Healthy Ageing ”

Project “Healthy Ageing ”

Final Report

Udine H.C.P.O. – Healthy Cities Project Office 31 st May 2015

E A L T H Y

A N D

A C T I V E

A G E I N G

INDEX

Introduction: The Story-telling of the Project 2 Part I - The transfer experience of the City Partners 3 Introduction 3 The support given to city partners in the transfer process 4 Klaipeda 7 Brighton & Hove 9 Edinburgh 12 Grand Poitiers 15 Udine 17 1. Main actions implemented 17 2. Expertise 22 3. Communication & Dissemination 23 Part II – The main results achieved 27 Klaipeda 1. Main results achieved and future developments 27 2. Main lessons learned 29 3. Project Assessment: “before” and “after” the Project 29 Brighton & Hove: 1. Main results achieved and future developments 31 2. Main lessons learned 32 3. Project Assessment: “before” and “after” the Project 32 Edinburgh 1. Main results achieved and future developments 35 2. Main lessons learned 37 3. Project Assessment: “before” and “after” the Project 37 Grand Poitiers 1. Main results achieved and future developments 39 2. Main lessons learned 41 3. Project Assessment: “before” and “after” the Project 42 Part III – Improvements in the good practices 44 Udine 1. Future developments 44 2. Main lessons learned 46 3. Project Assessment: “before” and “after” the Project 47 Part IV - The Model Proposal for a feasible transfer activity (by Fiorenza Deriu) 50 Introduction 50 What does it mean to transfer a good practice? 50 How can we transfer a good practice? 55 1

Introduction: The Story-telling of the project

The aim of the “Healthy Ageing” Transfer Network time, the project partners had the opportunity to 2 was to improve understanding and analysis of both know more about the good practices of Udine. At the local context and the living conditions of elderly the same time, they could also work in groups in people; to provide the cities with more effective order to think over the real opportunities for services that are able to meet citizens’ needs; to transferring the activities implemented by Udine in increase awareness on healthy lifestyles in later their own contexts. Some time was also dedicated ages, to encourage the participation of older people to put the partners on stage, by giving them the in initiatives with the purpose of keeping them opportunity to describe their local contexts; the mentally and physically active. challenges of ageing in their own cities; the For these reasons, the focus of this Pilot Network opportunities for transferring the good practices of was the transfer of some good practices Udine. implemented and positively experienced by the City of Udine. During 2014 the LE started some bilateral visits to the City partners in order to meet Udine, the so-called “giving city” , had the LSGs working at local level. In those occasions successfully undertaken and implemented the the LE presented the URBACT Programme and the following activities: main lines of action of the Healthy Ageing Pilot a) the production of a Healthy Ageing Profile of the Transfer Network, took part in some meetings with City and a very effective Integrated different stakeholders and answered to their questions. The LE visited Brighton&Hove (8-9 April Health Map System (GIS – Geographical 2014) and Edinburgh (20-21 July 2014). Information System), by matching the

distribution of the elderly population on the territory of the City to the provision of public, The first Transnational Peer Review health and social services offered at local level Meeting was held in Klaipeda on 16-18 June (health centers, general practitioners, post- 2014 and was focused on citizens’ engagement. offices, bus stops, community centres, The second one, which took place in Edinburgh (6-8 chemists’, etc); October 2014), was jointly managed with b) the deployment of the Vancouver Brighton&Hove and was concerned with preventative services in later ages. The last one was Protocol , a methodology developed by the held in Grand Poitiers (19-21 January 2015) and W.H.O. Age Friendly Cities Network, in order to was focused on the challenge of intergenerational engage citizens, caregivers and public/private policies on ageing. services providers in decision making;

c) the promotion and implementation of Finally, to better focusing on an intergenerational preventative services / activities , project developed by Udine, four Students aimed at keeping older people physically, mentally and socially active as long as possible Exchange Visits were organized (3-14 March (for example, walking groups, urban gardens, 2015) in order to disseminate the Project Project “Camminamenti” Move your “CamminaMenti” and its good practice based on the minds…minds on the move, etc). cooperation among different generations. These visits were very interesting for both the “giving” and the “receiving” cities. On one side, the LSG After the kick-off meeting in Paris (29-31 representatives had the opportunity to collect much January 2014), the network started the preliminary more information on this specific project and, on the work in order to draw up the Baseline Study. For this other side, the students could visit some health purpose, on 26-28 February 2014 the city of Udine centres for the elderly operating at local level in the was visited by the Lead Expert (LE) Fiorenza Deriu, four City partners and find out new ideas for future who collected as much information as possible in projects in Udine. order to have an idea on the implementation of the

good practices that had to be transferred in the receiving cities. This visit was also a preliminary The Final Conference , hosted by Udine on 20-21 March 2015, was the final event of the step aimed at planning the Partners’ Study Project, during which all partners presented their Visit , which was hosted by the Lead Partner from main results and hold a wider discussion on 5th to 7 th of March 2014. That was a very important methodologies and tools. starting point of the project because, for the first 2

PART I 3 THE TRANSFER EXPERIENCE OF THE CITY PARTNERS

Introduction

UDINE was the “giving city” of the “Healthy Ageing” Pilot Transfer Network and, as Lead Partner, it was in charge of proposing to the other partners its ‘good practices’ on healthy and active ageing, which means the experience that the city had gained both at the European and international level – considering its participation in the W.H.O. Healthy Cities Project and its leadership of the W.H.O. Healthy Ageing Subnetwork – and at a local level – with the implementation of many activities and projects aimed at promoting the quality of life of older people and allowing them to live as long as possible physically, mentally and socially active.

The most important “good practices” presented by the Municipality of Udine to the Project partners were:

a) the production of a Healthy Ageing Profile of the city, whose 4 aims are 1) to allow an overall understanding of the local context, 2) to provide evidence for promoting health at the local level, 3) to create new opportunities for cross-sectoral work and community involvement and 4) to act as a basis for setting priorities and taking decisions. The Health Profile is an important step in order to start a process of social health-building, where the population and all components of society (public institutions, private organisations, third sector, NGOs, etc) can share their ideas and evaluations. The profile is based on 22 indicators grouped into 3 main thematic sections: the population profile (Section A ), the access to health and social support services (Section B ), the socio-economic portrait of the local context in terms of vulnerabilities and strength points (Section C ). The first two sections have been built upon basic demographic, morbidity, mortality and access to services information; the third group is referred to the determinants of health on the basis of a life-course approach.

b) the development of a Mapping System , which allows us to match the distribution of the elderly on the city territory with the provision of public, health and social services offered at local level (by using GIS). This research was carried out in collaboration with the Department of Statistics of the University of Udine, which led to the production of some “City Health Maps”. These maps analyse the distribution of older people in the territory and the accessibility of services (for example, health structures, general practitioners, post offices, bus stops, free-time opportunities, care centres, chemist’s, etc) and show the exact points where services should be more implemented in the urban environment.

c) the development of the Vancouver Protocol within the W.H.O. Age Friendly Cities Network , in order to record the experiences and the needs of older people through a consultation process with citizens, caregivers and providers of services in the public, private and voluntary sectors, in order to discover not only the existing “age-friendly” urban features but also the barriers to active ageing. Starting from the W.H.O. statement that “a City is ‘Age-Friendly’ when it recognizes the importance of elderly people and 3

respects their decisions; encourages their participation and involvement in community life; faces at needs of ageing in a flexible way; promotes physical and societal environment supporting active ageing”, during the first phase , 5 focus groups were held (4 with older people aged 60-74 and over 75 and 1 with health carers). During the second phase , 3 more focus groups were added (1 with public service providers, 1 with 4 the private sector and 1 with volunteers). In each focus group, 8 topic areas were analyzed, in order to put into evidence barriers and gaps, and also to collect suggestions for future improvements.

d) the promotion of opportunities for elderly people to remain physically, mentally and socially active as long as possible through actions and initiatives at the local level. The city of Udine created supportive environments and established patterns for healthy living through food and mobility policies oriented to the elderly. A number of microprojects have been started in order to encourage and increase physical and mental activities among population in later years.

One of these Projects is called “Walking groups”: it consists of six groups of about 15-20 older people who, three times a week, meet regularly at a park or green area for a walk of 10-15 km a day. The walk gives both the opportunity to practice some exercise and remain physically active and the occasion to meet each other and to socialize. The walking groups meet in different town districts and are combined with other indoor physical activity programmes of gentle fitness.

The Project called “CamminaMenti - Move your minds… minds on the move” consists of a cycle of seminars and laboratories addressed to the elderly people on several topics (memory, games, popular traditions, foreign languages, intercultural laboratories, wellbeing, spice lab, botany & cooking, unusual tours in the city, music, etc). These courses are organized by the municipal Udine H.C.P.O (Healthy Cities Office) and the Alzheimer Udine Association in collaboration with other associations (UCAI – Association and Communities for Immigrants, Friends of Music, Game Library, etc) and a group of students from the Faculty of Nursing Sciences of the University of Udine, which give the whole project the added value of an inter-institutional and intergenerational approach , by making young and elderly generations working together.

Another important initiative that encourages an independent life among the elderly are the “Urban Gardens” , which, like “CamminaMenti”, are also the occasion for people to socialize and meet each other. Urban Gardens are green areas where people from different contexts (singles, families, schools and associations) meet and exchange experiences and skills on farming and raising plants and vegetables. People cooperate in order to create a network of solidarity and mutual help in managing and caring their own garden. In most of cases, they can collect the products free of charge, which makes them save some money on their expenditure on vegetables. There are currently 4 Urban Gardens in Udine, each one being made of about 20 parcels of land. Each parcel is worked and managed by a school class (free of charge) or by singles, families or associations (at a symbolic price of 4 euros per month). The plots are allocated after a public call, which is launched by the Municipality every 5 years and/or whenever some plots become available.

The support given to partners in the transfer process

Although the partners had a strong interest in investing and working on the topic of “Active and Healthy Ageing”, they had some difficulties in developing a systematic and coherent approach which could combine together the political will, the professional expertise and the community involvement. Udine has brought to their partners the experience gained throughout many years of active participation in the W.H.O. Healthy Cities Network and collaboration with W.H.O. and other European Cities.

Each partner has learnt from the example of Udine and from the transfer process some specific aspects that they adopted to their own local contexts. For example, Brighton expressed the need to sensitize the politicians and decision-makers to the importance of developing strategies for the elderly since they were much more interested in investing on young people. So, they regarded the strong political will in Udine as a good model to share with their politicians. Klaipeda was much interested in implementing concrete actions for the elderly – and thus decided to transfer activities such as the walking groups – and in reinforcing the 4

relationship and collaboration between the Municipality and the University. For this reason they greatly appreciated the opportunity to share experiences with the students coming from the Faculty of Nursing Sciences of the University of Udine and they also planned joint activities for the future.

All the partners regarded as innovative the activity of construction of health maps and they all activated to 5 transfer this action at their local level. They also produced excellent results, by understanding the importance of linking urban planning to health and social services to the well-being of citizens. Whatever was the specific action the partners were interested in, they were all very prompt to react to inputs coming from Udine and to encourage their local stakeholders to be active and try to transfer the experience within their communities.

The staff of Udine, working in team with the Lead Expert, has agreed a number of actions aimed at supporting partners in the transfer process of the good practices.

First of all, the City of Udine organised a Study Visit in order to offer as much information as possible on the “good practices” implemented at local level to the city partners in order to promote an “Age-Friendly City”. In the following months, in order to sustain the start up of the transfer process, the Lead Partner has provided partners with specific expertise on GIS mapping through prof. Alessio Fornasin of the University of Udine, who was the reference person for the Health Profile and Mapping.

A Dropbox area dedicated to the Project was created in order to collect, in a systematic way, all the documentation useful to partners for implementing the “good practices” of Udine. The Dropbox has become soon a virtual space where all partners could share and exchange their own experience within the Network as well as their knowledge on similar practices and issues.

Udine has also organised four students’ exchange visits in the four cities partner of the Healthy Ageing Project to favour an in depth knowledge of a Project named “Camminamenti” Move your minds…minds on the Move, that followed an intergenerational approach. Each “receiving city” was visited by a couple of students accompanied by an expert (the LE or a professor from the University of Udine). The expert played an introductive role presenting the URBACT II Programme and the Healthy Ageing Project as well as the general frame of the “CamminaMenti” good practice to those attending the visit; the students were more specifically called to bring their experience and to point out the added value coming from the implementation of the project.

