Presentation to follow.
1. The Chairman welcomed Mr Scott and Mr Clarke to the meeting.
2. Mr Scott set out his role as the Voluntary Chairman of the Older People’s Task and Finish Group, which was a sub-group of the Maidstone Health and Wellbeing Board. Mr Scott explained that he had a personal interest in the arts and health and wellbeing issues.
3. Mr Clarke explained that he was the Health and Lifestyle Commissioning Officer for Maidstone Borough Council, overseeing the Council’s Health Improvement Programme. He was attending the Select Committee in place of his colleague, Sarah Ward, who served on the Older People’s Task and Finish Group.
4. Mr Scott presented a series of slides (published in the agenda pack for the meeting) which set out eight of the Task and Finish Group’s workstreams. The other two (improving hospital discharge processes and falls prevention) were not directly related to loneliness and social isolation so had been omitted for this meeting. He referred to the charity Involve, which the Select Committee was to interview later, and explained that Involve headed up the specific work stream relating to loneliness and that he would not cover their activity in view of the impending visit.
5. He explained that there was a distinction between the terms ‘social isolation’ and ‘loneliness’; the first was objective, determined by external environment, the second subjective, determined by personality. Research had shown that some lonely people tended to become disillusioned, distrustful, difficult and disengaged. A study by the Office of National Statistics had concluded that loneliness did not increase with age, however, this contradicted the findings of other studies of loneliness. A reason offered for this was that loneliness was so damaging to health that many lonely people died prematurely and did not live to old age. In addition, older people tended to be stoical and did not identify themselves as lonely as they did not want to be troublesome.
6. In terms of risk factors, there were two types of prevention work which related to older people. Using falls as an example, intervention after someone had had a fall to avoid more serious falls, was a type 2 intervention, while identification of risks to prevent them having a fall was a type 1 prevention. Most interventions were type 2.
7. Mr Scott explained that, as his background was not in health and social care, he had spoken to a wide range of organisations to gather background material. He was struck by an apparent link between the level of engagement with older people and the ease of access and proactivity. He asked the Citizens’ Advice Bureau, health and social care co-ordinators and Community Wardens what percentage of their clients were older people. Their responses had varied: Citizens’ Advice Bureau said 17 – 19%, health and social care 30 – 40% and Community Wardens over 50%. This difference was partly due to the nature of the service offered by each group and the way in which they engaged with clients; some services were proactive and went out to find clients while other services relied on clients approaching them. This relationship suggested that there was a significant level of hidden need that a proactive approach could reveal. What was needed was an integrated, holistic approach to active ageing.
8. Research into the extent of loneliness in older people had suggested estimates ranging from 6 -13%. Given that loneliness was subjectively determined, estimates would depend on the questions asked. A mid-range estimate was that, in the Maidstone area, there were some 3,000 older people who often or always felt lonely. The objective of Involve for the next three years was to work with an extra 900 people, which would address only around one-third of the problem. There was much more work to do to reach the rest.
9. One of the Task and Finish Group’s workstreams was ‘to establish a Voice of Older People’, an initiative which did not currently exist locally. Part of the work for this had identified that 20% of the elderly population was in receipt of some sort of support, while 80% was living independently and in reasonable health, without any support. Work had tended historically to focus on the 20% and ignore the 80%, but preventative work needed to be done to address the needs of the 80%, to keep them living independently.
Co-production was a good way to develop meaningful services and while there was consultation, there was little evidence of this having been implemented involving older people in the service design process. The Voice of Older People workstream would be led by Involve as they already ran Maidstone’s Older People’s Forum, using a grant from the County Council. The Older People’s Forum in Maidstone was located centrally, so people in some parishes were not able to access it easily. Involve had identified parishes around Maidstone which were not well served and they would seek to establish parish groups, customised to the needs of that area. The Task and Finish Group sought to link up the Older People’s Forum, Age UK, the Active Retirement Associations and University of the Third Age (U3A) and other organisations in order to be able to create subject specific focus groups. These focus groups could not only provide a voice but could contribute to service design.
