SWBG blog

Edinburgh Integration Joint Board Grants Programme

Heather Williams, Training Lead at the Scottish Women’s Budget Group, discusses the latest proposals made by Edinburgh Integration Joint Board on their Grants Programme

There has been a lot said this week about the proposal made by the Edinburgh Integrated Joint Board (EIJB) to give 90 days’ notice to stop funding 64 third sector organisations across the city. It has been estimated that this will result in over 100 job losses and will t potentially cost £16million in lost additional funding, leading to further disadvantage being experienced by over 50,000 people who use the affected services.[1]

The integration of health and social care services was intended to ensure ‘those who use health and social care services get the right care and support whatever their needs, at the right time and in the right setting at any point in their care journey, with a focus on community-based and preventative care’.[2] Yet what we see in many areas of Scotland is a system which is failing to meet its intended purpose of providing the right care and support to people. This is partly due to the lack of proper integration in relation to the provision of services or budgets.

The EIJB proposal is the latest made by IJB’s across Scotland[3] that highlights that the siphoning off services for those with health and social care needs leave many of our most disadvantaged communities and groups in a worse position than pre-integration.

The paper produced by the EIJB sets out that these cuts are needed to ensure that the best use is made of finite resources to allow the EIJB to meet its core and statutory responsibilities. Reviewing the paper using a gender budgeting lens highlights some questions about the assessment that forms the basis of the proposal and how we assess the impact of the way in which we spend money or make cuts.

Value for Money

The proposal states that ‘the size of the deficit is such that without decisive action, the EIJB will be unable to meet its statutory obligations and unable to protect our most vulnerable. In the absence of a substantial (and recurring) increase in income, the EIJB needs to reduce the scale of the services it provides’.

There is no denying the tight financial situation that the public sector is facing but, given the particular challenges that we face in Scotland with an ageing population, cutting support which prevents or delays people needing to use higher cost statutory services seems a perverse way to go about balancing budgets.

The paper also states:  ‘the evaluation method used does not consider the opportunity cost associated with the grant allocations (i.e. what evidence is there that the activities funded through the EIJB grants programme was the best use of that money?). In the current economic climate where the EIJB (along with the rest of the public sector) is facing severe and persistent financial pressure against a background of rising demand and demographic change, a greater level of critical analysis is needed. It is not enough to know that money spent has brought benefit, the EIJB need to be assured that every pound has been spent to best effect and done as much good as possible’.

SWBG would not disagree with the need to question how the way we spend money helps us to achieve our outcomes and if there are better ways to spend money. Questioning the impact of how we raise and spend money is a key principle of gender budgeting. However, we contend that for this assessment to be fully effective all early intervention and preventative spend should have been looked at to assess its value, rather than just those currently funded through the grant programme.  It is important that as part of this assessment we understand how current active programmes interact and impact on other areas of the system, including where additional costs may arise because of these changes.

The questions used to assess value (as outlined in the paper) would benefit from some clarity on the criteria used, at the moment it appears that potentially we are measuring apples and pears. Addressing the following points would increase transparency:

• what outcomes Edinburgh IJB were measuring projects against, and how these relate to the outcomes the projects were funded to meet;
• what evidence Edinburgh IJB used to identify if projects contributed to meeting the outcomes;
• what evidence Edinburgh IJB used to allocate monetary values to the return on investment;
• how were the funded organisations involved in the assessment.

The fact that the Integrated Impact Assessment highlights this proposal will protect staff in statutory services does lead to questions about the underpinning assumptions made about the worth of different interventions funded by the EIJB.

Delegated Functions

The paper provides an explanation of the decision taken using the work of the Income Maximisation projects funded stating that, while a well-evidenced and effective intervention, income maximisation/poverty reduction is not one of the EIJBs delegated functions. Yet according to the scheme of integration[5] one of the delegated functions from the City of Edinburgh Council is the provision of general social welfare services under the Social Work Scotland Act 1968. The act describes these as the provision of advice, guidance and assistance on the scale as may be appropriate.[6] This therefore raises questions about what is seen as a core function of the EIJB and how this matches the objectives set out in the EIJBs draft strategic plan as well as the integration scheme.

The proposal also raises questions about how the benefit derived by health and social care from income maximisation was identified, as it is not clear what evidence the18p return is based on. Given the low value associated with this, it is likely that this could be contested. A report for Public Health England shows that for every £1 invested in financial inclusion £8.40 is generated and that:

• 41% of clients in receipt of money advice was linked to an improvement in their health;
• 67% of clients had noticed a reduction in their stress in response to the advice received.[7]

Preventative Approach

The 2023 inspection of adult social care services in Edinburgh found that there was an inconsistent and uncoordinated approach to early intervention and prevention services. This meant that there was little focus on preventing hospital admissions due to staff being focused on supporting those who have been discharged from hospital. The Inspection found that one aspect of good practice was in relation to building capacity in communities where an extended period of grant funding had assisted in the work to improve population health and tackle inequalities.^[8]

This proposal to remove funding from the 64 community organisations will undo the good work in this area highlighted by the 2023 Inspection.

