Savings programme 2024-25 – One Edinburgh integrated impact assessment

One Edinburgh approach to internal reablement

In order to deliver our vision of supporting preventative approaches that enable more people to remain independent at home, or in a homely setting, for as long as possible, it is essential that we make best use of capacity within the health and social care system. In order to achieve this, we know that we need to work differently, to ensure we have enough capacity, in the right place and at the right time, providing access to both reablement and long-term care at home services.

Our ambition is to implement a ‘One Edinburgh’ approach for all homebased support services, to ensure equity of access to quality support across the city for people and their carers. This approach will move to a predominantly reablement offer, so that we can support more people to live as independently as possible.

A transition under One Edinburgh will see reablement become the primary focus for our inhouse staff, where the majority of our internal service provision would be supporting people through reablement, and a small portion providing longer-term care. Whilst we continue to recruit to our internal service, we anticipate challenges in achieving the required resources immediately for our increased reablement offer. We are therefore going to maximise reablement by temporarily reducing our long-term care provision.

A full integrated impact assessment took place following two sessions in July and August 2022, considering the proposed changes within the entirety of the One Edinburgh Programme, including an increased reablement offer, more flexibility in visits, and optimisation work taking place with providers to ensure our shared capacity is maximised. An IIA was then held in June 2023 to specifically focus on the external commissioning framework element of One Edinburgh. We also had additional sessions specifically with carers and people who use our services.

Co-production has also continued with our external providers throughout this process.

28 February 2024

Name Job Title Date of IIA training
Rachael Docking

IIA facilitator and report writer

Programme Manager, EHSCP January 2020
Caroline Todd Programme Manager, EHSCP April 2022
Deborah Mackle One Edinburgh SRO, South West Locality Manager
Jo Gray, Note taker Personal assistant, EHSCP
Philip McAusland Project manager, EHSCP 24th October 2023
Susan Robertson Strategic Planning and Commissioning Officer, EHSCP
Chelsea Silk Contracts officer, EHSCP
Anna Duff North West Locality Manager, EHSCP
Catherine Mathieson Cluster Manager, EHSCP
Gavin Swan Home Care Coordinator, EHSCP
Sandra Boyle Social Care Worker, EHSCP
Lisa Forbes Hub Services Manager, EHSCP
Michael Scott Home Care Organiser, EHSCP
Sam Kotecki Contracts Officer, EHSCP
Brionna Wilson Project manager, EHSCP
Stef Milenkovic Senior Development Officer, EVOC
Karen Adamson Operations Business Change Manager, EHSCP
Holly Oladejo Social Care Assistant, EHSCP
Janice Lovie Home Care Coordinator, EHSCP
Peter Lloyd Data Analyst, EHSCP
Catherine Mcleary Interim North West Home care manager, EHSCP
Siobhan Murtagh Senior HR consultant, EHSCP
Gordon Alexander Home Care Manager, EHSCP
Linda Fridge Hub Services Manager, EHSCP
Susan Paterson Home Care Manager, EHSCP
Pauline Wilson Home Care Manager, EHSCP
Brian Motion Home Care Manager, EHSCP
Joanna Blaszk Home Care Manager, EHSCP
Robert Boswell Home Care Manager, EHSCP
Doreen Kelly Home Care Manager, EHSCP
Leigh Gordon Home Care Manager, EHSCP
Oyebola Omoya Social Care Assistant, EHSCP
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 (

EIJB Strategic Plan 2019 – 2022

Edinburgh Joint Strategic Needs Assessment (JSNA)

National Records of Scotland (NRS) population projections for local authority areas

Audit Scotland Report on Health and Social Care Integration

Data on the increasing after age of the City of Edinburgh population, and future projections.

Edinburgh will also see an increase of those with complex and long-term care needs within the adult population.

Estimates of future numbers of older people are sourced from National Records of Scotland (NRS) population projections for local authority areas. The number of people aged 85+ living in Edinburgh is projected to increase by 80% between 2018 and 2043.

There are estimated to be 65,084 carers in Edinburgh, or 13.7% of the population. One in five of these carers provides over 50 hours of care a week.

Data on service uptake/access EIJB Strategic Plan 2019 – 2022

Internal Service Reports

Care Inspectorate: Inspection of adult social work and social care services (March 2023)

EIJB Strategic Plan:

Increased need for homecare, reablement or outreach services:

Advances in health care and standards of living means more of us are living longer. More of us are living with frailty and multi-morbidity, placing more pressure on carers and the traditional approach to publicly funded health and social care services.

