Using an asset based approach to support people with learning disabilities into work

This blog is based on discussions from the Scottish Commission for Learning Disability conference, held in Perth in September 2017.

Introducing an asset-based approach

The term ” asset-based” is commonly used within community development and public health. It is used to mean an approach that identifies and emphasises the strengths and abilities of people within a community.

Instead of focusing on what people are unable to contribute, asset-based approaches instead focus on finding the value and potential of each individual, regardless of their background or personal circumstances.

At the SCLD conference in September, the audience heard examples of how asset-based approaches are being used within the field of employment support. A number of projects across Scotland are creating opportunities for people with learning disabilities to participate and contribute to their local community through meaningful work that recognises their abilities, and not the barriers created by their disabilities.

Facilitating a culture change

Research by Mencap found that although around 8 in 10 working age people with a learning disability have one that’s mild or moderate, fewer than 2 in 10 are actually in employment. Overall employment rates are also much lower than for the rest of the population or for people with physical disabilities – although recent data is lacking, in 2008 a study suggested that only about 17% of all working age people with a learning disability have a paid job.

Enabling people with a learning disability to enter employment is something that requires more than a change in policy or increased funding to improve skills and access to employment schemes (although that is also invaluable). To successfully integrate adults with learning disabilities into the workforce requires a change in employer attitudes. More generally it also requires a transformation in how we perceive learning disability within society.

One of the biggest barriers to participation in employment, are the attitudes and perceptions of other people. Increasing the understanding of how much people with learning disabilities can bring to a job and a workplace is crucial. This is where asset-based approaches can really help. They focus on identifying and making the most of someone’s abilities, and allowing individuals to offer these skills and abilities as a part of a positive contribution to their community through work.

Projects that put people at their heart

The Scottish Commission for Learning Disability (SCLD) has supported a range of projects for people in Scotland with learning disabilities. In September 2015, SCLD announced that the Scottish Government was seeking applications for development funding to support the refreshed delivery approach for The Keys to Life (Scotland’s learning disability strategy).

Of the projects awarded funding, two focussed specifically on tackling underemployment among the learning disabled population.

  • Wee enterprizers (a project that aims to increase employment opportunities for adults with learning disabilities) helped a group of aspiring entrepreneurs with learning disabilities to progress their micro business ideas. Events and workshops allowed participants to come together and share business plans, marketing ideas, and resource strategies. It also helped to identify suppliers and trading opportunities. The Yunus Centre at Glasgow Caledonian University conducted an evaluation of the project. It found that as well as helping business ideas to get off the ground, it also helped to encourage personal growth and independence in participants, improved communication skills and provided an opportunity for entrepreneurs to form a network of their own to help support each other.
  • Tayberry Enterprises provided creative art activities, volunteer opportunities and training placements in catering for people with significant health barriers to employment. The Multi-Storytelling Project offered adults with a learning disability, experiential training apprenticeships in techniques that would help them communicate effectively in a variety of different ways.

More than just work

What these projects had in common was their ability to promote the holistic benefits of training and employment. Like anyone else, opportunities to work allow people with learning disabilities to form new and engaging relationships, and to feel that they are making a positive contribution to their community. This in turn helps them to feel valued as people, not limited by their condition or circumstances.

The use of asset-based approaches adds an extra layer, as they often highlight the advantages of bringing people from different backgrounds together. For example, a project that helps to get people with learning disabilities into employment by offering training opportunities, could also double as a centre for older people who suffer from loneliness, with both communities bringing unique perspectives and contributions to the table. This enriches the experience for everyone and helps to create stronger and more resilient bonds within the community.

Final thoughts

Employment opportunities are limited for people with a learning disability. However, schemes which take into account and actively seek to make the most of a person’s assets, can go some way to reducing negative perceptions and prejudice within society.

Everyone should have the opportunity to learn, form relationships and live their dreams and aspirations, while demonstrating how they can thrive and positively contribute to their local communities.


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Joining up housing and mental health

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing  stable, safe housing  also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people  to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.


