Integrated Impact Assessments – Overnight home care proposal (interim)
Overnight home care proposal (interim)
The Edinburgh Health & Social Care Partnership (EHSCP) is reshaping how we deliver care at home with our internal Social Care workforce. Under the One Edinburgh programme our teams are transitioning to provide short-term interventions through reablement.
A savings proposal was submitted to the Edinburgh Integrations Joint Board (EIJB) in December 2024 to consider closing our internal overnight care service in favour of commissioning any night-time based personal care through an external provider (or providers).
EIJB approved taking this proposal into a planning stage. This stage will look at developing more detailed proposals that will look at market interest, workforce impacts and cost implications.
Our current overnight home care is a registered service that provides scheduled care visits across the city as well as an emergency response service that supports individuals and other service areas such as district nursing in delivering personal care in the community.
The team includes fifteen front-line carers and three office-based staff members. They currently deliver planned care to sixty-two individuals. Care is generally delivered by two carers per visit and the team use pool cars for travel.
EHSCP is refocusing our internal workforce to deliver short-term intervention, and the proposal acknowledges that this is not the type of service we currently provide through the overnight team. Further to this, work is underway to develop an enhanced care pathway that will see more people discharged from hospital into the community. It is proposed that our internal workforce will support the reablement and settlement of these individuals so that assessments for longer-term care can be made in a homely and stable setting. There could be potential for our internal overnight workforce to support this pathway of temporary intervention.A larger, more complex and comprehensive overnight service is likely to be required across the city and the proposal indicates a savings potential to deliver this through a commissioned service.
One Edinburgh Reablement IIA carried out in March 2024 and 04 February 2025 in terms of the strategic move to delivery short-term interventions through reablement with our internal workforce. These IIA also covered the moving of long-term packages of care from our internal workforce to external commissioned provider(s).
Workforce engagement with Director of Operations carried out in December 2024 ahead of the proposal being presented to Edinburgh Integration Joint Board.
Union engagement with Head of Service in December 2024 with future sessions scheduled in February 2025.
This IIA is considered interim as union representation was unavailable on 06 February 2025 and as an acknowledgement of the fluidity of the proposal at this stage. Impacted service user communication plan in development alongside a workforce engagement strategy.
06 February 2025
Identify facilitator, Lead Officer, report writer and any partnership representative present and main stakeholder (e.g. NHS, Council)
| Name | Job Title | Date of IIA training |
| Philip McAusland | Programme Manager (IIA Facilitator), EHSCP | October 2023 |
| Angela Lindsay | One Edinburgh SRO, Head of Service – Home First, Community Rehabilitation and Reablement, EHSCP | |
| Caroline Todd | Programme Manager, EHSCP | April 2022 |
| Holly Hart | PMO Officer (IIA scribe), EHSCP | |
| Siobhan Murtagh | Senior HR Consultant, EHSCP | |
| Lynn Forrest | Operational Representative, Community Reablement, EHSCP | |
| Karen Adamson | Operations Business Change Manager, EHSCP | |
| Lisa Forbes | Hub Services Manager, EHSCP | |
| Joanna Blaszk | Home Care Manager, EHSCP | |
| Claire Holmes | Occupation Therapy Team Lead, Intermediate Care, EHSCP | |
| Peter Lloyd | Data Analyst, EHSCP | |
| Wendy Michael | Business Manager, EHSCP | |
| Chelsea Silk | Contracts Officer, EHSCP | |
| Lynn Campbell | Overnight Home Care Organiser, EHSCP | |
| Aneta Szczodrowska | Overnight Home Care Coordinator, EHSCP | |
| Emma Gunter | Contracts Manager, EHSCP | |
| Lorraine Ross [arm’s length submission from overnight workforce] | Overnight Team Manager, 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 – where available use disaggregated data | Population and demographics – Edinburgh Health & Social Care Partnership (edinburghhsc.scot)
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 Internal Service Reports Scotland’s Census 2022 – Rounded population estimates | Scotland’s Census |
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 Care at Home Overnight service user demographics (Jan 2025)
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| Data on service uptake/access | Internal Service Reports
Edinburgh Integration Joint Board draft strategic plan – City of Edinburgh Council – Citizen Space Care Inspectorate: Inspection of adult social work and social care services (March 2023) |
Internal Service Reports
Overnight planned care supplied to sixty-two individuals. Woman make up a 2/3rds majority of service user group A white ethnic origin making up at least 63% of the service user group Older people with support needs accounts for 79% of the service user group, with physical disabilities accounting for a further 20% Emergency response for personal care forecast circa 1,000 visits per year Team comprises of fifteen carers and three back-office staff members EIJB Draft strategic plan: Primary focus of internal workforce on delivering reablement interventions. Ongoing care to be commissioned by external partners. Care Inspectorate: Inspection of adult social work and social care services identified a number of areas for improvement, including:
Care inspectorate: Overnight Care Grades – 2020 Quality of care and support 5 – Very Good Quality of staffing 4 – Good Quality of management and leadership 4 – Good “People told us how they could not manage without the overnight service. For example, some people required to be re -positioned at night to maintain comfort and reduce the risk of pressure sores. Other people required support with personal care to prevent skin breakdown and to maintain dignity. One person told us: ‘I go to bed early, it’s a long night until the morning carers come in, I would be very sore if not turned.’ Support staff were diligent of people’s care needs and reported any concerns back to the office at the end of their overnight shift. Management and Health Care Coordinators (HCC) would follow up these concerns with relevant other professionals if required. The impact of this duty of care meant people were being supported effectively to maintain their wellbeing and prevent any potential risk to their health. One relative told us : ‘The service is so reliable, if it wasn’t for their consistency, (relative’s) skin would have broken down a long time ago. I know their skin is being well looked after.’ |
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| Data on socio-economic disadvantage e.g. low income, low wealth, material deprivation, area deprivation. | Population and demographics – Edinburgh Health & Social Care Partnership
Poverty in Edinburgh – Edinburgh Health & Social Care Partnership Census 2022 – The City of Edinburgh Council Intranet Christie Commission (2011) |
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. |
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| Data on equality outcomes | Population health and inequalities in Edinburgh – Edinburgh Health & Social Care Partnership
Population and demographics – Edinburgh Health & Social Care Partnership Census 2022 – The City of Edinburgh Council Intranet Edinburgh Integration Joint Board draft strategic plan – City of Edinburgh Council – Citizen Space |
“While life expectancy is the average number of years those in a defined population are expected to live, healthy life expectancy (HLE) is the average number of years a person in a particular population is expected to live in a healthy state. People experiencing disabilities or limiting long term conditions tend to have poorer health overall. Females in Edinburgh experience fewer years of good health than males. In recent years, there is evidence of a widening gap between males and females which appears to be a combination of improvements in male HLE and a worsening of female HLE. Although females have a higher life expectancy, they spend more than 20% of that life experiencing a low quality of life. For many people, increased life expectancy will be offset by years lived with disability.” |
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| Research/literature evidence | Role and principles of reablement – SCIE
Overview | Intermediate care including reablement | Quality standards | NICE Overview | Intermediate care including reablement | Guidance | NICE |
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. |
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| Public / patient / client experience information | EHSCP Satisfaction Consultation Feedback March 2021
Feedback examples from family to locality team – on importance of access to information Edinburgh Pact consultation 2019 |
EHSCP Satisfaction Consultation Feedback 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 Care inspectorate: Overnight Care “People told us how they could not manage without the overnight service. For example, some people required to be re -positioned at night to maintain comfort and reduce the risk of pressure sores. Other people required support with personal care to prevent skin breakdown and to maintain dignity. One person told us: ‘I go to bed early, it’s a long night until the morning carers come in, I would be very sore if not turned.’ Support staff were diligent of people’s care needs and reported any concerns back to the office at the end of their overnight shift. Management and Health Care Coordinators (HCC) would follow up these concerns with relevant other professionals if required. The impact of this duty of care meant people were being supported effectively to maintain their wellbeing and prevent any potential risk to their health. One relative told us : ‘The service is so reliable, if it wasn’t for their consistency, (relative’s) skin would have broken down a long time ago. I know their skin is being well looked after.’ |
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| Evidence of inclusive engagement of people who use the service and involvement findings | Independent Review of Adult Social Care (2021)
Edinburgh Integration Joint Board draft strategic plan – City of Edinburgh Council – Citizen Space |
Care inspectorate report: Overnight Service
“We received 17 completed care standard questionnaires (CSQs) from supported people or their relatives. Everybody (100%) agreed or strongly agreed that:
88% of CSQ’s said the service would check with them to ensure they were meeting the person’s needs. Some comments included: ‘As far as I am concerned, the carers treat my relative with respect.’ ‘My relative has been receiving overnight support for several years, all staff are friendly and have ensured they are able to remain independently at home.’ ‘The same carers are on a shift pattern which really helps my relatives dementia. They have a lovely professional manner and contact me if any concerns which is reassuring.’ ‘Pleased and thankful for the service.’ ‘My relative thinks highly of the overnight care staff, never had anything negative to say about them.’ ‘I am grateful for this service. Sometimes I worry that due to holidays or sickness there may be occasion when I get carers who don’t know how to reposition me, mostly there is a regular carer though.’ ‘Fantastic team who are really professional and helpful. I live alone and having the service enables me to live independently. The overnight team are so caring and treat me with dignity and respect, thank you.’ ‘A very valuable service for my relative who couldn’t do without them.’ |
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| Evidence of unmet need | Internal Service Reports
Independent Review of Adult Social Care (IRASC) |
Approximately 2,300 hours of unmet need across community, hospice and hospital
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. |
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| Good practice guidelines | Role and principles of reablement – SCIE
Overview | Intermediate care including reablement | Quality standards | NICE Overview | Intermediate care including reablement | Guidance | NICE 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. |
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| Carbon emissions generated/reduced data | Climate change charter – Edinburgh Health & Social Care Partnership
2030 Climate Strategy – The City of Edinburgh Council Internal Service Reports |
100% of overnight care staff use car as primary method of travel. Council pool cars are used to ensure low emission status. | ||||||||||||||||||||||||||||||||||||||||
| Environmental data | Climate change charter – Edinburgh Health & Social Care Partnership | |||||||||||||||||||||||||||||||||||||||||
| Risk from cumulative impacts | Savings programme 2025-26 cumulative IIA | |||||||||||||||||||||||||||||||||||||||||
| 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 and Children’s Rights | Affected populations |
| Positive
A bigger provider workforce might have a different mix of ethnic backgrounds in comparison to our relatively small internal workforce. This could offer more choice and preference in service user care delivery. Current internal workforce is small, with approximately 8 front-line carers for any given shift. Commissioned overnight services could be larger in scale to deliver more care and reduce waiting times for planned care services. TUPE considerations for a commissioned overnight service would allow for transfer to a similar employment offering that maintains terms and conditions. Some service users receiving overnight care currently have day-time packages supplied by commissioned provider. Potential opportunity to deliver enhanced continuity of care if the provider or day-time care could also deliver overnight support. Potential to offer parity of service experience between day and night care delivery. Intervention and reablement focused across a 24-hour function with an aim to ensure appropriate ongoing care needs identified and maximised independence for service users. |
Older people and people in their middle years
Women Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems) Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers) People with different religions or beliefs (includes people with no religion or belief) Those vulnerable to falling into poverty: eg have low or no wealth, on low-income, live-in areas of deprivation, experiencing material deprivation (socio-economic disadvantage) People with low literacy/numeracy People experiencing difficulties with substance use Rural/semi-rural communities Urban communities Staff |
| Negative
Would commissioned services have contingency plans and replacement staff to deal with barriers? Would they have the same amount of training, including challenging behaviours/first aid etc – mitigated by clear contractual requirements that deliver parity of service delivery Cross working with internal partnership services, such as substance use teams, could be subject to delay when referrals coming from external provider – mitigated by effective processes and clear escalation planning Carers will be losing relationships with service users that have potentially been cultivated over prolonged period. Mitigated by workforce support tools such as PAM assist and line management support. The internal workforce will have made personal choices to work in an overnight setting. There may be considerable impact to individuals if comparable alternative employment is not available. Issues could include financial implications due to loss of shift enhancements, work/life balance changes, family care difficulties or alternative work environment concerns. Mitigated by open conversations about alternatives, potential for TUPE transfer to a like-for-like alternative and the formal redeployment process. Availability of pool cars in a commissioned working environment might be limited. This could result in a requirement for personal car use, addition travel costs and changes to insurance needs. Would providers have contingency plans in case of transport breakdown as our internal workforce does? Mitigated by contractual requirement to maintain suitable resilience plans. Staff with reasonable adjustments due to disability considerations may find alternative travel arrangements in commissioned service challenging. Mitigated by equalities elements of contractual delivery. Increased risk of individuals in workforce choosing to