Project Report from The

Making Connections

Project report from the Age Action Alliance Loneliness and Isolation Working Group

1 MAKING CONNECTIONS PROJECT REPORT

“Mr and Mrs W, both in their mid-80s, were living independently and appeared to be managing well when they completed the Boots questionnaire. When contacted by Opal, however, Mrs W revealed that they both have health and mobility issues and Mr W had recently collapsed as a result of a urine infection. Mrs W said that they were ‘starting to feel a bit vulnerable’. They accepted the offer of an OPAL home visit.”

Feedback from the Making Connections pilot

1. Executive Summary

a. The national Campaign to End Loneliness was launched in September 2011. Since then there has been a growing awareness of what it means to feel lonely with the consequent detrimental effects on a person’s health. Loneliness amongst many older people has been highlighted by government and through the media leading to a recognition that without considerable efforts being made to identify those suffering from the effects and measures put in place to alleviate the problems associated with loneliness, that all the Care Services will be stretched to the very limits to care for a growing population of older people. This recognition has started a national debate on health and wellbeing with Government recognising the problem and the detrimental impact.

b. Under the Age Action Alliance umbrella, partner organisations have worked effectively and collaboratively to develop a project that would help to identify those in the community who may be at risk of the effects of loneliness and to offer practical support and help to those affected.

c. The Making Connections project has highlighted the benefits of collaborative working across local communities. It has explored the role of community pharmacy, supported by local volunteers and local government to engage the public about isolation and loneliness and to offer support where possible.

d. Initial feedback has been positive – the project successfully identified individuals who requested help, information, advice and support.

e. The Making Connections project was an opportunity to test different approaches to identify those at risk of the effects of loneliness and there are good lessons to take away. Overall it offers a simple and effective model that must be refined and rolled out to support more people in our communities.

2 2. Introduction

a. The Age Action Alliance is the network for partnership working and practical action to improve older people’s lives. As an independent partnership organisation, the Alliance works to address the challenges of an ageing society and adopt a positive approach to the opportunities created by people living longer, healthier lives.

b. According to the Campaign to end Loneliness there are over 800,000 people in England who feel lonely all or most of the time. Loneliness is a bigger problem than simply an emotional experience. Research shows that loneliness and social isolation are harmful to our health: lacking social connections is a contributory risk factor to early death, whilst the overall effect on a person’s health is as bad as smoking 15 cigarettes a day and is worse for us than well-known risk factors such as obesity and physical inactivity.1

c. The Age Action Alliance Loneliness and Isolation Group identified Alliance partner organisations to find practical solutions on the issue of loneliness, to try to establish what action is needed to help alleviate it and to prevent people who are socially isolated from becoming lonely.

d. During 2014 these partner organisations worked together with local stakeholders to develop a new model: to utilise the skills and accessibility of pharmacists and local volunteers to identify and support those in the local community, offering information and into local links activities and other support services.

e. This report outlines the development of the Making Connections project, highlights key outcomes and findings and suggests next steps. The document has been collated by Janet Crampton (Aesop Consortium) and builds on the notes of planning meetings of the partner organisations and of the Age Action Alliance Loneliness and Isolation Group.

3. Partner organisations

a. The Age Action Alliance (AAA) secretariat and Hampshire County Council provided support and coordination for the project. The AAA Loneliness and Isolation working group, led by Councillor Shelagh Marshall, OBE, also contributed to the findings of the report.

b. Age Concern Hampshire (ACH) is an independent charity working across the county to promote independent living to over-50s. The charity provides information and advice as well as activities, wellbeing and care to over 58,000 people each year.

c. Alliance Boots is an international pharmacy-led health and beauty group. The group’s businesses in the UK include the Boots pharmacy chain, Boots Opticians and Boots Hearingcare. There are close to 2,500 Boots stores in the UK from local community pharmacies to large destination health and beauty stores.

1 Campaign to end Loneliness - http://www.campaigntoendloneliness.org/ - Accessed on 04/11/14 3 d. Hampshire County Council (HCC) is the county council governing the majority of the county of Hampshire. A non-metropolitan county council, public services include social care and public health. HCC has identified loneliness as a key priority to address as part of their work. Their Joint Strategic Needs Assessment (JSNA) highlighted the rising numbers of older and vulnerable people living alone across the county.

e. Older People’s Area Link (OPAL) volunteers provide short term support over one or two home visits or telephone call to help older people find out about local activities and services. All home visits are repeated three weeks after the initial home visit. They provide general information on other aspects of living independently including health and wellbeing and day care. OPAL volunteers are supported by Hampshire County Council.

