Agenda item

In attendance for this item were the Director of Public Health and the Cabinet Member for Health and Well-being.

The Director had prepared a presentation (available on the Council's website), and highlighted the main points for preventing loneliness and isolation, which included the context and approach, key facts about the effects on mental and physical health, potential answers, Worcestershire Health and Well-being Board's Loneliness Plan 2015-2018, examples of progess and the Reconnections Service.

As a county, Worcestershire was generally healthy but with a big demograph of older people, who were living longer but spending more years in poor health, especially in socially disadvantaged areas. A great deal of work was being done but this situation was not yet changing. Reducing loneliness was a key factor in addressing the health challenges facing Worcestershire's older population.

In 2014 the Health and Well-being Board held a loneliness event, which formed the basis for the Loneliness Plan 2015-2018 (included in the agenda). The work being done looked at triggers, how to identify and tackle loneliness; preventing loneliness in the first place was not yet included.

Research showed that a lack of social connections was bad for people's mental and physical health, and that loneliness increased the likelihood of premature mortality by 26%. Lonely individuals were more likely to visit their GP, go into residential care and use accident and emergency services.

One answer lay in looking at communities and focusing on what mattered to an individual rather than 'what is the matter with you?'. The three aims of the Plan included empowering residents and communities to maintain their connections, improving access to activities and services and raising awareness of isolation, identification, risk factors and local opportunities for prevention and intervention.

All approaches to tackling loneliness relied on having active communities and

the Director set out areas of progress relating to:

Reconnections - a new service run by Age UK Herefordshire and Worcestershire, this was an example of progress which the Panel may want to look at further. The service used innovative social impact bond funding and was progressing well. The model involved a core team which recruited and attracted volunteers to reach lonely people and reconnect them with their communities, building on their personal strengths, and was measured against scores from the University of California, Los Angeles (UCLA).

So far, Reconnections had supported over 1000 older people with needs and severity of loneliness higher than had been anticipated, but referral levels had been lower than expected. Reconnections appeared to provide value for money, but more thinking may be needed and it was resource intensive.

Social prescribing – for a pilot period paid social prescribers were being recruited, who would be based in GP surgeries to support people who needed social intervention.

Rural communities programme – led by Wychavon District Council, this work was routed very much within communities, with a project to identify and train the 'go to' people, who could spread the word about local services and assets.

Volunteer roles – this involved thinking more widely about volunteer roles, since while Worcestershire had higher than average volunteer levels, more could always be used.

The Loneliness Plan was due to be refreshed during 2018.

The Chairman invited discussion.

Main discussion points

·         Panel members were very interested in the principles behind the work on loneliness and were keen to help - the Director would welcome collaborative work.

·         Panel members were keen to know areas of need and progress and asked about data and mapping across their own divisions, however they were advised that this information could not disaggregated to a local level. The Cabinet Member for Health and Well-being suggested some information may be available through district councils.

·         Several members would welcome training, skills and a 'toolkit' to enable them to help within their own communities.

·         Social prescribers and Reconnections were putting together community directories and members pointed out that they could help with this.

·         A member asked whether loneliness was now a bigger issue in towns, since recent evidence suggested to him that people in rural communities felt able to get involved in growing initiatives, such as community shops. The Director explained that specific data on this was not available, however in her view age was the key driver. However it was certainly possible to be lonely in towns, and it was important to understand the factors behind it and to think about the physical environment.

·         A member reported that dropped kerbs had made a big difference to enabling disabled residents in her community to go out and the importance of footways being suitable for the elderly was flagged up.

·         In response to a question about prevention, the Director referred to areas such as understanding the impact of generational changes, since over time people gradually sank into a way of life which was isolated.

·         Members referred to other vulnerable groups, for example those who were divorced, disabled or from ethnic minorities.

·         For one member, older children who had been caring for elderly parents were a key group, in particular when the parent died, which may bring about complete change, for example in their housing – some social landlords' policies were a concern. The Director agreed it was important to raise staff awareness across the system to identify individuals at risk of becoming lonely, including those living with others.

