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)

Household data

Census 2022  

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

(Population and demographics – Edinburgh Health & Social Care Partnership (

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:

  • Staff training including cultural sensitivity
  • Recognition of the role of the Third Sector
  • Effective community engagement
  • Developing effective approaches to prevention including overcoming isolation.

3. Details the Strategic direction of the EHSCP

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)

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 ( 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

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

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.


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

A National Care Service for Scotland: Consultation

A National Care Service for Scotland: consultation – (

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

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.



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:

  • Around a third of respondents are not in employment, education or in receipt of a pension (23% in 2017).
  • The proportion of respondents in ‘very poor’ or ‘poor’ health has increased since 2021 (24%, up from 19% in 2021)
  • More than half of respondents provide more than 50 hours of care per week. This figure is up from 2021 (46%).
  • 30% of respondents are caring for more than one person. This figure is also higher than in 2021 (26%).
  • The proportion of respondents caring for someone under the age of 25 has increased from 29% to 36%. This has implications for the carer and for the services supporting both.

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:

  • Increased anxiety and stress as a result of uncertainty, particularly for those who may not always have access to the same communications and information (for example those who work shifts or those who are currently off sick or on maternity leave)
  • Impacts on staff morale
  • Increased workloads – either through delivering services with less staff, or through having to deliver significant savings programmes in addition to business as usual and the knock-on impacts on staff wellbeing and the risk of increased sickness absence;
  • Increased stress resulting from difficult conversations with service users and their families and having to convey difficult messages about reduced services;
  • Increased stress relating to the risk that staff may feel they are carrying through not be able to adequately meet need.
  • Delivering a programme of this size and scale whilst also going through an organisational restructure could exacerbate the stress and anxiety for staff.

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 – (

Edinburgh Joint Carers Strategy 2023

The Carers Strategy – Edinburgh Health & Social Care Partnership (

 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

There were no specific cumulative positive impacts identified as a result of this programme.


There were no specific cumulative negative impacts identified as a result of this programme.

Economic Affected populations

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

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:

  • Risk that their business is no longer viable with reduced funding. It was noted that different organisations will be in different situations, with some able to access reserves or leverage in additional funding sources, while others will have limited access to alternative funds;
  • Associated risks were noted of the impacts on third and independent sector workforce. It was noted that where people are employed on zero hours contracts, they may experience unexpected reductions in the number of hours they are offered. There may also be the risk of redundancy for some affected staff.
  • It was noted that average salaries tend to be lower in the third sector and as a result, any loss of jobs could affect lower paid people.
  • Destabilisation of the market which could lead to people having less choice of service.
  • Providers may be less willing to work with us and with each other if funding becomes more constrained.
  • Some of the savings proposals within the programme rely on community and universal services replacing statutory services, there is a risk that third sector organisations may be unable to respond to this if their funding is reduced.
  • Reduced funding for third sector organisations may also lead to a reduction in the number of volunteers being supported.
  • Increased fear and anxiety for the sector.
  • Risk that several different proposals within the savings programme could end up having impacts for the same organisation, with unseen or unintended aggregate impacts.
  • A potential knock-on impact was noted for wider local businesses, who may see reduced footfall if there are reductions in workforce in particular areas.
  • A range of volunteer-led, community and voluntary organisations rely on use of buildings owned by the Church of Scotland across the city;  At present the Church is reducing the number of ministers by up to 50%, and closing churches / church halls which these organisations depend on.

Mitigations for these risks were identified as follows:

  • 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;
  • 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.
  • Work with other partners to identify new and additional income sources eg creation of new income streams such as The Regenerative Futures Fund. Key partners at development stage are City of Edinburgh Council, Corra Foundation, National Lottery Community Fund, The Robertson Trust, Turn2Us & Edinburgh Trust, and William Grant Foundation.  Further potential developments include donations from philanthropic individuals and engagement with corporate partners.
  • Work closely with 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.
  • Work with voluntary and independent sector providers to map organisations that are providing a range of early intervention and prevention services eg via both place-based services including community centres (both CEC managed/owned and independently managed/owned) church halls, libraries, community cafes, sports venues, uniformed groups, sports/arts and outdoor/greenspace groups; and city-wide or specialist services with a themed focus eg mental health, older people, substance use, disability, unpaid carers etc.
  • Work with voluntary and independent providers including EVOC &  the Edinburgh Third Sector Interface to map and assess the sustainability (financial, people, skills, and other assets) of organisations and networks that contribute to the resilience of the health and social care system in Edinburgh
  • Work with providers across all three sectors to address workforce recruitment and retention issues, recognising the value of place based recruitment that supports carers, the wage differentials between sectors, and the challenges regarding housing and cost of living for the city, to increase the total number of people working in health and social care, as opposed to staff moving from one provider to another, based on different terms and conditions.
  • Again, a clear communications plan is essential which acknowledges the impacts but is clear about what the budget is protecting.
  • The plan to redesign the front door in an integrated way, with third sector at the heart of this, was recognised as an opportunity to build on early intervention and prevention.
  • Ensuring that community benefits from any commercial procurement contracts are fully realised could help to mitigate any reduced funding.
  • There is a plan to work with partners to develop a poverty strategy  for the EIJB which will also provide mitigation.
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.


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

Mike Massaro-Mallinson's signature

Name: Mike Massaro-Mallinson

Date: 4 March 2024