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

 

Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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Helping people with dementia to live well through good urban design

Earlier this year, the Royal Town Planning Institute (RTPI) published their first practice note on how good planning can play a stronger role in the creation of better environments for people living with dementia.

It summarises good practice guidance from Oxford Brookes University, the Alzheimer’s Society and the Scottish Government, among others.

Living with dementia

According to the Alzheimer’s Society, there are currently around 850,000 people living with some form of dementia in the UK.  Although the risk of developing dementia increases with age, it is not just a disease of the elderly.  There are currently around 40,000 people with dementia in the UK under the age of 65.

The vast majority of cases of dementia cannot be cured. However, there is a lot that can be done to enable someone with dementia to live well with the condition. Many people with dementia can continue lead active, healthy lives for years after diagnosis.  Even most elderly people with mild to moderate dementia can continue to live in their own homes.

The importance of good urban design

Evidence has shown that well-planned, enabling environments can have a substantial impact on the quality of life of someone living with dementia and their ability to retain their independence for longer.

For example, being within easy walking distance of shops and other local amenities can help people with dementia to remain physically active and encourages social interaction.

Having access to green space and nature also has particular benefits, including better mood, memory and communication and improved concentration.

Key characteristics of a dementia-friendly environment

Drawing on the principles set out in ‘Neighbourhoods for Life’, the RTPI advises that urban environments should be:

  • Familiar – functions of places and buildings made obvious, any changes are small scale and incremental;
  • Legible – a hierarchy of street types, which are short and fairly narrow. Clear signage;
  • Distinctive – including a variety of landmarks and a variety of practical features, e.g. trees and street furniture;
  • Accessible – access to amenities such as shops, doctor’s, post offices and banks within easy, safe and comfortable walking distances (5-10 minutes). Obvious, easy to use entrances that conform to disabled access regulations;
  • Comfortable – open space is well defined with public toilets, seating, shelter and good lighting. Background and traffic noise minimised through planting and fencing. Minimal street clutter;
  • Safe – wide, flat and non-slip footpaths, avoid creating dark shadows or bright glare.

Dementia-friendly communities

In addition to specific guidance on how to improve the urban environment, the RTPI practice note also highlights the crucial role of planners in the creation of ‘Dementia Friendly Communities’.

This is a recognition process, which publicly acknowledges communities for their work towards becoming dementia friendly.  It aims to involve the entire community, from local authorities and health boards to local shops, in the creation of communities that support the needs of people with dementia.

There are 10 key areas of focus.  Those particularly relevant to planning include:

  • shaping communities around the needs and aspirations of people with dementia;
  • the provision of accessible community activities;
  • supporting people to live in their own home for longer;
  • the provision of consistent and reliable transport options; and
  • ensuring the physical environment is accessible and easy to navigate.

There are currently over 200 communities across the UK working towards recognition as dementia-friendly.  Dementia Friendly East Lothian and the Dementia Friendly Kirriemuir Project are two such examples.

Local government policy

By 2025, it is estimated that the number of people diagnosed with dementia will rise to over one million.  Significant under diagnosis means that the number of people who experience dementia may be even higher.

However, the RTPI report that at present few local authorities have made explicit reference to dementia in their adopted local plans.

Worcestershire County Council and Plymouth City Council are notable exceptions:

  • Plymouth have set out their ambition to become a ‘dementia friendly city’ in its current local plan; and
  • Worcestershire are currently developing a draft Planning for Health Supplementary Planning Document that covers age-friendly environments and dementia.

A beneficial environment for all

While these are important first steps towards the greater recognition of the role of planning in supporting people with dementia, it is imperative that planning explicitly for dementia becomes the rule, rather than the exception.

Not only will this benefit people with dementia and reduce healthcare costs, it may also benefit the wider community, including young families, people with disabilities, and older people.

As the RTPI rightly state, “environments that are easy for people to access, understand, use and enjoy are beneficial to everyone, not just older people with dementia.”


