How Age Friendly Is Bristol? Draft Baseline Assessment

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How Age Friendly is Bristol? Draft baseline assessment

September 2015

Table of Contents Page

1.Introduction 2

2. Some insights into Bristol…. 3

3. What is an age friendly city? 5

4. The Eight Themes of an Age Friendly City 9

5. Theme 1: Outdoor spaces and buildings 10

6. Theme 2: Transport 17

7. Theme 3: Housing 25

8. Theme 4: Social participation 33

9. Theme 5: Respect and social inclusion 42

10. Theme 6: Civic participation and employment 48

11. Theme 7: Communication and information 54

12. Theme 8: Community support and health services 59

1. Introduction

Bristol wants to become an age friendly city. Bristol Ageing Better, a partnership of over 100 local organisations, (www.bristolageingbetter.org.uk) and Bristol City Council are signed up to making this happen.

The World Health Organisation sets out some steps that a city needs to take, if it is to achieve its age friendly objectives. One of the most important is to do a baseline assessment of the age-friendliness of the city in eight key areas:

o outdoor spaces and buildings o transport o housing o social participation o respect and social inclusion o civic participation and employment o communication and information o community support and health services. This report starts that process. It is not intended to be comprehensive but rather to start a conversation. What are Bristol’s strengths and areas for improvement, where are the opportunities and challenges that will help and hinder? What progress have we already made, what learning can be shared and what successes can be built on?

Although an ageing population will pose challenges for health and care systems, there will also be opportunities to improve the quality of life for Bristol’s citizens as they age. Older people are net contributors to the economy and cities who take an Age Friendly approach can benefit from the contribution of older people locally.

This draft baseline assessment is a working document that will require constant updating to reflect change. It needs the input of local residents, service users and providers, professionals, volunteers and community organisations to bring it alive and make it real.

The next step will be to develop a city-wide action plan to make sure that progress is being made.

If you’d like to contribute to this initiative or to find out more, contact [email protected]

2. Some insights into Bristol….

Comparing people over 50 years with those under 50

The following findings, taken from the Quality of Life Survey 2013, compare the experiences of people aged over 50 with those under 50 years of age

 More over 50s have no educational or technical qualifications: 36% of over 50s compared to 4% of under 50s  More have long-term limiting illness or disability: 45% of over 50s compared to 9.5% of under 50s  Fewer over 50s participate in active sport: 30% of over 50s compared to 55% of under 50s  Fewer report good health: 80% of over 50s compared to 90.5% of under 50s  More eat 5 or more portions of fruit and veg a day: 57% of over 50s compared to 46% of under 50s  Fewer have been victims of crime: 9% of over 50s compared to 15% of under 50s  More feel they ‘belong’ to their community: 69% of over 50s compared to 56% of under 50s  More are satisfied with household waste collection: 76% of over 50s compared to 69% of under 50s

Comparing people over 65 years with those under 65

Some differences change or become more marked when comparing the experiences of people aged 65+ with people under 65 years of age

 More over 65s have no educational or technical qualifications: 50% of over 65s compared to 12% of under 65s  Fewer are happy using the internet whenever they want: 47% of over 65s compared to 90% of under 65s  Fewer talk to friends and family most days: 64% of over 65s compared to 77% of under 65s  More feel they belong to the neighbourhood: 75% of over 65s compared to 59% of under 65s  More say people are treated with respect in their neighbourhood: 77% of over 65s compared to 66% of under 65s  More say poor health prevents them leaving their house as often as they want: 14% vs. 5%  More say disability prevents them leaving their house as often as they want: 13% vs. 5%  Fewer have had good health in the past 12 months: 77% vs. 87%  More have a limiting long-term illness or disability: 54% vs. 23%  More have accidentally fallen in the last 12 months: 27% vs. 15%

Comparing life satisfaction by ward

In the 2013 Quality of Life survey, nearly 70% of all respondents report medium or high ‘Life Satisfaction’, including those aged over 50. However, when broken down by ward this shows a rather different picture. For those over 50, life satisfaction ranges from 48% to 82%, depending on where people live.

Map 4: Quality of Life Respondents (over 50) Reporting Medium or High Life Satisfaction

3. What is an Age Friendly City?

An age-friendly city enables people to actively participate in their community and provides an environment where everyone is treated with respect, regardless of their age. It is a place that makes it easy for older people to stay connected to the people that are important to them. It helps people stay healthy and active even at the oldest ages and provides appropriate support to those who can no longer look after themselves. The World Health Organisation (WHO), describes an age friendly community as an environment where, all actions, buildings and services:

“are designed to support and enable older people to ‘age actively’ – that is, to live in security, enjoy good health and continue to participate fully in society”1

Recent national guidance by the Local Government Association has highlighted the need for councils to apply an ageing lens to policy and practice2.

“Becoming ‘age-friendly’ is about adopting a particular ‘lens’ through which to view policies and services. It is a way of focussing attention on the issues of particular relevance to older people. Given the huge democratic shift that is taking place and the other changes within this group, it is appropriate to consider their needs, assets and circumstances in quite some detail. That is what adopting an ‘ageing lens’ allows councils to do. As with any lens, it provides a much clearer and more detailed picture.”

An age-friendly city supports and enables people to age actively by:

 recognizing the wide range of skills, abilities and capacities of older people;  anticipating and responding flexibly to ageing-related needs and preferences;  respecting the decisions and lifestyle choices of older people;  protecting those who are most vulnerable; and  promoting older people’s inclusion in and contribution to all areas of community life.

A person’s health, and their ability to cope with the shocks and stresses that life brings, will change over time (for example, the onset of an illness or disability, divorce, a rapid change in financial circumstances, the death of a partner or close friend). There are a range of complex factors that can have a positive or negative impact on health and wellbeing, for example, lifestyle choices (diet, physical activity, alcohol consumption, use of tobacco); income; and genetic make-up (characteristics inherited from parents).

However, individual factors are not the only ones to consider. The work of the WHO Healthy Cities programme acknowledges the importance of wider environmental and social

1 See http://www.who.int/ageing/projects/age_friendly_cities/en/ 2 ‘Ageing: the silver lining. The opportunities and challenges of an ageing society for local government’. Local Government Association, 2015

5 determinants of health. Where someone lives can also have a positive or negative impact on their experience of ageing. Crime and anti-social behaviour within a neighbourhood, for instance, may discourage older people from going out and fully participating in their community. Feeling safe encourages people to be more active as they age. Participation can also be encouraged by easy access to public transport, local facilities and healthcare, traffic calmed streets, clean air and green space, as well as the availability of well-maintained and uncluttered pavements, access to toilets and benches in public areas. Ageist attitudes are still prevalent in society and can have a corrosive impact on how older people feel about themselves and their place in the local community. Challenging ageism is a key strand of any strategy to become more age friendly.

The strengths of an environmental approach to ageing well are considerable with benefits beyond the individual. If people can maintain independence through supportive environments, there is less need for them to require services that can reduce autonomy and dignity, and may prove costly for the individual or the public purse. Having insufficient support can limit coping and precipitate premature moves to more restrictive care settings.

World Health Organisation – Active Ageing

Source: World Health Organisation (WHO), Active Ageing Strategy, 2002 An age-friendly city emphasises enablement rather than disablement; it is friendly for all ages and not just “elder friendly” (WHO: Global Age-Friendly Cities: A Guide)

Because active ageing is a lifelong process, an age-friendly city is not just ‘elder friendly’. Barrier-free buildings and streets enhance the mobility and independence of people with disabilities, young as well as old. Secure neighbourhoods allow children to establish a habit of active lifestyles that can stay with them into adulthood. They allow younger women and older people to venture outside in confidence to participate in physically active leisure and

6 in social activities. The whole community benefits from the participation of older people in volunteering or paid work. Finally, the local economy profits from the patronage of older adult consumers.3 In short, making a city ‘age friendly’ also contributes to making it ‘all age friendly’.

Planning for an ageing society requires a strategic approach and a long term view. Examples of how other cities are tackling this are provided below4.

Good Practice Example: Manchester’s Approach to an Age Friendly Strategy

Manchester focused on five themes:

• Age friendly neighbourhoods - Improving age friendly locality structures and plans, working with regeneration teams, NHS agencies, and Council ward coordination groups; supporting locality networks, supporting community projects that increase social participation, including a small grants fund; promoting a range of volunteering opportunities.

• Age friendly services - Applying and ‘ageing lens’ to city plans and strategies, contributing to Living Longer, Living Better, leading the Health and Wellbeing Strategy work on ageing, delivering the next phase of ageing studies programme, expanding cultural opportunities, supporting a range of intergenerational projects.

• Research and innovation - Supporting the Manchester Ageing Study, developing Manchester as a centre of excellence, publishing a Research and Evaluation Framework, collaborating with (inter) national research and policy projects; developing an Economy and Ageing project with Institute for Public Policy Research (IPPR), supporting an Age- friendly design project

• Communication and engagement - Further developing the Valuing Older People Board and Older People’s Forum, improving how older people inform decisions about their areas and services, promoting the Age Friendly Manchester protocol for involving older people; improving on-line resources and promoting Age Friendly Manchester, reviewing communication with older people.

• Governance (older people’s involvement) - Supporting multi-agency a Senior Strategy group to lead and promote the programme, publishing an Action plan and annual progress statement, developing an Age Friendly Manchester multi-agency workgroup.

3 See Global Age Friendly Cities: A Guide http://whqlibdoc.who.int/publications/2007/9789241547307_eng.pdf?ua=1 4 ‘Ageing: the silver lining. The opportunities and challenges of an ageing society for local government’. Local Government Association, 2015

Good Practice Example: Nottingham’s Strategic Approach to Ageing

Nottingham is a member of the WHO Global Network of Age Friendly Cities and Communities and is implementing change as prioritized in the eight age friendly domains. Key steps include:

• Development of the Nottingham Older Citizen’s Charter. The charter demonstrates the values and standards that older citizens expect from Nottingham City Council and partner organisations. It was ratified by Nottingham’s Health and Wellbeing Board in February 2014 and launched at a high profile event. The charter includes a pledge to support the National Pensioners’ Convention’s Dignity Code which upholds the rights of vulnerable older people and sets expectations for how the personal dignity of older people should be maintained.

• Age Friendly Nottingham Steering Group. A cross-sector steering group with strong representation from older people is leading the development and implementation of the Age Friendly Nottingham action plan. Several working groups have been formed to take forward specific priorities eg. loneliness. The Health and Wellbeing Manager (part of the Public Health Team) is employed part time to take the initiative forward.

