Keeping our finger on the pulse: recent additions to our collection across health

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The health and care landscape has been changed in unprecedented ways over the past year. The coronavirus pandemic has not only highlighted strains within the system and required a response to a public health emergency unlike anything else that has been seen for decades, it has also provided an opportunity to push innovation in areas like digital infrastructure and partnership working, and encouraged decision makers to look at public health as an essential part of policy making in all areas.

The Knowledge Exchange database is full of reports, articles and documents which offer insight into these themes, published by organisations from across the heath and social care landscape. In this blog post, we’re highlighting some recent additions to our collection and some of the big themes being discussed within the sector.

Covid-19, “building back better” and a “health in all policies” approach

In March 2021 think tank IPPR published their report State of health and care: the NHS Long Term Plan after Covid-19. The recommendations form a £12 billion blueprint to ‘build back better’ in health and care and the report calls for an adaptation of the NHS Long Term Plan published in 2019 focusing on cancer, mental health, cardiovascular disease and multimorbidity. The authors believe the Long Term Plan needs to change to ‘build back better’ health and care post-pandemic, in relation to: ensuring a sustainable workforce; resourcing the NHS to deliver transformation; empowering integration; upgrading the digital NHS; funding and reforming social care; and levelling up the nation’s health.

Another report, from the Local Government Association (LGA), published in September 2020, provides specific guidance to local authority councillors on ways to improve the approach to population health and use of public health resources in dealing with the pandemic, highlighting the Health in All Policies (HiAP) approach to addressing health inequalities and improving wellbeing. There are a number of other resources which look at public health approaches to tackling other areas of policy such as youth violence and urban regeneration.

Build back fairer: the Covid-19 Marmot Review: the pandemic, socioeconomic and health inequalities in England, published by the Health Foundation and the Institute of Health Equity examines inequalities in coronavirus mortality, looks at the effects that the pandemic, and the societal response, have had on social and economic inequalities, the effects on mental and physical health, and the likely effects on health inequalities in the future. The report assesses the inequalities in the risk of COVID-19 and mortality and explores the impact of containment on inequalities in the social determinants of health, in terms of: early life; education; children and young people; employment and working conditions; a healthy standard of living; healthy and sustainable places and communities; and healthy behaviours.

Mental health

Mental health services have been under significant pressure in the UK for a number of years now, with children’s services (CAMHS) particularly stretched as the number of specialist practitioners is limited. The coronavirus pandemic has, according to many specialists, exacerbated existing pressures and placed even more demand on services. In April 2021 the All-Party Parliamentary Group on a Fit and Healthy Childhood published a report: The COVID generation: a mental health pandemic in the making – the impact on the mental health of children and young people during and after the COVID-19 pandemic  which explores a range of themes in relation to the impact of the pandemic on the mental health of children and young people. The report presents evidence from a range of sources on the potential implications of the pandemic on young people’s mental health and discusses the impact of school closures on children’s future health and well-being.

The Children’s Commissioner for England recently published a report  which looks at the progress made in improving children’s mental health services in England, and  the impact of the pandemic on the mental health of children. The report also examines the provision and accessibility of children’s mental health services in 2019/20, finding that access is still not adequate and not improving as quickly as expected.          

The other pandemic: the impact of Covid-19 on Britain’s mental health  explores how the mental health of people in the UK has been affected by the pandemic, drawing on a survey of over 4000 people. It describes the different experiences of groups across society and the highlights the disproportionate mental health impact on people who are exposed to higher levels of social deprivation, as well as on women, younger people and those who live alone.

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Structural reform

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, such as taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

One of the main focuses of the health and social care white paper published in February 2021 is around developing an integrated health and social care system and taking a ‘population health’ preventative approach to healthcare, while a report from the NHS confederation recommends a reformation of the framework for elective care and increased healthcare funding.

Digital transformation

Even before the pandemic, The King’s Fund was publishing widely on digital transformation. But their recent report Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic  looks specifically at the impact of the pandemic on accelerating the transformation of the delivery of some services by GPs to focus more on digital delivery and whether this change can (or should) be sustained once the pandemic is over. It explores the challenges around trust, staff and patient digital literacy and the evaluation of digital tools in practice. Parliamentary Office of Science and Technology (POST) published their own review of AI and healthcare , providing an overview of AI in the healthcare system and its potential impacts on the cost and quality of healthcare, and on the workforce.

Final thoughts

The landscape of health and care is changing. The Covid-19 pandemic has placed unprecedented demands on a system which was already facing significant challenges. While in some instances this has led to innovation and accelerated the pace of change, it has also exposed some of the significant weaknesses of the system.

This blog highlights some of the big topics the sector is currently grappling with, but there is more available for TKE members on our database. Members can also sign up to receive our health Topic Update, which will provide fortnightly email updates of items recently added to the collection in health, easily allowing you to stay up to date.

If your organisation is not a member of the Knowledge Exchange and you would like more information, please contact us.


If you liked this article you may also be interested in reading:

A nudge in the right direction? Using behavioural insights in health

Virtual reality: a game changer for mental health treatment?

Devolving health and social care in England: an opportunity to transform how we approach health and care?

Cross-border handshakes: what’s next for digital contact tracing?

Better housing for older people means better lives for all

“Sheltered Housing – MVRDV” by KJBO is licensed under CC BY-ND 2.0

Housing is at the heart of a good quality of life. This is especially true as we get older, when health and wellbeing, independence and end-of-life care can all be greatly enhanced by decent housing.

Four recent reports have underlined the importance of good housing for older people, and the wider benefits for society.

Housing with care: progress and problems

The Commission on the Role of Housing in the Future of Care and Support  (CRHFCS) was established last October by the Social Care Institute for Excellence (SCIE). The new commission aims to produce a blueprint to enable greater choice and availability of housing and support for people aged 65 and older who may find it difficult to live independently at home, or who choose to live somewhere which provides more support options. The Commission will focus on five key areas: care homes; retirement communities; retirement housing; supported living; and the Shared Lives schemes.

The first report of the CRHFCS highlights progress made since the Commission on Residential Care 2014 (CORC) reported its findings in 2014. There have been some positive developments concerning the take-up of more new technologies in care settings, such as telehealth, telecare and smart home devices to help people maintain their independence.