From data to intelligence and improvement – what cutting edge councils are doing in the UK

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By Steven McGinty

Data has the potential to revolutionise the delivery of local services. Just like the private sector – where organisations such as Amazon and Facebook have leveraged user data – local councils have the opportunity to reap significant benefits from analysing their vast silos of data. Improving efficiencies, increasing levels of transparency, and providing services which better meet people’s needs, are just some of the potential benefits.

Although many councils are still at the early stages of utilising their data, some are innovating and introducing successful data initiatives.

Wise Councils

In November 2016, the charity NESTA published a report highlighting the most ‘pioneering’ uses of data in local government. The report emphasised that most local services would benefit from data analysis and that a ‘problem-oriented’ approach is required to generate insights that have an impact on services. The case studies included:

Kent County Council

Kent County Council (KCC), alongside Kent’s seven Clinical Commissioning Groups (CCGs), have created the Kent Integrated Dataset (KID) – one of the largest health and care databases in the UK, covering the records of 1.5 million people. The core requirement of the dataset was to link data from multiple sources to a particular individual, i.e. that information held about a person in hospital, should also be linked to records held by other public bodies such as GPs or the police.

This integrated dataset has enabled the council to run sophisticated data analysis, helping them to evaluate the effectiveness of services and to inform decisions on where to locate services. For example, Kent’s Public Health team investigated the impact of home safety visits by Kent Fire and Rescue Service (KFRS) on attendances at accident and emergency services (A&E). The data suggested that home safety visits did not have a significant impact on an individual’s attendance at A&E.

Leeds City Council

Leeds City Council have focused their efforts on supporting open innovation – the concept that good ideas may come from outside an organisation. This involved the initiatives:

  • Data Mill North (DMN) – this collaborative project between the city council and private sector is the city’s open data portal (growing from 50 datasets in 2014 to over 300 data sets, in over 40 different organisations). To encourage a culture change, Leeds City Council introduced an ‘open by default’ policy in November 2015, requiring all employees to make data available to the public. A number of products have been developed from data published on DMN, including StreetWise.life, which provides local information online, such as hospital locations, road accidents, and incidents of crime.
  • Innovation Labs – the city has introduced a series of events that bring together local developers and ‘civic enthusiasts’ to tackle public policy problems. Leeds City Council has also provided funding, allowing some ideas to be developed into prototypes. For example, the waste innovation lab created the app, Leeds Bins, which informs residents which days their bins should be put out for collection.

Newcastle City Council

Newcastle City Council have taken a data-led approach to the redesign of their children’s services. The Family Insights Programme (FIP) used data analysis to better understand the demand and expenditure patterns in the children’s social care system. Its aim was to use this insight to support the redesign of services and to reduce the city’s high re-referrals and the number of children becoming looked-after.

The FIP uses data in three different ways:

  • Grouping families by need – The council have undertaken cluster analysis to identify common grouping of concerning behaviours, such as a child’s challenging behaviour or risk of physical abuse. When a child is referred to long term social work, senior social workers analyse the concerning behaviours of the case, and then make a referral to a specialist social work unit. Since introducing this data-led approach, social work units have been organised based on needs and concerning behaviours. This has resulted in social workers becoming specialists in supporting particular needs and behaviours, providing greater expertise in the management of cases.
  • Embedding data analysts – Each social work unit has an embedded data analyst, who works alongside social workers. Their role is to test what works, as well as providing insights into common patterns for families.
  • Enabling intelligent case management – Social workers have access to ChildSat, a tool which social workers use to help manage their cases. It also has the capability to monitor the performance of individual social work units.

Investing in data

Tom Symons, principal researcher in government innovation at Nesta, has suggested that councils need support from central government if they are to accelerate their use of data. He’s suggested that £4 million – just £1% of the Government Digital Service (GDS) budget – is spent on pilot schemes to embed data specialists into councils.

Mr Symons has also proposed that all combined authorities should develop Offices of Data Analytics, to support data analysis across counties. Over the past few months, Nesta has been working on this idea with the Greater London Authority, and a number of London boroughs, to tackle the problem of unlicensed HMOs (Houses in Multiple Occupation). Early insights highlight that data analytics could be used to show that new services would provide value for money.