4. The 8 Themes of an Age Friendly City

The World Health Organisation’s model provides eight criteria to help cities who are aspiring to become an Age Friendly City (‘Global Age-friendly Cities: A Guide’ (2007). A brief description of each topic area and the sort of issues they cover is provided below:

Age Friendly Theme Brief Description Outdoor Spaces and Buildings Quality of life, access, safety. Clean, green, somewhere to rest, pavements, roads, buildings, cycle paths, toilets Transport Availability, affordability, reliability, access, safety, comfort, community transport, taxis, parking Housing Affordable, appropriate design, maintenance, community integration Social Participation Good range of affordable activities, tackling social isolation, intergenerational and multicultural opportunities Respect and Social inclusion Ageism, intergenerational opportunities, economic inclusion Civic Participation and Volunteering, Training, Employment, valuing older people Employment Communication and Access to good information, plain language, assistive technology Information and digital inclusion Community Support and Health, social care, volunteering Health

In practice, there is no clear cut distinction between some of these themes, and they complement each other – for example, a number of the improvements that can be made under ‘outdoor spaces and buildings’ – such as improvements to roads and pavements, making neighbourhoods more walking and cycling friendly – also contribute to the ‘transportation’ theme and actions such as volunteering (which appears under the ‘Civic Participation and Employment’ theme) can contribute to a range of other themes, such as ‘Social Participation’ and ‘Community Support and Health’. The aim of naming individual themes is to encourage people to think of an ‘Age Friendly City’ in a broad, comprehensive and joined-up way.

In the following pages, each of these themes will be examined in turn, to highlight existing evidence and good practice and also areas where further improvements can be made. It should be noted at the outset, this is an initial assessment and, for reasons of report length, it will not list every single activity going on under each category. Its aim is to give an impression of the sorts of activity being undertaken in each category, as a starting point for debate with older people themselves.

5. THEME 1: OUTDOOR SPACES AND BUILDINGS

The outside environment and public buildings have a major impact on the mobility, independence and quality of life of older people and affect their ability to ‘age in place’. The World Health Organisation have noted that recurring themes in cities around the world include quality of life, access and safety.

The availability of outdoor spaces for leisure and recreation is important for the physical and mental wellbeing of all people and research has shown that taking up physical activity in older age has clear health benefits in respect to reducing the risk of dementia and increasing life expectancy. Research indicates, for example, that walking helps to (at least) maintain cognitive functioning in those with dementia and that the practicalities of getting ‘out and about’ in neighbourhoods, such as navigating through local environments, can play a pivotal role in maintaining a person with dementia’s sense of self and wellbeing5. Research also suggests that the ‘walkability’ of neighbourhoods has an important bearing on promoting the level of physical activity required to maintain fitness and prevent obesity and chronic disease6. In addition, leisure activities and the informal use of the local public realm encourages social contacts which in turn help to prevent isolation.

Evidence suggests that ‘age friendly’ outdoor environments have:

 Barrier-free public space and buildings that are accessible and useable for people with impairments  Places to be and stay outdoors  Urban environments that support community interaction and personal independence.

Bristol City Council’s ‘Core Strategy’ – which sets out the overall approach for planning development within Bristol provides a solid ‘framework’ for the development of an Age Friendly City, with an emphasis on mixed, balanced and sustainable communities, appropriate housing provision and urban design that promotes good health and wellbeing. It also encourages community involvement and engagement. Strategic planning policies that are relevant to the development of an age friendly city, include:

 BCS 12 Community Facilities  BCS 17 Affordable Housing Provision

5 Keady, J., Campbell, S., Barnes, H., Ward, R., Xia, L., Swarbrick, C., Burrow, S. and Elvish, R. (2012), ‘Neighbourhoods and dementia in the health and social care context: a realist review of the literature and implications for UK policy development’, Reviews in Clinical Gerontology 22 (2), 150–1. 6 Chaudhury, H., Sarte, A., Michael, Y., Mahmood, A., Keast, E., Dogaru, C. and Wister, A. (2011), Use of a Systematic Observational Measure to Assess and Compare Walkability for Older Adults in Vancouver, British Columbia and Portland, Oregon Neighbourhoods, Journal of Urban Design, 16:4, 433–454.

 BCS 18 Housing Type  BCS 21 Quality Urban Design  BCS 22 Conservation and the Historic Environment  BCS 23 Pollution

There are also Development Management (DM) policies, which provide more detailed planning policies used by the council when assessing planning applications, covering a range of issues from wheelchair accessible housing to transport development management and pollution control.

Neighbourhood Partnerships

Bristol’s 14 Neighbourhood Partnerships are developing a shared vision which mirrors the themes of the Mayor’s Vision for Bristol and the Council’s Corporate Plan. They are predominantly grouped around themes such as:

 Environment (Global Green Capital)  Traffic and Transport (Keep Bristol Moving)  Crime and Community Safety (Healthy and Caring)  Housing, Planning and major projects (Building Successful Places)  Quality of Life: Families, Younger and Older People (Vibrant Bristol)  Employment Training and Economic Development (Keep Bristol Working and Learning)  Community Buildings and Facilities (Building Successful Places)  Equalities, Community Cohesion, Active Citizenship, Governance (Active Citizens)

In general, there is a good fit between the over-arching themes of the Neighbourhood Partnerships and the eight themes of an Age Friendly City. Indeed, some areas of focus within Neighbourhood Partnership priorities which are not immediately aimed at older people can still have beneficial effects for them. For example, an emphasis on ‘improving the local environment for young people’ can include measures such as tackling anti-social behaviour and drug and alcohol misuse, which can contribute to making a neighbourhood feel safer for all age groups, including older people.

Into the future, Neighbourhood Partnerships could explore opportunities to create neighbourhoods which are more age friendly, particularly where significant numbers of older people live (ie. areas such as Westbury-on-Trym, Stockwood and Hengrove).

Neighbourhood Planning

Any community in the city can get involved in helping to plan their future development through contacting the Bristol Neighbourhood Planning Network or their local Neighbourhood Partnership.

The Localism Act (2011) introduced a new opportunity for communities to write their own Development Plan Documents to help guide future development. In brief, this involves designating a Neighbourhood Planning Area then designating a Neighbourhood Planning Forum for that area.

There are currently five designated neighbourhood planning areas in Bristol:

Lockleaze Neighbourhood Planning Area Old Market Quarter Neighbourhood Planning Area Lawrence Weston Neighbourhood Planning Area Knowle West Neighbourhood Planning Area Redcliffe Way Neighbourhood Planning Area

A number of these have now produced their own Neighbourhood Development Plans. These plans include a number of ambitions that will help make their communities more age friendly. For example, Ambition Lawrence Weston’s aim that ‘any new developments to deliver high quality urban design that creates a more positive, colourful and optimistic outlook for the estate’ or their commitment to ensure ‘better maintained paths and a more attractive pedestrian area along Ridingleaze’. The Old Market Quarter Neighbourhood Development Plan’s includes many ‘age friendly’ commitments, such as ensuring that parks and open spaces are better linked by a series of safe pedestrian routes.

Other examples of improvements made to outdoor spaces include projects undertaken as part of the Legible City project. Bristol Legible City started in the 1990s as part of the work of the Council’s Urban design Team. A number of projects have been delivered to improve open spaces in Bristol, support signing and provide information for pedestrians. These projects have included public art, physical improvements to streets and spaces and information design. Physical regeneration projects have also helped to transform areas of Bristol. In 1992 30% of properties in Queen Square were empty. Following the completion of major public realm improvements occupancy was almost 100% by 2002. More recently, Arnos Vale Cemetery has been transformed and the Councils Urban Design team have worked closely with the Health Authority to create relaxing green open spaces in the environment around the new Southmead hospital.

Bristol has a number of Green Flag Parks and Green Spaces. Green Flags awards recognise and reward the best parks and green spaces in England and Wales. Areas like the Downs and Troopers Hill Local Nature Reserve have been awarded Green Flag Status every year since 2007. There are also around 30 community park groups in Bristol which work to improve a park or green space in their area. Each is unique with different aims and interests. Areas like St Paul’s Park used a collaborative design process whereby local people, police and Council staff all worked together to provide a safe, welcoming green space. Community park groups successfully raise funds for new park facilities and play equipment, improve parks and green

12 space for the benefit of wildlife, hold fun days and other events, and lead guided walks and talks.

The availability of basic amenities, such as benches and public toilets are often cited as being important to older people, and the lack of such amenities can deter some older from going out and participating in the wider community. On its website Bristol City Council has a list of public toilets available in each Bristol postcode area (both city council toilets and those provided in outlets by major retailers – Tesco, Sainsbury’s etc) as well as a series of downloadable maps for major areas of Bristol. The website also includes a downloadable document showing toilet opening hours.

Good Practice Examples

The Greater Bedminster Toilets and Benches map, produced by the Southville Centre, Greater Bedminster Community Partnership and LinkAge. The idea for a toilet and benches map came from a discussion at the Older Peoples’ Forum. A national report indicated that some people were trapped in their homes because they were afraid to move too far from their own toilet. Many forum members understood this either from personal experience or through friends and relatives.

Good Practice Examples

Bristol City Council’s City Design team has worked with Bedminster Town Team and local traders to make East Street a ‘Street Green’ – a practical, tailored, and adaptable response to improving poor quality pedestrian environments. The improvements include integrated planters and seating, placed on existing paved surfaces. The City Design team has also added street trees to Whiteladies Road, supporting local residents in transforming and softening their parking dominated street in Green Close and Bronte Walk, landscaping in Straits Parade, Fishponds and tree planting and improved pedestrian facilities along Bath Road and Wells Road.

Good Practice Examples

As noted above, much of the work of Bristol’s 14 Neighbourhood Partnerships has contributed to making individual communities more ‘age friendly’ through improvements made to paths and greenspace and the provision of more seating. All Partnerships have been using Bristol Green Capital Neighbourhood Partnership Grants to make environmental improvements to their areas. A number of Partnerships also have what are known as ‘Street Champions’ who keep an eye on their local area reporting waste, highways, environment and other community safety concerns to ensure they are dealt with quickly. Where they

13 exist, Neighbourhood Planning Areas also include ‘age friendly’ enhancements such as widening footpaths and ensuring accessible crossing points at key road junctions.

What do Older People Think?

The annual Quality of Life in Your Neighbourhood survey has been asking a wide range of questions which are of relevance to age friendly themes for a number of years. Looking at responses over time can give us some indication of any change in perception (either positive or negative) to at least give us a ‘direction of travel’ in terms of the age friendly themes. The charts below draw solely on Quality of Life survey responses from those aged over 50. It should be noted that the Quality of Life survey changes a number of its questions each year so sometimes there will be gaps in the charts, indicating a year where a particular question was not asked.

Open Spaces and Buildings

In terms of feeling safe in their neighbourhoods, far fewer older people (defined here as the over 50s) think that their personal safety is a problem in 2013 than they did in 2005, so there has undoubtedly been an improvement in this respect.

Overall satisfaction with both neighbourhoods and the quality of parks and green spaces has always been at a reasonably high level over the years and has improved since 2005.

However, other indicators are less positive. For many older people street litter is a problem and has remained an issue for many people over the years, as has the issue of dog fouling, which appears to be an increasing concern among older people over time.

Although only asked in recent years, questions relating to how people view the success of police and public services in tackling crime and anti-social behaviour show some improvement over time, although there is obviously still some way to go to adequately address this issue.