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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

Buurtzorg: reinventing district nursing in Scotland

Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

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Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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Read more about innovative building design in our other blog articles.

“Business is an act of citizenship”: using BIDs to promote inclusive economic growth in communities

The key to inclusive place based economic growth?

The principle of Business Improvement Districts (BIDs) is pretty straightforward, and the legislation in Scotland is flexible enough to ensure that pretty much anyone can create and act on a BID-based idea. There are currently over 30 live BID projects in Scotland, with BIDs Scotland stating in their latest annual report that they believe this number could almost double to 65 by the end of 2017 if upcoming and scheduled BIDs are also taken into account. The report found that, despite continuing tough economic conditions, there appears to be little evidence of a decline in interest in the BID model. If anything, more people are turning to BIDs as a way of improving local high streets using limited local funds, private investment from local businesses, and other local assets.

BIDs themselves can be seen as a cross section – a mix of the entire economic ecosystem of a place. They can encompass economic, business, local, political and social elements and bring them together in a strategic way to build revenue to support the different aspects of the BID area, including aesthetics, security and commerce. They are locally developed, locally managed, locally financed and locally delivered, giving a sense of authenticity which is becoming increasingly popular among consumers. This popularity is evidenced by the successful renewal of all of the BIDs in Scotland who have gone to reballot to date, with many actually increasing their majority in favour of the BID model.

Collaboration and embedding BIDS within their local communities

As BIDs have been developed, and new models, partnerships and ways of co- operating have been established, BID coordinators and councils in particular are thinking about how to ensure the legacy of the BID within their locality and, more importantly, how to ensure that the economic benefits of the BID are felt across the BID area, not just within the businesses.

This area-wide benefit can be created by for example, re-investing money in security, street lighting, Christmas lights, and flower baskets to improve the feel and aesthetics of a place – actions which are commonplace in BID areas. However, there are some who feel that BIDs could and should go even further in increasing their social value within a community, while not losing sight of the interests of levy payers. This balance, which requires recognition of the wider roles and responsibilities of BIDs, is something which will have to be carefully managed by BID managers in order to ensure that BIDs do not try to do too much, but at the same time act in a way which makes them a key part of their local community and economy. It is an interesting and, at times, difficult place for progressive BIDs to be.

In many areas, BIDs have provided an opportunity for increased community development, and it has been suggested that there could be a formal role for BIDs to play in the wider community development partnerships within localities. BIDs are now being developed to sit alongside existing community anchor bodies, helping to create strong local partnerships and independent communities.

Through collaboration and co-ordination, BIDs are working alongside other services and organisations to help develop sustained community empowerment, helping communities to lobby, providing work experience placements to local young people and acting positively in the form of events to promote increased community cohesion and empowerment, as well as continuing with “normal practice”- increasing footfall in their local area to benefit businesses.

Not all about the money

While generating additional income for the local economy is one of the biggest drivers of support for BIDs in communities, in some instances one of the biggest assets they bring to a community (especially once they are firmly established) is their leverage and collective bargaining power. They have the power to campaign and support other groups in the community on issues that are important to them, as well as offering greater bargaining power with local authorities or other businesses.

As well as commitment to the levy payers’ interest and to improving the local area for people living nearby, another of the potential roles of BIDs is not to act as direct income generators, but as catalysts or facilitators, to encourage new investment and wider growth beyond the BID area – to engage strategically with other partners to encourage investment.

 

Where next for BIDs

As we have already seen, the flexibility of the BID model in Scotland (there are some legislative differences in England) is such that groups may only be limited by their own ambition. Currently Scotland has what is thought to be the world first food and drinks BID and the first tourism BID this side of the Atlantic. Another innovation is the Borders Railway BID, which seeks to maximise the collective benefit to businesses that are located along the railway route.

It has been suggested that the BID model could be used in a more flexible way to generate income for other public service projects, including the suggestion of a BID for health and a BID for schools. Although the intricacies of how these would work in practice are still being considered, there is much that can be taken from how the existing models use community empowerment, and engagement between the public, third and private sectors to create sustainable and inclusive local economic growth in an area.