Udine has also supported its partners in the budget & reporting activity by giving them full assistance in all phases. The staff of the Udine H.C.P.O. was in charge of all administrative and budget aspects of the project.

Moreover, In order to enable partners to get results from the transfer experience, the Lead Partner has also agreed with the LE the adoption of a “Toolkit” for transfer, which was presented to the City partners during the Transnational Peer Review Meeting in Klaipeda.

This Toolkit was based on a mixed methodology (quali-quantitative) which included a number of tools in order to assist partners during the different steps of the transfer process. It consists of 4 main sections: 1. the Section 1 was aimed at giving partners some tools showing the steps to follow for a good transfer activity. So, starting from the WHO methodology manual, two check lists were drawn-up: one for building City Health Profiles and City Health Maps and another one for deploying the “Vancouver Protocol”. A further check list has been drafted to remind the steps to follow for developing innovative preventative services; 2. the Section 2 included some supportive actions that partners could undertake to enhance the transfer process: 2.1 the LE site visits to City Partners; 2.2 the Peer Review and the Site Visits within the Transnational Exchange Meeting. In particular during the meeting in Klaipeda, a Monitoring Grid and the SWOT Analysis Table have been used to enable partners to reflect on their own experience working in their own city groups and then, in a plenary discussion, to share with other partners their experiences finding out innovative solutions to problems met, sustain their motivation in problem solving, increase their awareness about the possibility to achieve successful results in transfer;

3. the Section 3 included some monitoring tools for accompanying the transfer activity at partner level. The most important tool was the “ Project Diary ”, which was used by partners to track all the activities implemented to transfer the good practices of Udine. The Diaries have been the main source to draw up the Newsletters of the project, an internal communication tool useful to maintain all partners informed on what is 6 ongoing in the other cities. 4. the Section 4 included tools for project and activities assessment . A self-evaluation questionnaire has been drawn up to report the effects recorded in different contexts as a consequence of the transferring activity. So, partners were invited to fill in the questionnaire and to provide photos/videos, and other outputs to sustain their answers (brochures, photos, etc). Finally, at the end of the project, partners were invited to fill in a project evaluation grid , aimed at capturing the possible future changes in decision making driven by the project; the change in older people feelings; three lesson learned. The results of this assessment activity are shown in the Section III of this Report.

SECTION 2

SECTION 1 Supportive actions to enhance the City

Steps to follow for a feasible transfer activity

good transfer activity

- LE Site Visits to City partners and - Check list for building City their LSGs Health Profiles and City • Udine 27-28 February with PM Health Maps (GIS) • Brighton&Hove 9 April WHO Methodology • Klaipeda 19 June • Edinburgh 21 July - Check list for deploying the “Vancouver Protocol” - Peer Review Visits/Meeting • FG with elderly people • Peer Review and Site visits with • FG with services partners in Udine – 5-7 March providers • Peer Review and Site visits with WHO Methodology partners in Klaipeda – 16-18 June

- Check list for developing • Other Peer Review and Site preventative services visits planned in: • Observation grid 1. Edinburgh (6-8 October) • Questionnaire of self jointly to Brighton&Hove perception 2. Grand-Poitiers (January 2015)

- Project workshops at City level

SECTION 3 A DROPBOX devoted to the Project has Tools for accompanying the been created to share documents and transfer activity findings among partners

- The Project Diary - The Newsletter

SECTION 4 - The Monitoring grid Activities assessment at - The Swot Analysis Table project level

To be used during the Peer - Self evaluation questionnaire Review Meeting

- Project evaluation grid

Klaipeda

7 Main actions implemented

Klaipeda has focused its interest in transferring the following activities:

a) Integrated Health Maps; b) Citizens engagement in Seniors Action Plan definition (Vancouver Protocol methodology); c) Implementation of the “Walking Groups”

Given these priorities, the City of Klaipeda, following the methodological hints suggested during the first two meetings in Paris and in Udine, built up a Local Support Group, where different stakeholders were involved in the transfer process (Fig. 1).

Fig. 1 – Composition of the LSG - Extract from the Poster of the City of Klaipeda draft for the Final Conference

HOW was it built up?

A restricted group of individuals (the municipality’s doctor, Klaip ėda’s Public Health Bureau director, the director of the Social Department) agreed on which stakeholders to involve in setting up the LSG. Then, these stakeholders were directly contacted, so that they could choose their representatives. Hence, a very specific LSG was built up for the Healthy Ageing project. The restricted group took part in every meeting of the LSG so they could answer when called to refer on specific questions (e.g. when age map was constructed, people from university had been invited, etc…). This means that Klaipeda adopted a multiple level structure for its LSG.

Integrated Health Maps Before starting to build the Health Maps, a SWOT analysis has been carried out in order to identify both strong and weak points. The main factors of success concerned the possibility: a) to update information on already existing services and improve knowledge on real need of older people; b) to integrate information of different nature in order to make access to social and health services easier; c) to review the distribution of services on the territory in order to make them closer to older people’ residence. The Health Maps could also give useful hints on both improvement of access to existing services and creation of new facilities. During the development of the Health Maps, one of the most difficult aspects was to get through to LSG members and make them understand why this specific task had to be planned by specialists of that

particular field. In fact, Klaipeda involved the local University, where a number of students belonging to the Department of Statistics had the necessary skills and competencies to develop Health Maps. Experts showed also to LSG members the risk that mistakes in methodology could get to misleading results and evidences. For this reason, a contact with prof. Alessio Fornasin (University of Udine) was requested by 8 researchers of Klaipeda University in order to have an opinion exchange on the method used in building Health Maps. Further discussion between the LSG members and researchers of Klaipeda University was run in order to identify what kinds of data were needed for building the Health Maps that could support decision making.

Citizens engagement in Seniors Action Plan definition (Vancouver Protocol methodology) Due to the fact that 2015 in Klaipeda was the year dedicated to Seniors, from September to December 2014 there was an intense debate about the initiatives included in the Action Plan for Seniors. The main ideas included in the Seniors Action Plan have been discussed in different occasions: during the lectures give within the Courses of the Third Age University of Klaipeda ; through social networks and internet; distributing at local level information materials (posters, leaflets, brochures, etc). It is worthwhile emphasizing that older people played a fundamental role in this phase of discussion as they very actively involved into the debate. Their ideas, suggestions and needs were taken into consideration and included in the Plan. Then, in January 2015 the Plan was presented to an audience of city politicians, government officials, representatives of numerous institutions and elderly citizens. The Plan also includes some activities experienced during the Healthy Ageing Project (e.g. walking groups, “CamminaMenti” project, etc).

Walking Groups At the beginning of the Project, when Klaipeda representatives proposed to both LSG members and local administration to implement the “walking groups” initiative in the City, some major difficulties occurred, except the fact that it was required to support and prove the benefits of this new form of physical activity. The initial low commitment of local and political administration was overcome by proving the benefits coming from this kind of activity. A special stress was given to some strong points, such as the positive correlation - scientifically proved - between physical activity and wellbeing, social life and active participation to local community initiatives.

Brighton & Hove

9 Main actions implemented

Brighton & Hove has chosen the following key good practices for transfer: - Locality Health maps - GIS mapping - Ideas and learning about preventative services which promote healthy ageing - CamminaMenti – community based programme led by students of Nursing Sciences from Udine

Annie Alexander (Public Health Programme Manager and leader of the already existing “Age Friendly City Steering Group”) was the leader of the Local Support Group . The group has 14 core members from a wide range of key partner organisations with a ‘wider membership’ receiving information. It includes representatives of the University of Brighton; of the B&H City Council; of the Impact Initiatives service; of Age UK; of “The Fed”; of the AFC Focus Group, of the BHCC – Public Health Team; of the BHCC – Adult Social Care; it is made up as well of older people representatives from the Older People’s Council and the Age Friendly City Forum (hosted by Age UK Brighton & Hove). The Steering Group was also expanded in order to include colleagues from the health sector. It meets every two months.

The Healthy Ageing project has provided the opportunity to learn about health mapping and GIS development. Brighton & Hove has been in the process of developing an online mapping tool with key data. They have taken the citywide data and they have developed Locality Older People Health Profiles which have pull together the data relating to older people’s health and wellbeing and service. These data have been linked with the information on services and activities in the city. It is planned that these tools will be used by public, private and voluntary agencies to inform service planning and development in the city.

Fig. 1 A page of the “Community Insight” Integrated Map System in Brighton & Hove

In order to implement an integrated Health Map System, the Public Health Office has started the following actions: - to talk to public health colleagues to identify those interested in taking part to this activity; 10 - to identify who in the City Council did the maps already available; - to explore links with geography school at the University of Brighton; - to identify how to link it’s Local Actually System with other maps - to explore whether there were specific training needs.

Fig. 2 A page of the “Community Insight” Integrated Map System in Brighton & Hove

The ideas found out and the learning built on the experience in the Healthy Ageing Project have also influenced the development of services within the city. The City Council is currently in the process of doing a Joint Strategic Needs Assessment into falls prevention in the city. It is anticipated that this will result in a new approach, with more focus on early intervention and prevention. Brighton & Hove has also expanded and diversified activities for older people : digital inclusion, sports and physical activities, arts projects, walking groups, gardening projects in sheltered housing. The City has increased partnership working – police, fire and rescue, care homes, home care, faith groups, sheltered housing. The Department of Health has engaged a wider range of older people in discussion about activities and in taking part in activities. With respect to the Urban Gardens and the Walking Groups presented by Udine, it must be said that the Public Health Office has already activated Health Walks which older people attend. Anyway, during the Healthy Aging Project a new walk for older people along the sea front has been started, and ideas about combining walking with socialising/going out for coffee afterwards have been discussed. Moreover, the LE’s presentation on “Urban Gardens” at the LSG has particularly interested the Sheltered Housing scheme Manager who has started planning to do more with the ‘green and growing’ programme, possibly linking in with people with mental health issues, dementia etc… On the basis of the exchange visits with nursing undergraduated students coming from the University of Udine, Brighton & Hove is exploring the possibility of implementing the CamminaMenti (Move your mind…minds on the move) approach in the City with students from the local Universities. The actions implemented have tackled with some difficulties that the LSG has tried to overcome. The short term of the project meant that the transfer had to be very focused. Hence, the City was limited in how much could be transferred within the 15 months of the project.

The financial context within public services at the time of the project has been very challenging, meaning that very limited additional funding has been available to implement new ideas. Changes had to be made within existing resources. Anyway, the project has allowed the City to get time and space to think about its own approach to healthy 11 ageing, with the additional expertise from the lead and partner cities. It helped the LSG to identify and integrate new tools and methodologies of work and test out current approaches at both strategic and operational level. It has provided the impetus to develop the current use of GIS mapping to link with other service mapping in the city and develop locality health maps to inform service delivery. The programme has also provided an opportunity to explore new ideas from different countries in how to engage older people and the types of services that can be developed and allowed local service providers time to strengthen their relationships with each other and with commissioners of their services. This has resulted in better working relationships built on trust and understanding.

Edinburgh

Main actions implemented

Edinburgh priorities in transfer “good practices” include: - GIS mapping - Ideas and learning about preventative services which promote healthy physical and cognitive ageing - Cammina Menti – community based programme led by student nurses in Udine

The City was able to develop an existing ‘checkpoint group’ to take on the role of the Local Support Group . The group included representative from older people and equalities groups, along with key partner organisations. The LSG was made up of: • City of Edinburgh Council officers • Key partners: NHS Lothian, Edinburgh Voluntary Organisations Council, Scottish Care, Alzheimer Scotland • Service user, equalities and interest group representatives

In order to develop a GIS Health Mapping System, the Healthy Ageing project has provided the opportunity to employ an intern for 12 weeks . She was in charge of developing an online mapping tool with key data relating to older people’s service and activities in the city. The Department has planned that the tool will be used by public and voluntary agencies to inform service planning and development in the city. The City has also paid special attention to communication about this initiative: in fact, the local press has followed the process and informed the community (see the red box).

