The EHSCP will continue support to people with substantial and critical needs. These people are likely to be some of the most vulnerable citizens of Edinburgh.

The people whose care will be reviewed in this proposal will receive a holistic assessment from a team of professional practitioners who have experience conducting person-centric reviews based on the person’s outcomes. In general, this project will aim to build the independence of people with long term support needs.   

The Young Adult Disability Team work with people who need support from the age of 14 years old with the aim to create a smooth transition to adult services. There may be a reduction in the formal support some people receive during this transition, which is often be attributed to the skills someone has developed and being able to live more independently. This is often seen as a positive.

There could be perceived benefits from care providers, who in the past may not have known when reviews were likely to take place or how the reviews were to be conducted. A provider engagement session was arranged for 23 January 2025 and has since taken place, led by the EHSCP Interim Strategy Manager for Learning Disabilities. The session brought together approx. 50 attendees and generally the principle within this proposal of reviewing people provider by provider was well received in the room.

Negative

The concept of change and process of change can create anxiety for those impacted by this proposal, and especially older people. To mitigate against this people whose care will be reviewed in this proposal will receive a holistic assessment from a team of professional practitioners who have experience conducting person-centric reviews based on the person’s outcomes.

Carers of all ages could experience anxiety due to this proposal. Anxiety can be triggered by a range of causes depending on their specific personal circumstances.  This may lead to someone requiring more care for which there could be implications for unpaid carers in terms of increasing their commitment with potential adverse impact on employment, health & wellbeing and social.

Older carers will often take on more responsibilities as they progress through life   reducing their opportunities to enjoy their older years. It is important to ensure the cared for partner/parent/unpaid carer do not feel pressured to provide additional support needs that are required. There could also be an impact if a reduction in formal support prohibits a carer from pursuing paid employment and the health implications of this. The Carers Act specifies the need for carers’ outcomes to be considered. This needs to be handled sensitively. To mitigate against the overall impact to carers – the carers’ needs are included in the holistic assessment the Review Team and there is the offer of, and the option for carers to complete an Adult Carer Support Plan through Edinburgh Health and Social Care Partnership or Third Sector Partners.

This proposal will impact people who receive learning disabilities and mental health support from EHSCP who may see changes to their current care package. There is an additional cumulative impact on people with learning disabilities whose life expectancy is below the general population. The mitigation to this is the reviews are conducted based on proportionate care for someone’s assessed needs – the Review Team will not remove support from someone who meets the criteria and support is needed. The EHSCP Community Learning Disability Team are beginning more general health checks for people with additional support need

There could be a disproportionate impact on some people who have mild learning disabilities and appear verbally confident, but this doesn’t reflect their day-to-day function or capabilities. To partly mitigate against this impact EHSCP will work with the internal Learning Disability Positive Behavioural Steps teams. There is also the opportunity for the Review Team to use communication tools for speech and language from the NHS Occupational Therapy and Adult Intellectual Disability Service Teams. There is also the opportunity for safety net services to avoid crisis. It may not happen due to financial pressures but still required.

There are people within this review cohort whose care will be reviewed who have cognitive impairment, sensory loss or dementia and are vulnerable within this process. To mitigate against this impact, it is essential people have someone to represent them if required. The support from the Positive Behavioural Steps Team will be valuable. There could also be potential to use independent advocacy services too, dependent on their availability and capacity to deliver the service.

People with autism are a group of people who may be impacted by this proposal and their care reviewed but not to a greater degree due to this protected characteristic. To mitigate against this, their review would follow the same holistic assessment from a team of professional practitioners who have experience conducting person-centric reviews based on the person’s outcomes.

There was a concern raised that reviews conducted capture a ‘snapshot of time’ and someone could escalate into crisis. To mitigate against this the Review Team engage with care providers and carers prior to review who are known to the person and any other relevant others to inform a review outcome.

There was a concern that whilst someone’s fundamental needs are met following a review, their ambitions and aspirations are overlooked if the primary focus is to keep someone safe. As mentioned previously, the reviews conducted are holistic assessments from a team of professional practitioners who have experience conducting person-centric reviews based on the person’s outcomes.

People of minority ethnic backgrounds may be impacted due to this proposal to a greater degree due to their underlying disadvantage in accessing alternative services. A recent Welfare Commission Report provides further detail on this topic here.

To mitigate this, the Review Team will engage translator services or interpreter services to ensure the person can engage fully in the review. There is also the possibility to use standardised tools for translation which the NHS Lothian Occupational Therapy and Intellectually Disability Teams use. However, this mitigation is only partial due to the capacity constraints on these additional services.

There are cultural implications in some cases where a man needs to be present for someone’s care review. There are also circumstances where a male or female person has to be seen by a practitioner of the same gender. To mitigate this the Review Teams will make every effort to accommodate these preferences where they can, but it will not always be possible to deliver.