As well as their commercial enterprising side, BIDs are also realising their potential as agents of community development and improvement beyond that of economic input. The future currently looks bright for BIDs, which will hopefully mean that it also looks brighter for our local communities.


Business Improvement Districts Scotland is the national organisation for BIDs in Scotland, providing support, advice and encouragement to business groups, communities and local authorities considering and developing a business improvement district.

BIDs Scotland held its Annual Gathering on 28th March 2017 at Perth Concert Hall  with the theme of People – Place – Business: Business Improvement Districts – the key to economic growth.

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you enjoyed this article, you may also be interested in our other article on BIDs.

Information Service members can also access a research briefing on BIDs here (login required).

World Social Work Day: promoting community and environmental sustainability

Tomorrow is World Social Work Day (WSWD), and this year the focus is on community sustainability. The theme is inspired by the third pillar of the Global Agenda for Social Work, which was created in 2010 to integrate the aims and aspirations of social workers across the world. It stresses the important role of social workers in prompting sustainable communities and environmentally sensitive development.

This includes:

  • working closely with other partner agencies – including those beyond social work – to create communities of practice, particularly in relation to environmental sustainability;
  • promoting community capacity building, through environmentally friendly and sustainable projects, where possible; and
  • responding to environmental challenges, including helping communities to be resilient to and recover from environmental and natural disasters, as well as in relation to “human disasters” which includes refugee families fleeing persecution or war.

But how does this play out in everyday practice?

Supporting integration

Across the world, social workers are being asked to address ‘human disasters’ as they seek to support and integrate refugee families fleeing persecution and war in conflict zones. Some of the biggest challenges for social workers today relate to refugee and displaced communities. As well as dealing with the effects of trauma, they also help integrate refugees successfully into existing communities and build bridges with others to promote cohesion, reduce tensions and help them make positive contributions to society. Social workers also have a responsibility to encourage all members of the community to help with this support and integration process.

However, in a UK context, supporting people to make positive contributions to their community is not limited to refugee families. It also relates to intergenerational work, valuing the experience of older people, developing the skills of vulnerable adults, or encouraging children to feel connected to a place and community so that they might better take care of it as they grow up.

Supporting sustainability

The role of social workers in supporting the sustainability agenda may not be so obvious. The ability of social workers to adapt and respond to the needs of communities which are experiencing environmental sustainability issues is of growing importance in developing countries. However, social workers in the UK can still contribute to this element of the global social work agenda.

This includes behaving in a way that recognises the need to protect and enhance the natural environment. In practice, this may mean social work departments having policies on going paperless where possible, recycling in offices, and reducing the use of cars, or car sharing (for frontline social workers, however, this is often impractical).

Social work practice can also consider how it supports sustainable social development outcomes within a community, and maintaining personal CPD, education and training levels to reflect this. There should also, as always, be an attempt to share best practice and learn from others.

Final thoughts

This World Social Work Day, let’s take a moment to reflect on the positive contributions that social work professionals are making to their communities as well as to the lives of individuals. It’s also a chance to consider what the future might hold for the profession and how it can continue to promote and support the growth and development of sustainable communities.


If you would like to follow the events going on to mark World Social Work Day or, share any of your own stories you can do so on twitter using the hashtag #WSWD17.

We regularly write on social work topics. Check out some of our previous articles:

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Community planning in the devolved UK

Community planning is all about how public bodies and other partners work with local communities to design and deliver services that suitably reflect the needs and priorities or a local area. Effective community planning incorporates strong partnership working and a shared vision which has been created especially to fit a set of local circumstances.

Providing effective and efficient services, promoting community engagement and enterprise and engaging the third sector are all things that could now be considered part of “community planning”. It is founded on the idea that communities know best; they know what they need, they know how it can be delivered and how they will use services in the most effective way to get the most value from them. With an increase in political devolution we have seen different approaches to delivering community planning emerge in England, Scotland, Wales and Northern Ireland. Some nations embraced it from a very early stage, others less so. However, it has become an increasingly popular model over recent years, with all four administrations now using some form of community planning model.