The Scotsman (web) – The City of Edinburgh Council – 12 November 2014 “Mapping software to track Edinburgh's elderly” by David O’Leary Mapping software is to be used to track older people across Edinburgh in a bid to improve the location of services for the elderly. The move is the first key recommendation of a Europe-wide health study. Italian city Udine has used Geographic Information Systems (GIS) software to show where older people live and how they move about the city. The information was then used to help decide on the location of services such as pharmacies and clinics. Edinburgh is the only Scottish city to have been included in the pioneering Urbact Healthy Ageing project. The scheme's leading city is Udine, while the others are Brighton and Hove, south of the Border, Grand Poitiers in France, and Klaipeda in Lithuania. The project aims to "transfer learning" between European cities about their approaches to tackling issues such as demographic ageing and meeting the needs of older residents. GIS has been used in the past by Edinburgh Council to help with planning, parks and transport. European funding for the project will pay for an IT worker to develop an online mapping tool with key data relating to older people's services and activities in the city. Projects in partner cities have highlighted walking groups, urban gardens, poetic therapy and story-telling and activities to improve or maintain memory skills. City health and wellbeing leader Councillor Ricky Henderson, said: "The Urbact Healthy Ageing project is a fantastic opportunity to learn about successful ways in which the lives of older people can be improved, and gives us the chance to share our good practice too. "Promoting healthy and active ageing is an essential part of improving lives for older

people. If we improve health and wellbeing, then it's likely that the need for older people to access higher levels of care will be delayed". Scottish Green health spokeswoman Alison Johnstone agreed. She said: "Using technology in this way is a great use of resources in an effort to increase the health and wellbeing of our elderly population. Such 13 mapping will greatly help in locating the right services in the right areas. In the years ahead with an ageing population and stretched finances it is only right to the user that services are located in the right places and that they are as accessible as possible." Figures show that Scotland's population is ageing, and by 2035 over-65s will account for more than 30 per cent of people. Health experts have warned the NHS will struggle to cope with rising numbers of elderly patients with complex needs in the years ahead against a backdrop of reduced resources and dropping bed numbers.

The Healthy Ageing project has provided examples of opportunities for older people such as games, puzzles and activities aimed at keeping the mind active. An example of poetic therapy has been presented in Lithuania and Edinburgh has actively explored the possibility of transferring some of these activities with relevant services and organisations including libraries. 14 The City has also found economic resources to devote to these activities from the under spend of another grants programme, which would allow £35,000 to be allocated to this work. The ideas and learning have influenced the development of services within the city. For example decisions made in relation to the ‘Innovation Fund’ for voluntary sector projects which aim to improve health and wellbeing for older people, the development of day services and ideas for projects within libraries and other community settings On 14th August 2014 Caroline Clark, Tricia Campbell, Ian Brooke and Library Services have organized a meeting to discuss potential transfer activities that could be developed for older people in libraries including the use of poetry, storytelling and cognitive activities.

The Student Exchange Visit (March 2015) has offered to Edinburgh the opportunity to hear from students of Nursing Faculty from Udine, who lead education classes for elderly people, how to raise their awareness of brain function, perception and the importance of cognitive activity as part of healthy ageing, as well as how to reduce anxiety of older people in relation to cognitive decline. This interesting idea has been seriously considered by Edinburgh, even if it was not felt that its transfer would be deliverable within the project timescales as the curriculum of student nurses is planned years in advance. The Student Exchange Visit was attended by a Senior Lecturer from Queen Margaret University, who was keen to implement some of the ideas of the Project “Cammina-menti” (Move your mind…minds on the move). The programme of the Visit was very well balanced and scheduled both students presentations and visits to services and centres in Edinburgh. That was a very interesting experience for the students, who had the opportunity to meet the Intermediate Care Service Manager (Fiona Stratton), the Access & Emergency Social Care Service Manager (Sylvia Latona), an officer of the IMPACT service (Aileen Kenny), the Technology Lead of the Telecare control room. They also visited the Be-able service where they met the Assistant Unit Manager and then they reached the Queen Margaret University. After the welcome of the Senior Lecturer of the Division of Nursing, they made a tour of the Campus guided by a postgraduate Nursing student and enjoyed a meeting with some representatives of the Community Health Nursing programme team (TBC).

As for the difficulties encountered by Edinburgh, they were similar to those of Brighton & Hove. In particular, the short term of the project limited the possibilities of transfer. Moreover, the financial context within public services at the time of the project has been very challenging, meaning that no additional funding has been available to implement new ideas. Changes had to be made within existing resources.

Despite of these difficulties, the evaluation of the experience was extremely positive . In fact, the project allowed the City to think about their approach to healthy ageing, with the support of the competencies offered by the LP and partner cities. It provided the city the resources and the occasion for developing the use of GIS mapping and to inform people about the service delivered. It provided new ideas from different countries, in particular about how to engage elderly people and the types of services that can be developed for them.

Grand-Poitiers

15 Main actions implemented

Grand-Poitiers focused its attention on the following “good practices”: - the implementation of a GIS Health Mapping; - the deployment of the Vancouver Protocol and the Age-Friendly City Network; - the implementation of intergenerational projects/initiatives.

The staff of the Project has worked at setting up a Local Support Group to accompany all the Project’s phases. The Prospective and Territorial Cooperations Department of Grand-Poitiers, that was in charge to coordinate the Local Support Group, is a sector of the public administration competent for implementing innovative political policies by animating in an integrated way different structures.

The actors engaged in the LSG in Grand-Poitiers were: a) L’AFEV – Association Fédération des Etudiants pour la Ville : an Association funded by the State. The aim is sustaining students in addressing concrete actions for the development of neighbourhoods; b) Le CCAS – Centre Communal d’action sociale : a city centre whose action concerns three different sectors of intervention: early childhood, elderly people, and disabled persons; c) Le Centre Socio-Culturel des 3 Cités (Neighbourhood house) and Le Local (Neighbourhood house): These social-cultural associations are financed by both the city of Poitiers and the Region. Their objective is to contribute to the harmonious development of the neighbourhoods. d) Le réseau gérontologie Ville/Hôpital de Grand Poitiers (gerontology network of Grand Poitiers hospital and the city): This network facilitates the entire, individual and multidisciplinary care of older persons aged 60+ years who are in difficulty and need special medical and social assistance. The network does not replace the offer of treatment and other existing help services; it improves the efficiency, the orientation of the patient among the health disposals etc… e) SIPEA – Organisme Public de Logement : the Local authority landlord of Poitiers, which currently adopts a participative approach (“IHHS”) for the creation of a reference document with all the factors contributing to the wellbeing in a neighbourhood.

As for to the GIS Health Mapping transfer process , the LSG has asked the Lead partner to receive support to make it clearer how to obtain the data needed for building health maps (e.g. data on private sector services) as well as how to use the information provided as a decision making tool. The Lead Partner decided to get them in touch with prof. Fornasin, the demographer of the University of Udine who developed the Health Map System for the “giving city”. Once the “receiving city” gained the information needed, it managed a meeting with the direction of the public services in order to know better how to get Geographical information on public services available at local level (fig. 1).

Fig. 1 The meeting on GIS Health Mapping

Stephane Defontes (representative of Poitiers) presented a number of maps already available and a discussion on how to improve and further develop them was carried out. The group decided what kind of information had to be crossed in order to create new maps useful for political decision making.

16 Fig. 2 The meeting on GIS Health Mapping

As for the Vancouver Protocol methodology , since the beginning of the Project, the LSG has decided that much more information was needed on it. A seminar organised by the French Network Age- friendly cities, held on the 30th of June 2014 in Paris, has represented a very important opportunity to understand the benefits that the City of Poitiers could gain from joining this Network. The LSG has been informed about the relevance for Grand Poitiers to join this network. The forthcoming adhesion of Poitiers to the “Age-friendly Cities” Network will open the way to the future implementation of the Vancouver Protocol to favour the engagement of citizens in drawing attention to specific daily life problems affecting older people life; in identifying priorities and supporting more participative decision making processes. With reference to the project experiences presented by Udine to the “receiving cities”, Grand-Poitiers has analysed the initiatives in order to find out new ideas to implement at local level. Some ideas were already working on the territory of the City (e.g. walking groups): as an example, many local associations were already managing walking groups in Grand-Poitiers both intergenerational and exclusively for seniors.

The intergenerational perspective introduced by Grand-Poitiers in the reflection of the Network on policies for people in later ages has resulted in a very fruitful re-thinking of some initiatives already ongoing in the “giving city” itself. An example of how Grand-Poitiers has framed the policies for older people into an intergenerational approach is the implementation of the I2HS Innovation Habitat Habitants Seniors (Innovation inhabitants, accommodations for seniors) concerning the re-qualification of a real estate asset creating intergenerational housing solutions. This initiative has been promoted by a social landlord in the neighbourhood of “ Les Trois Cités”. The objective was to consult older people about their well-being in their accommodations and their neighbourhood. Starting from the needs emerged from the residents consultation, the landlord has started a very important work to restructure building improving the dimensions and the quality of dwelling where people already lived and creating at the ground floor several service areas: a) Community areas: spaces where people living in the dwelling and their friends coming from other neighbourhoods can meet, take a tea (there is a kitchen open to users) or have a fast break, to stay and spend time together; b) administrative service area: a space where people can go to ask for bureaucratic help and advice; c) health assistance area: spaces where people can go for consulting general practitioners and specialists; d) cultural service area: an open library space where people can go spend time in reading and attending seminars and small events on new publications, etc… The intergenerational approach is in the fact that the landlord has followed a mixed strategy in assigning the dwelling, distributing them in percentage among young couple with, and without, children; older people and single women with children. Moreover, the spaces open to the residents are managed by local associations and some activities are conceived to involve both the young people and the elderly.

Udine

1. Main actions implemented

Udine, as Lead Partner (LP), was contractually responsible for all the project activities. With reference to project management , as soon as the Project was approved and ERDF financed, the Board of Councillors of the Municipality of Udine officially approved the project with the resolution n. 18 dated 23 January 2014, which stated the full involvement of the city as LP in the “Healthy Ageing” project. The following staff of the Udine H.C.P.O. (Healthy Cities Project Office) was assigned to the project: - Stefania Pascut, Health Officer, with the role of Project Manager; - Riccardo Riva, Finance Officer, with the role of Communication Officer; - Paola Asquini, Manager Director of Udine HCPO and Financial Manager of the Project; who were in charge of all aspects of the project (organization of activities and meetings, budget, communication and reporting). During the progress duration, the following staff from other municipal offices was involved: - Luca Mestroni, Finance Officer, who was in charge of budget and contracting during the first phase; - Giampaolo Tarpignati, Finance Officer, who was appointed as FLC for the budget first level control; - Pamela Mason, Director of the municipal Statistics Unit, who helped Udine HCPO by providing statistical data and by establishing the Municipal Observatory on Healthy Ageing; - Andrea Romanini, Architect from Urban Planning Department, who helped Udine HCPO with GIS mapping. The political commitment in the project was guaranteed by the Mayor of Udine, Furio Honsell, who personally took an active part in all project activities and meetings.

Fig. 1 - Udine Political commitment Fig. 2 - Udine Project Staff

With reference to project actions, Udine, like the other partners, created its own Local Support Group which involved the following people. - Fabio Barbone, Antonietta Zanini and Stefania Zuliani, 3 teachers from the Faculty of Nursing Sciences of the University of Udine, who helped Udine HCPO with the organization of the Students Exchange Visits and, in particular dr Zanini, also took part in the Transnational Meeting in Poitiers; - Simone Martelossi, Martina Geatti, Veronica Battigello, Federico Carletta, Anna Lant, Letizia Gallina, the 6 university students who took part in the Students Exchange Visits (March 2015);

- Alessio Fornasin and Laura Pagani, researches of the Department of Statistics of the University of Udine, who developed the health maps and the evaluation of the project; dr Pagani also took part in the Transnational Meeting in Poitiers (January 2015); - Ferdinando Schiavo, expert in active ageing and councillor of the Association Alzheimer Udine 18 onlus, who also took part in the Transnational Meeting in Edinburgh (6-8 October 2014); - Donatella Basso, expert and inventor of the Project “CamminaMenti”, the main good practice that was transferred to partners; - other representatives and members of associations, organizations and partners in different projects, who took an active role in the activities during the Final Conference in Udine (March 2015).

The most important actions that were implemented in Udine during the development of the URBACT “Healthy Ageing” project were: - the Study Visit (5-7 March 2014) and - the Final Conference (20-21 March 2015).

The Study Visit . (5-7 March 2014), which was the real starting point of the project because, for the first time, all project partners had the opportunity to meet each other and know more about the good practices carried out by Udine.