Final thoughts  

After successive years of cuts, there has never been a greater need for adopting a data-led approach. Although there are undoubtedly challenges in using council data – including changing a culture where data sharing is not the norm, and data protection – the above examples highlight that overcoming these challenges is achievable, and that data analysis can be used to bring benefits to local councils.


Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other digital articles. 

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.

Planning for an ageing population: some key considerations

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On average, the UK’s population is becoming older and living longer, healthier lives.  This is due to historically low fertility rates and reduced mortality rates.  Between 2014 and 2039, the government predicts that over 70% of UK population growth will be in the over 60 age group. Although this trend is partially countered by migration, by 2037 there will be 1.42 million more households headed by someone aged 85 or over.

The implications of population ageing for society are so complex and far reaching that they are impossible to fully predict. However, a key priority is the provision of age-friendly environments.  This is where local government, and planning departments in particular, have a crucial role to play.

In this blog post – the first of two on the implications of population ageing for planning – we highlight some key areas for consideration.

Some areas will be more affected than others

While headline-grabbing statistics paint a very clear picture of the significant growth in the number of older people that is predicted, often they obscure the subtleties of the way in which population ageing will occur across the UK.

In reality, it is likely that population ageing will not occur equally in all areas of the UK.  The degree to which some local authorities – and therefore planning departments – will be affected varies considerably.

The impact of population ageing is measured by a ‘dependency ratio’ – the number of people aged over 65 for every person between 16 and 64.

Recent research has found that coastal localities are likely to have higher dependency ratios than urban areas.  Urban areas will, however, experience a larger overall number of older people.

Dependency ratios will vary considerably between local authorities.  On average, it is predicted that by 2036, there will be over four people aged over 65 for every 10 people aged between 16-64.  However, local figures are likely to vary – from just over 1 in 10 in Tower Hamlets, up to 8 in 10 in West Somerset.

You can see how your own area is likely to change in an interactive map created as part of the Future of an Ageing Population Project.

Differences between the ‘young old’ and ‘older old’

And while there is awareness of the growth in the overall numbers of ‘older people’, another complexity is that ‘older people’ are not a homogenous group. 

As life expectancy increases, the differences between different age groups become more significant.  For example, there are variations in the needs, tastes and lifestyles between the ‘older old’, i.e. those aged over 80, and the ‘young old’ who are just approaching retirement age.

Some planning departments are already taking this into consideration.  Northumberland County Council – who have a higher than average number of older people within their population – use a three phase definition as part of their strategy to prepare for the ageing population. They categorise ‘older people’ into three distinct groups: older workers; ‘third agers’; and older people in need of care.

Understanding social impact and interpretation

The physical environment is commonly understood to be a ‘societal context’ in which ageing occurs.  This is reflected in the term ‘physical-social environment’ – it suggests that there is no physical environment without social interpretation.

However, recent research has found that while planners were reasonably aware of the physical needs of older people, they were less aware of the social and economic contexts of older people’s lives.  This included the links between wellbeing and attractive environments, green space, activity and health, and the positive impact of place attractiveness on social interaction.

Related to this, older people’s social interpretation of the built environment – including the importance of place meanings, memories and attachments ­– is likely to become an increasingly important consideration for planners.  As too is the potential effect of redevelopment on older people – which may include feelings of insecurity and alienation, disorientation, loss of independence, and social exclusion.

Involving older people in the planning system

How to effectively involve older people in the planning system in an increasingly technology-dependent age will pose a number of challenges.

Planners will need to think creatively about options for engagement.  Increasingly, social media platforms and other online media have been used to engage with users.  However, these technologies may not be readily accessible or easily used by older people due to a lack of technological skills or access to the internet.

Older people may also need certain adaptations to support them to become involved – either online or in person – if they have physical or other disabilities.

Negative assumptions about technology’s usefulness held by some older people may need to be challenged or worked around.

Supporting healthy and happy lives

There is no way to fully predict the impact that population ageing will have across all sections of society.  Developing our understanding of the way in which the built environment can help to support and enable older people to live happy and healthy lives – and the implications of this for planning towns and cities across the UK – is increasingly important.