England

In England, the focus has largely been on housing and land use and the relationship between community plans (which consider services and public engagement) and local development plans (which focus more on the physical aspects of planning in the community, such as land use). Neighbourhood plans give communities the opportunity to develop a shared vision for and shape the development and growth of their local area. Neighbourhood plans are not a legal requirement, but a right which communities can evoke if they wish to. They are designed to fit alongside local authority produced “local plans” and provide an opportunity for communities to set out a long term vision for their area in terms of development, and “may encourage them to consider ways to improve their neighbourhood other than through the development and use of land.”

Scotland

The introduction of the 2015 Community Empowerment (Scotland) Act is a clear indication of the stance of the Scottish Government with regards to community planning. As well as statutory rights being strengthened with regards to consultation and community consultation, the legislation also places statutory requirements on public bodies with regards to supporting local community based service delivery, and actively engaging local people in decision making processes. As a result of the legislation 32 Community Planning Partnerships (CPPs) now exist in Scotland and they are responsible for developing and delivering community plans. These can take two forms:

  • a larger plan, which takes account of the whole CPP area (Local Outcomes Improvement Plan)
  • a smaller plan, which focuses on a smaller geographic area which has been identified as being in need of improvement (locality plan)

There is no limit to the number of plans CPP’s can create in a year, but the views of local communities are particularly important in creating these as that is the way to best reflect local needs and priorities.

In Scotland a consultation is also currently underway to consider ways to align community and spatial planning more closely, as it was recognised that planning for services should also be mapped along with physical development.

Wales

In a Welsh context the use of community planning focuses on resource allocation and the direction of resource to where it is needed. Promoting community cohesion and well-being through community planning is also something which can be seen in both Wales and Scotland. Increasingly, plans have attempted to incorporate a “place-centred”, “service focused”, “partnership led” approach, with the emphasis on individual need. It is hoped that by bringing service providers and other partners back in touch with the people who use their services that their views can be taken on in future planning projects. As in all community planning projects, partnerships are key; however in Wales one of the biggest challenges has been forming these partnerships and getting buy-in from local businesses. A similar challenge has also been seen with national level bodies.

This challenge of engaging national bodies in community planning has also been seen in Scotland. National bodies are expected to engage with rural and urban CPP’s in ways which reflect individual community need, something they had not been used to doing previously. As a result, promoting flexibility and adaptability and encouraging participation from a range of stakeholders in order to support the creation and delivery of community plans has been high on the agenda across the UK.

Northern Ireland

The situation in Northern Ireland is, to a large extent, still evolving. Executives at Stormont, as well as planners and developers, see engaging local people as important but they are also trying to find a model which works best for a Northern Irish context. Potential options for integrating community based models have included adopting models from England or Scotland respectively; creating their own model which takes elements from a number of different models; or making attempts to align the Northern Irish model closer to that of the Republic of Ireland.

Currently the legislative basis for community planning in Northern Ireland is set out in the Local Government Act (Northern Ireland) 2014. The Act makes a statutory link between community plans and local land use development plans, and makes the link between community planning for a district and well-being more explicit.

category-picture-community-development

Engaging difficult to reach communities in community planning

The views of local communities are particularly important when creating community plans, as their fundamental principle is to reflect service and resource need more effectively in order to benefit communities. As a result community planners across the UK face the unilateral challenge of getting people to engage. Different groups within a community may have different capacity and ability to engage. ‘Hard to reach’ groups are particularly important to the consultation process as it is often they who make the most use of services or have the greatest need for specific service provision. People in this group may include young people, older people, ethnic minorities or other socially excluded groups, and small businesses. They are also sometimes referred to as ‘seldom heard’ groups.

