The Savings and Recovery Programme includes a number of projects which will have a positive cumulative impact on older people.  Examples of these include Primary Care, Community Equipment and One Edinburgh Reablement, which will increase access to services, equipment, and maximise personal independence.

In addition, the programme as a whole will help the EHSCP meet its statutory obligations by ensuring that resources can be prioritised to support the most vulnerable, by delivering efficiencies wherever possible.

There will also be some positive impacts for working age adults with a learning disability or a mental health condition through the LD and MH Reviews project and the LD Redesign.  These projects will help to right-size care and support, maximise independence and provide the most appropriate living environment for people with a learning disability or mental health condition.  The Direct Payment: Aligning Outcomes project will also support people to use their direct payment to meet their care and support needs.

It is predicted that the programme will have a net positive impact on people delayed in hospital, people awaiting a social care assessment, and people awaiting a package of care.  This will be due to One Edinburgh: Reablement, the LD Redesign and the three Reviews projects maximising independence and right-sizing packages of care, freeing up capacity within the system.

There may be career development opportunities for staff resulting from a number of projects within the savings programme, including One Edinburgh: Reablement, LD Redesign and Direct Payments: Aligning Outcomes.  Training and development will be provided in a number of projects, which will be beneficial for staff involved.   

All 

People with a disability and young people transitioning into adult services

Staff

There is likely to be a net negative impact caused by the reduction of services for the elderly, reducing possible alternative supports.  Projects in this category include the Vaccinations Redesign if a vaccination site closes, the 10% reduction in block contracts for Older People’s Day Support and grants.  Some older people will also perceive the reduction in formal support following a review (One Edinburgh Reviews or DP: Aligning Outcomes) as a negative impact.  Mitigations are outlined in the IIAs for each individual project, however, as older people are the biggest group of people receiving health and social care services, where cumulative impacts exist, they are most likely to experience them.

Reductions in services and alternatives will also impact carers, including young carers, and as carers are disproportionately women, cumulative impacts are more likely to affect women.  Projects in this category include the reduction of grants, block contracts, OP Day Opportunities, the opportunity cost arising from the use of carers’ funding to meet additional costs of purchased care, the rationalisation of some MH services and the three Reviews projects. The impacts may include increasing carer stress and the potential for caring arrangements to break down, and may decrease a carer’s ability to engage in paid work.  The cumulative impact of reductions on carers can be mitigated through access to Adult Carer Support Plans, through signposting to potential alternative support groups, and through holistic assessments of care needs for the supported person.  However, there may not always be like for like replacements available and this cannot be fully mitigated.

There are a number of projects likely to result in reduced levels of social care support for people with physical or learning disabilities and mental health conditions, such as LD and MH Reviews, MH Rationalisations and the reduction in third sector support through the grants and block contract reductions.  This will lead to a cumulative impact as alternative provisions reduce.  While people will be signposted to alternative community or digital supports, choice and capacity within the third sector will reduce and it is likely that broader services will remain while condition or location specific supports serving only a small population are reduced. This impact can also be mitigated through clear comms and support provided throughout the changes.  People with low literacy skills may be harder to mitigate for and a specific communications strategy will be developed to ensure that they can be reached.

A reduction in services commissioned or funded specifically for certain groups of people will have a greater impact due to the lack of like for like alternatives.  This would apply when services were provided for people of minority ethnicities, for example.  People who do not speak English may experience more barriers to accessing alternative services.  This can be mitigated only partially by targeted communications.

Any reduction in funded formal or third-sector services is likely to disproportionately affect people in or at risk of poverty due to their reduced ability to fund or travel to alternative supports.  This is likely to include carers and young carers as well as the supported person.  In addition, the reviews of Direct Payments will focus spend on social care needs only, which can be felt as an impact if people have been using them incorrectly to supplement their income.  Mitigations for the financial impact include signposting to income maximisation services provided by the City of Edinburgh Council or other partners, to ensure that anyone entitled to benefits is receiving them.  In the past we have spent money on non-delegated functions where there has been overlap/correlation, such as on health inequalities. By reducing this spending here in the future we may impact on these groups so we need to work together with partners to ensure that affected individuals can access appropriate services. 

The savings programme as a whole may push people towards accessing alternative services such as A&E, GP practices or Social Care Direct, increasing the burden on these services.  However, these are needs assessed services and will only accept people who have eligible needs, mitigating the overall impact.

There may be a cumulative impact of reducing grant funding and block contract funding on people living in certain geographical areas.  This can be mitigated by provision of citywide or digital services.

Some projects will reduce overall staff numbers or redesign services.  This may include roles changing for some staff, or redeployment of others.  Change can be experienced negatively across all staff groups.  Staff impacts can be mitigated by appropriate support from line managers, HR, union and staffside representatives, by the provision of appropriate training where necessary, and by signposting to support services.  Staff who are themselves carers may experience cumulative impacts, and the majority of our workforce is female, so the staffing impacts will affect women disproportionately.  Older staff are more likely to be negatively impacted by staffing changes.  Each SRO is responsible for identifying impacts on staff affected by their savings projects and for taking into account any protected characteristics.  Any staff who are redeployed will be protected by the CEC/NHSL organisational policies around redeployment.

Carers, particularly female carers, young carers.

People with disabilities, including physical and learning disabilities, mental health conditions, long-term conditions and sensory loss, people with low literacy skills

People of minority ethnicities or non-English speakers, refugees and asylum seekers

People in or at risk of poverty, including carers and young carers, people in receipt of pensions, care experienced people, people experiencing homelessness.

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People living in rural or semi-rural areas

Staff

Some providers will receive more work as a result of projects within the savings programme.  For example, the move to reablement has involved freeing up internal capacity by placing people with external providers.  The LD Redesign programme will also offer opportunities for providers.  The Primary Care project will also offer an opportunity to local practitioners or businesses to take on a thriving practice with support.

There will be a cumulative negative impact on the business community due to multiple factors.  There will be a reduction of overall spend across every project, which will impact on providers, on the third sector and on the local economy.

In addition, no allowance has been made to support providers with National Insurance contributions.  This will increase pressure on organisations, which will make them less able to absorb the impact of commissioning fewer hours/services.  In partial mitigation, commissioners and contract officers are meeting with providers to support them to assess their operating models and provide guidance on their business models so that they can remain competitive within the market.

However, there remains a possibility that some providers, including third sector organisations, may reduce staff as a result of the changes to funding.  There is also a 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.  In partial mitigation, the Council has recommended that a Third Sector Transition Fund is created to ameliorate the effect of the withdrawal of grant funding.  However, this will not apply to any other type of reduction in spend with the third sector eg reviews or contract reductions.  The impact can therefore not be fully mitigated.

There will also be a cumulative effect of the savings made in 2024/25 and previous years with the savings made in 2025/26.  Purchasing spend overall has not reduced, but the rate of growth has been curtailed by the increased focus on savings, and again, some providers or organisations are likely to have seen a reduction where others have not.