Progress has also been made on age- and dementia-friendly housing design. And the report commends the Housing our Ageing Population Panel for Innovation (HAPPI) reports for raising awareness of housing specifically designed for older people.

However, little progress has been made on CORC’s recommended expansion of the market to give greater choice of housing with access to care. Options remain limited, especially for those struggling to pay for accommodation.

The CRHFCS sets out some initial policy proposals. These include planning reforms to make it easier to build retirement community housing, and improved information and advice to support informed decision-making for older people seeking housing with care and support facilities.

The Commission’s final report will appear in the summer, when it will make recommendations about the future shape of housing that facilitates care and support.

Needed: a clear vision about housing for older people

The findings from the CRHFCS report are echoed in another report, published in April by the Cambridge Centre for Housing and Planning Research. The Cambridge report identifies numerous constraints to supply, investment and demand in the market for specialised housing for older people. 

One of the study’s key findings  is that retirement community development is unviable in many areas outside of London and the South East of England.

“Coupled with the fact that the majority of house moves made by older people are relatively local, this constraint to supply reduces housing options for those living elsewhere in the country, particularly home owners who do not qualify for assistance with housing costs. Unless the viability of retirement community development can be improved and the supply of mid-range retirement properties be raised, these households will have very little choice around moving in later life.”

Among the recommendations in the Cambridge report are calls for national government to provide a clear vision about housing for people as they age:

“For example, greater clarity is required around the joint priorities of ‘downsizing’ and ‘ageing in place’, and how these priorities can be best implemented at the local level.”

The report also recommends that local authorities should give priority to housing for older people, through the creation of clear strategic and local plans and guidelines for developers:

“Collaboration between local authority planning, social care, health and housing teams could allow for better planning around retirement housing. For example, retirement housing may make savings possible within health and social care budgets.”

The Cambridge report encourages housing providers to diversify the retirement housing offer, and to gain a better understanding of preferences of different older people:

“Rather than drawing on stereotypes of old age, providers face the challenge of recognising older people as a complex and heterogeneous group of consumers with diverse aspirations.”

Closing the generational divide

According to a report by the Intergenerational Foundation (IF), England now has two housing nations: the first is older, well-housed, often well-off, with space to work and self-isolate; the second nation is younger living in cramped flats or shared homes with little or no access to outside space.

The IF says that the pandemic has exacerbated housing inequalities between the young and the old, and observes that “…while younger generations have lost their jobs, their homes and even their mental health during COVID-19, older generations have stockpiled space.”

The report also highlights a rise in the number of second homes as a consequence of the pandemic.  There are now 5.5 million second homes in England – a 50% increase between 2011 and 2020 – most of them owned by older people.

Space inequality has also increased. Owner-occupied homes have a third more space on average than privately rented homes, and almost double the space as social housing.

Like the previously mentioned reports, the IF calls for market failures on retirement housing to be addressed. It recommends reform of stamp duty to encourage downsizing, and reforms to the planning system both to give a greater voice to the homeless and badly housed and to encourage developers to build more retirement homes.

Making a house a home: impacts of poor-quality housing

While some older people enjoy the benefits of good housing,  there are substantial numbers of people aged 50 and older living in poor-quality accommodation.

A report by the Centre for Ageing Better (CfAB) has found that living in cold, damp housing, or homes in a state of disrepair can increase the risk of illness and accidents. Poor housing also has wider impacts: first-year NHS treatment costs for over-55s living in the poorest quality housing are estimated at £513m.

But there are barriers preventing older people from making the improvements that would help them live healthier, more independent lives. These include a lack of finance and uncertainty about where to find trustworthy information about home improvements.

The CfAB report calls for a  wider range of financing options, including government grants and loans, to help older people adapt their homes. It also recommends clear signposting and advice to support informed decisions about home improvements, as well as initiatives to raise awareness about the impact of poor quality homes on health and wellbeing.

Final thoughts

The number of people aged 65 and over is set to rise from 12 million to more than 20 million by 2030. While poor quality housing presents risks for older people, age-appropriate housing can keep them healthy, help them to live independently and reduce the need for social care.

These reports highlight important issues that must be addressed not only to support older people, but to advance the radical changes needed to fix Britain’s broken housing market. Better housing for older people is better for us all.


The reports highlighted in this blog post have recently been added to The Knowledge Exchange (TKE) database. Subscribers to TKE information service have direct access to all of the abstracts on our database, with most also providing the full text of journal articles and reports. To find out more about our services, please visit our website: https://www.theknowledgeexchange.co.uk/

Further reading: more on housing for older people on The Knowledge Exchange blog

Living and working in an ‘age of ambiguity’

The pandemic is having a wide ranging impact on all aspects of people’s lives. From the massive shift to home working for many to the furlough scheme for others, employees have experienced a fundamental shift in the way they work and live.

According to a recent survey of workers, employee happiness has declined and there has been an increase in presenteeism during the pandemic, as the boundaries between home and work, which were once certain, have become blurred.

Blurred lines and a culture of presenteeism

The survey by Aviva, polled 2,000 employees in February 2020 and again in August 2020, finding that most people were happier before the pandemic and that a culture of presenteeism had emerged. Key findings included:

  • More than half (52%) agree the boundaries between their work and home life are becoming increasingly blurred – up from 40% in February.
  • The number of employees who are completely happy almost halved: 20% in February vs. 13% in August.
  • 43% of employees ranked their mental health between ‘very bad’ and ‘fair’, compared with 38% in February.
  • 84% say that they would carry on working even if they felt unwell.

A significant trend of presenteeism and the ‘always on’ culture was highlighted by the survey. The increased uncertainty and heightened anxiety has led to many employees working longer hours and taking fewer sick days. In February 2020, 67% of employees took zero sick days over a three month period; this increased to 84% in August.

Employees may feel the need to prove their productivity while working from home, particularly if they feel their jobs are at risk. But such e-presenteeism is likely to have a negative impact on productivity and inevitably mental wellbeing. According to the report “the ambiguity experienced is compounding behaviour that is detrimental to long-term employee wellbeing.”

Young people (18-25) were found to be particularly affected, with 53% reporting feeling anxious compared to the national average of 34% and 17% ranking their mental health as bad compared to an average of 11% across all age groups.

There have been changes in employee self-determination across the board and the main priorities for employees have shifted as they are increasingly looking for a greater work-life balance over salary – a trend which has increased since the pandemic struck.

