Savings programme 2024-25 – community equipment integrated impact assessment

Grip and Control

  1. Review of SLA arrangements with all partners to ensure robust agreement, performance management and oversight is in place.
  2. Increased scrutiny of all non-core stock requests by approval through locality huddles or local governance arrangements.
  3. All high-cost requests to be approved through the high-cost panels.

Delegate budget to localities and implement spending limits.

  1. Delegate budget relating to direct equipment costs to each locality area with CELS professional advisor supporting teams in decision making.

Restrict core stock options.

  1. Remove all items under £25 from core stock.
  2. Cease refurbishment, maintenance and issuing of all rise and recline chairs.

There has been no public involvement in this proposal to date. Should the proposal be approved, a communications and engagement plan will be developed to inform service users of the changes along side partners and staff engagement.

8 March 2024

Name Job Title Date of IIA training
Heather Tait Hospital and Hosted services manager
Hazel Stewart Programme Manager Feb 2020
Sylvia Latona Senior Manager, Assistive technology enabled care
Emma Szadurski Service Manager
Zishan Mirźa Operations Lead, Community Equipment
Kirsty Dewar North East Cluster Manager
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 East Lothian by Numbers 2020 (East Lothian Partnership)

Midlothian (Council Area, Scotland, United Kingdom) – Population Statistics, Charts, Map and Location (citypopulation.de)

Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot)

  • EL: 109,580 (2020)
  • Midlothian: 94,680 (2021)
  • Edinburgh: 536,470 (2021)
Data on service uptake/access Service uptake For all partnership areas (Edinburgh, East and Mid) for one year period:

Core Equipment Orders:

  • 45,000 orders per annum
  • 74,000 items of equipment delivered
  • Total order value: £6.2m
  • Top 3 categories: Walking Aids (16,000), Toileting (10,000), Pressure Care (8,500)

Non – Core Equipment Orders:

  • 1,600 orders per annum
  • 2,200 items of equipment delivered
  • Total order value: £1.5m
  • Top 3 categories: Toileting (260), Slings/Hoists (230), Shower Aids (225).
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Edinburgh Poverty Commission People vulnerable to financial hardship may be disproportionately impacted by the proposals if low cost items were no longer provided.

https://edinburghpovertycommission.org.uk/wp-content/uploads/2020/09/20200930_Poverty_in_Edinburgh-Data_and_evidence.pdf

Data on equality outcomes
Research/literature evidence Iriss – Doing social work and social care differently publication Doing social work and social care differently | Iriss

Local Government Benchmarking Framework 2021/22.

Local Government Benchmarking

Public/patient/client experience information
Evidence of inclusive engagement of people who use the service and involvement findings VOCAL Carer’s Survey 2021 Insert presentation title here (vocal.org.uk)

Views of carers within Edinburgh and Midlothian

Evidence of unmet need Public Health Scotland Data Public Health Scotland – demand for care at home services across Scotland

Social care – Demand for Care at Home Services 25 April 2023 – Social care – Demand for Care at Home Services – Publications – Public Health Scotland

Good practice guidelines
Carbon emissions generated/reduced data
Environmental data
Risk from cumulative impacts The cumulative impact of this and other savings proposals for 2024/25 was assessed on 4th March 2024 and can be found here: https://www.edinburghhsc.scot/the-ijb/integrated-impact-assessments/
Other (please specify) The Independent Review of Adult Social Care

https://www.gov.scot/groups/independent-review-of-adult-social-care/

A National Care Service for Scotland: Consultation

A National Care Service for Scotland: consultation – gov.scot (www.gov.scot)

Inspection of adult social work and social care services: the City of Edinburgh  Inspection of adult social work and social care services March 2023

Additional evidence required
Equality, Health and Wellbeing and Human Rights Affected populations
Positive

  • The proposals could enable the Partnership to be more proactive in signposting people to information and resources to purchase their own equipment.
  • Seek to encourage service users to use online resources for purchasing equipment such as Ask Sara website – increasing knowledge and awareness of what is available and empowering users to purchase items directly.
  • The proposals would promote equity of access by ensuring equipment was available to those who needed it most.
  • Any communications or resources used to help service users with purchases would need to be accessible and available in different languages to ensure equity for those who don’t have English as their first language.
  • Better grip and control measures ensures that there is consistency in purchasing approvals and offers greater scrutiny of spend creating a more equitable service for Edinburgh.
  • More equitable access to equipment through a standard offer of items.
  • There is finite stock which a valuable resource and should be available to those who need it most, those with the means to purchase for themselves should do so ensuring that equipment is available to the most vulnerable in our society.
  • There could be a positive impact on staff by implementing a stricter financial/eligibility approval process which additional level of justification for staff who may be having to manage public expectations.
  • Increased clarity for staff on what equipment is offered by the Partnership.
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers
Negative

