Edinburgh HSCP Joint Strategic Needs Assessment: Health and Care Needs of People from Minority Ethnic Communities (April 2018)

Edinburgh Integration Joint Board Strategic Plan (2019-2022)

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.

Edinburgh Health and Social Care Partnership, Joint Strategic Needs Assessment, Minority Ethnic Communities Report, 2018

Details the Strategic direction of the EHSCP Strategic Plan.

The plan for the Rationalisation proposal 2025/26 will focus on services within mental health and learning disabilities.

Mental illness is one of the major health challenges in Scotland. It is estimated that more than 1 in 3 people are affected by mental health problems each year (Scottish Government). The most common mental illnesses are depression and anxiety and together they were estimated to account for a total of 9,733 years of healthy life lost across the City of Edinburgh in 2019 (Scottish Burden of Disease study).

Mental illness is often linked to other long-term conditions and alcohol and substance misuse, which themselves can exacerbate mental health challenges. Higher rates of mental illness are observed in areas of multiple deprivation, and studies have shown that Mental Health is a contributing factor to multimorbidity (Barnett et al., 2012) . As understanding of mental health conditions grows and the stigma attached to them reduces, the number of people being treated for mental health issues will rise.

The number of people reporting a physical disability, mental health condition, and/or long-term illness has increased between 2011 and 2022 in Edinburgh, as well as across Scotland as a whole. Physical disabilities increased from 5.1% to 6.7%, mental health conditions increased from 4.2% to 11.9% and long-term illness increased from 16.1% to 18.1% of the population. (Scottish Census, 2022). While not all of these conditions will require social care support, the growth may suggest increasing demand for services that needs to be managed now and in the future within limited resources.

All local authorities in Scotland collect information on the numbers of people with learning disabilities and/or autism in their area. Information is collected about everyone who is known to the local authority – not just the people who are using services.

There is a marked increase in the numbers of young people with Additional Support Needs (ASN) in recent years, driving a growing need for specialist resources and an impact on future adult service provision.

There has been an increase in the percentage of people reporting they have one or more of learning disability, learning difficulty or developmental disorder comparing 2022 with 2011. However, National Records of Scotland (NRS) are not currently able to break this down into each individual part from the Census results. This is due to the way the question was presented in 2022 compared with 2011 where descriptions were added next to the category. During their quality assurance procedures NRS identified that some respondents with a single condition may have incorrectly decided to tick more than one box if they were unsure what category they should have selected. This means NRS can only currently publish a combined measure covering learning disability, learning difficulty or developmental disorder, but they are confident that this is accurate. They have compared responses with the Scottish Government pupil census in 2010 and 2021 and although there is no increase in the percentage of school pupils with an Additional Support Need (ASN) of learning disability, there have been large increases in pupils with ASNs of learning difficulties, Autistic Spectrum Disorder and Social, Emotional and Behavioural Difficulties. In 2022, 5.2% of people in Edinburgh reported having one or more learning disability, learning difficulty or developmental disorder, the same as in Scotland, and up from 3% in 2011 (Scottish Census, 2022).

Whilst there has been a gradual managed decline in provision of traditional day care services in favour of the use of personal budgets (SDS), there will continue to be some people who require an environment that is commensurate with their needs. The way that the Council provides services has changed and will continue to develop and evolve with the impact of adult health and social care integration (as set out in the Public Bodies (Joint Working) (Scotland) Bill 2013) and implementation of the Self-Directed Support (Scotland) Act 2013.

Adult social care services face considerable challenges in order to address identified current and future demographic pressures.

Below are some reports and background demographic information about people with learning disabilities:

2019 Report, Scottish Commission for People with Learning Disabilities

6.1 Innovation and Sustainability Pipeline – Learning Disability Change Proposals.pdf

Insights into learning disabilities and complex needs: statistics for Scotland – 28 November 2023 – Insights into learning disabilities and complex needs: statistics for Scotland – Publications – Public Health Scotland

EHSCP Internal Data

People EHSCP support with additional support needs under the learning disability cost code. The data is accurate when it was extracted on 20 January 2025.

• Care at home – 651 people
• ISF – 25 people
• DP – 40 people
• Day Services (excludes block contract users) – 143 people

People EHSCP support with mental health needs. The data is accurate when it was extracted on 20 January 2025.