Potential Barriers to Age Friendliness

 Natural Features and Green Spaces – Bristol is not flat and hills in certain parts of the city can deter some older people from walking to local shops and facilities. Access to some parks and green spaces may be limited due to distance and/or transportation issues.  Pedestrian Infrastructure - There is limited funding for development and maintenance of pedestrian infrastructure (e.g., pavements, benches, public toilets); not all areas of the city have sufficient pedestrian amenities.  Buildings and Urban Design – Some existing buildings and facilities lack accessible features for older adults and those with disabilities (e.g., ramps, accessible bathrooms) with limited funding for improvement.  Outdoor spaces – although older people feeling personally safe in their neighbourhoods been improving in recent years, according to evidence from QOL, there is scope for a continued focus on making open spaces be safe and feel safe for older and vulnerable people.

6. THEME 2: TRANSPORT

Transport, including accessible and affordable public transport, is a key factor influencing active ageing. Being able to move about the city determines social and civic participation and access to community and health services.

The environmental impact of transport can have negative consequences. Heavy motor traffic can impact on the air quality of neighbourhoods and limit social interaction. Activities that lend themselves to social interaction - such as gardening and sitting outside - are especially vulnerable to traffic-related environmental impacts, such as noise and air pollution. As motor traffic, volume and speed increases, so does the barrier effect between opposite sides of the street. The threat of being hit, injured or killed by a car not only discourages people from spending time in the street but also means they are less inclined to stop and talk. More ‘liveable’ communities provide a variety of travel options and streets are well used by the whole community.

The aim of an ‘age-friendly’ transport system is to provide accessible, appropriate and reliable transport services which encourage people to maintain their mobility, independence and connections as they grow older. Key features include:

 Infrastructure for active mobility and walkability  Accessible and reliable public transport  On-demand services and other support to improve mobility

Since July 2012, Bristol City Council has been rolling out a 20 mph speed limit throughout Bristol. The vision for 20mph is to help create more pleasant communities for everyone to enjoy. Slower speeds and reduced car use for local trips will lead to less noise and more people-centred communities. The reduced speed makes it easier to cross roads, particularly for children and the elderly, reduces severance and helps people access local facilities. The long term benefits are that walking, cycling and outdoor activity become more attractive, all of which can have a positive impact on health and the community.

Resident Parking Schemes (RPS) can also bring significant benefits, by making it easier for local residents, businesses and their visitors to park, thereby reducing the amount of motor traffic, improving local air quality and reducing pollution. RPS areas can also offer significant benefits to Blue Badge holders, as they enable the Council to replace existing advisory disabled bays with statutory bays which can be enforced. This can make a significant difference to the quality of life of the person requiring the bay. As each RPS area is reviewed every year, new statutory disabled bays can be introduced and redundant ones removed in a timely fashion, which makes best use of the available parking capacity in each street.

MetroBus is a joint project between Bristol City Council, North Somerset Council and South Gloucestershire Council designed to increase access to employment, education and leisure

17 destinations. It aims to be greener, faster and more reliable than existing bus services and will remove the need to change buses in the city centre for many passengers. Services are expected to start in 2016 linking Long Ashton to Hengrove, Ashton Vale to Temple Meads and the northern fringes of the city, such as Cribbs Causeway, Bristol Parkway and Emerson’s Green to Hengrove, via the city centre.

There are plans for a £100m refurbishment and improvement of Temple Meads, providing Bristol with a better quality main transport hub. In addition to the electrification of rail lines to London and Cardiff, MetroWest will provide a 30 minute rail service using existing rail infrastructure, creating stations and reopening lines to Portishead in 2018 and Henbury by 2020.

In terms of affordability, bus fares across the city were reduced in 2013, including a three- stop-hop fare of £1 alongside £1.50 tickets for three-mile journeys inside a new inner zone. People of state pension age who live in the Bristol City Council area can apply for an older person’s bus pass which provides free travel on local buses. An older person can use their bus pass:

 On journeys starting within Bristol, Bath and North East Somerset, North Somerset or South Gloucestershire, Monday to Friday after 9am and anytime Saturday, Sunday or public holidays.  If you are blind or partially sighted you can use your bus pass for free travel at anytime on journeys starting and finishing in Bristol.  On Park and Ride services, on all Bristol community transport services and the Bristol International Airport Flyer  On local buses starting anywhere else in England, Monday to Friday 9:30am to 11pm and anytime Saturday, Sunday or public holidays.

In addition, it is also possible for people to apply for free companion travel, if:

 A person is unable to travel on public transport for the whole journey without help from a companion.  A person is unable to walk to a bus stop and get on/off a bus without help.

Older people can also purchase a Senior Railcard, which is available to anyone aged 60 or over. The railcard allows people 60 + to make savings on most rail fares in the UK.

A number of Bristol’s Supported Housing Schemes have mobility scooter stores, which residents can rent, although there is a waiting list. Schemes with mobility scooter stores are:

 Butler House, St George.  Butterworth Court, Inns Court.  Chichester House, St Anne’s.  Condor House, Lockleaze.

 Field View, Easton.  Haweswater, Southmead.  Jim O’Neill House, Shirehampton.  Padmore Court, Redfield.  Parbrook Court, Whitchurch.  Rosevear, Newtown.  Studland Court, Henleaze

Bristol Shopmobility is a Charity based in the City Centre whose aim is to assist people with mobility impairments, temporary or permanent, to get around the locality. Funded by Bristol City Council and with accommodation provided by the shopping centre management board, they work closely with shopping centres to ensure that accessibility issues are not ignored. Bristol Shopmobility is managed by a Board of Trustees, over 75% of who are Disabled people. By involving Disabled people in this way they ensure that their services are tailored to meet the needs of users.

Community transport schemes are of vital importance where the public transport system does not fully serve the needs of older or disabled people in particular areas. They not only connect people to essential services but they also provide a link to the community and enable people to foster social connections.

In Henleaze, Stoke Bishop & Westbury-on-Trym LinkAge has been working in partnership with The Working Group for Older People (WGOP) to organise a number of initiatives including 'Pick-Me-Up Activities' which focus on those older people who have mobility problems, are housebound or have difficulty using public transport. Many people have already enjoyed a variety of trips including Weston-Super-Mare, Oakham Treasures, Tyntesfield, Puxton Park and tea at the Mansion House in Clifton.

The transport has been provided by Dial-a-Ride. Bristol Dial-a-Ride provides a range of door to door, fully accessible transport services to disabled and older people who are unable to use public transport due to reasons of limited mobility or communication impairment.

Bristol Community Transport (BCT) is the largest community transport operator in Bristol (in terms of both size of fleet and number of passengers carried). It has a fleet of 48 vehicles that are used by over 800 not-for-profit organisations in and around Bristol.

Good Practice Examples

Bristol Community Transport: Wheelchair Accessible Car Club Vehicle

From April 2015, wheelchair users in Bristol have been able to use a fully wheelchair accessible car by the hour through a scheme from Bristol Community Transport and Co- wheels, using an on-street bay provided by Bristol City Council. The scheme, which is the

19 first of its kind in the country, brings together existing on-street car club technology with a fully accessible vehicle, helping Bristol’s wheelchair users to get out and about.

Although wheelchair accessible vehicle have been available in Bristol for over 30 years, this commonly involved people have to book over the phone during office hours and travelling to the Bristol Community Transport depot in Bedminster to collect the vehicle. This new approach provides a wheelchair accessible car in the heart of the City. Smartcard access and a dedicated on-street bay, located on Salisbury Road in Redland, Bristol, allows 24 hour access to the car with no need to pick up keys. The car is available to book in advance or up to 15 minutes before use through the Co-wheels online booking system.

Under the new scheme, members are charged on a simple pay-as-you-go hire basis, with an hourly rate plus a small mileage charge, with insurance included. Any current member of Bristol Community Transport can access the scheme, and can also access the whole Co- wheels Bristol fleet of fully electric, hybrid and low emission vehicles located throughout the city. New members of both can access the car if they meet eligibility requirements.

Bristol and Somerset based Royal Voluntary Service undertake journeys on behalf of older people. These may be trips to and from hospital or to a GP appointment or simply trips to the shops or into town. Similarly, Retired and Senior Volunteer Programme (RSVP) West uses volunteer drivers to transport people to medical appointments, including hospitals, local surgeries, dentists and opticians.

Cycling is not for everyone and people cycling on pavements can be an issue for older people using pavements. Improvements are being made to cycling infrastructure in and around Bristol which may help. Cycling is a common mode of everyday transport in other European countries among those aged 50+ and has an important role in helping to maintain fitness and social connectedness. For those who wish to cycle themselves, opportunities do exist. Life Cycle is a Bristol based charity that helps people build confidence to get the most out of bikes and encourages people to make cycling part of their everyday lives. With the support of St Monica Trust Community Fund and Bristol Green Capital Small Grants Fund, Life Cycle organises a programme of rides for people aged over 55. Silver Cyclist rides are based in local communities and give older people a chance to get out, take exercise and discover their local area by bike. Friendly ride leaders use traffic free and low traffic routes in and around Bristol and all rides are free.

There are also many activities based around walking (as both healthy exercise and a social activity) within Bristol. Walking for Health is a national initiative run by The Ramblers and Macmillan Cancer Support. The initiative supports around 600 schemes across England which all share the common aim of improving health and wellbeing through walking. Walk for Health Bristol Partnership started in 2003 and is a successful partnership consisting of 4 schemes and over 30 walking groups, supporting Bristol’s communities to become more

20 active through walking. Walk for Health organise led walks around the city, as well as provide opportunities for volunteers to lead walks themselves.

A Walking Strategy for Bristol forms part of the Joint Local Transport Plan (JLTP3) which Bristol has signed up to along with the other three former Avon local authorities. The Walking Strategy includes an action plan that sets out principles and actions for improving the walking environment in Bristol. The JLTP is based around five key goals of: reducing carbon emissions; supporting economic growth; equality of opportunity; safety, health and security, and; quality of life. Walking can play a key role towards promoting all of these goals. The principles set out in the Walking Strategy also help to inform Bristol planning policies, such as the Central Area Action Plan, to ensure that coherent pedestrian spaces and networks are protected during any future development in the city.

Lastly, car driving with ageing has to be balanced against function decline (eg, hearing and sight loss, response times) which impinge on safety. For older adults who have driven all their lives, the transition from driving to finding alternative forms of transport can be extremely difficult. Research shows that few drivers plan for the day when they are unable to drive and many find it a difficult prospect to consider or talk about. They often lack information about the different modes of transport available to them. This raises the opportunity to consider training in the use of public transport to boost confidence and knowledge in seeking the maintenance of mobility.

What do Older People Think?

Transport

Satisfaction with local bus services has generally been improving in recent years, although dipped a bit in 2013. A general 60% satisfaction still indicates room for further improvement.

Older People have also reported a general increase in satisfaction with the information provided on local bus services.

Similarly, the number of older people reporting that air quality/traffic pollution and traffic noise are problems in their neighbourhood has declined over the years, albeit slightly.

Some survey questions have not been asked every year, however a number of older people have, in the past, expressed concerns about issues about parking behaviour in their communities – ie. cars blocking pavements in their neighbourhoods.

Similarly, questions related to walking have not been asked for a number of years. The last time it was included in the survey, it indicated an increase in older people who were walking to local shops (albeit still at a relatively low level). The percentage of older people who walked for leisure remained fairly stable, again, at a relatively low level.

