An Age Friendly City – how far has London come? Anthea Tinker, and Jay Ginn, King’s College London Published by King’s College London, February 2015 Copyright © Anthea Tinker and Jay Ginn ISBN 978-1-908951-13-7 Contents
Foreword 2
Background, objectives, scope and methods 4
Executive summary: recommendations 6
Policy areas 1 Housing 9 2 Outdoor environment and neighbourhoods 14 3 Transport 17 4 Social, cultural and civic participation 23 5 Employment, skills and income 27 6 Community support and health services 31 7 Communication and information 36 8 Respect and social inclusion 39
Lessons from abroad 42
Some evidence from London Borough of Hackney 46
Conclusions 48
Notes 50
References 51
Acknowledgements, the authors, disclaimer, the Institute of Gerontology 56 Foreword
Foreword
The Institute of Gerontology was pleased to be asked by the Greater London Authority (GLA) to undertake this research. It follows our study for the World Health Organisation (WHO) in 2006: What makes a city age- friendly? London’s contribution to the WHO Age Friendly Cities Project (Biggs and Tinker, 2007). This is an independent review but we are grateful to be able to share with the GLA a clear commitment to valuing and supporting older people, identifying what can be done to promote their wellbeing and full social inclusion.
There have been considerable last report. This refers in particular to the improvements since our last report due increased accessibility of public transport to the efforts of London’s public sector and the extensions to when the Freedom organisations, older people’s organisations, Pass can be used and the age of eligibility individual older people and others. For [GLA 2014a]. Positive changes to the example parts of the city have benefited public realm were also acclaimed. from the accessibility improvements made for the London 2012 Olypmic and This report reviews research on what Paralympic Games and the GLA has additional actions the city could ensured the volunteering legacy through implement to make London more age- the Mayor’s Team London programme. friendly, in terms of Other GLA actions, such as the adoption of the Lifetime Neighbourhoods concept • better homes and ‘walkable’ and the Green Grid are enhancing people’s neighbourhoods; neighbourhoods and London’s outdoor • accessible public transport; environment in some areas. Programmes opportunities for employment and such as the London Living Wage and the volunteering; Mayor’s Know Your Rights campaign are • adequate incomes that enable a helping some older Londoners obtain comfortable life and participation in a better income. That, combined with desired activities; the public sector focus on reducing • accessible health and social care health inequalities, through the Mayor’s services that minimise the impact of Health Inequalities Strategy, and his adverse health conditions or disability; Digital Inclusion Strategy are designed to • readily-available information, including keep older people socially and digitally through the internet; connected. • dignity and respect through positive language and images of ageing for An internet survey carried out by the GLA all, irrespective of their gender, class, to inform this review indicates that older ethnicity or disability status. people and their organisations frequently cited enhancements to public transport as Resources are clearly important for the top improvement in London since the improving the material aspects of older
2 Foreword
people’s lives. However it is also crucial valuable - but sometimes unrecognised - to change the attitudes of society, so resource, to their families, to community that older people are seen not as a groups and to the economy and wider homogeneous group, but as individuals, society. Their contribution is maximised if with diverse lives and varied contributions they are valued and supported by suitable to make. policies at national and local level. The government, GLA, local authorities, We acknowledge that many of the service providers, employers and each decisions affecting the wellbeing of older and every one of us need to work towards people are taken by central government making London a more age-friendly city. and are therefore beyond the scope of the GLA or local authorities. However we Anthea Tinker (above left) strongly believe that older people are a Jay Ginn (above right)
Age UK London is delighted that this new 2015 report continues the work and momentum begun in 2006.
The report demonstrates the significance of an age-friendly London, and highlights practical opportunities for making Sam Mauger, this a reality. Areas such as housing and the enhanced Chief Executive commitment to Lifetime Homes and more fuel efficient Age UK London homes as well as the protection of older tenants so that they feel secure have been on the age agenda for many years. Developing areas such as our outdoor space, to make pavements “walkable”, to maximise green spaces, as well as libraries and community centres, remain crucial to active participation in the local community. Making people feel safe to travel with traffic calming actions, bus shelters and clean air help to keep people secure and well.
Above all this, the report acknowledges the importance of engagement with older people, putting them at the heart of change and using their knowledge and expertise to contribute to an age-friendly London. We look forward to the continued development of age-friendly policies in London and urge that it is progressed by all with drive and enthusiasm.
3 An Age Friendly City – How far has London come?
Background, objectives, scope and methods
4 Background, objectives, scope and methods
The Greater London Authority (GLA) aims to make London a more accessible and welcoming city for older people.
As part of this, the Institute of Gerontology, In each chapter, we identify a) features of a King’s College London has undertaken city that influence the social inclusion and to update previous research on Age wellbeing of older people; b) developments Friendly Cities for the worldwide since 2005, highlighting where London has initiative undertaken for the World Health made progress; c) gaps that remain to be Organisation (WHO) (Biggs and Tinker, addressed. We recognize that some policy 2007). This update summarises what areas and services are the prerogative of matters for older people, noting changes central government. However, we raise since 2005, identifying remaining problems the issues because they set the context and suggesting possible solutions. The for older Londoners’ material and social London study (Biggs and Tinker 2007) circumstances. Where possible, attention reviewed information about London is paid to gender, ethnicity and disability including from fieldwork with older people status. We have added some limited in two London boroughs. In some aspects, lessons from abroad and some evidence London excelled but in others there was from another research study on LB Hackney. scope for improvement. Methods Objectives The work has involved reviewing and Our aim is to increase awareness of local updating statistical and research literature needs, gaps and ideas for improvement to assess how well London organisations in order to stimulate development of are addressing the needs of older people, urban settings that are more accessible what problems remain and what can and socially-inclusive for older people, be learned from other cities. Sources thus promoting their wellbeing. Policies to examined include: data from official improve material conditions and the social sources, especially the GLA and community environment facilitate the less tangible and voluntary organisations concerned aspects of wellbeing. More social-inclusivity with older people’s welfare. Material on for older people has benefits for residents older people’s views was obtained through of all ages, especially children and those published surveys and researchers’ who are vulnerable due to physical or attendance at meetings of older people. mental impairments. Our research makes recommendations for the GLA and others. We divide each chapter into these sections: a. Features that influence wellbeing Scope and social inclusion of older people b. Developments since 2005 The report includes the topic areas of c. Gaps that remain to be addressed. the original WHO specification: housing; outdoor environment and neighbourhoods; We then follow this with recommendations. transport; social, cultural and civic participation; employment, skills and Disclaimer income; community support and health services; communication and information; The views expressed in this paper are and respect and social inclusion. solely those of the authors.
5 An Age Friendly City – How far has London come?
Image Beanstalk – courtesy of the Age Action Alliance Executive summary: recommendations
6 Executive summary: Recommendations
This study found that many of that ensures sufficient decent affordable homes for all Londoners in future, housing the GLA’s policies and plans are demand must be stabilised by well-directed towards making discouraging overseas buyers from using London a more age-friendly city. ‘Buy to Leave’ and ‘Buy-to-Let’. We recommend disincentives to using London housing as an investment for However, cuts since 2005 by central capital gain and policies at national and governments in the resources available regional level to distribute employment to the GLA and to Local Authorities opportunities more evenly across the UK. (LAs) have to some extent offset efforts to maintain and improve older As private rents become increasingly people’s housing, transport accessibility, unaffordable and inflate Housing Benefit community facilities, health services costs, we recommend rents be regulated and social care. Hence there is more to an affordable1 level, accelerating the to do to improve London as a city for landlord accreditation scheme to ensure older people. We recognise that some proper maintenance and tenant security. of the improvements required stem from national policies, but the latter To make neighbourhoods more ‘walkable’ have implications for older Londoners’ and exercise more attractive for residents, welfare and for measures the GLA might we recommend that LAs ensure take in mitigation. We set out below pavements are safe for walking and our recommendations to enhance older provide sufficient free accessible public people’s wellbeing and social inclusion. toilets. To ensure that urban renewal has This report is the sole responsibility of beneficial effects for neighbourhoods, the authors. we recommend that LAs involve older people in any changes being planned for To improve housing options for Londoners their neighbourhood and work with local as they age, we recommend more residents in creating more public gardens provision of a variety of Lifetime Homes, and small parks. including specialist housing, within each neighbourhood; homes to be close to To make London’s streets healthier, safer shops and transport, at affordable prices for walking and more pleasant, we or rents; and improvement of the energy recommend the GLA encourages reduction efficiency and condition of older people’s of traffic, especially daytime use of Heavy homes through refurbishment. Goods Vehicles (HGVs) on London’s roads; brings in cleaner engines for buses and taxis To alleviate London’s current housing as a matter of urgency; adheres to EU crisis, where demand outstrips supply, requirements for air quality; and encourages more affordable social housing is urgently boroughs to introduce 20mph zones. required. We recommend that available public land be transferred to LAs and HAs For older people in particular, we (Housing Associations) at low prices and recommend TfL continue to provide LA borrowing limits eased enabling them shelters and seats at bus stops where to build new social housing and to possible; that Transport for London (TfL) refurbish existing stock to a decent seeks government funding to accelerate standard. To retain these valuable assets making all Underground stations step- for future generations, we recommend free; and that Legible London signs LAs and HAs should be able to choose not include information on which routes are to sell. For a sustainable housing policy not wheelchair accessible. 7 An Age Friendly City – How far has London come?
To facilitate social and cultural raised training standards for care staff; participation, we recommend LAs and ensure compliance with the Human recognise the importance of community Rights Act in regards to all care home and centres, libraries and other cultural nursing home residents. facilities; support the community and voluntary groups that engage and assist To ensure people of all ages can older people, and continue to seek access information, services and innovative ways to do so. consultations, we recommend that digital communication, especially in the public To combat age barriers to employment, sector, should always be supplemented we recommend the GLA works with The by other means. To expand internet Age and Employment Network (TAEN) capability among older people, suitable in efforts to convince employers that mentoring sessions should be provided employing and training older workers is through libraries, adult education centres a sound investment. Government action and community centres. To prevent is needed to address the difficulties financial exclusion due to lack of a experienced by the many older people passport, a basic digital ID card acceptable struggling on inadequate incomes in an to banks should be made available to expensive city. This includes restoring older Londoners. the Winter Fuel Payment to its original value relative to fuel prices, maintaining To tackle negative attitudes towards older universal benefits and allowing older people we recommend that the GLA people to opt into the new single tier publicises and celebrates older people’s pension, the latter to be raised above the multiple contributions to society; that, in poverty threshold. We recommend the general, upper age limits be abolished; GLA seek to retain more of the revenue and that all public sector organisations generated in London, to ease the situation should commit to anti-ageist policies, of older Londoners in poverty through with the media encouraged to follow suit. funding LA service provision.