There are refugee or asylum seekers in communities who have a mistrust of people in an official capacity due to concerns about their right to remain in the UK.

Owning to certain groups of people may be more reliant on consulting relevant others outside their immediate household or are more likely to live alone (particularly the LGBTQ+ community), it could take longer to conclude the review outcome if other people need to be engaged. This is an aspect to be mindful of within the project.  To mitigate against this the Review Team would use relevant advocacy services where required and ensure any relevant other(s) who needs to be consulted during a review is/are contacted.

People with learning disabilities may rely on someone else to support them complete forms in terms of literacy and numeracy. This could create a greater degree of vulnerability relying on someone to advocate for you, or the person advocating from them may not have their best intentions. The mitigation is the same as above.

People who have experienced care and young people are especially vulnerable and the support they have received is very limited. To mitigate against this people whose care will be reviewed in this proposal will receive a holistic assessment from a team of professional practitioners who have experience conducting person-centric reviews based on the person’s outcomes.

There are fewer options for support in rural communities for people who could be disproportionately impacted. The mitigation is the same as above.

There are also limited travel options to connect people living in rural communities or people could find learning a new travel route difficult. To mitigate this there is some provision in the EHSCP Local Area Coordinator (LAC) Team who could provide travel training or relevant support. There may be similar support in the Third Sector, but this is predicated on service availability and their capacity to deliver against demand. Therefore, this is only a partial mitigation.

People who use learning disabilities and mental health support and meet the criteria for a review of their current care

Young people with additional support needs

Edinburgh Health and Social Care Partnership

Private and Third/ Independent Care Providers

People who use learning disabilities and mental health support and meet the criteria for a review of their current care and their relevant others, especially older people

Carers (including young carers and carers with protected characteristics)

Unpaid carers.

Older people

People who are unmarried, married or in a civil partnership

Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems) 

People with autism 

Everyone

Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers)

Refugees and asylum seekers

Everyone

The LGBTQ+ community

People with low literacy/numeracy

Care experienced children and young people

Those leaving care settings (including children and young people and those with illness)

Rural communities and the people who live there

The EHSCP Review Team impacts

Positive

The Internal Review Team have working arrangements to accommodate their team depending on whether they are part time or shift workers.

The Internal Review Team’s opportunity to work closely with staff within the Learning Disability Services teams could be a valuable addition to the team’s existing skillset.

Communication both for practitioners in the team and what they send out will be vital for practitioners to feel supported and the people whose care is being reviewed has all the information they need about the process, implications for them and how to maximise their existing assets (both financial and otherwise).

Negative

In terms of EHSCP staff the Internal Review Team will be impacted the most. The staff who go out to conduct reviews may encounter people who are nervous, or even angry. To mitigate against this impact – there is a lone working policy that the team adhere to, and the team will partner together in twos if necessary.

The proposal impacts the Internal Review Team’s way of working in the sense the team will focus on reviewing people with learning disabilities for the first part of the year and then shift to focus on people who require mental health support for the remaining months of the year. The objective is to review cases in a Provider-by-Provider approach where possible, this will be delivered in a coordinated way and planned with support from colleagues in contract and commissioning. Depending on the individual workers in the Internal Review Team, there could be different views on embarking on this focused piece of work – some may prefer it more than others. To mitigate against this, the Review Team seniors will be engaged through supervision and team meetings.

It can be stressful for workers in the review teams to make decisions about other people’s lives. To mitigate against this – it is important workers know these are decisions based on the organisation’s overall responsibility to ensure people’s care packages are proportionate to someone’s need and there is equity across the city. If workers engage with this message and feel supported, the ambition is they would feel safer in the practice. 

The table below shows the ten care providers who deliver the highest proportionate share of care to people who feature on the learning disabilities review list and would meet our criteria for review. This data is accurate as of mid-Jan 2025.

*Note: the table shows the ten care providers with the largest proportionate share. This data does not include those in the mental health cohort of reviews.

Positive

There could be perceived benefits from care providers, who in the past may not have known when reviews were likely to take place or how the reviews were to be conducted – in one block or staggered. A provider engagement session was held on 23 January 2025 and led by the EHSCP Interim Strategy Manager for Learning Disabilities. The session brought together approx. 50 attendees and generally the principle within this proposal of reviewing people provider by provider was well received in the room. 

Negative

There is anxiety about the consequences for the delivery of this proposal, in particular the level of additional pressure on community teams and whether there will be more calls for support potentially diverted to inappropriate care settings.

A point was raised in relation to the Independent Sector providing the majority of care in Edinburgh. Through the delivery of this proposal there was concern about provider staff doing more visits, greater intensity work and the implications for their wellbeing. It would be an anxious time for providers and their frontline workers. The mitigation against this was a provider briefing which was arranged for 23 January 2025. Since the IIA session, this event has taken place and was led by the EHSCP Interim Strategy Manager for Learning Disabilities. The session brought together approx. 50 attendees and generally the principle within this proposal of reviewing people provider by provider was well received in the room.