In our next blog post we will look at some of the ways in which planners can help support the creation of age-friendly environments through their influence on the design of the urban environment, transport, housing and the wider community and neighbourhood.


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.

Equal to the task? Addressing racial inequality in public services

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Throughout October, a series of events to promote diversity and equality will take place as part of Black History Month. Although there are many achievements to celebrate, it is an unfortunate fact that many people in the UK today still experience disadvantage due to the colour of their skin.

Over the summer, reports by the Equality and Human Rights Commission (EHRC) and the UN Committee on the Elimination of Racial Discrimination (CERD), found that racial inequality in the UK was ‘worryingly high’.

In its biggest ever review of race inequality in the UK, the EHRC concluded that:

“while for certain people life has become fairer over the past five years, for others progress has stalled and for some– in particular young Black people – life on many fronts has got worse.”

Audit of racial disparities announced

The government responded quickly by announcing an audit of racial disparities in public services. It promises to ‘shine a light on injustices as never before’.

From summer 2017, Whitehall departments will be required to identify and publish information annually on outcomes for people of different backgrounds in areas such as health, education, childcare, welfare, employment, skills and criminal justice.

As well as enabling the public to check how their race affects the way they are treated by public services, the data is also intended to help force services to improve.

The audit is being called ‘unprecedented’ – and it certainly is – up until now, public services in the UK have not systematically gathered data for the purposes of racial comparison. Indeed, according to the FT, very few countries, if any at all, currently produce racial impact audits.

‘Worryingly high’ levels of racial inequality

The audit will have its work cut out.  The review by the EHRC found that, compared to their White counterparts, people from ethnic minorities were more likely to be:

  • unemployed
  • on low wages and/or in insecure employment
  • excluded from school
  • less qualified
  • living in poverty
  • living in substandard and/or overcrowded accommodation
  • experiencing mental and physical health problems
  • in the criminal justice system
  • stopped and searched by police
  • a victim of hate crime
  • a victim of homicide

Institutional racism

Similarly, the CERD findings into how well the UK is meeting its obligations under the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) raised serious concerns about the level of institutional racism in UK public services. Omar Khan, of the Runnymede Trust, suggested that the findings would ‘embarrass the UK on the world stage’.

Longstanding inequalities in access to services, the quality of care received and patients’ health outcomes were criticised, as was the over-representation of persons belonging to ethnic minorities in psychiatric institutions.

The committee echoed the EHRC’s concerns regarding higher unemployment rates and the concentration of persons belonging to ethnic minorities in insecure and low-paid work.  They also criticised the use of discriminatory recruitment practices by employers.

In education, there were concerns regarding reports of racist bullying and harassment in schools, and the lack of balanced teaching about the history of the British Empire and colonialism, particularly with regard to slavery.

The committee also concluded that there had been an outbreak of xenophobia and discrimination against ethnic minorities, particularly since the EU referendum campaign.  Indeed, the rise in post-Brexit racial tensions has been widely acknowledged.

Equal to the task?

Although the audit has been welcomed by many, including the EHRC, others have raised concern about the extent to which it will tackle the root of the problem.  Danny Dorling, of Oxford University, remains sceptical, stating that “within two or three years every single one of these audits is forgotten”.

Some have noted that in order to be effective, the audit will also have to capture outcomes for migrant families, and for poorer White people, who also suffer from discrimination and disadvantage.  Others, including Labour’s Angela Rayner, shadow equalities minister, have noted that there is a ‘huge gap’ in the review as it would not include the private sector.

The EHRC have called upon the government to createa comprehensive, coordinated and long-term strategy to achieve race equality, with stretching new targets to improve opportunities and deliver clear and measurable outcomes.”

Certainly, the data produced by the racial equality audit may well provide some basis for the establishment of such targets.

So while this October there is cause for celebrating the progress made so far, the findings of the EHRC and the CERD underline just how entrenched and far-reaching race inequality remains.  As the EHRC states:

“We must tackle this with the utmost urgency if we are to heal the divisions in our society and prevent an escalation of tensions between our communities.”