Fig. 3 - Study Visit Fig. 4 - Study Visit

Fig. 5 - Study Visit Fig. 6 - Study Visit

The morning of each day was dedicated to the visits to local contexts (Walking Group, Urban Gardens, Ludoteca - Game Library), while during the afternoon sessions partners could work in groups and think over the real opportunities for transferring into their own contexts the activities implemented by Udine.

Fig. 7 - Walking Group Fig. 8 - Walking Group

Fig. 9 - Urban Gardens Fig. 10 - Ludoteca (Game Library)

Fig. 11 - Afternoon meeting session Fig. 12 - Afternoon meeting session

The last event of the “Healthy Ageing” project was the Final Conference (20-21 March 2015), during which all partners presented the main result achieved in their own cities. It was the chance for a wider discussion on methodologies and tools and, for this occasion, a market place was also created. 20 A great two-days event was organised by involving the whole community, in order to discuss and reflect on the theme of the project: the promotion of an active and healthy ageing. Many activities were proposed to people, both from a theoretical and a practical point of view. Specifically the agenda was scheduled as follows: - Plenary Session (20 March, morning): 10 speakers (delegations, Lead Expert, representative from Slovenia, expert from WHO Venice office, URBACT Pole Manager) and 100 participants; - Market Place (20 March, afternoon): 50 participants (delegations, local associations, physicians, politicians, students), - visit to local farm & physical activity (21 March, morning): 20 participants (delegations) + 50 participants (elderly people), - Conference on Healthy Ageing, Nutrition and Physical Activity (21 March, afternoon): 10 speakers (experts, testimonials, etc) and 100 participants. During the Plenary Session some international experts intervened: - Flavio Lirussi, W.H.O. expert on Healthy Ageing; - Eddie Adams, Pole Manager of the URBACT Programme; - Petra O čkerl, representative of IPoP - Inštitut za politike prostora / Institute for spatial policies of Ljubljana (Slovenia).

Fig. 13 - Final Conference – Plenary Session Fig. 14 - Final Conference – Plenary Session

Fig. 15 - Final Conference – Market Place Fig. 16 - Final Conference – Market Place

Fig. 17 - Final Conference – Afternoon session Fig. 18 - Final Conference – Afternoon session

On the last day a walking group activity with a lunch at local farm was organized for the delegations.

Fig. 19 – Final Conference – Walking group activity Fig. 20 – Final Conference – Walking group activity

Fig. 21 – Final Conference – Walking group activity Fig. 22 – Final Conference – Lunch at the local farm

Finally, during the Final Conference, some space was given to the group of students who took part in the four Students’ Exchange Visits in Brighton (4-5 March), Poitiers, Edinburgh and Klaipeda (12-13 March). The students presented their experience with enthusiasm to delegations and to the public during the 22 afternoon session.

Fig. 23 – Students’ interview Fig. 24 – Students’ presentation of results

2. Expertise

A relevant role in the project was performed by the Lead Expert , Fiorenza Deriu, researcher from the University of Roma La Sapienza, who supported the staff of Udine HCPO and the Pilot Transfer Network throughout all project. In particular, during the first phase (January-June 2014), she worked very closed with the Lead Partner both to better know the good practice to be transferred to the other partners and also to analyse the situation of the other partner cities in order to understand how the transfer could be facilitated. First of all, the LE took part in some bilateral visits to partners cities, in order to meet the LSGs working at local level and presentthe URBACT Programme and the main lines of action of the Healthy Ageing Pilot Transfer Network. These visits, which were all funded with project budget, were the following: - Udine (27-28 Ferbuary 2014): Meeting with the LE and the URBACT Pole Manager Eddy Adams to present and share all important and valuable aspects regarding the good practice to be transferred to the other city partners; this was a preliminary meeting helpful to investigate activities, collect data and information and better schedule the study visit in the giving city - Brighton&Hove (8-9 April 2014); - Edinburgh (20-21 July 2014); - Meeting with LP/LE in London (3 September 2014), organized by URBACT Secretariat; - Students Exchange Visit in Brighton (4-5 March). With the collaboration of Udine HCPO and Project Partners, the LE was able to deliver the following documents - Baseline Study (March 2014), which was the summary of the first phase and - Final Report (April 2015), which was the summary of the whole project and the results achieved.

Fig. 25 – Lead Expert Fig. 26 –Experts at the Final Conference

Another important aspect of the URBACT “Healthy Ageing” Project was the possibility given to cities to employ an External Expertise .

The Fondazione Giacomo Brodolini of Rome gave an excellent support to Udine H.C.P.O. in the management of the project. The Expertise contract was stipulated in June 2014 and, since then, the Fondazione guaranteed the City of Udine with a Senior Expert - Alberto Merolla - who took part in many transnational activities - the 2 Transnational Meetings at Edinburgh (October 2014) and Poitiers (January 2015), the Meeting with LP/LE in Paris (19-20 November 2014) - and played an active role during the "Final Conference" in Udine (20-21 March 2015). Moreover, the Fondazione supported the Lead Expert Fiorenza Deriu in her scientific activity.

Fig. 27 – Expertise (FGB) Fig. 28 – Expertise (Nordic Walking Association)

Another expertise was necessary to LP for the organization of the Final Conference in Udine. In this case, the FVG Nordic Walking Association of Udine (a local sports association dealing with sports and physical activities for all ages and the organization of events) supported the staff of Udine H.C.P.O. in all the practical aspects of the conference (graphics and printing materials, conference organization, experts, testimonials, etc) and in the organization of the activities with delegations (excursion to local farm, etc).

In addition to that, on the occasion of the two events in Udine, a valid Scientific Expertise was asked to 2 international experts from the WHO (World Health Organisation) , who has cooperated with Udine HCPO in the field of Healthy and Active Ageing for many years: - prof. Geoff Green , Senior Expert of Sheffield University, who gave a contribution on WHO strategies and objectives to promote healthy ageing during the Study Visit (5-7 March 2014), - dr Flavio Lirussi , W.H.O. expert, who intervened at Final Conference (20-21 March 2015).

Internal Expertise was finally asked to other offices of the Municipality, in particular to the Statistics Department (Pamela Mason) and to the Urban Planning Department (Andrea Romanini).

24 3. Communication & Dissemination

As for the communication , many initiatives were developed in order to ensure visibility to the URBACT logo and Programme. A specific project logo was created starting from a shared idea coming from partners' discussions (the idea of the tree with roots and branches). The logo was used in all the communication materials together with the URBACT and the EU ones. As concerns the printing materials , a brochure and a folder were printed and were used not only during the official meetings (Study Visit and Final Conference) but also distributed to local stakeholders, foreign contacts, partners in other projects and, in general, to all the subjects that could have a link with URBACT or could have had an interest in the specific theme of healthy and active ageing. The materials contained a short description of the objectives and activities of the “Healthy Ageing” project, together with a presentation of the URBACT Programme and its goals. For the "Final Conference", a special set of gadgets (pen, bag, folder, brochure) was produced and distributed to all the participants, which gave the opportunity to disseminate the URBACT experience within the whole community. Each city created 2 posters , which were both used for discussions and reflections during the market (March 2015) and taken to the URBACT City Festival in Riga (May 2015).

Fig. 29 – Poster Udine 1 Fig. 30 – Poster Udine 2

During the Final Conference, 2 large banners were attached to the Bollani Arch, an historical monument overlooking the main square and on the way to the Castle Hill, which gave great visibility both to the Conference and to the URBACT Programme.

25 Fig. 31 – Bollani Arch in Piazza Libertà Fig. 32 – Banner

The website of the “Healthy Ageing” project was updated with the information regarding the objectives and deliverables of the projects, the partners involved and the activities implemented. Pages have been updated monthly or anyway when something important was happening among the partners, for example in the occasion of the first Study Visit in Udine and the Transnational Meetings in Klaipèda, Edinburgh and Poitiers. All the editorial sections regarding the Lead Partner, the other city partners, the Lead Expert, the objectives and content of the project were completed. The relationships with press & local media were constant during all the reporting period, especially in the conclusive period when the project was at its end and the final conference was organised. The LP invited all the local media (Messaggero Veneto, Gazzettino, RAI, TelePordenone, etc.) to the Final Conference in Udine, in which also the Lead Expert and the URBACT Pole Manager took part. The Final Conference was organised as a public event to which all the community, especially older people, were invited. The aim was both to inform people of the results of the project and much more disseminate the principles and objectives of the URBACT programme, and to actively participate in concrete activities, by putting into practise the contents of the “Healthy Ageing” project. This was much appreciated by all the participants and local media which advertised the event. Following the initiative and in general the closure of the project, Udine and the URBACT programme have gained much visibility in the important national magazine “Espresso” and in TV channels (RAI, RAI Scuola, TV2000, etc.).

As for the dissemination , a lot of activities have been launched in order to disseminate the URBACT Programme and the specific “Healthy Ageing” project both at a local level and at a national and international level. At a local level , Udine, like each partner city, has disseminated URBACT and the project during many events 26 by involving the community and/or specific stakeholders. A good way to disseminate the project was also through the local support group. In all local events dedicated to the elderly, the LP has informed people of what was going on with URBACT, and also each partner city has organised local events during which the project was disseminated. At a national level , the project was disseminated among the meetings of the Italian Healthy Cities Network and dufing the event “Carrara Show” that took place in Carrara (30-31 May 2015). At a European level , the project was disseminated within all the partnerships and networks which Udine is taking part in, that means the European Healthy Cities Network, the Healthy Ageing Task Force of which Udine is the lead city, the Learning Cities Network, the European Innovation Partnership Platform and the AFE-INNOVNET circuit, the Age-Friendly Cities Network. In particular, there were some international events in which the LP has participated with the URBACT budget and after agreement with the URBACT Secretariat: - meeting "The cities and the youth employment: the solutions of URBACT cities and the role of the innovators to fight unemployment at local level" in Torino (12 September 2014), - workshop AFE-INNOVNET “Independent Living, Housing, Domotics. Age-friendly environment strategies" in Udine (30-31 March 2015), - URBACT City Festival in Riga (6-8 May 2015). It is worth mentioning that Udine, being part of the WHO Healthy Cities Network, is trying to disseminate the experience of URBACT among the other healthy cities in order to transfer and share knowledge, resources and best practices. To this purpose a representative from WHO, Dr. Flavio Lirussi, was invited to take part in the final conference of the Healthy Ageing project, since it was a good opportunity to meet one of the Pole Managers of the URBACT Programme, Dr. Eddy Adams, and discuss the possibility of future collaborations between the two networks on the themes of health and urban issues.

Finally, the LP took part in the URBACT Capitalisation process and has benefit from this opportunity not only to disseminate the project, but also to share ideas and reflections with other projects representatives. The first meeting was in Bruxelles on 3 July 2014 and Udine was involved.

PART II 27 THE MAIN RESULTS ACHIEVED

Klaipeda

1. Main results achieved and future development

The close cooperation between the LSG members and the scholars of the University of Klaipeda involved in the Healthy Ageing Project has resulted in the production in a relevant numbers of Multi-Layer Maps representing both the distribution of the elderly population on the local territory and the services available in different areas and districts of the City (green areas, indoor and outdoor sport training centres, bus stations, drugstores, etc…) (see Fig. 1).

Fig. 1 – An example of Health Map

On the basis of the information showed in the Maps, discussion with the reference person in charge at each sector of the administration started. With specific reference to outdoor sport facilities it emerged that the Maps were very important to increase the awareness of health planners on where and what kinds of additional facilities would be worth installing to meet better the needs of older population (see Fig. 3). The Health Maps System build on the exchange experience of the Healthy Ageing Project needs further improvement but at the moment the City of Klaipeda is motivated to continue investing in its implementation and considers fully sustainable this activity along time.

Klaipeda has also shown particular interest in developing activities that promote mental health. During the Project the Health Bureau has given special attention to “Walking groups” (fig. 2).

Fig. 2 Walking groups in Klaipeda

The Nordic walking group was the only one in Klaipeda before its participation in the Healthy 28 Ageing Project. The specialists of the City Health Bureau were responsible for the activities carried on by this group. The experience of the Healthy Ageing Project has driven to spread this activity in different regions of Klaipeda city in close collaboration with a number of communities’ representatives. As a result of this transfer experience, there are currently many other “Waking groups” in addition to the initial “Nordic Walking Group” . Elderly people are encouraged to walk and communicate with their own responsibilities in collaboration with communities’ representatives. And this new activity is currently coordinated by the Public Health Bureau specialists.

