Savings programme 2024-25 – older people’s day support integrated impact assessment

Rebalancing day opportunities and respite

Respite – Increased levels of short breaks/respite to reduce the stress on long term care support.

OPDO – Reduction of 10% to each providers’ contract value resulting in a move to a new business model incorporating private clients and SDS payments.

Current OPDOs providers have regularly been made aware of the potential of a reduction in contract value.

Open book exercise underway to understand a fair unit price for OPDOs with providers.

Current Review and Assessment Team carrying out work regarding care at home packages.

Thursday 8 February 2024

Name Job Title Date of IIA training
Andrew Farr External Provider – Libertus  
Fiona Johnston Senior Accountant  
Haneih Jamali Data Analyst  
James Cuthbert Interim Lead Commissioner  
Jay Sturgeon Project Manager  
Katie McWilliam Strategic Programme Manager  
Kellie Mercer External OPDO Provider – Caring in Craigmillar  
Kyle Oram Planning & Commissioning Officer  
Lewis Hunston Be Able Manager  
Paula Deegan Procurement Category Lead  
Rene Rigby Scottish Care – Independent Sector Lead  
Ryan Watson Project Support Officer  
Sarah Bryson Planning & Commissioning Officer November 2017
Susan McMillan Performance and Evaluation Manager  
Stef Milenkovic EVOC  
Tracy Lowe Be Able Manager  
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 ( 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 providers and what locality the service is provided in.
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

State of Caring In Scotland 2022 –

Scottish Government – Scottish Health Survey

Data on equality outcomes

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.

Research/literature evidenc Data around wait times for individuals to receive a care package before leaving hospital. We have the data regarding waiting times for individuals to receive a care package before leaving hospital, information from AIS Swift
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 (

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 – (

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) N/A
Additional evidence required N/A
Equality, Health and Wellbeing and Human Rights Affected populations

1.    The potential ability to access more respite services which will assist carers and service users.

Service users/Carers

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 effected 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.

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. Staff

2. Service Users & OPDO Providers

3. Male Service Users

4. Disabled Service Users

5. Ethnic Minority Provider & Service User

6. Service User & Carer

7. Service Users

8. Service Users

9. Staff

Environment and Sustainability including climate change emissions and impacts Affected populations

1.    Potential remobilisation of dormant care homes leading to additional capacity for respite services.

2.    Larger providers will be able to increase capacity if smaller providers struggle with the 10% contract reduction creating a more sustainable service for these providers.

3.    The SLWG are currently working on a toolkit to support providers with this transition to a new business model with providers that currently offer these services at the forefront of the creation of this documentation. It was noted that this work must be escalated due to the new proposals set out above.

4.    The creation of a blended service model (SDS/ Private Clients) for OPDO providers increases the variety on offer for individuals which may result in more uptake of the services.

5.    Prevent stress and distress for unpaid carers

6.    prevent or delay admission to long term care

7.    promotes “right care, right place, right time” philosophy.



1. Care home providers, carers, cared for person

2. OPDO providers

3. OPDO Providers

4. Service Users

5. Service users/unpaid carers

6. Service users

7. 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, an in depth internal comms plan must be created. 

2.    Respite is a necessary part of business. It was noted that some providers would not do respite as they felt it was not a good business model as it comes at an increased overall cost as it is a new individual each time.

3.    Smaller organisations may struggle to sustain their business with a reduction in funding and therefore a piece of commissioning & procurement will have to be carried out in order to re commission for the service. Smaller organisations may also not have the same flexibility to accommodate reduced numbers.

4.    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 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.

1. Organisational Sustainability & Loss of Staff

2. Carer & Cared for person (lack of availability)

3. Providers – Financial Sustainability

4. OPDO Providers, Cared for Person

5. Cared for Person, OPDO Provider

Economic Affected populations

1.    Increased levels of respite care, leading to reduction of stress on long term care both financial and individual

2.    It has been brought to the attention of the partnership that there are various situations whereby the individual is currently on the incorrect tariff (respite instead of long term care) which is leading to increased costs. There is currently no trigger on our systems to make practitioners aware that individuals need to make the change in tariff and so this is a current savings opportunity.  However, there have been various circumstances whereby practitioners have got in contact with EHSCP colleagues in regard to the changing of tariffs but have been left without a response. This was noted as urgent action.



1. Carers & Cared for Person

2. EHSCP Finances, Practitioners (additional training/support), Carer/Cared for Person (Increased Costs – Stress), EHSCP finances


1.    Increased respite costs leading to increased partnership purchasing costs but as noted above this short term increase in net cost will lead to a larger medium term saving.

2.    Could be seen as we are moving the financial burden from day opportunities to respite instead of making a direct saving.

3.    Some people present felt respite is a necessary part of business whilst others felt some providers would not do respite as they felt it was not a good business model as it comes at an increased overall cost as it is a new individual each time.

4.    Unlike block contract places, SDS & Private Clients are not guaranteed for a certain number of weeks and therefore this firstly creates an increased risk to a recurring income but also potential staffing issues. Staffing requirements will have to be agreed in advance as an expectation of service levels and therefore this may lead to lower staff-user ratios which will in turn lead to some activities being unviable.

5.    If there is an increased unit price the volume of places will be reduced as the budget we have for OPDO services cannot be increased. This will therefore lead to less services unless organisations incorporate the new business model of attracting SDS and private clients.




1. EHSCP Finances

2. EHSCP Finances

3. Providers & Variety for Service Users 

4. Service Users, OPDO Providers

5. Service Users, OPDO Providers

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
Jay to link with Robert Smith around the demographic of people receiving respite care and the financial reviews taking place after two weeks within the disabilities landscape. This information is then to be passed on to Viviene Robertson for review. Jay Sturgeon, Project Manager
Susan to connect with the residential review team around the current email response rate for financial assessments which is currently around 12 weeks. This is something that is increasing the need on the individual and thereafter increasing costs. Susan McMillan, Performance Evaluation Manager
Katie and Jay to confirm if Finlay Place is still open for respite services. Katie McWilliam, Strategic Programme Manager

Jay Sturgeon, Project Manager

Timeline for the 10% contract reduction to potentially be reviewed on a case by case basis. Katie McWilliam, Strategic Programme Manager

Vivienne Kennedy, Contracts Officer

Communication plan to be developed Katie McWilliam, Strategic Programme Manager
All risks have been recorded on a separate risk register which has been created through the Project Core group, appropriate mitigations have been recorded on that register and will continue to be considered each time the group meets, currently scheduled fortnightly. Katie McWilliam, SRO

Jay Sturgeon, Project Manager

April 2024 April 2024

A reduction in funding may lead to the loss of more specialist service provision, increased waiting times and potentially increased travel times for individuals.

There may also be a reduction in number of staff employed.

Through regular engagement with providers to understand any impact, regulat meetings are in the diary.