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

 

Hitting the ground walking: how planners can create more walkable cities, one step at a time

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In recent times, walking has been enlisted as one of the key weapons in the war on inactivity. Planners and policymakers have taken note of evidence highlighting the benefits of walking for health and wellbeing. Meanwhile, local and national governments have taken up the challenge of embedding walking into policy, strategy and guidance. There are now national walking strategies for England, Wales and Scotland, and from Belfast to Bristol local councils have published their own plans to get more people walking.

Travel trends and their costs

During the twentieth century, there was a shift from work involving physical labour to jobs of a more sedentary nature. In addition, the growth of suburbs and rising car ownership has contributed to a decline in people travelling on foot. At the same time, the attractions of television and home computers mean fewer people are spending their leisure time playing sports or taking part in outdoor activities.

The World Health Organisation (WHO) has put the consequences of these trends into stark perspective:

“Sedentary lifestyles increase all causes of mortality, double the risk of cardiovascular diseases, diabetes, and obesity, and increase the risks of colon cancer, high blood pressure, osteoporosis, lipid disorders, depression and anxiety.”

  • Worldwide, around two million deaths a year are attributed to physical inactivity.
  • In the UK, physical activity contributes to one in six deaths, and costs £7.4 billion a year to business and wider society. It is the fourth largest cause of disease and disability in the UK.
  • In Scotland, inactivity contributes to over 2,500 deaths each year, costing the NHS £94.1m annually.

The benefits of walking

Efforts encouraging people to become more active have had mixed results, and there is now a recognition that turning the tide of physical activity may take decades to achieve. But there’s also a growing understanding that physical activity that can be built in to everyday life can be as effective as supervised exercise programmes. And, as we reported last week, the health benefits of walking can be demonstrated in unexpected ways, such as the emergence of the Pokémon Go game as an incentive to exercise.

A recent report from the Arup design and engineering firm highlights that walking is good for cities as well as for people. It details more than 50 ways in which the world can benefit from walkable cities, including:

  • Social benefits – health and wellbeing, safety, placemaking, social cohesion and equality.
  • Economic benefits – city attractiveness, urban regeneration, cost savings.
  • Environmental benefits – addressing air and noise pollution, improving liveability and transport efficiency.
  • Political benefits – leadership, urban governance, sustainable development and planning opportunities.

Making walkable places

Another key theme of the Arup report was the importance of planning for pedestrians:

“If we want cities to be more walkable, the way we design cities has to change. Walkable places are more compact, dense with mixed uses. Streets have to be well connected with more shade from sun and rain, green spaces, trees and public spaces. And, we must pay more attention to the quality of public spaces, not just providing quantity of walkable space.” Joanna Rowelle, Director at Arup

The report lists 40 actions that city leaders can consider to inform walking policy, strategy and design. Among the ideas:

  • Temporarily removing cars from a city can transform roads into public spaces, raise awareness around car dependency, reduce air pollution, and reveal the potential opportunities created by having more – and safer – spaces for people.
  • Financial incentives and disincentives, including subsidies and taxes like congestion charges, can be used to encourage behaviour change.
  • Use of shared spaces to create a pedestrian-oriented environment where people are aware of fellow road users.
  • Unused infrastructure – such as New York City’s High Line – offers major opportunities for facilitating safe and attractive pedestrian routes and activity spaces.
  • Urban regeneration creates the opportunity to redevelop small pieces of land into pocket parks or public spaces with a green character.
  • Rivers and waterways can be transformed from barriers into walking and cycling routes by creating green and accommodating waterfronts.

Best foot forward?

Many of the suggestions in the Arup report are not hard to implement, and needn’t be costly. But even when schemes have been enacted, they may face opposition.

Each weekend, for the past seven years, a busy thoroughfare in Bucharest has been cleared to create Via Sport – a safe space for leisure and sport. This summer, the city’s new mayor claimed Via Sport has been causing traffic problems. The scheme has now been closed for the foreseeable future.