The perspective in the future is to involve a wider number of older people in this activity; to train more specialists to lead the groups; to suggest new routes and meeting points in order to favour as much as possible the elderly participation; to prepare a booklet to inform seniors about the benefits they could get from joining to such initiatives.

Klaipeda has not shown interest in developing further “Urban Gardens” because most citizens have already their own gardens in second residences nearby Klaipeda (about 20 km). People use to go there especially during summer time. Elderly people spend time in the gardens with family, friends, so it is very important not only for their physical health, but for their mental activity.

The Municipality of Klaipeda will strive hard to more actively engage the seniors in planning activities dedicated to their age group as well as in the decision making process adopting the Vancouver Protocol methodology of citizens’ consultation. The Health Bureau is also going to emphasize the importance of cross-sectoral cooperation in both planning and decision making; in the management of national long-term strategical action plans focused on older people. The Healthy Ageing Project has had also a positive impact on the stakeholder’s engagement in the LSG activity, giving them the opportunity to learn about the experience of Udine and strengthen their commitment and responsibility in future project-related decisions. The involvement of representatives of different policy sectors has improved the capability of the Health Bureau to implement at local level the “good practices” and the lessons learned from Udine.

The participation in the Healthy Ageing project has also resulted in several positive changes in elderly “sentiment”. First of all, the elders of Klaip ėda have understood that they are considered by the policy makers a fundamental group and that city‘s health specialists work in improving the quality of the services that are directed to answer their needs. In this way, the elders experienced the practical benefits of this project and discovered how easily activities that take place in other countries, could be organized in Klaip ėda, too. In addition, seniors have had an opportunity to recognized that everything that has been implemented has been positively evaluated by the foreign countries experts and project partners.

2. Main lessons learned

Klaipeda has gained useful lesson from each one of the city partners. 29 From Edinburg it has learned the importance to give attention and equal relevance to social groups of older people who are not considered at tall: as an example, the LGBT people who can meet specific problems with ageing. Edinburgh has developed specific activities and services to support and sustain people belonging to these groups. Klaipeda has taken this important lesson from Edinburgh and has started to evaluate the work with socially-sensitive groups and finding out new ideas on what it could be offered to them.

From Grand-Poitiers, Klaipeda has gained the importance of adopting an intergenerational approach in implementing activities and offering opportunities to both the youth and the elderly looking at reaching reciprocal benefits.

From Brighton & Hove, Klaipeda has taken the importance of a strategic planning. The city’s politics have received the message of the project that when organizing the strategical action plans, the emphasis should be given to the strategy of the healthy ageing.

From Udine, Klaipeda has learned to pay attention to the active engagement of seniors into the organization of the activities and the development of projects.

3. Project assessment: “before” and “after” the Project

before after

The already existing platform of dialogue has been improved and strengthened with the inclusion of new relevant stakeholders representatives in the LSG of Klaipeda. Even the capacity of the City to answer in an integrated way to identified needs has progressed. The Commitment of the City was already very high since the beginning of the Healthy Ageing Project but the press interest has boosted and much more information has been disseminated improving awareness on this issue among citizens. The commitment of the decision makers was already high but the participation into this project has increased the interest even with respect to future projects. Coherently to this growing interest of decision makers in future projects, the allocation of resources has seen an increase as new activities have been implemented due to the transfer process and they need to be continued along time.

Engagement of social actors and relevant stakeholders

high

Existence of local platform for dialogue (LSG, Steering group)

low high

Involvement of relevant stakeholders

Answers to local need of elderly people

30 high

Fragmented answers to local needs

low high

Joint responses to identified needs

City commitment and press interest

high

Commitment of the City

on the healthy ageing

issue

low Press interest in the high healthy ageing issue

Commitment of decision makers and resources

high

Commitment of local decision-makers

low high

Allocation of resources

Brighton & Hove

31 1. Main results achieved and future developments

Brighton & Hove has developed a very advanced online mapping too, available for anyone on the web, and sustained with a plan for how new data can be uploaded. The same tool will be applied to the locality health older people health profiles. The online tool “It’s Local Actually” is part of a contract that runs until 2017. An in depth on this tool is included in the presentation titled “Community Insights” (Annex 1) . From the homepage of this system the user can choose from a drop down list which city areas and services would like to appear on the map. The services can range from GP practice to hospitals, pharmacies, etc... The city areas are split into Local Authority (Brighton&Hove, Greater Brighton ity Region etc…) and wards (East Brighton, Hove Park and many others). On the left of the screen there is the Map Indicators including six main thematic headings (vulnerable groups, population, crime, health, housing, economy): Each heading contains a number of specific indicators. Once the area and the services have been chosen the user can click on an indicator on the left menu and it will be mapped. The user can zoom in and out of the map using the toolbar. In this way, it is possible to move from the ward to the district level and compare East Brighton to other areas. If the user wants to download a Report for an area he/she has just to click on the “View all reports available” link. Then the user finds the area to report for and clicks on the “Download as word” link. This command produces a word document reporting the result of the query. The Report takes a few seconds to load and gives the user the most up to date data available for the area with a summary page followed by more detailed information under each heading (population, housing, vulnerable groups, crime, health and wellbeing, deprivation and economy). If the user wants to know more about the indicator mapped he/she has to click on “More detail” link and the definition of the indicator will appear. The user can also create its own neighbourhood by drawing up the area on a map and saving the related data shown as a matrix or charts on a dashboard including information on key indicators. Data can be export to open/save into excel.

The ideas and thinking that have been shared with a range of partners who took part in the programme will continue to influence our future plans, for example in the development of public health older people programme and the roll out of the Locality Hub approach to commissioning and delivery of community support for older people. This approach is very important because it aims to build on what is already available in Brighton & Hove and create opportunities to stimulate a diverse range of high quality services. On a practical level, the Citywide Connect team facilitates hub meetings (North/Central, East and West) which bring key stakeholders and frontline workers together. Hub meetings will improve communication across sectors and providers by creating opportunities to share knowledge, best practice and resources. The Citywide Connect Programme Board oversees the activity. It will work with all partners to implement cultural changes which increase social connection and support positive health and care outcomes.

Another result of the participation into the Healthy Ageing Project is that 2015 will see the updating of the chapter on Healthy Ageing through an ongoing process for undertaking Needs Assessments.

Looking at future perspective the interactive maps will be further developed and linked with service data. The City has moreover pointed out the need to continually extol the benefits of prevention and early intervention. Preventative approaches could be further developed with the transfer of resources to support prevention (shift in the balance of care). The project has emphasised the importance of a community development approach – from the ground and based on the views of the people who will use the services. This approach needs to be integral to the design and delivery of all services, not just those concerned with older people. There is also a need to address stigma around ageing, and present ageing in a positive light. The achievements of older people should be celebrated and age should be seen as an opportunity not a threat. We should stop focusing on the negative aspects of ageing all the time, and regard our older people as an asset not vulnerability. Older people contribute a lot to society.

The importance of prevention, along with specific ideas relating to healthy physical and cognitive ageing, is currently influencing the development of preventative strategies in Brighton & Hove. There is a new Public 31

Health Older People programme which brings together all these issues in one place, informed by the data made available by our mapping tools.

The engagement of older people will continue to influence future planning and decision making. 32 The Healthy Ageing Project has built on existing groups and structures. The already existent structures have favoured the development of the Projects activities. The project has actually created the opportunity for stakeholders to be involved in the exchange visits and has given both the City Council and LSG representatives the time and space to develop new ideas and build trust and understanding. Local older people have been involved in the visits, which they enjoyed.

Innovative approaches from partner cities included urban gardens and health walks (Udine), dementia preventative services (Edinburgh), singing/poetry (Klaipeda) and intergenerational approaches to housing and community development (Poitiers). The LGBT Age project from Edinburgh and input from Brighton and Portsmouth University have provided a useful focus for an exchange about how accessible health and social care services are for older people from lesbian, gay, bisexual and transgender communities. Brighton & Hove has been able to exchange learning from strategic planning tools such as GIS mapping (Udine) and Joint Strategic Needs Analysis (Brighton and Hove). The City has also found of particular interest the Be-able project from Edinburgh and wish to transfer aspects to our own falls prevention programme.

2. Main lessons learned

Brighton&Hove has learned the following lessons from the participation into the Healthy Ageing Project:

1. The importance of time to develop relationships with both local stakeholders and those involved in similar work in other countries;

2. The importance of broadening our outlook beyond our city and country – this applies to all stakeholders involved in the project including older people, officers, partners and politicians

3. The power of maps – this allows a vast range of information to be available to all stakeholders and ensures that services are developed in a strategic way.

3. Project assessment: “before” and “after” the Project

The Project assessment is widely positive. The Public Health Programme Manager of the City Council has rated an increase in both the engagement of social actors, who were already involved in a Steering Group when the Healthy Ageing project started, and in the local platform for dialogue. In fact, even if a thematic Steering group was already working at local level at the beginning of the project, its composition was enlarged including new members representing further interests of local bodies and organizations. Moreover, a reduction in the fragmentation of the answers to older people needs has been accompanied by an increase in the capability to give joint responses to specific needs. The City commitment on the healthy and active ageing issue has risen thanks to both the work done within the Project and to a growly increasing interest of the press on this topic. A positive effect has been also recorded with respect to commitment of local decision makers who, at the beginning of this experience, were much more focused on youth issues. As a consequence the major interest of the policy makers has favoured an improvement in the allocation of resources on healthy ageing initiatives and older people. The allocation of resources is becoming more challenging due to increasing financial pressures on public services. The current position is fair, but it is likely to become more difficult beyond March 2016.

before after

Engagement of social actors and relevant stakeholders 33 high

Existence of local platform for dialogue (LSG, Steering group)

low high

Involvement of relevant stakeholders

Answers to local need of elderly people

high

Fragmented answers to

local needs

low high

Joint responses to identified needs

City commitment and press interest

high

Commitment of the

City on the healthy ageing issue

low high Press interest in the

healthy ageing issue

Commitment of decision makers and resources

high 34

Commitment of local decision-makers

low high

Allocation of resources

Edinburgh

35 1. Main results achieved and future developments

The use of GIS has always been well established within the City of Edinburgh Council, with a focus on planning, property management, parks and gardens, transportation and research and information. Nevertheless, the use of GIS analysis within older people’s health and social care services has been limited due to a lack of capacity and resources to undertake this work. The Healthy Ageing project has provided the opportunity to employ an intern for 12 weeks, in partnership with Edinburgh Voluntary Organisations Council, to develop an online mapping tool with key data relating to older people’s service and activities in the city. The tool will be used by public and voluntary agencies to inform service planning and development in the city. The online mapping tool is currently available for anyone to use on the web, and can be sustained with a plan for how new data can be uploaded.

Fig. 1 Some examples of maps created by Edinburgh Health and Social Care Department

Isabel Cayon, the GIS intern has created an interactive online mapping resource , making available a range of maps, listed below. The maps have been also presented to various audiences and groups operating at local level.

Population maps based on census data • Age ‘heat’ maps • Health ‘heat’ maps • Dementia prevalence ‘heat’ maps (using census population data and dementia prevalence rates (Eurocode)) • Unpaid carers ‘heat’ maps

Service data • Health and social care boundaries • Day services and catchment areas • Care homes • Sheltered housing • GP surgeries 35

• Falls prevention services • Preventative services e.g. singing groups, green spaces

Isabel has been employed for 6 months to work jointly with EVOC (the voluntary sector) and the Council to map data on older people populations and services, to inform future planning. 36 The interactive maps can be further developed with additional data to be added, and to include other service not only for older people. The Department is going to continue the work done by Isabel Cayon. The power of mapping has been emphasised through the project, which is likely to have a tangible impact on future decision for the location of services and activities. This mapping work will be incorporated into the new Strategic Plan for health and social care and the new locality plans that all Scottish partnerships are required to produce.

