Savings programme 2024-25 – Working age adults pathway 2 integrated impact assessment

LD services: Remodel of the current day support services offer (interim)

This proposal is one element of a wider programme of work called ‘working-age pathways’, which is focusing on accommodation and support at home for people needing the most intensive services, focusing on adults with life-long conditions of any age who have a condition which limits their ability to live independently (except those who have a main diagnosis of a functional mental illness).

The specific proposal is looking at standardising our current offer of day support to ensure equity and efficiency of service, and to provide more choice, flexibility and cater for more people, to include:

  • Consideration of a new framework and a standardised single block contract negotiated
  • A review of all existing day support packages
  • Agree a reasonable range of offers to sit within the block contract
  • Improve digital offer to balance potentially reducing access to day centres
  • Consider service offer that is more flexible, to include evening and weekend options and support to access community activities as well as more traditional supports

This particularly impacts people on SDS option 3, where we are arranging support for someone on their behalf, but it excludes care at home or supported living.

This proposal is one of a range of proposals under the new ‘working-age pathways’ programme which has required an IIA. Updated IIAs will be held as each proposal within the programme are developed.

27 February 2024

Name Job Title Date of IIA training
Robert Smith

IIA facilitator

Disability Services Manager, EHSCP 15/12/21
Rachael Docking

IIA scribe and report writer

Programme Manager, EHSCP January 2020
Jayne Kemp

Learning Disability Representative

Strategic Planning and Commissioning Officer – EHSCP
Blair Christie

3rd Sector Learning Disability Provider Organisation Representative

Service Manager – The Richmond Fellowship
Siobhan Murtagh

HR representative

Senior HR consultant, EHSCP
Dr Ganesan Rajagopal FRCPsych

Consultant Psychiatrist

Clinical Director

Intellectual (Learning) Disability Service

NHS Lothian

Emma Jowitt Occupational Therapist, NHSL
Reed Cappleman Consultant Clinical Psychologist, Professional Lead for Learning Disabilities Psychology
Blair Christie Richmond Fellowship
Simon Pearce-Madge Teens Plus
Catherine Steedman AIS Scotland
Elspeth Pike Consultant Psychiatrist (FAST)
Anna Duff Interim North West Locality Manager, EHSCP
Stuart Millar

Adults with Learning Disabilities and Complex Needs  Representative

Care and Support Manager (Acting) – EHSCP
Ashleigh Chambers

Adults with Learning Disabilities and Complex Needs Representative

Care and Support Manager (Acting) – EHSCP
Scott Taylor

Adults with Learning Disabilities and Complex Needs Nursing Representative

Nurse Consultant – NHSL
Laura McLean Occupational Therapist

Learning Disability


Stella Morris Primary Care Liaison Nurse, Learning Disabilities, NHSL
Annie Strong Community Learning Disability Charge Nurse
Rachel Fleming Head Occupational Therapist, NHSL
Lisa Graham Learning Disability Inpatient and Associated services (REAS), NHSL
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 2019 Report – SCLD

6.1 Innovation and Sustainability Pipeline – Learning Disability Change Proposals.pdf (

Public Health Scotland (PHS) – Insights in Social Care: Statistics for Scotland (2022/23)

Public Bodies (Joint Working) (Scotland) Bill – Parliamentary Business :  Scottish Parliament

Social Care (Self-directed Support) (Scotland) Act 2013 (

4. Dynamic Support Register – Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge – (

Carers (Scotland) Act 2016 (

Carers’ charter – (


Vocal Carer Survey 2021

All local authorities in Scotland collect information on the numbers of people with learning disabilities and/or autism in their area. Information is collected about everyone who is known to the local authority – not just the people who are using services. Provides current and projected estimates on the LD population in Scotland and Edinburgh.

Provides a summary of how evidence on population in need has fed into the Innovation and sustainability programme.

A summary and data on the numbers of people receiving support and the differences in social care support and service types provided.

Demonstrates a marked increase in the numbers of young people with Additional Support Needs (ASN) in recent years, driving a growing need for specialist resources and an impact on future adult service provision.

Whilst there has been a gradual managed decline in provision of traditional day care services in favour of the use of personal budgets (SDS), there will continue to be some people who require an environment that is commensurate with their needs. The way that the Council provides services has changed and will continue to develop and evolve with the impact of adult health and social care integration (as set out in the Public Bodies (Joint Working) (Scotland) Bill 2013) and implementation of the Self-Directed Support (Scotland) Act 2013.

Adult social care services face considerable challenges in order to address identified current and future demographic pressures.

The Covid 19 pandemic has had a devastating effect on the lives of carers. Closure or significant reduction in support provision for supported people, reduction in the workforce due to workers isolating, and criteria for accessing support becoming available only to those in significant/ critical hardship, have impacted Carers significantly.