Employer considerations

Most employers have implemented new ways of supporting employees, which has been welcomed, but the survey highlights that more needs to be done. Despite a majority of employees believing employers have made some effort to adapt, there is still a loss of motivation among employees. Just 15% of employees agree that their employer is trying really hard to understand what motivates them and only a quarter (26%) agree their employer is genuinely concerned about their wellbeing.

With research confirming a conclusive link between wellbeing and productivity – employees are 13% more productive when happy – no organisation can afford to ignore the issue of employee wellbeing.

Indeed, employee wellbeing was already rising up the corporate agenda pre-Covid-19 but the pandemic has propelled it further into focus for many organisations.

It is argued that a new partnership is required between employees and employers. Personal control surpasses employer control when it comes to what employees want and there is clear evidence that more tailored support, rather than a one size fits all approach, is required.

Aviva’s report argues that “now more than ever there is a case for employers to embrace the ‘Age of Ambiguity’ to support their workforce with their mental health, physical and financial wellbeing.” To this end, Aviva recommends five ‘employer considerations’:

  • Understand how they can deliver on emerging flexibility needs.
  • Personalise mental health and wellbeing support.
  • Create sense of purpose, clarity and autonomy in the workplace.
  • Prepare workers for fuller working lives and the transition from work to retirement.
  • Create more targeted interventions by understanding personality types.

Towards a happier future

As all personality types were found to desire flexibility, it is suggested that prioritising employee wellbeing as a ‘need to have’ rather than a ‘nice to have’ and incorporating flexibility into working life could be a way forward for businesses when it comes to recruiting and retaining the best workers.

The ‘age of ambiguity’ could be the perfect opportunity for businesses to make the necessary changes to support their employees, helping them to improve their physical, mental and financial wellbeing – for mutual benefit.

The pandemic has thrust the world of work into a period of intense change and uncertainty, but many of the trends were already underway, particularly the shift in employee outlook. Employees’ desire for flexibility continues to grow as they seek a better work-life balance and there is no sign of this abating. The Aviva survey has shone a spotlight on this trend and suggests that “employers who embrace their employees’ desire for long term flexibility will see the benefit of a healthier and happier workforce” – leading to a happier future for all.


Enjoyed reading this? Why not take a look at some of our previous posts on working conditions:

Follow us on Twitter to find out what topic areas are interesting our research team.

Levelling up: can charities get a piece of the action?

The UK is one of the most geographically unequal countries in the developed world. It ranks near the top of the league table on most measures of regional economic inequality. Fixing this is a priority for a government elected in 2019 on a pledge to address inequalities in former industrial regions, and in coastal and isolated rural areas.

So far, over £8bn has been put aside by the government for additional investment in so-called ‘left behind’ areas. The policy also appears to enjoy public support. The recent success of the Conservative candidate in the Hartlepool by-election, and the election of mayors in Teesside and West Yorkshire show that voters will back politicians with strong levelling up messages.

Local authorities and businesses are eager to bid for the first pots of levelling up funding that are coming onstream. But is there room for charities to get involved, and is there still time for them to shape the levelling up agenda?

This was the focus of a webinar organised by NPC, the think tank and consultancy for the charity sector.

Defining levelling up

There are different views about what the phase ‘levelling up’ actually means. But Tom Collinge, policy manager at NPC explained that this has become clearer now that various initiatives under the government’s levelling up agenda have got under way:

The Levelling Up Fund is a £4.8bn fund to invest in infrastructure that will regenerate town centres, upgrade local transport and invest in cultural and heritage assets.

The Towns Fund is a £3.6bn fund to support the regeneration of towns.

The UK Community Renewal Fund will provide £220 million additional funding to help places across the UK prepare for the introduction of the UK Shared Prosperity Fund (the UK’s replacement for structural funding from the European Union).

The Community Ownership Fund will provide £150 million to help community groups buy or take over local community assets at risk of being lost.

Levelling up funds: making the case for charities

Looking at this funding from a voluntary sector perspective, Tom acknowledged that charities may find it hard to see how they can fit into the kind of work that is eligible for funding. A lot of the focus is on capital spending – transport infrastructure, repairing buildings and creating new parks. An NPC analysis of the levelling up funds found that as much as 87% could go on capital investment. This could be challenging for charities whose work involves delivering services in areas such as youth provision, addiction or homelessness.

Even so, Tom suggested that charities shouldn’t write off their chances of accessing these funds. He explained that a lot of the language used in the funding documents is ambiguous – there are repeated  references to ‘community’ and ‘community assets’ without making clear what they mean. This ambiguity could work in charities’ favour. At the same time, many charities work under the banners of skills, employment, heritage and culture. It’s up to charities, therefore, to identify elements in the funding that match what they can offer.

Deadlines are tight: bids for the first funds must be submitted by June 18. So, the time has come, said Tom, for charities to be vocal and make an economic case for levelling up funding.  Collaboration with local authorities and metro mayors is likely to be crucial, and Tom suggested that charities with already good relations with local stakeholders are more likely to succeed in their bids.

Levelling up : the local perspective

Kim Shutler, Chair of Bradford District Voluntary and Community Sector (VCS) Assembly agreed that collaboration with local councils is key for charities looking to bid for levelling up funds. But although Bradford’s VCS has a strong relationship with local government, Kim explained that making the voluntary sector’s voice heard can be challenging.

While Kim has experience of partnering with statutory services in delivering mental health support to adults, bids for levelling up funds are handled differently. She was critical of the lack of clarity in how charities can influence the levelling up agenda in meaningful and sustainable ways, and suggested that the top-down nature of the process is detrimental to grass-roots charities.

Where charities can succeed, she suggested, is to demonstrate to local authorities and other partners that the voluntary sector has a compelling story to tell. Learning the language of the people with the money, making a good business case and articulating what charities can bring to the table means the voluntary sector can find a way into the levelling up process.

Shaping the levelling up agenda

As corporate director of children’s services at Barnardo’s, Lynn Perry is well placed to talk about levelling up. Much of what the charity does involves working at the heart of communities, in partnership with local agencies, young people and families. 

Charities like Barnardo’s have a unique understanding of the challenges facing the country’s poorest communities. Lynn believes that this perspective strengthens the voluntary sector’s offer, not just in terms of service delivery, but in designing policies and thinking about community assets.

