East Lothian Context
Demography and Population Health 
East Lothian’s population has increased significantly in recent years, growing by 11.6% in the 10 years from 2013 to 2023 – the second highest percentage growth rate in Scotland for that period (behind Midlothian). The most recent estimate puts the population of East Lothian at around 112,300 people.[1]
It is projected that the East Lothian population will continue to increase over the coming years to around 121,743 people by 2043. Overall, it is estimated that the population will have grown by 15.1% from 2018 to 2043, the equivalent of almost 16,000 additional people[2].
Over this period, the only the youngest age group (aged 0-15) is projected to decrease in size, with an estimated reduction of 1.1%. The largest growth will be seen in the older population, with a projected 40.8% increase in the over 65 age group and a 93.4% increase in over 75s. The working age population is set to grow by 11.5%.[3]
Population growth is significant in terms of considering future need for health and social care service provision. An increase in the older population is of particular significance in terms of their higher use of health and social care services. Figures show that 77% of people receiving social care support in Scotland are 65 and over[4] and that older adults are disproportionate users of health services. This includes having more healthcare appointments, taking a higher number of medications, being admitted to hospital more often, and requiring longer hospital stays. People aged 65 and over also make up 70% of emergency hospital admissions in Scotland[5].
2022 Census data shows the proportion of the East Lothian population reporting a range of specific health conditions. The most common type of health issue reported was a ‘long-term illness, disease, or condition’ (21.3%) which included conditions such as arthritis, cancer, diabetes, and epilepsy. Having a mental health condition was the second most commonly reported condition and this showed the highest increase from the previous census, rising from 3.8% of people in 2011 to 10.3% in 2022. Although there was a rise in the percentage of people identifying as having a mental health condition across all age groups from 2011 to 2022, the most significant increase was in the younger age groups, with a 12.2% increase for those aged 16-24 and a 13.1% increase for 25-34 year olds.
The rise in the proportion of people living with multiple long-term conditions (MLTCs) has been identified as one of the most significant challenges facing health services, both currently and in the coming decades. The proportion of people with MLTCs increases as people get older, so again a key issue that will impact on service demand in East Lothian.
The Scottish Burden of Disease Study[6] indicated that the national annual disease burden will increase by 21% by 2043, despite an overall reduction in the Scottish population over that period, largely as a result of ageing population and the growing number of people living with chronic disease. Although specific projections are not available for East Lothian, similar growth in the local burden of disease is expected and will impact on future demand for health and social care services.
Comprehensive information on the East Lothian population is available in the East Lothian Joint Strategic Needs Assessment (JSNA)
References:
[1] National Records of Scotland (NRS), 2023.
[2] National Records of Scotland (NRS), 2020.
[3] National Records of Scotland (NRS), 2020.
[4] People who Access Social Care and Unpaid Carers in Scotland, Scottish Government, 2023.
[5] Health and social care strategy for older people: consultation analysis, Scottish Government, 2022.
[6] Public Health Scotland, 2022.
Health Inequalities
There is a strong relationship between life expectancy and deprivation, with higher deprivation being linked to lower life expectancy. This can be seen through analysis of Scottish Index of Multiple Deprivation (SIMD)[1] data. Whilst overall life expectancy in East Lothian is higher than the Scottish level, men living in the least deprived areas can expect to live around 8 years longer than those in the most deprived. For women, those in the least deprived areas can expect to live around 6 years longer.[2]
There are a range of ‘drivers’ (shown in the illustration below) that impact on health and wellbeing outcomes. Clearly the provision of good quality, accessible health and social care is important. However, the drivers of population health go beyond health and social care provision, with the social, economic and environmental conditions in which people are born, live, work, and age heavily influencing health outcomes – these are often referred as ‘the wider determinants of health’.
The Scottish Government’s Public Health Framework reflects the need to take a whole system approach to improving health. IJBs have a lead role in the strategic planning and commissioning of accessible, good quality local health and social care services, as well as working as part of a wider system approach to improving health and wellbeing. This approach is dependent on partners working collaboratively, both operationally and strategically, including through alignment of their strategic priorities.
References:
[1] Note that SIMD data only provides insight into area-based deprivation and not people living in less deprived areas who are experiencing deprivation linked to their individual circumstances.
[2] East Lothian Mean Life Expectancy at Birth by Sex and SIMD Quintile, 2019-2023 (NRS, 2024h)
Infographic is adopted from Chief Medical Officer for Scotland Annual Report 2022-23 (Scottish Government, 2023a). Caution is warranted in interpreting the percentage breakdown because the drivers of health variation are not mutually exclusive.The Financial Context
Integration Joint Boards (IJBs) throughout Scotland have continued to face increasing pressure on budgets, having to achieve savings year on year to deliver balanced budgets. Inflationary pressures; pay settlements; and the rising cost of treatments and prescriptions have added to this challenge. For East Lothian, additional pressure has come from Scottish Government funding not reflecting the population growth in the area.
To date, IJB budget gaps have largely been bridged by non-recurring savings; leaving vacancies unfilled; and making use of reserves – none of which provide a sustainable solution for the longer term.
Whilst the East Lothian IJB financial outlook for 2025/26 improved from the previous year, five-year projections suggest that budget gap will increase in subsequent years, rising to over £31.5 million by 2029/30 if no action is taken.
East Lothian IJB has already carried out a range of efficiency measures and made a number of difficult decisions regarding service provision. However, given the financial projections, further measures will be needed to deliver the significant savings required.
Concerns have been expressed about the impact of further financial recovery measures, including the cumulative impact of having to deliver savings year on year. IJB discussion has focused on the challenge of delivering a balanced budget whilst ensuring that services continue to be delivered at the level needed to reduce harm and keep people safe. The importance of continuing to invest in prevention and early intervention approaches has also been highlighted in terms of helping to mitigate against some for projected rise in service demand resulting from demographic pressures.
The IJB’s Five-Year Financial Plan will continue to be reviewed to ensure that it aligns with the strategic objectives and delivery priorities identified in the Strategic Plan. Consideration of budget positions will be a key part of producing the Annual Delivery Plan (the Annual Delivery Plan sets out how the IJB’s strategic objectives will be delivered in each year of the Strategic Plan).