Agenda item

Rebecca Jarvis (Head of Strategic Commissioning and Policy, Essex County Council), Kirsty O'Callaghan (Head of Strengthening Communities, Essex County Council)


1.            Ms Jarvis and Ms O’Callaghan introduced their roles and explained what those roles entailed.  Ms Jarvis’s portfolio included prevention, digital services, carers and information and guidance, and work to prevent or reduce delays in transfers of care. Ms O’Callaghan was part of the Public Health team and had a background in mental health and learning disability services.  She worked on strengthening the links between Public Health and Adult Social Care and the grants programme for the community.


2.            Ms Jarvis thanked the Select Committee for the invitation to address the committee and tell them about what Essex was doing to address social isolation and loneliness in Essex. She said Essex County Council was committed to the agenda and identifying the wider impacts of social isolation and loneliness and improving the outcomes for vulnerable people.  The work was exciting, and she was keen to share the work that Essex County Council was doing and what it had found in its research.


3.            Ms Jarvis and Ms O’Callaghan presented a series of slides which set out the approach Essex County Council was taking and highlighted key features of its work.  Older people had been involved at the outset in identifying their concerns.  Essex was a very diverse county and 75% of it was rural.  National evidence had shown that those in isolated rural communities were prone to loneliness. Ms O’Callaghan added that loneliness had been linked to the development of dementia, with lonely people being 60% more likely to develop the condition.  She added that 20% of GP appointments were taken by people who were lonely rather than had a medical complaint. 


4.            The case for change had suggested that work needed to be cross-cutting across a range of services; Adult Social Care, Public Health, Housing, Council Tax and Transport, and look at the role each had to play in addressing social isolation and loneliness and how they could work together.  Partners in this work included the volunteer community, health, social care and faith groups, to pursue a shared vision.  A joint working group had started small in its first year but now included more than 40 participants.  Essex had historically taken a traditional approach to addressing social isolation and loneliness by looking to befriending as a solution, however, having spent some time researching the impact of this approach and speaking to multiple citizens and partners, it was now necessary to transform this approach.


5.            Ms Jarvis added that there was much activity going on but there was no joining up or systematic approach, and this now needed to be achieved. It was important not to replicate each other’s efforts but to join them up to make the most effective use of available resources. Ms O’Callaghan added that conditions needed to be established to support safe collaboration.   Ms Jarvis said that a wider issue was the need to stimulate action across communities.  The shared vision of the partners had identified four key ambitions and sought a community response rather than a statutory response.  National campaigns needed to be applied locally, and working out how best to do this was part of the challenge.   Ms O’Callaghan added that work needed to be viewed in the context of the community, and build on local interest.  The project’s research had shown that people cared a lot about the place in which they lived and were motivated to make this place as good as it could be.


6.            Ms Jarvis said that raising awareness of lonely people and gaps in provision was important.  Older people and those with learning disabilities and dementia struggled to access activity within their community to live independently and well. A campaign to encourage social movement sought to identify and champion social isolation and loneliness by using ‘Community Connectors’ and creating a ripple effect, similar to the spread of knowledge and awareness pursued by Dementia Friends.  A similar scheme was running successfully in Frome in Somerset, and Ms Jarvis offered to send the Select Committee the details of this project.


7.            Ms O’Callaghan set out the measures planned to address the need for easier access to information, including a single point of access. A GP, for example, could ring a central information point on behalf of a patient. This would trigger a call back to have a conversation about the patient’s needs or give a link to a community agent or lifestyle prescriber.  The patient’s needs may be able to be met easily by signposting, but if they had more complex needs they could be referred to an appropriate professional as a new client.  Essex used System 1, which was used by most GPs in the county. A GP referring a patient would receive a message back to tell them what had happened as a result of their referral and would know that their patient was safe and being helped through an appropriate pathway. System 1 was provided by a company called ‘Provide’ and allowed service use to be tracked so that future commissioning needs could be assessed and gaps in provision identified. The Chairman commented that this seemed a good way of engaging GPs and addressing the problem which often discouraged them from engaging with projects, ie that they feared losing track of, or contact with, their patient.  It also had the benefit of telling GPs the outcome of their referral. Ms O’Callaghan confirmed that most GPs had been enthusiastic about taking part.


8.            Ms Jarvis emphasised the need for a network to be local to an area so it could be tailored to the needs and characteristics of that area and hence work in the best possible way for that community. Research used as part of developing the project had compared the health risk factors of being lonely to those of being a smoker or drinker and concluded that lonely people were as much at risk, health-wise, as smokers and drinkers. She set out the hierarchy of need and the clear fact that one size certainly did not fit all. An organic approach was sought to encourage system change.


