Transcript: How can we ensure that older people are equal partners in developing preventative approaches?

Podcast Episode: How can we ensure that older people are equal partners in developing preventative approaches?

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

VM - Vivien Moffat
IW - Irene Weeden
SC - Sarah Currie
GP - Gerry Power
AM - Agnes McGroarty
GW - Glenda Watt
BM - Betty Milton

VM Plan P - new approaches to prevention with older people is an Iriss project which addresses the issue of social isolation and loneliness amongst older people. Each quarter, the Project Advisory Group records a discussion about a related aspect of prevention. This is the second discussion and the topic is “How can we ensure that older people are equal partners in developing preventative approaches?” I am Vivien Moffat - I lead the Evidence Informed Practice Programme at Iriss.

IW I am Irene Weeden - I am a Development Officer for Moray Council, developing projects in the community, sustainable projects in the community for older people.

SC I am Sarah Currie - I am the Programme Manager for the Health & Social Care Pathfinder Programme of Work for the Scottish Council of Voluntary Organisations, SCVO.

GP I am Gerry Power - I am from the Joint Improvement Team and I am leading on Co-production and Community Capacity Building.

AM I am Agnes McGroarty - Vice Chair of the Scottish Seniors Alliance.

GW I am Glenda Watt - I work with the City of Edinburgh Council. I lead on Edinburgh’s Plan for Older People and I organise the Scottish Older People’s Assembly, along with the Committee of the Scottish Older People’s Assembly.

BM I am Betty Milton - I belong to ‘A City for all Ages’ which is based in Edinburgh.

VM Okay, so the evidence suggests that interventions are more effective in addressing social isolation and loneliness where older people are actively involved in their development and implementation - so this means, as equal partners, but how well do we do this? So our question today is “how can we ensure that older people are equal partners in developing preventative approaches?

IW Well I can say that older people are at the very heart of everything that I do, because if they weren’t involved, if they weren’t signed up to the different community projects, they just wouldn’t work - it’s very much a bottom up approach, so it’s essential that they are involved from the beginning, right through the project.

VM I think that’s important, yes, that older people are obviously involved in every aspect of it. We talked about things like time banking and how that is a way of involving everyone as equal partners … I don’t know if you want to talk about that?

GP Yes, I think sometimes some of the so called solutions that are provided to help individuals, older people to live more independently at home don’t address the issues of social isolation. So some of the solutions like tele-care, for example, where we bring in technology to ensure that people are maintained safely at home, etc, don’t actually have that human contact that we all need to sustain us. And I don’t think that we can rely on statutory services to actually provide that - I think some of the solutions lie within our own hands, within community’s own hands, within the hands of us as individuals. And one of the areas that we discussed earlier was around time banking, and particularly the project that I was involved in within the West Edinburgh Time Bank. The Time Bank itself is inter-generational, however the ‘Time for Life’ project looked at how time banking supported older people. And this was about trying to understand what they needed from time banking, and we used Talking Points to ascertain that a lot of the time it was about being connected, having friends, being more socially active. And what happened was that individuals sought befriending services, etc, which actually helped them to, if you like, address their issues of social isolation. Do you want me to talk a bit about what time banking is? Would that help? Do we have time?

VM Yes, great, yes.

GP Time banking really uses time as a currency - essentially an hour of my time is worth an hour of anybody else’s time, so I might actually provide … I might transport you, in terms of taking you to your shopping, or I might actually do some gardening for you - in return you might show me how to … teach me how to cook for an hour, etc, so it’s about an exchange of time. So there is a reciprocal agreement there. So in a sense, how it worked in Wester Hailes in west Edinburgh was that for a lot of people, they could offer a skill - they might actually, for example, provide childcare for an individual, and that individual might do some shopping for them. So there is a reciprocal exchange there. And in some ways, the community starts to build up those resources within itself to actually sustain more people, and certainly for older people to address issues such as social isolation through befriending, etc. So it’s quite a powerful tool, but basically what it demonstrates is that these are resources that are actually within communities and that statutory services really aren’t set up to provide. So it has to be a combination of both, I think, in terms of how we sustain older people in the community - it has to be about those services that are provided from statutory services, but also about what individuals in communities themselves do to sustain themselves.