In addition, society and government are becoming increasingly aware and taking account of the effect of mental illness, living with disabilities and a range of long-term conditions.

Audit Scotland’s recent report reviewed the changes being introduced through the integration of health and social care. The report sets out the challenge of increasing demand for services and growth over the next 15 years in Scotland.

Homecare and Reablement Support Information:

Combined care at home (externally commissioned) and home-based care (internally supported) deliver over. 6 million hours of care and support every year.

Care Inspectorate: Inspection of adult social work and social care services identified a number of areas for improvement, including:

  • There were significant weaknesses in the design, structure, implementation and oversight of key processes, including the assessment of people’s needs and in their case management
  • Approaches to early intervention and prevention were uncoordinated and inconsistent
  • Long standing significant delays in discharging people from hospital, people waiting for assessment of their care needs and meeting vulnerable peoples’ unmet needs had recently begun to improve
  • Self-directed support had not been implemented effectively
  • There was insufficient support for unpaid carers
  • Prioritised actions will be required to ensure the needs of people and carers are met, and their wellbeing improved, more consistently
Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. Edinburgh Joint Strategic Needs Assessment (JSNA)

Christie Commission (2011)

EIJB Strategic Plan 2019 – 2022

JSNA provides key data on socio-economic disadvantage

The Christie Commission highlighted that the greatest challenge facing public services is to combat the negative outcomes for individuals and communities arising from deep-rooted inequalities.

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

EHSCP Edinburgh ‘Offer’ Pact Consultation 2019

EHSCP IIA Strategic Plan 2019-22

BME Equality Workers Forum Statement

JSNA Provides data on demographics of minority ethnic communities

Edinburgh Offer Pact Consultation raised themes for the citizens of Edinburgh around:

  • Making information accessible
  • Equality /SIMD;
  • Aware of those who do not have a voice;
  • Fairness;
  • Meaningful consultation (allowing time to respond)

EHSCP IIA Strategic Plan 2019-22:There is considerable data available on health inequalities showing significant inequalities throughout all parts of Edinburgh as well as inequalities for some nongeographic groups.

Taken from a statement provided by the BME Equality Workers Forum regarding equality issues within the workforce:

According to the records gathered by SSSC (2019), in the City of Edinburgh Council within the public sector care at home and housing support services, 79% of staff are female and at least 60% of staff are over 45 years old. Unfortunately, SSSC has not yet gathered ethnic origin data. However, according to the data held by Scottish Government gathered through Annual Population Survey (2018), the majority of workers from ethnic minority backgrounds are employed in health, public admin and education sector (inclusive of social care) with 43% of Black workers holding employment in this sector. Other estimates of Scottish workforce within health and social care suggest 20% of social care workforce to be from the European Union.

literature evidence
NICE: Overview | Intermediate care including reablement | Guidance | NICE

Reablement outcomes references:

1 (

Role and principles of reablement | SCIE

Scottish Government – National Health and Social Care Integrated Workforce

In Scotland improving workforce planning is vital to sustaining our high quality and safe services into the future. National comparisons of healthcare workforce planning have underlined the need for a range of responses to global supply and demand challenges.

Future Workforce: The skills that will be required and shaped by our ongoing transformation of services, in line with patient and service user demand.

Efficient Use of the Workforce: Alongside growth and retention, we need to make more efficient use of existing resources. This will involve a range of approaches, including improvements in rostering.

client experience information
EHSCP Satisfaction Consultation Feedback March 2021

Feedback example from family to locality team – on importance of access to information

Edinburgh Pact consultation 2019

EHSCP Satisfaction Consultation Feedback early findings indicate areas of support individuals and carers value the most for the care and support they receive through external care providers

Regular IIAs held as the programme develops, additional sessions specifically held with carers and people using our services, and ongoing co-production with the market

Evidence of inclusive engagement of people who use the service and involvement findings Independent Review of Adult Social Care (2021)
Evidence of unmet need Internal Service Reports Data

Internal Engagement with Workforce Focus Groups and Interviews

Independent Review of Adult Social Care (IRASC)

Internal Service Reports evidence of unmet need and capacity


As the older population has increased and resources have been focused increasingly on those in greatest need, a smaller proportion of the adult population is in receipt of social care support than was before austerity, with the result that the needs of a number of people are probably not being met and for others they are being met in a crisis response rather than to anticipate or avoid such interventions.

