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 (edinburghhsc.scot)
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:
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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 (edinburghhsc.scot)
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:
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. |
Research/ literature evidence |
NICE: Overview | Intermediate care including reablement | Guidance | NICE
Reablement outcomes references: Role and principles of reablement | SCIE Scottish Government – National Health and Social Care Integrated Workforce https://www.gov.scot/publications/national-health-social-care-integrated-workforce-plan/pages/6/ |
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. |
Public/patient/ 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
IRASC: 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 |
IRASC:
Examples of the kind of improvements that people are trying to make include:
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 |
Positive
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
All Low income Vulnerable people Homelessness Carers Learning disability and low literacy / numeracy Substance misuse |
Negative
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 Carers Low incomes Vulnerable families Staff |
Environment and Sustainability including climate change emissions and impacts | Affected populations |
Positive
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 |
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Negative
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 |
Positive
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) |
Negative
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.
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.
None
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 |
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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 |
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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 |
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Travel – need to look at CEC plans on low emission zones and permits, and the impact on reablement staff |
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Coordinate reablement roll-out activities centrally and locally, and ensure a robust training package is built throughout the roll-out |
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Include a human rights-based approach into core training, and 3rd party reporting training with Police Scotland |
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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.