Looking at the bias towards capital projects in the levelling up funds, Lynn argued that a broader definition of infrastructure is needed. Support for families, care for the elderly and improving the lives of disabled people is every bit as important as 5G and better transport. And with the right social infrastructure, young people who get early and continued support can grow up to be the nurses, engineers and climate scientists we’ll need in the years to come.

Lynn observed that this is a unique moment to recognise the value charities can bring to the levelling up agenda. During the pandemic, the voluntary sector has played a vital role in supporting communities in ways that some public services could not. She believes that the future of the levelling up agenda should be shaped by working with communities and the charities that support them. And, along with Kim Shulter, she stressed the need to make better use of the insights and social data collected by charities to demonstrate the real value of the voluntary sector.

Tom Collinge supported this, and suggested that while it might be too late for charities to influence the existing levelling up funds, they should be looking towards the Shared Prosperity Fund. The delay in its introduction may be beneficial, giving the voluntary sector time to think about making the case for revenue funding.

Raising the voice of the voluntary sector

The UK has a long road to follow before it can say the work of levelling up is done. As the Institute for Fiscal Studies has observed,

“The differences between regions are rooted in history going back decades, even centuries. Having fundamental effects on them will require reallocating capital spending for sure, and a whole lot more — investment in skills, in health, in early years, and a coherent and long-term industrial strategy.”

Working with local stakeholders, charities can bring their insights, skills and experience to this process, both in terms of accessing funds and influencing future programmes. It’s now time for the voluntary sector to speak up on levelling up.


Further reading: more from The Knowledge Exchange on community development and regeneration

Transport’s journey to sustainability

Over the past year, our ability to travel within the UK and further afield has been heavily restricted as a result of the ongoing Covid-19 pandemic. As a result of ongoing restrictions, there has been a reduction in the amount of carbon dioxide emitted by the UK. According to figures published by the Department for Business, Energy, and Industrial Strategy (BEIS), over the past year, the UK has recorded a 10% reduction in carbon emissions. The reason for this large fall has been attributed to the substantial drop in road traffic as a result of several national lockdowns.

Analysis by BEIS found that in 2020 there was a 19.6% reduction in the amount of carbon dioxide emitted by the transport sector. Previous research found that the transport sector was the biggest polluting sector in the UK, therefore, the reduction of the number of cars on our roads naturally had a considerable impact on our overall carbon emissions.

As this year’s host of the UN COP26 climate conference, and signatories of the Paris Agreement, the UK is committed to and has a large role to play in the journey to reach carbon neutrality by 2050. Therefore, as we see restrictions ease, the way we use transport cannot simply return to business as usual.

Sustainable choices

Naturally, as we return to something closer to normality, people’s need to travel and move around will increase. Whether it’s returning to the office or going on holiday, transport levels will be quick to return to normal levels, with statistics published by Transport Scotland highlighting that in the past week car journeys were only down 10% compared with the pre-pandemic baseline.

It’s unrealistic to ask people to reduce their transport to the levels seen during national lockdowns. However, we all can make more sustainable choices when it comes to our everyday journeys.

There are several options available when it comes to making sustainable choices around our method of transport. All of these options tend to focus on reducing our dependency on petrol/diesel cars, particularly, when it comes to short journeys which can be made using active or public transport.

Research conducted by the University of Oxford’s Transport Studies Unit found that switching from the car to active transport for one day a week could result in an individual’s carbon footprint being reduced by a quarter. Additionally, regularly walking or cycling has been found to improve our physical health, reduce anxiety, and improve levels of self-esteem. However, our ability to switch to alternative means of transport is heavily reliant on the provision of sustainable transport infrastructure.

Supporting sustainable infrastructure

For people to make more sustainable choices surrounding their method of transportation, infrastructure that supports active and public transport will have to be as reliable and safe as using a car. Across the UK, there is often a disparity in the choices that are available to people, this is particularly acute for people who live in less densely populated areas.

Expanding and improving active transport infrastructure is a relatively cost-effective way in which local authorities and governments can reduce the carbon emitted by the transport sector.

On top of the previously mentioned personal health benefits, research commissioned by the European Commission has found that there are many economic benefits to the deployment of sustainable transport infrastructure. There was found to be strong evidence that the following interventions had both environmental and economic benefits:

  • enhancements to public transport systems
  • cycling infrastructure
  • personalised travel plans (PTP)

The development of PTPs has been flagged as a particularly cost-effective way to help people  make more sustainable transport choices. Evidence from across the world has found PTPs are successful in reducing the number of car journeys made. Information about the state of a local transport network (for example, how many rental bikes are at a station or when the next bus will arrive), can help individuals make more sustainable choices. 

Smarter transport

For PTP to be successful, the transport network has to get smarter and provide real-time information about the state of the network. This includes information on the availability of rental bikes, the time of the next arriving bus, and if there are points of congestion that should be avoided. All of this can be used to enable individuals to make more sustainable choices that are responsive to changes in the transport network.

At Idox, we are at the forefront of designing solutions that can support the deployment of smarter transport networks. From urban traffic management and control to real-time passenger information, these interventions can help support the development of sustainable transport networks and allow individuals to make better choices.

Final thoughts

We’ve all had to make changes to our day-to-day lives over the past year to protect our communities from Covid-19. The threat posed by climate change poses a similar threat to our day-to-day lives. If we are to reach carbon neutrality, we all have to make changes to reduce our carbon footprint.

Making more sustainable transport choices is a simple action that we can all take to reduce the carbon emitted by the UK’s most polluting sector. By making these choices we won’t only be protecting our environment and local communities, we will also be improving both our physical and mental health.

However, to make these choices, the development of smart sustainable transport infrastructure will need to be a focus. Here at Idox, we stand ready to help and have solutions that can make the transport sector smarter and more sustainable.

Idox’s transport solutions support traffic management and the delivery of real-time passenger information across all modes of transport. Innovative services and solutions enable complete management across all forms of transport, supporting the safe and efficient movement of people and vehicles – whatever the end goal. To find out more, visit our website.


If you enjoyed this TKE blog, you may also like to read:

Free for all: fare-free public transport is going places

The ‘Netflix of transportation’ – could MaaS be the future of urban mobility?

Public transport: lessons from our Nordic neighbours

Follow us on Twitter to see which topics are interesting our research team.