10. The Task and Finish Group sought to establish an Older People’s Champion to provide a voice for older people in the community, working on an idea included in NICE guidance note 32 – ‘the Health and Wellbeing of Older People’. Ageless Thanet, who had just been interviewed by the Select Committee, had attempted to create Older People’s Champions but had found recruitment difficult. They suggested that the Champion role would suit a retired Parish, District or County Councillor. However, upon contacting parishes, only three had so far expressed interest and more were needed to make a pilot project viable. It was hoped to run a pilot Older People’s Champion project. Mr Scott undertook to re-contact parishes and if he could find sufficient support he would seek funding to establish an Older People’s Champion pilot.
11. There were currently up to ten different databases of older people’s services running in Maidstone, of which about half were run using money provided the County Council. However, these overlapped, had gaps, were not always well maintained and were generally not shared. These databases needed to be concerned not just with services but include information about sports and arts facilities and events. Involve, in conjunction with West Kent CCG had received new funding from Public Health England to develop and run a Social Prescribing project. Creating a database was a significant part of required outputs. Involve started to implement the project in August and were seeking to appoint a data manager to create and run the database. The ideal was to have one public, integrated database which would make it possible to take a reliable overview of activities available that could support social prescribing. Once developed, gap analysis would reveal what type and where services needed to be developed. It was currently evident that areas of relatively high deprivation were poorly supported by sports, cultural and creative organisations.
12. Critical life challenges such as retirement, bereavement and the development of long-term medical conditions happened to and thus affected older people more than young people, and failure to deal with these challenges was identified as a significant risk factor for deterioration in mental health and wellbeing. There were limited resources to identify and address these challenges. Addressing these challenges would not necessarily require new processes but would need to make the best use of existing systems and fill in gaps in existing support.
13. Many people considering retirement gave very little thought to anything beyond the immediate financial effects of ending work and failed to plan for and take the opportunities presented in the next 15 – 20 years of retired life. They needed instead to rethink their lifestyles and goals and this should include consideration of volunteering which was proven to have both individual and community benefit. Much time and talent was wasted once people retired from paid work, and some of this could be put towards volunteering in the community. Many younger older people with time, energy and skills could make a difference. It was a sad fact that those most in need of support to plan for retirement were the least likely to get it. However, funding to facilitate and support such projects would need to be found.
14. The Task and Finish Group sought to establish an Age- and Dementia-Friendly Maidstone working with “Building Dementia Friendly Maidstone” and supported by Maidstone Borough Council. An initial focus would be to encourage local businesses to be more age- and dementia-friendly. Successful age-friendly schemes were already running in Thanet and Co Monaghan in Ireland. It was proposed to model our approach on the County Monaghan initiative and approach businesses with the support of Maidstone Borough Council and One Maidstone.
15. Mr Scott concluded his presentation by setting out future targets. By January or February 2019, it was hoped that implementation plans and workstream teams would be in place.
16. A view was expressed that the phrase ‘… Champions’ was much over-used and not always viewed in a positive light. Mr Scott advised that an alternative for a similar role had been ‘village agents’. He agreed to review the title and use one with better connotations.
17. It was suggested that a ‘loneliness watch’ scheme, similar to Neighbourhood Watch, could be established, in which the community could look out for older people who lived alone and be ready to offer them help if it seemed to be needed. Lonely people could also be encouraged to volunteer and help others, and, by becoming involved in this way, would no longer feel lonely. There was much being done elsewhere that Kent could copy and learn from. Mr Scott agreed that finding examples of best practice from elsewhere and learning from them was a good way to work.
18. Where there was much already going on, the key was to co-ordinate existing work and seek to place the available funding where it could be most effective. Mr Scott agreed but said that it would be problematic and a significant challenge if the County Council were to seek to lead initiatives. Good integration would involve statutory, commercial and voluntary organisations with a diverse range of funding sources, objectives and operating processes. As the amount of funding available to the County Council diminished, they were changing their approach and organisations needed to develop strategies which made them less dependent on County Council funding, if they were to survive. Voluntary organisations could not rely on the County Council to be able to provide the funding necessary to develop services at a time when they were most needed. They needed to consider a wide range of funding sources including the NHS and grant-making trusts and earning income from services. While these alternative sources of funding may share the broad strategic aims as that of the County Council, the specific outcomes they wanted would not automatically be aligned.