Methods to improve communication and consultation with hard to reach groups vary, but some potential barriers and solutions to engagement include:

  • Jargon and technical language – Policy and planning documents can be very long, and very dense, with lots of planning specific technical jargon, create an easy access version so that everyone can be engaged in discussions and not feel intimidated by “high level” documents.
  • Digital illiteracy – Increasingly consultation documents, some forums and copies of the plans themselves are held online, and improving access to these would help to encourage more people to participate.
  • Awareness and accessibility – Promoting consultations or community planning events, and holding them at a variety of times and in a variety of settings to allow people from different groups to attend. In addition providing them in multiple languages, using language that is more accessible for young people, or in a larger type size may also help to encourage people to participate.
  • Showing impact – Create follow up documents so that people can see how their input has made a difference. Even if the plan won’t be implemented for a number of months, let people know how what they said influenced or changed the decisions that were made.

It is clear that England, Wales, Scotland and Northern Ireland are at different stages in their community planning journey. However, they have all, in one way or another recognised the importance of engaging communities to identify needs and attempt to allocate resources accordingly. In many instances, these community agendas have not just been linked to spatial, or even service planning, but also to wider issues around inequality and well-being and how resources and planning across all areas can best be directed to tackle this. It may be that we see this reflected further in future legislation.


This blog reflects on a recent paper by Deborah Peel and Simon Pemberton “Exploring New Models of Community based Planning in the Devolved UK” a study funded by the Planning Exchange Foundation.

Idox Information Service members can access our research briefing on engaging communities in planning.

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Planning for an ageing population: designing age-friendly environments

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In the UK, increased life expectancy means that people can expect to live longer than ever before.  While this is clearly good news – and has a number of potential economic benefits – the shift in demographic structure towards an increasingly elderly population has a number of significant implications.

Following Wednesday’s blog post on the implications for planning of the ageing society, today we highlight some of the ways in which planners can help support the creation of age-friendly environments by influencing the design of the urban environment, transport, housing and the wider community and neighbourhood.

The importance of an age-friendly environment

Age-friendly environments are underpinned by three key factors:

  • Safety
  • Accessibility
  • Mobility

Such environments impact positively upon the quality of life of older people by enabling and encouraging physical activity and social connection.  This in turn has a beneficial impact upon their physical and mental health, and helps to tackle social exclusion – which can be a particular problem among older people.

Conversely, as the World Health Organisation (WHO) notes, poor design can have a negative impact:

“older people who live in an unsafe environment or areas with multiple physical barriers are less likely to get out and therefore more prone to isolation, depression, reduced fitness and increased mobility problems”

Creating an age-friendly environment

There are a number of areas in which planners may have an influence on the provision of age friendly environments:

  • the design of the urban environment
  • supporting appropriate transport options
  • the provision of age-appropriate housing
  • adequate neighbourhood and community facilities

Urban environment

In terms of the urban environment, green spaces are an integral aspect of age friendly environments.  Access to green spaces supports the physical activity of older people, makes a positive contribution to their health and wellbeing, and provides opportunities for social interaction.

Research has found that green spaces that are poorly maintained, perceived as unsafe, or contain potential hazards resulting from the shared use of parks and walkways are less likely to be used by older people.  Suggestions for improvement include the creation of small, quieter, contained green spaces and improved park maintenance.

Paths, streets and pedestrian areas are also a key planning consideration. Older people have greater reliance on pedestrian travel and are more likely to be physically active in areas that are pedestrian friendly.  The perception of safety also influences use – therefore, lighting and road safety measures can help to enhance this.

Adequate public toilet provision will also become an increasingly important issue.  Recent cutbacks have resulted in many public toilets being closed – in their review of public toilet provision in the UK Help the Aged noted that provision was sporadic. They found that the majority of older people had experienced difficulties in finding a public toilet, and even when toilets were found, they were often closed.

Transport needs

Responding to the transport needs of different groups will also present a key challenge. For example, an analysis of major European cities  by the Arup engineering consultancy found that older people typically make fewer journeys, use private cars less, public transport more (trams and buses in particular) and walk more.  In addition to this, older people’s typical walking speed – as well as the average length of walking trips – were lower than younger people’s patterns.  These differences must be considered when designing age-friendly environments.