Old instincts die hard. Those rethinking patterns and processes of urban design to stimulate walking (and cycling) will face a few bumps in the road. But the potential rewards will be great. As David Sim of Gehl Architects observes:

“The key strategy is about getting people to actually spend time out on the street. They become a part of the space, familiar with their neighbours, and are in tune with city life.”


Our previous blog posts on urban planning for pedestrians and cyclists include:

 

Growing places: community gardens are rising up the policy agenda

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In April, a study by Central Scotland Green Network (CSGN) reported a significant increase in community growing between 2010 and 2015. The results of the study found a rise of 79% in the number of sites devoted to community gardens, taking the total to 84, with land coverage rising to 29 hectares.

The increasing popularity of community gardens is also reflected elsewhere in the UK. The Federation of City Farms and Community Gardens (FCFCG) estimates that there are now around 1000 community gardens around the UK.

What are community gardens?

Community gardens are defined by Greenspace Scotland as:

“locally managed pieces of land that are developed in response to and reflect the needs of the communities in which they are based.”

They differ from allotments in that the focus is on communal, rather than individual growing space. Most community gardens concentrate on cultivation of fruit and vegetables, although they may also promote complementary elements, such as recreation, biodiversity and education.

Last year, our Idox Information Service briefing on community growing highlighted a number of these projects, including the Incredible Edible community growing project in West Yorkshire and G3 Growers in Glasgow. Further examples include the Culpeper Community Garden in Islington, north London, and the Grove Community Garden in Edinburgh. Meanwhile, in Streatham, south London, a patch of waste ground next to a health centre has been transformed into a community garden by a group of patients with long-term health conditions. The garden is now supplying enough produce to sell fruit and vegetables to patients and visitors at a nearby hospital.

Benefits of Community Gardens

A 2009 report from the FCFCG identified a range of social, economic and environmental benefits stemming from community gardens. These included:

  • social interactions and inclusion
  • healthy eating
  • natural therapy (feelings of relaxation, appreciation, happiness, achievement)
  • skills development, training and development
  • environmental awareness and activities

More recently, a 2015 report on community gardens in Glasgow indicated that participants enjoy physical and mental health benefits, make new friends and develop community empowerment.

In addition, community growth projects have a role to play in the local economy, providing stepping stones to employment and generating income through the sale of fruit and vegetables.

Community gardens: the policy challenges

As the benefits of community gardens have become more apparent, public policymakers have come to view community growing as a vehicle for delivering policy goals in sectors as diverse as health and the environment, business and planning.

In Scotland, a number of community gardens are being supported by funding from the Scottish Government’s Climate Challenge Fund, administered by Keep Scotland Beautiful. Other public funders of community gardens include the Big Lottery Fund and Scottish local authorities.

Earlier this year, research findings highlighted increasing support for community gardens from policymakers in Scotland at national and local levels, and the widening range of funding policy initiatives:

“There is no doubt that national and local government policy agendas are changing in response to the mounting evidence linking urban greenspace with a range of positive health, social, economic and environmental benefits and that increased support will be available for community gardens in Scotland in the future.”

However, the authors also identified a number of challenges facing community growing projects, including planning and legal issues, land availability, funding issues, winning the support of local communities and addressing skills shortages.

Tackling these issues, the authors argued, will need support at local and national levels, but they went on to highlight problems encountered by community gardens in Scotland when applying for grant funding:

“…because the policies relevant to community gardens span such a wide range of concerns across a variety of sectors (including health, land use, social regeneration and the environment) and because funding tends to be located within individual sectors, they often feel pressured to fit in with social policy agendas and associated grant funding criteria which are not entirely suited to their original aims or the needs of their users in order to be eligible for grant money.”

As an example of this, one of the research participants recalled a local health group meeting where the direction of their community garden was pushed from a “therapeutic mental health benefit” agenda to a “back to work” agenda in order to fit in with a recent policy change.