Potential Barriers to Age Friendliness

 Walkable neighbourhoods – a number of the barriers highlighted for ‘Outdoor Spaces and Buildings’, such as the presence of hills in certain parts of the city and the limited funds available for pedestrian infrastructure improvements remain relevant issues for the ‘transport’ theme.  Private Transport - Heavy motor traffic is a barrier, as are a lack of parking, insufficient and inadequate signage and the difficulty of maintaining driving skills as one ages  Community Transport – Very popular with older people but, like many services, it is vulnerable to budget reductions as local government funding is reduced  Public Transport - Some older people may experience discomfort on public transportation due to other passengers who are disrespectful or who do not yield seats designated as priority seats for older people and those with disabilities, range and frequency of services can be a barrier and crime and/or fear of crime may deter older adults from using public transport in the evenings/at night  Cycling - Cyclists can be a concern for some older pedestrians (ie. cycling on pavements) and older drivers.

7. THEME 3: HOUSING

Housing is essential to safety and well-being. There is a link between appropriate housing and access to community and social services and in influencing the independence and quality of life of older people. The World Health Organisation research shows that housing and support to allow older people to age comfortably and safely within the community to which they belong are universally valued.

Housing is a basic need and the type, location and condition of housing can have a significant impact on a person’s health. Good housing conditions can help older people remain active, independent and socially included.

There are a range of housing options for older people within Bristol. For example, supported housing provides a home specially designed for older people who value their independence. Such accommodation is easy to manage and emergency support is available 24 hours a day. There are 70 supported housing schemes throughout Bristol (including sheltered housing). These individual units of accommodation are self-contained. They have their own front doors, kitchen, bedroom, bathroom, heating and emergency alarm system. These schemes normally have:

 parking  gardens  community room, for use by residents, older people’s community groups and older people within the community  laundry  guest bedrooms

Bristol City Council’s Housing Advice team offer advice that is tailored towards older people, including information on special schemes that enable older people to stay in their present homes. This includes links and contact details for Bristol and Somerset Energy Efficiency Advice Centre and links for West of England Care and Repair who can undertake home security assessments and carry out small repair jobs in people’s homes (you pay for any materials used but the labour is free). West of England Care and Repair also provide a service called Silverlinks, which looks at ways to support older people when they’re facing major challenges in their life, such as returning home after a period in hospital, or suffering from a bereavement or ill health. In brief, Silverlinks aims to puts older people who have been through similar situations in touch with each other, to help and support them through it, giving hem advice about potential housing and care options.

The Council also provides information on Disabled Facilities Grants, which can assist with the cost of installing a shower, a stair lift or other adaptation for a disabled or mobility impaired person and details of Wessex Home Improvement Loans; a not for profit organisation working in partnership with Bristol City Council’s Private Housing Service to

25 provide low cost loans to homeowners on low incomes to undertake essential repairs to their home to bring it up to minimum standard or help towards high cost adaptions which are above the grant threshold.

In terms of the design of new housing for older people, Development Management policy 2 (DM 2) of the Core Strategy (the Council’s development plan for the city) deals with specialist housing for older people and outlines criteria to establish appropriate locations for older persons’ housing that promote opportunities for social interaction and independence. The policy also sets out criteria to ensure that appropriate design and accessibility standards are met. This includes the application of the Lifetime Homes standard (www.lifetimehomes.org.uk) to all homes provided and 20% of homes designed to be wheelchair accessible or easily adaptable to wheelchair users. As a guide, public transport connections should be within 400 metres of the accommodation. Connections should have a high frequency of service.

Good Practice Example

Bristol City Council and Housing Partners: Extra Care Housing (ECH)

Bristol City Council, along with 5 other housing providers (Brunelcare, St Monica Trust, Housing 21, Guinness Trust, Hanover Housing Trust) have worked together to provide one or two bedroom extra care housing flats which form part of a complex. They each have communal facilities like a restaurant and activity rooms. The flats have been designed to promote lifelong living and independence. Within every flat there will be an alarm linked to a 24-hour control centre. Other services available at an extra cost include personal care, domestic help and a meals service – there is a care and support service at every ECH.

Extra care housing accommodation is aimed at people over the age of 65 or people over the age of 55 who are disabled, have learning difficulties or have mental health issues.

The schemes house older people with a variety of care needs. Therefore, within one scheme there will be both people with high care needs as well as those who have low level care or support needs. The schemes also act as a local resource for older people living within the neighbouring community. This is because some of the on-site facilities are open for public use, such as activity rooms lunch clubs and hairdressers. There are also opportunities to take part in on site organised activities like arts and crafts and take day trips, along with residents. Everyone who lives in an ECH scheme will have been referred by the Council’s adult care team following an assessment of need.

Bristol has over 600 Extra Care flats for older people and are currently tendering for more, (including flats to buy for people who own their own homes), which puts the city well above the national average per head of older person population. Bristol wants ECH to be a viable alternative to residential care for people with social care needs.

Extra Care Housing Schemes in Bristol

The Decent Homes Standard is a broad measure of housing condition. In order to meet the standard a dwelling must achieve all of the following:

 A - be above the legal minimum standard for housing, and  B - be in a reasonable state of repair, and  C - have reasonably modern facilities (such as kitchens and bathrooms) and services, and  D - provide a reasonable degree of thermal comfort (effective insulation and efficient heating).

Those homes that do not meet all of these criteria are described as ‘non-decent’. It should be noted however that a ‘non-decent’ dwelling need not be in a terrible state of repair or in appalling condition. Something as simple as inefficient heating and a lack of insulation can cause a dwelling in otherwise pristine condition to be classified as ‘non-decent’. The owner of such a property may well think that there is nothing wrong with their home.

In order to better understand the condition of private sector housing, the council undertook a Private Sector Housing Stock Condition Survey in August 2012.

The map on the following page provides a breakdown of the estimated proportion of non- decent dwellings within each Ward in Bristol. There is a core of wards near the centre of the City that have the highest rates of non-decency. These wards all have a high proportion of older, pre 1919, dwellings and are associated strongly with private renting. Whilst energy efficiency improvements have been made to dwellings in this area, there still remain significant numbers of ‘hard-to-treat’ dwellings, such as those with solid walls, which continue to affect non-decency.

For owner occupiers in Bristol, it would appear that older people are no more likely to be living in a non-decent home than any other age group. However, for the private rented sector the picture is much more volatile. As age increases ‘non decency’ also increases dramatically. That is to say, there is a high likelihood that people aged over 65 who are living in private rented accommodation will be living in accommodation that is considered ‘non- decent’. However, it should also be noted that only a small percentage of private rented sector tenants are aged over 65.

In response to the findings of the stock condition survey, the Council has introduced initiatives such as Warm Up Bristol. Warm Up Bristol is designed to help Bristol residents save money on their energy bills and encourage the reduction of carbon emissions through energy efficiency improvements. Warm Up Bristol will provide assessments on the energy performance of homes, identify potential improvements, and provide options and advice for grant funding. As Councils and Housing Associations already have a duty to adequately insulate their properties, Warm Up Bristol is aimed specifically at owner occupier and privately rented properties within the Bristol City Council area.

Rates of non-decent dwellings by sub-area (ward) (Source: BRE Models and Bristol HCS 2011)

Source: Bristol City Council Private Sector Housing Stock Condition Survey (August 2012)

Good Practice Example

RSVP West - Cold Homes: Fuel Poverty

RSVP (Retired and Senior Volunteer Programme) is part of the national volunteering charity Volunteering Matters. One of their many volunteer initiatives to help older people has been to work with the Bristol-based national Centre For Sustainable Energy (CSE) to help older people live in energy-efficient homes that cost less to heat and maintain.

In brief, an RSVP Organiser publicises and promotes the benefits of energy efficiency and how to set about it. Training for volunteers is provided by CSE, which has extensive experience in this area.

The work involves taking information and advice to people in their own homes. Volunteers advise on how to reduce condensation and damp, identify home improvements that a partner organisation may be able to help with, such as home adaptations. They demonstrate how heating controls work and how to read gas and electricity meters, and explain issues concerned with fuel bills or debt and how to change energy supplier.

Beyond that, volunteers work to raise public awareness by organising and running local events and presentations as well as general publicity.

What do Older People Think?

Housing

Questions relating to housing have been fairly limited in the Quality of Life Survey, and what questions there are, have not been asked for a number of years. Residents were last asked about their satisfaction with the cost and availability of housing in 2010. Trend data indicates a very slight improvement between 2005 and 2010, though both house prices and private sector rents in the city have risen continuously since then. We know from other sources, such as the Citizen’s panel (as well as from current house prices) that there is an ongoing need for more affordable housing in Bristol.

Similarly, questions relating to the state of repair of people’s homes have not been asked very often. What responses we have, show a fairly high level of satisfaction. Responses remained fairly stable during the three years the question was asked.

Overall, older people are broadly satisfied with their neighbourhood and this has been improving over the years.

In terms of home improvement and energy saving, there have been improvements over the years, such as with respect to the number of respondents aged over 50 who report that they have cavity wall insulation.

Potential Barriers to Age Friendliness

 Affordability – Housing in Bristol is expensive, both to rent and to buy. In 1997 the house prices were around three times the average annual salary. In recent years house prices in Bristol have risen to almost seven times the annual salary.  Supply – There continues to be an undersupply of new housing for both young and old in Bristol, both to buy and to rent.  Housing Stock and Condition - A significantly above average proportion of housing in Bristol was built before the First World War, particularly during the Victorian era. Building during the inter-war period also occurred at an above average rate to the national average, but from 1945 onwards, private sector housing has been built only in relatively small quantities. Most Council housing was built from the mid-1960s onwards. Older housing stock tends to be more difficult (and costly) to heat than newer housing, which can be a significant issue for older people.  Proximity to Services - Some existing housing is situated far from public transport and important services used by older people.

8. THEME 4: SOCIAL PARTICIPATION

Social participation and social support are strongly connected to good health and wellbeing throughout life. Participating in leisure, social, cultural and spiritual activities in the community, as well as with the family, allows older people to continue to exercise their competence and maintain or establish supportive and caring relationships. A lack of such social networks can have a detrimental impact in terms of health and wellbeing and can result in social isolation.

Bristol has a rich and diverse cultural landscape. As well as being home to the UK's oldest working theatre, it has live art, festivals and community events, location filming, dynamic community arts activity and an innovative approach to the use of empty space. Bristol offers great potential for ‘active ageing’. Although many of Bristol’s festivals and events, such as the annual Harbour or Balloon Festival or the Shaun in the City Adventure Trail are not age specific, they do aim to be as open and inclusive to all ages as possible. Indeed, organisations like LinkAge have organised inter-generational activity around a number of established Bristol events. For example, as part of their ‘Summer of Age’ LinkAge organised an intergenerational walk (with participants ranging in age from 9 months to 80) to identify all of the ‘Shauns’ on the harbourside loop of the Shaun in the City walk. One of the participants said:

“I really wanted to look for the Shaun’s but it is no fun on your own. This has been so much fun today, I got to see lots of Shaun’s in a really friendly and welcoming group and having the young people and little ones here has been lovely. They get so excited when we find one. The whole group has been buzzing all morning and we’ve had a real laugh. I wish we had more opportunities to do things like this. It’s nice feeling part of something and I am so glad that LinkAge arranged this.”