Since health inequalities indicate the potential for improving health, we Our major recommendations recommend tackling the social and are that older people should be environmental determinants of ill-health consulted, by a variety of means, at all ages; in London, this includes reducing air pollution and improving to enable their views to be taken housing conditions, access to transport into account; and that LAs should and green spaces, social cohesion have sufficient resources to and access to social engagement maintain their local services and opportunities. To enable older people to facilities, since these are essential remain in the community as long as is practical and to support informal carers, for older people’s health, safety we recommend that LAs restore an and social inclusion. adequate level of home care services for older disabled people, including those with ‘moderate need’. In the light of the poor standards and even abuse of older people in some care homes, we recommend that governments require
8 Image courtesy of Pollard Thomas Edwards, Architects The OWCH (Older Women’s Cohousing) Barnet development
policy area: 1 Housing
9 An Age Friendly City – How far has London come?
Housing for older Londoners is affected Well-designed homes with sufficient space, by rising overall demand and increasing adequate heating, modern kitchen and disability among older people. bathroom facilities and energy efficiency measures all help to prevent ill-health. As The London population rose by 1.2% p.a., older people spend 80-90% of the day at from 6.8 to 8.4 million between 1986 and home, good housing is especially important 2013, with the number of households and respiratory illness, heart disease, stroke, projected to rise by 40,000 each year. arthritis, rheumatism, falls and winter deaths Meanwhile the number of homes rose are all linked to poor housing (Adams 2009, by less than 0.8% p.a. or 25,000 p.a. Thus GLA 2013b). The Decent Homes Standard London has a persistent and increasing (updated in 2006) requires social housing to shortage of homes to buy or rent, for people be in good repair with modern facilities and of all ages; moreover, there is ‘a massive adequate warmth. However, according to shortfall of homes that most Londoners can Shelter, in 2004, 51% of older people lived afford…...an affordability crisis’ (GLA 2014b: in non-decent housing, 25% had no central 4). In 2013 the average price of a London heating, 40% spent 5-10% of their income house rose to £450,000, widening the gap on fuel and 9% lived in damp or infested between London and elsewhere in the UK homes (Edwards, 2005). In London 29% of to 75% and private rents rose to twice the older households live in social rented homes national level (ibid). The UK population (local authority or housing association), 5% aged over 65 is projected to grow by 47% by in privately rented homes and two thirds in 2041, faster than the population as a whole a home they own (GLA 2013b) and in each at 23%, while those over 85 are expected sector there are homes in need of repair and to be more than double by 2023 (GLA improvement. In 2005, about 12% of rough 2013a). In London, older people are 10.7% sleepers in London were homeless people of the population, compared with 16.4% in aged over 55. England and Wales (ONS 2012). b) Developments since 2005 Older people are living with disabilities and longstanding illnesses for a greater In 2013, the average London house price proportion of their life, although this rose by 12% while owner occupation varies with social class, ethnicity, gender declined from 57% to 50% between 2001 and location. At age 65 men are now and 2011, with an increase in private renting expected to live with disability for 7.9 (GLA 2014b: 10). Older people share the years, women 9.9 years (ONS 2014a). adverse effects of rising rents; the median This, together with the growth of the private rent rose to over £1,300 per month, very old population and persistent health double the amount of the state single inequalities, has implications for older tier pension to be introduced in 2016. A people’s housing if their preference for London Rental Standard of management for ageing in place – living independently in landlords and letting agents was launched their own home - is to be met and their in May 2014, with 100,000 landlords to be health and wellbeing protected (Adams accredited by 2016 (GLA 2014b:5). Landlords 2009). Currently 90% of older British will be encouraged to offer tenancies people live in mainstream housing, 6% in for a longer period than the statutory some form of sheltered housing and 4% in minimum and London boroughs to use only residential settings. accredited landlords when discharging their homelessness duty (GLA2012). The majority a) Housing features that influence wellbeing of older tenants live in social housing. For and social inclusion of older people. those entering a new tenancy, their rent
10 Policy area 1: Housing
can be up to 80% of market rent. Despite ensure independence and quality of life bearing no relationship to average incomes1 with on-site support (GLA 2013b) and such this is still termed ‘affordable’ (Ambrose homes in private retirement villages are 2007). State pensions lack London increasing. However, lease conditions, Weighting to offset London housing costs. charges, resale restrictions and inadequate care provision are potential drawbacks. The GLA aims to improve standards in new homes for older people so they can be used Among those aged over 75 in the UK, ‘safely, easily and with dignity regardless 2 million live alone, of whom 1.5 million are of …age, disability, gender or ethnicity… women (Age UK London 2012) with [and be] responsive, flexible, convenient, increased risk of social isolation. However, accommodating and welcoming… new options such as Homeshare and [adaptable] for people who are frail, older, cohousing schemes facilitate care for older visually or hearing impaired, have learning people in a co-operative inter-dependent difficulties or are wheelchair users.’ (GLA setting, helping maintain the older person’s 2013a:28). London Design Guide standards agency, identity and dignity. Homeshare have recently been adopted. These include schemes arrange rent-free or low rent a minimum space per person that is 10% accommodation for a helper in an older higher than the previous Parker-Morris person’s own home in return for a few standard for council homes; generous hours per week of practical assistance and balconies if there is no garden; full company, but not personal care (Tinker et al. accessibility for disabled people; 10% of 2012). Cohousing enables people to enjoy homes adapted for wheelchairs; long term more social interaction and to provide adaptability to suit changes with ageing mutual aid, while maintaining independent and household size; and housing designed living in their own private accommodation to facilitate successful neighbourhoods. All (www.cohousing.org.uk), Brenton 2001). It new London homes must meet the Lifetime is less well-developed in the UK than in the Homes standard (GLA 2014c: 32/33) and Netherlands, Denmark and Sweden, where existing homes are being improved to meet there has been more institutional assistance the Decent Homes Standard. (Tinker et al. 2012) but there are two cohousing projects in London nearing In 2011/12, 17,200 ‘affordable’1 homes completion. Since 2005 the London Older were built (DCLG 2014). London boroughs Women’s CoHousing network (www.owch. also granted planning permission for over org.uk) has started projects in Muswell Hill 74,000 Lifetime Homes and nearly 8,000 (www.cohousingwoodside.co.uk) and in wheelchair-accessible homes (GLA 2013d). High Barnet. By delaying entry to specialist The GLA runs the Seaside and Country housing or a care home, these are attractive Homes scheme, which helps around 200 options for the GLA and London boroughs older social housing tenants move out of to promote in the future. London each year, as well as the Housing c) Gaps that remain to be addressed Moves scheme for tenant moves within London. To encourage downsizing, more A lack of genuinely affordable homes choice and better quality homes are suitable for older Londoners remains planned as well as tax incentives (GLA 2014b). (Johnson 2013) and there is no regional policy to distribute industry, jobs and For older people with care needs, 1,800 population more evenly across the supported homes built to Lifetime Homes country (Meacher 2007). Social rented standards are planned. Self-contained accommodation is scarce, with 800,000 retirement homes for owner occupation on London’s waiting list (Observer 2014)
11 An Age Friendly City – How far has London come?
an increase of 84% since 2004 (www. 2014b). About 60% of new-build homes londoncouncils.gov.uk/londonfacts). are sold abroad, often to Buy-to-let Chronic lack of sufficient funding has or Buy-To-Leave investors in Hong prevented direct local authority (LA) King, Singapore or Beijing, thus lost investment in expanding or improving to Londoners in housing need (Radio the housing stock. In the past, central 4 2014). Regeneration projects that government took 75% of the receipts entail demolition and replacement can from Right to Buy sales (over £550pa) fail to take account of the social cost of and £1.55bn pa from councils’ Housing disrupting communities as tenants are Revenue Accounts (HRAs) severely displaced. Older people’s own view is that restricting their ability to invest in such projects ignore their attachment to building and improving stock (Meacher their local community support network 2007). The Coalition government’s cut in and familiar neighbourhood (Johnson capital funding for new social housing, 2013). Residents from across London while accelerating the sale of council recently protested at LA decisions houses, has led to up to 35,000 such to demolish their estates to allow homes lost in one year through Right developers to build luxury flats. The to Buy (RTB) (Pickard 2014). The Local issue of displacement and destruction of Government Association has pointed out older people’s social support networks the ‘poor value for the public purse’ of was picked up by the BBC (BBC 2015). RTB arrangements, urging that LAs be The squandering of social capital by allowed flexibility in setting the discount insensitive regeneration plans, with rate and in how receipts can be spent increased risk of social isolation and (Fisher 2014: 2). A novel solution to the exclusion, was recognised as a mistake in loss of council homes and abuse of RTB the slum clearances of the 1960s (Power by private landlords has been proposed 1965). Where refurbishment is chosen, by a London Assembly member, Tom however, many landlords make efforts to Copley: introducing a ‘Right Not To Sell’ reduce disruption to tenants. for LAs (Copley 2014). Although the government now allows councils control Private renting in London is also insecure, over their HRAs, ending the negative with variable management standards, subsidy, councils are still held back by a some landlords reluctant to modernise cap on borrowing to build. Bringing social or repair and high unregulated rents housing up to the Decent Homes standard (Resolution Foundation 2014). The latter has been uneven and slower than inflate the cost of Housing Benefit (HB), planned. In 2009, over 20% of London now over £24bn pa. Most pensioner council homes fell short of the standard, tenants live on low incomes and need HB, as many as 50% in three boroughs, due but some private landlords are unwilling to inadequate funds for improvements to take tenants on HB. The ‘bedroom tax’ (Bartlett 2010). By 2014, 18% of LA-owned affects older people who need a spare homes still fell below the standard, more room for grandchildren, a partner or other than a third of the stock in five boroughs informal carer and for disability equipment. (DCLG 2014). As care needs increase, older people have Most ‘affordable’ housing1 is provided to consider leaving mainstream housing through HA schemes, with only around for specialist housing (sheltered, extra- 15% ‘affordable’ within mixed tenure care or retirement homes). Yet a lack developments, giving a total of around of specialist housing that is attractive, one third‘affordable’ overall (GLA conveniently-located, well-designed,
12 Policy area 1: Housing
sufficiently spacious, for sale or rent at and damp due to poor insulation and affordable prices for older people is likely inadequate heating systems, defective to discourage or prevent such a move. wiring and lack of help with home repairs About 80% of London’s specialist housing and adaptations. These deficiencies had is rented and is often outdated, uninviting led to falls and ill-health. Unfortunately, and difficult for older people - bedsits, there seems to be no systematic data maybe with shared bathroom facilities, available from LAs on the prevalence of or upstairs with no lift. (GLA 2013b, Three such problems in their rented housing. Dragons 2014). Despite a 2008 all-party Older people want more information on commitment to improve disabled people’s how to access help with heating costs and access to housing, an increasing number of repairs; and they want to be involved in older disabled people in the UK are living decision-making on the planning and in accommodation unsuited to their needs design of housing stock. According to (Morris 2014: Executive Summary). Harrow Law Centre’s research among older people, many private tenants live in The GLA recognises that the housing squalid conditions while paying exploitive needs of older people are an increasingly rent and unlawful evictions are occurring important planning issue facing London. with no notice given (Omonira-Oyekanmi To help ensure boroughs plan for the 2014). Such practices in Harrow draw accommodation requirements of older attention to the need to monitor and Londoners, borough level benchmarks for regulate landlord practices throughout older person accommodation have been London. incorporated into the Further Alterations of the London Plan (GLA 2014d: 96). Recommendations The benchmarks break requirements down by tenure (private, intermediate Provision of a variety of affordable1 and affordable). The Further Alterations Lifetime Homes, including specialist to the London Plan require boroughs housing close to facilities, within each to demonstrate in their Local Plans and neighbourhood and the improvement of other relevant strategies how they will the energy efficiency and condition of address the housing needs of older older people’s homes. Londoners, drawing on these benchmarks. Further guidance on this will be provided Available public land to be transferred in an update of the London Housing to LAs and HAs at low prices and LA Supplementary Planning Guidance. borrowing limits eased, enabling them to build new social housing and to refurbish Some older Londoners urge the need for existing stock to a decent standard, with more safe and suitable housing for older the option not to sell. people to rent or buy; all homes at Lifetime Home standard; more council Disincentives to using London housing as housing of various sizes; a range of an investment for capital gain. options close to family and services; more sheltered homes as flats (not rooms) and Policies at national and regional level to with a manager on site. While welcoming distribute employment opportunities more progress in improved housing, some older evenly across the UK. people have reported health and safety risks such as from a lack of handrails, poor Governments to regulate private rents to lighting on steps, entrances and stairs, an affordable1 level and to support landlord uneven steps and loose floor tiles, cold accreditation schemes.