• Care at home – 990 people
• ISF – 9 people
• DP – 23 people
• Day Services (excludes block contract users) – 34 people

As both the Seasons service and the Mental Health Information station are drop in services, it is difficult to quantify the exact number of service users that will be affected by the proposed changes.

The most recent report (2014) stated that the Seasons service 45 service users, 25 of those actively attended sessions.

The Mental Health Information Station had 126 drop in’s between March and June 2024 (4 months) however, some people visited multiple times so an accurate number of contacts cannot be derived from this data.

Edinburgh Poverty Commission

Joint strategic needs assessment – Edinburgh Health & Social Care Partnership

There is also a specific JSNA topic paper on population health and inequalities, which demonstrates that Edinburgh generally is more affluent and has better health that other parts of Scotland, but this hides significant health inequalities in Edinburgh especially when compared Scotland. – Edinburgh Health and Social Care Partnership – Population health and inequalities in Edinburgh

The SIMD (Scottish Index of Multiple Deprivation) looks at the extent to which an area is deprived across seven domains: income, employment, education, health, access to services, crime and housing. A map of the geographical areas of deprivation in Edinburgh can be found using the SIMD site.

Poverty in Edinburgh – data and evidence, Edinburgh Poverty Commission, 2020 – 15% of the population, and as many as 20% of children, live in relative poverty. This poverty is spread throughout the city, with two thirds of those living in poverty not living in areas described as deprived. The majority of those in poverty are in employment.

There are many sources of evidence which outline that people with learning disabilities and mental health are disproportionately impacted by poverty. Below are a range of report from different bodies which support this view:

Mind the Craic, EVOC, Aug 2020

End Poverty in Edinburgh, CEC Progress Report, 2023

Poverty Commission Edinburgh

Special educational needs and their links to poverty | Joseph Rowntree Foundation

Racial inequality and mental health services in Scotland – new report calls for action | Mental Welfare Commission for Scotland

Scottish Government

Public Health Scotland

Home – Learning Disability Today

Protected characteristics of people accessing MHIS:

*Data collection period unknown – est. 3 months

These links research into equality outcomes across Scotland:

The Independent Review of Adult Care in Scotland published in February 2021 set out the Scottish Government’s vision for a new health and social care system. The review both gathered information of people’s/ organisation’s views to inform the body of the review, but also the equality of outcomes for people who require support and care in Scotland were the focus on the review which emphasised people’s human rights.

Timely discharge from hospital is an important indicator of quality. It is a marker that care is person-centred, effective, integrated and harm-free. A delayed discharge occurs when a hospital patient who is clinically ready for discharge from inpatient hospital care continues to occupy a hospital bed beyond the date they are ready for discharge. More information from Public Health Scotland is available here: Delayed discharges in NHS_Scotland monthly, Public Health Scotland and People requiring a social care assessment and care at home services, Public Health Scotland – Dec 2024

People with learning disabilities from Black, Asian, and minoritised ethnic communities are at a higher risk of early and avoidable death, yet annual health check uptake among this group is typically low. Here, Dr Jahan Foster Zabit, Senior Researcher at the Race Equality Foundation, discusses a project which is working to improve this uptake by promoting cultural sensitivity, accessible communication, and community engagement. The vital role of annual health checks: tackling health inequalities in minority ethnic groups

Scottish Government

Coming Home

Scottish Government

The report from the working group into Delayed Discharge and Complex Care which makes recommendations of actions to be taken at national and local levels to reduce the number of delayed discharges and out-of-area placements for people with learning disabilities and complex care needs. More information can be found here Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge – gov.scot and Coming Home Implementation report.

Within the Coming Home Implementation there is also a Dynamic Support Register (referred to as the Register) is ultimately to avoid people with learning disabilities living in hospitals, or in out-of-area placements which they/their family have not chosen. It has been designed to help professionals working with people with learning disabilities to better respond to situations where there is a need for a more intensive level of care management.

It aims to:

• Identify and address risks of admission to hospital or out-of-area placement
• Support the development of local community placements

More information about the Dynamic Support Register.

Below are relevant health and social care legislation in relation to this proposal:

Social Care (Self-directed Support) (Scotland) Act 2013

Carers (Scotland) Act 2016

Carers’ charter – gov.scot

The Keys to Life, Scottish Government

Healthcare Improvement Scotland

Scottish Government

Scottish Commission for People with Learning Disabilities

Scottish Government

As a response to this Healthcare Improvement Scotland produced New Models for Learning Disability Day Support Collaborative. The key themes from this engagement of wellbeing, living, working and learning – were discussed in detail at a series of engagement events which took place across the country.

