Savings programme 2024-25 – EIJB investment in the Alcohol and Drug Partnership interim integrated impact assessment
Withdrawal of IJB social care funding from EADP services
This is difficult to identify at this stage: the proposal is that a reduction in the overall EADP budget will be made. The effect of the proposal would be to reduce the IJB’s contribution to drug and alcohol services by 460,000 pa (approximately 4.75% of the total ADP budget).
This money was originally allocated at the time of a large, sudden cut in ADP funding from the SG which was largely achieved through a savings plan (reducing funding in a range of services) but which could not be achieved in full – the IJB allocated this money to reduce the scale of the reductions which had to be made. Since then, additional investment has been made by the SG along with new expectations of the partnership. The funding which it is proposed to withdrawn is not from the SG allocation directly to the ADP but will obviously have an impact on the overall level of investment in drug and alcohol services in the city.
The expected impact in the first year is likely to be mitigated by our current reserves but will require reductions in non-recurring spending plans. However the full impact will be realised in 2025-26 and reductions in revenue funded services will be required. The EADP Joint commissioning group will develop a proposal for making these longer term reductions and present it to the EADP Executive in the first half of 2024-25.
At this point, before a specific plan has been developed, only the impact of a general reduction in funding for alcohol and drug services has been assessed.
None directly – evidence from other public engagement activities have been incorporated.
11 March 2024
| Name | Job Title | Date of IIA training |
| Cat Young (facilitator) | Assistant Programme Manager (Thrive) | November 2018 |
| Elenora Ho | H&SCP | |
| Patricia Burns | Mental Health & substance Misuse Manager, EH&SCP | |
| David Williams (report writer) | Programme Manager, Edinburgh Alcohol and Drug Partnership | |
| Ian Davidson | Strategic planning and commissioning officer, Edinburgh Alcohol and Drug Partnership | |
| Flora Ogilvie | Consultant, NHSL Public Health |
| 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 | Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot)
Edinburgh Community Food 23-24 Impact Alcohol Health Needs Assessment (draft) NHS Lothian Drug Related Deaths Annual Report 2022 Summary of Edinburgh’s implementation of the Medication Assisted Treatment (MAT) Standards for Drug Users, Jan 2024 Health Needs Assessment – 2017 – Harm Reduction Team (nhslothian.scot) Edinburgh SDCF needs assessment and feasibility study – Executive Summary |
Provides current and projected data on the wider population in the City of Edinburgh
Alcohol harms and overprovision of alcohol have a significant impact on the population of Edinburgh There are ongoing rises in Drug related deaths in Edinburgh and these are contributing to a public health emergency in Scotland. Aspects of the Medication assisted treatment standards are being met in Edinburgh but there remain significant challenges in sustaining the progress made and in achieving them in primary care and criminal justice settings. Needs assessment for injecting drug users Needs assessment of ongoing drug related harms in Edinburgh and evaluation that a Safer drugs consumption facility and a Drug checking service should be funded to extend existing services Housing emergency Needs assessment for SDCF Milestone house development ARBD MAT standards reporting |
| Data on service uptake/access | ||
| Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. | Joint Strategic needs Assessment City of Edinburgh HSCP (2020)
https://www.edinburghhsc.scot/the-ijb/jsna/ Tackling Inequalities to reduce mental health problems – Mental Health Foundation (Jan 2020) Edinburgh poverty commission report – A just capital: Actions to end poverty in Edinburgh End Poverty in Edinburgh Annual Progress Report 2023 |
Provides current and projected data on the demographics within Edinburgh
Drug use is highly concentrated in areas of deprivation and in groups already vulnerable groups. Actions to end poverty – commitment to end poverty in the city by 2030 |
| Data on equality outcomes | JSNA-Health-Needs-of-Minority-Ethnic-Communities-Edinburgh-April-2018.pdf (edinburghhsc.scot)