13 An Age Friendly City – How far has London come?
policy area: 2 Outdoor environment and neighbourhoods: streets, buildings and parks
14 Policy area 2: Outdoor environment and neighbourhoods
Ageing in place, that is living (Camden 2013; Southwark 2014). It is unclear how far gyms will be useful to in one’s own home and older people with physical disabilities. neighbourhood for as long as possible, has been widely Feeling safe to go out allows pursuit of interests and maintenance of recognised as older people’s relationships, promotes independence preference. and self-esteem, and enhances social capital and social inclusion (Scharlack and Lehning 2013). ‘Lifetime Neighbourhoods’, In this chapter, we examine what makes a where the built environment is well- neighbourhood age-friendly, and an area maintained, ‘walkable’ and offers where older people feel they belong and continuity with the past can foster can stay. confidence, a sense of security, belonging and connectedness in a neighbourhood a) Features that influence wellbeing and (DCLG 2011). The key to success is the social inclusion of older people involvement of older residents in any changes during the planning process Good neighbourhood design enables (Bevan and Croucher 2011). ‘Bottom-up’ older people to feel safe when going out planning capitalises on older residents’ for basic necessities such as shops and experience of the neighbourhood, health services and for social and leisure drawing on their ideas for using spaces purposes. It encourages exercise through differently, including for activities that walking, which benefits health (Traynor at invite community participation (Scharlack al. 2013). Helpful features are proximity and Lehning 2013). to shops, services and transport links; wide, flat tarmac pavements without Barriers to going out, such as speed of clutter and manageable kerb heights; easy traffic, noise, fear of crime or falling, road crossings that allow ample time and affect half of older people, contributing ‘countdown’ technology at traffic lights; to social isolation. Barriers are greater 20mph speed limits; sufficient benches for those in sheltered accommodation or along the route; sheltered bus stops with care homes (Handler 2014) and for those comfortable seating and electronic display with physical or cognitive impairments of buses due; well-maintained, clean such as dementia. Wheelchair users may toilets open all day; and clearly visible, be deterred by difficulties in accessing easily understandable signage (Living a building, or by scarcity of wheelchair- Streets 2014). Green routes and small accessible toilets (Buffel et al. (2012). parks make walking outside more inviting When urban development is driven by and can lift mood: older people living market-led imperatives and does not close to an open green space are more involve older people in the planning likely to be satisfied with life. A “senior process, this can lead to their social playground” – a free outdoor gym with exclusion (Handler 2014). Changes may several exercise devices to provide a full include a disconcertingly rapid shift body workout, fun and socialising among in population age structure, class and the over-60s – has opened in a secluded ethnicity that undermines confidence in area of Hyde Park (Age UK 2014). Camden going out. and Southwark councils have recently provided a number of free outdoor gyms across their boroughs, for use by all ages
15 An Age Friendly City – How far has London come?
b) Developments since 2005 including lack of gritting in icy weather, danger from mobility scooters and The GLA has recognized the importance of insufficient separation from the road; a the outdoor environment; ‘[Older] people need for more benches in public places who do not find it easy or enjoyable to including stations; and longer crossing get outdoors can spiral into poor physical time at traffic lights. Older people wanted health, less social contact with others free and accessible toilets signposted in and a reduced quality of life overall’ all public places and deplored the closure (GLA 2013a: 15). ‘…people should have of free public toilets, both locally and a good quality environment …accessible in central London. Some public toilets and inclusive, aesthetically pleasing were dirty, accessible only by steps, and safe’ (ibid: 16/17). Contributing to lacked paper or were out of order, despite this aim is the All London Green Grid charging up to 50p. (ALGG) a network of green infrastructure across London, including accessible open Some London older people found local spaces, biodiversity, woodland and river police very helpful and were disappointed corridors (GLA 2014f). The Green Grid will by closure of the local police station connect town centres, public transport following funding cuts. They want an hubs, major employment and residential accessible local police station with areas with parks and open spaces, the adequate staffing there, as well as on Thames and the green urban fringe, the beat, so that older people, especially thus promoting cycling and walking for women, who tend to feel less so, can feel travel and for health. Better streets are safe after dark. However, trust in some planned, with £310 million invested since police and LA staff was low. Cuts to fire 2005 in public space projects and efforts services worried older people as those to improve availability of toilets for the who are less mobile could be trapped in public, including in business premises, to the event of fire. Preventive work by fire promote shared road space and to extend officers in fitting smoke alarms free was 20 mph zones (Mirza, 2014). appreciated.
c) Gaps that remain to be addressed Recommendations
Street crime and disorder remain a major That local authorities (LAs) ensure issue for older people, discouraging pavements are safe, to improve local going out. Older people call for more ‘walkability’. police on the beat and for work with different age groups to increase mutual That LAs provide sufficient free accessible understanding and respect. Streets are public toilets and signage to where public still often cluttered, badly-designed, toilets are available. poorly maintained and hazardous to older people (Deuchars 2014). That authorities involve older people in any changes being planned for their Older people appreciate parks and green neighbourhood and work with local spaces for walks. In one local authority residents in creating more public gardens (LA) older people helped staff organise and small parks. park events for families and children. In another, older people value the LA- organised daily health walks. But other people mentioned hazardous pavements,
16 policy area: 3 Transport
17 An Age Friendly City – How far has London come?
Older people’s travel tends to is particularly important for people aged over 60 who face a 47% risk of fatality, if hit be more local than for the by a vehicle, compared to 7% for younger average for all ages but still people (20’s Plenty 2014). Because older has beneficial effects on health people (85% of women and 76% of men) cannot cross the road quickly enough to be and wellbeing. safe on a pedestrian crossing (Asher et al. 2012) they are especially uneasy about fast Convenient transport systems facilitate traffic. social and civic participation, including employment, volunteering, meeting The Legible London signage system was friends, pursuing hobbies and interests, designed by TfL as a city-wide way finding participating in the wider world of the city. system with over 1,300 signs showing This fosters the sense of freedom and maps and routes, half of them in central connection with society. London. These encourage and facilitate walking in London, including from buses a) Features that influence wellbeing and or trains to a destination. The signage social inclusion of older people is being extended throughout the city, but it currently lacks information on Frequent and accessible public transport wheelchair accessibility of routes (Steer throughout the Greater London area Davies Gleave 2014). Countdown signs is vital for enabling older people to and traffic islands at frequent intervals participate fully in the life of their borough in a high street make crossing easier. and further afield. Driving is preferred This encourages walking, increasing by some but is not always an option, exercise. Older Londoners rarely cycle, especially for those with particular health contributing only 7% of cycle journeys problems. Moreover, policies that reduce in the capital. Cycling at all ages is more car usage benefit Londoners, since cars common in other countries where physical contribute to poor air quality and noise, separation of cycle tracks makes it a safer as well as road deaths and injuries. Toxic and more attractive option, including for emissions from vehicles have been linked older people2. to worsening asthma, increased risk of heart attacks and respiratory ailments. Making buses and trains accessible for Fumes are a health risk for all Londoners all has been a recurring plea from older but are especially injurious to older people, people and others with impaired mobility whose respiratory systems take longer to or sensory difficulties. Physical disability repair than for younger adults (Lambert affects about 40% of men and women 2014). Ways of reducing car usage and aged 60-64, rising to 46% in the age group encouraging walking, cycling and use of 65-69; the prevalence of disability is about public transport instead are discussed by 10 percentage points higher for women Hanson (2003). These include free/low cost than men (Banks et al. 2010). While the travel on public transport, reallocation ‘active travel’ concept, where walking and of road space and 20mph speed limits cycling are integrated into daily travel, is or zones in all but main through routes. well-intentioned, this must not diminish Slower traffic speed is demonstrably efforts to ensure public transport is well- effective in preventing road injuries, as designed, flexible and disability-friendly well as increasing walking and cycling, (Schwanen and Ziegler 2011) to help with benefits to health, and improving the older people to travel with confidence. area generally (RoSPA 2012). Slower traffic Accessibility of buses, Underground
18 Policy area 3: Transport
and suburban trains - with low floors, and lurches. This can effectively exclude ramps for wheelchairs and sufficient them on certain routes and at certain times. space for them on board - are essential, It is hoped to reduce overcrowding with £50 as are step-free stations, to enable those million extra funding for more buses and with severe mobility impairments to other new rolling stock. participate in the social and economic life of London (Transport for All 2014). The Freedom Pass, held by 1.3 million Where there are multiple flights of steps, older Londoners, is highly popular and has lifts or escalators are needed and where a a positive impact on wellbeing, as shown newly-built interchange between different in numerous studies. Travel is affordable Underground lines involves a long walk, a for social as well as functional purposes, travelator helps those for whom walking is thus maintaining social engagement (Hirst difficult or painful. and Harrop 2011). Nationally eligibility to free bus travel is tied to state pension age, For those who have severe difficulty age 66 in 2018, but the free Oyster 60+ in using public transport, Dial-a-Ride, card has been available in London since operated by TfL, provides a free door-to- 2012 for those aged 60 and over but below door minibus service. But demand outstrips state pension age. The Mayor is committed supply, restricting older people’s travel (TfL to the continuance of the Oyster 60+ 2012a). The Taxicard Service, funded by card. At present, the Freedom Pass and London Councils with support from TfL, Oyster 60+ cards cannot be used on some allows eligible disabled people subsidised suburban trains within the Greater London journeys in licensed taxis. However, many area until after 9am or 9.30am, but the GLA cash-strapped local authorities (LAs) is negotiating with the train companies to are cutting the number of trips allowed. remove those restrictions. Motorised mobility scooters are an alternative for the mobility-impaired but In planning transport development, a they need to be allowed for in planning and user-led approach benefits older people in regulations (Schwanen and Ziegler 2011). (Handler 2014) as the priorities of planners The average collision rate of 10 p.a. (one and users tend to differ. For older users, per 33 scooters each year) demonstrates social journeys to maintain connections the potential for harm (Mature Times 2014). with family and stay in touch with ‘normal life’ are as important for wellbeing and Whilst crime on buses has come down social inclusion as journeys for shopping significantly, buses are not always perceived or to hospital. Roads need not be designed as safe. About two fifths of disabled older primarily for the convenience of motor people, women and individuals from Black, traffic, but can be planned to maximize Asian and Minority Ethnic groups (BAME) amenity for pedestrians and cyclists. TfL said they were discouraged from using works with Mobility Forums of older and public transport because of anti-social disabled Londoners, to receive feedback behavior and crime (TfL 2014). Yet bus use and to communicate its own plans. is a site of social interaction, both at bus stops and on board; this ‘latent conviviality’ b) Developments since 2005 of buses is especially beneficial to older people who are otherwise isolated (Hirst Air pollution in London continues to and Harrop 2011). Overcrowding of buses exceed European Union (EU) air quality and trains discourages travel by older limits, due mainly to vehicle emissions but and disabled Londoners, because of the also to old heating systems in buildings. difficulty in standing on a vehicle that sways Both speed and acceleration of traffic