GW I think I might like to go back to the question - “how can we ensure that older people are equal partners in developing preventative approaches”. The first thing I would like to say is that in Scotland, the majority of older people are independent, and it’s only small numbers of peoples - only thousands in some areas, but in terms of the total population of older people, it is only a proportion of them that are really requiring services or particular support, and it’s usually those older older people. From the experience that we have had in Edinburgh, people need to know what kind of services are provided and who provides them - and when people come into contact with the statutory services, older people will say first of all that they are confused - they don’t know how to access them, it seems to be quite a myriad of systems, particularly those provided by the NHS - they might be different from those provided by the Council, and different from those provided by the voluntary sector or the private sector. It can be a minefield for older people to find their way around and decide what kind of service they would like. So for an older person to be an equal partner within the system would actually be very, very difficult - and it will require a lot of change for those who are working within the system to enable an older person to become an equal partner. They need information about what already exists, they need to find or understand the language that professional people use, and that can be very difficult. And so there has to be a kind of meeting of minds and I think an openness and a willingness on the part of professional people, wherever they come, that in general the older people or the older person is actually welcome. But the professionals have got to make some changes in the first instance in terms of use of language and acknowledging how their systems are currently used.

VM I think something about the preventative approaches that are with current service provision, the kinds of initiatives that might involve older people before they come to services that are truly preventative, we don’t know …

BM Yes, we have got to find out … for example, I did something with the art students, and they asked me what made me happy. If I was fed up, what do I do? Do I go for a drink or what do I do? And I was telling Glenda today, my feelings of happiness is when I have got music - I love music, I just love music - and a lot of people love music, but they forget to put on their radios because the telly is there, blah, blah, blah - but radios, to me, I think to older people, are quite important. And another thing that I think is very important, because I am a lousy sleeper, and if you don’t sleep your mind ticks, and before you know it you have got every illness under the sun - you will find it yourself, you are not well, it is always worse through the night. Now Talking Books are the greatest thing that was ever, ever invented - especially for older people - even if you can’t sleep, put something on and listen to it - you can totally go with it. I did something about the suffragettes recently and it was amazing what I learned - it was brilliant. So prevention to me is start with being happy, trying to keep healthy, having respect from other people no matter what age you are is very important. And that’s what I find - young people now … not young people, the sort of middle aged people seem to think because you are old you are going a bit doolally, and it kind of bugs me. And okay, maybe they walk slowly or maybe they curl up - that doesn’t mean that up here they are not absolutely with it. So I think there are a lot of things for prevention first - let’s get them used, you know, they are there. I can give you an example - an old lady across the road from me, 89, fell and broke both her wrists when they had that Black Saturday - so she was taken to hospital. When she came out, the daughter who works in a chemist shop … she was the only person to look after her, was told “you will have to take time off - you will have to bath her, you will have to look after her”. How does she go about doing that? I mean her mother had two broken wrists, she has got her job, how does she do it? So she came to me and I gave her all the information. Within 3 days she had help from everywhere she should be getting it - but nobody at the hospital had told her. Now we are talking about a 43 year old lady - it’s not that she didn’t know … but people don’t know what they are allowed. So I think this is very important.

SC That’s a good point about accessibility - how do people know what is available.

AM That’s right.

SC And that is something we are trying to uncover in the Pathfinder work we are doing in East Dunbartonshire - about making things available to people. There are so many databases and ways to (… unclear) people can, if they are an organisation or a project they can register themselves with - but what is the best way for people who are using the services and activities to find out? So as you said, if that girl needed to know - she could go to the Council, she could go to her NHS and ask …

AM But why does the hospital not pass on these things?

SC Yes, so it’s general awareness from all sectors and all partners.

