This is a summary of feedback gathered from Edinburgh third sector organisations in response to the EIJB Strategic Plan consultation. These comments will help inform a response to the strategy consultation from the Third Sector Strategy Group.
The points have been summarised from a combination of conversations and survey responses and are presented anonymously.
An online AI platform was used to reduce the time taken to collate these responses.
1. EIJB’s Control Over Funding and the Democratic Deficit
- EIJB is centralising financial power away from elected councillors, reducing local democratic control over health and social care funding.
- Councillors are losing decision-making authority on community health investment, despite being the only directly elected representatives in this governance structure.
The third sector has no formal decision-making power within EIJB, despite delivering a substantial portion of preventative services. - Public consultation has been inadequate, rushed, and largely ineffective, excluding service users and frontline organisations from shaping the strategy.
EIJB leadership has provided inconsistent messaging, creating confusion about the long-term vision for health and social care. - No regulatory oversight mechanism exists to monitor whether EIJB’s decisions align with national health and social care commitments.
2. A Cost-Cutting Plan Disguised as a Strategy
- The strategy prioritises budget cuts over long-term investment in prevention, leading to unintended “domino effects” across multiple services.
- EIJB has not commissioned a financial impact assessment, meaning it is unclear how the cuts will affect the broader healthcare system.
- Cost-cutting has been prioritised without assessing public health consequences, which should be a basic requirement for strategic decision-making.
- The proposed savings are misleading—cuts to preventative services will lead to increased demand on crisis services, eliminating any financial benefit.
- No commitment to alternative funding models, such as community wealth-building, social investment, or sustainable multi-year funding.
3. Hidden Financial Risks and Unintended Consequences
- The financial model assumes third-sector organisations can continue operating with reduced capacity, which is unrealistic.
- Funding uncertainty is forcing organisations to freeze recruitment and downscale, creating service gaps even before cuts are finalised.
- No transitional funding has been provided, meaning organisations losing grants have no opportunity to restructure.
- Cuts to community services will increase NHS costs, as more people enter crisis without early intervention.
- Social prescribing is missing, despite its proven success in reducing demand on NHS services.
- No inflation-adjusted budgeting, meaning even funded services will operate with reduced real-terms investment.
- No additional support for unpaid carers, despite increased reliance on family-based care.
4. Legal and Policy Failures
- Non-compliance with the Carers Act (Scotland) 2016, which mandates that unpaid carers must be included in service planning.
- Legal uncertainty over EIJB’s authority to override Council funding decisions, raising potential governance conflicts.
- Contradictions with Edinburgh’s Joint Carer Strategy, which aligns with national legal frameworks.
- Lack of transparency in EIJB’s contracting process, meaning third-sector organisations have no clear pathway for future funding applications.
- No consultation with service users before service withdrawal, which is legally questionable.
- Failure to legally review the shift from grant funding to competitive commissioning, which could lead to severe service gaps.
5. Neglect of Prevention and Wellbeing
- The plan focuses exclusively on hospital-based metrics, ignoring wider public health and wellbeing outcomes.
- Frailty prevention is missing, despite Scotland’s aging population and the rising cost of late-stage interventions.
- Nutritional support and food poverty have been ignored, despite their direct link to hospital admissions.
- Health inequalities are treated as an afterthought, rather than being central to service planning.
- Mental health prevention services are being cut, leading to increased crisis interventions.
- Lack of commitment to intersectional healthcare models, meaning services will not meet the needs of diverse communities (LGBTQ+, migrant health, disability access).
6. Workforce Crisis in the Third Sector
- Staff burnout is increasing, as demand rises while budgets shrink.
- High staff turnover and redundancies will result in a loss of sector expertise, with major consequences for service delivery.
- No workforce retention strategy has been proposed, despite clear risks to staffing sustainability.
- Volunteers are being asked to fill gaps left by redundancies, yet there is no additional funding for volunteer training and management.
- Lack of recognition of fair pay and working conditions for third-sector employees, despite their critical role in health and social care delivery.
7. Failure to Address Social Determinants of Health
- Housing, poverty, and employment are not considered, even though they directly affect health outcomes.
- Food insecurity is absent from the strategy, despite being a major public health issue.
- No investment in welfare rights services, even though financial insecurity contributes to poor mental and physical health.
- EIJB fails to recognise the economic benefits of social enterprises, which could contribute to community-led health improvements.
8. Failure to Recognise Intersectional and Marginalised Communities
- No tailored approach to racial, gender, and economic health disparities, despite well-documented evidence of unequal health outcomes.
- LGBTQ+ health services are overlooked, despite specific mental health and isolation challenges.
- No provisions for refugee and asylum-seeker health access, leaving vulnerable populations at risk.
- Disability rights and accessibility have been ignored, meaning many disabled service users will struggle to access care.
9. The Risk of “False Economies” in Health & Social Care
- Short-term savings will lead to long-term costs, increasing demand for high-cost crisis interventions.
- Third-sector organisations are currently subsidising NHS and Council services, but will be unable to continue without funding.
- Cuts to preventative services will result in more emergency hospital admissions, wiping out any proposed savings.
- Carer burnout will escalate, leading to increased demand for formal respite services.
10. Breakdown in Cross-Sector Collaboration
- Lack of inter-agency coordination, creating significant risks for service integration.
- Social work and healthcare professionals were not adequately engaged, meaning frontline concerns were not considered.
- Failure to develop a partnership approach with housing providers, despite the direct impact of housing on health outcomes.
- No commitment to structured third-sector engagement, despite previous government policies advocating for co-production models.
11. The Human Cost of These Decisions
- EIJB’s financial targets ignore the impact on real people—the strategy is built around numbers, not lived experience.
- Families will be forced to take on additional unpaid care responsibilities, leading to financial and emotional strain.
- Community groups will struggle to meet rising demand, leading to burnout and organisational collapse.
- Individuals who rely on these services are already reporting distress, fearing sudden service withdrawal.
- No monitoring system is in place to measure the real-world impact of these decisions, meaning suffering will remain invisible in official reports.
12. The Political Risk for Edinburgh Council and the EIJB
- Public trust in the EIJB and Council is at risk, as communities experience the impact of these cuts.
- EIJB’s power grab exposes the Council to backlash, as the distinction between EIJB and the Council is unclear to many residents.
- The Scottish Government may intervene if the EIJB fails to meet statutory obligations.
- Failure to align with national policies could result in reputational damage, as Edinburgh appears out of step with Scottish Government priorities.
- If major service failures occur, it could create a public scandal, putting political leaders under intense scrutiny.
13. The Need for an Alternative Approach
- Community-based commissioning should be prioritised, allowing local providers to shape services around actual needs.
- Multi-year funding agreements would prevent financial instability, ensuring long-term planning.
- Investing in prevention would deliver long-term cost savings, rather than shifting costs to crisis services.
- Stronger partnerships should be developed between the third sector, NHS, and Council, ensuring integrated, holistic service delivery.
- Alternative financial models should be explored, including Community Wealth Building and Social Investment.
