On 18 March 2024, the Edinburgh Integration Joint Board (EIJB), the body responsible for strategic planning of health and social care in Edinburgh, announced plans for proposed savings to reduce their budget deficit of £60mn. Although the EIJB has been clear that no frontline staff will be the target of these spending cuts, the impact will be palpable to all staff, and most critically the clients we work with.
An overview of cuts proposed in Edinburgh
Some services are being cut or closed outright; on Monday 18 March, the BBC reported on the closure of two council-run care homes (Clovenstone and Ford’s Road) with a total of 68 individuals now needing to be moved elsewhere. You may be surprised to learn that this news article was the first myself and my colleagues learned of the closures. Another service to be axed outright is Be Able – a multi-disciplinary service for clients with reduced mobility. The service aims to prevent the implementation of long-term packages of care with the hopes of increasing people’s independence and reducing reliance on formal interventions from social care services.
Other services will see a significant amount of reduction in funding and the biggest intended savings will come from the ‘managing new and existing demand’ section of the savings and recovery plan for the coming year. An intended £13.4mn is forecast to be saved from these measures. This is a continuation of the previous programme approved by the EIJB earlier this year, with the intended saving of £6mn to April of 2024. The programme has drawn workers from most teams across Edinburgh council to review current packages of care throughout the city and reduce the spending where it can. It has also placed tighter controls on budget approvals for packages of care with a reduced weekly permitted limit before packages go to a panel where they are scrutinised. Then all new packages are to be signed off by senior managers, which would have previously been carried out by senior social workers within teams. The intention is that the high level of scrutiny will continue for the foreseeable future.
Challenges of proposed alternatives to cuts
The focus of these particular measures is to reduce the reliance of clients on statutory services thereby “maximising independence with consideration of digital solutions and community-based supports” (page 21, Savings and Recovery Programme). There are two significant issues with this statement alone. Being involved in health and social care services, I am in no way against maximising people’s independence. However, how are we possibly able to do that as practitioners when community-based support and digital solutions are not available to clients?
Community-based support isn’t even a route I usually explore with my clients, because third sector and charity organisations have had their funding slashed continuously for several years and many have not recovered since Covid-19. Even those which are still available to clients, often have significant waiting lists for people to access them or are time-limited when they do access them. The council’s further funding cuts to third-sector services announced in the budget are at complete odds with the notion that frontline workers need to look to them as viable alternatives for clients who are not deemed to have sufficient need to warrant a statutory service.
Cuts to substance misuse services
If cuts to social care were already not bad enough, there are further plans for cuts which will have a significant impact on the ability to deliver services to the most vulnerable in Edinburgh. There is a planned reduction of nearly half a million pounds to substance misuse services, currently a chronically underfunded area of service. Given the context of rising drug deaths in Edinburgh, compared to the lower rate of drug-related deaths the previous year, how is it justifiable to reduce any funding to these services in any manner?
Substance misuse services saw a 23% reduction in funding in 2017 which, mercifully, did not impact jobs. The shortfall in cuts to other areas of the service was plugged by a rolling input of £420k from the social care fund, which is now being axed by the EIJB. Again, it is not intended for this new cut to the service to affect jobs, but even with that, the effect will be felt by the clients we work with. Clients with drug and alcohol problems require flexible, approachable and tailored services to meet their needs and deliver input which responds to Scotland’s long history of drug and alcohol-related deaths – a problem directly linked to the chronic underfunding of public services across all sectors including education, housing, social services and health.
Informed, multi-agency, intensive supports are required to tackle this problem, highlighted for many years across careful and considered research into drug and alcohol use. Services such as these have been slashed over the years by successive conservative governments and local authorities approach them as easy targets for funding cuts. They are a completely neglected group of individuals with frontline staff doing what they can to provide them with the support they require to tackle this monumental concern for public health.
Cuts to mental health and learning disability services
In addition to this, we also see a £700k cut to mental health funding. The intended savings come from a review of individuals in housing and the support embedded into their packages of care. The idea is that some people who live in supported accommodation or housing with support models can potentially have their packages reduced or alternative arrangements made to increase their independence. This raises two key issues, the first being that often services, such as supported accommodation, will require a minimum number of hours per week which are signed off by budget-holders to enable a tenancy to commence and be sustained.
Cuts to associated packages of care for individuals may then affect their ability to retain a contracted tenancy agreement with fixed support hours. This leads to the broader housing crisis concern, announced formally by the City of Edinburgh Council in November 2023, but evident to anyone working in the sector for a number of years. I am completely behind the idea of increasing people’s independence, but how are those clients, their families and carers not going to be alarmed at the prospect of them having to be moved elsewhere if their needs no longer match with the intended support hours?
Some clients have remained in one place for several years. The prospect of losing their home, support hours and bonds with support staff is an absolute farce. Thrown into the world of uncertainty which has long been the case for Edinburgh’s social housing situation, it becomes even clearer that the EIJB have little interest in protecting the city’s most vulnerable. The task falls to overstretched, burnt-out staff to find a solution while they remain continually uncertain about their ability to continue to provide quality services to their clients. A similar story is seen with learning disability funding, with the projected savings totalling £3.46 mn.
Again, the intent is to move away from supported accommodation models and to the development of core and cluster models of housing (where clients have their own tenancy and support workers deliver visiting support to them in their own homes for a designated number of hours per week). I welcome the idea of developing these models for all clients across mental health and learning disability services, but they can’t be seen as suitable alternatives for all clients. We have to recognise that there are clients who benefit from one type of service over the other, but those in existing supported accommodation, having lived there in some cases for many years, will likely struggle to adapt to maintaining an independent tenancy with reduced support. Expecting that the impact will benefit vulnerable people in increasing their independence (a phrase I think is used all too often when cuts are made to services I would highlight) is not being realised in these proposed plans.
Cuts to social care impact staff and clients
I feel outraged, as will many frontline staff, about the most recent budget announcement by the EIJB this week. Although our jobs remain intact, the future of social care services looks bleak for ourselves as practitioners and for the clients, their carers, their families and the wider community as a result. I do not disagree with a level of scrutiny for implementing services to clients across all areas of the council, but the measures announced within the budget make me question where my professional autonomy lies in the long term. Oversight is one thing, but the proposed level set out in the budget and seen in recent months makes me wonder if it is possible to retain my status as a professional in this field.
We ask a lot of clients to trust us as workers to deliver a service to them where it is needed, but my confidence in doing so is continually hindered by measures such as this. Not knowing if my assessment will be ‘good enough’ to warrant a service from someone who is so far removed from frontline practice and is so anxious about the intended implications for the budget, does not allow me to practise in a manner which instils belief from the people we work with. Investment in public services is critical and anything other than that will impact on the city significantly.
It was highlighted very clearly by trade union representatives in response to the budget that although there may be short-term financial gain from these intended cuts, the long-term implications will be grave. It disheartens me as a worker in this local authority that these decisions have been made with a lack of consultation with those on the frontline.
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