Good practice guidelines Independent Review Adult Social Care

Health and Social Care Standards (2018)

Health and Social Care Integration (2016)

Guidance framework on the national health and wellbeing outcomes and indicator measures (February and April 2015)

Digital health and social care strategy (2018)

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 – Person Centred Care


Examples of the kind of improvements that people are trying to make include:

  • Reducing use of institutional/residential care – increased opportunity for support at home
  • Making better use of adaptations and technology
  • Involving people and their families more in decisions
  • Including wider community supports in care
  • Professionals working together better across traditional boundaries of health, social care support and other services such as housing
  • Fair Work principles to improve workers’ working conditions; peer support and supervision; and a more consistent approach to providing high quality training for staff

Health and Social Care Integration and Standards- As part of the integration of health and social care we have a requirement and duty of care to work with our local communities and providers of care to ensure care is responsive to people’s needs and that we follow the guidance for the national health and wellbeing outcomes to ensure:

People, including those with disabilities or long-term conditions, or who are frail, can live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

Carbon emissions generated/

reduced data

City Vision 2050 consultation – Policy and Sustainability Committee agreed a ‘Short Window Improvement Plan’ (SWIP) in October 2019. City vision is to be net zero on carbon emissions by 2030. More sustainable routes for our outreach mobile workforce could help to impact on reducing carbon emissions from the 32% of our workforce who are registered car users for delivery of homecare services.
Environmental data City Vision 2050 consultation – Policy and Sustainability Committee agreed a ‘Short Window Improvement Plan’ (SWIP) in October 2019. The continued move to provision of services at locality level should reduce CO2 emissions for residents, but health care professionals will need to make a greater number of vehicle trips which may increase emissions
Risk from cumulative impacts None identified None identified
Other (please specify) Independent Adult Social Care Review (IASCR) 2021 ‘(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’.
Additional evidence required Health and Safety Executive (HSE) “It is the employer’s duty to take every reasonable precaution to ensure the safety of lone workers and to carefully consider and deal with any health and safety risks for people working alone.”
Equality, Health and Wellbeing and Human Rights  Affected populations

Those who have acquired physical disability or neuro condition – reablement is an excellent service for that group of people

Reablement is a positive offer, for those who will be eligible for it (majority will be)

How we communicate this is essential – accessibility and public information, varying ways that people communicate 

Reablement provides opportunity to look at income maximisation, as people can have opportunities highlighted to them via reablement process 

People shouldn’t be disadvantaged by going through reablement, it is available to all 

For some vulnerable people it is a good check-in point – clear expectations and mechanisms to manage and refer them to external partners 

Comms – need to be clear that packages can be increased as well as decreased – this will focus on making sure we get it right at any point in time 

Homelessness – means different things for different people, reablement is for people with potential to make a recovery through their own independence 

Carers – tension between ambitions of carers and ambitions of cared for person, must communicate benefits of reablement to carer, links to respite need to be strong at start of process – could ease some of the pressures on carers 

LD and low literacy and numeracy – reablement will be a very supportive process, so less likely to get lost in system, someone will help them through that process 

Substance misuse – in reablement we can find engagement difficult with that group, any support to help make that journey more positive would be helpful – we do have substance misuse teams, look at how we connect and be explicit about going to colleagues to support 

Development of skills, working in a different way, continuous changing group 

Opportunity for training beyond internal staff group – EVOC keen to see policies that bring forward training around equalities

Positive effect for those who are discriminated against or harassed, some of the elements that you might be harassed about could be supported

Improve the outcome of the long-term service that people receive at end of reablement

Aligns with 3Cs, asset and solution focused approach – open conversation, it should naturally fit with level of support that is required and the next step – should naturally evolve which conversation the support sits with

Reablement has a positive impact on all elements of equality and human rights, providing more choice, control, inclusion, resilience, among other things

Middle years – 35-55/60


Low income

Vulnerable people



Learning disability and low literacy / numeracy

Substance misuse


Some people have only ever experienced one provider and a transition to a new provider will be a challenge

There will be people who have long-term conditions that fluctuate and have digressive diseases that require flexible and consistent care packages

Significant impact on ppl already in long term care system, those that are likely to move to market

We need continuity of care for people with dementia, who will be distressed with change

What happens to the % of people who are not suitable for our internal reablement – connecting people to wider opportunities – link to IIA on managing incoming demand

Diversity of carers – some providers will have more diverse staff than others, and any transition of packages should consider this

LGBT people will “de-gay” their house – want to make sure that the continuity of care is maintained

Male and female carers – people specific about only wanting one or the other, be upfront in public info and say can’t guarantee that

Link to IIA on housing support – for people who need ongoing support that is chargeable, and SDS choices, personal care and reablement are free but elements of housing support are chargeable – anyone assessed in reablement that needs housing support could be disadvantaged