There was some agreement with the points raised above but not universally. Regarding the pressures on staffing on care providers in the independent sector, EHSCP do hear that providers do struggle to retain staff, so there may be opportunities for providers to optimise their operational models through this planned review process.

There was a general point raised about the provision of Third Sector funded early intervention, prevention and advice services impacted across Edinburgh. To mitigate against this, any service user who has critical or substantial needs will be eligible for a social work assessment (or review, if they already access statutory services) which will mitigate these needs, however there is likely to be reduced opportunity to act to prevent future needs arising, which may in turn lead to higher demand for services to meet critical / substantial need and therefore less capacity to deliver a quality service for the existing high need population.  Signposting to alternative community services will also mitigate in part but it is acknowledged that alternative community services depend on the organisation’s individual financial situation and viability.

Third Sector early intervention, prevention and advice services

None recorded in discussion

None recorded in discussion

The EHSCP will continue to support people with substantial and critical needs. These people are likely to be some of the most vulnerable citizens of Edinburgh.

By adopting a provider-by-provider approach to reviews there could be opportunities to review support arrangements of on an individual and aggregate basis. By adopting this holistic approach to reviews there could be the opportunity through economies of scale for providers and EHSCP to ensure their respective resources are utilised efficiently and effectively and support is configured in the most appropriate, both in terms of people’s outcomes and operationally.

If any of the changes during the review result in financial pressures for the individuals there are mitigations available through the City of Edinburgh Council: Help if you’re worried about money – The City of Edinburgh Council. The City of Edinburgh Council holds a significant responsibility for inequalities across Edinburgh and providing the appropriate routes to reach support, including direct responsibility for some areas which as some overlap in health and social care such as housing. Although it is worth noting that mainstream advice services are not always accessible to people with additional support needs, so this is only a partial mitigation.

EHSCP and Care Providers in the private sector and Independent/ Third Sector

Everyone, but especially:

• Unemployed
• People in receipt of benefits
• People in receipt of pensions
• Vulnerable families e.g. young mothers, people experiencing domestic abuse, children at risk of statutory measures, includes disabled adult/child, minority ethnic families
• Families with a child under 1/Larger Families (3+ children).
• Care experienced children and young people
• Those leaving care settings (including children and young people and those with illness)

It is important people impacted by reviews of their support are aware of how to maximise their income. While, income maximisation is not a delegated service to the EIJB and a number of alternative services are provided by the City of Edinburgh Council, it is important to recognise that there is already a level of unmet demand in the city, and so any reduction in service is likely to affect overall levels of access. In addition, the EHSCP has a duty to provide information and advice under the Carer’s Act, which may include signposting to benefits information. Women, those with a disability and minority ethnic populations are more likely to be affected by poverty and therefore disproportionately affected by any reduced availability of poverty mitigation interventions such as welfare advice. We cannot fully mitigate against service provision in other sectors as each organisation’s viability is reliant on their own individual financial situation but as a partial mitigation, the Review Team need to be knowledgeable about methods to maximise someone’s income and share the relevant information with the individual impacted and their relevant others or refer/ link someone to the relevant services as appropriate.

The client groups who are the focus of this proposal have a higher risk or poverty, higher living costs and are using food banks. They are less likely to respond to information, attend an appointment or visit the doctor. This proposal increases the risk of someone’s welfare and poverty risk higher further. To mitigate against this impact, the reviews conducted are holistic assessments, are sensitively conducted. It is important particularly in these situations where people are more financially vulnerable that the Review Teams are equipped with the appropriate level of information to share.

People in or vulnerable to poverty are more likely to feel a disproportionate impact of any service loss or reduction.  They may be less able to afford alternative supports or any associated travel.  Migrants with no resource to public funds are likely to be more affected than others. The mitigation is the same as above.

A number of programmes support those who are homeless. Care experience is a risk factor for homelessness so those populations may be disproportionately affected.  The mitigation would be signposting to alternative services or access to statutory services where appropriate. However, we acknowledge that alternative community services depend on the organisation’s individual financial situation and viability.

• Unemployed
• People in receipt of benefits
• People in receipt of pensions
• Vulnerable families e.g. young mothers, people experiencing domestic abuse, children at risk of statutory measures, includes disabled adult/child, minority ethnic families
• Families with a child under 1/Larger Families (3+ children).
• Care experienced children and young people
• Those leaving care settings (including children and young people and those with illness)
• Women
• Minority ethnic people (includes Gypsy/Travellers, migrant workers, non-English speakers)
• Disabled people (includes physical disability, learning disability, sensory loss, long-term medical conditions, mental health problems)
• Unpaid carers

Everyone but especially refugees and asylum seekers

People who experience homelessness