4. Developing the project and determining the aims and objectives

a. Previous studies have identified common risk factors associated with loneliness. Those who are at risk may include:

i. Single pensioners ii. Those who are widowed or retired iii. People unlikely to meet friends or family regularly iv. People unlikely to interact with neighbours v. Those in poor health, suffering from depression or poor mobility vi. Those with sensory impairment vii. People who may be struggling financially.

b. Considering these factors and other indices, it was agreed that the Making Connections pilot would explore effective ways to identify those living in the community who may be at risk of the effects of loneliness; the best way to communicate with customers and patients, aged over 60 years with one or more long-term condition(s) and in receipt of a repeat prescription.

c. It was proposed that customers and patients fitting this profile would be asked to complete a questionnaire to assess how receptive they would be to accessing activities, services or advice to alleviate their perceived loneliness and hopefully stem any tendency towards social isolation. To realise this it was decided that the survey would focus on those customers and patients receiving repeat prescriptions and / or receiving a Medicines Use Review (MUR).2

d. By surveying a target sample, it was hoped that the respondents would become connected to activities that would interest them and to widen their circles of contacts and supports. The success of the project would be measured by:

2 A Medicines Use Review is a free NHS service offered by pharmacies in the UK. The review involves an appointment with the patient’s local pharmacist in a private consultation room. It is an opportunity for the patient to discuss his/her medicines with a pharmacist, to understand how the medicines should be used and why they have been prescribed, as well as solving any proble ms the patient may have with them. 4 i. The response rate and number of survey forms returned (see Appendix 1) ii. The number of short-term connections made with people who had returned the forms iii. Measuring the wellbeing of those people in the more long-term (3-6 months later).

5. Methodology

a. Two Boots stores in Hampshire were identified to take part in the project: Romsey and Winchester. Both are in high street locations and provide a range of health services to the local community.

b. It was agreed that the best way of engaging with people potentially at risk and getting user feedback was to devise a simple questionnaire that would be handed out to a target 100 customers by each pharmacy team over a six week period3. At each of the sites, 50 questionnaires would be given to customers collecting prescriptions and 50 would be handed to customers receiving a Medicines Use Review - a copy of the questionnaire is attached at Appendix 2. Staff would be on hand to help customers and patients to complete the questionnaire if necessary and Age Concern Hampshire would gather the returned questionnaires so that people could be linked to the appropriate services where they had provided contact details.

c. Funding had been identified for printing the questionnaires and for the graphic design work and the documentation would bear the logos of the partner organisations.

d. The questionnaire was devised to elicit the situation of people of pensionable age and to establish what sort of help/information they required or what they wanted to do and whether they were disposed to seek it. Return of the questionnaire also provided a trigger for an interview by Age Concern Hampshire (ACH) to explore their needs further and to clarify the outcomes sought. The questionnaire design looked to establish the outcomes broadly in four main types:

i. No help actually needed despite request ii. Keep ACH free-phone number for future reference now contact ma iii. Information given in response to request or specific enquiry iv. Home visit requested for more in depth discussion / support

6. Outputs from the project & lessons learned

OUTPUTS

a. Over the six weeks, 115 questionnaires were collected:

3 Between the period 28th April 2014 – 8th June 2014 5 i. In the Romsey Store, 90 questionnaires were completed by customers and patients, including 28 from MUR patients. Those collecting a repeat prescription were given a pencil and a clipboard and were happy to complete the form there and then. Local team members would have been happy to continue giving out the questionnaires to customers at the time of picking up their repeat prescription. It became clear this was the preferred method by customers and after a brief debate, this became the local policy. Romsey reported that they were so pleased with the feedback from customers they wished to continue with an on-line referral.

ii. In Winchester, 25 questionnaires were completed - An initial hiccup meant that the Winchester store had to be provided with another supply of questionnaires and further technical difficulties in retrieving the returns may be reflected in the relatively low recorded return to ACH.

Further data is available in the appendices, as well as analysis of the results in pie- chart format. b. Plans were in place to follow up quickly: Age Concern Hampshire acted upon the answer to the first question. All requests were followed up in 48 hours and given a charity number by Age Concern Hampshire. c. Case Studies proved helpful both at planning stage and during the course of the project. For example, one person contacted, although not requiring any action said they would keep the telephone number for a future use. Others were grateful for the contact call. Furthermore Boots in Romsey had positive feedback from customers who were grateful for the help ACH had provided. Further case studies are attached at Appendix 3.

