The Knowledge Exchange Blog

The official blog of The Knowledge Exchange from Idox

“A new journey”: creating a dementia-friendly public transport system

People diagnosed with dementia can live independently for many years – in fact, 1 in 3 people with dementia are still able to drive safely.  However, as the disease progresses, people with dementia must eventually stop driving.  Public transport can be a good alternative to driving for those in the early stages of dementia, enabling them to stay connected with their families, friends and local communities, and provide access to healthcare.

Indeed, the provision of easily accessible public transport options is a key aspect of dementia-friendly communities.  It is difficult to overstate its importance:

“If I didn’t have coping strategies to remain independent and mobile I’d be very lonely and soon sink into depression. Travel brings normality to an often abnormal life” Wendy Mitchell, recording a Dementia Diary for Upstream

However, the challenges faced by people with dementia mean that travelling by public transport can be daunting.  This is because dementia affects more than just memory.  Environments that are noisy and busy can be extremely disorientating for people with dementia, particularly when there are added time-sensitive elements such as bus or train times.

People with dementia often lose the confidence to travel.  They may experience difficulties purchasing the correct tickets, become confused by different fares or travel options, or feel hurried or pressured.  They may feel anxious or unsafe, for example, when becoming separated from their luggage or they may have a fear of becoming lost, or getting off at the wrong stop/station.

In addition to the cognitive, emotional and sensory challenges faced by people with dementia when travelling, there are a number of additional barriers.  These include:

  • Difficulties with journey planning
  • The use of fast changing technology which can exclude certain groups of people
  • A lack of service integration
  • Staff with limited awareness of the needs of people with dementia
  • Poor, inconsistent or confusing signage – or unclear rules regarding reserved seats/spaces

Policy and practice

The UK has set out the goal of becoming the best country in the world for people with dementia by 2020.  It has made some significant steps forward – currently, there are now over 200 communities working towards becoming ‘dementia friendly’.

In regards to transport improvements specifically, earlier this year, the Bus Services Act gained royal assent in England.  The Act provides powers to ensure that buses make both audible and visual announcements about the route and the next stop.  These reminders can help to reassure people with dementia.  The government has committed to work alongside the bus industry, passengers and disability groups to develop the policy further.

The government is also currently consulting on a draft ‘Accessibility Action Plan’, which addresses the barriers faced by people with disabilities using public transport, including a focus on hidden disabilities, such as dementia.  It also commits to updating existing guidance on ‘inclusive mobility’ to incorporate current knowledge and understanding of the needs of those with hidden disabilities such as dementia.

Involving people with dementia in service design

Involving people with dementia in the design of services can help to ensure that their needs are addressed.  Upstream is a project that does just that.  It helps to give people living with dementia across Scotland a voice in the design of future mobility services.

Projects have involved visiting various groups in the Western Isles to learn about the challenges of island transport, workshops to gather insights about travel with Dementia Friendly East Lothian and the North Berwick Coastal Area Partnership; and developing training programmes in conjunction with transport providers.  They have produced a report of their work so far.

Use of technology

The expansion of real time audio and visual information as set out in the Bus Services Act provides a good example of where technology can be used to make transport more accessible for people with dementia and other disabilities.

Other ways in which technology may help include the expansion of live departure boards at bus stops and increasing the use of journey planners – either online or via the telephone.  Apps may also have the potential to help organise shared modes of transport for groups of people in rural areas, and in the future, driverless cars may offer an additional transport option for people living with dementia.

Improved awareness of dementia among travel staff

Improving awareness of dementia among transport staff, and developing training programmes on how to respond to the needs of passengers with dementia, is another key way in which services can be improved.

For example, East Anglia Trains, has worked with the Dementia Society to deliver a dementia-awareness training pilot for staff at four of its stations, and plans to roll this out to all East Anglia staff. Arriva Rail Northern has also announced funding to develop the Bentham Line from Leeds to Lancaster and Morecambe as a ‘centre of excellence’ for people with dementia.

Transport assistance cards are another example of possible ways to improve transport for people with dementia. These cards record details of an individual’s needs so that the individual can show the card privately to the driver or other travel staff as a means of asking for extra assistance. Many individual transport operators and local authorities across the country already issue such cards.  Standardising these schemes across the UK may be one way to help improve people’s confidence when using public transport.

Future developments

While these initiatives are making a significant impact, there is still much to do.  If the growing number of people living with dementia are to maintain their independence, then it is essential that transport services become more dementia-friendly. Bringing together the shared knowledge and experiences of those living with dementia, and the skills and experience of professionals involved in the design and delivery of transport services will help to create a more inclusive, person-centred public transport system.

Dr Joy Watson, an ambassador for the Alzheimer’s Society who herself has been diagnosed with dementia, sets out an admirable goal:

A diagnosis of dementia is not the end of the road, but the beginning of a new journey.  Some people need a little more help to take the first steps, and if I can contribute to them living well, then my mission is fulfilled.”


The disability employment gap – what needs to be done to change employer attitudes to disability?

Disabled parking (1).jpg

By Heather Cameron

‘Employment rates amongst disabled people reveal one of the most significant inequalities in the UK today’ (The work, health and disability Green Paper, 2016)

The government’s recent green paper highlights the extent of the disability employment gap in the UK, showing that less than half (48%) of disabled people are employed, compared to 80% of the non-disabled population.

Despite an increase in the number of disabled people in work, this employment gap between the disabled and non-disabled population has remained largely static at around 30 percentage points for the past decade. There are nearly four million disabled people in work, but research has shown that more disabled people have fallen out of work than moved into work, while the rest of the population has experienced movement in the opposite direction.