The growing population of older people in rural and semi-rural areas, and the reliance on cars in areas with limited public transport options were also identified by Arup as important issues.

Age-appropriate housing

There will be increased demand for age-appropriate housing that meets the needs of older people as the population ages. People are likely to have longer periods of retirement and possibly longer periods of ill-health. As noted by the Future of an Ageing Population Project, unsuitable housing can damage individual wellbeing and increase costs for the NHS.

In order to meet demand, it will be necessary to both adapt existing housing stock, as well as ensure that new housing can adapt to people’s changing needs as they age.  Age-appropriate housing that supports independent living can reduce demand on health and care services, and positively enhance the lives of older people.

Thinking ‘beyond the building’

There is also a need to think ‘beyond the building’. It is thought that interventions that improve homes are likely to be less effective without similar improvements in the neighbourhood.  The ability to socialise and to access services is considered to be particularly important.

Therefore, planning for the provision of local shops and other community facilities such as GP surgeries, post offices and libraries, in tandem with an increased focus on walkable neighbourhoods and public transport provision, will help older people to be physically active and more independent.

Raising awareness

Despite a pressing need for action, the provision of age friendly infrastructure in the UK has been constrained by a lack of resources, and assigned a relatively low priority.  However, there is growing recognition of the need to raise awareness of the potential effects of the ageing population and its implications for the design of cities, towns and villages across the UK.

Planning departments cannot address these implications in isolation.  However, for their part, knowing and understanding the potential implications of the UK’s ageing population is a positive step towards the creation of a successful age-friendly built environment.


For further information, you may be interested in our other blog posts on the creation of age-friendly towns and cities and the economic opportunities presented by an ageing society.

We have also published two members-only briefings on Ageing, transport and mobility and Meeting the housing needs of older people.

Mobilising healthy communities: Bromley by Bow Health Partnership

Ian Jackson of the Bromley by Bow Health Partnership was the guest speaker at the first Glasgow Centre for Population Health (GCPH) seminar series of the year.

The Bromley by Bow Health Partnership (BBBHP) is a collaboration between three health centres and other non-primary care partners in the Tower Hamlets area of London. The aim of the partnership and the new primary care delivery model which comes with it is to transform the relationship between the public and primary health care. This means considering the wider determinants of health when the partners plan and deliver care, rather than treating healthcare in a purely biomedical way.

Edited image by Rebecca Jackson. Map via Google Earth

Edited image by Rebecca Jackson map via Google Earth

Effect of social determinants on health

In the 1890s Charles Booth created a map of London which categorized areas of the city of London depending on their levels of deprivation. The most recent Indices of Multiple Deprivation Report showed that those same areas considered deprived in the1890s are still facing the highest levels of multiple social deprivation and health inequality today. It is no secret that disadvantage has a negative impact on people’s ability to make the best choices when it comes to health. And disadvantage at a social level can have a significant influence on poor physical and mental health across a range of conditions.

More recent research conducted by Michael Marmot looked more closely at what determines health outcomes in populations, and the extent to which other factors influence people’s health, or rather their ability to be well.

He produced what is known as the 30/70 model: 30% of what determines your health is your genetics and improvements in pharmacology, the other 70% is related to other “external factors” including poverty, environment, culture, employment and housing. BBBHP has used this as the foundation for their primary care model, arguing that primary care providers are not just dispensers of medical products, but have a responsibility to contribute to people living healthier lives in their community.homeless

Social prescribing

One issue highlighted by the BBBHP was the significant number of people presenting at GP surgeries with “non-medical” ailments, or medical ailments triggered by “non-medical stimulus”. People were arriving at the practices and booking appointments because they were lonely and it gave them somewhere to go. Others were presenting with symptoms of depression, which on further investigation were found to have stemmed from issues around debt or domestic violence. A social prescribing service was set up by the partnership to try to tackle some of these non-medical conditions and improve the health of the general population by non-pharmacological means.