A nudge in the right direction? Using behavioural insights in health

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Behavioural insight is a term which has been increasingly heard across a range of policy areas worldwide in the past decade. Essentially it involves using a combination of psychology, economics and studies of behaviour and decision making to better understand how people react to specific interventions, and evaluating and learning lessons from the way people react to help decision makers to develop better, more effective policies.

Its application has been widespread in the USA and Europe. In the UK, first under the Conservative-Liberal Democrat coalition and then more recently under the Conservative administrations in the UK, the approach has gained increasing traction, with the establishment of a UK government “behavioural insights team”.

The Behavioural Insights Team, also known as The Nudge Unit, is now a social purpose company. It is partly owned by the Cabinet Office, employees and Nesta

The coronavirus crisis has posed a big challenge for those who need to be seen to be creating policies that protect and support the public. It has also been challenging for those trying to predict how people will respond, whether they will comply and how we can “nudge” the public to make what the government sees as “better” choices.

As well as informing steps to ease lockdown and the recovery from coronavirus, behavioural insights is being more widely applied to understand how people make choices in relation to their health, and how these can be applied to preventative health measures and health based inequalities.

Nudging as part of policymaking

Nudging as a technique has been used widely across a number of different policy areas, including criminal justice and education. Its application in relation to public health has been wide ranging and has had significant implications for health policy of previous governments.

Key policy areas in public health for the UK behavioural insight team include:

  • antimicrobial resistance
  • vaccination
  • obesity
  • mental health

Using behavioural insights across all of these areas, the idea is to develop an understanding of how people think about these topic areas as issues and how their behaviour is influenced by their own thoughts, patterns of behaviour and environmental factors like ease of access to services.

Techniques like direct incentives (such as vouchers in return for healthy behaviour), measures that restrict choice (like restricting takeaways from schools), and outright bans (such as the restriction on smoking in public places) are all interventions designed in one way or another to “nudge” us towards certain behaviours.

Steps like text message reminders for appointments, offering salads or fruit instead of fries as a side, or opt out organ donation are further examples of how behavioural science techniques are being applied to encourage people to make healthier choices and reduce the strain on health services.

Many of the steps being taken are designed not only to save time and money for the public and organisations delivering services, but also to help encourage early intervention and preventative action, a key focus of public health strategies in the UK.

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A crucial role to play in understanding vaccine rollout

Vaccination decisions can be a complicated and emotive process, but with the rollout of the coronavirus vaccine understanding the routes to uptake and how people make decisions on vaccination are more important than ever.

Behavioural scientists have been at the forefront of the vaccinations programme, looking to create a better and more thorough understanding of how to manage the rollout and develop an understanding of how people see the benefits and challenges of vaccination, both collective and individual.

The ‘Increasing Vaccination Model’ they say is a helpful framework for categorising the barriers to vaccination and possible behavioural interventions. The evidence indicates that closing the ‘intention–behaviour gap’ in vaccination behaviour by improving ease of access (and thus removing practical barriers to vaccination) is the most effective type of intervention. In contrast, focusing on motivation or educational interventions appears to be less helpful.

However, behavioural scientists have noted that in relation to the coronavirus vaccine even more barriers exist, with one survey reporting that 16 per cent of UK adults would ‘probably’ or ‘definitely’ avoid a COVID-19 vaccine. There is a suggestion that compressed development timelines, misinformation and media reporting could all undermine confidence and therefore uptake. Behavioural scientists are working hard to understand what steps could be taken to understand vaccine hesitancy and improve uptake across all communities in the UK and internationally.

Final thoughts

Behavioural insights, data analytics and “nudge” techniques have been part of policy making for the best part of ten years. They aim to help policymakers understand people’s reactions to policies and use this insight to help more effective policy in the future.

The coronavirus pandemic has presented a new and challenging opportunity for behavioural insights and has required them to apply their knowledge and understanding of how policy is applied and received like never before, with vaccine rollout being just one key area, along with other lockdown measures which require mass compliance in order to be effective.

How behavioural insights will continue to inform the recovery and public health strategies more widely remains to be seen, but it does appear that for the meantime at least, the “nudging” will continue.


If you enjoyed this TKE blog, you may also like to read:

Taking the long view: futures thinking and why it matters

Cross-border handshakes: what’s next for digital contact tracing?

Virtual reality: a game changer for mental health treatment?

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Britain’s town centres: down, but not out

Image: Mayfield development, Manchester (U+I plc)

Town centres have taken a battering in the past year, with many shops and services forced to close during lockdowns and growing numbers of stores going out of business.

But even before Covid-19, UK high streets were already under pressure. Economic recessions, rising business rates, higher rents, the growth of online shopping and development out-of-town retail parks have left Britain’s town centres struggling to survive.

Last month, Planning magazine brought together a panel of experts to discuss the future of town centres. Among the issues considered were trends affecting town centres, how demand for town centre property is changing post-pandemic and how developers are responding to changes in market demand and planning laws.

The bigger picture: online shopping and working from home

Jennet Siebrits, head of CBRE UK’s research team, gave a helpful overview of two key trends affecting town centres.

In the past decade, e-commerce has seen a dramatic increase in activity. Since 2011, the value of online shopping has mushroomed from £23 billion to £58 billion –a 158% increase. But in 2020, even that figure was eclipsed, with the value of e-commerce rising to £84 billion – a 44% increase in just one year. The evidence from the first national lockdown suggests that this step change is here to stay.

The impact of this, along with the Covid-19 restrictions, has been grim for town centre stores. Over 11,000 shops closed in 2020, and while not all of those closures were due to online shopping, it’s clear that e-commerce has been a real driver of this.

Jennet suggested that, as the restrictions ease, it’s likely that supermarkets, along with in-store health and beauty and DIY stores will continue to attract customers. But other sectors will have to come up with innovative ways to lure consumers off their iPads.

Jennet also highlighted the increased move towards home working. Once people return to their workplaces, it’s likely that many will ask to continue working from home, at least for part of the working week.

The rise in home working may also affect demand for residential property, with more people moving further away from city centres. This could have a knock-on effect for ancillary services like coffee kiosks and sandwich bars, with local town centres capitalising on the losses experienced by city centres.

The legal perspective: changes to planning laws

David Mathias, a specialist planning solicitor at Shoosmiths law firm described some recent planning law changes that have particular relevance to town centres.