19 An Age Friendly City – How far has London come?
increase toxic emissions and research To improve cycling safety, TfL is suggests that London could be the most working to redesign roads, for example polluted capital city in the world (Carslaw segregating cycles on the Whitechapel 2014) placing children and older people to Bow roundabout route, as well as at the greatest risk of harm. Pollution planning additional segregated cycle is said to be the second biggest cause superhighways and cycle lanes. Eight of premature death after smoking. The Outer London boroughs will receive funds Mayor disputes some of these claims. In to improve their cycling environment the all-London Low Emission Zone (LEZ) and community groups are also working emissions of buses on TfL routes have to improve cycling safety, including for been reduced (GLA 2010). Also proposed disabled people. Ideas include fitting for central London is an Ultra-Low London’s 8,500 buses with sensors that Emission Zone (ULEZ) coterminous with trigger the brakes when the bus is too the Congestion Charge area and incurring close to a pedestrian or cyclist. The extra charges for high emissions in future. increased cycling in London which GLA Congestion in London is higher than in projects by 2031 is expected to bring any other mainland UK city (TomTom health benefits valued at £250 million. 2014). HGV lorries add noticeably to Limiting traffic speed to 20mph was found congestion, noise, pollution and road to reduce the rate of cyclist deaths and damage, while being frequently involved serious injury rate by 38% (GLA 2009). in cyclist deaths and injuries. Suggestions include banning HGVs in rush hours and Disabled people, 55% of whom are aged transferring heavy goods to rail. Road over 60, make 1.3 million trips a year deaths and serious injuries to London on London’s public transport. But older pedestrians were 3 per day in 2012; 134 disabled Londoners are only half as likely road deaths included 69 pedestrians and to travel on any kind of train as non- 14 cyclists, a steep rise in recent years disabled Londoners. For example, 18% of (GLA 2014g). disabled older people use Underground trains, compared with 40% of non- Introduction of 20mph zones by some disabled people (TfL 2014). The GLA is LAs have cut collisions and casualties by committed to improving the physical 40% and reduced the children killed or accessibility of the transport system, seriously injured by half (BMJ website). including streets, bus stops, stations Expanding these zones across the and vehicles, as well as provision of capital would be especially beneficial to information and staff service (GLA 2012). older people, usually less nimble than In 2013, Underground trains recorded younger and much more likely to die from 1.265 billion passenger journeys, a 3% rise collision injuries. A 20mph speed limit for on 2012, and trains have been designed residential streets is approved by 72% of with greater capacity (Beard 2014). By the public (BSAS 2012) and is supported the end of 2012, 66 Underground stations by many organisations including Age and half of London Overground stations UK, RoSPA, the BMA, and the UK Health managed by TfL were step-free to the Forum (Cooper 2014) as well as the Royal platform, with more planned, and manual College of Pediatric and Child Health. boarding ramps are being introduced The monetary cost of traffic collisions where step-free access to trains is lacking was £15bn in 2012, nearly £2 million per (TfL 2012a). Over 250 wide gates have collision (DoT 2013). Countdown displays been installed for wheelchair users and at traffic lights will be extended by 2015 those with assistance dogs (GLA 2013b). (TfL 2012b). All the new Crossrail stations will be
20 Policy area 3: Transport
wheelchair accessible. The DLR has level improved communication between TfL access to trains and although stations are and vulnerable users. mainly unstaffed, each train carries staff who can provide assistance to older and c) Gaps that remain to be addressed disabled people as necessary. Older people’s overall satisfaction with Bus use in London doubled between 1995 buses, Underground trains and Dial-a Ride and 2013 (TfL 2012a). The Freedom Pass was around 90% (TfL 2014). However, the and Oyster 60+ card are now valid 24/7 major barriers to using public transport on buses (GLA 2013c). Over 2,500 digital among Londoners aged over 65 are displays have been provided at key bus overcrowding (for 39%) and anti-social stops. The 8,000 London buses have behaviour of others (for 34%) (TfL 2014). low floors for wheelchair access and the Just as London’s rapid population growth proportion of London’s bus stops that frustrates attempts to achieve adequate are ‘accessible’ is planned to rise from housing for all, so transport services have 75% to 95% by the end of 2016. Audible to provide for ever-growing passenger and visual information is given on buses numbers. Thus despite TfL’s investment and trains. £50 million is being invested to improve services and rolling stock, over 10 years in staff training (GLA 2013c) overcrowding in both suburban and with a further £25 million announced in Underground trains is frequent, creating 2014. Buses are increasingly accessible particular difficulties for older and to wheelchairs, sharing priority with disabled people. pushchairs in using the designated space inside. A driver training programme is Older Londoners greatly value the run by TfL, who value the input of older Freedom Pass, saying that without it and disabled people to develop the the quality of life would be seriously programme. A free Travel Support Card impaired, increasing the risk of being is offered by TfL for those with hidden housebound and isolated. But use of the impairments to show to transport staff Freedom Pass on some suburban rail when needing help. Dial-a -Ride minibus services in London is still prohibited on use is increasing with low floor minibuses weekdays before 9.30a.m. To overturn now standard. The service was positively this ATOC (Association of Train Operating rated by over 90% of users. Companies) rule, GLA and LAs will have to reach an agreement with the private Preventing transport crime, a major train companies. Station toilets need to concern of older people, is to be tackled be more accessible for older people, with by joint working with safer neighbourhood entry by Freedom Pass. Older people teams, using CCTV, lighting and signage. would like to see shelters at most London Visible policing and station staffing is part bus stops (Deuchars 2014). Some older of the strategy (GLA 2012), but the plan to Londoners would like bus drivers to close most ticket offices is controversial; allow more time for older people to sit some older Londoners fear that there down, and to avoid sudden stops or fast could be fewer staff available to give cornering that cause anxiety and even assistance and information. However, falls among standing passengers. It was staff are being moved, not reduced, also mentioned that children’s buggies as TfL has explained to the Mobility cause obstruction and schoolchildren can Forum of older and disabled Londoners. be a nuisance; that eating food causes The Forum, introduced a year ago, is a mess; and that the complaints procedure very welcome development, allowing is unclear. Orbital routes are needed;
21 An Age Friendly City – How far has London come?
and ideally more frequent buses in Outer individuals may contact the hospital for London, to avoid long waiting times. travel assistance. Tight restrictions on When routes change, information at bus Taxicard travel were also frustrating. LA stops has been lacking. Older people provision of sufficient spaces for Blue would welcome a verbal reminder of Badge holders near shops and public the function of priority seats on buses transport would help disabled drivers. and TfL is considering introducing audio announcements about this. Recommendations Accessibility to public transport for all disabled people has not yet been That GLA encourages reduction of traffic, achieved, although there has been especially daytime use of Heavy Goods progress on this. Physical difficulties with Vehicles (HGVs) on London’s roads; access to buses affected 19% of older brings in cleaner engines for buses and people and to trains 11%. On the London taxis as a matter of urgency; adheres suburban train network, universal step- to EU requirements for air quality; and free access, with lifts operating fully encourages boroughs to introduce 20mph at all stations, is still lacking. Yet the zones. government’s planned cut in Access for All funding by 42% between 2015-2019 That TfL continues to provide shelters and will mean fewer suburban stations than seats at bus stops, where possible. planned being made step-free. That TfL seeks government funding Older people appreciate the helpfulness to accelerate making all Underground of Underground staff. Planned closure stations step-free. of Underground ticket offices causes concern. This may be unjustified, since That Legible London signs include staff will be available at a focal point in information on which routes are not the concourse under a neon light, ready wheelchair accessible. to give assistance; and staff numbers will not be reduced. Older people find that audio information is not always clear and signposting to platforms is often misleading. The DLR is praised as easy to navigate, with good staff, signage and lifts. ‘KEEP LEFT’ signs on stairs would avoid jostling. A popular suggestion was that for train travel outside the London area, the Freedom Pass could function as a Senior Railcard; but this requires agreement from the Association of Train Operating Companies (ATOC).
Dial-a-Ride is found to have improved over recent years but some older people experience long waits to book through call centres and difficulty in getting regular bookings; they regret that Dial-a-Ride cannot be booked to visit hospitals or GPs due to NHS rules, although disabled
22 ©Hayley Madden Capital Age Festival
policy area: 4 Social, cultural and civic participation: engagement and involvement
23 An Age Friendly City – How far has London come?
Older people’s participation for local clubs to thrive over time. Shared spaces, such as local authority supported in London‘s immense variety community centres, church halls or pub of cultural events and civic rooms, can encourage intergenerational activities - from world-class and multi-ethnic connections. Lunch clubs, especially if they have volunteer transport museums, galleries, concerts, available and outreach to ex-members plays, films and lectures to or those known to be sick or isolated, aid social inclusion of the most vulnerable the local hobby and interest older people. groups, educational and Leisure. Central London offers a myriad exercise classes, political, of choices that are usually age-friendly in material terms, providing for disabilities social, ethical and trade union in terms of wheelchair access and, where associations – provides interest, appropriate, braille and large print. But in social terms such institutions may social interaction and a sense of be less inclusive. Concerts and films purpose. are expensive for most older people. Museums, although free, are often Yet access is not always age-friendly in overcrowded and the predominance of terms of the ‘social’ design of cultural children in school parties can be off- activities and events. In this chapter, we putting; monthly ‘late opening’ may examine what facilitates older people’s not suit older people reluctant to return participation and their contribution as home after dark. Museums are a natural volunteers and informal carers. place to value the life experiences of older people, as exhibits may recall their a) Features that influence wellbeing and childhood and other life experiences. But social inclusion of older people museums need to be welcoming to older people, engaging with them to stimulate Local group activities. Older people prefer and inform. A recent conference hosted a nearby location of events (e.g. social by the British Museum resulted in a activities, classes, cultural activities, and Manifesto for an Age-Friendly Museum. civic group meetings) or one within easy This goes beyond addressing physical reach by public transport; convenient access needs - such as seating with back timing; accessible buildings; clear rests and arms and entry/exit accessibility information as to location and time; and - to celebrating ageing and the positive concessionary prices, if any. A wide range contribution of older people to society; of activities and events is necessary to working to dispel negative perceptions of match the interests of a diverse older ageing and forging better links between population and older people need to be generations. It recognises diversity in involved in planning and organising. Local older people’s lifestyles, experiences authority (LA) provided adult education and viewpoints, using collections to courses include options to suit all tastes value individual knowledge, skills and and interests, although fees may be life experience, encourages learning and prohibitive. University of the Third Age creative thought. It provides opportunities (U3A) classes and study groups (37 in for engagement by an older audience and London, with over 18,000 members) reaches out to those unable to visit. Staff provide for many older people’s interests. would be trained in understanding older Affordable community spaces are crucial audiences and would collaborate with
24 Policy area 4: Social, cultural and civic participation
other museums, academics, older people’s but some had felt obliged to provide care organisations and older people in the and found it onerous (Clarke and Roberts community (Age Collective 2013). 2003) especially where combined with employment or parent-care (Arthur et al. Volunteering. Volunteering in community 2003). In London, 5-10% of families use and voluntary organisations helps grandparents for childcare, in order to to confirm older people’s sense of manage their own jobs. The economic competence, inclusion and purpose, also value of grandchild care is estimated as faciliating enjoyable social interaction. up to £590 million per year; the economic A quarter of Londoners aged 65-74 are contribution per grandparent is between formal volunteers and 15% of those aged £3,200 and £6,300 per year (Barrett 2013). 75 and over. Work includes fundraising, The contribution of grandparents has serving on a committee, driving, visiting, been shown in recent research (Glaser et advising, informing and counselling al. 2013; Glaser et al. 2014). (Barrett 2013). In addition, some older people use their skills to work unpaid as b) Developments since 2005 reading assistants in schools. Informal volunteering, by 27% of 65-74 year Building on the experiences of the olds and 23% of over 75s, is mainly London 2012 Olympics and Paralympic neighbourly actions for those who could Games, the GLA’s Team London project otherwise be socially-isolated; this provides volunteering opportunities includes keeping in touch, shopping, for Londoners of all ages, through its collecting pensions and responding to website (http://volunteerteam.london. needs as they arise (ibid.). Thus older gov.uk/#s). Volunteers may contribute volunteers contribute to the social in many ways, for example as guides, inclusion of vulnerable older people, gain surveyors of opinion, befrienders of older satisfaction and increase social capital people and young volunteers enabling in their locality. The economic value of older people to feel confident with using volunteering (among those aged 50 and digital technology. However, voluntary over) is estimated as nearly £1,000 pa per and community organisations that volunteer, worth £800 million per year in require LA support for hire of premises total. or drivers’ expenses have been hard hit by the austerity programme since 2008 Informal care. One fifth of Londoners bringing cuts in government grants. aged 65-74 provide informal care to Community centres have had to close parents, children or partners, as do 16% or increase room hire charges, forcing of those 75+; women aged 65-74 are twice community and voluntary organisations as likely as equivalent men to provide and lunch clubs to close down or move care but the proportions are equal for to less accessible venues. LAs have also those 75+, mainly care for a partner. rationalised Adult Education courses, Such caring is estimated as 33 hours raising fees and favouring vocational per week on average and takes its toll classes over interest-based ones, reducing on carers; half of older carers in London or closing courses that were a source of said their relationships, social life or stimulation and social contact enjoyed by leisure was affected. The economic value many older people. Cuts have thus tended of informal caring by those aged 65+ is to be a false economy, undermining estimated as about £2.2bn pa (Barrett the aim of a Big Society characterised 2013). Grandparents value the emotional by volunteering and mutual aid. In this closeness fromcaring for grandchildren; difficult context, LAs need to explore