The VOCAL (2021) Carers Survey gathers the views of carers looking after people in Edinburgh (approx. 2/3rds of respondents) and Midlothian.

Data on service uptake/access 6.1 Innovation and Sustainability Pipeline – Learning Disability Change Proposals.pdf (

Keep Safe scheme – Police Scotland

A breakdown of the LD services in Edinburgh is provided in the Innovation and Sustainability paper.

Since 2014, Police Scotland has been working in partnership with award winning community charity, I Am Me Scotland. This has been to establish a network of Keep Safe places across Scotland. The initiative works with businesses and community buildings

Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Vocal Carer Survey 2021

Keys-To-Life-Implementation-Framework. 2019-2021

Women are known to be disproportionately affected by their Unpaid Caring role, with a greater impact for those over 50. Nationally women carers represent 60% of carers compared to men who represent 40%. Many Unpaid Carers give up work to carry out their caring role and can struggle to re-enter the workforce. The Covid-19 Pandemic has had a significant impact on unpaid carers, therefore disproportionately women.

Vocal survey highlights 72% of respondents finances were impacted as a result of their caring role with 64% having stopped working completely or reducing their working hours in order to provide unpaid care. The proportion of carers not in employment, education, or receiving a pension has increased from 25% in 2017 to 34% in 2021.

Statistics show that people with learning disabilities do not yet enjoy the same life chances as others.

Data on equality outcomes Keys-To-Life-Implementation-Framework. 2019-2021 As above within ‘socio-economic disadvantage e.g., low income, low wealth, material deprivation, area deprivation.’
Research/literature evidence Bild, International Journal of Positive Behavioural Support, 12, Supplement 1, 2022 The 2013 International Journal of Positive Behavioural Support (IJPBS) special issue acknowledged the evolving nature of positive behavioural support (PBS).

It proposes an updated, refined definition of PBS and a guide to future PBS delivery for the UK that captures the developments and issues arising as described below

Public/patient/client experience information Priorities – The keys to life The keys to life strategy recognises that people who have a learning disability have the same aspirations and expectations as everyone else and is guided by a vision shaped by the Scottish Government’s ambition for all citizens.
Evidence of inclusive engagement of people who use the service and involvement findings Adult Social Care: independent review – (

A National Care Service for Scotland: consultation – (

The same as you? 2000

The keys to life 2013

Keys-To-Life-Implementation-Framework. 2019-2021

 Coming Home Implementation Report

06839-annual-review-2022.pdf (

Evidence of significant consultation and engagement on a national level with people with a learning disability, first with ‘The Same As You?’ (2000), and more recently through the ‘Keys to Life’ (2013 & 2019). These documents, combined with the ‘Coming Home Report’ (2018) and recently published ‘Coming Home Implementation Plan’ (2022), clearly lay out the priorities for people with learning disabilities.

The Edinburgh Learning Disability Advisory Group (ELDAG) meet on a monthly basis with membership including people with Learning Disabilities, the Edinburgh HSCP Planning and Commissioning Officer for Learning Disabilities, and advocacy representation. Information on the review of LD services has been regularly shared with the group feeding back valuable lived experiences.

Health Improvement Scotland launched a programme in 2021 called New Models of Day Support – this programme was designed to support Partnerships to define and consider approaches to day support for adults who have learning disabilities. This programme is now entering phase 3 and continued engagement with people will further inform the New Models of Day Support programme and the wider Learning Disability Review. Extensive engagement with people impacted and found that demand was high for services that are more flexible, evening and weekend options, and support to access community activities as well as more traditional support.

Evidence of unmet need Care Inspectorate: Edinburgh Inspection of adult social work and social care services (March 2023)

‘We deserve better’: new report on healthcare barriers (

RHO-Executive-Summary-LD-Report.pdf (

The inspection of adult social work and social care (March 2023) identified a number of areas for improvement.

A local mapping exercise undertaken across health and social care services and roles to: understand work, tasks and pressures within the Community Learning Disability Teams (CLDT), specialist teams (MHIST, FAST, PBS) and Local Area Co-ordination (LAC); understand areas of duplication, gaps, team capabilities and capacity, with a view to recognising where change is needed.

Provides evidence on people with a learning disability from ethnic minority backgrounds, who die at an average age of just 34, compared to an average age of 62 for white people with learning disabilities. This significantly shorter life expectancy is triggered by poorer healthcare access, language barriers, cultural and religious insensitivity, and a lack of information during transitional care in hospital and home.

Literature, which has spanned over two decades, has acknowledged that the intersection of ethnicity and disability, two marginalised identities in society, results in compounded discrimination.