The Healthy Ageing project has also focused on activities that support healthy physical and cognitive ageing. Examples of projects taking place in both the Lead Partner City (Udine) and the partner cities include walking groups, urban gardens, poetic therapy and story-telling, activities to improve or maintain memory skills, education and awareness-raising of healthy cognitive ageing. Many similar activities already existed in Edinburgh, but the project has led to some new ideas and consideration of areas for potential development, working in partnership with voluntary organisations in the city. In fact, the exchange with the other partners has been fruitful for Edinburgh. The ideas and thinking that have been shared with a range of partners who took part in the programme will actually continue to influence the future plans of the City, for example in the development of a preventative strategy . Preventative approaches could be further developed with the transfer of resources to support prevention (shift in the balance of care). The project emphasised the importance of a community development approach – from the ground and based on the views of the people who will use the services. The Community Connecting Project supports people to re-build lost confidence and try out new things, or to get back involved with previous interests and hobbies. Older people can take part in one-to-one support, group sessions and may also receive telephone support. See the video at the following link http://youtu.be/UC4_9pSvFA0 (6 mins). The importance of prevention, along with specific ideas relating to healthy physical and cognitive ageing, will influence the development of preventative strategies. The engagement of older people will continue to influence future planning and decision making, too. Another project that has been further improved with new ideas thanks to the Healthy Ageing Network is Moose in the Hoose , an example of innovative practice, giving a voice to volunteers and older people living in care homes in Edinburgh. The film demonstrates active ageing and the promotion of social connectivity by showing residents access Skype, the Internet and various other computer activities assisted by specially trained Moose volunteers. See the video at the following link: http://aceit.org.uk/moose/?p=1525 (9 mins). These results have been achieved because the project has been built on well established, existing groups and structures. Nevertheless, the project has created further opportunities for stakeholders to be involved in the exchange visits. Local older people were particularly involved in the Edinburgh visit, which they enjoyed. A local older person, Joyce Armstrong, wrote a report of her experience of the visit and this was included in a report to the Council committee: http://www.edinburgh.gov.uk/download/meetings/id/45121/item_81_- _healthy_ageing_european_project_update

Involvement in the project helped the City Council staff in making the older people who took part feel valued, listened to and actively engaged. They enjoyed learning from experiences from other countries and in helping to showcase the positive work from Edinburgh. The LGBT Age project from Edinburgh has provided a useful focus for an exchange about how accessible health and social care services are for older people from lesbian, gay, bisexual and transgender communities. Further input was received from Brighton and their links with Portsmouth University. See the video at the following link http://vimeo.com/106340077 (password: lgbt).

The Dementia Campaign from Edinburgh was another area that other cities were keen to learn from. See the leaflet in attachment ( Annex 2 ). Innovative approaches from partner cities included storytelling and poetic therapy as was to encourage older people to express themselves (Klaipeda), and intergenerational approaches to housing and community

development (Grand-Poitiers). Edinburgh has been also able to exchange learning from the Joint Strategic Needs Analysis (Brighton and Hove). Brighton and Hove have been particularly interested in the Be-able project from Edinburgh and wish to transfer aspects to their own falls prevention programme. 37

2. Main lessons learned

The importance of broadening our outlook beyond our city and country – this applies to all stakeholders involved in the project including older people, officers, partners and politicians

The power of mapping data – this allows a large amount of data to be analysed in a very visual and meaningful way for a wide range of audiences

The challenges faced by different countries and cities related to the issues of healthy ageing are very similar and approaches are very transferrable.

3. Project assessment: “before” and “after” the Project

before after

Most areas have seen an increase, building on an already good position. So, the already existent platform of dialogue has been further improved favouring the participation of new interested stakeholders; the interest of the press has been increased in the healthy ageing issue, and the capability to give joint answers to fragmented needs of older people as well. The allocation of resources has become more challenging over the timeframe of the project due to increasing financial pressures on public services.

Engagement of social actors and relevant stakeholders

high

Existence of local platform for dialogue (LSG, Steering group)

low high

Involvement of relevant stakeholders

Answers to local need of elderly people

high

Fragmented answers to

local needs

low high

Joint responses to identi fied needs

City commitment and press interest

high

Commitment of the City on the healthy ageing issue

low Press interest in the high healthy ageing issue

Commitment of decision makers and resources

high

Commitment of local decision-makers

low high

Allocation of resources

Grand Poitiers

1. Main results achieved and future developments

Grand-Poitiers has mainly centred its action in developing the Health Map System . The main result achieved from the participation in this project is the production of a number of maps merging population and services data related to a specific ward of Poitiers. In May 2014 there has been a meeting with the local support group in order to present the work done regarding geographic information systems in Grand Poitiers for healthy ageing (Fig. 1). Benoît Morillon, in charge of geographic information systems in Grand Poitiers, has presented 3 maps as an example of the work done (Fig. 2). On the basis of these information (but not only), Angelique Branchelot, in charge of the city centre of social actions, has shown the actions of prevention done in Grand Poitiers by the Municipality.

Fig. 1 Meeting with the LSG to present the first 3 maps

Fig. 2 Example of a map on population aged 65+ and the services offered by the Trois Cité district of Poitiers in 2014

The maps will be used for the coordination of an integrated policy on the «live-together» and on active ageing on the territory. The maps will also improve the current knowledge of the local support group. See the presentation attached in Annex 3 .

Another important result achieved by Grand-Poitiers, thanks to the experience of Udine, concerns the decision to join the Age Friendly Cities Network . The participation into a seminar organized by the French Age Friendly Cities network has enabled Poitiers to identify the points of main interest for its local context. First of all, the Vancouver Protocol is a methodology that favours a participative democracy, giving back free speaking to older people. This enables to inscribe on the territory a global and integrated policy on active aging. In fact, the actions led by the public administration should intersect other city policies. It also favours the governance empowering older people agency in the society. The older people are not only collective memory keeper but they also give a vision of the future.

Grand-Poitiers has also found out new ideas from the exchange with the other city partners to further develop the Project Tous Connectés aux 3 Cités .

The objectives of the Project are. To reduce the digital divide in the 3-Cités District To improve and maintain seniors connected to family and friends through the computer technology To have fun with videos, games, and music. The project has been hosted by the Marie Louise Troubat senior housing facility. The idea was to bring older people spending time at the “3 Cité” social centre to join older residents of the Marie Louise Troubat house. Older people was encouraged to build new relationships and to share time with other people. The M.L. Troubat house provided residents with tablets and offerend to those who attended the courses 2 hours per week of training.

The main topics of the programme were: Switching on and off the digital tablet Surfing the internet To create and use a mailbox (sending and receiving e-mail and messages) Communicating via social networks To capture photos and videos To select applications that meet their needs Playing with digital tablet (games)

The project has also involved a number of young volunteers who have attended a training course before tutoring the seniors in the project.

At the very end of the year 9 residents of the M. L. Troubat and 11 from the “3 Cité” social centre attended the first training session.

Fig. 3 A group of young volunteers attending the training session to become senior’s tutors.

Fig. 4 An example of intergenerational approach

2. Main lessons learned

Grand-Poitiers has gained some useful lessons from the participation into the Healthy Ageing Network:

1. the importance of using technologies, at different levels. The use of GIS to create a cartography tool to support decision making; to favour the access and the use of open data; the wi-fi availability in all buildings to make older people always connected. 2. the importance to enter the “Age Friendly Cities” network to make effective the Vancouver Protocol methodology as a tool for engaging and activating older people in raising problems and finding out solutions; 3. to explore further solutions with respect to housing solutions for seniors; 4. to enhance new activities to keep the elderly mentally and physically active with ageing; 5. to enlarge the partnership and the participation into the LSG activities to new stakeholders.

Fig. 5 Lessons learned for the future

3. Project assessment: “before” and “after” the Project

before after

The project assessment has highlighted a relevant improvement in both the existent platform of dialogue and the capacity of the City representatives to involve new stakeholder on the healthy ageing issue. The local needs remains still fragmented and this also the reason why Grand-Poitiers is so interested in joining the “Age Friendly Cities” Network as well as in adopting the Vancouver Protocol methodology to better identify people’s needs. At the same time, the participation into the Healthy Ageing Project has improved the capacity of the City to give joint responses to elderly’ needs.

The commitment of the City is much more oriented to develop intergenerational policies than policies specifically thought on the ageing issue. This is the reason why improvement on this dimension has not been recorded. Otherwise, the interest of the press on the ageing issue has increased. Finally, commitment of decision makers has not changed with respect to the ageing issue, whereas the allocation of resources has recorded an improvement.

Engagement of social actors and relevant stakeholders

high

Existence of local platform

for dialogue

(LSG, Steering group)

low high

Involvement of relevant stakeholders

Answers to local need of elderly people

high

Fragmented answers to local needs

low high

Joint responses to identified needs 42

City commitment and press interest

high

Commitment of the City on the healthy ageing

issue

Press interest in the low high healthy ageing issue

Commitment of decision makers and resources

high

Commitment of local

decision-makers

low high

Allocation of resources

PART III IMPROVEMENTS IN THE GOOD PRACTICES

Udine

1. Future developments

The experience that the Municipality of Udine is carrying on in the field of Active and Healthy Ageing is absolutely sustainable at the local level, also thanks to the strong political commitment and leadership of the Mayor of the city, Furio Honsell. In fact, he has brought health and healthy ageing as a core theme at the top of his political agenda and as a priority in all implemented policies. Moreover, the costs of the good practices are very limited and often benefit from the co-operation of different organisations and from the contribution of volunteers, so they could continue in the future.

The “good practices” implemented by Udine are going to be improved and extended to as many people as possible. The experience has allowed the local administration to test the actions of their good practices and to carefully observe where they could be modified or refined for better results. Many of the activities proved to be valuable and worth implementing but some of them have the potential to be further improved and disseminated within the community.

The “good practices” proposed by Udine could be certainly enhanced through the following actions: - the implementation of participative and consultative processes , involving the community in the decision-making process regarding urban environments;- the development of an cross-sectoral approach, with the involvement of local stakeholders, institutions, organizations, local associations, the private sector; - a change from temporary ad hoc projects to stable policies and actions with long-term objectives (Move your minds, walking to school, oral hygiene, walking groups, soft fitness, etc.); - the increase of co-funding and investments on health initiatives, with also the application to European funds; - the increase of awareness and responsibility towards health by the municipal administration and by the community as a whole (health literacy, healthy lifestyles, healthy ageing, physical activity, etc.).

The Healthy Ageing Project has been a good starting point for further developments , both for the implementation of activities in the field of active and healthy ageing, and for the opportunity to collaborate at a European and international level.

The results of the project, the opportunity of dialogue, exchange of know-how and experience with other cities, has strongly stimulated the decision-makers to invest on these opportunities since they enrich the community not only in funds from the European Union but also in expertise, relationships and skills. Even the Regional Government and other municipalities have expressed their interest in co-operating with Udine in a future application to URBACT calls or similar programmes. The impact of the project has been very positive since it has given the opportunity to the Municipality and to the W.H.O. “Healthy Cities” Project Office - which was the one responsible for the project - to reinforce the relationships with many of the members of the Local Support Group. Their involvement in the project has made them more responsible and aware of their role in the community and, therefore, more willing to act as a support to the citizens, especially to older people, and more ready to co-operate with each other. Some new stakeholders entered the LSG group, such as the Planning Department of the Municipality, some other voluntary associations and local organisations (for example, the “Nordic Walking” association) and other stakeholders began to feel much involved and to strongly co-operate for common results (for example, the Statistics Department).

These new relationships have led to some progress of the good practice in the giving city, for example (fig. 1): - the health maps will be updated and, where possible, integrated with new data; - the project has stimulated further analysis on the quality of life and well-being of the elderly, so that the Statistics Department has set up a permanent Observatory on Healthy Ageing; - some planning pilot experiences have been launched in terms of analysis of the accessibility and age-friendliness of urban environments and proposals for possible improvements/interventions; - some initiatives have been extended and improved as well as enriched with new opportunities (for example new courses have been introduced in the project Move your minds); - events aimed at raising awareness and offering activities to the elderly have been organised at the local level and have set up permanent relationship that will continue also in the future; - the collaboration with the University, especially with the Nursing Sciences Faculty, has been greatly strengthened and has been the starting point for future innovative approaches and actions; - intergenerational activities have received more attention and will be the focus for future projects.

