Draft Social Wellbeing Strategy – 2016
Reducing loneliness and increasing participation
1. Vision and objectives
The City of London Corporation’s Adult Wellbeing Principles includes a commitment that people are not socially isolated and that they have the relationships and support they need. The objective of this strategy is to realise this commitment in practice. We will do this by pro-actively reaching and supporting socially isolated individuals and by investing in personal and community assets to better respond to the challenge of loneliness.
2. Background
2.1 The extent of loneliness
Loneliness is a national issue. A report from Age UK found that 7% of people aged 65 or over in England said they always or often felt lonely. Including those who say they are sometimes lonely, the figure rises to 33%.1 There are reasons to believe that the City may be particularly affected, due to its older population and the prevalence of single person households. Greater London has an average of 11% of residents over 65, while the City has 14%, and 51% of these older people live alone, compared to a national average of 33%.
While loneliness can affect anyone, certain groups have been found to be more at risk. Older people are significantly more likely to be at risk, especially when coupled with a loss of income or existing relationships, living alone or in residential care. Being single, widowed, divorced or never married increases the risk of loneliness, although those who have a partner or child but do not feel close to them are more likely to report loneliness than those who are single or childless.2 A range of personal characteristics make loneliness more likely, such as entering later old age (75 years and over), being from an ethnic minority community, being gay or lesbian or having a mobility, cognitive or sensory impairment.3
While social isolation is predominately an issue for older people, it can be an issue across the life course. A survey conducted on behalf of Family Action found that one in five new mothers lack support networks to help them through pregnancy and are unaware of the services available to help with depression. Among mothers living in low income households or from certain ethnic minorities, the figure rises substantially.4
A survey by the Campaign to End Loneliness found that 16% of over 60s would not know where to go for help if they were feeling lonely, while many people are unwilling to seek help or identify as lonely because of the stigma associated with the issue. This is therefore not
1 Age UK Evidence Review: Loneliness in Later Life 2 Loneliness, relative deprivation and life satisfaction; Panayotes Demakakos, Susan Nunn and James Nazroo 3 Campaign to End Loneliness Risk Factors: Factsheet 4 Mahadevan J. New mums lack support to cope with isolation and depression 1 an issue which all individuals will have the capacity to solve for themselves and intervention from the statutory, voluntary and community sectors is required.
Public services are concerned about loneliness for three reasons. Firstly, because dissatisfaction with one’s level of social contact leads to lower personal wellbeing. Secondly, being lonely has a significant impact on an individual’s physical and mental health, which in turn leads to earlier than expected support needs and requires the provision of health and social care services.5 Finally, social isolation can mean that someone is more at risk of abuse or neglect.
5 The costs of an individual being chronically lonely are estimated at £12k per year in additional GP and A&E visits and social care costs. 2 2.2 Social isolation and loneliness
The relationship between isolation and loneliness is a complex one and while the two terms are closely linked they are distinct concepts. Isolation is an objective term to describe a person with limited social connections. Loneliness is a measure of a person’s feelings about their social relationships. It is a deeply subjective, personal state and a level of social contact that may satisfy one person may leave another profoundly lonely.
While the two states can be closely related, one does not imply the other. It is possible to be socially isolated but not lonely; a person may prefer a life of relative solitude and find that this has no adverse effects on their quality of life. It is also possible to be lonely without being isolated and older people in large households and care homes are more likely to report loneliness.6 Both social isolation and loneliness are recognised as issues that should be addressed in the context of improving health and wellbeing, although it is uncertain whether they have independent effects on health or whether isolation impacts on health via loneliness. There are therefore three groups affected by either social isolation or loneliness:
the socially isolated and lonely – the most obvious target of any intervention, whose loneliness may be reduced by reducing their level of social isolation; the lonely but socially connected – interventions targeting this group may concentrate more on improving the quality of existing relationships, providing opportunities for specific interactions or reframing their attitude to the time they are alone; the socially isolated but satisfied – although happy with their limited social relationships, this group could be at risk if their personal circumstances change.
2.3 Policy context
The 2010 Marmot Review sought to identify the most effective evidence based strategies for reducing health inequalities. These included:
putting empowerment of individuals and communities and reducing social isolation at the heart of action on health inequalities; paying attention to the importance of stress and mental health in shaping physical health and life chances, and the importance of personal and community resilience; concentrate on the ‘causes of the causes’ – that is, invest more in the material and psychosocial determinants of health.
Following on from Marmot, the NHS Five Year Forward View provided a renewed emphasis on community planning and improving the social determinants of health.
The Care Act 2014 creates a clear imperative for a range of key local partners to take action to address loneliness and isolation. It states that a local authority must promote wellbeing when carrying out its support functions. The wellbeing principle includes; personal dignity, physical and mental health and emotional wellbeing, protection from abuse and neglect, control by an individual over day to day life, participation in work, education and leisure activities, social and economic wellbeing, maintaining personal relationships and the individual’s contribution to society.
Loneliness and social isolation present substantial barriers to a number of these principles. The City Corporation’s Adult Wellbeing Principles therefore includes a commitment that people are not socially isolated and that they have the relationships and support they need.
6 Age UK Evidence Review: Loneliness in Later Life 3 4 2.4 Level of need in the City’s population
Within the City 14% of residents are aged 65 and over, higher than the Greater London average of 11%. The City also has a higher proportion of older people in the more at risk group, with 4% of the population over 75 years of age, compared to a Greater London figure of 3%. This is due in large part to the City’s high life expectancy, which at 83.4 years for men and 87.3 for women, is the highest in England and Wales.
The City also has a large number single person households and around a fifth of these are home to a person over 65. Nationally 13% of people live alone (in 30% of households); 9% of people aged under 65 and 33% of people aged 65 years or more. In the City, 34% of people live alone (in 56% of households); 31% of people aged under 65 and 51% of people aged 65 years or more. About 58% of these older residents living alone are women and 42% are men.7
Household Composition by Census Resident Zones; Source: Office of National Statistics © Crown Copyright 2012
By no means will all, or even the majority, of these people be lonely or socially isolated. However, as older age and living alone are such strong risk factors, they can be used as a starting point to estimate the level of need in the population. In addition the fact that the City’s population profile is expected to age further suggests that loneliness and social isolation may become increasingly prevalent.
The English Longitudinal Study of Aging (ELSA) (analysed by Age UK) has informed work from the Office for National Statistics on the risk of loneliness in the over 65 year old population. The darker areas of the map (below) show the areas with the greatest predicted prevalence of loneliness in the City and Hackney. The probability of loneliness is based on the proportion of older people in later old age (75+), those who are widowed, divorced or separated and those reporting very bad, bad or fair health in the 2011 Census. The closer the value is to 0, and the darker the shading, the greater the probability of loneliness.
7 Census 2011 / ONS 5 This indicates that older people in two areas, Golden Lane and Portsoken, home to large concentrations of the City’s population, stand out as being in the third and second loneliest deciles across Greater London. That the City’s other main population centre, the Barbican, appears to be relatively low risk is likely due to the map’s focus on poor physical health as a cause of, and thereby proxy for, loneliness. While older residents living in the Barbican may be less likely to report poor health than their counterparts living elsewhere in London, other sources of local evidence suggest that it would be a mistake to assume there is no problem with social isolation here.
The City Corporation and Healthwatch hosted a series of ‘Ageing Well in the City’ workshops in 2014 to learn about people’s needs as they grew older. The events brought together residents, including Adult Social Care service users and carers, to help shape the future development of services. A particular theme raised during the events was a need to do more to tackle social isolation and loneliness. In addition, anecdotal evidence from housing officers and City residents suggests that the socially isolated ageing population tends to be concentrated in the north of the City, and may be ‘asset rich and income poor’.
In order to better understand how to assist residents experiencing loneliness and social isolation, the City Corporation commissioned Dr Roger Green, from the Centre for Community Engagement Research at Goldsmiths University, to explore the level and nature of need in the local older population. This powerful piece of research provides an insight into the personal experience of loneliness as lived by City residents.