leave service, rather than redeployment/TUPE. Could lead to a loss of capacity and experience within service. This could result in an increased reliance on overtime or destabilisation of current service delivery. Mitigated by clear and open engagement with workforce including close working with union representatives and legal department. Timescales for procuring a commissioned service could disadvantage workforce as redeployment opportunities are based on available roles at the time-of-service closure. Organisational review will be complete ahead of any commissioning exercise. Mitigated by clear and open engagement throughout process. Reduced sense of control over work environment. Mitigated through clear and open engagement with workforce. Uncertainty around future of service will cause anxiety across workforce and service users. Mitigated through engagement, communication and setting out expectations for next steps. Internal workforce carries a lot of experience, which might not be available with market providers. Mitigation is time to develop experience, potential TUPE and contractual requirements for workforce support and skill mix. Current internal service works closely to support other services including district nurses. Removing this support could result in extra pressures on already stretched services elsewhere. Mitigated by commissioning alternative support or enhancing other service areas. During incidents the internal overnight service provides a fallback position for day service failures. Often picking up potentially missed visits or getting to areas that might have been off limits during the day. This is unpredictable so would be difficult to commission. Severe weather is a good example, with rising frequency. Mitigated through enhanced contingency planning and contractual specification. Our internal carers represent the provider of last resort, meaning we have a responsibility to deliver care when a provider fails or has to hand back work. Even on a short-term basis, when stabilising a situation there is a risk to not having internal staff that work through the night. Mitigated through enhanced contingency planning and contractual specification |
Older people and people in their middle years Women Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems) Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers) People with different religions or beliefs (includes people with no religion or belief) Those vulnerable to falling into poverty: eg have low or no wealth, on low-income, live-in areas of deprivation, experiencing material deprivation (socio-economic disadvantage) People with low literacy/numeracy People experiencing difficulties with substance use Rural/semi-rural communities Urban communities Staff |
| Environment and Sustainability including climate change emissions and impacts | Affected populations |
| Positive
Commissioned services could lead to an increase in the efficient delivery of overnight visits.
|
Local businesses (providers)
Staff Rural/semi-rural communities Urban communities |
| Negative
A commissioned overnight service potentially puts more carers out in cars overnight with associated increase to emissions. Current internal service uses electric fleet, but providers might not have access to this type of vehicle. Mitigated by environmental and sustainability elements of procurement and contract award process. |
Local businesses (providers)
Staff Rural/semi-rural communities Urban communities |
| Economic | Affected populations |
| Positive
Increased local and visa-based employment through providers across city Commissioned services have an hourly rate for personal care delivery that is significantly lower than our internal service rate. Potential to use money saved from overnight home care to further enhance reablement and deliver care to more people in-year. Planning stage could potentially identify further activities to realise savings and efficiencies within the internal service delivery. All options to be explored. |
Local businesses (providers)
Staff |
| Negative
Cost implications of additional vehicle requirements through either provider provision of carers using personal vehicles. External providers may not be financially able to absorb potential TUPE implications. A commissioned service with TUPE costs included might not be financially viable. |
Local businesses (providers)
Staff |
Commissioned provision of social care services is covered by our Contractual or Framework Agreements. Whilst we currently deliver overnight care through an in-house model our care at home providers are capable of delivering this type of care. All providers are registered with the care inspectorate to deliver specific types of care and are subject to the same practices, guidance, terms and conditions of delivery. This includes 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 are covered as requirements of contract award.
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. See section 2.10 in the Guidance for further information.
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.
Evidence to be gathered to look at market interest, workforce impacts and cost implications. Further work is also required to develop a detailed specification of the overnight care needs of the partnership, including current care at home visits, unplanned responsive care and complex needs stemming from an enhanced care pathway.
| 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 |
| Full IIA | Philip McAusland – Programme Manager, EHSCP | March 2026 |
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.
Name: Angela Lindsay
Date: 12.02.205