Cuts totalling £33 million have been made to Edinburgh's health and social care budget amid a crisis in funding and staffing essential services for the city's most vulnerable residents.
Tears were shed during a meeting where measures to help balance the books were passed, as attendees were warned they would "certainly lead to more lives lost".
However council and health chiefs stressed the proposals - which included axing an employability scheme for people with severe mental health issues - were the "least worst" options available in the face of a £47m financial black hole.
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They have also promised a "longer-term transformation" of care services and how they are financed, and agreed to write to Scottish Ministers about concerns over the "severity of cuts which will be needed should additional funding not be made available".
Councillors, NHS staff and care service users who have oversight of Edinburgh Health and Social Care Partnership (EHSCP) met on Tuesday (June 13) to debate and approve the cuts.
Councillor Tim Pogson, chair of the group, known as the Edinburgh Integration Joint Board (EIJB), said members were in "a place that none of us want to be".
He said: "We are reluctantly looking at these steps but doing everything we can to take those steps that will have minimal impact.
"The proposals that are before us are the least worst."
Members of the Community Wellbeing Collective, a group of youngsters from Wester Hailes who run activities to support community wellbeing, called on the Board to reject the cuts.
Tearing up during a powerful deputation, one said: "There is nothing left to cut - any potential savings from certain areas of care are needed in social care.
"The cuts already seen in Edinburgh and the cuts proposed in this agenda are already beyond severe - adequate to a dangerous loss of life. Cutting further will certainly lead to more lives lost.
"Your power to negotiate against the cuts is stronger if you haven't voted for them; if you are not the ones putting them through."
Among the package of cutbacks which have reduced the in-year deficit to £14m is a decision to shut down 'The Works', an employability programme which assists individuals with mental illnesses such as schizophrenia and bipolar disorder into work, which is expected to save £430k.
Around £15m came from unfilled vacancies in the Partnership, which is in the midst of a recruitment crisis.
EIJB chief officer Tony Duncan said this presented a "huge strategic issue".
He explained that while trying to fill the positions to improve services, there would be "even more pressure on us" if they managed.
He added: "It's one of those very difficult ones to solve."
Plans also include reducing spending on community care equipment and transport for people receiving care, as well as cutting the number of interim care home beds for recovering patients who are between the hospital and home.
A report said discontinuing The Works - which is currently accessed by 41 people with nine on the waiting list - would put people at "increased risk of social isolation and loss of hope".
Des Loughney, secretary of Edinburgh Trade Union Council, told the meeting he was disappointed to read about plans to defund the service, and said there had been no consultation around the move.
He said: "I don't think there's any substitute for the occupational therapy within other third sector providers of employability support - to axe The Works eliminates a valuable resource for disabled people."
Linda Brown from trade union Unite's Edinburgh Non for Profit Branch agreed with Mr Loughney, adding: "We don't understand how you can centre your recovery plans around early intervention and in the same breath propose specialist services like The Works.
"We see no consultation or real replacement offered, just a vague suggestion that the third sector can take on the work.
"I've not seen any proposal to support the people that would otherwise be using The Works".
Service User Representative Alister McKillop said closing the service would be "unfounded and unpalatable".
He said: "We're hitting the most vulnerable portion of our population within Edinburgh.
"I know for a fact that the people who have been helped flourish and they feel far more part of our community if they are managing to do whatever role they can.
"With nothing in place these people will be lost because there's no other service that equatable to what they're getting at the moment."
Meanwhile Derek Durkin from Trade Unions in Communities said his biggest fear was that the budget plan would "drive the issue of social and health care into the hands of privateers".
He warned that in some cases the treatment of carers by private employers amounted to "modern day slavery".
Moria Pringle, EHSCP's chief finance officer, said the cuts came "at a time of increasing demand for services, increasing frailty of much of our population" as well as increased cost of living and pressure on public finances.
She said: "If this programme is approved today that will still leave us some way adrift of in-year balance, we'll have a remaining gap of £14m."
She added further measures to close that gap, which could include closing care homes and cutting grants to the third sector, would have "significant impacts" on care services.
The EIJB's vice chair Katharina Kasper said: "There is nobody in this room that who would think that cuts to care or any type of service is a good thing - absolutely nobody.
"Everybody in this room is very aware and very much in agreement that we need more funds to be injected into the system.
"To base our decision making on the hope that we will have more funds given to us, hope is not a strategy - we know what the reality looks like and in light of that it's an absolute duty for us to really consider what our options are."
Cllr Pogson said: "Despite the huge challenges posed by a £47m budget deficit we have been able to put together a package of reforms which will not only cut the deficit in a manageable way over three years, it will allow us to improve services for the people of Edinburgh.
" With smarter commissioning, use of technology and better care plans we can close the gap over three years whilst protecting vital services and driving our Improvement Plan for more person-centred care.”
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