The study used a community focused qualitative ethnographic approach to gain older residents’ views. While living in the City of London was experienced by older residents in a
6 number of different ways, the experience of being socially isolated or lonely was voiced by many residents. However, a number of keys themes emerged from this:
Many residents chose to live in the City because of the anonymity that comes from living in the centre of a large conurbation. This solitude can turn to isolation and become problematic following a major change such as retirement or bereavement.
Other residents spoke of feeling separated from friends and relatives living elsewhere in the UK or abroad. While many maintained regular phone contact, they still complained of feeling isolated from family. Looking at ways to support these residents to improve their existing relationships could be worthwhile.
The passive exclusion of minority groups from existing community groups and social networks also emerged as a common theme. Ethnicity appears to be an issue on the Mansell Street Estate, with one resident saying said she felt that there was ‘no bridge’ between the different communities that would allow for natural socialising and community building to take place.
At the Barbican, evidence of social isolation was particularly prevalent amongst LGBT residents. Dr Green found that their involvement with the Barbican’s community groups and activities was minimal and that there was no contact with befriending or good neighbour schemes despite an evident need.
A final theme to emerge was the difficulties presented by the physical landscape of the City. Some felt isolated by the extremely urban built environment and those in later old age or with physical disabilities found the physical layout of their estates difficult, while several Barbican residents commented that they found the experience of living in such a vast, yet often quiet, estate alienating in itself.8
While Dr Green was asked to look specifically at the experience of older people, it should be remembered that other groups may also be affected. For example, carers, younger disabled adults, parents with young children, the long term unemployed, people with mental health issues, and refugees and asylum seekers are all known to be at greater risk of loneliness.
In the City 42.5% of adult social care users said they had as much social contact as they would like. While this is similar to the average for Greater London (41.8%) and England (44.8%) there is clearly still a long way to go. Among carers the City performs noticeably better than average with 46.4% of carers expressing satisfaction with their level of social contact compared to 35.5% across Greater London and 38.5% across England. While this is certainly an encouraging sign, it still shows a majority of carers experiencing elements of social isolation and loneliness.
Anecdotal evidence from Health Visitors and Early Years Practitioners working in the City also suggests a considerable number of new parents experience isolation and feelings of loneliness. If left unchecked, these can quickly escalate into mental health problems and increased isolation, extending to the children as well. This problem appears to cut across demographic groups. Nationally parents on low incomes or from BME groups are more affected by isolation. In the City these longer term residents tend to have enough of a social network to mitigate at least some of the problem. In contrast, high income professionals who move to City for employment, and are then isolated from family and friends in other parts of the country or abroad, have no social network and may be just as at risk.
8 Dr Roger Green and Tim Stacey, The Voices of Older People: Exploring Social Isolation and Loneliness in the City of London, October 2015 7 8 2.5 Segmenting loneliness
The evidence and data above can be used to produce an estimate of how many, and which, City residents are affected by loneliness. The calculations used, together with an explanation are provided in Appendix A.
Overall we estimate there are at least 287 individuals in the City living with severe loneliness. This number can be further broken down by demographic group and into six geographic areas.
The addition of data on social care service users, informal carers and parents of young children does not substantially alter the ELSA / Age UK data mapped in the previous section. As with the previous analysis, this finds that the Golden Lane and Portsoken areas are home to the majority of individuals at risk of loneliness.
The use of social care and birth data to complement the ELSA study gives the Barbican a stronger presence, accounting for just over a quarter of the total at risk population. However, Dr Green’s research suggests that this is still likely to be an underestimate and figures should be seen as a minimum.
Only a small number of potentially lonely people live outside of the City’s main residential areas. These individuals may be especially hard to identify and link in to appropriate services. The loneliness model also allows the estimate of isolation to be broken down into key demographics.
The ‘loneliness across demographics’ chart (left) provides an at a glance breakdown between older (blue) and working age (green) groups, as well as all those providing informal care (by viewing the dark blue and dark green sections together) and all those receiving formal care (by viewing the light blue and light green sections together).
This suggests that around two thirds of lonely individuals in the City are over 65. Around half of the total is made up of older people who neither provide nor receive care, and as such they are unlikely to already be known to Adult Social Care.
9 A quarter of lonely individuals are informal carers and around two-thirds of these are of working age. Some, but by no means all, of these people will be known to Adult Social Care services. In the 2011 Census, 121 people said they provided at least 20 hours of unpaid care per week. However, only 60 carers are known to Adult Social Care and 22 engage with the City Carers Service per quarter.
One in seven lonely City residents receives care from Adult Social Care. The majority of these are older people. A similar number of working age parents are thought to experience loneliness. These will all receive personal contact from a Health Visitor and an information pack from the FYi service, but those who become isolated are unlikely to have yet taken up the offer of the play groups and early help services that the City Corporation provides. Finding the isolated parents, informal carers and older people without care needs will be a key challenge in tackling loneliness in the City.
Many people who experience severe loneliness will not fall into any of the groups listed above. In the previous section, the unemployed were noted as a group at risk of isolation. In March 2016 the City had 120 Jobseeker's Allowance claimants and while most re-enter the workforce quickly, 20 people had been claiming for a year or more. Half of all claimants are in Portsoken, with a quarter in Golden Lane and a quarter in the West of the City. Most long-term claimants are male, aged between 25-50 and previously worked in sales, retail or customer service. While issues of loneliness and isolation may be best resolved by finding work; building confidence and social networks may also help the long-term unemployed to find work and it would be beneficial to also include this group in whatever loneliness interventions are developed.
Again it must be recognised that loneliness is an experience unique to each individual and factors that may leave one person lonely, another would take in their stride. The figure of 287 should be seen as a minimum, acknowledging that the figures for the Barbican based on ELSA data may be an underestimate and recognising that loneliness does not just affect older people, carers, new parents and people with disabilities. While it is helpful for services to target these groups, they should also be open to all comers and look to tackle loneliness wherever they encounter it.
The geographic and demographic estimates above can be combined to give a snapshot of loneliness in each part of the City. It is unhelpful to view the Barbican as two separate areas, as this is a statistical division rather than one which is recognised by local residents or services. LSOA001A and LSOA001B are therefore presented combined.
Loneliness in the Barbican
The loneliness estimate for the Barbican looks similar to the City as a whole. The majority of those at risk of loneliness are over 65, around a quarter of the total provide unpaid care and another quarter are parents of young children. Only a small proportion of the Barbican estimate receive social care and these are almost all older people. Anecdotal evidence tells us that the lonely older population in the Barbican is likely to be asset rich but income poor. Dr Green’s study also observed a particular problem with the LGBT population.
Loneliness in Golden Lane
Loneliness in Golden Lane appears to be overwhelmingly an older people’s issue, with 80% of those thought to be affected over 65. While the proportion providing informal care is in line with the City average and a slightly higher number receive formal care, the vast majority have no known care needs. There are fewer working age carers and parents at risk of loneliness on Golden Lane and a negligible number of working age care recipients. 10 Income may be a factor restricting social activities for some older people on Golden Lane. Of the City’s 130 Pension Credit claimants in August 2015, 50 lived on Golden Lane. Claimants are overwhelmingly single (45) and probably live alone, most are female (35) and half (25) are in later old age (80 are over). Given the overlap between the characteristics of Golden Lane’s Pension Credit claimants and the risk factors associated with loneliness, it is likely that a large number of these lower income pensioners are also dealing with issues of isolation.
Loneliness in Portsoken
Loneliness in Portsoken is also primarily an older person’s issue, but this is much less pronounced than in Golden Lane, with working age people accounting for 40% of the total.
Few older residents provide informal care, while a large number of working age residents do. Porksoken is also the only part of the City where working age recipients of social care feature in larger numbers (primarily receiving support for physical disabilities).
Portsoken has a higher number of Pension Credit claimants (60) than Golden Lane, despite having fewer people of pension age overall, indicating that income is likely to be an even larger barrier to socialising here than in the City’s other area of social housing. Pension Credit claimants here are slightly less likely to live alone (50), have an even split between men and women and are younger, with only 15 claimants over 80. People here are also more likely to receive the guarantee element, which has a greater correlation with income. Taken together, this means that lower incomes are more prevalent amongst older people in Portsoken than on Golden Lane and that those affected look less like a unique sub-group and more similar to the general local population.