9.            Ms O’Callaghan referred to the use of social media in spreading the campaign and encouraging people to become involved.  70% of older people in Essex would welcome involvement with social media but did not know how to start into this.  Ms Jarvis and Ms O’Callaghan had mapped every place-based social media site in Essex and identified their organisers.  A well-known local social media user, Jon Morter, had been engaged to lead the social media side of the project.  It had been decided that the leader should be a socially-identified person rather than a County Council representative, as it was felt that an ‘official’ person might discourage public involvement and might be harder for some to trust. The County Council would be an enabler or convenor.


10.         Ms Jarvis and Ms O’Callaghanwere thanked for their powerful presentation, which was the best the Select Committee had seen during its evidence-gathering sessions.  The Community Connectors in Essex seemed to equate to Kent’s Community Wardens as a multi-skilled local resource.  Ms Jarvis and Ms O’Callaghan were asked how the Community Connectors had been recruited.  Ms Jarvis explained that none had yet been engaged but the project was starting to gather insight to design and develop a model for recruitment. The plan was to make the best use of people already in similar roles by raising their understanding of social isolation and loneliness.  This would maximise those roles rather than replicate them, and achieve a ‘layering’ effect of people available to support the daily needs of people at risk of social isolation and loneliness. Ms O’Callaghan added that, in one town, there had been 11 un-coordinated community builders all seeking to work with the same service users. It was quite chaotic for people seeking to access their services as they did not know whom to contact. These people could become Community Connectors.  The effectiveness of these connectors would be monitored.  Ms Jarvis added that layering of community engagement was as important as targeting of resources.


11.         A comment was made that this organisation seemed to have been very well thought through and a question was asked about the budget available to realise it all. Ms O’Callaghan explained that the Community Agents would cost £600k per annum and the Care Navigator or Community Prescriber role £250k - £270k per annum.  The single point of access would cost £50k per annum. Ms Jarvis added that the current befriending service cost 143k annum, although Essex was looking to invest further in a new approach to social engagement. The Campaign for Social Movement was funded by one-off funding and she hoped that this sum could be increased.  The total cost of the project was £1m per annum.


12.         Asked if the project would engage with and involve NHS services, Ms Jarvis explained that all three STPs were engaged through partners with this work. The STP had social isolation and loneliness as a key priorityand was seeking investment for it. Ms O’Callaghan added the that West Essex GPs had initially been reluctant to engage with the care navigator model but, after it had run for two years, had started to invest in it. A comment was made that the issues Essex was experiencing with its GP engagement was much the same as those experienced across the rest of the UK.  Ms Jarvis added that the Acute Trusts were fully engaged.


13.         Asked if it would be necessary to change society’s culture and attitudes to community to make such a project successful, both Ms Jarvis and Ms O’Callaghan agreed that this was the ultimate aim.  Ms Jarvis added that, if nothing was ever tried, nothing would ever change.


14.         Asked if writing social isolation and loneliness into the plotlines of popular TV programmes such as soaps would help to raise its profile, Ms O’Callaghan told the Select Committee that a Facebook user in Essex had run a fake news campaign, set up and run without being asked, about a lonely bin called Eric. A local water company had pledge investment to help ‘Eric’ and the campaign had captured the interest of the public and encouraged them to talk about social isolation and loneliness.  Ms O’Callaghan offered to send a link to the campaign to the Select Committee. 


15.         Ms Jarvis reassured the committee that the campaign to tackle social isolation and loneliness was not being pursued to save money but to identify and meet demand for services and improve the quality of life for lonely and isolated older people in Essex. If residents could be helped to live healthier lives there would be less demand for health service interventions.  She added that the Cabinet Member and directors for her portfolio fully supported the project.  Ms O’Callaghan added that, from her past experience as an NHS commissioner, she knew what was needed to keep older people out of care. She gave an example of a lady who had been helped by the joint efforts of several professional partners, each of which had claimed to have been the ones who ‘saved’ her.  Where the most credit lay was not important; the success was a combination of all their efforts. All felt they had played a useful part and hence viewed the joint working as a positive, preventative exercise and one which could potentially save their services money in the future. A comment was made that costs savings arising would be very difficult to measure.  Ms O’Callaghan gave an example of another older lady who lived alone and had multiple health problems. After being encouraged to engage with her community, she had changed her life, gaining confidence, losing weight and giving up her anti-depressants. 


16.         Ms Jarvis said that it was easy for carers to become isolated so they needed support to become connected to their communities and to others in the same situation.  Their isolation, together with the burden of caring for a dependent person, increased the risk of their health deteriorating.