19. The recent proliferation of care co-ordinator/navigator-type roles and duplication of the signposting function was an example of the difficulty faced in developing an integrated approach. Taking adult health and social care commissioning for older people as an example, the delay in determining an approach, apparently caused by financial considerations and the need to work more closely with clinical commissioning groups had created significant frustrations. Many voluntary organisations had had to decide how best to move forward without a clear steer. Given that integrating the approach of public health, social care and health was understandably proving a challenge, adding both commercial organisations and the voluntary sector into that challenge may not be a role that the County Council by itself could undertake. The previous speaker agreed with this view and added that a community should be allowed to organise its own services to meet its own needs; in a community, people would look after each other.
20. Asked if he was familiar with and used social media, Mr Scott said he did not currently use social media for the Older People’s Task and Finish Group but agreed that it should be used in the future. In a separate project, it had been demonstrated as a useful way of reaching new volunteers.
21. Mr Clarke pointed out that, in the contracts required for health and social care work, the voluntary sector was in competition with each other and replicated some areas of work. Voluntary organisations were unwilling to work with each other or share information as that information had value for their own work. A comment was made that voluntary organisation contacts had said in the past that some County Council contracts had not been big enough for them to bother with as it cost them money to prepare and submit a bid. Mr Scott added that some local authorities were looking at returning to grants instead of contracts.
22. Mr Clarke said that, in terms of preventative work, for instance, projects to encourage social interaction, safety had been a big issue, along with access and the availability of practical facilities, such as sufficient toilets and benches, to accommodate older people’s health needs.
23. Asked what other services could have a positive impact on loneliness, Mr Scott added that suitable housing was a priority. Most housing developments did not address the needs of older people. Many older people were left living alone in their family houses, which were expensive to maintain and heat and no longer met their needs. Development of mixed accommodation would attract a mixed age range and could help alleviate loneliness among older people. If there were somewhere suitable for an older person to move to, their larger family homes could be freed up for use by families. He said he would like to see a housing policy to encourage this. An example was given of housing at Kings Hill, where the type of mixed development described above had proved very difficult to realise as land values had simply not made such mixed development an economically viable option for a developer. Such issues needed to be tackled by planning authorities, preferably by resurrecting the former Structure Plan process.
24. Mr Clarke referred to the ‘make every contact count’ approach, by which lonely people could be identified and signposted to suitable services. Close partnership working was required between the County Council, housing providers, the NHS, etc. People could now be treated at home for minor ailments but this was not necessarily a good thing as they were not going out of their homes to access services.
25. Mr Scott referred to the Public Health-led ‘mind the gap’ initiative to address health inequalities and said that this could be supported in communities in which people looked out for those who might be vulnerable. An approach was needed to make this easier to do in deprived areas. Some communities did not offer many opportunities for social inclusion. With housing growth, new people would join communities and bring fresh thinking, new ideas and skills. A view was expressed that, to make this possible, it might be necessary to change the culture of some communities. Some people would think they were prying if they were to check up on a neighbour. They would need courage to take on a new, pro-active role, and would need to have some training to do it effectively.
26. Mr Scott gave an example of a theatre group in Detling, where the audience shared a sense of community as many were involved in common cultural activities. In some areas, this opportunity would not be possible as there was no similar organisation, no cultural appetite to establish one and no shared sense of belonging. Asked if it had been difficult to establish such a group, Mr Scott explained that there had been a local actor who had retired and wanted to run a group. Similarly, a retired singer might set up a local choir. To establish such groups needed creative people who were willing to take on the organising and who were confident enough to approach and encourage local people to join in.
27. Mr Clarke referred to the Healthy Walks programme he had run, with each walk being led by a volunteer. These had involved much effort to set up but local appetite for such activities varied. Take-up had been patchy; the Bearsted group had 50 participants and the Shepway group had 4. In some places, people had larger prevailing problems to contend with and going out in a walking group was simply not a priority for them.
28. It was pointed out that, in some places, the older members of a community who had the time and willingness to run local activities had passed away, and younger people either had no interest in taking on the organisation of groups or were working longer hours and had no spare time. Clubs and activities would have to close down if there were insufficient hands to run them. A local choir had been run by a young professional music director giving her time for free, but when she could no longer accommodate this, the choir found that to pay for a director to take on the same role was prohibitively expensive.
29. The Chairman thanked Mr Scott and Mr Clarke for giving their time to attend and help the Select Committee with its information gathering.