The programme has now closed. Healthcare Improvement Scotland worked with Health and Social Care Partnerships from October 2020 to March 2023 to:

• gather and provide insights into different approaches to review and design of services
• develop and test tools to support services to understand the needs of supported people, carers to inform future service design
• support exploration and define the issues in a local context
• provide opportunities to meet and learn from peer teams throughout Scotland
• share learning from different models of day support
• provide access to team coaching support
• host a space to share innovation, and
• influence national organisations.

In terms of internal engagement, which was led by the EHSCP, an Integrated Impact Assessment meeting was held with members of the Edinburgh Learning Disability Advisory Group (ELDAG) on 8th September 2023. Some of the key points from this discussion included:

• Flexible support is not about responding to crisis only, it is for us to live a full independent life as equal citizens. There is not enough prevention and early intervention and that is why many people are in crisis. More support early on to avoid crisis is what we need.
• A range of housing options for people with learning disabilities is needed.
• Reduce waiting times for mental health support
• They have to plan support around us and our lives. There should be no expectation that we will plan our lives around support staff. Person-centred means being led by the person themselves and what they want, not being told what to do and when to do it.
• For the impact of this to be good on people with learning disabilities, they have to think about human rights and the rights of disabled citizens, not how to best manage people to fit them into services
• Hidden disabilities may not be taken into consideration e.g. sight loss, mental health, autism.
• The Council needs to hear us and our specific experience that is not the same as many other disabled or older people. If they care about the impact they have to think specifically about our needs and our rights as citizens.
• The impact of this plan will only be good if our points are taken on board, otherwise our problems will be brushed under the carpet. We don’t want that.

The Scottish Health and Care Experience Survey commissioned by the Scottish Government is sent randomly to around 5% of the Scottish population every two years. The latest update was received in July 2024 for the results of the 2023/24 survey. National indicators from this survey included in the EIJB’s Annual Performance Report show that in Edinburgh:

• 75.2% of adults supported at home agree that they are supported to live as independently as possible, compared to 72.4% for Scotland
• 57.2% of adults supported at home agree that they had a say in how their help, care or support was provided, compared to 59.6% for Scotland
• 63.1% of adults supported at home agreed that their health and social care services seemed to be well co-ordinated, compared to 61.4% for Scotland
• 74.1% of adults receiving any care or support rated it as excellent or good, compared to 70% for Scotland
• 72% of adults supported at home agree that their services and support had an impact on improving or maintaining their quality of life, compared to 69.8% for Scotland
• 78.6% of adults supported at home agreed they felt safe, compared to 72.7% for Scotland
• 31.3% of carers feel supported to continue in their caring role, compared to 31.2% in Scotland

The Scottish Commission for People with Learning Disabilities position themselves as a Human Rights Defender. Their vision is of a Scotland where people with learning disabilities live full, safe, loving and equal lives. They influence the development of policy, practice and legislation and are respectful, inclusive, collaborative and pioneering and focus on: Human rights, Leadership and Evidence. Further information about their engagement with people with learning disabilities can be found in their Annual Review 2022-2023.

A consultation informed the Independent Review of Adult Care in Scotland published in February 2021 which set out the Scottish Government’s vision for a new health and social care system A National Care Service for Scotland: consultation provides more information about the consultation people had the opportunity to engage with.

Scottish Commission for People with Learning Disabilities

In an increasingly digital world, it is important that people with learning disabilities are empowered with the tools and knowledge they need to take advantage of the opportunities digital presents.

In 2022 SCLD was given funding by the Scottish Government Digital Health and Care Directorate’s Technology Enabled Care (TEC) Programme, to consider how digital technology can transform the lives of people with learning disabilities. Throughout 2023 the SCLD had conversations with people with learning disabilities about their experiences with digital technology, as well as looking at innovations in digital technology – both mainstream and specialist. To read the full report of their finding, access the link: Our right to be techy!

Adult Social Care: independent review, The Scottish Government, 2021

A National Care Service for Scotland: Consultation

A National Care Service for Scotland: consultation – gov.scot (www.gov.scot)

Inspection of adult social work and social care services: the City of Edinburgh  Inspection of adult social work and social care services March 2023