Since the demise of Woolworths in 2008, more and more UK department stores have been closing down, leaving big gaps on the high street. In future, it’s likely that many property developers will want to convert from retail to residential.

Until recently, permitted development rights for conversion to residential only applied in a limited set of commercial uses. But the UK government has announced new permitted development rights in England enabling greater flexibility on conversions without the need for planning permission. These will go ahead in August, subject to certain conditions.

In addition, further legislation on expansion of permitted development rights introduced last summer allows the construction of an additional storey on freestanding blocks and buildings on a terrace to create additional housing, and the demolition of buildings built before 1990 and construction of new dwellings in their place.

The government has argued that these changes will help to revive town centres, although others believe easing planning rules for developers will have the opposite effect. 

The developer’s perspective: re-imagining Manchester

Martyn Evans from the U+I Group offered his view of how developers are responding to changes in market demand and planning. He did so using U+I’s development at Mayfield in Manchester.

Located next to Piccadilly railway station, in the centre of the city, this 24 acre-site is being redeveloped from derelict railway land. A consortium of Manchester City Council, Transport for Greater Manchester and London & Continental Railways (LCR), along with U+I, has been working to regenerate the area, with the first buildings due for completion next year.

Right from the start, the consortium focused on the importance of creating a place where people want to live, work, rest and relax. One important feature of the development is a seven-acre park. Although it was planned into the scheme years ago, this green space has become all the more significant in the past year.

Image: Mayfield development, Manchester (U+I plc)

The pandemic has demonstrated the importance of green space as a vital part of city living, both for physical health and mental wellbeing. Such spaces not only attract workers, residents and visitors, they also increase the value of developments. And because decisions about commercial property are increasingly being taken by HR teams rather than finance departments, the wellbeing benefits of workers’ surroundings are being taken more seriously. In short, understanding quality of place gives developers more of a competitive edge. 

The local authority perspective: managing change

To conclude, Michael Kiely from the Planning Officers Society looked at what local planning authorities can do to help sustain town centres.

Michael described some of the planning tools local authorities can use, including strategic planning, masterplanning and local plans. But with recent changes in planning laws, including the use classes order, Michael argued that policies such as Town Centre First may be ineffective.

However, local authorities can still make a difference, through partnerships with other stakeholders, such as land owners and Business Improvement Districts (BIDS), and the use of intervention and compulsory purchase powers.

In closing, Michael suggested the need for a licensing or permitting regime to manage and curate activities so that they do not cause harm and town centres can thrive.

Future perspectives: rethinking town centres

A £150m project to revamp London’s Oxford Street signals that high streets are already re-imagining themselves as leisure-focused and “experiential shopping” centres. And the Mayfield site in Manchester has the potential to transform a part of the city centre that has been underused for decades.

These are just two examples of the planning community working together to help sustain town centres. Britain’s high streets face substantial challenges, but this interesting discussion suggested there are good reasons to optimistic about the future.

A recording of The Future of Our Town Centres discussion is available to watch on-demand at the Planning magazine website.


Further reading: more on town centres from The Knowledge Exchange blog

Could arts and culture hold the key to the digital divide?

The rapid shift to digital content creation, distribution, audience engagement and participation since the start of the pandemic has enabled the continued experience of arts and culture, despite cultural institutions having to shut their doors. But a significant proportion of the population still face barriers to digital engagement – 7 million people have no internet access at home, 9 million people struggle to use the internet independently and 17 million people only use the internet for limited purposes.

Previous research has shown that engagement with cultural institutions such as museums and galleries, both on-and off-line, “remains deeply unequal”. Perhaps more worrying was the finding that “the gaps between the haves and the have nots are even wider online than in the case of physical visits.”

During a recent webinar by the Digital Culture Network, presented in partnership with Google Arts & Culture and their Connected to Culture playbook, the scale of the digital divide was highlighted, as was the important role arts and culture can play in addressing it.

The discussion focused on three areas:

  • Digital inequalities, barriers and exclusion
  • Knowing your audience
  • Projects that have successfully increased inclusivity

Digital divide

Kicking off the discussion on the digital divide, Jane Mackey, Senior Research & Evaluation Manager at the Good Things Foundation highlighted three key areas when we think about the digital divide:

  • digital access (7million people in the UK are excluded on this basis)
  • digital skills (11.7million people in the UK don’t have digital skills needed to engage online)
  • motivation and confidence (people might have access and some skills but lack the motivation or confidence to use it)

The latest data from the Office for National Statistics shows that a perceived lack of need, followed by a lack of digital skills are the main reasons given for not having household internet access.  The focus has mainly been on engaging and upskilling those who already have access to digital technology. But, as the discussion highlighted, the excluded 20% would be likely to benefit more from targeted action.

Jane noted that the digital divide is not static, but is more of a spectrum that people can move along throughout their lives. Based on its current research, the Good Things Foundation recommends that the arts and culture sector commits to be digitally inclusive by default. This will help to overcome barriers to digital by engaging directly with the digitally excluded and partnering with other organisations.

Zak Mensah, Co-CEO at the Birmingham Museums Trust, similarly highlighted barriers to digital, such as the infrastructural barriers depending on people’s location. Some rural areas, for example, do not have the digital infrastructure needed for access. Even in cities, which tend to have faster broadband, much of it is focused on the centre and businesses rather than individual households.

Zak also highlighted the importance of motivation, and giving people a reason to use technology.

Role of arts and culture

While some think the key is to get everyone to have the internet at home, Zak suggested that arts and cultural organisations can help people’s access by using their physical spaces better and also by taking the technology to the excluded.

Libraries have been successful over a number of years in providing space for people to access technology with free internet and support in using it. Similarly, arts and cultural organisations are in a position to do the same through their digital tools.

One suggestion was not switching off the Wi-Fi at close of business; another was potentially reducing restrictions on what people can access using their Wi-Fi (while obviously maintaining some control) so people can use it for wider purposes.

One project Birmingham Museums managed recently involved taking digital kit out to care homes for digital arts sessions. This was not only great for wellbeing; it also showed how digital technologies can be adapted to connect with people within communities. As Zac said “ultimately we have to go out more, we can’t always get people to come to you.”

Zak also explained that collaboration is key – sharing resources, ideas and skills – to reach as many people as possible.

Inclusive practice

Jenny Williams, Project Director at Revoluton Arts in Luton, also highlighted the importance of new partnerships.