LESSONS LEARNED d. It was clear that the general simplicity and design of the questionnaire had been favourably received and well-understood. Some confusion might have been avoided, however, when people were asked if they wanted help (Yes/No) and then later asked for contact details. If they had ticked ‘Yes’ but not provided contact details, the team were left with no means of recourse. Conversely, people had indicated ‘No’ to a request for help but then had provided contact details. e. Similarly there needs to be clarification of what is meant by the terms ‘well-being’ and ‘loneliness’. Some customers found it quite difficult to judge well–being (Question 3) when it was in a MUR situation. f. A lesson for the future might be to find other effective ways of eliciting responses and/or to consider other ways of distributing and collecting the survey forms - for example through GP surgeries and on-line surveys.

6 g. Involvement in the planning proved crucial - Local success appeared to derive from representatives attending the planning meetings regularly and having active and continuous involvement and input to the project design throughout the planning of the pilot and implementation and also to involve the local pharmacist from the start.

7. Initial conclusions

a. From the feedback received, it appears that the most successful way to distribute the questionnaire was via the pharmacist as part of the customer receiving their repeat prescription. Store pharmacists received a positive reaction from the customers and they did not receive any negative comments on the questionnaire. Raw data from the survey is attached.

b. One store had a better return than the other, which may have been because of the ability of that branch to participate more fully in the planning of the project, but all figures showed a relatively even distribution between those who had turned up for a repeat prescription and those who were having a Medicines Use Review and most were on multiple medications.

c. More women than men completed the form but the detail on the documentation was unclear as to the precise split between male/female respondents. Unsurprisingly the majority of respondents were in the 66-84 age range but, less predictably, the majority of participants were not seeking help.

d. It was important to keep the questionnaire simple to get the best chance of a good return but this in itself carries some risks: that the information derived from the form is too general or unspecific to be of sufficient help to plan interventions or appropriate responses. It may be that a future survey would need to collect more information.

e. In summary and in analysing the results and presenting the findings, Janet Crampton shared her thoughts on the project:

i. The limitations on the outcomes were a direct result of the relative narrowness of the survey ii. There were noticeable difference in results from the two pharmacies that took part iii. A satisfying number of people submitted completed questions (c. 57.5%) iv. A relatively small number of participants sought help (and presumably didn’t perceive their loneliness as an issue) and 37 people (32% of the respondents) were provided with help/advice/information they might not otherwise have had.

8. What Happens Next?

a. Despite some operational issues relating to the distribution of the survey forms, and the collating of data, there is strong anecdotal evidence of the value of the Making

7 Connections project in that the views were received from 115 people who otherwise may have remained unknown to partner agencies as people at risk of loneliness. These people were given the opportunity to find out more about what could be available to them and the other agencies that might have information/advice or services to offer.

Action 1 – Reconvene the planning group within 3-6 months to establish whether the project successfully helped people to ‘make connections’ and that their loneliness had been alleviated.

b. The value of working with a well-known and highly-reputed High Street pharmacy chain and other community partners gave the survey a validity and authority that lent confidence to the participants.

Action 2 – Share outcomes with other Age Action Alliance members and stakeholders. Continue to explore community partners who would be able to access members of the public easily and whose reputation attracts confidence and trust.

c. It is recommended that the results are closely analysed with a view to understanding local demand (and supply) of appropriate service and information responses; and also widening the survey area and repeating the exercise elsewhere.

Action 3 – Get underneath the apparent lack of interest in being contacted to take further people’s wish for more information, service and involvement as this may be a symptom that they didn’t know what was available, or whether it might interest or benefit them.

Action 4 - Undertake further work on the feedback to understand where improvements in the process can occur, whether the questionnaire needs modification, the amount of involvement of the partners, what is the scope for widening the project to other parts of the country etc.

Action 5 – When and if the project is repeated to consider the role of social prescribing and in particular the role of GPs and primary care practitioners especially in finding other ways of reaching out to people at risk of loneliness and distributing questionnaires.

8. Acknowledgements

This report has been produced by Janet Crampton from notes provided by Shelagh Marshall and from minutes of previous meetings and best endeavours have been made to ensure comprehensive reporting, reflecting everyone’s contribution and efforts. At the meeting of the AAA Loneliness and Isolation Working Group on 9th September 2014, Shelagh thanked Janet for pulling the report and its findings together and the whole project group wished to express thanks to all taking the project forward in the local sites, acknowledging that this was ‘on top of normal business’. These are listed at Appendix 4.