Dr Green’s research observed a particular problem with BAME older people in Portsoken, particularly those giving their ethnicity as Bangladeshi. Portsoken is a relatively young area, with just 13% of the population over 65, compared to 19% across Golden Lane and Barbican. The BAME population is younger still – while people of Asian origin make up 28% of the total population, they represent only 9% of over 65s. This is true of other BAME older people, who make up 20% of the total population, but only 9% of over 65s. When discussing social isolation in the older BAME population, it is important to remember that the number involved is likely to be quite small. However, national data and our local research indicate that problems with loneliness are likely to be especially prevalent.
A large proportion of Portsoken’s older people are Jewish – 11% of those aged between 65- 74 and 31% of those over 75. This older Jewish population is 33% male and 66% female.
Loneliness in the West and Central areas of the City
The total estimate of lonely people in the non-residential areas of the City is small, making up only 10% of the total in the west and central areas of the borough combined. The picture of who is lonely is also very different here.
In both areas it is mainly working age people who are affected. In the centre of the City, loneliness is primarily thought to affect parents of young children. In the West of the City unpaid carers stand out as making up almost half of the total. Housing tenure is likely to restrict the population in both of these areas to affluent individuals.
Targeted interventions aimed at busy professionals juggling work with parenting or caring responsibilities could be considered here.
11 12 2.6 Current provision
A wide range of activities are already on offer in the City that provide opportunities for social interaction and guard against social isolation and loneliness. A list of services provided or funded by the City Corporation can be found in Appendix B.
These include activities with a wide ranging appeal, such as Spice Time Credits and the reading, interest and skills based groups available through the City’s libraries, to groups targeted at specific demographic groups or geographical areas such as the City 50+ Network or the Ralph Perring Club serving Golden Lane. An even greater variety of activities are available to those able to travel outside of the City’s boundaries and a Small Grant Scheme is available to residents who want to set up a new social group.
A wide range of provision is also available for parents of young children, mostly delivered in Children’s Centres and Libraries. Some schemes are aimed those facing social isolation, such as Outdoor Explorers, a six-week course designed to build confidence when taking children outside and on public transport, and Nanny Stay and Play, which aims to provide Nannies with a support network and tackle loneliness. Outreach and Early Help services are good at linking parents into suitable services once they become known. The difficulty with this group is finding at risk families, given that by definition they have few links to services and community groups.
Volunteering is an important step individuals can take to reduce feelings of loneliness and is one strand of the New Economics Foundation’s ‘five ways to well-being’. The City’s volunteer activities are commissioned from Age UK and Spice Time Credits. Spice’s 2015 evaluation found that 60% of volunteers said their level of social contact had increased as a result of Time Credits, 32% said they felt less socially isolated and 13% had started a new community group. The recent Volunteering Review found that the volunteers being recruited are reasonably representative of the City’s residential communities.
Dr Green’s study found that there was a degree of passive exclusion present in some less formal community groups, with some residents commenting that a selective atmosphere prevailed. The problems experienced by BAME or LGBT residents have already been discussed. Other resident groups represent only leaseholders to the detriment of tenants, and others still are subject to considerable controversy and conflict. As a result accessing a community group was problematic for some residents.
Community events that aim to bring people together between estates have typically struggled. This is particularly evident in Portsoken, where events will attract residents from either Mansell Street or Middlesex Street, but not both. The Mansell Street Estate has been identified as having particular issues, due to residual connections to Tower Hamlets, specific challenges presented by its harder to reach population, and communication issues arising from its status as a Registered Provider, rather than City Corporation, Estate.
Work is already underway to address some of these issues. Southwark Mediation Centre are working with our Community Development team to establish inclusive and positive organisations across the City. The Avondale Community Events (ACE) Group already provides an example of a good community initiative in practice that others could try to emulate. The CityPlay East aims to use a major arts project to strengthen connections between the two Portsoken estates, giving a lasting sense of community cohesion, while the Aldgate Square scheme will provide the area with a pleasant, central, public space by 2017.
13 2.7 Evidence on interventions
Overall, evidence of what makes for an effective intervention to reduce loneliness and social isolation is limited. One systematic review of the evidence evaluating interventions to address social isolation amongst older people was carried out by Cattan and White.9 A later summary of the evidence base on loneliness interventions compiled by for the National Institute for Health Research came to much the same conclusions as Cattan. The researchers were able to say that:
Group based interventions showed promise in reducing loneliness, especially when targeted at a specific group and with a specific activity in mind. Long-term effectiveness may be improved by providing activities that enhance self-esteem and personal control. Where groups have a support purpose (i.e. bereavement), attendance needs to be over a period of five months or more to be of benefit. Getting a lonely individual to be a regular participant in such a group should be seen as an important milestone of success. One on one contact from health or social care workers may be successful at achieving other objectives, but had no impact on loneliness. One on one voluntary interventions appear to be of limited impact and the majority of evidence reviewed did not demonstrate any statistically significant effects of one-to- one interventions on loneliness or social isolation. Befriending schemes have been shown to have a modest effect on depression in some population groups, but the benefit of such schemes in older people is unclear. While they have less of an evidenced impact, interventions of this kind still have their part to play, especially for individuals with difficulties making new connections and with physical barriers to engaging in larger groups or new settings. While following this evidence may indicate a preference for group based interventions, it should be remembered that many groups already exist and these have not been enough for a large number of lonely people. This is because groups are only accessible for those who already possess the social skills to participate. One on one interventions that have shown promise are those that aim to find and work with individuals at the stage before they can begin access the lunch clubs, book clubs and other groups activities. Interventions of all kinds were far more effective when participants were given some level of control and when they were involved in service design and delivery. The outcome of technology-assisted interventions depends on whether existing relationships are being developed and new ones being sought. There is some limited evidence of benefit from computer training to enable older people to communicate more with friends and family. Three systematic reviews of telephone- based interventions looking to match people with new contacts showed no decrease in loneliness.10
Evidence also suggests that an asset based approach is likely to be effective in tackling social isolation and loneliness. Cattan and White touched on this when they advised involving participants in the design and delivery of services. Embracing an asset based approach goes further. Instead of looking for deficits in communities which public services need to fix, this methodology seeks from the outset to identify and value the capacity, skills, knowledge, connections and potential within a community.11
9 Cattan et al. (2005). ‘Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions’. Ageing and Society 25:1. pp.41-67 10 Interventions for loneliness and social isolation; The University of York Centre for Reviews and Dissemination, January 2014 11 I&DeA, A glass half-full: how an asset approach can improve community health and well-being 14 This involves a switch in perspectives on behalf of agencies to go from thinking about what action can be taken to improve communities, and to instead think about how communities can be empowered to improve themselves. Instead of being passive recipients of services, residents are instead thought of as active agents in their own lives – not as having problems needing to be solved but as being the source of solutions. Taking an asset based approach to tackling loneliness is more likely to yield effective results as this is most likely to deliver a range of services that are what older people want, to genuinely involve older people and to be sustainable in the longer term.
A demonstration of the assets City residents might be able to offer to tackle loneliness can be found in the National Indicator Set. This contains several sets of indicators that, when put together, are used to give a proxy measure for levels of social capital.
Indicator12 City of Greater England London London People who feel they get on well together 91.6% 76.3% 76.4% People who feel they belong in the neighbourhood 58.7% 52% 58.7% People who feel they can influence local decisions 41.8% 35% 28.9% People who participate in regular volunteering 23.6% 20.8% 23.2%
On all measures the City of London exceeds the Greater London average and either exceeds or matches the English average. Our communities already have a high level of social capital and a willingness to get involved. The challenge for the City Corporation comes in finding a way to fully unlock the community’s potential and enable it to deploy to resources of local residents to tackle social isolation.
Across the range of interventions discussed in the following strategy, care should be taken to empower communities to take action for themselves from the outset. Control should be shared not only over how services are commissioned but also over what services are commissioned. Residents have already had some input into the formation of this strategy through the Aging Well events and by participating in Dr Green’s research. This must be an on-going, iterative process.
