“Essential and wonderful" and "the only dedicated cancer support service in the area"
GPs back social care projects as city councillors rally around plan to stop "dangerous" cuts
The dismay and even anger have been there for all to see.
When the Edinburgh Integration Joint Board (IJB) released a report last Friday recommending its £4.5 million IJB grants programme be scrapped within 90 days for 64 charities across the Capital, its beleaguered leadership must have expected a reaction. They perhaps didn’t foresee how determined, widespread and vocal it would prove to be.
The outcry from affected charities, individuals and their supporters, local GPs and the wider Third Sector in Edinburgh (some petitions here , here and here) has been forceful. So forceful in fact that the immediate risk at least may be about to be averted.
Councillor Ross McKenzie, the independent councillor for Sighthill-Gorgie, which includes some of the areas hardest hit by the cuts, has told the Inquirer councillors are drafting a cross-party response to be debated tomorrow rejecting the proposed cuts. They will instead suggest NHS Lothian or Edinburgh Council plug the funding gap until the end of the financial year, and delay a decision on what form the grants programme should take in 2025/26.
What exactly is the Edinburgh IJB proposing?
The EIJB report warns that, although the institution has always run on a deficit of tens of millions of pounds, it is now necessary to close that gap. While in previous years, Edinburgh Council and NHS Lothian have stepped in to plug end-of-year budget gaps, the report states, “A deterioration in the macroeconomic climate has reduced the capacity of the partner organisations to continue providing this level of support.”
The report then says all non-statutory services are being reviewed in a bid to close this year’s £60 million budget gap, and next year’s £50 million (the total spend is around £900 million per year). Following review, IJB claims the money dedicated to the Third Sector grants programme would be better spent on other services.
Contextualising the scale of cuts
While the Third Sector has become accustomed to financial pressures in the last few years, a number of things make these funding cuts particularly catastrophic for the affected organisations.
First is the scale of the funding. Many organisations are losing their core funding for essential staff - around 100 jobs are expected to be at risk. The loss of match-funding which relies on organisations receiving public funds makes their financial situation even more critical.
Several charities have said these cuts would likely force them to close their doors completely. Of the 39 members of the Edinburgh Community Health Forum (ECHF), 15 say they are at risk of closure due to these cuts, while the majority say their services would be drastically affected.
Stephanie-Anne Harris, ECHF’s strategic development officer, says: “This disinvestment will lead to the closure of numerous charities and an increased reliance on statutory services, including the NHS and Council. Furthermore, it contradicts the Scottish Government’s and Public Health Scotland’s advocacy for prevention and early intervention strategies. Evidence overwhelmingly supports that investing in prevention is one of the most cost-effective methods to improve health outcomes and reduce inequalities. This short-term approach to achieving savings is fundamentally misguided.”
For example, the Health Agency in Wester Hailes will struggle to continue as an organisation if the cuts go ahead. The charity stands to lose 11 full-time and 16 sessional workers and £327,671 in match-funding from the cuts. This will mean the suspension of services to 2500 individuals per year, including 251 receiving cancer-specific support, 260 receiving counselling or CBT, and 216 attending healthy eating and weight management courses. “This is a vital service in the area,” says one local practice nurse.
One Health Agency client says: “The Health Agency is an incredibly important part of trying to get our community out, together and fitter. For me personally it’s one of the only gateways to getting my body moving and working.”
Perhaps more shocking is the suggestion that the final two months of funding previously promised in the grant programme be removed, leaving affected charities with only three months to find new funding options. With many Third Sector jobs based on fixed-term contracts for each yearly funding cycle, it’s difficult to see how these charities will be able to pay staff for the final two months of their contracts.
Removing funding after it has been awarded seems ethically, as well as potentially legally, questionable - can the IJB simply break a contract? Lewis McLachlan, who launched the Save Our Sector campaign this week, says the funding cuts were “damaging to what little trust had been built between the public and Third sectors over Covid.” Other believe the report had been deliberately kept quiet, and then published late in the week to push the cuts through with minimal scrutiny and publicity.