25 An Age Friendly City – How far has London come?
alternative ways to support the voluntary A local ‘hub’ for older people in each organisations that are so vital to older borough, such as an Age UK centre, would people’s participation in social life. be of great benefit, to give information and advice, hold lists of associations, Gaps that remain to be addressed operate a cafe for informal socialising and facilitate group outings. A local network London’s free museums, art galleries, of people who live on their own and could libraries, talks, guided tours, social offer mutual aid in a neighbourly manner clubs, choirs and walking groups are all would also be valuable. appreciated by older people but they find that admission prices to some cultural Recommendations events are unaffordable. They enjoy events provided by LAs and Housing That LAs recognise the importance of Associations as well as outings or community centres, libraries and other projects run by residents and community cultural facilities; support the community associations. Such activities bring people and voluntary groups that engage and together but they may need LA support, assist older people, and continue to seek for example in providing an affordable innovative ways to do so. venue. There is great concern where libraries are closed or threatened; in addition to lending books, CDs and DVDs, libraries are also a site of valued social activities and access to the internet.
Image Andrew Gibson – courtesy of the Age Action Alliance
26 Image Allison Czerwinka – courtesy of the Age Action Alliance
policy area: 5 Employment, skills and income
27 An Age Friendly City – How far has London come?
There is a strong association and 5% self-employed. The majority, 84%, were retired and the remaining 4% between employment and were studying, looking after the home better health. or long term sick/disabled (ONS 2014b). Londoners aged over 50 contribute 18% Yet we cannot assume employment of London’s Gross Value Added, or £47bn is beneficial to health since the causal p.a., including £3bn from those aged 65+ relationship is uncertain: those who are (Barrett 2013). healthy are better able to retain their job and tend to have higher occupational Having accredited skills increases choice, status. For older people in particular, but older people are less likely than extending employment does not younger to have formal qualifications. necessarily increase wellbeing. Legislation Among Londoners aged 60-64, 23% against age discrimination and abolition of women and 18% of men were of a default retirement age at 65 enhances unqualified, due to earlier and current opportunities to work longer, but retiring lack of opportunities for education and from a menial or stressful job due to training. However, among men and ill-health is usually a relief. Although women aged under 40, 94% had some retirement timing clusters around state formal qualifications (ONS 2012) which, pension age (SPA) leaving employment is if employers place more value on these often a complex transition; some workers than on skills acquired ‘on the job’, will stay in their job, perhaps part time, others make later cohorts more employable ‘retire’ then take a new job, or embark in their 60s than the current cohort. A on self-employment. In this chapter, we majority of older people believe that age consider older people’s employment, discrimination in workplaces persists, skill levels and incomes in relation to especially in terms of lesser access to wellbeing. training (Age Concern/Help the Aged 2009). a) Features that influence wellbeing and social inclusion of older people In London, around 20% of jobs pay less than the London Living Wage of £9.15 The key to older people’s life satisfaction per hour (GLA Economics 2014) a higher during the retirement transition is to proportion than in 2005 and with low pay have a genuine choice of timing but concentrated among those of Pakistani this is limited by employers’ priorities and Bangladeshi origin. Earnings tend (Vickerstaff et al. 2004). Only half of to fall after age 50. The GLA encourages individuals aged 50-69 in 20 EU countries employers to pay at least the London were in their preferred role, due to Living Wage, but for the part time work financial and other constraints (Ginn that older workers prefer, the Living Wage and Fast 2004). Longer employment is is not enough to meet costs. Private preferred where the job is satisfying, pensions can provide a useful stopgap free of ageism, with flexible hours and before SPA is reached but class, ethnic training available (McNair and Flynn and gender gaps in private pensions 2005). Nationally 68% of individuals aged remain substantial (Ginn and Arber 2001). 50-64 were employed in 2013 and 10% of those aged over 65 (ONS 2013a). Among Older people are often poor enough to Londoners aged 65 and over, 12% were qualify for Pension Credit but take up is employed 15% of men and 9% of women. low; it is estimated that 27,000 to 50,000 Among the 12%, 7% were employees older Londoners are eligible for Pension
28 Policy area 5: Employment, skills and income
Credit but not receiving it, losing about 2014). If this pattern applies in London, £35 per week. Some older Londoners the effect will be severe for the 5% of also lack the Housing Benefit and Council older Londoners who are self-employed. Tax Benefit to which they are entitled Ageism, often interacting with sexism, is (GLA 2013b). According to the ONS, older perceived to persist in the workplace and people have suffered most from cost of may be increasing (Age UK 2011, TNS living rises since 2002, mainly because Opinion and Social 2012) further reducing they spend a high proportion of their older people’s chance of a job. income on food and energy where price rises have been particularly steep (Hyde Since 2005, the GLA has undertaken to 2014: 11). For older people, the security of support employment opportunities for their income is most important (ILC 2014). older workers; to reduce inequalities in Although the majority report they can pay by gender, ethnicity and age; and to manage financially, despite a low income, encourage wider adoption of the London a minority struggle and suffer mentally, Living Wage (GLA 2012). Inner London especially if they have a mortgage debt. had the highest rate of older people’s Budgeting on a low income requires poverty in the UK at 24% after housing effort and resourcefulness and is often costs, while that of Outer London was emotionally draining (Age UK London 16%, still higher than the national average. 2011). Low income is associated with Similar proportions of older Londoners poorer health, lower life expectancy, lower were recorded as materially-deprived quality of life, less social participation and - unable to live according to accepted more stress, all these combining to bring social norms due to poverty, ill-health or about social exclusion. In later life, poverty isolation (GLA Intelligence 2014). For older has particularly adverse effects due to Londoners, the cost of energy to heat being a persistent state with no prospect their homes has increased far more than of improvement (Carrera et al. 2011) and their incomes, indicating the urgency of also to the prevalence of disability, mental ensuring their homes are well-insulated. ill-health and isolation. The poverty rate is higher in the oldest age groups, higher c) Gaps that remain to be addressed for women than men and much higher for people from Asian communities (38%) As the SPA rises, there is a need for more and for Black people (27%) reflecting suitable and flexible jobs to allow for inequalities in earlier life. caring commitments. Age discrimination persists in recruitment, retention, b) Developments since 2005 promotion and training, including at line manager level. Older people feel a sense The recession from 2008 and subsequent of injustice about the inadequacy of the policies have affected employment and basic pension, high levels of council tax earnings nationally, including for older and the intrusive nature of means testing workers. Older Londoners’ jobs were (Scharf et al. 2004). Older women feel it affected by recession but less than in than is unfair to exclude them from the Single the rest of the UK. Since 2008, London Tier State Pension to be introduced in claimants of Job Seekers Allowance aged 2016, since their low state pensions 50-64 increased by 90%, compared with are due to missing out on care credits 200% nationally (GLA 2013b). UK weekly introduced too late for them. Fuel poverty3 earnings fell between 2008 and 2011, by remains a major concern. Older people 9% for employees, but by 24% for the added their views: Finding jobs was self-employed, from FRS data (Gardiner difficult because help is more directed at
29 An Age Friendly City – How far has London come?
young unemployed people, ignoring the Recommendations value of sharing older people’s skills with younger colleagues. State pensions are That the GLA works with The Age and insufficient to pay for bills and repairs, Employment Network (TAEN) and while those who are disabled cannot campaign to convince employers that resort to Do-It-Yourself repairs. The NPC employing and training older workers (National Pensioners Convention) urges is a sound investment. that to tackle older people’s poverty the basic state pension should be paid to all That the government restores the Winter older people at £175 per week, uprated Fuel Payment to its original value relative 4 annually by the triple lock ; and that the to fuel prices and older people be allowed Winter Fuel Payment should be raised in to opt (in 2016) into the new single tier line with fuel prices. pension; the latter to be raised above the poverty threshold (about £175 per week in 2014).
Image Vicky Hodgson – courtesy of the Age Action Alliance
30 policy area: 6 Community support and health services
31 An Age Friendly City – How far has London come?
The preceding chapters have These fundamental differences in life expectancy and disability-free life indicated how the material, expectancy reflect the cumulative impact social and financial environment of inequalities in education, housing can influence older people’s and employment conditions throughout the life course as well as the effect of health for better or worse. current income and the quality of housing and neighbourhoods. These social Life expectancy in London rose by 4 years determinants of health also influence for men and 3 for women in the decade lifestyle in terms of exercise, diet and from 2001-2011, a welcome achievement. use of tobacco, alcohol and other drugs. But structural health inequalities persisted Poverty, poor housing and neighbourhoods from 1971 to 2005, indicating the potential characterised by crime, fear and distrust for improving the health of many, with contribute to mental ill-health and benefit to their quality of life and savings unhealthy lifestyles (Marmot 2010), with to the economy (Marmot 2010). In implications for the effectiveness of health this chapter we outline inequalities in promotion programmes. Londoners’ health; consider how far health promotion can be effective; and assess Lifestyles and health promotion the adequacy of community support and health care services for older people. Health promotion aims to reduce the incidence of conditions such as heart a) Features that influence wellbeing and disease, stroke, diabetes and dementia social inclusion of older people through advocating a nutritious diet, sufficient exercise and no smoking or Substantial inequalities in health and life excessive alcohol consumption. Where expectancy with social class and region individuals are able to act on these have persisted over many decades in the messages, they will significantly reduce UK. Life expectancy (LE) and disability-free their risk of contracting these conditions. life expectancy (DFLE) at birth in London Yet the potential for changing lifestyles are similar to the rest of the UK5. But through health promotion alone seems within London, stark inequalities between limited. We know that older people’s health the most affluent and most deprived areas behaviour varies according to gender, exist on both measures. Table 1 shows the class and ethnicity, with women and those figures for ‘best’ and ‘worst’ boroughs. with higher incomes having healthier lifestyles (Cooper et al. 2000; Ginn et al.