Edinburgh Integration Joint Board Mainstreaming Equality and Outcomes Progress Report 2020 (draft) Informing Equality: A Resource Document For All Agencies Working With Or For People Who Misuse Alcohol Or Drugs. Revised Edition 2013 |
Provides data on demographics of minority ethnic communities
Resource documents describing the relationships between equalities and substance use. |
| Research/literature evidence | Hard Edges Report -Scotland Drugs death task force report scottish-drug-deaths-taskforce-evidence-paper-final-version.pdf (knowthescore.info) | Health impact on people experiencing multiple disadvantages
Several key points on trends in harm and specific harms to particular groups |
| Public/patient/client experience information | Living Experience Groups Overview | A number of pieces of patient experience information, most of which indicate that the existing system of care is unable to meet a range of their expectations within current resources |
| Evidence of inclusive engagement of people who use the service and involvement findings | ||
| Evidence of unmet need | Edinburgh Integration Joint Board Strategic Plan (2019-2022) | Details the health needs and priorities for the people of Edinburgh |
| Good practice guidelines | Alcohol-related brain damage – new guide | Mental Welfare Commission for Scotland (mwcscot.org.uk) | ARBD is under diagnosed and under treated. Developing a fuller response to ARBD is a key, but resource dependant, element of the ADP draft strategy |
| Carbon emissions generated/reduced data | N/A | |
| Environmental data | N/A | |
| Risk from cumulative impacts | ||
| Other (please specify) | https://www.evoc.org.uk/wp-content/uploads/2022/06/MICU-Evaluation-Report_V8.pdf | Milestone House report |
| Additional evidence required |
If you would like to view any of the documents noted in the table, email david.williams@edinburgh.gov.uk
| Potential benefits of change | Affected populations |
| Positive | |
Some potential unintended benefits of change were identified:
|
All |
| Equality, Health and Wellbeing and Human Rights | Affected populations |
| Negative | |
| In addition to this specific proposal of cuts, People who use drugs and alcohol may be particularly adversely affected by any wider HSCP proposals to reduce focus on prevention. they will also be impacted by the wider pressures in the public sector (e.g. the Edinburgh housing emergency, the cost of living crisis) – they have intersectional needs and will be multiply disadvantaged by reductions in the social safety net.
Any further reductions in key spend in other budgets (such as on welfare advice and supported housing) will further risk increasing the number of individuals who go on to experience substance use as well as reducing harm reduction and recovery opportunities for those who use drugs and alcohol at present. |
People who use substances |
A range of core EADP service activity is directed at the needs of children and young people:
All of these are resource intensive interventions but all carry significant risk of present and future harm if not delivered fully Development of a whole family approach to intervention will be hampered by reduced funding- Availability of Whole Family Approaches |
Young people and children
|
| The compromised health of ageing population of drug users is an established driver of DRD and management of the complex clinical needs of this group is challenging and will be more so with additional capacity pressures on services
sdf.org.uk/wp-content/uploads/2017/06/Working-group-report-OPDPs-in-2017.pdf the majority of alcohol and drug related deaths occur in older people (median age 45 for DRD) and DRD in those over 55 are the driver of increased total deaths in lothian |
Older people and people in their middle years
|
| Approximately 2/3 of drug service users are men and c70% of Lothians DRD are male | Men |
| What the Research says about LGBTQ+ People and Substance Use – SFAD | Trans and LGBTQ |
| It is estimated that 3% to 5% of children are affected by prenatal alcohol exposure. Stigma surrounding this is very powerful – shame of mothers in particular. Diagnosis is very challenging – long waiting lists in Edinburgh (6 years for assessment!). Early identification, support and interventions can significantly improve life chances for those affected and the quality of life for them and their families.