Every project should aim to involve service users in design and delivery. The beneficiaries of the first round of a befriending project should be encouraged to become befrienders themselves in the second stage. Embedding Time Credits in every project wherever possible will help realise this. Schemes like the Neighbour Network should be facilitated by the City Corporation while they find their feet, but the medium term aim should be for them to be autonomous and run by local residents, for local residents, with the council only providing what the community cannot do for itself. Running activities in this way not only makes them sustainable, by virtue of embedding them in the community, but also recognises that volunteering and taking an active role in civic life is in itself an empowering experience and a powerful way to connect to neighbours and wider society.
Many experts have also highlighted the significance of intergenerational contact as a key feature of successful interventions. A review of Asset Based Community Development approaches found that intergenerational contact was a common feature of successful interventions.13
12 Place Survey 2008 13 Klee, D, Mordey, M, Phuare, D, Russell, C. (2014), Asset based community development – enriching the lives of older citizens, Working with Older People, Vol. 18 Iss 3 pp. 111–119 15 3. Strategic Theme One: Pro-actively reaching, understanding and supporting lonely individuals
Throughout Dr Green’s research, City of London residents report being lonely but also that something is holding them back from engaging in the community life they know, to a greater or less extent, to exist on their doorstep. He found that many lonely people were waiting for a helping hand to take the first step and approach these groups, either because they were unaware of what was available, because of a lack of confidence and a fear of rejection or simply because long established habits can take some encouragement to break.
Instead of waiting for lonely individuals to come forward and ask for help, there is a need for a more nuanced befriending approach that reaches into the City of London’s communities directly and pro-actively. These services aim to reach individuals, understand their needs and strengths as individuals and then support them to re-engage with the wider community.
Identifying lonely individuals is a key challenge and will form a constant part of an effective service’s day to day work. The City Corporation should seek to identify and support lonely individuals in the following ways:
Implementing a ‘Community Connector’ service to use social networks and as yet untapped sources of referrals to identify and engage with lonely people Utilise the Fire Service’s Home Fire Safety Visits, targeted at vulnerable people living alone, to address issues of isolation and unmet social needs as well as reducing risks in the home Enlisting City Corporation providers of services that have a social aspect to re- establish contact with those who have dropped out of attending Using frontline council officers and contractors as our ‘eyes and ears’, making the most of every contact with a resident at risk of isolation and loneliness Enhancing social prescribing in the City to fully utilize the GPs surgery as a means to find and support lonely people
3.1Implementing a ‘Community Connector’ service to use social networks and as yet untapped sources of referrals to identify and engage with lonely people
A system of Community Connectors would emulate the successes of the Gloucestershire Village Agent scheme discussed overleaf. The Community Connector, supported by a number of Volunteer Connectors, would use their existing networks along with referrals from a range of sources to identify and then pro-actively contact at risk individuals.
They would frame their contact not as a loneliness solution, but as a holistic and person- centred service, aimed at promoting healthy and active ageing, building resilience and supporting independence. A ‘guided conversation’ – a relatively unstructured engagement with the older person – would explore their circumstances, needs and wishes leading into a discussion about what might be available to improve their wellbeing. The Community Connector would then either refer the older person to services that may be better placed to help, or provide support themselves. This might include making introductions to other people in the community who share their interests, accompanying them to the first few sessions of a community group, or buddying them up with other new attendees.
Using a ‘Bobby on the Beat’ approach, the Community Connectors will become a familiar and trusted neighbourhood presence. Recruiting Volunteer Connectors to offer their time and personal networks in support of the paid worker will ensure the project has as broad a
16 reach as possible. Referrals will also be sought from a variety of non-traditional sources. Very few isolated people have no contact with anyone at all and by seeking to use as a wide a range of referrers as possible, the project should be able to effectively reach a large number of lonely people.
Local residents have the best potential to know who in their neighbourhood is at risk of loneliness. However, Dr Green’s research found that many would not be comfortable making an unsolicited approach themselves and others may lack the time to get involved further. This has been echoed by Estate Staff, who feel that in many instances residents can be more comfortable bringing problems to them rather than approaching each other.
The ‘gatekeeper model’, widely used and found to be effective in North America, can enable these people to play a part by referring individuals they believe to be at risk to the Community Connectors for further action. In practice this would require work to raise awareness of the Community Connectors amongst members of the public and a well- publicised and easy to use set of referral contact details. The scheme and referral process should also be promoted to other potential sources of referrals in the community, including local clergy, pharmacies, cafes and other businesses with a predominately resident client base.
Camden Community Connectors (CCC) have five full-time Area Coordinators, serving a population of 25,300 over 65s (2013 JSNA Estimate). For the City’s much smaller population of 1,276 older people (2014 mid-year estimate), an equivalent level of staffing would be one 0.25 FTE post. The Project Manager at CCC warned that working on this basis would present too many practical challenges. The worker will need to work around client, volunteer and partner availability, as well as the timings of the events people may ask for support to attend. However, while the worker may need to be available on a full-time basis, they are likely to be able to combine the role with other duties.
The success of project would be gauged by user self-evaluation, with clients asked to rate their satisfaction with their social networks at the start of the project and again after a period of time. A variety of tools have been developed to capture this information in an scientifically valid and reliable way, such as the Campaign to End Loneliness Measurement Tool, The De Jong Gierveld 6-Item Scale and the UCLA 3-Item Loneliness Scale. CCC collects their baseline data from the worker’s impressions of guided conversation at the start of the service user’s contact with the organisation. This avoids a direct focus on loneliness or completing forms, both of which might be unhelpful to gaining the client’s trust. An asset- based self-evaluation, similar to the framework of Developmental Assets created by Sutton Council, could also be combined with the guided conversation and includes a helpful focus on personal strengths, rather than weaknesses.
3.2Using frontline council officers and contractors as our ‘eyes and ears’, making the most of every contact with a resident at risk of isolation and loneliness
Council officers and contractors are well placed to identify socially isolated individuals while carrying out their core duties. The Barbican car park and cleaning staff have already been identified as the only people some members of the community come into regular contact with. Those carrying out assisted bin collections, housing repairs, benefits home visits and an array of other services delivered in and around people’s homes may also discover instances of social isolation during the course of their work.
As with members of the public, these officers may not feel comfortable starting a conversation about loneliness or may not have the capacity to really offer help. Offering staff a quick and easy referral route to the Community Connectors solves both of these problems
17 and enables every contact to count in the bid to tackle loneliness. This action feeds in to the Community Connectors and will share their evaluation. The number of referrals coming from each team and their suitability can be monitored to highlight where further guidance may be required.
Adult Social Care Social Workers should ensure that assessment and support planning work with carers promotes having a life outside of their caring role, making use of referrals to the Reach Out Network, Community Connectors and other sources of support as appropriate. The Carer’s Strategy Action Plan commits us developing a carer’s buddying system to provide additional one to one peer support. The implementation of these actions will be monitored through the contract monitoring of the commissioned carers provider and quality assurance monitoring of case work with carers.
3.3Utilise the Fire Service’s Home Fire Safety Visits, targeted at vulnerable people living alone, to address issues of isolation and unmet social needs
The London Fire Brigade already carry out a rolling programme of Home Fire Safety Visits, aimed at those most at risk of experiencing a fire in their home. These people share many characteristics of those likely to be socially isolated, including entering old age, living alone and having disabilities or mobility problems. The Community Connectors can tap into the work that has already been done to identify these individuals and accompany Fire Officers on their visits to talk about aging well, improving social networks and accessing opportunities in the community. A similar partnership between Age UK Cheshire and Cheshire Fire and Rescue Services succeeded in being invited in to 98% of homes targeted, opening the door to signposting, support and reductions in isolation. The visits carried out will share the Community Connectors’ evaluation and the suitability of residents visited can be monitored to inform whether the partnership is worth continuing.
3.4Enlisting City Corporation providers of services that have a social aspect to re- establish contact with those who have dropped out of attending
A range of directly provided and commissioned services, identified on page 11 and in Appendix B, provide opportunities for social contact and companionship. Looking at those who have recently dropped out of attending may help identify those affected by social isolation. Initially staff from the service area should seek to re-establish contact with the resident. Ostensibly they would call to talk about the service and residents may have an unrelated issue for non-attendance, such as having moved out of the area, or they may have comments relevant to the service. However, staff should also be alert to any social issues that may arise and should either seek to deal with these themselves or seek permission to refer on to the Community Connectors or other services as appropriate.