The social prescribing service, where GPs refer people to other local services for help, can be used as a replacement for pharmaceutical interventions, or be supplementary to them. GPs, or other primary care staff, may refer any adults over the age of 18 to one of over 40 partnership organisations. These range from walking groups to formal sessions with advisors in debt or domestic violence agencies, as well as art classes, community gardens and companionship services to combat loneliness. The organisations can provide help and advice on issues such as employment and training, emotional well being and mental health.Ölfarbe

The challenges of quality and funding

Maintaining quality in the provision of social prescribing is a particular challenge for BBBHP. They work regularly with trusted partners, particularly the Bromley by Bow Centre. However, there is no consistent quality check for many of the services from the health partners themselves. Evaluative studies and feedback sessions are used to assess quality and impact, and consider the scale of demand. And while it is acknowledged that more formal frameworks for assessing quality and impact of social prescribing services are preferred in formal assessments, in reality, word of mouth, participant feedback and uptake rates are used as a standard for quality as much as official feedback in a localised community setting.

A second issue is funding. BBBHP identified that finding long term funding was their main issue in providing security for providers and service users, as well as for GPs referring to services. Funding is vital not only to ensure the survival of the community groups who provide some of the referred services, but also to allow them to develop longer term partnerships and build capacity within the social prescribing service. The BBBHP works closely with the Bromley by Bow Centre, a key provider of support services for the local community, but like many services which rely on funding, they increasingly have to plan for tighter budgets.

blue toned, focus point on metal part of stethoscope

A final challenge for the staff at BBBHP was changing people’s expectations of primary care, and what it means to live well. Some patients were suspicious and reluctant to be recipients of “social prescription”, as this did not fit with the traditional expectation of what GPs should do to make people well. This can be a big change in mindset for some people, according to Ian Jackson, when people come expecting to be prescribed antidepressants but are instead “prescribed” a walking club or a debt advice service. He noted that the reaction from patients can sometimes be confused or hostile, and some patients do not even turn up for referrals.

Improving patients’ understanding of the benefits of social prescription, ensuring people attend referral appointments, and that social prescriptions have a long term impact is something which BBBHP are hoping to research further. They feel that looking at the long term impact of non-pharmaceutical interventions and how these feed back into the wider agenda of tackling inequalities is important to allow the partnership to continue to build healthy communities and save on primary care costs in the long term.

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Creating positive social connections to improve community health

Social prescribing and other associated projects have sparked new social connections. Members of the community have come together to form their own support groups. The Children’s Eczema support group run by local GPs and the DIY health scheme, which sought to educate and support parents who were anxious about minor ailments in children, have helped parents in the area to set up WhatsApp groups, organise coffee mornings and go to one another for support. Such initiatives are regarded by BBBHP as important in tackling wider, systemic social inequality in the area.

Currently, primary health care in communities is focused on illness. This needs to change, according to BBBHP, with local community-based health delivery based as much around social health as biomedical issues. Through its social prescribing and other services BBBHP has aimed to focus on supporting people in a holistic way, tackling health inequalities as well as biomedical illness, to allow them to make good choices to improve their health.


If you’ve enjoyed this article, you might also like more of our blogs on health and wellbeing:

Local poverty, national wealth: reflections from the annual SURF conference

The annual SURF conference took place in Edinburgh on the 1st September 2016. The theme for this year’s conference was Local poverty, national wealth: resourcing regeneration. Delegates came from a range of organisations across Scotland, including local authorities, the Scottish Federation of Housing Associations, COSLA, Creative Scotland, Skills Development Scotland and Transport Scotland. Speakers on the day included director of the Common Weal, Robin McAlpine, Minister for Local Government and Housing, Kevin Stewart MSP, Fiona Duncan from Lloyds TSB Foundation Scotland and Sandra Marshall coordinator and community activist from Leith Hub.