8 Furthermore, Shelagh drew attention to the valuable lessons learnt, the contribution of the group in discussing the project and that the outcome may be helpful to other projects, for instance those initiatives successful in Big Lottery Fund applications in Yorkshire, especially where pharmacy workers are to be trained to recognise signs of loneliness and isolation.

Janet Crampton 26th September 2014 amended 19th November 2014

9 Response Type

The types of response were as follows:

Response Type Type No MUR 56 Walk in 59 Total 115

10 Gender Distribution

The Gender Distribution of the respondents was as follows:

Gender Distribution Type No Male 24 Female 66 Male & Female 3 Not Specified 22 Total 115

11 Age Group Distribution

Respondents were asked to indicate which age group they belonged to The summary of these is as follows:

Age Group Distribution Type No 60-65 13 66-75 29 76-84 42 85+ 9 Not Specified 22 Total 115

12 Health Rating

Health Rating Rating No 1 2 2 7 2.5 1 3 36 4 26 4.5 1 5 19 None 23 Total 115

Poor = 1 through to 5 = excellent

Appendix 2

14 15 Appendix 3

CASE STUDIES

Mrs L has been worried about all the driving her husband has had to do to get to various medical appointments. She had also requested information on getting help with shopping and gardening. The Age Concern Hampshire telephone advice team gave Mrs L details of a local help group that can help with these things and take the pressure of Mrs L’s husband.

Mr and Mrs W, both in their mid-80s, are living independently at the moment and managing well; however they both have health and mobility issues and Mr W collapsed recently as a result of a urine infection. They are ‘starting to feel a bit vulnerable’. The Age Concern Hampshire telephone advice team arranged for one of our Opal volunteers to visit them at home.

The Opal visitor gave them lots of useful information including Guide to Better Care, a list of local activities and details of gardening help. After the visit, the volunteer contacted Information and Advice to find out about accessible transport for the couple, as they would like to visit relatives in Essex and Cornwall.

The couple were very appreciative of the time spent with them and the information given.

Mrs R (67) lost her husband two years ago. She still drives, but is worried about how she will manage getting to the bus stop when she can no longer use her car. She recently had a problem with her boiler and was not sure where to get help. She is ‘not very good’ on the internet. The Age Concern Hampshire arranged for an Opal volunteer to visit Mrs R at home.

The Opal visitor has reported that the visit ‘went well’ and she was able to give Mrs R a lot of useful information regarding getting help for problems and possible transport options. Mrs R requested extra copies of the information to pass on to a friend.

Mr D (80) and Mrs D (72) returned from France two years ago after Mr D was diagnosed with Alzheimer's disease. He also suffers from tinnitus and has a pacemaker fitted. They were getting out of the house every day but were not engaging in any social activities. Mrs D said she needed a break from her role as a carer. They accepted the offer of an Opal home visit.

The Opal volunteer gave them information on local activities and help available from organisations including Princess Royal Trust for Carers and Dementia Advice Service. Six weeks later, Mrs D reported that Princess Royal Trust for Carers have helped them to set up an emergency plan. They have had a Home Fire Safety Visit from Hampshire Fire and Rescue. They have joined two local social clubs, and Mr D has made friends with one of the helpers. Mr D and the helper have been playing chess together, giving Mrs D a much-needed break. Mrs D was very grateful for the visit and said she found all the information she was given very helpful.

16 Appendix 4

I would like to acknowledge the contribution of the following to the work of the Making Connections pilot.

Samantha Agnew, Age Concern Hampshire Alex Burn, Head of Older People’s Well-being Team, Hampshire County Council Lucy Cork, Group Public Affairs Manager, Alliance Boots Janet Crampton, Aesop Consortium Campaign to End Loneliness Helen Dimmock, Later Life Engagement Team Leader, Department for Works and Pensions Dr. Mary Laurenson, Acting Head of Department, Health Technology and Perioperative Practice, Faculty of Health & Social Care. Hull University Sheila Nevines and her team, Boots Romsey Pete Pattison and his team, Boots Winchester Dr. Allison Smith, Cabinet Office Tracey Whitton, Boots Romsey

Shelagh Marshall OBE Chair, Future Years, Yorkshire & Humber Forum on Ageing Lead, Isolation and Loneliness Working Group, Age Action Alliance 13th October 2014