17.         A comment was made that, to capitalise on the localism value of community wardens and similar projects, social media and local radio should both be used more.


18.         It had been well evidenced that activity and engagement, such as the Walking for Health programme, were good for a person’s physical and mental health, and had the bonus of being cost-free to users, and the Better Lives programme was a good end in itself.  Asked if Essex and Kent could possibly join up in a project, possibly with Suffolk, Ms Jarvis said that Essex County Council had indeed shared their work with Suffolk County Council and shared their social media campaigns.  The two councils shared a set of principals which each would implement locally.  A model could be ‘lifted and shifted’ from one area to another but must be applied locally to be relevant and effective. Much work was going on nationally (for example, a good project in Mendip Council, which she offered to send to the Select Committee), but no systematic approach was evident.


19.         Asked if the Essex team had engaged with the group being run by Tracey Crouch, MP for Chatham and Aylesford, Ms Jarvis explained they had engaged with the Essex representative for a Campaign for Loneliness. Ms O’Callaghan pointed out that no-one else was using social media the way Essex County Council was. They were using the unofficial decision makers in the community rather than the official elected council decision makers.  A comment was made that the use of social media offered exciting opportunities, and there could be a role for local elected Councillors.  Ms O’Callaghan added that it made sense to engage with people where they were, whether that be physically or online, and let them say what they were interested in. A Community Chest project offered an interesting way to do this, and Digital Buddies and community fix-it groups could help support change, for example, by helping those less confident with computer skills to engage online and by providing benches in popular local areas to help older people enjoy a walk outside and perhaps meet and chat to dog-walkers and others. Asked how these schemes would be funded, Ms O’Callaghan advised that funding for an administrator came from the Community Chest, for which she had to bid for a grant. This form of participatory budgeting was useful for this sort of scheme and she would seek to do more of it.


20.         Asked about the statistic that 60% of people with dementia were more likely to be lonely, Ms O’Callaghan said that this statistic had been gathered by Public Health England two years ago so was up to date.  Ms Jarvis added that there were national statistics that said approximately 60% of people with dementia went out of their houses less than once a week. In sparsely-populated rural areas, it was harder for older people living alone to find the opportunity to mix with others.


21.         Asked if volunteers initiating an approach to someone would avoid using the word ‘lonely’, Ms O’Callaghan said that volunteers would avoid this word. She added that volunteers themselves were often people who had formerly been lonely and were using volunteering as way of reaching out to others.  Ms Jarvis emphasised how important an initial conversation was. Asked how consistency of approach was supported, Ms Jarvis explained that a model of guided conversation had been copied from Frome in Somerset and offered a good example for others to follow. Ms O’Callaghan added that people would be asked what they really wanted to do and a volunteer befriender would help them to go out and do it. For example, one lady had said she just wanted to go to the seaside and have an ice cream, and this outing was very easily achieved.


22.         Asked how the project fitted into Essex County Council’s corporate strategies, Ms O’Callaghan said that the Council’s Health and Wellbeing Board Strategy had social isolation as one of its key points, and worked with its District Council and Live It Well partners to act on this. The work undertaken was then reported back to the Health and Wellbeing Board. Ms Jarvis added that social isolation and loneliness appeared in the Council’s Mental Health, Dementia and Carers’ Strategies, however there was a fragmented approach across these work areas.  Strategy documents historically tended to sit on a shelf, and she sought to change this and make the social isolation and loneliness project work different.


23.         An example was given of the approach taken to advertising a new dementia clinic which was being set up.  The word ‘lonely’ was not used, although lonely people were a major part of the clientele for the clinic. This approach had been successful as people had switched on and engaged well. Ms Jarvis agreed that it was good to maximise the opportunities to engage lonely older people.


24.         One Member of the Select Committee told how he had established a veterans’ sea fishing group for men over 60, to share his love of fishing. This group now had six members, all in their 70s and 80s. This was commended by all present as an excellent project.


25.         Asked if there was anything else they would want to do or see happen to help address social isolation and loneliness, Ms Jarvis said she wanted to see their work evolve and spread rather than stagnate, and continue to identify and meet people’s needs.  She wanted to continue to involve corporate partners and digital and intergenerational work.  Lloyds Bank had offered the support of their Digital Champions.  Ms O’Callaghan added that their work could lead to a change in the appearance of the voluntary sector and encourage people to work together under their own steam rather than be directed or co-ordinated by the County Council. Ms Jarvis added that it could lead to a different type of adult social care provision, with reduced demand due to more older people being successfully supported to live independently in the community.


26.          The Chairman thanked Ms Jarvis and Ms O’Callaghan for giving their time to attend and help the Select Committee with its information gathering.         

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