The government’s manifesto ambition is to halve the disability employment gap by 2020 – equivalent to 1.12 million more disabled people in work – but at the current rate of progress, it has been suggested that it would take more than 200 years for the employment gap to halve.

At a time when the UK’s employment rate is at its highest level since records began, with almost 75% of the working population in work, this is a disheartening statistic.

Barriers

This suggests that disabled people continue to face significant barriers to work. Some that are regularly cited, include:

  • physical barriers such as access to transport and accessibility within places of work;
  • a skills and qualifications gap between the disabled and non-disabled population, with disabled people only about half as likely to go to university as non-disabled people, and less likely to take up an apprenticeship;
  • insufficient support for disabled people;
  • insufficient support for employers; and
  • employer attitudes.

Employer attitudes have been cited as an ongoing issue which appears to stem from a lack of awareness and understanding.

A recent survey of recruiters found that 95% said companies are ‘fearful’ or ‘unsure’ about hiring disabled people. And analysis from disability charity Scope, suggests that employer attitudes haven’t improved over the last four years.

A new report from the Work and Pensions Committee found that many employers are not sure of their Equality Act duties, or are unwilling to make adjustments for disabled employees. It also suggested that there may be ‘discriminatory or unhelpful attitudes’ about the capabilities of disabled people.

Employers’ views

Indeed, employers themselves have highlighted the challenges of employing disabled people. Recent research from Disability Rights UK, which surveyed businesses from across the UK, reveals that one in 10 businesses believe they are unable to employ disabled people.

It also found that the biggest challenge to employing disabled people is that applicants aren’t always willing to be open about their disability, with around half of respondents (47%) saying that it would help if job applicants were more willing to be open about their health condition. Other challenges highlighted include:

  • fellow staff or line managers not having sufficient training to support disabled colleagues, and the lack of accessibility of some businesses for people with certain types of impairments;
  • concern that disabled people are more likely to take time off work;
  • difficulties in discussing the management of disabilities;
  • the cost of modifying equipment, making it expensive to employ disabled people; and
  • concerns that disabled people will claim discrimination if the job does not work out.

Such concerns are often misplaced, however. The survey indicates that businesses feel constrained by a lack of information about the adaptions they may need to make, and the support available to them. It seems that not enough people are aware of Access to Work, the government scheme that provides grants for adjustments to support people with disabilities or health conditions in employment.

And not all attitudes were negative. The vast majority (84%) of respondents said that disabled people make a valuable contribution to the workplace; and more than four-fifths (82%) considered disabled people as productive as non-disabled staff.

Final thoughts

The research clearly demonstrates that more needs to be done to tackle the disability employment gap. The Work and Pensions Committee report concludes that the government will stand little chance of halving the gap unless employers are fully committed to taking on and retaining more disabled people.

In particular, a transformation in attitudes to disability employment and support for disabled people will be required.

As the government’s green paper argues, “real and lasting change will only come about if we can also address negative cultural and social attitudes about disabled people and people with long-term health conditions.”


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What’s preventing health and social care from going digital?

Two women using a tablet computer.

Image by Innovate 360. Licensed for reuse under Creative Commons.

By Steven McGinty

In the first of two articles focusing on technology in health and social care, I will be looking at some of the barriers organisations face in adopting digital technologies. Financial pressures such as the reduction in public spending, as well as an ageing society, mean that health and social care will be expected to meet greater levels of demand with fewer resources.

The UK Government believes that the implementation of technology is the solution to helping the health and social care system become more efficient and more effective at delivering patient care. However, before health and social care can reap the benefits of technology, a number of barriers have to be broken down.

Information sharing challenges

Integration has been a main focus of health and social care in England, as well as the devolved administrations. If integration is to work successfully, different organisations must be able to share data securely. At the moment, data is recorded in a variety of ways across a number of different IT systems. We also have a situation where the main method for sharing data securely in local authorities, the Public Services Network (PSN), is not fully integrated with either the NHS in Scotland or England. Eddie Copeland, of the Policy Exchange, suggests that full integration of the NHS with the PSN should be seen as a priority.

Financial costs

The financial costs of rolling out new technology within an organisation can be significant. These costs can include the procurement of hardware and software, internet connections, and the training of staff. For organisations which are undergoing major budgets cuts, it may seem very difficult to justify the investment in technologies, even if there is the potential for savings in the future.

Management issues

The importance of technology in organisations can be underestimated by decision-makers. For example, according to Martin Ferguson, Director of the Society of IT Management (Socitm), the ICT challenges involved in introducing the new Care Act in England are not being given enough priority. He highlights that if organisations are unable to share information safely by April 2015, they risk failing to comply with new reporting regulations.

Local authorities can also have policies that restrict the use of technology. A recent Skills for Care report into the digital capabilities of social care found that local authorities are still wary of certain technologies, including cloud based systems, which can offer low-cost solutions, and social media, which can lead to savings for local authorities if used correctly.

The health and social care workforce

The Skills for Care report highlights that over 95% of staff feel they are confident in basic online skills. However less than a quarter of managers believe that they have staff with enough skills to make use of digital technology. This mismatch means that managers may be hesitant to introduce new technologies over fears that staff may have difficulties in using the technology, as well as the costs associated with staff training.

There is also a suggestion that social care staff may be resistant to the introduction of new technologies, due to concerns that introducing technology may over-complicate things and move the focus away from the patient. As we noted in a recent article on digital services within government, a key part of introducing any new technology is changing the mindset of staff and having effective leadership in place to champion it.

These are just some of the challenges associated with introducing digital technologies into health and social care. In a future article, we will look more at how technologies can be used within health and social care and the benefits they can bring to organisations. We also look at a case study of an innovative technology partnership between Calderdale Council and Idox, which is addressing the shared services agenda in social care.


Further reading:

 

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