Savings programme 2024-25 – Mental health pathways integrated impact assessment

 

Mental Health services are provided through a combination of community and in-patient services with a budget of approximately £47 million.

This proposal will focus on people living in 133 housing with support placements in 14 locations across the city.  A saving of £700k will be realised by utilising the citywide Community Rehabilitation Team (CRT), in collaboration with third sector providers, to review the support and care needs of these individuals and right-size support appropriately. There will be a need to include MH framework providers in the review process and ensure that independent advocacy is provided where appropriate. The review process will include considering different support options through A Place To Live, the Thrive Collective, Thrive Welcome teams and the Capacity to Collaborate programme.

The project will also review contractual arrangements and consider establishing block contracts if this is found to be more cost-effective and efficient.

Place to Live is one workstream of Thrive Edinburgh – we have ongoing stakeholder engagement   and we met with Place to Live Providers on 20 February.

1 March 2024

Name Job Title Date of IIA training
Dr Linda Irvine Fitzpatrick Strategic Programme Manager, Thrive Edinburgh, EHSCP  
Dr Rachael Docking Programme Manager, Innovation and Sustainability, EHSCP March 2020
Alison May Chief Executive, Carer Council  
Ben Baldock Chief Executive, Advocard  
Claire Bothwick Head of Nursing, EHSCP  
Graeme Mollon North East Locality Mental Health & Substance Misuse Manager, EHASCP  
Ian Waitt South West Locality Mental Health & Substance Misuse Manager, EHSCP  
Katie Bryce North West Locality Mental Health & Substance Misuse Manager, EHSCP  
Michele Mason Chair of Mental Health Forum  
Stef Milenkovic Senior Development Officer, EVOC  
Cat Young Assistant Programme Manager, Thrive Edinburgh November 2018
Emma Gall Assistant Programme Manager, Thrive Edinburgh  
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)

Supporting documents – Scottish Household Survey 2021 – telephone survey: key findings – gov.scot (www.gov.scot)

Thrive Welcome Teams Trak data

Scottish Gov MH Strategy

AUDIT Scotland Report on Adult Mental Health

Joint Edinburgh Carers Strategy 7.1 The Joint Edinburgh Carer Strategy Refresh 2023-26.pdf

Joint Edinburgh Carers Survey: https://www.vocal.org.uk/wp-content/uploads/2021/11/Full-Data-Set-Report-2021.pdf

Polish Unpaid Carers in Scotland | Feniks – Edinburgh

Shed your armour, show the scars!

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

Provides robust evidence on the composition, characteristics, attitudes and behaviour of private households and individuals as well as evidence on the physical condition of Scotland’s homes

Referral and demographic data for MH single point of access

Mental Health and Wellbeing Strategy 2023 – 2025 which describes the approach the Scottish Government will undertake to improve mental health for everyone in Scotland.

The report contains a number of recommendations for the Scottish Government, local authorities and partners, many of which reflect the themes set out in The Scottish Government Strategy.

The VOCAL Carers Survey gathers the views of carers looking after people in Edinburgh and Midlothian

Data on service uptake/access National Benchmarking data

Thrive Collective quarterly reports

SLA reports – NHS

Thrive Progress Report

2021/22 LGBF data shows an increase in the number of people supported to live as independently as possible.

Demonstrate the uptake of services within 3 partnerships of the Thrive Collective.

Report on what is being delivered across Edinburgh and the impact of such activities

This document sets out the aspirations of Thrive Edinburgh and what has been delivered against Thrive Pillars and Adult Health and Social Care Workstreams and Change Programmes in 2023.

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/

MH Foundation Covid 19 report: Coronavirus: Mental Health in the Pandemic Study | Mental Health Foundation

Poverty commission reports https://www.povertyalliance.org/epe/

Collective Advocacy (People’s conference report) What is the People’s Conference? – CAPS (capsadvocacy.org)

https://www.gov.scot/binaries/content/documents/govscot/publications/research-and-analysis/2023/11/peoples-panel-community-resilience/documents/peoples-panel-community-resilience-research-findings-peoples-panel-members-community-resilience/peoples-panel-community-resilience-research-findings-peoples-panel-members-community-resilience/govscot%3Adocument/peoples-panel-community-resilience-research-findings-peoples-panel-members-community-resilience.pdf

Food Fund lessons learned Food Fund and Lessons Learned report Final

Early Intervention and Prevention in Edinburgh – Mind the Craic https://www.evoc.org.uk/wp-content/uploads/2020/09/EVOC_MIND-THE-CRAIC_AUG20_WEBRES_FINAL.pdf

End Poverty in Edinburgh CEC Progress Report https://democracy.edinburgh.gov.uk/documents/s64814/Item%204.1%20-%20End%20Poverty%20Edinburgh%20Annual%20Report.pdf

Edinburgh Poverty Commission https://edinburghpovertycommission.org.uk/timeline/

ESS Learning from a Stitch in Time https://evaluationsupportscotland.org.uk/resources/sit-learning-from-a-stitch-in-time-a-commissioning-guide/

Provides current and projected data on the demographics within Edinburgh

Pandemic effect on mental health

End Poverty Edinburgh is a group of independent citizens aiming to raise awareness of poverty in Edinburgh, influence decision-making, and hold the city to account.

