Savings programme 2024-25 – cumulative integrated impact assessment
2024/2025 Savings and Recovery Programme – Cumulative Impacts (final report)
To meet our commitment to a fairness test for key decisions and our legal obligations under the Equality Act 2010, we carry out integrated impact assessments (IIAs or Impact Statements) of proposals that will result in a change to services or policies in the next financial year.
It is recognised that the opportunities for developing and effectively delivering significant savings proposals within a single financial year has become increasingly challenging and brings risk to performance and quality outcomes. In the current financial climate, the delivery of further savings will depend on complex funding, workforce and service change and redesign initiatives, that extend past a single financial year. To address this, we need to evolve our thinking and adopt a longer term, strategic approach. As a result, we have developed our medium term financial strategy (MTFS), which will address sustainability in the longer term and avoid the need to relentlessly develop savings programmes that lead to inefficient “salami slicing”. Effectively the MTFS is a set of longer term transformation change projects, expected to deliver improved care and financial benefits as part of a multi-year programme.
The MTFS identifies annual savings and recovery programmes to ensure financial balance. A series of savings proposals have been developed for 2024/25. These proposals aim to:
- Achieve a balanced budget
- Improve efficiencies in service delivery
- More effectively target resources
- Protect the most vulnerable and ensure delivery of our statutory duties.
This Cumulative IIA provides an opportunity to review collectively, the equality impact of the proposals on the population of Edinburgh. It provides a level of assurance that a robust consideration of potential impacts has taken place. As well as providing an overarching strategic perspective of how projects link together, this process is helping to ensure that work is not progressing in silos.
As well as the impact of individual proposals, it is essential to consider how our overall plan could affect people. In this report, we have tried to consider the emerging cumulative impacts of our proposals from several perspectives. The information and evidence used to inform this cumulative analysis draws on the individual IIAs produced for proposals that will change services in 2024-25.
Summaries of the proposals will available on the City of Edinburgh Council website from Monday 11th March 2024 when papers will be published in advance of the EIJB meeting on the 18th March 2024.
The Savings and Recovery Programme is currently undergoing option approval. Several budget workshops involving EIJB members, including elected members and non-executive NHS Board members have taken place.
4 March 2024
Name | Job Title | Date of IIA training |
Pat Togher | Chief Officer | |
Moira Pringle | Chief Finance Officer | |
Robin Balfour | Medical Director | |
Jacqui Macrae | Chief Nurse | |
Nikki Conway | Locality Manager | |
Robert Smith | Disability Services Manager | |
Emma Gunter | Contracts Manager | |
Katie McWilliam | Strategic Programme Manager | |
Linda Irvine-Fitzpatrick | Strategic Programme Manager | |
Matt Kennedy | Principal Social Worker | |
James Cuthbert | Interim Lead Commissioner | |
Jessica Brown | Innovation & Sustainability Manager and report writer | |
Rhiannon Virgo | Project manager and facilitator | February 2020 |
Siobhan Murtagh | Senior HR Consultant, CEC | |
Louise Morgan | ||
Bridie Ashrowan | Chief Exec, EVOC | |
Rene Rigby | Independent Sector Lead | |
Tom Connolly | Unison Branch Secretary | |
Heather Tait | Hospital and Hosted Services 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 | 1. Joint Strategic needs Assessment City of Edinburgh HSCP (2020)
2. Edinburgh HSCP Joint Strategic Needs Assessment: Health and Care Needs of People from Minority Ethnic Communities (April 2018) 3. Edinburgh Integration Joint Board Strategic Plan (2019-2022) |
1. Provides current and projected data on the wider population in the City of Edinburgh
(Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot) 2. Provides an understanding of what contributes to poor health and wellbeing and the barriers and challenges to seeking and obtaining support (many being interrelated). Actions highlighted as needed to address these include:
3. Details the Strategic direction of the EHSCP https://www.edinburghhsc.scot/wp-content/uploads/2020/01/Strategic-Plan-2019-2022-1.pdf |
Data on service uptake/access | National Benchmarking data | 2021/22 LGBF data shows general service uptake and access.
For detail of individual proposals, see individual IIAs. |
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/ Edinburgh poverty commission report – A just capital: Actions to end poverty in Edinburgh |
Provides current and projected data on the demographics within Edinburgh |
Data on equality outcomes | JSNA-Health-Needs-of-Minority-Ethnic-Communities-Edinburgh-April-2018.pdf (edinburghhsc.scot) | Provides data on demographics of minority ethnic communities
For detail of equality outcomes for individual proposals, see individual IIAs |
Research/literature evidence | See individual IIAs | |
Public/patient/client experience information | See individual IIAs | |
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)
Edinburgh Carers Survey November 2023 (Scotinform) End Poverty Edinburgh annual updates |
Details the health needs and priorities for the people of Edinburgh |
Good practice guidelines | See individual IIAs | |
Carbon emissions generated/reduced data | N/A | |
Environmental data | N/A | |
Risk from cumulative impacts | 1. Individual IIAs
2. Risk of cumulative impact from previous years’ savings programmes |
1. Impacts identified within each individual budget proposal IIA have been considered to undertake this cumulative impact assessment.