Cllr McKenzie says he had heard “rumours” of cuts in the previous weeks, but had only received empty responses to his requests for information. He believes this cutting-short of funding is being proposed due to the fact grant funding was initially only planned for three years from 2019-2022, and has been continued on an informal basis since then.
“Threatening the fabric of our community support systems”
While the report confirms that all of the 64 organisations are delivering a beneficial service to their communities, only 1 was reported to fulfil all of IJB assessment criteria. Most third sector organisations fell down at the “cost effectiveness” barrier.
Other services, particularly income maximisation services, were excluded because their benefits are not important enough to the IJB’s specific remit. The report states that, “The case for investing in income maximisation services is incredibly strong but given that so little of the return on investment materialises within EIJB’s delegated functions, it is difficult to justify this continued investment from the EIJB given its own financial situation.”
Essentially, IJB is arguing it is unable to fund improvements that aren’t directly linked to its specific performance goals. One reason councillors may be planning to reject the proposal is that it makes the local authorities’ own holistic poverty reduction strategy untenable.
Several organisations which rely on IJB funding are anchor organisations in Edinburgh’s community support network, which the local authority has pledged to put at the centre of its poverty reduction work. “This drastic cut threatens the very fabric of our community support systems” says Harris from the ECHF.
One of the affected organisations in Fresh Start, which the Council used as its flagship example for poverty reduction only a few weeks ago. Another is the Ripple, which offers a huge array of services to community members of all ages in Pilton. The council’s popular plan to support community networks to identify those who are most vulnerable in society, and offer them support at the earliest stage possible, will be impossible if the organisations central to these networks are gutted by funding cuts.
What do statutory healthcare professionals think?
The IJB report claims the £4.5 million removed from the third sector could fund 1,500 GP sessions per year, of staffing for two hospital wards per year.
However Third Sector and medical professionals have also spoken out against the cuts. Speaking about the Health Agency in Wester Hailes, a local GP says the service is “essential and wonderful,” while another says the Health Agency is “the only dedicated Cancer Support Service within our area, which caters for a population that has a high level of health issues.” Members of the ECHF add “they have seen first hand that people who get support from their services are less likely to go to hospital, have higher life expectancy and better mental wellbeing.”
The IJB report addresses claims that even though the people accessing the soon-to-be-axed services will be worse off without these services, they would not be so desperate that they would qualify for statutory social or health care services. Regarding healthcare the report makes a rather shaky claim that “access to most health services is also routinely based on the stratification of risk and it is common for services to apply a higher threshold for access and treatment today than would have been the case in previous years.”
One NHS physiotherapist, with experience in stroke rehabilitation and emergency departments, detailed the time and resources which are dedicated to “social admissions” to emergency departments in hospitals. These are patients who aren't coping at home but can’t afford or wait for social care services such as a care home. “They end up in ED because they have nowhere else to go, even though they don’t have acute medical problems,” she says. She even adds that she has seen patients brought to hospital by their care workers, who are simply too burnt out to look after the patient.
Because securing a care home place or a care plan is a lengthy process, these patients can remain in hospital for long periods. This is not the ideal environment for the patients, takes up beds which are designated for rehab patients, and also diverts physiotherapists' time from facilitating rehabilitation for stroke patients to simply planning discharge from the hospital.
“When there’s just not enough social care around these charity organisations are absolutely essential, to make sure you’re not sending someone home and having them bounce straight back to hospital,” she says.
Difficult decisions ahead
With councillors, Third Sector workers and medical professionals rejecting the proposed funding cuts, it will be a relief for many if we see funding continued at least until March 2025. Rachel Reeves’ budget might also bring some solace; with over £3 billion extra in the Holyrood budget, and Westminster setting an example of large funding increases for the English NHS, there may be more money available for statutory and Third Sector health interventions.
However there is still no guarantee that the grants scheme, which was planned to end in March 2025, will be continued or replaced. The question is likely to rear its head again as next year’s council budget is hashed out; however following this debacle, local leaders across the CEC, NHS Lothian and the Joint Board will have little hope of escaping scrutiny next time.