Conference space for people to have their voice heard – this year focused on what makes a house a home

Data on equality outcomes JSNA-Health-Needs-of-Minority-Ethnic-Communities-Edinburgh-April-2018.pdf (edinburghhsc.scot)

Human Rights

Provides data on demographics of minority ethnic communities
Research/literature evidence Carr Gom Impact report Carr-Gomm-Impact-Report-2022-2023-Final.pdf (carrgomm.org)

Penumbra penumbra.org.uk/wp-content/uploads/2023/11/Impact-Report-2023-compressed.pdf

Change Mental Health Our 2022-23 Annual Report and Impact – Change Mental Health (changemh.org)

Health in Mind Health in Mind | Annual Satisfaction Survey Report 2022 (health-in-mind.org.uk)

SAMH samh.org.uk/about-us

Cyrenians Impact_report_2022_(web)_original.pdf (cyrenians.scot)

Advocard Reports – AdvoCard

Public/patient/client experience information HM Inspectorate of Constabulary in Scotland Thematic Review of Policing Mental Health in Scotland

https://capsadvocacy.org/about-caps/publications-and-reports/

https://rehpatientscouncil.org.uk/wp-content/uploads//2019/05/Strengthening-the-Patient-Voice-Results-Reports-190508.pdf

Assess the state, efficiency and effectiveness of Police Scotland’s provision of mental health-related policing services. Published its thematic review of policing Mental Health in Scotland.
Evidence of inclusive engagement of people who use the service and involvement findings Complaints/ compliments
Evidence of unmet need Edinburgh Integration Joint Board Strategic Plan (2019-2022)

Welfare reform

Experience of REH patients Marks-Final-PE-report-2021.pdf (rehpatientscouncil.org.uk)

Mental health law review – not getting economic welfare and social rights Scottish Mental Health Law Review Final Report (rcpsych.ac.uk)

https://www.mwcscot.org.uk/sites/default/files/2022-09/SMHLR%20Final%20Report%20-%20Summaries%20and%20Recommendations%20-%20EMBARGOED%20UNTIL%201300%2030th%20SEPTEMBER.pdf)

Capacity 2 Collaborate reports

Details the health needs and priorities for the people of Edinburgh

Strategic-Plan-2019-2022-1.pdf (edinburghhsc.scot)

Welfare reform report: Impact on families with children (www.gov.scot)

Scottish gov response Scottish mental health law review: our response – gov.scot (www.gov.scot)

The Capacity 2 Collaborate report was shared with the group undertaking the IIA.  If you would like to receive a copy, please apply to linda.irvinefitzpatrick@nhs.scot

Good practice guidelines SIGN guideline for specific mental health conditions

thetriangleofcare-thirdedition.pdf (nhslothian.scot)

https://www.sign.ac.uk/

https://www.nice.org.uk/guidance/ng58/resources/coexisting-severe-mental-illness-and-substance-misuse-community-health-and-social-care-services-pdf-1837520014021

https://www.nice.org.uk/guidance/ng181/resources/rehabilitation-for-adults-with-complex-psychosis-pdf-66142016643013

Our guidelines (sign.ac.uk)
Carbon emissions generated/reduced data N/A
Environmental data N/A
Risk from cumulative impacts
Other (please specify)
Additional evidence required
Equality, Health and Wellbeing and Human Rights

 

Affected populations
Positive

Reviews will provide assurance that people are getting the right level of support

 

A lot of support for veterans that we don’t maximise as we don’t ask the right questions e.g. if  a man did national service is eligible for a lot of support that people often don’t know about – review process could ask if  a person is a veteran

 

 

All groups

 

 

Veterans

 

 

Negative

 

If there is a reduction in care, the population often do not have static level of support need and require the flexibility of the framework to support that – how do we collectively take responsibility that we can support people in that situation

If people are assessed down the way this will put pressure on other areas of the system (people won’t be able to then access support)

Reduction in access to daycare services for older people – cumulative impact across IIAs where people might be using different services

Loss of adapted accommodation through those that provide services – potential that people may not be rehomed

Housing – req. for minimum level of paid support, if that is reduced it could impact someone’s ability to stay there – but People should still have tenancy rights, so more about how people are supported

Right to a home – key risk here with support removed and potentially losing home as a result

MH law review on social, cultural rights etc – government will be placing this expectation on statutory services and those that we commission

Those with MH problem are economically disadvantaged – poverty is a major factor if someone has a diagnosed MH issue.