In addition, Bristol does have its own age specific festival aimed at older people.

Good Practice Example

Celebrating Age Festival

In 2007 the Older People’s Partnership Board (see below under Respect and Social Inclusion) decided that it was time to celebrate all the talent of older people in Bristol, and to let everyone know about the activities available in the city by funding a Festival. The first Festival lasted a week, and 500 people came to the Celebrating Age Festival Day itself held in the Council House (now City Hall). The most recent Festival lasted two weeks and involved thousands of Bristolians in a range of activities across the city. The Festival shows the community what assets older people can be, shows younger people that growing older offers opportunities to take a full part in the community, and invites older people to join in the many activities and chances to volunteer that Bristol offers.

As well as a number of leisure centres and swimming pools, the City Council maintains 17 outdoor bowling greens across Bristol. There are also indoor bowling facilities at Bedminster and Whitchurch. In addition, there are a range of activities available in parks themselves, such as Tai Chi and Nordic Walking.

In addition, there are over 100 allotments sites and more than 3,000 allotment plots (defined as 300 square yard, 253 square metre or 10 rod plots, otherwise referred to as Full Plot Equivalents) actively managed as allotment gardens in Bristol.

Good Practice Example

LinkAge Hubs

LinkAge was an Older Persons Partnership Board initiative that started with two pilot hubs in Lawrence Hill/Easton and Bedminster/Southville. Due to the innovative practice and success of these two pilot hubs, LinkAge has subsequently been rolling out across the city. LinkAge works with people 55+ and local communities to facilitate social activities that enrich lives, reduce isolation and loneliness and promote active participation. LinkAge offer a wide range of activities for older people, including art and crafts, boat trips, dancing, foot care, gardening, lunch clubs, photography, skittles, walking groups and many more. LinkAge is older person/community led and draws on the knowledge and expertise of older people themselves. It recognises that each community is unique and uses the knowledge and skills of people in each area to create vibrant and active communities, wherever they operate.

LinkAge now has national recognition for its work and best practice. Among other achievements, LinkAge featured as a national good practice case study in Relate and the New Philanthropy Capital’s report ‘Who will love me when I’m 64? the importance of relationships in later life’ and was visited by the Centre for Social Justice (a London think tank) in 2013 who also highlighted them as good national practice.

In 2010 Bristol was recognised by Central Government as being the Street Party capital of the UK. Within Bristol, Easton was recognised as the leading street party community, with over 40 street parties, 19 being held in one year. This recognition of Bristol as a Street Party capital is obviously due in part to Bristol’s neighbourly culture, but is also due to the collaboration between the City Council Highways team and Streets Alive, a charitable group which has been helping to build community spirit at the street level since 2001 across the UK. One of Streets Alive latest initiatives is Age Friendly Streets.

Good Practice Example

Age Friendly Streets

Being friendly with neighbours can reduce isolation and loneliness of all generations in streets, especially of older people. The Age Friendly Streets neighbours' campaign is being trialled in Bristol. It includes the many activities that residents have found that helps

34 residents of all ages to build a more friendly street, without necessarily being 'friends'. The campaign and its Toolkit shows how residents meet, keep in touch and organise informal activities between generations. The Toolkit is offered to residents directly to make their street more age friendly, and to build a debate about how such small neighbourly actions create a friendly street atmosphere and can reduce isolation. Early results from the campaign show that it is popular and works in raising awareness and encouraging small acts of neighbourliness.

Bristol has undertaken a lot of work around the issue of tackling social isolation. The City Council has worked with the Marmot Team (Institute of Health Equity, University College London) to look at the issue of social isolation as it affects people across the life course. With respect to social isolation among older people, this is being addressed by the Bristol Ageing Better Partnership.

Bristol Ageing Better (BAB) is a wide partnership of older people and organisations across Bristol who are working together to develop services and support for older people that address isolation and loneliness. There are over 110 voluntary, statutory and private sector organisations involved in the BAB partnership. BAB is committed to putting older people in “the driving seat” by significantly involving them in every aspect of the programme including governance, development, management and delivery. In September 2014 the Big Lottery Fund awarded BAB £5.9million for the initial 5 year programme which begins in April 2015.

The Bristol Ageing Better programme aims to deliver:

 An increase in the number of older people who report that ‘they have the amount and type of social contact that they want to reduce isolation and loneliness’.  A greater number of older people respondents who say that they can influence decisions that affect their local area and how services are designed and delivered.  More older people are able to contribute to their community through such mechanisms as volunteering, belonging to a forum, steering group or other activity.  Evaluation and learning from BAB projects/initiatives will help to build an evidence base to ensure that future services in Bristol are better planned and more effective in reducing loneliness and social isolation.

Good Practice Example

Bristol Ageing Better Partnership

While Bristol is not alone in winning Big Lottery funding to tackle social isolation, it has one of the most ambitious and wide ranging programmes planned to reduce social isolation for older people. The range of activities cuts across all of the themes of an ‘age friendly city’ and a number of the activities and organisations already cited as good practice in this report are linked to the work of the Bristol Ageing Better Partnership. The BAB programme includes:

 Age Friendly City - Achieving Age Friendly City status to provide a strategic vehicle for action across a comprehensive range of domains, all of which impact on the risk of isolation and loneliness.

 Public Understanding - Aardman Animations to work with older people to co-produce an animation and BBC will collect life stories – all with intention of changing the general public’s thinking about loneliness.  Asset Based philosophy - A programme of training in asset based practice to bring about a significant culture change in statutory and voluntary sector staff working with older people in Bristol.  Preparation for Later Life - Structured curriculum to help people adopt a positive approach to later life and in particular to build resilience against loneliness  GP Case finding - Proactive scanning of patient lists (especially those 85 plus) with follow up to identify those at risk of loneliness or isolation.  Social Prescribing - A pathway to refer isolated older people to support from within the community in order to promote their wellbeing and encourage social inclusion and self- care  Community Navigators - Older people trained and supported to undertake holistic assessments and signpost people to appropriate support.  Community Case Finding - Local community figures to be trained in identifying older people who are at risk of loneliness and isolation, with simple referral process to alert concerns.  First Contact Checklist - A series of simple but holistic questions that a wide range of public and voluntary sector staff can ask in their day to day contact with older people, with simple referral mechanism.  Community Development for Older People - City wide roll out of successful LinkAge asset based community development model. Community activities for and provided by older people. Asset based approach in action.  Schools for All Ages - A major intergenerational programme with local schools to make them hubs of intergenerational activity, with a focus on involving isolated older people who live in the local area.  Community Chest Fund - Additional resource for community groups who have an idea for challenging and changing the causes of isolation and loneliness.  Community Researchers - Train and support a group of older people to become competent in qualitative research. They would undertake community audits and some evaluation of the BAB programme throughout its life.  Wellbeing Service - A response service for the ‘community case finding’, this will provide brief solution focused therapy for those with emotional problems which contribute to isolation and loneliness.

 Group Work and Peer Support - A programme of group work and peer support for those at risk of loneliness (e.g. bereaved, carers). Some with professional facilitation; others ‘self help’ based.  Combining Personalisation with Community Empowerment (CPCE) - To institute a new way of working for people assessed as eligible for adult social care whereby isolated older people receive additional volunteer support from the local Community Development hub.

What do Older People Think?

Social Participation

The Quality of life survey has asked several questions about the social life of residents for many years – from how often people meet family and friends to how often they attend cultural events. A sample of the responses to these questions is presented below.

In terms of meeting family and friends most days, we can see an upward trend for people aged over 50 between 2007 and 2013. Those who report meeting family and friends on a weekly basis is relatively stable but shows a gradual decline over time.

At the other end of the spectrum, those who report they only meet family and friends monthly or only a few times a year also shows a decline over time, which would tend to indicate that social interaction with family and friends among older people is gradually improving (ie. more older people are indicating regular social contact and less older people are reporting having little or no social contact with family and friends).

The number of people aged over 50 who report that they live alone has remained fairly stable over the years.

In terms of attending cultural events and activities, it would appear that an increasing proportion of people aged over 50 are satisfied with the range and quality of outdoor events in the city.

Although only measured in recent years, the number of older people over 50 who are satisfied with theatres and concert halls and museums and galleries has remained fairly static, though has increased slightly. Satisfaction with libraries, on the other hand, has decreased slightly over time.

Potential Barriers to Age Friendliness

 Participation in Outdoor Events - Rainy and cold weather during winter months can deter some older adults from outdoor physical activity.

 Transport – it is not always easy for older people to access activities, if they do not have their own transport or have limited access to public transport  Social Isolation – Older people are no more alike than any other age group. Some older people are naturally more outgoing and sociable than others, other older people will be harder to engage and so a wide range of activity that recognises people’s different needs and requirements is necessary.

9. THEME 5: RESPECT AND SOCIAL INCLUSION

The extent to which older people participate in the social, civic and economic life of the city is also closely linked to their experience of inclusion. While older people are respected in many communities, negative preconceptions of ageing still exist. There is a need to facilitate intergenerational interactions to dispel such notions. Education about ageing should also begin early to raise awareness on ageing and associated issues, so that people learn to appreciate the older people around them. Negative perceptions about ageing (which can be internalised by older people themselves) can have a detrimental effect on individual wellbeing and there is some research to suggest it can shorten life expectancy.7

Age-friendly initiatives where older people can share their skills and experiences with others helps keep them engaged in their community. It is also important to ensure older people are actively involved in any decision making that may affect them. If a negative perception of ageing can have a detrimental effect on an individual’s health, then an active and positive image can contribute to enhanced health and wellbeing.

Many of Bristol’s older people are actively engaged in making decisions about their future and promoting a more positive image of older people. Bristol has an Older People’s Partnership Board (OPPB), for example, that focuses on the issues, services and developments relevant to older people in the city. The OPBB is resource for the Council and partner organisation and involves older people, carers, council officers and representatives from the health, voluntary and private sectors.

The OPPB aims to improve the quality of life of older people by:

 promoting the needs, aspirations and concerns of older people in Bristol  using its influence, knowledge, skills and experience to ensure that the needs of older people are understood and taken into account  seeking opportunities to actively contribute to the development of policies, services and activities  promote working across directorates within the Council and between agencies across the city.

The Board meets 4 times a year (or more if necessary at the discretion of the Chair) and reports to Bristol’s Health and Wellbeing Board, among others. A number of the initiatives outlined in previous pages, such as the LinkAge pilots, started out due to the Older People’s Partnership Board.

Since 1993 Bristol also has had an Older People’s Forum, a completely independent, self- governing organisation, which has recently been granted Charity status. The Forum is run by

7 Levy, B., et al., Longevity Increased by Positive Self-Perceptions of Aging. Journal of Personality and Social Psychology, 2002. 83(2): p. 261-270.