Fetal Alcohol Spectrum Disorder in Scotland (alcohol-focus-scotland.org.uk) Edinburgh ADP funds a dedicated pregnancy intervention team PrePare (edinburghadp.co.uk) |
Women and pregnancy |
| A key impact of reduced resource is expected to be decreased flexibility, personalisation and outreach – provision of universal services is a more efficient approach, but cuts will reduce services’ ability to adapt to individual needs. | All groups |
| Members of most BME communities access services at lower rates than the average. However, there are established additional barriers to members of many BME communities using mainstream services (perceived issues of cultural exclusivity, increased stigma in some communities) and low service uptake may well indicate a hidden need. | BME communities |
| Drug and alcohol treatment provides primary and secondary prevention of unemployment and treatment and recovery are known to result in increased levels of economic activity. Only 30% of those assessed at drug and alcohol services are economically active at the time that they enter services. | Unemployed and in receipt of benefits |
| Several areas of ADP services focus on lone parents and vulnerable families – Child protection work, Family support services and whole family approaches are all is resource intensive elements of the system of care. | Lone parenting and vulnerable families |
| The EADPs services have a number of impacts on care experience – the treatment of adults has a primary prevention effect, enabling families to safely remain together in may cases. The ADP also funds direct support to Looked after children and care leavers and targets young peoples substance use support on this group | Care experienced young people |
| The ADP, in line with the SG strategy, supports two main areas of development for adult carers of people who use alcohol and drugs:
Offering dedicated funded support for them as a group (via VOCAL) And promoting family inclusive practice (involvement in care plans and their loved ones’ support) |
Adult Carers |
| Low levels of literacy are more common than average in users of drug and alcohol services. EADP services have an ameliorative affect providing support and advocacy on behalf of their clients and removing barriers to access to other systems (housing, benefits etc)
As noted above, the likely impact of reduced resource is reduced flexibility for this type of activity. |
Those with low literacy |
| All cuts to this budget will, perforce, impact adversely on those who use substances | Problem Substance use |
| Veterans are overrepresented in substance use services and the EADP makes a number of contributions to veterans’ wellbeing | Veterans |
| Turnover in this population in Edinburgh create resource-intensive challenges in meeting this need. | Students |
| Much of the ADP services’ work is with people with relatively poor access to transport (though this is mitigated as far as possible through supporting access to public transport and, for those at the highest risk, providing transport to key services).
As noted above, the ability to offer more flexible access and to expand provision outwith fixed location centres is one of the areas at greatest risk of being compromised by reduced funding (e.g. additional satellite clinics or bases require staff time but offer better access into areas of high need) |
Geographical communities |
| Almost all of the budget is spent on staff therefore numbers are likely to fall, as are security. wellbeing and morale
Recruitment is already a challenge in a number of professional groups and apparent vulnerability of service’s funding may act as a deterrent to potential entrants to the sector among professionals choosing their specialisms |
Staff |
| Substance use is subject to powerful stigma and those who experience it often are denied a range of rights
Substance use access requires Provision of high quality services which is very much resource dependant |
Human rights and equalities |
| Treatment and recovery has a known impact on drug related crime. One of the key areas of development in the EADP strategy is focussed on ensuring that criminal justice involvement can become an opportunity for treatment access. | Those involved in the Criminal Justice system and
Crime and perception of crime |
| Ongoing substance use is a well established risk factor for poor sexual health. ADP services both directly provide risk reduction activities and promote access to sexual health services | Access to sexual health interventions |
| Enabling recovery for an individual is a key to family recovery and improvements in relationships are a known impact of effective drug and alcohol treatment | Relationships |
| Reduced resource will prevent improvement in premises in which people are seen – many of the existing facilities used are extremely unsatisfactory and regarded as stigmatised locations for the delivery of healthcare services | Physical environment |
| Environment and Sustainability including climate change emissions and impacts | Affected populations |
| Positive | |
| Negative
Reduction in local provision resulting in people having to travel more |
All |
| Economic | Affected populations |
| Negative | |
| Untreated substance use has an array of economic costs associated with it including loss of productive capacity, healthcare, criminal justice and other expenditures | Economic |
| Demand on drug and alcohol services can rise in response to recessions.
High prevalence of substance use in an area contributes to deprivation and has a direct impact on the cost of living for those affected – substance use is a cause and a consequence of deprivation |
Cost of living |
| Untreated substance use is strongly correlated with lack of economic activity: only 30% of people at time of assessment are in work (DAISy)
Substance use services, by providing trusted relationships, advocacy and co-location with/ pathways to income maximisation services, minimise financial exclusion for some of the most excluded and stigmatised groups in the Edinburgh community |
Income maximisation, employability and benefits |
This will depend on the detail of the savings plans but all services are required to complete ERIA
Again – dependant of the detail of the savings plan
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.
No
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 |
| Consider the IIA | IJB board | April 2024 | |
| Target the reductions to minimise the impact on protected groups | EADP programme manager/ EADP exec | April 2025 | |
| Mitigate harms with innovation and training | All partners | April 2025 | |
| Continue to monitor the cumulative impact of reductions in funding across partnerships and to advocate sustaining key preventative spending | All partners | Ongoing |
These are to be reviewed as part of any future IIA.
As per fuller IIA to be completed based on the detailed savings plan