Stigma and discrimination – people can live in places with others who are really accepting of them,  accommodation is embedded in their community

If someone reviewed from personal care to housing support package – impact for those on low incomes who might not be able to afford chargeable items

 

Housing support is chargeable – Might identify services that have been wrongly identified in the first place

Chargeable services – there is discretion in our gift, if placed under different criteria that can be off-set

Benefits – people are in the main on benefits, which pays rent, which means HSCP are not paying accommodation costs – massive risk also to the housing provider, will receive benefit for the building but not rent or to staff building

Increased social isolation and loneliness for a number of characteristics   the numbers of people that come into drop-in centres and social prescribing, over 8,000 last year

If people  assessed down the way will put pressures on other parts of the business – when peoples packages go down they seek support elsewhere – impact individuals and impact on wider org

Loss of community and friendship – social isolation. Not just about the service. Sense of community comes from being in a shared space, majority of individuals are single. people stay in these areas, people they trust and relationships – not just the service – majority of people are single and unmarried, so this is felt significantly more for them, their close network can come from living in shared accommodation

Cumulative effect on both MH & physical illness – services that cover a range of services

Disabled – might people lose access to adapted accommodation? Would we re-house people? Other income brought in from 3rd sector contract, it might be that premises need to be brought in

Disabled people – strong evidence that those that are disabled are economically disadvantaged as well, poverty is major factor if someone has a diagnosed MH issue

Particular cultural communities could lose trusting relationships

People then not spending money in local shops as they have lost that community.

 

Older People living in supported accommodation may be impacted as they will be included in the reviews.  If levels of support are reduced they may perceive this as a negative.

 

Reduction in some people’s access to day care services for older people may have a cumulative impact where people might be using different services

 

If levels of support reduce following a review there will be an impact on carers and these tend to be older carers for this particular group Women – more likely to be carers, which also impacts on their economic input

Trans men and trans women, continuity of care – loss of trusting relationships

 

Already mh impacted upon due to  stigma and discrimination

 

Cuckooing of people – increasing exposure of that risk – a particular problem in the city already – has to reflect the current context that we are in

 

 

All protected characteristics, particularly those at risk of abuse/harassment etc. – continuity of care, safe relationships that they have, likely across race and other areas as well

The impact on carers – older cares will be more impact within this particular group

.

People living in poverty

All groups

People with mh problems and physical health challenges

BAME communities

 

 

 

Older People

Carers

Female carers

 

 

 

LGBTQIA+

 

 

 

 

 

 

 

 

 

 

All groups

 

 

Environment and Sustainability including climate change emissions and impacts

 

Affected populations
Positive

 

 

 
Negative

Some parts of the city are not connected well with public transport which impacts accessing services

 

South Queensferry – if package is cut there is not much else to support – areas not as well connected will see greater impact

Housing – requirement for minimum level of paid support, if reduced then it becomes unstable – people may then not be able to remain in the accommodation

Risk that people become homeless – domino effect

Potentially more of a risk for female carers – women are more likely to be carers or within that dual role which can have an economic impact also.

A lot of activities hang off these, if lose core contract with org you lose all the support that is provided by that org – a lot of org might use the core funding but utilise wider money to spend on their wider activity – need base of funding to access other sources.

If core fund is reduced for an organisation this will have an effect on off shoot services

If reviews mean that people can’t stay in their accommodation, then this will have an impact on the housing crisis

 

 

 People living in more remote areas

All groups

 

 

 

 

Female carers

 

 

 

Providers

 

 

 

 

 

 

 

 

Economic

 

Affected populations
Positive

 

 

If people were spread out rather than in supported accommodation might increase resources

Negative

Having to rapidly increase knowledge base around wider community support and the potential changing nature of this

Impact of the threat of change – increased stress and problems retaining workforce in an already competitive environment

Risk of job loss if packages go down

More reliance for use of voluntary services, which puts strain on these groups and reliance on them

Increased stress and workload on other staff that pick up anything that is lost elsewhere

More vulnerable staff on contracts at increased risk

Additional stress for staff dealing with relationships with individuals and carers – challenging conversations are hard enough as it is – need to look after the resilience of the workforce

Best practice in terms of notice – make sure 3 month notice etc if jobs are lost

If less providers, less offices, footprint will be reduced

 

 

Staff

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wider communities

 

 

 

 

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
Regular place to Live Commissioning nd Review Group meetings Linda Irvine Fitzpatrick, Strategic Programme Manager April 2024 August 2024
Clarity on review process Linda Irvine Fitzpatrick, Strategic Programme Manager April 2024 August 2024
Publication of New Era Cultural Change Programme Findings and Toolkit Linda Irvine Fitzpatrick, Strategic Programme Manager April 2024 August 2024
EHSCP should meet with partners affected by the savings to discuss the impact and plan together for going forward Linda Irvine Fitzpatrick , Strategic Programme Manager Commence late March 2024 August 2024
A shared impact of the savings should be circulated for transparency and learning Pat Togher May August 2024
Continue, and strengthen, the approach already being taken by the EHSCP contracts team to monitor impacts across providers and allow for early warning where a specific provider may be at risk through reductions. Emma Gunter Ongoing throughout 2024/25 August 2024
Ensure that community benefits from any commercial procurement contracts are fully realised to help mitigate any reduced funding. Emma Gunter/ Moira Pringle March 2025 June 24

Yes.  The actions outlined above will mitigate the majority of negative impacts to some extent, but the size and scale of the financial challenge means that it will not be possible to remove them entirely.

Regular meetings with partners and stakeholder groups to monitor impact, changes and learning.

Name: Mike Massaro-Mallinson

Date: 11/03/2024