  • The proposals go directly against the proactive and preventative agenda which the Partnership promotes to enable people to remain independent at home for as long as possible.
  • The proposal to remove low cost aides would negatively impact on service users particularly in relation to their dignity, safety, independence and human rights affecting their quality of life. Further work is needed to assess the impact of not providing these aides on an item by item basis.
  • Older people are more disproportionately impacted by these proposals as they are the largest group that access equipment to enable them to remain at home. The proposals could see an increase in hospital or care home admissions due to a lack of available equipment.
  • Increase in length of time of approvals through grip and control measures will delay people receiving equipment.
  • The proposals could increase delayed discharges through a longer process for approving equipment requests.
  • Could negatively impact on people’s physical activity, mental health and wellbeing and life skills.
  • Difficult decisions for localities through reduced service provision
  • Delays in decision making risks health and safety.
  • Staff would be required to have difficult conversations with service users on their eligibility.
  • Could increase stress at work for staff by holding onto caseloads for longer, and potential lack of available funds to purchase equipment due to budget limitations.
  • Staff’s health and wellbeing could be impacted due to the proposals and could negatively impact on job satisfaction.
  • Could compromise on professional standards.
  • Impacts on the autonomy of staff to make decisions about care needs.
  • Staff (home care, nursing etc) may be unwilling to provide care and support without suitable equipment being available in people’s homes.
  • Staff could see increased harassment due to policy decisions.
  • Could have a socio-economic impact particularly for those in vulnerable groups with limited finances who may not have the ability to purchase items directly. This could be mitigated by ensuring people are linked to income maximisation to ensure they are receiving all financial help they are entitled to.
  • Service users could become more dependent more quickly and could increase the risks of falls for example, if equipment was not available or not available in a timely manner.
  • There could be a cumulative impact on families if they have more than one person in the household that needs equipment, this could be costly and create greater pressure on carer’s / relatives to purchase multiple items on an individual basis.
  • There is a potential risk of harm or injury to carer’s and cared for people if they do not have access to suitable equipment to keep them safe.
  • If budget limits are introduced at locality level, there could be inequity of access to equipment as the year progresses, without strict budget management process in place.
  • Budget limits could discriminate against service users depending on the time of year the request is received – less budget available as the year progresses meaning less ability to purchase items towards the end of the financial year.
  • Service users may not have the ability to purchase for themselves, particularly online purchases if they are experiencing digital poverty.
  • Could increase the risk of accidental injury or infection through service users purchasing or loaning items that don’t meet required safety standards, is unsuitable for the patient and/or is used incorrectly.
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers
Environment and Sustainability including climate change emissions and impacts Affected populations
Positive

  • Less deliveries could make the Partnership more carbon neutral
  • Could reduce the travel requirements of the Partnership through reduced deliveries
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers
Negative

  • Less deliveries by the Partnership could mean more deliveries in the private sector and would transfer the environmental impact from the Partnership into the private sector.
  • Could be less efficient by reducing bulk ordering and placing the responsibility onto individuals increasing the purchase of individual items multiple times.
  • The proposals would create more waste as items would be purchased by individuals and there would be no recycling of items as is current practice.
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers
Economic Affected populations
Positive

  • By stopping the provision of certain items such as rise and recline chairs would make the Partnership more aligned to other areas nationally as we are the only Partnership that provides this item.
  • Stopping the provision of rise and recline chairs could be managed through grip and control measures and should not result in more expensive alternative postural chair provision.
  • Could improve quality and access to services through better proactive signposting.
  • Could increase support to local businesses such as community pharmacies by raising awareness of the aides they offer, enhancing their provision and creating market opportunities.
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers
Negative

  • May see an increase in the purchasing spend overall by the removal of equipment, if low cost items are removed there may be a requirement to increase care provision which is much more costly than the purchase of equipment.
  • Reputational damage to the Partnership by not meeting the basic assessed health and care needs of service users.
  • Conflicted requirements across health and social care as healthcare is free at the point of delivery, need clarity on where the responsibility transfers from health into social care to ensure statutory compliance, particularly affects hospital discharge and community nursing care.
  • The proposals could reduce the quality and access to services for some service users.
  • Could increase the cost of living for some service users if asked to purchase their own equipment.
  • The proposals could have a negative impact on existing suppliers if the Partnership were to purchase less. Could also negatively impact on existing contract arrangements.
  • Potential to negatively impact on partners purchasing costs by reducing the items that Edinburgh purchases driving item costs up.
  • Adults and older people requiring community equipment in Edinburgh
  • Staff
  • Suppliers

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
A final IIA would be required if the proposal is agreed Heather Tait 31/4/24
Items identified as low cost require to be assessed against the impact they will have to service users, services and cost benefit analysis Heather Tait 31/3/24
National guidance on statutory requirements for the provision of items in relation to palliative and end of life care needs clarified Heather Tait 31/3/24
National benchmarking needs to be undertaking to understand how Edinburgh compares with other Partnership areas Heather Tait 31/3/24

Should the proposals be agreed, management and monitoring of the impact of changes will be included in the implementation plan and associated risk register.

Mike Massaro-Mallinson's signature

Name: Mike Massaro-Mallinson

Date: 11 March 2024