Blackburn with Darwen Borough Council, Directorate of Public Health. Integrated Strategic Needs Assessment “Communities Together, Loneliness Never” Loneliness and Isolation in Blackburn with Darwen September 2013 Michael Rawsterne 1 Integrated Strategic Needs Assessment Loneliness and Isolation Table of Contents Defining the issue .................................................................................................................................... 1 Why is this issue highlighted? ................................................................................................................. 4 Who is at risk and why? ........................................................................................................................ 10 Level of Need in the Population ............................................................................................................ 15 Good Practice ........................................................................................................................................ 16 Current Services and Initiatives ............................................................................................................ 22 Gaps ...................................................................................................................................................... 31 Value for Money ................................................................................................................................... 33 Involvement .......................................................................................................................................... 34 Recommendations ................................................................................................................................ 41 Existing strategies, plans and policies ................................................................................................... 43 Where to find out more ........................................................................................................................ 44 References ............................................................................................................................................ 44 Defining the issue Social Isolation In the past, social isolation has been defined as simply referring to the absence of contacts.60,1,2 This assumes that all social contacts have the same function, provide the same support and have the same value. More recent investigators have noted that it includes a number of different aspects. For instance, if there are a large number of contacts which are brief and cursory, then a person might still be isolated. However, extended and meaningful contact with only one individual might well mean that a person is not isolated at all. Loneliness Loneliness is “an individual’s subjective evaluation of his or her social participation or social isolation and is the outcome of …having a mismatch between the quantity and quality of existing relationships on the one hand and relationship standards on the other.” 3 This means that loneliness is about how the lack of satisfactory relationships makes you feel. Defining the issue Corporate Research Joint Intelligence Unit 2 Definitions of loneliness derived from engagement activities in Blackburn with Darwen and the question “What does loneliness mean to you?” Loneliness can be a chronic condition which gets worse as a person ages or it can occur as a consequence of various life events. Scope of the ISNA The original impetus for the ISNA came from the 50+ Partnership and there will therefore be a substantial element of the ISNA devoted to older people. Although the proportion of older people who endure loneliness and isolation is not apparently greater than for other age groups, it is thought that it is a greater problem for older people due to their circumstances making it more difficult for them to engage in activities that would reduce their loneliness and isolation. The purpose of the ISNA is to define priority issues, research questions, assess risks and make recommendations for commissioning services. Defining the issue Corporate Research Joint Intelligence Unit 3 The Campaign to End Loneliness has produced a “Toolkit for Health and Wellbeing Boards”4 This suggests a four step cycle in respect of developing and utilising the ISNA. The four steps are:- 1 Gather Information 2 Feed into strategy development 3 Strengthen partnerships 4 Monitor and evaluate This ISNA has been guided by this cycle and is part therefore of a process of continuing development, partnership engagement and evidence based evaluation. In line with the recommendations made in the Campaign to End Loneliness Toolkit4, the ISNA includes material derived from relevant bodies within the borough, such as the 50+ Partnership, The Alzheimer’s Society, Public Health and Public Health Intelligence, housing associations, The Care Network, transport providers, neighbourhood managers/ representatives, the Clinical Commissioning Group, the Borough Council, Hospitals, Education and Fire and Rescue. National and international data will be used as well as local data that is available. As well as these sources, The Campaign to End Loneliness Toolkit emphasises that it is also important that local voices are heard. The data from other sources is not always particular to Blackburn with Darwen so local data needs to be obtained. Further, numerical data can be significantly enhanced by material supplied by local residents communicated in their own way. Also, by its nature, loneliness and isolation means that relevant groups are unlikely to be heard through the normal channels or, in some cases, unlikely to appear in the conventional statistics. The local data will include findings derived from engagement activities with groups that might otherwise be excluded. Target population The population of interest in this ISNA are people residing within the borough of Blackburn with Darwen who are more than 18 years old. The populations to consider will include vulnerable populations as defined by place, income, ethnicity, gender or age. These might include people living in poverty, people with a disability, ex-offenders, people living with HIV/AIDS, people with a mental health condition, people who are homeless and older people. Defining the issue Corporate Research Joint Intelligence Unit 4 Why is this issue highlighted? Policy Background Local Policy In the Blackburn with Darwen Joint Health and Wellbeing Strategy 2012-2015 it is noted that ……” there is a significant section of the local population that is socially isolated, and therefore at risk of loneliness”.5 It then goes on to note that “There is a clear link between loneliness and poor mental and physical health, with lonely and socially isolated adults being more likely to be admitted to residential care and individuals who are socially isolated being between two and five times more likely than those who have strong social ties, to die prematurely”. It then makes clear that there is a need to determine the extent of the situation in respect of loneliness and isolation in Blackburn with Darwen. Loneliness and isolation is therefore a key issue for the Story of Place and the Health and Wellbeing Strategy. The Blackburn with Darwen 50+ partnership requested an ISNA on loneliness and isolation as a priority for the borough. This was because loneliness and isolation is now perceived to be a significant problem in terms of health, wellbeing and quality of life and also something that results in significant costs for health and social care services and the 3rd sector. Government Policy There is increased government interest in “Social isolation is not something that the loneliness and isolation. For instance, in Government or services can tackle on their March 2012, a “Summit on tackling own, but we can initiate action to recognise loneliness in older age” was held by the and identify the most isolated people. We must Campaign to End Loneliness and the work together to tackle social isolation. The Department of Health. This was attended work led by the Campaign to End Loneliness by representatives from the Department and the Local Government Association launched of Health, Department of Work and at the Government’s recent loneliness summit is an important contribution to this. Building on Pensions, local government, charities and the Department for Work and Pensions’ Ageing businesses. There was a ministerial Well programme, the Government will work address by Paul Burstow MP, Minister for closely with the Age Action Alliance to find Care Services and Steve Webb MP, practical approaches to improve the lives of Minister for Pensions. (See boxes) older people.” (White Paper, “Caring for our Future”)6 Following on from the 2012 social care White Paper6, a further indication of government support for the reduction of loneliness and social isolation is the inclusion of a new measure of loneliness and social isolation in the new 2013/14 Adult Social Care and Outcomes Framework. Specifically, the measure is self-reported levels of social contact as an indicator of social isolation. Although initially confined to social care service users, the intention is that the Why is this issue highlighted? Corporate Research Joint Intelligence Unit 5 measure will be expanded to cover the general “……there is a compelling public population. In this respect, the ASCOF Reference policy need, a compelling human group (June 2013) has made two recommendations.