Table 1. Life expectancy at birth and disability-free life expectancy of men and women in 2 London boroughs.
Men Women % of life % of life LE DFLE disabled LE DFLE disabled Richmond 81.2 70.3 13.5 85.6 71.8 16.2 Newham 76.5 56.5 26.1 81.4 58.5 28.1 London as a whole 79.3 67.6 14.7 83.5 68.6 17.9
Source: ONS 2014c
32 Policy area 6: Community support and health services
2001). Obesity is increasing and London Alzheimer’s, Parkinson’s and osteoarthritis. has sharp inequality in obesity rates across GPs face increasing pressure for boroughs, indicating that health promotion consultations, yet GP funding fell from is heeded most by the healthiest (Marmot 10.3% of the NHS budget in 2004 to only 2010) thus increasing social inequalities. 8.4% in 2011; 80% of GPs say they have For older people, where disabilities are insufficient resources for quality patient- common (Banks et al. 2010) exercise such care (www.rcgp.org.uk). Long waits for as walking to shops that sell fresh food appointments transfer pressure to A&E can be awkward and painful and cooking departments, while most of London’s difficult, with adverse effects on both hospitals are in deficit, not least due to exercise and diet. Hence, enabling healthier expensive PFI contracts, as researchers lifestyles requires action on the social have established (Pollock et al. 2002). factors that influence these lifestyles – Inequalities in health cost the NHS £5.5bn freedom from poverty, a built environment pa, a financial reason to tackle the social that promotes physical activity and social causes of ill-health (Marmot 2010). cohesion, plenty of opportunities for social engagement, employment and information Nationally, about 3% of older people live in described in other chapters of this report. residential care homes, usually run by private companies with high fees (over £35,000 pa in Community Support London) and often poor quality care. The LA pays for those with low incomes and assets Community support can help disabled and but self-funders must subsidise the gap ill older people remain in their own home between care home charges and LA (mainstream or ‘specialised’) as long as maximum rates. Unsurprisingly, many older possible, delaying or preventing a move to people dread being admitted to a care home residential care, and policy is to encourage or nursing home. this. Support is mainly from informal care, lunch clubs and ‘Meals on wheels’, b) Developments since 2005 but informal care may be unavailable and charges are rising for formal services. Austerity since 2008 has brought many Providing care round the clock and all changes that threaten the health of older week can be exhausting and damaging people and the services on which they rely to informal carers’ own health. Physical, for support and healthcare. In London, the financial or emotional abuse of older number of adults using food banks rose people does occur, though it is difficult from 408 in 2009 to over 34,000 in 2012 to monitor. Among Londoners aged over and research indicates that ‘pensioner 65, 7% are estimated to have dementia, hunger and malnutrition [in London] is a although this is probably an underestimate problem that requires urgent attention’ (GLA 2014h). For carers, dementia is (GLA Health and Environment Committee particularly problematic as 24/7 presence is 2013: 3). This report recommends that required in the later stages. Local authority LAs assess food poverty among older (LA) social care services are being cut due people as part of their health remit and to reduced government grant. ‘reinvent community meals’ (ibid: 5). Yet community centres and associated Health and Social Care Services services for older people are under financial stress since government grant The National Health Service (NHS) has to LAs was cut by 28% over the 4 years had to adapt to population ageing and from 2010. Some centres have closed increasing prevalence of diseases such as while others raise rents or cut services,
33 An Age Friendly City – How far has London come?
a loss to older people who valued the London. There were plans to close up to social meals, company, activities and a eight of London’s A&E units, as well as to change from being at home. Home care reduce other hospital services and to merge services for disabled or ill older people some hospitals (Ham et al. 2013). However, are increasingly restricted to those with to date only three have closed with no ‘substantial’ or ‘critical’ needs, as LAs plans cut more before 2017. Concentrating struggle with reduced budgets (Tinker et clinical expertise in fewer, more specialist al 2012). Those with needs assessed as centres has been implemented in services ‘moderate’ must either buy the assistance for stroke, major trauma and cardiac care, they need or go without; unmet need is resulting, it is claimed, in significantly growing. This contributes to increased improved clinical outcomes (BMJ 2014). demands on the NHS. According to Andy Burnham, shadow health secretary, The NHS Five Year Forward View calls for removing home care for older people with the NHS to break down the barriers in moderate disability ‘is a false economy how care is provided between family that is piling pressure on hospitals and doctors and hospitals, between physical is a root cause of the A&E crisis’ (Smyth and mental health, and between health 2014: 4). Moreover, restricting home care and social care. In future, care is to be in this way may be unnecessary. One LA delivered locally with some services in (Hammersmith and Fulham) has found specialist centres. This will be organised ways to save money so that they can to support people with multiple health scrap the existing £12 per hour home conditions and not just single diseases care charges for residents needing help (NHS England 2014). This view, however, with tasks such as washing, dressing and retains the highly controversial element of shopping. Stephen Cowan, leader, said competitive bidding for health service they will ‘abolish what has rightly become contracts, discussed above. Moreover, the known as a tax on disability’ (Prynn 2014: 24). aspirations will depend on sufficient funding.
The Health and Social Care Act 2012 has The patient transport system is not aroused much opposition from healthcare working at some hospitals, with patients professionals and patient groups; they waiting for hours and missing appointments, are concerned that NHS contracts can according to Transport For All (2014). be awarded to any ‘qualified’ provider, Some medical staff predict that healthcare including international healthcare will be rationed, with a poor service for corporations whose interest is in making a most people while the well-off buy private profit from the £100bn NHS annual budget insurance. Older Londoners living on (El Gingihy 2013) and that this will cause relatively low incomes are unlikely to be fragmentation of services, instability and able to afford insurance. The trend to uncertainty (Leys and Player 2011; Pollock privatisation in the NHS follows the et al. 2012). London Health Emergency pattern established in residential care claims the cuts to the NHS are heavier in homes, where the bulk of LA homes have London than in other regions. been sold. Cases of physical and mental abuse and neglect reported in the media Older people prefer local hospitals, but have shocked the public but been perceived the trend has been to centralise services, as exceptions. However, it seems likely lengthening journeys for patients and that abuse is widespread, especially among visitors. This preference is held despite the those without kin to visit frequently and to argument that centralisation of A&E services speak up for them. Harrowing accounts ensures consultant cover 24/7 across have been sent to official bodies (Chubb
34 Policy area 6: Community support and health services
2013) and the Care Quality Commission be maintained as publicly owned and admits that about half of care homes (and controlled, combined with a satisfactory many hospitals) inspected give rise to system of care in the community. Closure concern. Care staff need better training, of community centres and reduced including the opportunity to put themselves domiciliary care provision was deplored in the position of a disabled or confused as damaging both to sick older people and resident, to transform attitudes and practices. their hard-pressed informal carers. Closure of LA residential homes was regretted by The GLA’s health inequalities strategy has some older people, who added that it was five main objectives: ‘To empower individuals not clear how this saved money unless and communities to improve health and staffing and care standards were lower in well-being; improve access to high quality a private care home. Having to move health and social care services, particularly between care homes was a painful experience for Londoners who have poor health for residents. The NPC calls for a national outcomes; reduce income inequality and tax-funded, fully public Health and Care the negative consequences of relative Service free at the point of use; and a poverty; increase the opportunities for people legally binding Dignity Code to improve to access the benefits of good work and care quality for older people. Condemning other meaningful activity; and develop creeping privatization in the NHS, they and promote London as a healthy place ask, ‘How can any system that has to pay for all’ (GLA 2010). This is to be achieved dividends to its investors be expected to through work across the health system cost less?’ and urge that GP funding be including NHS and local authority partners increased to 11% of the NHS budget by 2017. as set out in a rolling series of delivery plans, the latest of which is to be published The London Health Commission Report in 2015 (GLA 2015). This will include published in October 2014 recommended measures aimed at helping to reduce health increasing investment in primary care in inequalities amongst older people. A long London and it is likely that the Mayor will term strategy to improve health would endorse this aim. tackle the social causes of poor health across the lifecourse (Wilkinson and Pickett 2009; Recommendations Marmot 2010). That the social and environmental c) Gaps that remain to be addressed determinants of ill-health at all ages are tackled; in London, this includes reducing In London as elsewhere, health inequalities air pollution and improving housing remain stark, while community support conditions, access to transport and green and health services are increasingly spaces, social cohesion and access to restricted and care homes charge large social engagement opportunities. sums for care that is often poor or abusive. Age discrimination in health and social That LAs restore an adequate level of home care services remains (DEMOS 2012; CPA care services for older disabled people, 2010) and 180,000 older Londoners left including those with ‘moderate need’; and hospital malnourished each year (Age UK maintain local community centre services. 2011). Some older people found hospital staff disrespectful. A common theme was That governments require raised training that local hospitals should be kept open so standards for care staff, to prevent abuse; that older people and their kin would not and ensure compliance with the Human have to travel long distances. Another Rights Act in regards to all care home and common theme was that the NHS should nursing home residents.
35 An Age Friendly City – How far has London come?
policy area: 7 Communication and information
36 Policy area 7: Communication and information
Access to relevant information 65-74 had never used it, 66% if aged over 75 (ONS 2013b). The ‘digital divide’ by age ensures older people can is a matter of concern because non-users obtain the services and lose the opportunity for online savings on purchases and bookings, for pursuing benefits they need. interests and obtaining information on services and events. Most important, they It also keeps people connected to social, lack an easy means of contact with friends cultural, leisure, volunteering, civic and family that can alleviate the loneliness activities and employment opportunities, of physical isolation (AgeUK 2012). hence socially included. Younger people Despite all this, the main reasons older mainly use the internet or smartphone people give for not using a computer but since fewer older people are digitally- (and by implication the internet) among connected, a variety of other channels is individuals aged over 60 were lack of required. inclination and of confidence in IT (CIT 2012). Future cohorts of older people will a) Features that influence wellbeing and be more familiar with IT but changes in social inclusion of older people software and phones are so rapid that even experienced users must update their A priority is to provide information on skills frequently. rights to social security benefits and health and social care services, as well as For travel, clear maps at bus stops the procedures to exercise those rights. and stations are of value but these Claiming entitlements by filling in long do not replace the need for staff at and complex forms can be confusing and Underground and mainline ticket offices off-putting – one reason that only two and platforms to help travellers when thirds of older people eligible for Pension trains are cancelled or electronic displays Credit claim. Informal carers often do disrupted and to help disabled people not identify themselves as such, so fail when lifts are out of use. Alongside digital to claim assistance they are entitled to, dissemination, it is vital for older people and may lose up to £1,400 each year. that other forms of communication are Non-claiming is particularly prevalent maintained: posted leaflets, national and among black and ethnic minority informal local newspapers, radio and TV as well carers. Older workers may need advice as bulletin boards at community centres, on their right to carer’s leave and other libraries, doctors’ surgeries and hospitals. working conditions, their pension options Suitable adaptations are needed for those and their right to claim unfair dismissal with visual impairments or if English is or redundancy pay; such advice is best not the local first language. Large print provided at the workplace by employers helps older people and clear language is and by trade unions, for those who appreciated by people of all ages. are members. Knowing how to locate information is the first requirement, b) Developments since 2005 especially for socially-isolated people. If the telephone is the chief source used to Since 2008 the Mayor of London has run locate information, it is helpful if there is an annual Know Your Rights campaign to a human being to ask. Some older people give older Londoners financial help and find machine options hard to use. advice on benefits and other support. Since face-to-face advice is most effective, Older Londoners’ use of the internet is the campaign works with the London low but is increasing; 34% of those aged 37 An Age Friendly City – How far has London come?
