Transcript: What do we mean by prevention?

Podcast Episode: What do we mean by prevention?

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
GW - Glenda Watt
BM - Betty Milton
IR - Irene Reid
DY - Derek Young
GP - Gerry Power
AM - Agnes McGroarty

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 Advisory Group records a group discussion about a related aspect of prevention. This is the third discussion. What do we mean by prevention, is it early intervention or universal prevention, or both? Recorded on the 25th of June 2014.

VM I am Vivien Moffat, I am the Evidence-Informed Practice Programme Manager at Iriss and leading on Plan P.

GW I am Glenda Watt, I work for the City of Edinburgh Council.

BM I am Betty Milton, I belong to A City for All Ages

IR I am Irene Reid and I work for Moray Council

DY I am Derek Young and I am a Policy Officer with Age Scotland

GP I am Gerry Power, I am National Lead for Co-production and Community Capacity Building with the Joint Improvement Team in Scottish Government.

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

VM Today we are talking about what we mean by prevention, do we mean early intervention to prevent further isolation for older people who are already at risk, or do we mean universal prevention, which is about building stronger, more connected communities that can stop people becoming isolated in the first place? Perhaps we need to do both? But how can we find a balance between these two approaches? On the one hand, interventions to strengthen communities, and on the other, those targeted at older people.

GP Well, I think both are important, however in building community capacity, generally speaking, I think that there’s a lot of value in focusing on the intergenerational mix of services, because I think then you have a much richer resource pool to fish in. I think there are some services, for example, as community transport, which are important for all sections within the community, certainly as far as younger people are concerned, they need to be able to access training and job opportunities, whereas for older people, it may be maintaining contact with friends and family, as well as the basics of accessing shops etc, so that’s one example. But I think that other examples are by building a stronger community between generations, it overcomes suspicions, misunderstandings, even fear that some individuals have about either younger or older sections of the community. There will be specific interventions which are important for older people, as there are for younger people, but if we are focusing on building stronger communities, I think that we need to take an intergenerational approach to that and view how we look at common areas in a way that actually supports the general community.

VM So, has anyone got any examples of where that kind of project has worked?

AM One of the things that happened while we were working with the Change Fund, when it first started, and last year, Age Concern and ourselves, and the local housing associations, had 10 meetings throughout Glasgow, and the resounding thing that came out of all of those meetings was that people wanted a local spot, whether that was a One Stop Shop, well, it was a one Stop Shop, or whether that was an actual shop in that community or whether it was a phone which, Silver Lining, of course, could take that over, and that would need to be … concentrating more on getting … letting people know about that. But that seemed to be the thing that people wanted, and if that was the case, then we could then have the community within a boundary, if you like, and that would certainly make it, I think, more manageable in order to bring groups together with a common identity, if you like, but that was certainly … it came through at every single meeting we had, that was the emphasis, they wanted a local … and whether that was something on local stuff, or even for information about where they would go for other kind of help.

GW Yes, I would agree we found that as well, that people want things in their local area, they don’t want to have to travel too far, something like a community hub, exactly what you are saying. So I think that could perhaps be universal.

AM It comes to my mind in terms of building stronger communities, is looking at the infrastructure and looking at the buildings that are already there, looking at the systems and the services, the parks, the roadways, the pavements, and I think that all of these areas have really got to be part and parcel of making secure environments for people and preventing falls and ensuring that there’s good lighting so that people can feel safe when they are out and about. But possibly looking at the use of buildings as well, and many buildings exist, but they might have a single purpose and it might require people to think very laterally about how a particular building could be used for a whole range of different people.

DY One of the things, sorry, Agnes, that Glenda has just touched on … I think there’s a connection between the point Glenda made and the one Gerry did, which is the discussion that’s now happening around Age Friendly communities. Recently Kilkenny, in Ireland, had actually a very strong intergenerational project where young people and older people were walking around together in their community, to see how accessible and friendly the community was for older people, it actually got some European money to try and fund that - and there’s a definition that the World Health Organisation has put in place on what an Age Friendly Community looks like, and getting people, other people who are not older, not yet, in the community to try and adopt a different perspective so that they can see for themselves what the challenges and issues are and how they could be improved.

I think that does strengthen the resilience and connectedness of a community, but also provides a focus for what it is that older people need in order to fully engage and participate in the life of the community and be able to access all parts of it. Age Scotland, in previous years, provided a tool kit called ‘Walk In Our Shoes, Act On Our Issues’, which was to encourage the same sort of thing, but it’s now apparently spreading to different parts, there are attempts to try and look at these types of issues in places like Glasgow and Edinburgh, but it would be especially be important in smaller, more rural communities as well.

F There’s a connection to the World Health Organisation Global Age Friendly Cities Network, and there’s a UK Network where a number of local authorities in various cities have adopted this particular holistic approach and looking at all kinds of issues about the whole city to make it much more accessible and friendly to the likes of older people, but that then requires older people to be very actively involved and to have a voice and to work with a whole range of other people to produce plans, look at maps, look at how things could be changed, and it might not require a lot of money to do this.

AM … sort of take ownership, you know if you have got a … I think you are more likely to have a community taking ownership of their community and what’s happening within that, I think all of that would, you know, come into this.