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Looking ahead

It’s likely that prevailing policy will continue to affect the way community growing projects organise and develop. In 2015, the Scottish Parliament approved the Community Empowerment (Scotland) Act, which includes provisions giving communities the right to take over land in urban and rural areas, enabling, for example, the transformation of waste ground into community garden. And in its 2016 manifesto for the Scottish Parliament elections, the Scottish National Party pledged to work through the Community Empowerment Act to increase access to land for food growing purposes to develop allotments and community gardens.

If community gardens are to grow further, it appears that organisers will have to explore inventive ways of navigating a complex funding landscape, while satisfying the objectives of policymakers at national and local levels.


If you enjoyed this blog post, you may be interested in some of our other posts on community development:

The Govanhill Baths: a successful example of community-led regeneration

SURF Awards winners: success stories in Scottish regeneration

The potential of the Community Empowerment (Scotland) Bill to strengthen community planning

Child obesity – public health or child protection issue?

By Heather Cameron

The issue of childhood obesity is in the spotlight again. Just weeks after the Channel 4 series Junk food kids: who’s to blame? highlighted shocking stories of children having gained several stones in weight and children as young as four with rotten teeth, a new study reveals that parents rarely spot obesity in their children.

The results of the survey, given to nearly 3,000 families, showed that nearly a third, 31%, of parents underestimated the weight of their child. It would therefore be fair to say, as highlighted by one of the researchers, that “if parents don’t recognise a child is obese then they’re very unlikely to do anything to help their child move to a more healthy weight. Then it’s a potential major public health crisis being stored up.”

Obesity experts have called for stricter rules on the advertising of unhealthy foods and drinks in a bid to help address this public health issue. And the public would seem to support this, according to a recent poll, which revealed that almost two-thirds of Britons surveyed want a ban on junk food TV ads until after the watershed.

But is the childhood obesity epidemic just a public health issue?

There has been a high degree of contention for some time over whether obesity should also be considered a child protection concern. Numerous news reports have questioned whether children should be taken into care if they are considered obese and potentially at risk of harm.

Just last year it was reported that up to 74 morbidly obese children in the UK were estimated to have been taken into care over the previous five years, according to figures obtained under Freedom of Information laws.

Prior to this, an article from Protecting Children Update that looked at physical abuse in children highlighted obesity as a form of abuse, suggesting that many professionals see obesity as a form of neglect.

Similarly, the researchers of a much cited paper published in The BMJ in 2010 – When does childhood obesity become a child protection issue?argue that parents who refuse to help their overweight children to lose weight are neglectful. They say that whilst obesity alone is not a child protection issue:

consistent failure to change lifestyle and engage with outside support indicates neglect… childhood obesity becomes a child protection concern when parents behave in a way that actively promotes treatment failure in a child who is at serious risk from obesity.”

The report raises questions over how obesity should be addressed in terms of child protection, however, noting that there is evidence that families of obese children were being unfairly accused of abuse where rare genetic conditions were involved. It also suggests that removing obese children from their parents may in fact make matters worse.

With a lack of published evidence and guidelines for professionals, the report therefore suggests the following framework for action:

  • Childhood obesity alone is not a child protection issue
  • Failure to reduce overweight alone is not a child protection concern
  • Consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children
  • Obesity may be part of wider concerns about neglect or emotional abuse
  • Assessment should include systemic (family and environmental) factors

There is certainly no room for complacency, considering the knock-on effect the failure to recognise obesity could have on the nation’s health, not to mention health and social care services.


 

The Idox Information Service can give you access to a wealth of further information on public health and social care topics, to find out more on how to become a member, contact us.

Further reading

Some resources may only be available to Idox Information Service members.

Overcoming obesity: changing hearts and minds, IN Community Practitioner, Vol 87 No 3 Mar 2014, pp16-18

Process evaluation outcomes from a global child obesity prevention intervention, IN BMC Public Health, Vol 14 No 757 2014

The inactivity time bomb: the economic cost of physical inactivity in young people (CEBR, 2014)

Preventing child obesity: a long-term evaluation of the HENRY approach, IN Community Practitioner, Vol 83 No 7 Jul 2013, pp23-27

Is obesity a child protection issue?, IN Community Care, No 1833 2 Sep 2010, pp16-17