AM Absolutely right.

SC So to me that’s an equal approach for everybody.

AM But also information that is very local - quite often there is a lot of information comes out, but it’s general, and I think you have got to have a local slant to the information that is being sent - so that even a telephone … a local telephone number that you could use, you know, “where can I get this information”, or a one-stop-shop in your area. But I think it has got to be local and it has got to be kept up to date of course.

IW Yes, a one-stop-shop would solve a lot of problems, and if all the health and social care agencies knew about that, they could give that to the area, so people could go and find out all their information and then they don’t have to go through loads of different calls or organisations - they get all their information from one place. And that could be provided by the voluntary sector.

SC Yes, and a good example of that actually is in East Dunbartonshire - we have something called the ‘Older People’s Access Line’, or OPAL as it’s called - and it has been set up. It is through the third sector and it’s 3 organisations at the moment that are taking the lead on it - Citizen’s Advice Bureau, Carer’s Link and Care to Us, which is an advocacy organisation. And they have got exactly that - it’s one local phone number … … and they have all the local projects and organisations that want to be registered with them are registered there, and they have a little bit about what they do. So if somebody phones up and exactly wants something local to them, or it’s geographically local, or the type of activity they are looking for - they can signpost them to that particular service. But they have all the information at their disposal, and it’s working really well - they have got good buy in, not just council and sort of statutory sectors, but people like GP’s are really engaged with it. So for a GP, again it makes their life easier, because they might not be aware of what the current range of activities are. So it is certainly a project that is working quite well at the moment and we are keen to explore that further and see how that progresses.

AM I think that is very important - we did … using some of the Change Fund money, Age Scotland and ourselves and other capital organisations came in - and we did local … we had 10 local meetings throughout Glasgow - and that was one of the things that came up in almost every meeting was the need for good local information and a one-stop-shop or a telephone number. And I would agree with you about the GP’s, I think the GP’s have to be brought in here some way or another - and certainly I think going to my GP - there are at least 25 notices, all about this and that and the next thing, and some are contradicting other ones, and it’s just shocking. And so they are really very bad at signposting and they need to be brought into this in some way or another.

GW In Edinburgh we have to the ‘Get Up and Go’ annual booklet which is produced by the libraries, and this contains a lot of information about services and opportunities and activities that are available for older people in Edinburgh. So it comes out as a paper copy and information is also online, and it’s on the Council website, linked into the libraries. Age Scotland have a helpline as well and it provides assistance from a whole band of volunteers. There is a Silver Line as well which is linked into Age Scotland, and this is a new befriending organisation. So there are actually lots of opportunities for older people to access information, and I still think it needs to be in a variety of different formats as well, because not everybody is on the internet - some people might have difficulty using the phone, but people need booklets. And of course, within Scotland we have also got people from a diverse range of communities - there are people who are from the Asian community, the Chinese community, the Polish community - and information needs to be provided to them in their own languages, or it should be translatable if possible.

GP I think that a lot of statutory services are provided for older people with the best possible intentions of trying to support their desired outcomes, the difficulty of course is that what some professionals and services feel are the best possible outcomes for individuals, are not what they feel are the outcomes they want themselves. Certainly I think that one of the more positive aspects in terms of how services have engaged with older people are through trying to determine what those personal outcomes are. So rather than simply asking a series of questions which are very technical in detail and geared towards dependency or independence, the idea of trying to assess what outcome rather than what output an individual requires is important. And the use of tools like Talking Points which try to ascertain what the outcome is are one way of ensuring that we can actually start to design and provide services around what people really want. Because yes, people do require adaptations, they do require tele-care and tele-medicine, they do require professional and technical inputs, but they also require things, as I was saying earlier, that perhaps are not immediately available from statutory or even voluntary organisations - things that, in terms of dealing with social isolation, things like compassion and love and things that can only be provided within the local community. And therefore there needs to be much more co-design and co-commissioning of services which address both parts of those equations, both the technical and professional and process driven issues - but also start to ensure that we invest in communities and in local services which can provide things that perhaps statutory and non-statutory organisation, formal non-statutory organisations are not particularly set up to do. So I think in future there needs to be much more coming together of trying to understand, through tools like Talking Point and understanding what outcomes are - to design services which are holistic and which provide both for the physical and emotional and community based issues for older people. And so I think a focus on outcomes is going to be important in future, in trying to understand, from an individual point of view, what is it that you are hoping … what would be success for you? And I think we would be surprised by some of those answers.