She noted that when lockdown first started the staff wanted to keep engaging, so moved online with the help of Zoom. Because they didn’t really know about how it worked Revoluton called upon people within the community to help teach others.

They now have a suite of materials online that can help artists and others.

Revoluton has also worked with Marsh Farm Outreach who ran lounge sessions every night with live music, working with local artists and reaching huge audiences. One session titled The Creative History of Marsh Farm was about reminiscence, memory, sharing stories of place, and engaged 6000 people. While acknowledging that such online communication is great for international reach, Jenny noted that it can also make a big difference locally.

They have also used digital tech to create safe spaces online to attract members of the community that might not have otherwise engaged. One of their residency programmes, Touch Commission, was co-commissioned with Wellcome Collection which explored the theme of touch through arts and creativity. The project was centred on Bury Park, a predominantly Asian community in Luton. The dialogue and understanding that was shown helped to engage with those most excluded.

Another project highlighted by Jane was the Power Up initiative, a collaboration between the Good Things Foundation and JP Morgan Chase Foundation, which aims to drive economic inclusion through digital in communities.

Other partnerships showcasing inclusive practice include:

  • Engaging older audiences – Birmingham Museums Trust & Arts Council Collection partnership programme aimed at reaching the over 75s in care homes.
  • Dance and Time with the Museum – Presented in a partnership between University of Cambridge Museums and local sheltered housing and assisted living services; this blog outlines how the project was safely moved online.
  • Bussy – Prompted by Revoluton’s experiences of creating safe spaces for everyone online; this is an example of a creative organisation doing the same.

Way forward

There were a number of key takeaways from the discussion for arts and culture organisations. These include:

  • it’s about knowing your audience, knowing what their barriers to access are and planning an approach to these from the start;
  • empathy and understanding that happens as a result can be important; and
  • it’s about understanding the resources you have and how they can be used, particularly through partnerships.

There’s no quick fix for breaking down the barriers to digital engagement: as Zak eloquently put it, “it’s a marathon not a sprint”. But, as the many practices highlighted during this webinar demonstrate, the arts and culture sector has the tools to make a difference on the digital divide.


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Taking the long view: futures thinking and why it matters

Photo by Kelly Lacy on Pexels.com

Take yourself back to the beginning of the last decade, Gordon Brown is the Prime Minister, the term Brexit has yet to be coined, and the Nokia 1280 was the world’s best-selling phone. In the ten years that followed it’s no understatement to say that the world is almost an unrecognisably different place. And that’s before we even discuss the impact of the Covid-19 pandemic.

Consider the widespread roll-out of high-speed internet and the adoption of smartphones: the development of both of these technologies has massively expanded the locations in which we can learn, work, shop, and consume and produce media. In 2010, 28% of the UK population actively used a smartphone, by 2019, it had almost trebled to 82%.

Developing the digital economy

The widespread adoption of devices that provide users with the ability to easily access the internet and download applications has created an entirely new sector of the economy. Apple estimates that the iOS App Store in the UK alone has generated more than £3.6 billion in total earnings and supports up to 330,000 jobs. Analysis by Vodafone has estimated that the UK internet economy is now worth £82 billion – that’s 5.7% of the UK’s GDP.

Put simply, in the space of a decade, technological advancements have enabled the development of an almost entirely new sector of the economy and changed the way we all interact with each other.

Unfortunately, not everyone experienced the benefits of the digital age, as can be seen by the numerous closures of big-name high-street retailers. Many of these failed to anticipate the pace and extent to which consumers would embrace e-commerce and online-only retailers, such as Asos and Amazon. The failure to anticipate the speed at which people would begin to use smartphones, gain access to high-speed internet, and shop online is a prime example of the need for futures thinking.

Embracing uncertainty

Futures thinking (sometimes known as strategic foresight) is an approach that can help identify the drivers of change that will shape the world in the future. Crucially, futures thinking is not about predicting the future, rather, it’s about considering how the numerous plausible potential futures may have an impact on today’s decisions or policymaking. A key element of futures thinking is the need to embrace uncertainty, and accept that our future is not predetermined and can be altered at any time, by any number of factors.

Techniques that are commonly used within futures thinking include:

–       Horizon scanning

–       Axes of uncertainty

–       SWOT analysis

–       Backcasting

However, it’s important to acknowledge that there is no set approach to futures thinking; it’s flexible and can be adapted to meet the needs of any organisation. This flexibility is something that the Government Office for Science highlights as a key benefit, as it actively encourages “creative approaches” and supports a high level of customisation.

If we apply this to the previously mentioned example of the widespread adoption of smartphones in the 2010s, you can see how futures thinking may have been a useful approach to help decide how much focus traditional retailers placed on developing their online stores. For example, most of the evidence at the time concurred that the use of smartphones and e-commerce would gradually grow. However, the pace at which they would grow was relatively unpredictable.

Therefore, a futures thinking approach may have considered how different paces of smartphone adoption may impact the number of people shopping online. This may have been useful to determine the level of investment required to develop an online platform that would meet the demands of an ever-increasing number of online shoppers.

Creating a futures culture

Taking a long view and considering how future events may impact the decisions you make today can have several benefits. One of these is the development of more resilient policies which can take advantage of changing circumstances, and mitigate against potential risks. The Department of the Prime Minister and Cabinet (New Zealand) contends that this approach allows for the creation of “policy that helps shape the future to promote your desired outcomes and prevent undesirable events”.

Additionally, the Government Office for Science, argues that even just by undertaking futures thinking exercises, an organisation’s focus can be shifted towards a more long-term outlook. In turn, this can generate new ideas and approaches, which can lead to innovative solutions to potential future challenges.

In short, futures thinking can facilitate an entire culture change, and create organisations that are more responsive and proactive in addressing emerging opportunities and challenges.

Limitations

Naturally, futures thinking does have its limitations. It’s not always an appropriate approach and it cannot anticipate every possible eventuality.

For futures thinking to be successful, it’s important to recognise that it provides the best results in situations where there is a great deal of uncertainty. As a result, in scenarios where there is relative certainty surrounding changes that may affect a policy, there is little benefit to adopting a futures thinking approach.

