Savings programme 2024-25 – Older peoples pathways review integrated impact assessment

  1. A new care home admissions policy that defines the financial threshold on when it is appropriate to consider a care home placement instead of care at home provision.
  1. A review of existing people who use services that receive a package of care over the defined financial threshold to understand if a care home is more cost effective and appropriate to meet the user’s needs.

There have been discussions with Scottish Care on the contents of this proposal and there have also been initial discussions with some care home providers in Edinburgh to understand a reasonable price for beds. There has been no formal public involvement on this.

29 February 2024

Name Job Title Date of IIA training
James Cuthbert Interim Lead Commissioner  
Hazel Stewart Programme Manager Feb 2020
Alexis Heeren Project Manager  
Shirley Middleton Care Booking manager  
Jane Brown Senior Care Home Manager  
Gail James Senior Social Worker  
Emma Gunter Contracts Manager  
Vivienne Kennedy Contracts Officer  
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 Mid-2021 Population Estimates Scotland

EIJB Joint strategic needs assessment, on demography


BAME groups

health inequalities


mental health and dementia

Further evidence required about older LBGTQ people, who may experience higher rates of social isolation. Work underway.

See also socio-economic disadvantage through the SIMD (below).

Data on service uptake/access Care at home services provided and/or funded by health and social care partnerships in Scotland 2022/2023

Public Health Scotland reports on delayed discharges from hospital

Census of Hospital-based Complex Clinical Care

TURAS care home dashboard reports of care home capacity, occupancy and staffing.

Care Home Census for Adults in Scotland 2022-23

EHSCP Swift case work and financial management system, for data about purchased services for people with eligible care needs.

EHSCP weekly capacity, occupancy and Isaac & Neville dependency scores of residents in CEC care homes.

Care Inspectorate Datastore of regulated care services in Scotland (MDSF)

These data showed at the frequency of large care at home services compared with other Partnerships.

Delays in hospital are measure of scarcity for nursing and dementia care home services.

Comparison of Edinburgh HBCCC with peers indicates shortage of high-intensity care home services.

TURAS routinely counts care home workforce and capacity in Council and independent home in Scotland. It demonstrates the declining rate of availability care home beds in Edinburgh since Nov 2021.

Care Home Census is a detailed annual survey of the health of the care home market, including detail not found in TURAS about prices; residents’ sources of funding; lengths of stay; demography; reason for care; health conditions; and need for nursing care.

EHSCP records external care home provision and spending in Swift. They show the share of economic activity in the care sector that is funded by Partnership spending

Activity in and spending on in CEC homes is recorded out with Swift. These data complete the account of EHSCP spending on care homes and add useful information about dependency levels

MDSF is the database of the number and quality ratings of regulated care home services in Scotland.

Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Scottish Deprivation Indices

Dynamic small-area analysis of SIMD

Use of zero-hour contracts

Deprivation indices of economic and health deprivation can between them predict the need for care.

Small-area analysis of SIMDs are useful terms in the distribution of health and care resources, supporting place-based commissioning.

In the last quarter of 2023, 3.8% of people in employment in Scotland have a zero-hour contract of employment. They are frequently used in social care to manage employment costs when revenues decline.

Data on equality outcomes Requires further work especially the effected on Protected Characteristic; economic deprivation; and specific disabilities and long-term health conditions.
Research/literature evidence
Public/patient/client experience information Might require further work, in particular about people the experience of people moving between care homes where the move is motived by cost rather than changed needs.
Evidence of inclusive engagement of people who use the service and involvement findings Engagement with stakeholders in a development session including members of the EIJB, Scottish Care and Edinburgh Voluntary Organisations’ Council among others. The programme routinely visits care homes, Council and independent sector to hear from staff, residents and management.
Evidence of unmet need EHSCP Care Bookings weekly reports of “unmatched” people waiting to move to a care home

See also routine delayed discharges from PHS (above).

Good practice guidelines
Carbon emissions generated/reduced data None for the near-team aims of this savings proposal. The medium- and long-term aims of the Programme include investment in care home accommodation, with commensurate improvements in energy efficiency.
Environmental data See previous item.
Risk from cumulative impacts Please refer to cumulative IIA for the MTFS, 4 March 2024.
Other (please specify) A National Care Service for Scotland

A National Care Service for Scotland: consultation – (

Additional evidence required LaingBuisson Care Cost Benchmarks

The National Care Home Contract and fees.

12th Edn. One of the three established independent unit-costing and cost comparison tools for care homes. It is repopulated with mostly English data but will be enhanced with data from Edinburgh’s care homes for this Programme.

The NCHC is the normal contract for them and defines terms and conditions other that the fee rates that this proposal treats.