GW Yes, and I think as an example it might be that the person might say “I really would like to get out and about more than I am doing”, but they don’t need a service from the local Social Work or Health Dept. or voluntary sector - they might want to go along to the library on a regular basis, they might want to go to the art gallery, they might want to go the theatre, they want to go to the leisure centre. And I think what would be very helpful is for these services to be much more sensitive to the needs to older people, and particularly people with dementia, people with hearing problems, people with sight problems - and so if there was a movement that will help all of these different services, some of which are provided by the local authority, others are independent services - I mean shopping as well, for example - and another example is recent we were asking people with dementia what would they like to make their lives more comfortable, and they said “we just want to keep going with what we are able to do - but we want to be able to go to the places that we used to go to, and it would help to know that we weren’t going to be shunned or we weren’t going to be turned away if somebody sort of thought that our behaviour was a little bit odd”. So we have to make, I think, cities, localities, more age friendly, more dementia friendly - and that really involves a whole different range of services. But also maybe raising awareness for the staff in these organisations about the needs of people who have got particular problems, or what dementia really means.

IW I can give an example of that - there was a lady who used to go to the Senior Citizen’s, and for whatever reason she didn’t feel comfortable going there any more - so she came along to one of the smaller Coffee & Chat groups, and she mentioned to one of my colleagues last week that not only is she feeling happier, but her family have noticed a great increase in her capabilities. And that is amazing - just from coming to a different group and feeling part of it. So we didn’t expect that level of success really, but it’s really good.

AM Older abuse - that is quite a funny thing to say - and I mean we did talk about it, and I thought “how does that happen” - until it happened to me. And it was dead weird - I was coming down with my shopping and the buses come along to turn up to go to Wester Hailes, and it stopped to let me, and he told me to go on - so I started to cross when this car came round. Honest to god, if he hadn’t had good brakes he would have hit me - and the abuse I got from him … he said “get back to the home you should be from, blah, blah, blah, blah, blah, blah”. Now I am quite a strong person, but when I got across the road I started to cry - I felt dreadful - I felt absolutely dreadful. But it did me good, because now when people talk about it, I can understand their feelings - the same as going through the underpasses - I am quite good at it, but a lot of older people hate it. So when they discuss it, it is so good to know how to treat something if you have done it yourself, and that’s true. If you get older people into your conversations, into the things that they really need - like Glenda talks about - it’s amazing what you hear when I go to Glenda’s meetings round that table - that’s where you know yourself, the one meeting you were at - that’s where you learn - from their own experiences.

BM Word of mouth is very powerful, and I think elderly people use it more than … older people use it more … stuff goes on, you know - you can hear … I have been stopped in the street and somebody said to me “you had a meeting yesterday and I believe you talked about” … this was one of our forums - and I said “well why don’t you come along?” “I’m looking after my grandchildren, and somebody had said … and I wondered if, you know, whatever”. So word of mouth does get out, and you know, if you can get that kind of information locally - how you do that locally is difficult … well it’s not difficult, but I think it can be done - and that would help, and that would certainly spread along the lines of people being advised on different things.

BM The best thing in their lives is being needed - being asked to do something. I mean if my kids phone me and ask me, I feel great.

VM Which brings us back to equal partnerships - I think it is interesting that the conversation talked about access to information and having services that meet what people want - their own outcomes - which kind of demonstrated lots of barriers that we still have towards really having an equal partnership … thank you everyone.

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