Futures thinking can also be complex, trying to envision and anticipate numerous eventualities can be difficult and requires an element of trial-and-error to explore the tools and approaches that will be useful for each organisation. In particular, it’s important to consider the scope and objectives of any futures thinking exercise, as there is potential to take too wide a view of an issue and over-extrapolate data. This runs the risk of ignoring the context of an issue, which may highlight that certain scenarios won’t conform to typical linear prediction models.

Final thoughts

Amid a global pandemic, where certainty is regularly sought after but rarely found, a futures thinking approach may be useful to help those who make decisions and create policy.

Lockdowns, vaccines, and other public health mitigations do look like they will provide us with a chance to live with the virus , and get back to something that resembles normality. However, the potential for new variants of concern to develop and spread around the world creates a level of uncertainty. Futures thinking provides the framework in which to consider how each of these potential eventualities, may impact the decisions and policies made today.

In short, in a world where certainly is hard to come by, futures thinking may provide us with a way in which to continue to create policy and make decisions that can continue to be advanced no matter what the future brings. However, for this to happen, it’s important to remember that no one can truly predict the future.


If you enjoyed this article you might like to read:

–       Changing government, changing society: what now for public innovation?

–       Implementation science: why using evidence doesn’t guarantee success

–       What works now: how can we use evidence more effectively in policymaking?

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Multi-agency partnerships and the transformation of domestic abuse support

Photo by Anete Lusina on Pexels.com

Domestic abuse has been rising up the political agenda in the past few years. 2019 saw the appointment of the UK’s first Domestic Abuse Commissioner, and last month, the updated Domestic Abuse Bill was introduced to the UK Parliament (expecting to see Royal Assent in April 2021). But domestic abuse is still a widespread and endemic problem across the UK, with figures suggesting incidents across all areas of the country and across multiple demographic groups.

Often people who experience domestic abuse are difficult to identify and can struggle to engage directly with domestic violence support services. However, there is a growing recognition that knowledge sharing, and partnership working between statutory services, like housing or health teams, is vital to identifying and supporting victims and survivors in a timely and effective way.

Increasingly, the criminal justice system, health sector, social housing providers, charities, and local government have been attempting to work together to ensure that they are all able to respond effectively and provide the necessary support to domestic abuse victims and survivors.

The impact of lockdown

The most recent Crime Survey for England and Wales released by the Office for National Statistics (ONS) showed that an estimated 2.3 million adults aged 16 to 74 years experienced domestic abuse in the last year (1.6 million women and 757,000 men). Research published by the London School of Economics (LSE) after the first lockdown found that in London domestic abuse calls to the police increased by 11.4% on average, compared with the same weeks in 2019. The increase was, in a large part, due to an increase in calls from third parties not directly witnessing the incident, including neighbours or family members.

Similarly a report from Women’s Aid found that those delivering services needed to grapple not only with increased demand for support, but also with the challenge of delivering effective support in a different way as many services were only able to be accessed virtually.

Coordinated community responses transforming support for survivors

Organisations are becoming increasingly aware of the roles they can play in supporting people who experience domestic abuse and in the early identification of people at risk. Research also suggests that if someone is experiencing abuse, there is a high likelihood that they will also be experiencing other “needs”, which may cause them to come into contact with multiple services at once. Co-ordinating the response between services encourages organisations to share information to ensure consistency of care and experience; it can also help identify any gaps in support and allow for appropriate signposting and places the onus on the organisations, rather than on the person experiencing abuse.

Coordinated community response (CCR) approaches encompass the broadest possible response to domestic abuse; CCR addresses prevention, early intervention, dealing with crisis, risk fluctuation, and long-term recovery and safety, working with a wide range of services, pathways, agencies, and systems.

The fundamental premise of the CCR is that no single agency or individual can see the complete picture of the life of a family or individual within that family, but all may have insights and can provide interventions that are crucial to their safety and wellbeing. The CCR enables a whole system response to the whole person. It shifts responsibility for safety away from individual survivors to the community and services existing to support them.

The CCR is made up of 12 components: survivor voice; intersectionality; shared objective; structure and governance; strategy and leadership; specialist services; representation; resources; co-ordination; training; data; policies and processes. Taking a CCR approach provides communities with method for coordinating a response to domestic abuse. It places survivors at the heart of decision making and is an approach many frontline services can and do take when designing and implementing support services for people who have experienced domestic abuse.

Photo by Christina Morillo on Pexels.com

A pilot roll out for wrap around housing support

The Whole Housing Approach (WHA) to domestic abuse was first conceptualised in 2018 by the Domestic Abuse Housing Alliance (DAHA) in collaboration with the National Housing and Domestic Abuse Policy and Practice Group This approach aims: “to improve the housing options and outcomes for people experiencing domestic abuse so that they can achieve stable housing, live safely and overcome their experiences of abuse.”

The approach enhances how people who have experienced domestic abuse have control over their own lives, considers what they want to achieve and change, and offers interventions based on this. The key principles of the WHA are outlined as: safety; inclusivity; empowerment; accountability; and prevention, with 12 additional key components which make up the practical application of WHA programmes.

The initial WHA pilot project was delivered in three areas from October 2018 to the end of March 2020. Six specialist domestic abuse organisations, as well as a civil society organisation, have been working with 10 local authority areas, including in London, Stockton and Cambridgeshire to establish comprehensive and consistent housing practices and deliver a WHA.

A whole housing approach toolkit has been published which contains more information on the pilots, evaluations and analysis of the programme. The toolkit includes a dedicated section for each of the twelve components of the WHA. Each section can be read as a standalone toolkit that outlines key initiatives to help survivors achieve safety and stable housing. It offers practical guidance and resources to local areas to deliver a consistent WHA to domestic abuse.

Image Via DAHA

Final thoughts

While the landscape of domestic violence support is varied and is delivered in different ways by different agencies, there is a growing understanding of the practical steps which should be taken to ensure that partnership working and effective coordinated responses between services are offered to survivors of domestic abuse. It is clear that there is an appetite among those who work within frontline services to improve the availability of support. The ultimate aim of a coordinated response and a wraparound service to survivors of domestic abuse is achievable if current best practice and effective pilot schemes can be built upon, with additional funding and wider roll outs.


If you enjoyed this article you might like to read:

Domestic violence during quarantine: the hidden crime of lockdown

Safeguarding in social isolation: how social care teams are adapting to the new normal

A home for life? Developing lifetime neighbourhoods to support ageing well in place

Follow us on Twitter to see which topic areas are interesting our research team.