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Image by Rebecca Jackson

Building resilient and equal communities through regeneration

The conference focused on connecting policy, practice and people within communities to promote effective regeneration of spaces to reduce inequality. One of the recurring themes of discussion throughout the day was the localisation of power and services, allowing local communities the ability to plan and decide the best way to regenerate their local area. Other general themes discussed during the day included finance, infrastructure to facilitate regeneration at a local level, and how to create a network of support and integrate professional knowledge to support community regeneration plans. Revisiting a theme from last year’s conference, cooperation with communities rather than imposition of regeneration, formed the backbone of discussion for the day.

Image by Rebecca Jackson

Image by Rebecca Jackson

Economic planning is key to reducing inequality and promoting regeneration

The first session of the day focussed on the policy and economic context around regeneration and reducing inequality. It was suggested in the opening remarks that there needs to be effective development and investment where people live- that poverty and inequality lead to degeneration, and that both must be tackled in order to facilitate effective regeneration of an area. In a way the two are not mutually exclusive: regeneration can help to alleviate poverty and inequality, but in order for regeneration to be as effective as possible, poverty and inequality should be eradicated as far as possible.

As well as this abstract macroeconomic debate delegates and panellists discussed locality based funding, including cooperatives. Panellists suggested that in Scotland the problem is not a lack of money, but a lack of effective distribution of resources. They also discussed how to reduce the gap between the lived experience of communities and what politicians think lived experience is. These insights were put into poignant context by panellist Sandra Marshall, who discussed her own personal struggles, and those of others she has helped in her community of Muirhouse in Edinburgh.

Tackling inequality is high on the agenda of the current Scottish Government, something which was emphasised during the panel session by Kevin Stewart MSP. Working at a community level and having the power to do so was also something which was highlighted as being vital to helping communities affect change through regeneration. Kevin Stewart highlighted the proposed decentralisation bill currently being discussed within the Scottish Parliament, which aims to give greater power to local communities to effect their own change.

pink pig and coins

Resourcing regeneration: the view from funders

There was a general consensus that funding is one of the key enablers, but also one of the biggest barriers to those who want to carry out community regeneration. The ease of access to funders and the ability to identify and engage with them was seen as a big barrier. Longevity of funding was also raised, with most funders donating grants for 3-5 years, despite acknowledging that many projects take longer to come to fruition. The second session of the day invited funders from major Scottish regeneration funding bodies: the Big Lottery Fund, Heritage Lottery Fund, Highlands and Islands Enterprise, Resilient Scotland, and the Scottish Government to present themselves and their funding options to delegates. Panellists were able to highlight their major funding schemes, how to apply and allow people the opportunity to chat directly with funders. The panellists also took part in a “funding cafe” exhibition which saw representatives from 20 of the major funding bodies in Scotland host stalls and interact with delegates.

Making connections and sharing learning

During the afternoon session delegates were able to hear about the lessons from SURF’s Alliance for Action collaboration projects. The projects in Govan, Kirkcaldy, Rothesay and Dunoon highlight the work done by SURF and their partners in using regeneration to promote community cohesion and reduce inequality. Discussions focussed on the projects themselves, how they were implemented, the challenges, barriers and differences in each of the projects, particularly in relation to scale, and the impacts and outcomes they produced. They also discussed how the models used in each of the projects are sustainable and transferable, and considered the role of SURF as the intermediary body through which policy and practice can be merged to the benefit of communities.

Community concept word cloud background

Community concept word cloud background

A bold new vision for regeneration in Scotland

The final session of the day put forward some suggestions for the future of regeneration, in particular using regeneration as a tool to reduce inequality within Scotland’s communities. Panellists discussed alternative and innovative funding methods, including co-operative and community ownership models, the decentralisation of power to help improve community decision making and the importance of addressing systematic and structural themes which underpin inequality within our communities and hinders the process of regeneration.

The conference was a day filled with interesting and unique insights into the regeneration agenda and the impact it can have on reducing inequality within communities. It also provided a platform for discussion about the future potential for regeneration projects within communities. Speakers and delegates came from a variety of policy, practice and community backgrounds, which resulted in a wide ranging and thorough discussion about many different aspects of the regeneration agenda within Scotland.


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