42 an elected management committee drawn from its membership of almost 2800 members and aims to raise the profile of older people, locally, nationally and internationally, and to achieve for Bristol pensioners the same rights, influence, security and income enjoyed by older people in most other European countries. The Forum has a close relationship with the Council, Age UK and LinkAge, and is affiliated to the National Pensioners' Convention. The vision of the Bristol Older People’s Forum is that: ‘All over 55s living in Bristol are happy with their quality of life, have the goods and services they require, are treated equally, listened to by decision makers, no longer feel isolated and have the opportunity to participate in the community’.

Intergenerational practice aims to bring people together in purposeful, mutually beneficial activities which promote greater understanding and respect between generations and contributes to building more cohesive communities. Intergenerational practice is inclusive, building on the positive resources that the young and old have to offer each other and those around them. (Source: Centre for Intergenerational Practice: Beth Johnson Foundation, 2001)

Good Practice Example

LinkAge: Intergenerational Activity

LinkAge provide a number of intergenerational projects around Bristol that bring together both younger and older people around meaningful activity. Among the initiatives they have pioneered are:

Film and Graffiti Projects – Working with groups of unemployed young people through the Princes Trust and local older people, participants created a thought provoking film about visual impairment and graffiti workshops which challenge stereotypes whilst learning new skills and helping the young people gain confidence to help them find work.

Cooking Classes – A group of young people received training and qualifications to support them in leading cooking classes for older people in Bristol, attracting those who cook alone at home but also a number of gentlemen who were widowed and had no cooking experience. The project was recognised with a golden spoon award from the health lottery for its impact on the community and also celebrated after 2 young people gained full time work in a local care home. iTea4U – A monthly session for older people to receive 1 to 1 support from young people in how to use technology including laptops, tablets, mobile phones and digital cameras. Sessions have proved extremely popular with requests of support ranging from paying bills online to setting up social media and skyping with family.

Creative Connections - LinkAge working in partnership with Young Bristol have used intergenerational creative workshops and skills sharing activities in the Ashton Vale and Sea

Mills areas of the city to improve relationships between younger and older members of the community, while providing opportunities for young people to achieve an Arts Award.

LinkAge also have Advisory Groups in each of the areas in which they operate. The advisory groups are seen as central to activities in each area as all such activity is older people led and arises from the ideas and suggestions put forward by the advisory group. Typically members of this group will have a finger on the pulse of their community/neighbourhood and so will be able to speak on their behalf.

Good Practice Example

LinkAge: BME Elders Groups Consortium

LinkAge also undertake cross cultural work to enable local black and minority ethnic elder groups to come together, get to know each other and share ideas and best practice. A BME Elders Consortium Group has been established that meets bi monthly at Barton hill Settlement Centre, to look at issues including funding, sustainability and promotion.

Agendas include:

Arranging and running joint training sessions for the members (Voscur & Health Watch)

Highlighting funding opportunities and training opportunities, events, activities and invitations to BME Elder related meetings/ conferences.

An ongoing offer from LinkAge to support groups on an individual basis to improve their sustainability as well as collaborating with other organisations to offer support services to groups

Sharing knowledge, support, experience and resources across and between the different member group- in particular, keeping all the groups updated and fully engaged with BABs (the Bristol Aging Better programme)

Promoting joint trips/events, opportunities and activities (selected by Consortium group members)

Some people or groups of people are more at risk of social exclusion than others. Older people in Black Minority and Ethnic (BME) communities, for example, can face significant isolation and exclusion. The Inner City Health Improvement Team (part of Public Health Bristol) work to build capacity, connect individuals and organizations and provide community health development support, and training for local community organizations and individuals to engage and lead on actions to maintain and improve the health and wellbeing of the local population. They have developed a number of initiatives with BME elder groups to reduce social isolation, and work closely with LinkAge among others. Examples of the sort of groups and activities supported include:

 Malcom X Elders and Golden Agers Clubs: Both groups are led by volunteers from Afro Caribbean community and facilitated by Link Age. Malcom X Elders Club is a social club which has run for over 20 years with around 50 attendants. 70 -90 elders attend every Monday. The group is run completely by volunteers and they also raise their own funds for transport costs, flowers for everyone’s birthday and one day trip a year. They prepare and cook two course Jamaican hot meals every week. Golden Agers have run for 25 years with around 80 attendants. They also provide hot lunch and activities including IT classes, flower arranging, patchwork and reggae gentle dance exercise activities.  Healthy Lifestyle Group (Bristol and Avon Chinese Women Group): The group runs singing, gentle exercise, dancing and storytelling. The members participate in gentle exercise run by an English speaking instructor who has designed a set of gentle chair- based simple exercises. There are dancing activities and two dancing tutors lead groups of storytelling sessions with language support. The session jogs life memory of their youth, favourite food, games, sports and past time.  Dhek Bhal Social day centre: The group runs a biweekly men’s group and a weekly women’s group and provides a range of life-enhancing activities that include light exercise, massage, walks in local parks, card playing, board games as well as housing and welfare advice and health awareness workshops on diabetes and heart conditions. The group is for the South Asian community but also interacts with people from other ethnic groups such as Somali, West Indian and white British.  Social Hub (Bristol Somali Resource Centre): This group runs fortnightly with activities for Somali elders aged over 55. Activities include table tennis run by a certified ping pong trainer, computer classes, trips and walks, advice and information sessions on health and personal care, along with quizzes and reminiscence activities.

What do Older People Think?

Respect and Social Inclusion

A number of questions asked in the Quality of Life survey over the years can be taken as indicators of general perceptions about respect and social inclusion. For example, people feeling they can influence decisions that affect them can be taken as a sign of social inclusion. This has improved slightly over the years for older people, though it is still at a relatively low level.

Only small numbers of older people feel that they have been discriminated against or harassed due to their age and the number of older people reporting such issues has slightly declined over the years – but obviously the issue still exists for some older people.

Fortunately, a far larger proportion of older people report that nothing prevents them from leaving their house when they want to.

Around 70% of people aged over 50% agree that people treat other people with respect in their neighbourhood. This has risen from just over 60% in 2006, so there has been improvement, though obviously we would like that figure to continue to rise.

Around 60 % of older people participating in the Quality of Life survey also think that people from different backgrounds get on well together in their community. This has been improving slowly over time, though there still remains some way to go.

Potential Barriers to Age Friendliness

Respect – A number of good examples of intergenerational activity exist, although more could possibly be done to increase intergenerational activity to help build trust and understanding between different age groups. Influencing Decisions - People feeling they can influence decisions that affect them can be taken as a sign of social inclusion. Quality of Life survey information indicates that this has improved slightly over the years for older people, though it is still at a relatively low level. Social Inclusion – Although the Quality of Life survey shows that perceptions among older people that people from different backgrounds get on well together has been improving, there is still more work to be done to raise these numbers higher.

10. THEME 6: CIVIC PARTICIPATION AND EMPLOYMENT

Older people do not stop contributing to their communities on retirement. Many continue to provide unpaid and voluntary work for their families and communities. Increasing numbers of older people continue to engage in paid work beyond State Pension Age. In many cases this is because people enjoy the sense of purpose and fulfilment and social connections that work provides. In other cases, it is because of their financial circumstances. An age-friendly community provides options for older people to continue to contribute to their communities, through paid employment or voluntary work if they so choose, and to be engaged in the political process.

Good Practice Example

Bristol City Council: Flexible Retirement Policy

Bristol City Council has a flexible retirement policy. There is no-longer a default retirement age for employees of Bristol City Council. Council employees (excluding teachers who have their own separate policy) can choose to resign from the authority and draw their pension benefits from the Local Government Pension Scheme (LGPS) at any time from age 60 onwards, as long as the minimum period of notice has been given. Alternatively, staff may apply to reduce their hours in the run up to retirement, without drawing pension benefits, using the Work-Life Balance Policy. Staff can also apply to reduce their hours and draw pension benefits from the Local Government Pension Scheme (LGPS) while continuing to work for the authority – which is known as ‘flexible retirement’.

‘Preparing for Retirement’ courses are also open to Council staff who may be thinking of retiring in order for them to better prepare for the change

Moreover, anyone aged over 65 who wishes to work can apply for a job with the City Council and be considered equally with other applicants.

Bristol City Council is not alone in this approach, a number of private sector companies in the city also have flexible recruitment and retirement policies. ASDA in Whitchurch had an employee working until she was 82. She dropped her hours gradually over time until she was ready to leave. The home improvement retailer, B&Q, is also proud of the diversity of its workforce, and around 28 per cent of its store employees are aged over 50. B&Q scrapped its own retirement age in the mid 1990s after a project saw an entire store in Macclesfield, Cheshire being staffed by employees over 50. The initiative produced 18 per cent higher profits and six times less staff turnover. Its oldest employee worked up until he was 90, and was employed at their store in Longwell Green, Bristol.

Looking at longer term trends, although employment rates amongst Bristol males aged 50+ years was largely the same in 2014 than it was in 2005, female 50+ employment rates

48 increased during the same period. The proportion of economically active women, aged 50+ years, increased by nearly 7 per cent between 2005 and 2014.

Yet older people have also been hit by the economic downturn. As of September 2015, the number of Bristol Job Seekers Allowance (JSA) claimants aged 50 to 64 years remains well above that for pre-recession July 2008 (1,085 versus 675 in 2008). The proportion (20%) of JSA claimants that are aged 50 to 64 year is at an historic high and 49% of claimants in this age group are long term claimants.

A wide range of volunteering opportunities exist for older people in Bristol. Retired and Senior Volunteer Programme (RSVP) West has been working with Bristol City Council for the last three years developing volunteer schemes in care homes with the aim of improving the quality of life for care home residents. Over the last year they have developed this work into setting up a successful lay assessor scheme for Care Homes. Following the success of this scheme Bristol have asked RSVP to undertake a pilot scheme to visit people who receive a Home Care service in Bristol.

Good Practice Example

RSVP: Lay Assessors

Care Home Lay Assessors It is well known that some Care Homes struggle to provide the level of care most people would expect. RSVP is committed to improving these services by using volunteers as Lay Assessors to assist Bristol City Council’s quality assurance team in their work to inspect and monitor care homes for older people in the Bristol area

Before the quality assurance officer carries out the inspection visit, the Lay Assessor will make two or three unannounced visits to the Care Home to get a better understanding of how the home works and have the opportunity to talk to residents, relatives and staff. The Lay Assessors concentrate on the quality of life of residents finding out what it is like to live in the Care Home. Their work has been described as having an extra pair of eyes. Following these initial visits, the Lay Assessor visits jointly with the quality assurance officer to assist with the inspection of the Care Home. The idea is that by visiting the homes on more occasions than the council staff are able to, the Lay Assessor brings a fresh and different perspective as well as hearing in more detail the views of the residents and their relatives.

This scheme is widely accepted as an excellent service to Care Home residents and highly valued by the council’s managers and staff in carrying out their responsibilities. Most Care Home managers welcome the scheme as they feel that by visiting on several occasions, the Lay Assessor can gain a more rounded picture of their service. Feedback from the residents and relatives has also been very encouraging.