Asking officers to perform a duty outside of their core responsibilities requires support from other Departments and Senior Officers. This action is more labour intensive than the gatekeeper referrals and asks officers to set time aside to initiate additional conversations with their own service users. This should still not require additional resources to be provided as the numbers involved will be small and the conversations may also yield information that is directly useful to the services involved, as well as producing social isolation referrals. Commissioned services should also be able to make the calls without additional payments. A requirement can be added to contracts with all new providers, while the same could be done for existing services through a compact with providers, adding a key performance indicator around social isolation referrals to complement existing requirements around safeguarding.
18 Training may be required to enable staff to make the calls confidently and effectively. Targeting people who have recently dropped out of services may find people who have experienced a significant life event, such as bereavement. These conversations and any subsequent referrals will need to be handled sensitively. The calls may raise a number of other issues, for example a resident may have stopped paying for a leisure club to offset a reduction in income, and officers will need to be able to refer to a range of services to meet a wide variety of needs.
3.5Enhancing social prescribing in the City to fully utilize the GPs surgery as a means to find and support lonely people
There is growing evidence that the local GP surgery is an effective place to find lonely individuals who are not yet accessing other services. 76% GPs report 1-5 patients a day come to their surgery because they are lonely. In London, 7% of GPs report seeing more than 10 patients a day primarily because they are lonely, compared to a UK average of 4%.14
The City already has access to two social prescribing schemes, Family Action and One Hackney and City, both commissioned via the CHCCG. These allow GPs to refer patients with social and emotional wellbeing needs to receive tailored support from the voluntary and community sector. This might include welfare advice, befrienders, walking clubs, art clubs and exercise groups and a major aim of the scheme is to tackle social isolation. Family Action report that while the Neaman Practice have recently increased from being low to average referrers into the service, there may be potential to increase this further. One Hackney and City’s internal evaluation found that City organisations are low referrers into the scheme despite a need amongst City residents – referrals do come in for City residents who are already accessing Hackney services, such as a specialist HIV clinic. The Neaman Practice are low referrers into the scheme and only occasional referrals come from Care Navigators and Adult Social Care.
The Neaman Practice have suggested that some participants could benefit from additional support and advocacy through the social prescribing process. Family Action prescribers work with patients for typically two sessions, then encourage them to attend activities on their own. Further support in the form of volunteer buddying, is available on request. Family Action have requested that GPs use their referral forms to indicate if this extra support is needed. Encouraging GPs to refer vulnerable people to One Hackney and City, which offers more intensive support, may also prove beneficial here. Initial discussions with One Hackney and City suggest they would be happy with this approach.
The Carer’s Action Plan commits us to enhancing the social prescribing offer to carers. For most patients, GPs will make a referral to social prescribing if issues of social isolation become evident during a consultation. Given the likelihood of carer’s both experiencing loneliness and attending the GP’s surgery, we would like GPs to pro-actively discuss social wellbeing with all carers and consider making referrals to social prescribing.
Both City and Hackney social prescribing services have indicated that their knowledge of community assets in the City is not as good as for Hackney. Providing a comprehensive database of community groups and activities in the City would help prescribers make the most of what is already on offer, developing more personalised prescriptions which have a greater chance of success.
Family Action have also suggested that the cost of activities in the City can be prohibitive when prescribing for lower income residents. Further work is on-going to establish whether
14 Campaign to End Loneliness / Comres 2013 19 this could be resolved by providing better information about low cost activities, such as Fusion’s Young at Heart programme, or if there is a need for the City Corporation to support social prescribing in the borough by providing a modest budget to enable clients to participate in prescribed activity.
In addition to the City and Hackney social prescribing services, 18% of City residents are registered with practices outside CHCCG. These people are concentrated in the east of the City, with 12% attending a GP in Tower Hamlets and 9% attending the Spitalfields Practice. Tower Hamlets CCG are planning to roll out social prescribing across the borough by September 2016. City residents who have a Tower Hamlets GP will be able to make use of the service. Providing the Tower Hamlets Wellbeing Service with access to the same comprehensive database of community assets would ensure that their social prescribers are able to offer City residents a relevant service. The need for improved information, for both professionals and residents, is discussed in more detail in the following section, Strategic Theme Two: Unlocking the community’s potential to respond to the challenge of loneliness.
Each of the three social prescribing services will have their own evaluation processes for judging their success in reducing clients’ isolation and we do not need to replicate this. We will know our intervention has been successful if;
Referrals from the Neaman Practice to One Hackney and City increase while referrals to Family Action stay at least constant; GPs at the Neaman Practice report that their more vulnerable patients are now adequately supported through the social prescribing process by One Hackney and City; Social prescribers at all three services report that they have a good knowledge of City community assets and are confident when making referrals in the borough; City residents receiving support from the Tower Hamlets Wellbeing Service achieve outcomes at least as good as Tower Hamlets residents, as measured by THWS’ evaluation.
20 4. Strategic Theme Two: Unlocking the community’s potential to respond to the challenge of loneliness
Instead of focussing on lonely individuals, this second range of approaches centred on the way in which the community responds to the challenge of loneliness. These interventions may not be recognised as being intended to reduce loneliness by the communities they serve. Instead, they are focused on shared activities. Bringing people together in a natural way is an inevitable by-product of their apparent primary purpose.
Utilising the assets already present in City’s communities offers a far more effective way to tackle social isolation than any service the City Corporation could directly provide from scratch, hoping to identify deficiencies in the community and then fill in the gaps itself. Community based responses have the potential to reach isolated individuals that officials ones could never hope to connect with, to be sustainable in the long term by making use of resources that are owned and controlled by the communities they serve, and by involving people affected by loneliness in their design and delivery – which makes the services more likely to be what people want and provides a further opportunity for social contact and networking to take place.
The City Corporation still has an important role to play in creating the conditions necessary for community groups to thrive and supporting more vulnerable members of the community to take part and feel able to contribute their personal assets. This should be done by:
Improving access to existing opportunities by providing better information, making it easier for residents to find a community group that suits their interests Build on Neighbourhood Development successes to build community capacity and empower residents to address issues of social isolation for themselves Increasing the Small Grants Budget to give residents greater control over the type of activity on offer and to encourage a greater diversity of provision Enhancing current community spaces and ensuring the built environment is accessible to people with a range of needs Working with Opening Doors London to meet the needs of the older LGBT* community
4.1Improving access to existing opportunities by providing better information, making it easier for residents to find a community group that suits their interests
Running through this strategy is the premise that a good deal of community and voluntary activity is already going on in the City of London, but there are barriers that make it difficult for socially isolated people to get involved. Some of these barriers will take considerable efforts on the part of Community Connectors, befrienders or others to overcome. Some may be dealt with more simply and improving communications offers a way a relatively large number of people with low level needs can be effectively supported to engage with the community. Both Dr Green’s research and the Volunteering Review found that information about current activities had considerable room for improvement. Time and again residents interviewed had little or no knowledge of what was already on offer. Several actions can be taken to remedy this:
A comprehensive online resource
Providing a one-stop website listing community groups would be a useful resource for residents trying to find a social activity that matches their needs. This would list activities
21 directly provided, commissioned or hosted by the City Corporation as a minimum, but would aim to map all relevant community assets within the borough.
Currently the Adults section of the Family and Young People’s Information Service (FYi) Directory is the best place to look for this information. While this is not a complete picture of community activity and many of the assets listed in Appendix B are not found in the Directory, it is an active database with a user-friendly interface and a good deal of information already available. This should be added to.
Providing preventative, universal information for adults and older people is currently outside of the FYi team’s remit. To fill this gap, Community Connector volunteers could be asked to contribute to the Adults pages of the FYi Directory while they are waiting for a DBS check. There will be a need to offer them some relevant but not client-facing work to maintain their interest during this period and asset mapping is ideal for this. There might be a slight workload increase for FYi staff in editing and approving the content provided by the volunteers. This should reduce as people get used to the system.