Citizens Advice Bureau and Age UK to services are often carried out solely London. The latter, with GLA support, on line, excluding many older people, organised intergenerational mentoring, who rely most heavily on these services. using young volunteers to help older Bus route changes may be advertised people become more confident in using online or available on smartphones but computers and online services; by May the information is unavailable to many 2012, 1,450 older people had been reached older people unless posted at bus stops. by 800 volunteers across 26 boroughs. Where older people do use on-line As a result, older people gained skills to communications they are particularly build on with 200 becoming volunteers vulnerable to fraud and need technical themselves. Better intergenerational advice and training against such abuse. relations were fostered and the project Support is required for older people provides a model and toolkit for to learn how to use computers at local similar ones elsewhere (GLA 2013b, libraries, so they can benefit from the MiCommunity Toolkit 2012). Broadband useful information available on the web. coverage has been increased, as well as Discounted broadband deals for older free Wi-Fi in city centres and in specific people would also encourage internet use. residential areas; free Wi-Fi for customers Not all older people have a bank account is increasingly available in hotels, bars for direct debit and see it as unfair to and cafes, while public libraries offer charge them extra for services. But banks computers with internet access. require proof of identity before providing a service, thus excluding those without c) Gaps that remain to be addressed a passport from opening an account. In order to prevent such financial exclusion, Extending internet use among older a free or inexpensive basic ID card, with a people requires involving them in photograph and other forms of ID certified user-friendly design of devices and by a high street solicitor, could be made software, including mentoring by ‘digital available for older Londoners. champions’ from among older people. ICT courses in adult education centres Recommendations could be oriented towards older people, affordable and inviting; these could be That digital communications, especially in supplemented by informal sessions in the public sector, including the GLA group, community centres. Finding the best should always be supplemented by other way to inspire and support older people means. in using digital technology would help combat social isolation, empowering older That mentoring schemes to help older people and increasing their independence people to access and use the internet (Milligan and Passey 2011). should be organised through libraries, adult education centres and community Older people note that many services centres. are only accessible on line, sometimes with no telephone number or postal That a basic ID card acceptable to banks address provided. Computers could be should be available at low cost to older made available for the public to use in Londoners. council offices, with staff to help, and public bodies should continue to send out important information by post. Surveys and consultations about changes
38 Image Laurie White – courtesy of the Age Action Alliance
policy area: 8 Respect and social inclusion
39 An Age Friendly City – How far has London come?
To feel respected - in both Older people’s lives are often undervalued, as if they have no further useful personal social interactions and contribution to make, and this can affect in the public sphere through allocation of resources by policymakers. media and official language, The unpaid work by older people as volunteers and carers (see chapter 4) imagery and policies – is most should increase respect for the older important to older people’s generation, but it often goes unnoticed by the wider society and the media, where sense of self. the language of ‘economic inactivity’ is often used in relation to the growing Respect and recognition as an equal older population. Images of older people citizen are vital aspects of social inclusion. who are ill or impaired in the media tend Neither concept is easily measured, yet to confirm a universal deficit model, as we know that disrespect is associated with does the scarcity of healthy, active and ageism, that is discriminatory attitudes productive older people – especially older and behaviours towards older people. The women – as TV presenters, reporters, enormous diversity of functional age (as analysts and interviewees. Ageist distinct from calendar age) among older attitudes may be internalised by older people tends to be ignored. Widespread people themselves, eroding their self- ingrained ageist stereotypes set older esteem, autonomy and sense of identity, people apart from mainstream society inhibiting their ability to assert their as a homogeneous group defined by needs and rights. Acceptance of rude and a deficit model of ageing: ‘dependent’; discriminatory behaviour allows a climate ‘unproductive’; ‘a drain on the economy’; that can heighten the likelihood of abuse or ‘a burden’. Older people are even (Scharf et al. 2004). Because of the double blamed in some quarters – scapegoated standard of ageing, older women are - for the bleak future facing many young perceived as less able and less desirable people during austerity. Repetition of than men of the same age (Sontag 1995, prejudicial epithets in the media, without Arber and Ginn 1991). Gendered ageism serious challenge or critique, as well persists in employment, entrenched in as in official reports and speeches by deeply internalised prejudices (Itzin and politicians, serves to legitimise public Phillipson 1995, Duncan and Loretto 2004). prejudice. When older people are treated as stupid, ignored as if invisible, spoken Ageism, and the disrespect associated to in a patronising or infantilising manner, with it, contributes to social exclusion. their views dismissed, their voice denied, Older people are sensitive to this ‘social their potential to contribute brushed and economic apartheid’ in which older aside, this is not only demeaning and people can feel physically and spiritually annoying. It takes work and energy shut off from the mainstream of city life, to combat discriminatory attitudes, to with its new jobs, designer shopping, conform to the pressure to ‘age well’ or festivals and café culture. Social exclusion ‘actively’. The struggle to dispel negative (and isolation) are closely linked to relative age stereotypes can be harmful to health, poverty and to age-related physical or creating cardiovascular stress (Levy 2003). mental impairments that restrict normal Officials to whom older people turn for activities. These can be tackled by suitable assistance should take them seriously; this policies. includes staff in the health service, in care homes, in the transport system, in benefits offices and among the police. 40 Policy area 8: Respect and social inclusion
a) Features that promote social inclusion Sunday event since 2013 is a national of older people celebration of older people, highlighting regular activities and offering people Poverty in later life can be reduced by aged over 65 free activities to suit all social security arrangements, as shown tastes, ranging from cinema screenings, by variation across countries and time, dance classes, games, computer sessions, while the extent to which impairments afternoon tea, guided tours and more. become disabling depends on the physical Such events enable older people to share and social environment. Thus previous a day out in which they can feel their age chapters have illustrated how older people is valued and catered for. can be included in mainstream society through living in healthy, suitable and c) Gaps that remain to be addressed. secure housing; an outdoor environment The persistence of ageist attitudes among that is attractive, clean and physically easy younger people may stem from a dread to negotiate; a neighbourhood perceived of old age, a wishful denial of ageing. as safe and familiar, thus encouraging More positive images of older people in social participation in neighbourhood the media – engaging in employment or activities; access to local transport that self-employment, playing vital roles in can open up wider opportunities for civic society, publishing books, directing employment and volunteering as well films, designing fashion, running art, as for leisure, learning and cultural craft, dance and other adult classes, events; adequate income that enables generally pushing boundaries – would full participation in social life; good help to counter the fear of ageing community support and health services and to supplement the benefits of that make living with disabilities easier intergenerational activities organised and less disempowering than it otherwise by schools and voluntary or community would be; confidence that a care home groups. Following the removal of the will accord full respect and dignity to mandatory age of retirement from all residents; access to information, employment, other upper age limits especially through the internet and hence should also be removed, replaced where benefitting from the many opportunities necessary by competence tests. The of being digitally connected to the wider near-universality of ageing, as distinct world. from other characteristics subject to discrimination such as ethnicity, class b) Developments since 2005 or sexual orientation, means that policies and practices to normalise Engaging older people in local projects positive attitudes to ageing will benefit that affect them – housing, urban spaces everyone as they eventually become old and parks, a care home integrated within themselves. a community and so on - not only benefits the design of the project, but accords Recommendations appropriate respect for older people’s experience. Brighton University conducted That the GLA continues to publicise participatory research, inviting older and celebrate older people’s multiple people to join a team to explore how to contributions to society. That, in general, promote wellbeing. A video and booklet upper age limits be abolished. That were co-produced as a learning resource all public sector organisations commit for those working with older people to anti-ageist policies, with the media (Barnes, et al. 2012). An October Silver encouraged to follow suit.
41 An Age Friendly City – How far has London come?
Lessons from abroad
42 Lessons from abroad
Background
As noted in the introduction affiliated programmes and networks. On 1.10.14 the WHO launched a new to this update, part of our website ‘Age- friendly World’. The site research was: ‘Examining provides guidance and tools for starting, studies in other cities undertaken implementing and evaluating Age Friendly initiatives as well as information about since the main international projects that are already up and running WHO report in 2007’. around the world. The main findings: The plan was to obtain a list from the web and from WHO and send questionnaires 1. The concept of Age Friendly Cities has to all 33 of the original cities which took widened to Age Friendly Cities and part in the original research. However Communities; initial contact with the WHO revealed that ‘there were 9 cities that had undertaken 2. There is now more attention paid to some sort of prioritisation and concrete Dementia Friendly Cities/Communities. planning since the initial study, which In England over 60 towns and cities we took as indicating significant ongoing have committed to become dementia activity. Up to 20 reported still doing friendly – including London, through something, but it is likely that this was parliament and the GLA; extremely limited, and unlikely to have involved the municipality itself’ (WHO 3. Attention is now turning to Age personal communication 11.8.14). They Friendly Rural Areas where it is realised were unable to supply contact addresses that some of the problems of the for these and the others. We then carried city such as a sense of isolation and out a search on the web to try to find loneliness may be even more acute; about more on these 33 cities and on others that had subsequently taken part in 4. There is also interest in what is the initiative. Please note that this is not a described as a ‘Village Model’ where systematic search due to the constraints non- governmental organisations of the resources. develop a membership-based grassroots initiative to facilitate social Developments by the WHO since engagement as well as access to the 2007 report services (Scharlach et al. 2014).
In 2011 the WHO established the Global 5. There are now (WHO 2014) about 210 Network of Age-Friendly Cities and cities in 26 countries involved in the Communities to foster the exchange of Global Network Initiative. Countries experience and mutual learning between with the highest number of cities/ cities and communities worldwide. communities are the USA (38), Spain In May 2014 they identified 210 cities (36) and France (25). The UK has and communities in 26 countries 7.The purpose of the network is to signed up to the Network with more link cities to one another, facilitate in the process through the network’s the exchange of information and best
43 An Age Friendly City – How far has London come?
practice, foster interventions that are 2. An overview of initiatives across the appropriate, sustainable and cost world encourages a wide approach. It effective for improving the lives of is argued that ‘some basic community older people and to provide technical conditions must be in place, if cities support and training. To join the and communities are to pursue network cities must apply, indicating meaningful age-friendly initiatives. their commitment to the Network The necessary minimum level of cycle of continual improvement and favourable community conditions can start a cycle of stages (planning year be achieved through a combination 1 – 2, implementation, year 3 - 5, of well-planned outdoor space, progress evaluation end of year 6 and building, housing and transportation, subsequently continual improvement); sound economic activity, law-abiding behaviour of residents and well- 6. Cities seem to come and go/wax and operated municipal services’ (Fitzgerald wane in interest in the concept; and Caro, 2014 p. 4).