Vulnerable families and those on low income are more likely to live in areas of high deprivation, need to ensure we have external providers available

Internal challenges on recruitment – particular areas that we struggle to recruit staff to – to offer reablement across the city we have to acknowledge the challenges in recruitment to achieving this

Having providers working in those areas to offer long term support to those who need it – if external market can’t provide then the internal market becomes blocked

Often areas at peripheries of localities can be a challenge, geographics can be an issue on what we can provide in reablement

Parking – SE issue, which is why we have providers that won’t work in certain areas, also some of those areas don’t have neat runs with walking travel time – need incentives for providers

Reablement won’t be right for every member of staff, might be used to working with someone for a long period of time, a more fluid approach won’t support everyone

Staff with protected characteristic – continuous change may not suit everyone

Transition period – staff will need to be moved around as we release for training and reablement, logistical disruptions for staff that could impact

Training and development programme – situations coming up where people have to support people they don’t have the skill to do so – FLS, back office and managers

Communication – BSL, Talking Mats etc., think about wider communication methods

Back-office staff have other duties that they do because they don’t have a huge turnover of service users, whereas reablement coordinators are starting new packages every day – activities that won’t be done

Risk to staff group if training and induction of workforce is not properly coordinated

People do not tend to want to move to external providers – our ongoing work with providers should help with this

What happens to the people that would be referred to us and who it would look at first glance that they would not meet criteria for any service – as people are entitled to an assessment regardless. So someone referred for housework, for example, clearly wouldn’t meet criteria and would not be offered an assessment through reablement – up-stream will need to ‘screen’ these referrals out – this will be further addressed through the IIA in relation to the front door, and how we support people to appropriate options







People in long term care

People with dementia

LGBT communities


Low incomes

Vulnerable families


Environment and Sustainability including climate change emissions and impacts  Affected populations

If reablement runs are made more efficient we can work to reduce travel time, but a lot of barriers across the city to this e.g. parking, public transport, and low emission zones

More walkers and less drivers – local recruitment will reduce drivers etc.

More people supported through reablement, working in wider teams can liaise with localities on the housing support that people might provide

Links to home fire safety visits – direct referral route into fire and rescue for home fire safety

Improvements made to buildings e.g. lighting via direct contact with reablement teams




Low emission zones in city – challenge for internal and external – recommendation need to look at CEC plans around low emission and permits 

Economic Affected populations

Income maximisation – positive opportunities that can be advertised via reablement

Supporting the local provider market

Whilst less going to market, it is the right need going to market and could enable the market to manage the appropriate level of need, they just may need to change to support that

If more people through reablement, more coming out perhaps needing long term support, established and right-sized packages, which are given to providers

This makes it safer for people – coming out of a comprehensive handover and assessment – safer transition of care

People on low incomes

Local businesses (providers)


If providers do fail, there will be an impact on the external market

Local businesses (providers)

The reablement service is entirely in-house, however by providing a reablement model we will know what needs commissioned via our external framework with our providers. We continue to co-produce the external commissioning framework to ensure equity of access to quality support across the city for people and their carers. This includes commissioning improved integrated support options for adults living at home which are sustainable, well-coordinated, accessible, and appropriate at point of need, supporting improved outcomes and maximising independence. All equality, human rights, environmental and sustainability issues will be covered by the Contractual or Framework Agreements, good practice guidance or the contracted terms and conditions.

This will involve collaboration with planning and commissioning 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 have also agreed for FAIR (Family Advice and Information Resource) to produce an easy-read version of the final IIA report once published.

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
Take careful consideration for anyone being transitioned to a new provider Caroline Todd
Public comms need to be very clear on what the offer is and what the change in offer is and the restrictions of our workforce
  • Rachael Docking
  • Phil McAusland
  • Rachel Howe
Link to IIA on housing support –reablement is free but elements of housing support are chargeable – anyone assessed in reablement that needs housing support might require support
  • Deborah Mackle
  • Caroline Todd
  • Rachael Docking
Ensure close working for staff with substance misuse teams, as reablement can be more difficult, look at how we connect and be explicit about going to colleagues to support
  • Rachael Docking
  • Phil McAusland
Travel – need to look at CEC plans on low emission zones and permits, and the impact on reablement staff
  • Rachael Docking
  • Phil McAusland
Coordinate reablement roll-out activities centrally and locally, and ensure a robust training package is built throughout the roll-out
  • Rachael Docking
  • Phil McAusland
Include a human rights-based approach into core training, and 3rd party reporting training with Police Scotland
  • Rachael Docking
  • Phil McAusland

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.