The scheme has been running for over a year, and the Lay Assessors have worked in over thirty Care Homes in Bristol. RSVP will be recruiting more volunteers to become Lay Assessors as the scheme develops.

As well as providing training, RSVP consider good support to the Lay Assessors as essential and they meet regularly for peer support.

Home Care Lay Assessors RSVP have now set up the pilot for a lay assessor scheme for Home Care. The lay assessors will visit the people who have a Home Care service from private agencies commissioned by Bristol City Council to find out what people think about their service.

There are now plans to set up the scheme on a long term basis and RSVP will be recruiting volunteers over the next few months to set up the new Lay Assessor service for Home Care.

It is anticipated that the Lay Assessors scheme will be extended to other Bristol service areas, e.g. learning difficulties, extra care housing, domiciliary, children, day care and other unregulated services. It is also likely that the scheme will be taken up with other neighbouring local authorities.

RSVP volunteers also undertake a range of other activities, from helping to improve the lives of people who live in care homes, or running regular gentle activities sessions for older people in local community settings, through to listening to schoolchildren read and working with GP surgeries to offer all sorts of help including transport for older people who can’t get to a health appointment.

Bristol Ageing Better is looking to recruit retired or senior volunteers to undertake research into the lives of older people as Volunteer Community Researchers. As noted in previous sections, the BAB partnership is developing a wide range of actions to address loneliness in older people in Bristol and wants to train and support a group of community researchers to explore these issues.

Research tasks are varied, ranging from advising on research questions to helping with community audits of neighbourhood resources. Volunteers receive initial training and support organised through Professor Robin Means of the University of the West of England. All expenses are paid. It provides an ideal opportunity for older people to gain some new skills whilst at the same time doing something very useful for the community.

In 2014 Bristol was named as one of seven to take part in a national Cities of Service programme. The result of a collaboration between the Cabinet Office and Nesta, the Cities of Service programme looks at how volunteers can play a role in helping solve local issues. In brief, Bristol City Council will identify local challenges facing the city, mobilise volunteers to address those issues and measure the impact that they are having. Bristol is tackling key city issues including literacy, loneliness and isolation.

Bristol has successfully engaged volunteers to help increase reading rates of 5 to 7-year-olds in 5 local schools to increase the number of children who leave primary school with strong reading profiency. Bristol is also leveraging volunteers through local partners Cruse Bereavement Care and Bristol City Council to reduce loneliness and feelings of isolation among the city's older population.

Through the reading initiative, Bristol plans to make sure that all children in Bristol learn to read well and love reading for the rest of their lives. Cities of Service is linking with local companies through the Ablaze Programme, the Retired and Senior Volunteers Programme, our two universities and local community projects with a view to developing a citywide programme of reading recovery in Bristol’s primary schools.

To tackle the problem of loneliness among older people, Age UK Bristol has developed befriending services. The service works by assigning each older person a befriender, who provides friendly conversation and companionship on a regular basis over a long period of time. Age UK also provides a telephone befriending service called ‘Call in Time’, which consists of a regular daily or weekly phone call. The relationship is structured so that each befriender makes the call at a regular pre-agreed time. All of the befrienders are volunteers, who freely give up their time to help lonely older people.

The Care Forum’s Well Aware website also allows people to find volunteering opportunities near to where they live.

Education is a great way for older people to improve their skills for work, learn about something they are interested in, meet new people or have an active retirement. It is estimated that there are over 600,000 learners aged over 60 in England alone. The City Council provide information on Adult Learning Courses available in the city each year. People can sign up online at www.bristolcourses.com.

Bristol has recently dedicated to become a Learning City, to promote and celebrate all that learning can do to transform lives, organisations and the city. Learning Cities are being developed across the world to promote the importance of learning and encourage participation. The vision of Bristol as a Learning City is that it:

 Promotes and demonstrates learning as an accessible way to transform lives  Encourages a culture, in Bristol, where citizens are proud to continually learn at school, work and in communities across the City  Develops a highly skilled workforce, joining skills taught in schools and colleges with business needs for the future  Supports the development of an enterprising, diverse and sustainable world class City

It recognises that learning is for life and can offer great benefits to those facing challenges in their lives. It seeks to encourage all ages to actively learn in ways that are enjoyable and fun

51 and is yet another method by which social isolation, for both young and old, is being tackled in Bristol.

What do Older People Think?

Civic Participation and Employment

There has been a gradual decline of people aged 50 or over who are satisfied with employment opportunities in their local area, although with the economic downturn from 2008 onwards, this has been an issue for all people of working age.

The number of older people volunteering at least three times a year has slowly increased in recent years, from around 25% in 2005 to 30% in 2013 – though, given the number of volunteering opportunities that are being made available, there is scope for improvement.

Potential Barriers to Age Friendliness

Employment – employment options for older adults are still limited, the lack of computer skills on the part of some older people may be a barrier to employment, employment that lacks flexibility in working hours etc can be an issue for older people. Age discrimination – is still seen as a barrier by some older people.

Civic Engagement and Volunteering - some older adults may lack access to information about volunteer opportunities, especially lower-income older adults, often the same people are involved in many of the volunteer activities, volunteer opportunities that are rigid in their schedules and time requirements are not as desirable.

11. THEME 7: COMMUNICATION AND INFORMATION

Staying connected with events and people and getting timely, practical information to manage life and meet personal needs is vital for active ageing. The World Health Organisation state that in an Age-friendly city it is important to have relevant information that is readily accessible to older people with varying capacities and resources. This is particularly important in an age when rapidly evolving information and communication technologies are both welcomed as useful tools yet also criticized for excluding older people who may not have access to the internet.

The Care Act 2014 will bring far-reaching changes to social care provision in Bristol and across England. The aim of the Act is to ensure that social care is more up to date, able to help people live more independently and meet the changing needs and expectations of adults. As part of the Act, local authorities have a duty to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them.

A range of information for older people is already provided by the Council, including on:

 the benefits available to older people, such as Pension Credit and Council Tax reduction  issues such as dementia, support for carers, advice on pay for care and support and the services available to enable older people to continue to live at home (adult social care and health advice)  the Local Organisations Database, which provides information and contact details for over 900 local community, voluntary and self-help groups, clubs and societies, and other resources and facilities in the Bristol area.

The main way to contact Council’s Adult Care (Social Services) is through Care Direct where advisors can:

 Provide information and advice  Inform people about other organisations that may be able to help and  Inform people about the information that is available on the Council website.

For people who need more support, Care Direct will carry out an assessment over the phone. They will then either:

 Set up support over the phone  Refer someone to the Council’s re-ablement service (short-term support in a person’s own home to enable them to be more independent) or  Arrange for someone to visit to carry out a more detailed needs assessment.

Care Direct also provide assistive technology (telecare and electronic aids) if necessary. Examples include:

 A pendant alarm which can be pressed to call for help  A falls detector that attaches around the waist and which will raise an alarm in case of a fall  Magi-plugs which stop baths overflowing  Memo-Minder: helpful for forgetful people by providing reminders when someone walks past, for example ‘It’s night time, best go back to bed’  Easy 5 Silver Phone: a simple mobile phone with only seven buttons  Bed occupancy sensor: can prevent falls by switching on a light when someone gets out of bed  programmable automatic pill dispensers.

The Care Forum is a health and social care voluntary organisation providing a mixture of frontline services and support to individuals, groups and organisations. The Care Forum aims to promote health and social well-being by:

 Enabling voluntary and community organisations and individuals to participate fully and equally in the planning and improvement of services  Empowering individuals and groups to represent themselves and make informed choices  Improving people's access to services.

The Care Forum is funded by (most) local Councils and Clinical Commissioning Groups to provide Well Aware, a free online and telephone directory of groups and agencies offering health and wellbeing services and activities in Bristol, South Gloucestershire, North Somerset and Bath & North East Somerset. Well Aware also has specialist information on support and activities for e.g. people with learning disabilities, low vision resources, mental health and employment, men’s health and wellbeing issues.

Since June 2015, Bristol Ageing Better Radio has featured on Ujima Radio 98FM. The show is run by and for older people and features interviews, discussions and news of interest to older people in the city.

Good Practice Example

LinkAge: What’s On Guides

In each area where they operate, LinkAge produce ‘What’s On’ activity Guides. They are available for:

Bedminster and Southville Henbury and Brentry Lawrence Hill and Easton

Stockwood Whitehall and St George Shirehampton, Sea Mills and Lawrence Weston Hengrove, Knowle and Filwood Henleaze, Stoke-Bishop and Westbury-on-Trym Redcliffe

These guides are available in local libraries, community centres and LinkAge hubs, or can be downloaded directly from the 'Your Area' section of the LinkAge website. LinkAge also produce a 'Celebrating and Supporting Bristol's Cultural Diversity' leaflet.

The health and social care reforms of 2012 set out a commitment for statutory services to ensure that they put people at the centre when planning, designing or delivering services. To help realise that ambition, the reforms created an organisation called ‘Healthwatch’ in every local authority area across England, along with Healthwatch England - the national body. Healthwatch Bristol acts as a voice for children, young people and adults in health and social care living in Bristol. Anyone, young or old can speak to Healthwatch about their experiences of health or social care services (including GPs, hospitals, mental health services, social care teams) and tell them about what was good and what was not good. Healthwatch Bristol then ensure that service providers and commissioners hear this feedback to they can make changes to their services. When someone contacts Healthwatch with feedback about a service they have used or tried to use they will:

 Signpost them to other helpful services (using the Well Aware directory available at www.wellaware.org.uk)  Help them to access advocacy support if they wish to make a complaint about an NHS service  Record their feedback and ensure that service users have their voice considered in decisions about the running of health and social care services (through quarterly Healthwatch Bristol Issues and Concerns reports).

Healthwatch Bristol also invite members of the public who can represent community groups they are part of to volunteer with them to ensure everyone has their voice heard in the development of health and social care services. Similarly, Healthwatch undertakes outreach work to engage people who might otherwise not give their views, in thinking about and feeding back on the services they use.

While it is acknowledged that not all older people have an interest in the internet and the communication and information options it can provide, Bristol has undertaken a range of initiatives in order to get more older people familiar with new technology. For example, for a number of years the Council has run a computer re-use scheme working with Byteback to provide people with a computer (running Windows 7), flat screen monitor, keyboard and mouse for just £75. The scheme is aimed at people who are:

 Over 65 years of age,  Have a disability,  Are full time carers,  Receive means tested benefits,  Have a child receiving free school meals,  On a very low income.

Having the right skills is as important as having access to IT equipment. Another initiative, ‘Get IT Together Bristol’, focused on increasing digital inclusion in the Bristol area for anyone 55 or over, disabled adults and their adults carers through providing free, basic IT courses. A partnership between Bristol City Council, Citizens Online and BT, Get IT Together Bristol ran for three years from 2011 and worked with many local partners including Bristol Libraries, LinkAge, Local Learning (Learn Direct), Job Centre Plus, The Vassall Centre Trust, Bristol Older People’s Forum, North Bristol Advice Centre, Housing 21, Bristol City Council’s Learning Communities Team and the Tithe Barn. It has been estimated that the social return on investment for the Get IT together programme has been £3.40 for every £1 spent. The Get IT Together pilot finished in 2014 and there are now plans to continue this approach being taken forwards by the Council’s Learning City programme. Meanwhile, LinkAge is providing a version of the original service that requires significant expansion.