Fig. 1 Summary of the new ideas to be further implemented by the Municipality of Udine

In the field of prevention services / interventions the W.H.O. Healthy Ageing Project has been very fruitful, since it has fostered the active involvement of the Faculty of Nursing Sciences of the University of Udine and the implementation of intergenerational activities. The students’ engagement has concerned not only the 45 activities in Udine (for example their participation in the project “CamminaMenti / Move your minds”) but also the transnational partner meetings and the transfer process among partner cities. The 4 exchange visits organised in March 2015 have been a good occasion for mutual learning and new ideas. In fact, the perspective for the future would be to invest on new services for the elderly, by promoting intergenerational activities and by exploiting the professional skills of these students on themes regarding falls prevention, contrast to isolation and solitude, safety programmes, healthy lifestyles, etc.

The involvement in the “Healthy Ageing” project has been an important opportunity also for the community and for elderly people . Older people were already very satisfied with the activities that the city and the Municipality offered to them, but was not able to perceive “their special contribution”. When they had the opportunity to share with foreigner people coming from other countries their experience, they felt much more valued and proud of what they were doing. So, it has been a strong input for improvement and enthusiasm. Moreover, considering that sometimes Europe is regarded by older people as a far framework from their everyday life, the project itself has brought Europe much closer to them who could perceive the importance of European projects. At the local level, activities gained in visibility and dissemination opportunities. This was very important since even the best initiatives sometimes lack of proper dissemination and are not able to reach the entire community.

Fig. 2 Some key messages to keep in mind for the future development of the “good practices” of Udine

2. Main lessons learned

For the city of Udine, the impact of the project HEALTHY AGEING has been much stronger than expected at the moment of presenting the application, especially due to well-functioning management and partnership and to the high level of experience and enthusiasm shown by the partners. The project has offered the opportunity to learn from other best practices, to reflect on the state of the art of our local community and to know its needs and interests regarding opportunities and resources. This has obviously increased among policy-makers, professionals and the community in general both the awareness about the importance of healthy ageing and the interest in implementing strategies to make our city an age- friendly city.

The 3 main lessons learned from this project could be summarised in:

1. The importance of creating a solid relationship between the following 3 levels : the European level , the political level and the community level , in order to develop a systematic and evaluated approach to EU resources and to allow citizens to recover or maintain trust in institutions and public organisations as well as reliability and consciousness of the importance of the European Union as a whole;

2. The importance of spin-off initiatives launched through this transfer network projects and initiatives promoted by programmes like URBACT. Considering the increasing pressure of everyday work activity, little time remains for lifelong learning and training opportunities. These European platforms are an added value for cities since they give the opportunity to share expertise, experiences and ideas and to encourage innovation and urban development in processes and approaches. In this sense, the methodology used by the URBACT Programme of “giving city - receiving city” could be simply changed into a “creative mutual exchange” process , since we learned through the project that each city has something to teach and to learn and Udine which was supposed to be the giving city has received much from the other partners.

3. The need to adapt the good practice to the local context of each partner cities, since it often happens that cities are not at the same level of progress as regards the themes you are dealing with. The analysis of the local context before starting implementing activities and sharing experiences is of primary importance. For this reason, the Baseline Study has been an essential starting point for the Healthy Ageing project. Then each partner had the opportunity to choose those actions which were more appropriate for their communities.

3. Project assessment: “before” and “after” the Project

before after

As for the “receiving cities” the participation into the “Healthy Ageing” Transfer Pilot Network has benefited also the Lead Partner, Udine. Looking at the diagrams, the City has further improved its capability to involve relevant stakeholders on the issue of healthy and active ageing as well as in the enlargement of the initial platform of dialogue. An improvement has been also recorded in a joint answer to older people’s needs who are currently less fragmented than they were at the beginning of this experience. The participation into this project has also produced a resonance in the media and in the local press offering an opportunity to publicly discuss about the healthy and active ageing issue. In this way much more information has been driven to the attention of the citizens of Udine. Finally, the resources allocated on this heading of policies have seen an increase as the Mayor has announce that he will continue investing on this field of action. As it could be easily foreseen the commitment of the City on health ageing issue as well as the commitment of local decision makers on the same topic remained stable at a very high level coherently with the strong will and commitment declared by the Mayor in every occasion of participation in this Network.

Engagement of social actors and relevant stakeholders

high

Existence of local platform for dialogue (LSG, Steering group)

low high

Involvement of relevant stakeholders

Answers to local need of elderly people

high

Fragmented answers to local needs

low high

Joint responses to

identified needs

City commitment and press interest

high

Commitment of the City

on the healthy ageing issue

low Press interest in the high healthy ageing issue

Commitment of decision makers and resources

high

Commitment of local decision-makers

low high

Allocation of resources

PART IV A MODEL PROPOSAL FOR A FEASIBLE TRANSFER PROCESS by Fiorenza Deriu (LE)

Introduction

This final section results from the reflection following the completion of the activities of the “Healthy Ageing” Pilot Transfer Network. It does not represent what the Network has actually done but what, in light of this experience, we have tried to “model” for a more effective EMPOWERMENT of a transfer process.

Hence, in the following pages a theoretical and a practical framework within which a transfer process should be developed are presented. It is a re-elaboration of our experience in the Healthy Ageing Project; it is a result of the RESONANCE that this experience has had on our background.

It represents what we have learned from the reciprocal exchange; from what we have done; from the methodologies used; the steps followed. But it results mainly from what we HAVE NOT DONE ; from what we have MISSED or OMITTED .

In this sense, the EMPTIES are much more informative and INSPIRING than the full. In fact, we have to learn, first of all, from our mistakes or omissions. Otherwise, knowledge will never grow up!

What does it mean to transfer a “good practice”?

The concept of “transfer” is complex; it is multifaceted: for this reason it can result ambiguous. First of all, it is a “process”; it is a dynamic concept concerning different steps and phases strictly connected ones each other. The main idea is that there is a starting point and an ending point. So we need to define the extremes and what is in the middle. Then, our task is to identify the most effective strategy that the Lead partner should undertake to enable the “receiving cities” of a Transfer Network to store and re-elaborate the knowledge and the profound sense of the experience of the good practice to be implemented, possibly in an innovative form, in different contexts.

Hence, the second question raising is: what are the steps of a transfer process? The experience of this Pilot Transfer Network has enabled us to identify five main steps on which the transfer process is built on: Information, Knowledge, Contextualization, Creative planning, Implementation. These phases are mainstreamed by a cross component: Innovation (Fig. 1).

Fig.1 Diagram of the Transfer Process

INFORMATION

IMPLEMENTATION KNOWLEDGE

INNOVATION

CREATIVE PLANNING CONTEXTUALIZATION

Let’s move on describing the phases of this approach.

First phase: INFORMATION ABOUT THE “G OOD PRACTICE ”. It is mainly based on the collection of data and information on the “good practice” to be transferred. There are several types of information that the “giving city” can offer to the “receiving cities” in this phase: a) descriptive data; b) data on processes; c) organizational data; d) critical data. Descriptive data: this category of data is focused on what does the good practice concern; on the main goals and objectives it is aimed at; on the needs it is addressed to; on the actors involved; on the institutional bodies committed in it; on the target population considered, etc…These data include also information on the activities run, the results achieved and the economic and human resources needed. Data on processes: These data concern the steps followed by the “giving city” from the beginning until the end of the experience that has become a “good practice”. The process starts from when the decision to implement the activity has been adopted and pass through the identification of the resources needed, the partners to involve, the citizens engagement, the networking among key stakeholders, the methodologies used to make people working together, the communication strategy adopted, etc…Data on processes are data on methods and techniques used by the “giving city” to make the project working at its best. Organizational data: these data are much more focused on the specific activities implemented and on the organizational model applied to realize as better as possible the objectives of the project. Organization concerns mainly, but not only, human resources: it also looks at material and economical resources management. Critical data: these information are of fundamental importance because they highlight the critical aspects that could occur in developing the “good practice”. It points out at threats, constraints and obstacles that could intervene in each phase of the implementation process of the “good practice”. These data provide the “receiving cities” with some hints and tips on how to overcome possible challenging events.

Anyway, the INFORMATION PHASE is not merely a one-way direction occasion of collecting data on the “good practice”. It is basically an OPPORTUNITY FOR THE “RECEIVING CITIES ” to make QUESTIONS to the actors engaged in the “good practice” presented; to get information material, PAPER DOCUMENTATION to gain a deep understanding of the “good practice”; to VISIT , when possible, and OBSERVE directly the subject of the case study. KEY WORDS of this first phase are: 51

- Data collection - Questions - Observation - Documentation

Second phase: KNOWLEDGE ON THE “G OOD PRACTICE ”. This is a very important moment in the process of transfer of a “good practice”. According to many scholars (Barnard et al. 2001; Hemsley-Brown 2004; Kirst 2000; Love 1985), there are six main steps in a dyadic knowledge transfer process: K. generation; K. adaptation; K. dissemination; K. reception; K. adoption; K. utilization. The three first steps are attributed to those who generate knowledge; the other three steps concern users. In our case, we can consider the “giving city” as the player who generate a “good practice”, whereas the “receiving cities” are those who will use the knowledge got from the “good practice”. Starting from this basis, we have both re-elaborated this process and suited it to the transfer process experienced within the “Healthy Ageing” project.

In fact, in this second phase of our model of transfer, knowledge consists in a re-elaboration of what the “receiving cities” have learned from the first phase (Information). The re-elaboration passes through a REFLECTION phase that brings the “receivers” to interiorise the main contents of the “good practice”. At this stage “receiving cities” have to reflect on what they have listened to; what they have seen and observed; what they have red and experienced during the Information Phase . They must go in depth and UNPACK the experience done. It implies the raise of AWARENESS of knowledge in receivers. It means that “receiving cities” are interested in the “good practice” and they are fully aware of the concrete needs it could eventually satisfy (Becheikh et al. 2008); they have a clear idea of both the context in which the “good practice” has been run; the problems it was tackling with; the solutions proposed. Then, the concept of awareness is basic in this discussion. It has a lot to do with another key concept: RESONANCE . Resonance happens when you face at something that reminds you something else you have already met in your previous experience; resonance brings your memory back to similar experiences, facts, events. In doing that your mind re-elaborates your experience and enriches it. As a consequence, those data collected and transformed in useful information, become your own knowledge, UNDERSTANDING and cultural heritage. We can summarize this step saying that the “receiving cities” have RECEIPT KNOWLEDGE .

KEY WORDS of this second phase are:

- Reflection - Resonance - Understanding - Reception

Third phase: CONTEXTUALIZATION OF THE “G OOD PRACTICE ”. In this phase the knowledge gained in the previous steps should be CONNECTED to the own CONTEXT of each “receiving city”. The “receivers” should ask themselves how this knowledge could BENEFIT their cities; if it could offer a useful answer to city’s problems; if their cities could be MOTIVATED to use or not use that knowledge; if there could be any kind of RESISTANCES to adopt in their own contexts the knowledge got from an external “good practice”; if LOCAL ACTORS could be interested in assuming the LEADERSHIP of the “good practice” at local level; if what they have learned is compatible with existing POLICIES and practices; finally, if RESOURCES are available to adopt the “good practice” (Rogers, 1983; Roy et al. 1995; Hemsley-Brown and Sharp, 2003). So, at this stage it is worth trying to combine to and merge the knowledge components with the specificities of the local context where the “good practice” should be transferred. The evaluation of all these aspects well focused on the cities’ own context can be sustained by the engagement of potential stakeholders in a preliminary discussion about the interest in adopting/transferring the “good practice” at local level. This is a way to build up bridges and bonds between local actors and public administration.

KEY WORDS of this third phase are:

- Connection - Merging - Bridging - Bonding

Fourth phase: CREATIVE PLANNING OF THE “G OOD PRACTICE ”. At this stage the “receiving cities” should try to develop an “idea” coming out from the knowledge and the contextualization phases. This step requires a further effort in being CREATIVE and INNOVATIVE . The “transfer” process is not merely, and it could not be merely, a de plano transposition of the “good practice” from one to another context: it is a creative process of re-elaboration of the initial experience enriched by the lesson learned and by the specificity of the context in which it should be transferred. In this creative process, aimed at introducing innovative elements in the initial “good practice”, developers should have an attitude towards innovation; they should be aware that innovative aspects exist in the new idea; they should be able to decide whether to adopt or not such an innovative idea; and finally, they should confirm their decision (Rogers, 1983; Roy et al., 1995). At this point the knowledge generated through the previous steps is applied in order to achieve specific goals and objectives (Bichel and Cooley, 1985; Love, 1985). The adoption of a creative planning implies the possibility to use the new “activity/idea/project/service” to solve concrete problems or to meet specific citizens’ needs (instrumental); to support thinking and reflection (conceptual); to legitimate and justify decision making (symbolic). For this reason I prefer to use the verb TRANS -CREATE than TRANSFER .