As well as residents looking for information themselves, both social prescribers currently operating within the City use our website as a Directory of Service when finding activities for clients. Ensuring it is as complete as possible will make their services more effective. Only a small proportion of clients seen by the Tower Hamlets Wellbeing Service will be City residents, so providing easy to access and comprehensive information on City assets to their prescribers will be necessary to enable City residents to get the most from the service.
Promoting community groups offline
Similar information should also be made available in a physical format such as a leaflet or such as a City Over-50s Guide. Dr Green’s report found that providing leaflets and information in community libraries and the Green Box was effective at reaching residents who accessed these spaces. While leaflets exist to promote the programme at one particular community centre or to promote one specific group or activity, and FYi produce a comprehensive leaflet of activities for parents and young children, there is no publication giving a City-wide overview of community activity.
Producing a leaflet would fill this communications gap and enable people who are not online to access the same information. The leaflet could also encourage self-referrals to the Community Connector Service and include general health and wellbeing information relevant to older people.
Raising awareness through current communications
Dr Green’s report identified that not enough use was always made of existing communication channels to tackle social isolation. DCCS should use channels such as the Barbican Broadcasts and pilot Barbican Information Centre to inform residents about relevant community groups. We should work with the Public Relations Office to maximise the use of City Corporation publications such as ‘City Resident’ for this purpose. There are reasons why this has not always been possible in the past - content needs to be kept fresh and relevant to engage readers and information will need to be finalised several months in advance of an event in order to coincide with print deadlines. These existing communication channels should also be utilised to promote the work of partner organisations and other strands of the strategy, such as the Community Connector Service, Micro Grants scheme and ‘Get Connected’ IT classes.
Improving information about volunteering opportunities
22 Without an umbrella organisation to oversee voluntary activity, the City of London has duplication of some services for older residents and gaps in other areas. Those surveyed by the Volunteering Review commented that there was a lot of volunteering activity, but no overall co-ordination. One interviewee said that there are ‘many brokers in the space’, and another described this as ‘very messy’. Dr Green’s study echoed this and found that many residents, “were either unaware of existing services despite current information being available and in addition were unclear how to access and maintain a service, for example, being supported by a volunteer and what befriending schemes were available and how to contact them.” The People’s Steering Group is due to consider how to take forward these recommendations in August.
In the meantime, departments across the City Corporation should continue to embed Time Credits in services wherever volunteers are used. Time Credits encourage those who don’t usually volunteer to do so – and amongst those who participate in Time Credits 60% say their level of social contact increases and 32% say they feel less socially isolated. Departments should also look at where Time Credits can be accepted as payment for activities. Ideally some of these activities will lend themselves to further social contact.
4.2Build on Neighbourhood Development successes to build community capacity and empower residents to address issues of social isolation for themselves
The problems experienced by existing Resident Associations have already been discussed. The City Corporation has commissioned a team of experienced mediators to help move past old disputes and deliver a clear forum of tenant and leaseholder issues to be heard. As well as service focused resident groups, this will also seek to emulate the success of Avondale Community Events (ACE), which sees local people organising community events and activities for themselves.
The Volunteering Review found that a number of interviewees thought that more local and community based volunteering options would help to break down some of the barriers of confidence and language and provide opportunities for more face to face contact. In particular, there was a call for more housing estate based volunteering projects. Following the lead set by ACE should meet this need.
The re-launch of the Neighbour Network (previously the Good Neighbour Scheme) has also already been touched on in the evidence on interventions section. Developing this scheme in an asset based way and giving residents control over the design, delivery and eventually management of the scheme will enable it to be as effective as possible. Focusing on what more vulnerable people can offer in mutually beneficial relationships should reduce people’s reluctance to ask for help, while strong links with the Community Connectors would offer another route for socially isolated individuals to come to the Neighbour Network’s attention.
The Neighbour Networks could work in a variety of different ways. At Great Arthur House the residents have chosen to focus their network on dealing with impact of major works. At the 2015 Residents Day Celebration, people suggested holding very local book groups and coffee mornings, or being a snow friend and checking on a neighbour if there was a spell of bad weather. The existing volunteer Handyperson Scheme is being discontinued and replaced by a contract with Hackney Council’s Home Improvement Agency for minor repairs and adaptations in the homes of vulnerable people. While this is no doubt appropriate for larger and more specialist tasks, the Neighbour Networks may be interested in offering DIY skill swaps for smaller tasks. The Neighbour Networks could also be useful for new parents, linking those with few local connections to older people who have their own experience of bringing up children to share. Vulnerable people could also be supported by sharing food, along the lines of the Casserole Club, where volunteers share extra portions of home- cooked food with people in their area who aren’t always able to cook for themselves. 23 While these ideas can be put to the Neighbour Networks, they can only ever be suggestions. In order to succeed, Neighbour Networks must grow organically, with residents deciding on the issues that are important to them and the solutions they see as being most effective for their communities. In order for this to work, the City Corporation will either need to provide a resource to support the formal administration of the networks, or to be comfortable in guiding people to set up their own informal groups that do not have the same need for administration or safeguarding procedures such as DBS checks and food hygiene certificates. Whichever route is chosen, offering early training to everyone involved in running the groups will help make groups self-sufficient and sustainable. The National Training Academy offers online courses for community groups and is widely used by councils and housing associations.
To support these initiatives a post for a Community Development Officer for the North of the City has been created. This will sit in the Neighbourhood Development & Engagement Team and will complement the work of the Community Development Officer for the East of the City.
Consideration should be given to how Neighbourhood Development can be carried out on the Mansell Street Estate. Dr Green found that several residents felt that the estate’s managers were not as involved as they could be in terms of supporting older people or those affected by loneliness. This does not mean the community are not doing things for themselves - Time Credits have supported a 50+ group, a sowing group and a girls group. However, there is potential to achieve more with the right support.
4.3Increasing the Small Grants Budget to give residents greater control over the type of activity on offer and to encourage a greater diversity of provision
A greater diversity of community groups and activities in the City would engage more residents and offer isolated individuals more opportunities to make new contacts and socialise. While the City Corporation’s current community provision, such as the City 50+ service, is aimed at broad demographic groups, Cattan and White’s research suggests that specific activities targeted at smaller subsections of the population are more effective at reducing loneliness.
A number of smaller groups have already been identified as having no specific provision. Dr Green found that current activities may not be appealing to older members of the LGBT and BAME communities. Older men, already harder to engage with loneliness interventions, may also be underserved by groups which have a focus on conversation rather than practical activity. The lack of a community, rather than council, run parents or parent and baby group may be a missed opportunity for parents at risk of isolation. Aside from meeting the needs of these specific groups, there is potential to engage more people by widening the variety of activity on offer.
Having officers design new groups would take control away from local residents, making participation less likely and failing to make use of the assets available in the community. Instead, residents should be empowered to set up new community groups for themselves through an enhanced Small Grants Scheme. This approach also takes advantage of the reductions in social isolation that come from volunteering and the social links that form through running a group.
In the 2015 grant round, the Small Grants Scheme budget was allocated to a range of community groups providing older people’s social activities as well as specific craft, gardening, film, campaigning, reading, music, dance and pre-employment groups for people of all ages. The £20,000 budget is a constraint on the amount and variety of activity that can be funded. Increasing the budget, by a suggested £5,000, would enable a greater range of 24 community groups to operate. This is especially relevant now, as if Neighbourhood Development work to launch ACE-style residents groups on Golden Lane and Middlesex Street is successful, there will be two additional groups eager to bid for funding.
New bids to the Small Grants Scheme could also be encouraged by using £2,500 of the uplift in funding to trial an element of the scheme funding individuals rather than formal groups. Badged as Micro Grants and limited to a maximum of £500 to recognise and limit the addition risk involved in directly funding individuals, this would encourage new groups to form and new activities to be tested. Paying individuals rather than groups avoids the need for governance documents and structures, group bank accounts and DBS checks, all of which are seen as onerous and off-putting to members of the public with fresh ideas for community activities, but little experience of running events formally.
An expedited decision making process should also be found for Micro Grants. The Small Grants Panel meets twice a year to consider applications, which means an applicant could be waiting up to six months. Commissioning Officers could carry out an initial evaluation of an application as it comes in. If it meets a minimum standard, it could be circulated to Panel members by email for decision, avoiding the need to wait for the Panel to next convene.