·         On the subject of crime, the Director felt it was helpful to talk about the fact that fear of crime was often the issue; there was a need to make people feel safe.

·         Members asked about engagement with parish councils and learned that they were well connected with the Directorate's work and were very keen to be involved.

·         It was explained that the UCLA scores were a set of statements designed to measure wellbeing, which it was important to monitor – and it was agreed to provide further details of the UCLA scoring to the Panel.

·         How sustainable was the Reconnections service, given the rise in referrals? The Director was less concerned about this, since the referral process was robust, a good model and funding had attracted national attention. However in respect of prevention work, the Director felt it was important to do fewer things, but do them really well.

·         Everyone acknowledged that loneliness and being alone were different; you could live alone and not be lonely, just as you may not live alone, but feel lonely.

·         Some members spoke favourably about facilities and groups in their areas.

·         A member pointed out that more information about members' divisions, for example food bank use, could be useful in understanding needs, and that often parishes could be complacent about their own area.

·         The Cabinet Member referred to his recent visit to see assistive technology in action (at Telecare), which although excellent, lessened personal contact with an individual.  

·         The Chairman referred to the Loneliness Plan and asked for comments on the statement included in the section on analysis of potential factors, 'there is no robust quantitative data on the statistical link between socio-economic factors and loneliness'. The Director advised that the Council in conjunction with partners ought to be able to identify those likely to be lonely; there was a moral commitment to think and to take action to prevent loneliness.

·         When asked how the Public Health Directorate's work could feed into members' individual areas, the Director pointed out the importance of planning and little things such as dropped kerbs, public seating, toilets and crossing times – in encouraging people to get out into their communities. The relevant planning document would be circulated.

·         A member raised concern that care should be taken not to regard loneliness as an older person's issue, as this ignored groups such as mothers on maternity leave, who may be very lonely and have less activities available to them. The Director agreed but pointed out that such groups already had a structure and network around them, whereas the elderly did not have that infrastructure.

The Chairman invited comments from the representatives from other organisations who were present.

Carole Cumino, Chief Executive of Worcestershire Association of Carers commented that loneliness had a number of causes and could affect people of different ages, as evidenced by the recent report from Carers UK and the Jo Cox Foundation ('The World Shrinks: Carer Loneliness –https://www.carersuk.org/news-and-campaigns/news/8-in-10-people-caring-for-loved-ones-have-felt-lonely-or-socially-isolated). This work highlighted that 8 out of 10 people caring for loved ones had felt lonely or socially isolated – things which would help included a more understanding society, more awareness and the need for carers to interact with others. Younger carers in particular may have missed out on opportunities for social interaction. Those caring in excess of 50 hours a week and also those caring for both their children as well as elderly relatives (sandwich carers) were other groups at risk of loneliness. It was also important to recognise that however many opportunities were available to carers, the effect of lack of confidence should not be underestimated.

Jo Ringshall from Healthwatch Worcestershire found the work taking place positive but queried awareness amongst GPs about Reconnections. The Director would feed back to the service and advised that there would be a newsletter. The service had been careful to build up gradually, rather than through a big launch.

Summing up, the Chairman referred to the interest from the Panel and HOSC members present in the work taking place on preventing loneliness and isolation. The Reconnections service merited further promotion and the Panel would like to see more preventative work. Panel members had flagged up potential risk factors for adult and child carers. The Loneliness Plan indicated the volume of work taking place but to date this did not tap into local members' knowledge to the full extent.

The Director welcomed the request for training and information in order to equip local members to work with their communities, parish and town councils – this would be arranged in liaison with Reconnections. Panel members Mrs Tucker and Mr Adams would meet with the Director about this. Taking on board the Panel's comments for more prevention work, the Cabinet Member and Director would look to strengthen this aspect when the Loneliness Plan was refreshed later this year. The Panel expressed interest in being involved in the refresh of the Plan.

The Panel also requested details on:

·         UCLA measures

·         Parish involvement

·         Carers UK/JO Cox Foundation report