7. Some countries have been particularly 3. The intergenerational link is now enthusiastic including Canada (which being highlighted and in particular to led and co-funded the original 2005 encourage the contribution of older research and the 2007 report), the USA people. and France; 4. ‘Rather than assuming that 8. Very few initiatives have been communities that are good for older evaluated. However there is now a adults are also good for younger clear evaluation framework (including generations, it is important to develop mixed methods of quantitative, community change models that qualitative and other methods) which intentionally engage people of all ages London and other cities can use to see in collective efforts designed to benefit how age friendly they are; multiple populations, encourage alliances, rather than a competition 9. Most articles/press releases etc. are for resources and promote a sense of descriptive, ‘shared fate’ across the generations, racial and ethnic differences’. (Brown Some lessons for London and Henkin 2014, p. 7)
From what evidence there is, it is possible 5. Involving older people as partners is to draw some conclusions for London: key. This was identified in an early review of the literature in 2009 (Lui et 1. The original emphasis of the Age al. 2009). Studies of Manchester and Friendly Cities concept in the mid- Brussels have shown that there is ‘the noughties was on infrastructure such recognition that older adults are not as ‘safe and accessible outdoor spaces just the beneficiaries of age-friendly and buildings, public transportation, communities, they have key roles to adequate housing, and social and play in designing and fostering their health services’ (Provencher et al, 2014, distinctive features (Buffel et al. 2014: p. 8). The emphasis now seems to be 70). This partnership is not necessarily not so much on the infrastructure but achieved by adopting a bottom up on enhancing a sense of community approach or top down but by fostering (wider initiatives to make older people collaboration. A case study of Quebec feel more included). showed that what had helped were 44 Lessons from abroad
the advantages of a ‘dynamic seniors’ ‘greater satisfaction, feelings of security secretariat, subsidies, social discourse and longer housing independence for active aging, fighting structural among those living in ISAs compared ageism, government policy on aging, with other elders’ (Singelenberg, et al. program to counter mistreatment’ 2014, p. 69). (Garon et al. 2014, p. 84). 6. A network seems to help so that cities 8. The importance of strong back up at can be mutually supportive of one all levels of government, the need to another. London does not belong to a support communities and on-going network. promotion of the concept was shown in research in Manitoba (Menec et al. 7. As an alternative to a formal 2014). network some countries have joined together to share best practice. For 9. Countries/areas which seem to have example in 2009 a group of varied undertaken research to evaluate their professionals from four European initiatives include San Francisco, countries (Germany, the Netherlands, Atlanta, Georgia, Philadelphia, and Switzerland, and Denmark) identified Melbourne. It would be good for ‘Integrated Service Areas’(ISAs) as London to be seen as the leader both providing a range of co-located and in making the city/community more locally integrated services in small age friendly, but also in evaluating communities as a useful model. such initiatives. Preliminary research has pointed to
45 Co-designAn Age workshopFriendly completed City – How as part far has London come? of the study Mobility, Mood and Place
Some evidence from the London Borough of Hackney
46 Some evidence from LB Hackney
Background
A UK Research Council funded industry and residential homes and with young and old. research project, led by the – On transport: links are very good Engineering and Physical especially buses, the Freedom Pass Sciences Research Council is brilliant, 20 mph is good on roads. – Green space and the canal. (EPSRC), named ‘Mobility, – Graffiti which is artistic in public Mood and Place’, is exploring places show that there is a vibrant scene but not wanted near homes. how places can be designed – The well built houses (many with 3 collaboratively to make pedestrian bedrooms) with garages built in the mobility easy, enjoyable and 1960s are excellent. meaningful for older people. 2. What could be improved/done – Many buildings need a face lift – Anthea Tinker is a member of the research especially the industrial ones. team. Part of this is bringing together – The canal, in parts, is in a bad researchers, designers in training (post condition and so are some of the graduate architects and landscape barges. architects) and older people to envision – The past needs to be recognised places, from home to public spaces, which as it is a source of pride, e.g. a are inclusive, enabling and inspirational. sculpture recognising the industrial Part of this involves working with groups past would be appropriate. of older people in three areas. One of – More shops and places to eat. these is LB Hackney. A group of 13 older – On transport, the law on cycling on people and 21 students met together with pavements needs to be enforced; researchers in September 2014 to consider there are also problems with the area by walking through part of it mobility scooters with drivers and then making suggestions about how going too fast and dangerously, but the area could be improved. They were also more attention to be paid to also asked to help with the GLA-funded the needs of cyclists. More time is research on how London can improve as needed on pedestrian crossings. an Age Friendly City. – More green (and communal) spaces would be good and green roofs are Findings a good idea. – More seats need to be provided and 1. What is liked about the area especially for more than one person – It has improved since the London to sit. 2012 Olympic and Paralympic Games – Need for more public toilets. – a real improvement to the area – Every station should have a lift and and facilities such as the swimming all ramps and stairs should have pool which everyone can use. handrails. – More people (including artists) have – The ‘bedroom tax’ is not fair, as moved into the area giving it a buzz older people need a spare room for it did not have before. family/ carers. – A mixed community with some – More affordable housing is needed. 47 An Age Friendly City – How far has London come?
©VisitBritain Pawel Libera Conclusions
48 Conclusions
Preceding chapters outline since population ageing provides an excuse for cuts elsewhere in public how a city can promote the spending, allowing some of the public social inclusion and wellbeing to blame older people for the plight of younger people. of older people. The second factor that tends to frustrate Due to the efforts of London’s public efforts to improve the city for older (and sector organisations, older people’s younger) Londoners is the rapid increase organisations, individual older people in London’s population. It would be facile and others, progress has been made. to urge that more housebuilding on its The Decent Homes programme and the own is a sufficient solution. If new homes GLA’s housing design standards aim to simply attract buyers from the rest of the improve people’s homes. The adoption UK and abroad, Londoners will continue of the Lifetime Neighbourhoods concept to face a housing shortage and price rises, and the Green Grid are enhancing as well as increasing population pressure some neighbourhoods and London’s on transport and roads, flood defence and outdoor environment. Public transport is sewerage, air quality and green spaces, increasingly accessible and the Freedom education and health services. An age- Pass is cherished by older Londoners. friendly city would use small builders The Mayor’s Team London programme is to infill on brownfield sites and restore making volunteering easier. The London empty properties, providing a suitable Living Wage and the Mayor’s Know Your mix of homes with easy access to facilities Rights campaign are helping some older and avoiding largescale displacement of Londoners obtain a better income. The people. But a too-rapid population inflow Mayor’s Health Inequalities Strategy sets to the city may prevent such a local, out programmes and targets to reduce small-scale approach to building and health inequalities. Programmes to improving homes. support digital inclusion aim to keep older people socially and digitally connected. In many of the policy areas discussed, it is the 33 London LAs that have responsibility We welcome the progress made since for services that benefit older people, our previous report in 2007. As indicated whether directly or through facilitating by older Londoners’ feedback, there is third sector organisations that require a still more to be done, by the government, measure of LA support. LAs require more GLA, local authorities, service providers, revenue to enable them to provide or employers and each and every one of facilitate the services that older people us, to make London a more age-friendly need for wellbeing. Yet most LAs are city. Well-intentioned plans have been constrained by annually-reducing budgets. obstructed by austerity policies since Even with some justifiable cuts in the 2008 that include widespread cuts in highest staff salaries and savings through public spending, job losses in the public creative schemes for joint working with sector, reduced grants to local authorities neighbouring councils, LAs face dilemmas (LAs) that lead to contraction of the as to which services to reduce in order to community support and health services maintain others. Thus for London to make on which older people rely. These cuts better progress towards being an age- in resources have undermined efforts by friendly city, we urge local authorities to LAs to improve the material and social prioritize services for vulnerable groups, environment of older people. Cuts have including older Londoners. Technical, legal also served to legitimate ageist attitudes, 49 An Age Friendly City – How far has London come?
and practical assistance to community to exploit this and to increase the social groups by LAs can enable them to flourish. visibility of older Londoners’ contributions to the economy and to the quality of life of A notable finding is the benefits to be other generations. Older people may then obtained from involving older people in be accorded more respect and recognised planning and decisions about infrastructure not as a liability but an asset, not as a as it affects them. The GLA could do much burden but a resource.
Notes
1. A general criterion of affordability 3. A person is said to be in fuel poverty if is whether, after paying housing they spend over 10% of their income costs, there is enough money left for on fuel. a healthy, safe and participative life (Zaccheus Trust 2005, www. Z2k.org. 4. The government guarantee to increase uk). A genuinely affordable weekly the state pension every year by the rent was suggested in 2013 as £73 higher of inflation, average earnings or (single) £147 (couple) and an affordable a minimum of 2.5%. purchase price as £140,000 (single) and £170,000 (couple) (Johnson, D. 2013). 5. ‘Disability’ is used here to include impaired mobility, balance, sight, 2. In the Netherlands (NL) cycling is hearing and mental state. common for all ages and investment in cycling is €25 per person pa compared with €11.5 in London. Among 10 EU member states, using a bicycle as main mode of daily transport ranged from 31% in NL, to 13% in Germany, 3% in France and only 2% in UK, BBC report of August 8th 2013.
50 References
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Acknowledgement Disclaimer
The authors would like to thank the The views expressed in this paper Deputy Mayor, Victoria Borwick, and her are those of the authors and are not team at the GLA for commissioning this necessarily those of the GLA. research and thanks are especially due to Sue Johnson, Senior Diversity and Social The Institute of Gerontology, Policy Officer. Thanks also go to Dr John King’s College London Beard, Director of the Ageing and Life Course Department of the World Health The Institute of Gerontology at King’s Organisation, Geneva, Switzerland; to is one of the world’s leading research Dr Alex Kalache, formerly of the WHO centres for the study of ageing. It is and now Director of the International dedicated to advancing understanding Longevity Centre (ILC), Brazil and Dr of the characteristics, key influences Louise Plouffe also formerly of the WHO and effects of ageing throughout and now Senior Researcher at the ILC the life course. In the 2014 Research Brazil. They are also grateful to Dr Chris Assessment Framework, Gerontology Hiley who conducted a search of Age was submitted as part of the Department Friendly initiatives across the world. of Social Science, Health and Medicine for assessment as part of the Sociology The authors category. Where 4* represents world leading research in terms of originality, Professor Anthea Tinker is Professor of significance and rigour, it achieved the Social Gerontology in the Institute of highest proportion of 4* research outputs Gerontology (IoG) where she has been of any Sociology submission. In addition, for over 20 years. Much of her research 100 per cent of its research impact was has been on ways of keeping older people awarded a 4* or 3* rating, a striking in their own homes. Her expertise is in testament to the Institute’s strength. Social Policy and Ethics. King’s College London was confirmed Dr Jay Ginn is a Sociologist. She has as one of the world’s leading research undertaken the research for the chapters Universities in the Research Excellence in this report, drawing on her previous Framework (REF) 2014. It rose to 6th research into the material circumstances, position nationally in power ranking health and caring situations of older (based on research quantity and quality). people, as well on recent literature about Age Friendly Cities.
56 57 An Age Friendly City – How far has London come?