Some additional eligibility criteria would be required to ensure the scheme does not present a safeguarding risk. Micro Grants would not fund anything that would be regulated activity, and therefore require a DBS check, if it was instead carried out by a community group. Micro Grants would also not fund any activity involving children not accompanied by a parent or guardian, which would require child protection policies to be in place.
The scheme aims to provide a stepping stone up to Small Grants and if a project is successful and an applicant wanted funding for a second year, they would be expected to constitute their group and apply for a Small Grant. A condition of funding could be that Mirco Grant recipients take part in the National Training Academy programme discussed in the previous section to equip them with the skills to constitute their group.
Adding a requirement for 25% match funding for Micro Grants would mitigate some of the risks of providing funds directly to individuals. Applicants would need to secure funds from another grant giving organisation, carry out their own fundraising activity or commit their own resources to their project. The match funding element could also be paid in Time Credits, recognising the contributions Time Credits volunteers have previously made and the skills they will bring to running a new activity.
In the Volunteering Review the key messages from residents not currently volunteering were that volunteering opportunities should involve the minimum amount of administration and be local. It was felt that spending on local projects could encourage new small groups of volunteers to form and it would be a good way to involve more people. Providing Micro Grants is a good way to meet these goals.
4.4Enhancing current community spaces and ensuring the built environment is accessible to people with a range of needs
The built environment can have a significant impact on whether or not a person becomes socially isolated. It influences access to family and friends, health services, community centres, shops and all the other places and spaces that enable individuals to build and maintain their social relationships. As well as providing access, certain spaces in any given geographical area become locations where people not only ‘meet and greet’ each other but also allow social and community capital to emerge and friendships and social networks to develop.
25 Dr Green identified Fortune Park near Golden Lane, the Waitrose and the Library at the Barbican and the Artizan Centre and garden square area at Middlesex Street as spaces that already encourage social contact between neighbours. However, he found that the Green Box at Mansell Street and the Community Centre on Golden Lane lent themselves much less easily to facilitating this kind of informal relationship building.
The freeholders of the Mansell Street Estate, the Beetham Organisation, are exploring completely redeveloping the estate to increase the density of homes. Their proposals include a community rooftop top space for Guinness residents and a ground floor public Community Centre on Mansell Street. This should provide a more effective and inviting community space for the area and the City Corporation should use the planning process to ensure these elements remain in the final design.
It has been proposed that the Golden Lane Estate Community Centre could be refurbished and reconfigured to accommodate the City of London Community Education Centre (COLCEC) and the Golden Lane Estate Office. The aim is to create a welcoming and accessible space, which would be able to remain open for longer by sharing reception staff between COLCEC and the Estate Office, overcoming the issues with access arrangements and opening hours which have contributed to making the Golden Lane Estate Community Centre an underused space. To encourage a wide range of community groups to make use of the new centre, inspiration could be taken from the Artizan Centre, which asks residents renting space for a financial payment for the first hour of use to cover the centre’s fixed costs, but will then take payment for subsequent hours in Time Credits.
It is possible that both of these projects will involve the closure of existing community spaces while works are carried out. Interim spaces should be provided. At Mansell Street, the City Café at Aldgate Square may be completed before the Green Box is closed. At Golden Lane, a social landlord over the border in Islington may be willing to repeat a previous offer to let residents use their community facilities.
The elderly, people with physical disabilities, people with dementia, and parents with prams or young children can all struggle negotiating the built environment and public transport. As well as making streets pedestrian friendly, appropriate facilities such as benches, public toilets and baby change facilities should be provided at regular intervals.
Although public sector spaces like libraries and community centres are important, they are not the only venues where residents go to socialise. Other venues such as religious buildings, pubs, cafes and shops are also important places where relationships are built and enjoyed. The public areas in the Barbican Centre already serve as an informal meeting point for many and this should be built upon. The City Corporation’s influence over these spaces is much more limited, but some steps could be taken to try to work with community venues to set up social activities or offer space for community use after-hours.
26 4.5Working with Opening Doors London to meet the needs of the older LGBT* community
Dr Green’s research found that social isolation was a particular issue for older LGBT people, mainly on the Barbican Estate. He found that their involvement with the Barbican’s community groups and activities was minimal and that there was little contact with befriending or good neighbour schemes despite an evident need. This experience is not universal; some evidence of neighbourly support was found and some older LGBT people are active participants in the social life of the Barbican. However, there is enough evidence of need to target an intervention specifically at this group.
A pilot project run by Opening Doors London would aim to develop and maintain a social activity group for older LGBT people living in the City. The group would meet locally and offer an informal, relaxed and supportive environment. As well as offering social activities itself, it would act as a gateway into ODL’s befriending service and London-wide program of events.
The group would initially run for a period of nine months and would be managed by a Community Development Worker from ODL supported by ODL volunteers from neighbouring areas. To promote the group the Community Development Worker would carry out outreach work, posters would be put up in locations as such the libraries, GP surgery and Estate Office and a short article could be put in City Resident and the Barbican Broadcast. Adult Social Care, Housing and ReachOut Network staff would also be asked to consider referring anyone they thought may benefit to the group.
After the nine month pilot stage it is hoped that the group will have a core of regular attendees who are able to take over much of the organisation and promotion of the group from the Community Development Worker on a voluntary basis. The Commissioning of ODL should therefore be seen as pump-priming and a one-off expenditure. In the long-term, the group can be provided with ad-hoc support from the Community Development Officer for the North of the City and can bid for funding for activities and promotional costs from the Small Grants Scheme.
27 5. Strategic Theme Three: Valuing personal assets and improving skills to make the most of existing relationships and enable new ones to form
Enhancing existing relationships is likely to be a more effective way of tackling loneliness than starting from scratch. These methods have a headstart on those that need to build new connections from the ground up. They also have potential to bring about large reductions in loneliness, as research has shown that having a child or partner but not feeling close to them is a major driver of loneliness, ahead of being childless or single. Helping residents gain the language skills to form new relationships for themselves also offers a reduction in loneliness that is sustainable in the long term.
Residents can be supported to strengthen their existing relationships or form new ones by:
Suggesting relationship counselling to those whose relationships are under strain, perhaps due to life transitions which have brought them into contact with services Training residents to use technology to enjoy more fulfilling interactions with family members who live in other parts of the country or abroad Supporting residents to improve their English language skills to enable them to build stronger relationships in the wider community
5.1Suggesting relationship counselling to those whose relationships are under strain, perhaps due to life transitions which have brought them into contact with services
Research by Relate found that around one-in-five adult couple relationships are distressed to the point where the relationship problems are having a clinically significant impact on one or both partners’ wellbeing. There are also clear links between relationship distress and depression, anxiety, increased blood pressure and heightened risk of heart attacks.
Several life events older people are likely to experience, such as retirement, children leaving the home or becoming a carer risk putting relationships under considerable strain. However, only 4% of Relate clients are over 60. Becoming a parent, particularly for the first time, also puts people at risk of experiencing personal and relationship distress. It is estimated that 40- 70% of couples experience a decline in relationship quality in their first year of parenthood.
Providers of counselling and support services typically operate a pay-what-you-can-afford model to ensure services are as accessible as possible. However, cultural attitudes often delay people seeking support and research indicates that most people who access relationship counselling believe they left it too late. Personal relationships are widely held to be a private matter and people often feel obliged to address any issues themselves without accessing help. Similarly relationship support is often perceived as a specialist activity – the preserve of specific provider organisations. Frontline practitioners may need support to identify relationship distress, value relationships as an asset, and make appropriate referrals.
A range of courses are available for professionals to aid them to identify relationship difficulties, respond using active listening and solution-focused techniques, and review needs for further support. It is well-recognised that embedding relationship support in services which are already accessed and trusted by people, such as GPs, health visitors, social workers and housing officers, can achieve more widespread take up.
5.2Training residents to use technology to enjoy more fulfilling interactions with family members who live in other parts of the country or abroad
28 Dr Green found that across all four housing estates, but particularly the Barbican and the Golden Lane, a majority of older people had only very basic computer skills. This was particularly evident in discussing how residents became both physically and visually separated from their families who might live in another part of the UK or abroad, and felt very isolated from them despite regularly speaking to a child or grandchild over the phone.