F You’re right. The One Stop Shop, you are dead right, because we have one … our area are fortunate, our bit has got great motorway and it provides one section of the housing area and our section and what we found, they have got a One Stop Shop, and all Broomhouse go to that, that’s an area of Edinburgh, and I have been trying to get more involvement with everything and it’s so difficult, because that One Stop Shop is exactly what the Broomhouse people want, they want to stay that side, because they have to use the underpasses, they have to come the shops and they have got 5 little shops, I think, that it’s such a shame because there’s so much to come over for, but we found that divide is very difficult, and

I find that with the older people, they won’t come to our meetings because they’re at this side, and if I go to that side you don’t go to those meetings, it’s very, very difficult, so it is essential that they have, as Glenda says, where they have no underpasses, they have safe walking and they can go to anywhere in their district without being scared, so I totally understand.

GW I think that raises the issue of natural neighbourhoods, so people have different perceptions of their own neighbourhood and of course there are distinct barriers in neighbourhoods that might have only been seen by the people who actually live there, so that’s another sort of area that needs to be looked at, a kind of a question that needs to be posed or … is your area … or is your neighbourhood, where do you see your neighbourhood …?

F And that links which what you mentioned earlier about how you used your local resources and buildings and infrastructure, parks and walkways and how people are connected.

DY The idea of place also is very closely connected to issues around housing for older people as well and it’s one of the chief causes of people having to move house in later life, is that if their needs are such, mobility-wise, for example that they … you know if they are up 3 flights of stairs, for example, that might no longer be suitable for them if their mobility is challenged, but that can lead to all sorts of other dislocation, because you will not, if you move to a completely different place, not very close to where you were before, then it becomes harder to find groups and make connections with your existing friends that you want to be in touch with.

Even things like, if you have to register with a new GP practice, for example, if you are the sort of person who has multiple complex health needs, the process of registering with a new GP might take several weeks to complete, especially if you need different forms of identification and … you know, a letter saying what your new address is and so on … so that can actually cause people to, inadvertently, fall into a …

F Absolutely, that’s just happened at Westerhale, with the new health centre … the amount of older people … the walks too much from the bus stop to the health centre, it’s dreadful, we have been fighting …

DY Yes, so there are obviously health impacts, but then there are social impacts as well because that may contribute to the feeling of being isolated and lonely, not understanding what … you may understand physically what the name of the community is and how far it goes, but you just don’t know anyone else in it to begin with.

F But when it comes to solutions, or possible solutions, sometimes it does require a group of people to come together to actually exchange ideas. Agnes has just given us an example of an older man who lives up 3 flights of stairs but cannot get out and there’s no aid, mobility aid to get him downstairs and we were just thinking about how that problem could be tackled, and the suggestion that’s came up was to make contact …

GP Well yes, it wasn’t a flippant suggestion, but I mean in a sense, to draw or to point a spotlight on it, I mean you know, we discussed about whether calling Mountain Rescue might be the option if you couldn’t get somebody down, and I think really in a sense that the message that gives to those in authority who should be dealing with these things is, look, we have had to call an emergency service that is used to get people off the Munro’s to actually get somebody down 3 flights of stairs, and that’s just not acceptable. So, what does it take to actually get someone to take responsibility for this type of thing?

I mean the point was made, and in cities like Glasgow, where, you know, there is a predominance of tenements, I mean that’s the type of city you live in, you have to plan around that, you have to have ways of actually understanding that when you bring tenements together with older people, then there needs to be facilities provided to actually accommodate their ability to communicate and remain connected with their communities. So it wasn’t a flippant suggestion, but …

F No, it was a very good idea, and another good idea … why don’t you inform a newspaper, they would love it, they would love it, ’this old gent would like to come out, is there anybody willing to help?’

F I think there’s also a place then for targeting and preventative things, I think we spoke a lot about the communities and that’s very important, but there is also a place for targeting preventative things, because GP’s do say that a lot of people go to their practice for things other than health, there’s a lot of people who continually go because they are very lonely, so there is a case for targeting preventative interventions for people … by keeping them involved in the communities, for setting up things that help them to remain in their communities.

F Perhaps an idea might be that the local GP sets up his surgery in the local community education centre or the local leisure centre and that … so people who have to visit their GP for a consultation in a completely different environment that is not medical …

F But then if we had the health visitors and the district nurses that we required, then the GP could just refer, which they did before, that’s what used to happen, you know, the member of staff who was attached to that GP attachment was there for just that purpose, you know, someone isolated could be referred very easily, whereas, I don’t know what they do with them now, I think they are all … I don’t know if there are any …

F Well there’s work to do with social prescribing, so encouraging GP’s to prescribe …

F Yes, I believe the Scottish Government are looking at what’s called NUKA, I don’t know if I am pronouncing it properly, it’s N U K A, and some people have gone over to Alaska to look at that, and perhaps you know and can say a bit more about it, Gerry …

GP Well, I am not familiar with the detail of that but certainly I know that Scottish Government are looking for examples about how communities can actually develop, and there will be unique aspects of that particular community, but there will be broader lessons to learn, I am sure we can find out details about that.

F But we did have it, you know we had an easier access to other people, such as health visitors and social workers, and GP’s, which they don’t have now.

F I saw an advert, not an advert … information from the Scottish Government about posts, medical assistants, I think … and these people would undergo a kind of, an almost full medical training, but I am not quite sure if I am getting this correct, but these people who have got some qualification would be able to meet people prescribe treatments, but they will not be a fully qualified medical practitioner.

VM In summary, I guess we have kind of talked about the importance of having local resources and local people being involved, about how much a hub can help, where people can get together and talk about what’s needed in the local area, and people who understand how the local infrastructure and environment affects, and it may well they can be connected, things like our gentleman on the third floor, if people in the community are brought together, then they can make a difference, so there is still a great challenge about how we do that, and also we’ve talked about the importance of still continuing to support people who are lonely and isolated and having the resources and interventions that can help that group, so thank you very much.

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