

Good practice guidelines Chief AHP Lead Budget Savings Development Proposal

Scottish Government National falls and fracture prevention strategy 2019-2024

Scottish Government Dementia Strategy Scotland 2023

Be Able supports current thinking in falls prevention.

Ambition 2. Build resilience at population level – National falls and fracture prevention strategy 2019-2024 draft: consultation – (

New dementia strategy for Scotland: Everyone’s Story – (

Carbon emissions generated/reduced data N/A
Environmental data N/A
Risk from cumulative impacts ·       Larger or cumulative financial impacts of closing the service by way of greater pressure/demand in hospital and within care at home/reablement services may exist
Other (please specify) Chief AHP Lead/Be Able Management This change will impact 20 staff currently working to support the city-wide Be Able service.

This team have already been through  a similar change when day services ceased, and their jobs were changed as a result of challenges during the pandemic.

Additional evidence required Edinburgh Falls Report NHS Lothian Analytical Services

Carers Census Scotland 2022-23

Additional contributions

·       Included available research on hospital admissions risk for these groups

·       Longer term impact financially on hospital occupancy against cost investment in prevention to avoid admission (cost vs benefit analysis)

·       Included additional data references relating to gender ratio in unpaid carers

Carers Census, Scotland, 2022-23 – (

Contributions from invitees unable to attend including unions, older peoples forum representatives, strategic programme manager for older peoples services

Equality, Health and Wellbeing and Human Rights


Affected populations

·       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

Older people, disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems)
































































Unpaid carers










Business community, particularly third sector and community organisations


























Rural communities



Environment and Sustainability including climate change emissions and impacts


Affected populations

·        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)




·       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

Older people, disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems)


Affected populations

·       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


Older people, disabled people
·       Reduced quality of access due to lack of in person support to help with technical issues – noting support offered through other services ATEC24 however noting reduced referral potential to these services

·       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)


Older people, disabled people













Business community, third and community sector organisations

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.

Additional data has been noted for follow up.

Additional contributions have been sought from those unable to attend the IIA.

Additional data supplied on hip fracture admissions affecting frail/elderly groups.

Scottish hip fracture audit – reporting on 2022 – Scottish Hip Fracture Audit – Publications – Public Health Scotland

Incidence continued to increase: An additional 584 patients sustained a hip fracture in 2022 (8,380 cases), compared to 2021 (7,796 cases) Scottish Hip Fracture Audit Report 2023 (

The percentage of people who died within 30 days of admission increased in 2020 to 8.6% (7.7% in 2019). Scottish Hip Fracture Audit – Reporting on 2020 – Scottish Hip Fracture Audit – Publications – Public Health Scotland

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
Contributions from older peoples forum to be included Claire Bennett 29/02/2024 8/03/2024
Contributions from attendees invited but unable to attend the meeting including union representation, strategic lead for older people and unpaid carers Claire Bennett 29/02/2024 Complete
Seek contribution from senior NHS representation Hannah Cairns 29/02/2024 5/03/2024
Available data relating to hospital admissions for at risk age group Hannah Cairns 01/03/2024 Complete
Available data for cost benefit analysis of savings against cumulative costs in relation to  hospital admissions Susan McMillan 01/03/2024 Complete. No reliable available source data.
Additional data included relating to hip fracture admissions. Claire Bennett 08/03/2024 Complete.
Consideration to be given to development of alternative process for managing older people’s registered day opportunities, in the event that this savings proposal is approved. This could include include reinvestment in the brokerage model, or another operational team that have the skills and capability to deliver the functions. Katie McWilliam July 24 April 24

Whilst some of the group believed that there was an opportunity to achieve many of same outcomes for people through other existing services, such as falls prevention, therapy and reablement, others felt very strongly that Be Able is delivering a unique offer and that other services did not offer mitigation for the loss of the Be Able programme. It was noted that reablement currently needs additional OT resource to redesign the service to the scale required. As such, there was not a clear consensus on whether impacts resulting from the closure of this service could be mitigated.

Name: Mike Massaro-Mallinson

Date: 08/03/2024