The EIJB paper sets out that ‘most individuals accessing services funded from the grants programme would not meet the criteria of critical or substantial need and therefore the discontinuation of the grants programme would not lead to an increase in statutory service provision.’  It is unclear over what time period they are basing this assertion on. If it means immediately, this may be correct but from a gender budgeting perspective it is important that we take a lifetime perspective wherever possible. It is unclear from the paper what consideration has been given to how soon those who are being supported by the community organisations would be likely to show up in higher cost statutory services. Likewise, the proposal does not mention anything about how long the savings (they believe) these cuts will make will be sustained for.   

The lack of disaggregated data about those who use the funded services makes it difficult to fully understand how likely this proposal is to actually realise the savings it states will be made.  

Gender budgeting encourages us to be transparent and to show the workings behind decisions/assessments. This proposal would benefit from greater transparency and detail in relation to how the impact of the removal of services will interact with people’s need to use statutory services and what this will mean for demand and unmet need. This is particularly important to assess if the proposal will actually lead to savings anywhere other than on a column on the balance sheet.

Section 12 of the proposal provides data on what the £4.5million saving could fund if used differently including additional GP appointments. Section 34 states that preventative work which stops people attending the GP or A&E does not ‘directly translate into financial savings as cash can only be released by reducing the provision within those areas.’

This assessment seems to misunderstand the nature of early intervention and preventative work, which aims to stop problems happening in the first place or reduces the level of harm[9].  Preventative work delays the need for individuals to use higher cost statutory services. While the assessment undertaken appears to miss the impact that this decision could have on demand, the Integrated Impact Assessment does recognise the inherent risks in this cut that ‘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.’ However, the mitigation they suggest that users can be signposted to other community services seems to be based on an untested assumption that there are services available and that there is capacity within these.

Reducing Health Inequalities

The initial grant programme aimed to reduce health inequalities along with funding early intervention and preventative approaches. Yet the paper is largely silent on this issue and how the proposal made will impact on the IJB’s responsibilities under the Public Sector Equality Duty.

Both the paper and the Integrated Impact Assessment are largely silent on the number of people likely to be affected by this proposal, their characteristics and the areas they live in. The lack of disaggregated data means it is difficult to understand the potential longer-term impact of this and whether these savings will actually be realised or whether they will just result in money being spent in other areas. This is particularly important when it comes to a reduction in care services, and its likely impact on women’s economic inequality.

Conclusion

The IJB proposal highlights that the focus on the need to balance budgets year or year has led to a very short-term approach to assessing the value of investment and the impact of cuts. It misses out on identifying the impact these proposals will have on the public purse in the longer term, as well as on other parts of the system which can result in additional costs.

This approach has led to early intervention and prevention being deprioritised as found by the Accounts Commission, who are clear that tackling the issues facing IJBs must have early intervention and preventative approaches as its heart. Additionally, the Accounts Commission has stated that IJBs must ensure that the savings set out in its plans are actually achievable. We contend that this must  be supported by the use of sex disaggregated data.[10]

To tackle the challenges currently faced in the public sector there must be a move away from the siloed approaches taken to the delivery of services and to consideration of costs and savings. Ensuring that decisions are based on the use and comprehensive analysis of sex-disaggregated data showing that savings are realistic and achievable is essential. Without this there is a very real risk of entrenching inequalities further.

 

 

---

[1] https://democracy.edinburgh.gov.uk/documents/s76315/7.2%20Edinburgh%20Integration%20Joint%20Board%20Grants%20Programme%20and%20Public%20Social%20Partnership.pdf

[2] https://hscscotland.scot/integration/#:~:text=At%20its%20heart%2C%20integration%20is,community%2Dbased%20and%20preventative%20care.

[3] https://healthandcare.scot/stories/3766/k/

[5] https://www.edinburghhsc.scot/wp-content/uploads/2019/11/Integration-Scheme-1.pdf

[6] https://www.legislation.gov.uk/ukpga/1968/49/section/12

[7] https://observatory.leeds.gov.uk/wp-content/uploads/2019/10/Improving-Public-Health-through-Income-Maximisation.pdf

[8] https://www.careinspectorate.com/images/documents/6997/City%20of%20Edinburgh%20inspection%20report%20March%202023.pdf

[9] https://publichealthscotland.scot/our-areas-of-work/public-health-approach-to-prevention/the-three-levels-of-prevention/

[10] https://audit.scot/publications/integration-joint-boards-finance-and-performance-2024#:~:text=In%20this%20Account%20Commission%20briefing,the%20bodies%20providing%20these%20services.