KEY WORDS of this fourth phase are:

- Creative - Innovative - Transcreate

Fifth phase: IMPLEMENTATION OF THE “G OOD PRACTICE ”. This step goes into the direction of making the “creative planning” working. It puts the idea into action! The result is always something different from the initial idea, from the “good practice” inspiring the new “plan”. It can be similar, but it will never be the same. The added value of the transfer process is actually in these differences, in the creative part of its development. Anyway, for a successful transfer process, implementation needs a synergy of actors and resources as well as a strong supervising and coordination body. What does it mean a strong coordination body? It does not mean an actor who stay close to those involved in the implementation process at each steps; it actually means an actor who supports and accompany the participative and cooperative process of all those who are committed in the implementation of the “good practice”. The LSG is, on my opinion, the best body that could be in charge for this role. In order to have some evidence of the results achieved by the transfer process, it would be also worth carrying on an ex ante and a post evaluation analysis in order to point out how the implementation of the “good practice” has benefited the citizens at local level.

KEY WORDS of this fifth phase are:

- Action - Differences - Synergy - Evaluation

Now, let us move on forward the cross component concerning INNOVATION . As stated at the beginning of this Section, innovation is a component that passes through all the phases described above. How can it be possible?

During the first phase, when partners are informed about the “good practice”, they should not merely collect data but try to discover those innovative aspects that could benefit their cities; these starting new ideas could be re-elaborated in a knowledge-building process that could reshape the “good practice” in a suitable way for its implementation in a different context; at this stage the innovative hint can be subject to creative planning and implementation. Innovations’ adoption is a path, a process where 1) there is awareness of the existence of an innovation; 2) decision makers and actors involved in the process have an attitude towards innovation, they are sensitive to it; 3) they decide whether to adopt or reject the innovation; 4) they decide to implement the idea; 5) they confirm the adoption of the decision (Becheikh, Ziam et al. 2008).

Anyway, remind that Innovation is not compulsory! When you have an exchange about a “good practice” you could not find anything new or innovative. You could merely find that factors, resources, elements already existing are mixed in a new way, and that the new way to manage those resources is the key of success of that “good practice”. So, we must not be mistaken looking at innovation in an obsessive way. We have just to pay attention, to be aware that in a “good practice” there could be some interesting and innovative aspects that we could identify and re-elaborate in a very personal way.

How can we transfer a “good practice”?

As stated by W. J. Rothwell, in order to capture lessons from an experience and to transfer the knowledge built on a “good practice”, several strategies should be followed (2004). Rothwell designed its 12 strategies reasoning on knowledge transfer processes in management. Hence, we have chosen some of these strategies according to the specificities of the mission we had to tackle with in transferring the good practices developed by the ‘giving city’ to the ‘receiving ones’.

We have adopted the following strategy based on a nine cells matrix crossing two main dimensions: on the one side, the level of activity of the partners (city level, partners level, project level); on the other side, the way they were called to work (alone, in group or at community level) (Table 1).

Table 1 – Model of a Strategy of “Transfer”

How are you At what level are you working? Transfer working? phases City level Partners’ level Project level Alone Data collection Presentations of Reports on the Information Drawing up diaries ones own context data and Documentation Information from information partner collected experience In group LSG meetings – Working group: Study visits Knowledge agenda and - in ones own LE visits Contextualization reports on LSG city TEM Peer review Creative activity - in mixed meetings planning groups Storytelling In a community Dissemination Drop-box Open Space Creative activities for the Market Place planning local community: Community of Implementation - Local press practice on-line Storyboards - City Council website

In a Pilot Transfer Network there is a first level of a partner’s work that is preliminary to what will follow. In this phase there is a lot of work that the partner must run on its own along three levels of activity: at City, 54

Partners and Project level. After the kick-off meeting each partner should go in depth in studying the project activities scheduled; in collecting data useful for future meetings; and, finally, in starting drawing up the diary of the project. Each partner will be invited to prepare documentation (on paper, videos, ppt) to favour the exchange of experiences with the other project partners: in this phase, the “giving city” plays a crucial role because it is called to show and describe in details the activities run. Anyway, to give partners the opportunity to describe their local situation is important as well. This could be a first step for a more fruitful discussion on how eventually transfer the good practice in a very different context.

SPECIFIC TOOLS : Projects diaries Video-film Presentations Leaflets Reports

The INDIVIDUAL WORK will accompany the entire life of the project and it will benefit from using the project diaries, tracking the single steps done in developing the project activities; from videos, presentations and other dissemination material, useful for sharing as much information as possible on one’s own experience; from the reporting activity that is also a very important tool because in drafting it the partner has to re- elaborate at a first stage the experience done. So, the report is already a reflection on the experience and it makes it possible to stress in its pages the lessons learned, the challenges that could be faced at; the opportunities that could arise; the threats to prevent.

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Anyway, during a transfer process it is crucial to WORK IN GROUPS with other City partners as well as with ones own local partners. At this stage, at City level the LSG represents the main actor to involve in the activities of a transfer process. The agenda and the reporting activity of the LSG should contribute to proceed on working together with the main stakeholders in finding out innovative ideas looking at the lessons learned from the “good practices” to be transferred. The work of the LSG is accompanied by the meetings with the other project partners who are met in occasion of both the Study visits and the Transnational exchange meetings aimed at keeping the representatives of the cities together to share their experiences, opinions and ideas about the “good practices” presented by the “giving city”.

In order to EMPOWER THE EXCHANGE among the cities, during the transnational meeting the LE devote some slot of time to working groups: according to the objective of the working group the LE decides whether make partners working within their own City or with other City partners. When the objective is “contextualization” or creative planning”, make partners working in a city group is much more effective; otherwise, when the objective is INCREASING UNDERSTANDING of and knowledge about the “good practice”, to make representatives from different cities working together could be more useful and inspiring. In fact, in this phase, UNPACKING KNOWLEDGE is possible only if people coming from different cities and cultural backgrounds share their different views on a same topic. Storytelling was in these occasions a powerful way of transmitting wisdom and experience from a city to another. The description of what was happening at local level with respect to the transfer of the “good practices” presented by Udine was a starting point for further discussion.

SPECIFIC TOOLS : Working groups LE visits Study visits Transnational Exchange Meetings Reports Storytelling

There are many well known techniques that can be adopted to manage a working group. Anyway, there is one technique that could result particularly effective in building knowledge and pushing forward to creative planning: the CRITICAL INCIDENT INTERVIEWS AND THE SIMULATIONS .

In business management this technique is used, as an example, by older workers to prepare the younger employee to face at critical situations in an effective way. This is a way used by great enterprises to transfer knowledge from a generation of employee to another.1 Something similar can be done in a project of transfer of a “good practice”. Starting from the SWOT analysis done by each City on a good practice, the LE prepares a “scene”, focused on a criticism to be solved related to the practice object of transfer. Then, the LE assigns to each member of the working group a role; asks participants to study the case; to read the role they are called to perform and then the session starts. This technique is very useful because enables participants to face at a concrete problem related to the “practice” they are studying and calls them to an effort in finding out a solution. This simulation (a sort of role playing) favours the reflection on specific critical issues of the “good practice” and enables partners to find out solutions that otherwise they would not have found. It is important to build up a mixed group, because it enriches the probability to collect many different views on the criticism.

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Another important working level is the community. What does it mean? It means that cities can work at transferring the “good practice” at local level involving the community spreading and disseminating ideas to start a participative process of creative planning. Local press, on the one side, can be a powerful means of communication about the exchange experience with the other European cities involved in the Pilot Transfer Network; on the other side, information uploaded to the City Council website can be a vehicle to reach representatives of the civil society interested in such a topic. Anyway, there is also another community of work: the partnership itself. The representatives of the city partners are themselves a COMMUNITY OF PRACTICE, a group that comes together to share information and knowledge about a common problem, issue or topic, and try to find out solutions and new ideas in a gradual increase in understanding. A community that is working in person and/or on-line. In the Healthy Ageing Transfer Pilot Network we have built an on-line community of practices, where each partner could access and consult documentation uploaded by the other partners and grow up in knowledge and problem understanding. Another step in knowing ones each other and sharing the steps forward to implementing the good practices of Udine has taken place during the Final Conference of the Project. At this stage we have organized an OPEN SPACE MARKET PLACE (anticipating in a sense the “Meet the Cities” session set up in Riga) where each city partner has been invited to prepare two posters showing the former the main results of the transfer activity process; the latter the perspective lines of action for the future. The posters were conceived as a STORYBOARD , a paper placed on the wall to show how a City had performed in a specific situation in order to transfer the “good practice” at local level. The storyboard had not only the aim to show the results achieved by the partners nut also to offer to those were attending the final conference an opportunity to get new ideas.

SPECIFIC TOOLS : Local press and websites Drop-box Open Space Market Place Storyboard

KEY LEARNING POINTS :

1) the success of a transfer process depends mostly on understanding the priorities of each City partner with respect to the Project. I mean that we shouldn’t make the mistake to pretend to transfer everything everywhere, because each City has its own priorities in the transfer process and we have to take into account these priorities. In our case, for example, all the city partners have indicated in

1 The author of this Part IV (Fiorenza Deriu, LE) has used this technique in a research committed by a great Banking Group in Italy to study the Seniority among their personnel aged 55 and over. In particular, it was used in a training course directed to 40 Human Resources Advisors to prepare them to conduct more than 100 face-to-face interviews to senior employees (over 55 years old) of the Bank. In order to prepare the HRA to face at critical situations that could intervene during an interview, the LE planned 20 different “scenes” concerning 20 different criticisms, roles were given to participants (interviewer, interviewee and observers) and then results discussed in plenary in order to draw up a Vademecum for conducting interviews. The activity was very welcomed from particpants and from the manager of the Bank for the positive follow up and impact on their personnel in the following months. 56

building City Health Maps their common priority. So, this point has become the focus of our project. Then, the second point is quite different from ones each other. Edinburgh looks at finding out new ideas on preventative services; Brighton in citizens’ engagement; Klaipeda in politicians’ engagement; Grand Poitiers on intergenerational initiatives.

2) to meet the managing authorities of the City Council is an important point. It is crucial to meet the Director of the Departments (in our case the Health or Social Care and health Managers) managing the project at the local level, and to outline the relevance that the transfer process has at a wider level. The managing authorities seem to give a considerable importance to this issue as well as to getting more information on possible future development of these activities in a third phase of the Urbact Programme. When, as in the case of Brighton e.g., the managing authorities had other priorities – for example young people and not elderly people – the visit has contributed to support partners in sensitizing the Directors to look at the healthy ageing issue from a different perspective. In the case of Brighton, for example, to imagine intergenerational initiatives that could at the same time benefit the youth as well the elderly people;

3) The involvement of universities representatives in the project can also represent a strength point. As an example, in our project, one of the representatives of the City of Klaipeda was at the same time an associate professor of the University and the chief in charge of the Board on Social and Health care services of the City Council. This double role of some representatives can effectively sustain the engagement of the City in developing the transfer process;

4) To create partnership including in their own staff or well connected with people who have the technical competencies needed by the project. For example, in our project some cities have met much more difficulties than others in finding the staff that had tools and competencies in using GIS Systems, in analysing statistical data and in using specific software to implement City Health Maps. Anyway, all the cities have built their maps at the very end, reaching interesting results also going well beyond the “good practice” of the “giving city”.

5) It must be considered that some activities that the partners had to carry on in this Project were very time consuming and expensive and this programme do not allocate enough money to deliver the outcome expected. So, Cities have had to tackle with the need to allocate resources to make some activities possible (e.g. Edinburgh has allocated money to take an intern to devote exclusively to Health Mapping building.

URBACT is a European exchange and learning programme promoting sustainable urban development. It enables cities to work together to develop solutions to major urban challenges, reaffirming the key role they play in f acing increasingly complex societal challenges. It helps them to develop pragmatic solutions that are new and sustainable, and that integrate economic, social and environmental dimensions. It enables cities to share good practices and lessons learned with all professionals involved in urban policy throughout Europe. URBACT is 181 cities, 29 countries, and 5,000 active participants