Good practice guidelines Health and Social Care Standards: My support, my life (

Strategic-Plan-2019-2022-1.pdf (

The same as you? 2000

Keys-To-Life-Implementation-Framework. 2019-2021

The keys to life 2013

‘Coming Home’ Report Published – The keys to life

 Coming Home Implementation Report

Adult social care 2022 to 2023: joint statement of intent and next steps – (

Human Rights Based Approach | Scottish Human Rights Commission

The Panel Principles: Taking a Human Rights Based Approach – YouTube

A Fairer Scotland for Disabled People: delivery plan – (

The Good Lives Model of Offender Rehabilitation – Information


Social Care (Self-directed Support) (Scotland) Act 2013: Self Directed Support (SDS) Statutory Guidance (

Social Work (Scotland) Act 1968 (

Positive Behaviour Support (PBS) | bild

NICE Guidelines:

Behaviour that challenges

Challenging behaviour and learning disabilities prevention and interventions

LD and Behaviour that Challenges. Service design and delivery

These Health and Social Care Standards (the Standards) set out what we should expect when using health, social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld.

The EIJB vision remains to deliver together a ‘caring, healthier and safer Edinburgh’. The intent is to further develop integration to deliver an affordable, sustainable and trusted health and social care system for Edinburgh.

*The EIJB Strategic Plan is currently under development and on completion will continue to inform progression of this work.


The same as you? was launched by the Scottish Executive in May 2000 and reviewed the services then available to people with learning disabilities and people on the autism spectrum. It said that people with learning disabilities had the right to be included in, and contribute to, society, to have a voice, and to have access, with their families, to support to live the life of their choosing.

‘Care in the Community’ as first mandated in The Same as You (Scottish Executive, 2000) has still not been universally realised and we are failing those who are still delayed in hospital or in inappropriate out-of-area placements through the lack of provision of proactively planned quality care and housing in community.

Carbon emissions generated/reduced data
Environmental data
Risk from cumulative impacts
Other (please specify) Independent Adult Social Care Review (IASCR) 2021

Health and Care (Staffing) (Scotland) Act 2019 (

Health and Care Staffing in Scotland | Turas | Learn (

Framework | Turas | Learn (

‘(A)…foundation that needs nurturing and strengthening is the social care workforce. For us to achieve the improvements we seek, they need to feel engaged, valued and rewarded for the vitally important work that they do’.

Our workforce is the most important asset in the delivery of safe and effective care to the people of Scotland. Our skilled and compassionate health and social care employees make up the largest workforce in Scotland

To deliver safe and effective care, we need to ensure there are the right people with the right skills in the right numbers and in the right place at the right time.

The introduction of the Health and Care (Staffing) (Scotland) Act 2019 provides the statutory basis for the provision of appropriate staffing in health and social care services, This enables safe, high quality care and improved outcomes for staff as well as people being supported.

The Health and Care Staffing in Scotland Knowledge and Skills Framework reflects the guiding principles for health and care staffing.   It will support staff in understanding the requirements of  their role in the application of the Act.

The Health and Care Staffing in Scotland Knowledge and Skills Framework has been developed to reflect the guiding principles for health and care staffing.

Additional evidence required HSE: Information about health and safety at work It is the employer’s duty to take every reasonable precaution to ensure the safety of employees, including lone workers and to carefully consider and deal with any health and safety risks for people working.

If you would like to view any of the documents noted in the table, email

Equality, Health and Wellbeing and Human Rights


Affected populations

Planning and commissioning – extensive engagement with people impacted and found that demand was high for services that are more flexible, evening and weekend options, and support to access community activities as well as more traditional support

A review of day support can mean a reduction or increase – increasing the offer could be a benefit for all requiring support

Disadvantage for older people – are they getting the same access to life skills and support needs if any reductions made

ILF fund, transition fund – need to make sure we maximise what we ask for to get the most out of it for people

Social enterprise – LD least likely to be represented in working market, good model to support people to take more control. Help those with additional support need to come off a benefit situation where they can, requires significant engagement and support to get someone there – can offer more opportunity to have support to do this

Some people do like Mon-Fri structure and want weekends for family time or friends – in some cases people want a more flexible model but for others they won’t – change in our relationship as a commissioning org with our providers, our role is to ask providers to have those mixed offers that meet all diversity of interest and need – flexible and dynamic types of support

Criminal justice system – don’t have robust offers for people who have been on the forensic pathway – opportunity to try and improve the service offer for that group

Low literacy/numeracy – having day services that actively support people to nurture talents and knowledge base could be beneficial.  No age limit on these opportunities, seeing an intake of older people who want to come back to educational type day service (Mon-Fri) – positive impact of looking at opportunities that could provide this

transportation to day services is often a challenge, would like to improve offer and proximity of the services we have. So people can access those services within a reasonable distance from their home – an aspiration

Transport – significant factor in people’s ability, things being more neighbourhood based is what we should be aspiring to be

Staff working weekends and evenings, might have positive impact on wages

Could positively impact staff skills, working in different ways and less dependence focused