Residents were unaware of the social benefits of using Skype with a camera to keep in closer contact with family or friends. Better use of technology could help improve these existing relationships and reduce feelings of loneliness.
The City Corporation’s Adult Skills and Education Service has previously run a course aimed at promoting digital inclusion amongst older people and is well placed to develop this further. Delivering the course at COLCEC would be convenient for the majority of learners, while community transport could be provided to provide easy access for residents across the City. This is especially important for those with mobility problems as they may stand to benefit the most from online communication. The scheme could also benefit from heavy and pro-active marketing as per Viridian’s Active Online programme (below).
Age UK ran a similar programme, CitySmart, in 2014-15. They found that providing on- going support is important, as older people often let their use of IT lapse if they cannot have an easy refresher or get help to troubleshoot any problems they have experience with their devices. Including a peer support element to the project, either from fellow learners or a local volunteer mentor, would help ensure the benefits of the course are sustained.
5.3Supporting residents to improve their language skills to enable them to build stronger relationships in the wider community
People who do not speak English well will find their ability to make new friends outside their own linguistic community limited. Chance encounters with neighbours or at the school gates will not lend themselves to allowing relationships to form, while gaining employment or joining a community group will be more difficult. ESOL (English for Speakers of Other Languages) classes have an important role in promoting social integration and community cohesion.
In the 2011 Census, 101 residents said they could not speak English well or at all. These were mainly (80) working age people concentrated in the East of the City. In Portsoken 18% of households contain no-one who speaks English as a main language, 4% of households do not contain an adult who speaks English as a main language and 11% of households have at least one but not all adults who can speak English as a main language. This means 33% of households in the ward could benefit from additional English language education.
The City Corporation’s Adult Skills and Education Service already provides ESOL classes for a range of ability levels, as well as the Speaking English with Confidence programme, which enables learners to practice speaking English with local volunteers. The service is experiencing growing demand and learners come from across Greater London.
Offering additional pre-entry and entry level ESOL classes at Sir John Cass's Foundation Primary School in Aldgate would make the classes more accessible to local people in Portsoken. Running classes at the school would be an especially effective way of engaging with parents, including the 4% of local households which do not contain an adult who speaks English. Offering on-site childcare during the lessons would also make it easier for parents of young children to attend.
29 6. Measuring the impact
Evaluating the impact of any intervention to reduce loneliness presents a number of difficulties. As discussed in the ‘Evidence on Interventions’ section, problems of under- reporting, fluidity, subjectivity and uncertainty over whether the most vulnerable have been reached persist. A number of different evaluation methods are available and using a combination of these would enable a more accurate picture of our impact to be produced.
User self-evaluation A range of scales are available which ask users of services to rate their social connections in a structured and quantifiable way. These can provide a guide to how much of an impact a service has made to an individual’s loneliness after a period of time. If service users report relatively low scores at the beginning of a project, this can also be taken as some evidence that isolated individuals are successfully being reached.
Asset based self-evaluation An alternative to the more commonly used loneliness measures discussed above would be to measure an individual’s personal assets and what they can now do as a result of an intervention. This would be similar to the framework of Developmental Assets created by Sutton Council and measure whether an individual feels comfortable joining a new group of people or whether they feel they have something to contribute to their community.
Community inclusion It has been noted that many existing social groups in the City do not adequately reflect the wider population. Measuring the extent to which community groups change and new ones emerge to genuinely reflect the City’s population could be one measure of success. While this does not measure social isolation directly, the prevalence of groups that include tenants and leaseholders, old and young, and those from different backgrounds would indicate that more opportunities exist for everyone to get involved in community life and that for those who do attend, more fulfilling interaction is available.
Public Health Outcomes Framework As discussed in ‘Level of need in the City’s population’ section, the Public Health Outcomes Framework asks Adult Social Care service users and unpaid carers whether they are satisfied with their current level of social contact. The Department of Health are also planning to introduce a measure of loneliness for the general population. Improving the scores for care service users and carers and obtaining a relatively high score for the general population figure when it is introduced would be encouraging signs that our approach is reaching those in need. However, the confidence intervals attached to the data for the City of London are high. This means that while improving scores would be an encouraging sign, as they are unlikely to be statistically significant, they should not be solely relied upon.
Reducing costs elsewhere Many loneliness interventions, especially those tied to the health service, aim to reduce costs elsewhere in the system. Social prescribing aims to reduce the costs of unnecessary and repeated visits to GPs surgeries. Keyring aims to reduce the need for formally provided social care services. If these cost savings can be realised, it could also indicate that the individuals concerned are more integrated into the community.
Measuring inputs If we accept the evidence from others that a particular approach generally works to reduce loneliness, a measure of how much of an intervention can be provided could be used as a proxy for reducing loneliness. For example, if we accept that successful homeshares
30 generally reduce householder loneliness, we could use the number of new homeshares set up and lasting for at least a year as a partial measure of success.
Randomised Controlled Trials (RCT) Adopting a measure more commonly used in a health rather than social care setting, RCTs involve randomly allocating participants to two or more groups, one which will receive the intervention, while a control group operates on a business as usual basis. This provides robust evidence whether an intervention works and by how much. However, the pilot nature of the approach would mean there was considerable delay before the control group, or wider population, benefitted from the intervention. An example of how this might work in practice can be found in Family Mosaic’s RCT of a personalised wellbeing support service (Health at Home, February 2016).
Community Research Using a consultancy such as Community Research would essentially repeat Dr Green’s research on a smaller scale, taking the temperature of the local community on loneliness and the interventions the City Corporation has already put in place. Researchers recruited from within the community would interview others, gaining more frank and honest information, qualitative data and suggestions for further improvement and ensuring a wide and representative cross section of the community is reached.
31 7. References
Roger Green and Tim Stacey. (2015) The Voices of Older People: Exploring Social Isolation and Loneliness in the City of London
Department of Community and Children’s Services, City of London and the Social, Therapuetic and Community Studies Department of Goldsmiths University of London. (2015) Social Isolation in the City
Susan Davidson and Phil Rossall. (2014) Age UK Evidence Review: Loneliness in Later Life
Panayotes Demakakos, Susan Nunn, and James Nazroo. (2006) Retirement, health and relationships of the older population in England: THE 2004 ENGLISH LONGITUDINAL STUDY OF AGEING (Wave 2): Chapter 10 Loneliness, relative deprivation and life satisfaction
Janaki Mahadevan. (2012) ‘New mums lack support to cope with isolation and depression’ Children and Young People Now
Action for Children (2015). Quarter of parents feel “cut off” and lonely
Cattan et al. (2005). ‘Preventing social isolation and loneliness among older people: a systematic review of health promotion interventions’ Ageing and Society 25:1. pp.41-67
The University of York Centre for Reviews and Dissemination (2014) Interventions for loneliness and social isolation
Robyn Findlay. (2003) Interventions to reduce social isolation amongst older people: where is the evidence? Ageing & Society 23, 647–658.
Jane Foot and Trevor Hopkins, Improvement and Development Agency (IDeA). (2010) A glass half-full: how an asset approach can improve community health and well-being
Karen Windle, Jennifer Francis and Caroline Coomber (2011). SCIE Research briefing 39: Preventing loneliness and social isolation: interventions and outcomes
Klee, D, Mordey, M, Phuare, D, Russell, C. (2014) Asset based community development – enriching the lives of older citizens Working with Older People, Vol. 18 Iss 3 pp. 111–119
Public Health England. (2015) Local action on health inequalities: Reducing social isolation across the lifecourse
Kate Jopling, Campaign to End Loneliness. (2015) Promising approaches to reducing loneliness and isolation in later life
Victor, C. (2011). Loneliness in old age: the UK perspective. Safeguarding the Convoy: a call to action from the Campaign to End Loneliness.
Victor C, Burholt V, Martin W. (2012) Loneliness and ethnic minority elders in Great Britain: an exploratory study J Cross Cult Gerontol. 2012 Mar; 27(1):65–78
Campaign to End Loneliness. Measuring your impact on loneliness in later life
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