2. https://www.edinburghhsc.scot/the-ijb/integrated-impact-assessments/ In 2023/24, the EIJB carried out a Savings and Recovery Programme which aimed to deliver £20.68M. In 2024/25, the savings requirement is much greater, at £69.7M. There is a risk that vulnerable groups of people will be impacted by different savings proposals. This IIA will consider the cumulative impact of each proposal, as well as any cumulative impact of the 23/24 programme. |
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) |
|
Additional evidence required |
Equality, Health and Wellbeing and Human Rights | Affected populations |
Positive
We know that some care packages are excessive in size and a result of this can be that people become more dependent and their independence is not maximised. One of the cumulative impacts of this programme will be that provision of care is right-sized. This offers opportunities for some people, particularly young people in receipt of services, to improve their quality of life. Several of the proposals will ensure clearer understanding of roles and responsibilities and will improve practice and process. There are cumulative positive impacts of this for people in receipt of services who may have a more streamlined experience and increased fairness and equity of approach. The programme will see an increase in some types of provision which we do not currently have enough of – for example, high-intensity bed based services. Those requiring this type of service will see a positive impact from this and there will be additional knock-on positive impacts for the rest of the health and social care system as a result. |
Older people, disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems) All those in receipt of services. Older people, disabled people.
|
Negative
There may be a cumulative impact of people waiting longer for assessment of need and/or waiting longer for a service to be provided once an eligible need is identified. This could have potential knock-on impacts – for example, people deteriorating more quickly, increased hospital admission, increased requirement for residential care at an earlier stage. There may be people who require a service who are no longer able to access it. Older people are one of the biggest groups who receive services from us and as a result, where cumulative impacts exist, they are more likely to experience them. Some disabled people will be in receipt of services which are non-statutory (for example, sensory impairment) and as a result, these services may be deprioritised to protect statutory service provision to the most vulnerable. The availability and take up of some day support services has reduced since the pandemic. Groups who are more isolated and have less access to support systems are more likely to feel the cumulative impacts of this programme. This includes the LGBTQI community. There may be cumulative impacts for children and young people, particularly where the young person is acting as an unpaid carer, or where the young person is care-experienced. It was noted by the group that young people have already suffered a range of negative impacts as a result of the pandemic. There is some risk that young people are impacted by multiple savings – for example, within the commissioning pathways programmes and also within the review and assessment proposal. There is an opportunity to mitigate this through closer working relationships with Children’s Services colleagues in the Council and opportunities for better care planning arrangements. There are multiple proposals within the programme which may see a reduction in the provision of statutory support. This comes with an increased risk of carers stress and carers arrangements breaking down. A significant majority of unpaid carers are women and therefore it may be women rather than men who experience a disproportionate cumulative impact from this programme. Examples of these impacts may include increased carer stress and the requirement to reduce or give up paid employment opportunities if the support provided to their loved one is reduced. We know that this risk already occurs but the frequency or the extent of the risk may increase. Edinburgh Carers Survey 2023:
Where statutory services are reduced, there is a risk that minority ethnic people, particularly those who may not speak English, may be more likely to struggle to access universal services and supports without additional help. The group noted that minority ethnic people tend to be more likely to be in poverty and less likely to seek early support. As a result they may be more likely to experience deterioration in their condition or other impacts, such as an increased risk of homelessness. This can be mitigated to some extent by very clear communications and engagement plans which help support people to access what they need. Similar impacts to those outlined for minority ethnic people may also be experienced by refugees and asylum seekers. The group noted that in the event of any sudden increase in numbers of people seeking asylum, we may have less capacity and resilience in the system to respond. Adults and children with disabilities, and those that care for them, including unpaid carers, may be adversely affected by these impacts: “On average families with a disabled adult or child need an additional £1,100 per month to have the same standard of living as a non-disabled household” p11 7.1 End Poverty in Edinburgh Annual Progress Report.pdf Potential cumulative negative impacts were noted for those who may be at risk of falling into poverty. This includes carers and young carers, who may receive less support. It also includes those who may not currently be charged a contribution towards their support but who may be going forward and as a result will have less disposable income. The group noted the links between poverty and health inequalities. A potential mitigation for this was outlined in relation to ensuring that all partners are focused on maximising benefits for those who are entitled to them. A further mitigation was identified in relation to place-based thinking, which may include for example, place based recruitment to ensure people can access quality jobs within health and social care in their local community. Any reduction in the volume and availability of services may result in a cumulative impact on rural communities since these are areas which may have less choice of services to begin with and a more fragile infrastructure. Less choice in rural areas means that people may not be able to easily access alternative options. A range of potential negative impacts on staff were identified. These include:
It was noted that some staff will fall into the protected characteristics groups and be accessing services and supports and as a result, there may be a direct cumulative impact from this. A number of mitigations were identified in relation to the increased pressure on our workforce. This included the need to ensure appropriate training for staff; the need to strengthen leadership development; clear messaging that staff have managerial support when being asked to make difficult decisions; clear succession planning to address the issue of an ageing workforce; and a clear focus on culture and behaviours, so that frontline staff do not come under significant pressure from senior management, partners and the Scottish Government to continue to improve performance in the context of such constrained funding. Clarity of communication with staff was identified as a mitigation. It was also noted that a focus on place-based recruitment may also help to mitigate, as this could mean that staff are working more locally to where they live and may have reduced travel costs as a result. Some general system impacts were also noted, including the fact that delivery of a programme of this size and scale may mean that the EHSCP is less able to invest resource or funding in issues that affect wider system thinking. An example of this may be wider community planning work going on within the city, or the city-wide response to increased homelessness and the housing crisis. This can be mitigated to some extent by ensuring that EHSCP still has a seat at the table for strategic discussions and can ensure joined-up approaches, even if our funding needs to be more restricted to statutory health and social care provision. It was also noted that it was important that the Scottish Government has a sense of the cumulative impacts, not just in Edinburgh, but from similar savings programmes in HSCPs across Scotland. Opportunities to collectively explore how we use the remaining budget for third sector – with focus on most vulnerable. |
Older people, disabled people Older people Disabled people LGBTQI community; unpaid carers, people with disabilities, people in poverty, Minority ethnic people Children and young people. Women, unpaid carers, cared for people National Carers Strategy National carers strategy – gov.scot (www.gov.scot) Edinburgh Joint Carers Strategy 2023 The Carers Strategy – Edinburgh Health & Social Care Partnership (edinburghhsc.scot) Edinburgh Carers Survey (Scotinform; forthcoming) Nov 2023 Minority ethnic people Refugees and asylum seekers Those vulnerable to falling into poverty, carers, young carers Impact of reduction in income to voluntary and independent sector providers (who provide 80-90% of health and social care services in Edinburgh) on ability to retain current staff and sustain local place-based recruitment Rural communities Rural North West Edinburgh eg Kirkliston, South Queensferry, Ratho, Newbridge, and Lanark Road corridor. |
Environment and Sustainability including climate change emissions and impacts | Affected populations |
Positive
There were no specific cumulative positive impacts identified as a result of this programme. |
|
Negative
There were no specific cumulative negative impacts identified as a result of this programme. |
Economic | Affected populations |
Positive
The group identified that whilst this was a very challenging savings programme, there would be a requirement for close partnership working in order to deliver it. There is an opportunity for new ways of working to be identified and for partners to coalesce around how we invest our remaining funds into services and supports which will have most impact. |
Business community, third and community sector |
Negative
The group acknowledged that there are potential cumulative impacts for businesses in both the third and independent sector since the programme is essentially seeking to make significant reductions to the cost of commissioned and contracted services. Specific impacts for these affected business may include:
Mitigations for these risks were identified as follows:
|
Business community, third and community sector |
The Edinburgh Health and Social Care Partnership commissions services from both the third and independent sector. Robust contract management arrangements ensure that this will be addressed.
A full communications plan is in place, to ensure communication with service users, the general public, partners, provider organisations and staff. Where individual savings proposals impact on these groups, appropriate communication methods will be used.
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 |
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 | June 24 |
Work closely with other partners to identify alternative funding sources (such as the Big Lottery) to offset any loss of funding. It was recognised however, that such funds are under increased pressure nationally. | Linda Irvine-Fitzpatrick | Ongoing throughout 2024/25 | June 24 |
Work closely with third sector partners to prioritise and innovate to spend the remaining funding in the most effective way. It was recognised that there was opportunity to consolidate community bases to focus on areas of deprivation and thereby contribute more to the local economy in these areas. | Linda Irvine-Fitzpatrick | Ongoing throughout 2024/25 | June 24 |
Enact a clear communications plan which acknowledges the impacts but is clear about what the budget is protecting. | John McKee | End of March 24 | |
Continue to develop plans to redesign the front door in an integrated way, with third sector at the heart of this as an opportunity to build on early intervention and prevention. | Pat Togher | March 25 | June 24 |
Ensure that community benefits from any commercial procurement contracts are fully realised to help mitigate any reduced funding. | Emma Gunter/ Moira Pringle | March 25 | June 24 |
Work with partners to develop a poverty strategy for the EIJB and ensure that all partners are aware of income maximisation approaches and opportunities. | Pat Togher | March 25 | June 24 |
Ensure that robust tracking and monitoring arrangements are in place to assess both the delivery of financial savings, but also any escalating risks or impacts. | Pat Togher | May 24 | April 24 |
Consider approaches for implementing place-based recruitment for health and social care jobs. | Mike Massaro-Mallinson | August 24 | May 24 |
Ensure appropriate leadership, training and development plans are in place to support staff, alongside clear succession planning to address issues of an ageing workforce. | Mike Massaro-Mallinson | August 24 | May 24 |
Ensure that the EHSCP continues to engage with partners in strategic discussions such as homelessness, poverty, community planning, even where unable to invest additional funding in these initiatives. | Pat Togher | Ongoing throughout 2024/25 | July 24 |
Name: Mike Massaro-Mallinson
Date: 4 March 2024