Other training options are also available across the city. For example, Bristol’s ‘University of the 3rd Age’, members run their own computer groups in community venues and Age UK Bristol run a course called 'Introduction to Computing', whose main objective is to promote social inclusion by building confidence and teaching the basic skills of computing. They also run beginner’s courses on how to use an iPad.

What do Older People Think?

Questions relating to communication and information in the Quality of Life Survey have been fairly limited over the years, but there is some relevant information. For example the number of QOL respondents (over 50) who feel that they have information and advice on benefits has remained fairly stable over the years, although at a fairly low level. However a declining number of people over 50 would like to see more information and advice on benefits, which would tend to indicate that this information and advice is finding its way to older people.

With respect to the internet and internet use, a range of questions were asked in 2013. The evidence seems to show that a significant number of older people are now happy using the internet (some 63%), though there remains a sizeable number of older respondents to the survey, who are not interested in using it (around 18%).

Potential Barriers to Age Friendliness

Availability of Information - Some older people may still feel there is a general lack of access to services and information and although the Quality of Life survey would tend to indicate that this situation is improving, there is still some way to go. Internet Based Information: There is a lack of knowledge and understanding of technology such as computers and the internet on the part of some older adults, not all older people have access at home to a computer and/or the internet.

12. THEME 8: COMMUNITY SUPPORT AND HEALTH SERVICES

A person’s health status impacts on their ability to work, participate in society and on their quality of life. Age is related to health in that many illnesses are more common among older people and many conditions become more severe and limiting with increasing age. Older people are therefore more at risk of poor health and poor health may be more limiting to them. Health and support services are vital to maintaining health and independence of older people in the community.

Older people all have different health care needs and preferences. A range of services along the continuum of care for older people, such as preventive care, specialist clinics, hospitals, adult day opportunities and support hubs, respite care, rehabilitation, residential and nursing care, home care and palliative care, currently meet these diverse needs. These services should be easily accessible and at convenient locations. Care homes that are located within residential areas would allow older people being cared for there to remain connected to their familiar surroundings, family and friends. Education on the health system and available health services would raise awareness among older people of the areas of care available to them. Health services should also be affordable or support available to cover the costs, to provide older people with peace of mind that they will be able to receive care regardless of the ability to pay.

Many of the examples already cited in this document are ultimately aimed at improving the health and quality of life for older people, such as the work to enable people to continue to live more independent lives in their own homes, the work to tackle the issue of social isolation and the work to keep older people more engaged with their communities through volunteering, intergenerational and social activity. However, a number of other examples can be cited which also contribute to the theme of community support and health services.

Home Care services are available to older and disabled people. Currently 1,700 people in the city rely on the council to arrange care for them at home – and they receive over 21,000 hours of care each week. These services have recently been recommissioned. Under the new contracts, the main providers have committed to delivering flexible care services which put an individual’s preferences at the heart of things. Care will focus on helping people to be more independent and participate in activities they enjoy. This will include enabling people to connect with local community services and support with their general health and wellbeing. The providers will also have offices across the city, so people can more easily discuss their care needs face to face. The main providers will pay the current living wage, offer all new employees guaranteed hours contracts and ensure staff are paid for all the time they work, including travelling to care visits. Furthermore, each main provider is looking to recruit staff that live in the local area so they understand the needs of their community and the people that require home care services.

One of the projects being developed as part of the Bristol Ageing Better programme is ‘Combining Personalisation with Community Empowerment’ (CPCE). The aim is to ensure that isolated older people, including those in receipt of social care services, also receive additional volunteer support to improve their quality of life and emotional wellbeing through linking them to social activities. A ‘life plan’ will be developed based on someone’s personal aims, which helps them make the most of flexible local, voluntary and community services. The services offered help people have fulfilling lives, achieve personal goals and take part in social activities, thereby reducing social isolation and supporting them to stay in their homes longer. At first, all services offered are additional to existing care packages. However, over time, it is hoped that people may become less reliant on statutory care services and that any cost avoidance achieved as a result, can be reinvested in the local community.

A Better Care plan for Bristol has been developed by Bristol Clinical Commissioning Group and Bristol City Council in partnership with the main Health and Social Care providers. The plan was approved by Public Health England in December 2014. The plan seeks to improve the ways health services and social care services work together, starting with services for older people and people with long term conditions. The main aims are:

 Improved services even though there is greater demand and less money.  People cared for in their own homes, reduced lengths of stay in hospital.  Help for people to better manage their health conditions.  Spending money on supporting people to live well in their communities, to prevent them needing costly health or social care services later.

As part of the consultation process when developing the plan, a number of case studies were used, so people could consider what services were already in place and what services could potentially exist in future. 87 year old Bob, and his 85 year old wife, Irene, who live together in Bristol, were one such case study and resulted in the following diagram, outlining the services currently available and what could be made available if there was a greater integration of health and social care services.

The top priorities for change are:

 More Joined Up Services including Health and Social Care, community services and the voluntary sector  Patients only needing to ‘tell their story once’  Services closer to home and in the community  More focus on reablement  More focus on prevention and self-care

Tackling the risks posed to older people by falling is one of a range of preventative health measures being undertaken by Public Health Bristol. Reducing falls risk not only helps reduce the chances of injury, but also helps build people’s confidence and contributes to their ability to enjoy life. Public Health Bristol is working with the Department of Health and VOSCUR to train community and voluntary sector organisations to signpost older people who are potentially vulnerable to falling. Through the Avonsafe Partnership, Avon Fire and Rescue Service are identifying and signposting vulnerable people and Public Health (Bristol) is funding the training of 600 social workers to do the same. Public Health have also funded a project to improve the management of falls in care homes and building falls and other health outcomes into the service specifications for residential care. Bristol Community Health is contributing to the safety net approach and, as well as delivering important falls- related primary care services, has trained its staff to screen people for falls vulnerability.

A £430million redevelopment of Southmead Hospital was completed in April 2014 and it is now a centre of excellence for the South West and beyond in a range of services and major specialties, including:

 Neurosciences - including pioneering deep brain stimulation techniques for the treatment of functional disorders such as Parkinson’s disease and strong links with the University of Bristol with ground-breaking research into the treatment of conditions including Multiple Sclerosis and Dementia.  Orthopaedics – one of the largest orthopaedic centres in the South West with an international reputation for hip and knee surgery, carrying out 1,000 knee replacements a year. A highly experienced team for hip fractures, including specialist services in lower limb reconstruction, spinal surgery and upper limb reconstruction.  Renal and Transplant - at the forefront of the living kidney transplant programme for many years and has some of the best success rates in the country. Also the UK’s largest referring unit for the pancreatic transplants. More than 430 patients receive dialysis at Southmead Hospital or one of their satellite units including a new dialysis centre at the redeveloped Cossham Hospital in Kingswood.

Research shows that older people who are supported at home after returning from hospital are less likely to be re-admitted. We also know that people who volunteer are happier, have an increased sense of wellbeing, and enjoy a better quality of life. The work of the Royal Voluntary Service has combined both aspects in their ‘Home from Hospital’ services.

Good Practice Example

Royal Voluntary Service: Home from Hospital Services

Older people’s charity Royal Voluntary Service has partnered with University Hospitals Bristol NHS Foundation Trust (UH Bristol) to launch several new services to help older

62 patients recuperate safely at home after a stay in hospital; and also to live safely and independently in their own homes for as long as possible. Volunteers are being sought to:

- Assist with the Home from Hospital service which supports older patients following their discharge with up to 6 weeks of regular home visits to aid recuperation and reduce the likelihood of re-admission;

- Work alongside hospital staff and existing hospital volunteers to help prepare older patients for going home, with practical assistance like providing a lift, collecting prescriptions and general befriending to reduce anxieties;

- Participate in a ‘Good Neighbours’ service to support older local residents; especially those who wish to stay living in their own homes for as long as possible and might just need a little assistance with simple day-to-day tasks.

The services, which will be offered at Bristol Royal Infirmary and South Bristol Community Hospital, are being funded using profits from the facilities currently run by Royal Voluntary Service volunteers at hospitals across Bristol.

Bristol has been the focus of a number of studies that illustrate the effectiveness of the collaboration between health services and voluntary and community sector organisations. For example, an assessment of the impact of the LinkAge hub in Whitehall and St George in 2012 by University of the West of England (UWE) indicated that for every £1 invested in the Whitehall and St. George Hub there was a Social Return on Investment (SROI) of £1.20 and this was considered an underestimation of the potential return in the medium term. Similarly, another 2014 study by UWE of the Wellspring Healthy Living Centre's Social Prescribing Wellbeing Programme found that for every £1 of investment in the intervention, £2.90 of social value was created. Again, this was considered by UWE to be a likely underestimate.

Local authorities and health services are having to manage ever shrinking resources and so will need to continue to explore new approaches to meeting local health needs. A fundamental shift in emphasis is required over the next few years, giving greater prominence to care co-ordinated around individual needs rather than single diseases, and a much greater focus on prevention and support for maintaining independence.

What do Older People Think?

There are numerous questions in the Quality of Life Survey that relate to Community Support and Health Services. There appears to be a high level of satisfaction among people over 50 with local health services, and this satisfaction has increased slightly over the years. Satisfaction with social services is also increasing, though remains at a lower level than for health services.

Those reporting a limiting long-term illness, health problem or disability has remained relatively stable over the years, at around 45% of respondents. However, the number of people over 50 who say their health has been good or fairly good during the past year has remained stable at a high level.

The number of people reporting in the survey that they have fallen in the previous 12 months has remained fairly static over the years, with around a quarter of all over 50 respondents having reported a fall each year, between 2006 and 2013.

The Quality of Life Survey shows a reduction over time in older people who smoke, and also in those who live with a smoker.

Those people aged over 50 who regularly exercise or eat at least 5 portions of fruit and vegetables per day has remained fairly static over the years.

In terms of health facilities a high percentage of people aged over 50 report easy access to a doctor. A somewhat lower percentage report easy access to a hospital, although the question has not been asked since 2009 so it is difficult to gauge current perceptions.

Overall, however, very many people aged over 50 report that they are happy and this has remained consistently high for many years.

Potential Barriers to Age Friendliness

Access – According to Quality of Life data many older people have easy access to a doctor, but there are still improvements to be made to ensure easy access to a hospital.

Diet and Exercise – According to Quality of Life data, just over half of respondents aged over 50 are having 5 or more portions of fruit and vegetables per day – this has risen very slightly over the years but there is still some way to go (though people aged over 50 are performing better in this respect than those aged under 50). Those reporting taking exercise at least 5 times a week has remained fairly static at around 35% for a number of years.

Social Care and health Services - Some individuals lack knowledge or information about available services. Nevertheless, satisfaction with health services is high. Satisfaction with social services has been improving but remains lower.

How Age Friendly is Bristol: Draft Baseline Assessment has been produced on behalf of Bristol Ageing Better and Bristol City Council. www.bristolageingbetter.org.uk

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