Support being more flexible and in local communities, people might experience harassment or discrimination in those settings, or it could over time decrease those risks

if we only have a single way of supporting people currently, we are discriminating against those who don’t want to be supported in that way, could create greater equity of opportunity

Improve offer to those who want that flexibility

Enabling people to have more control over their social and work environment

Where we don’t have standardised approaches to how we procure support, it creates inequity in the support accessed – frameworks could reduce that differential status for people using services

How does it work for those who are happy with the way their services operate – they would still have the options to do that within their eligible budgets

If we get to greater number of smaller services in neighbourhoods could increase community capacity, rather than large scale traditional institution models

If exposed to more community resources, there might be increased fear but by being more present in their communities might be less likely to experience hate crime







Older people



Those involved in criminal justice system

People with low literacy / numeracy

Rural areas



Those experiencing harassment or discrimination




Community capacity

Reducing crime and fear of crime


For people who have had support in a predicted and settled way, change might be more difficult when re-assessing the offer

Transitional services – when people are leaving school, people not ready to finish education, need to ensure not all day services are the same and can look at what it offers/delivers, as long as assessment is clear on what that young person can undertake and what they need

Adverse consequences of generalised approaches to commissioning – groups that don’t have a large representation often don’t get their needs met as uniquely on a case-by-case basis and spot purchasing – to do things more generally could negatively impact on those who require a more bespoke service

If support changes, or how they access support, consequence on unpaid carer and their relief or ability to work in paid employment – require day support that meet the needs of the wider family

Lone parents – where there is no one to share opportunities for work and care

Some people struggle with certain times of year e.g. Christmas, higher domestic abuse or family goes into crisis, during those times they need access to support outside of usual hours. Impact on unpaid carers during seasonable holidays – option 3 arrangement should consider that not all services are available at those times, and we should try to place people in services where we know they can be accessed continuously

If we put out a framework and providers don’t want to work in that operating model, there will be an adjustment period whilst people are reviewed, could disturb market stability if people do choose to leave. Some services might see growth if they can change in that way, whilst others might not

Staff working in these services – if we are looking at more flexible services there might be demands for weekend and evening opportunities that staff working in day support don’t currently offer

Could lose staff and impact market stability, day services often attract staffing due to their standard hours, altered hours might cause retention and recruitment issues

More choice, flexibility, more person centred, cater for wider groups of people, all sounds positive – but easier to highlight those who are adv or not further along the process once we know what this approach will look like


Children and young people

Anyone requiring a more bespoke service

Working carers (predominantly female)

Lone parents

Families experiencing crisis / vulnerable families

Provider stability


Environment and Sustainability including climate change emissions and impacts


Affected populations


Transport impact – promoting 20-minute inclusive neighbourhoods with trying to reshape the day support offer, if people have less travel there is less carbon impacts

Potential impact from building based services – if they choose to operate differently, utilise community resources differently etc.





Providers might choose to increase premises and that could double carbon footprint



Affected populations


By trying to standardise how we contract and work with this type of provision we are trying to fundamentally improve the baseline quality of all offers

Those working at different times might attract different pay – wider shift options

Income maximisation – build those into services seeking to support micro-businesses and income aside from benefits






Improve working conditions – some will welcome opportunity to work at different times and others will not




The purpose of reviewing and standardising day support options is to ensure equity of access to quality support across the city for people and their carers. This includes providing appropriate support options which are sustainable, well-coordinated, accessible, and flexible, supporting improved outcomes and maximising independence. All equality, human rights, environmental and sustainability issues will be covered by the appropriate assessment, reviewing, and co-production of a suitable framework and review approach for day support services.

This will involve ongoing collaboration with communication colleagues and partners to ensure a wide range of communication tools, including easy read, large print, alternative language options and online access to information. We also work closely with FAIR (Family Advice and Information Resource) to continue to produce an easy-read version of any documentation required.

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
Through this change in our relationship as a commissioning organisation, we will need to ensure that providers have those mixed offers required to meet all diversity of need – flexible and dynamic types of support. Significant engagement with providers is required Robert Smith

Disability Services Manager, EHSCP

A carefully thought-out MDT review and re-assessment will be required to support those who may struggle with any change and any potential impact on their carer Robert Smith

Disability Services Manager, EHSCP

Impact on unpaid carers during seasonable holidays – option 3 arrangement should consider that not all services are available at those times, and we should try to place people in services where we know they can be accessed continuously Robert Smith

Disability Services Manager, EHSCP

Day services often attract staffing due to their standard hours, altered hours might cause retention and recruitment issues. We will continue to look at any impact on staffing and potential ways to mitigate this impact.

This proposal has been developed as part of the work from the Partnership’s Innovation and Sustainability Programme and will continue to be monitored within the wider programme. The impacts on different groups, including those with protected characteristics will be monitored through the programme working group and ongoing review of progress and challenges.