Equality, Health and Wellbeing and Human Rights


Affected populations

–        For some, a care home is less restrictive than large packages of care at home, particularly those involving multiple daytime visits and overnight care.

–        The proposal offers choice. It allows people who use services to choose where their care needs are best met.

–        People who live alone may be less isolated and have better social support in a care home.

–        The proposal does not increase the risk that vulnerable people will falling fall into poverty as care will be funded by the local authority.

–        Could reduce discrimination against, and harassment of, lone-working homecare staff, particularly if the person displays stressed and distressed behaviours.

–        Could promote a healthier lifestyle for people who use services as there is more opportunity for staff in a care home to promote healthier choices and more activity.

–        Developing a Care Home Admissions Policy should result in more consistent and equitable treatment of Edinburgh residents by supporting Social Workers to make decisions about appropriate settings of care.

–        People living in residential care home settings within the target range including older people and people with learning and physical disabilities.

–        Social work and care home staff.


–        Staff will be asked to review of people supported at home and will be required to have difficult conversations and moving to a care home.

–        Staff will be required to consider care home provision as an alternative to care at home which might be seen as a change in ethos and practice. A policy will be developed to assist staff with implementing new standards (An explicit policy on the care home admission threshold is not in itself negative; a new policy and guidance offers clarity and support the assessment outcome.)

–        Providers who provider large packages of care may see reduced revenue if their customers move to a care home.

–        Homecare staff may see a reduced workload, and fewer hours for those who work on a zero-hours contract, whose customers move to a care home.

–        This proposal disproportionately affects individuals with higher care needs (including people with disabilities) because people on smaller packages of care are out of scope. Not all individuals on high packages of care will want to move into a care home. Some may prefer to stay at home. This proposal does not mandate moving to a care home, since that decision depends on factors other than cost, the intent might nonetheless be seen as discriminatory if personal choice is not respected.

–        At the same time, it was acknowledged that views about moving sometimes change when people have the opportunity to visit a home. The proposal should consider how to support people, their guardians and families to make informed decisions.

Environment and Sustainability including climate change emissions and impacts


Affected populations

–        Potential to reduce the Partnership’s overall carbon footprint through reduced travel, particularly to people who use services receiving several daily packages of care with two carers and an overnight service.

–        More oversight and support of people who need twenty-four-hour care; better infection control; less risk of accidents, falls and fire.

–        Potential to improve living conditions for some people, particularly those prone to hoarding or whose home is not suited for care.

–        Potential to save energy from heating and electricity if people move from single households into a multiple occupancy care home.

–          Older people over sixty-five who are in receipt of or are considered for, a package of care that costs more than the national care home contract rate.

–        Staff groups

–        Providers



–        Potential to increase travel requirements for families if people who use services move to a care home that is not local.



Affected populations

–        This proposal would benefit the Partnership by reducing the number of people with care at home, especially those in a rural areas where intensive care at home can be hard to arrange and sustain.

–        This proposal would be more financially viable for the local authority.

–        May reduce or increase living costs, depending on the result of the financial assessment and contributing to care home fees. The consequences might be positive or negative.

–        Could support local businesses by working with care providers in local areas.

–        Could support employment opportunities by working with care homes that have good working conditions and business models.


–        May reduce or increase people who use services cost of living so could be positive or negative.

–        Scarce Social Work resource will be required to conduct these assessments and engage with people who use services and families. More analysis is needed understand if the savings accrued by this proposal are worth the investment in staff time.

–        Might require people to sell property to fund a care home placement. This could cause distress. The loss of a financial asset might negatively affect families’ finances.

–        Some Partnership staff might be impacted if care at home services close due to a reduced need for that service. On the other hand, this could free up more resources for others who are waiting for care at home.

–        Potential for negative economic impact on homecare providers who may rely on large packages of care to remain profitable, especially those specialising in large packages. This could have a knock-on effect on employment and local economies. More engagement with providers is needed to understand how they are impacted by these proposals.



Should this proposal be agreed, a communications plan will be developed to inform staff of the changes to the existing procedure. This would be developed in collaboration with communications colleagues and would meet all accessibility requirements.

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.


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.

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
Gather evidence on user and carer experience and the potential impact on LGBTQ community James Cuthbert 31/3/24 July 2024
Estimate financial consequences for providers and families James Cuthbert 31/3/24 July 2024

Increased financial contributions for care home service compared with care at home.

Should the proposal be approved, there will be a project and implementation plan developed with clear project documentation including RAID logs and benefits realisation plan. The impact on these groups will be monitored through project governance.

Name: Moira Pringle, Chief Finance Officer 

Date: 08/03/24