Top research resources for social care and social services

The news in June that the Government’s Green Paper on social care will now be delayed until the autumn (having already been deferred since 2017) brought sighs of weariness rather than real surprise from the sector.

The recent focus on NHS funding, and the NHS’s 70th birthday, has also highlighted ongoing concerns that the funding crisis in other areas, including social care, mental health services and public health is being pushed to the sidelines.

What is clear, is that the need for evidence-based interventions, and proven value for money, is only getting stronger as budgets continue to be stretched.

The value of research

So, what’s the role of research knowledge within social work and social care? The Social Care Institute for Excellence has suggested that research can help practitioners and decision-makers to understand:

  • the social world in which those who use services live
  • why positive and negative events occur in the lives of some and not others
  • the relative success of interventions and their impact on these events
  • the role of the social care practitioner in relationships and interventions with service users
  • how social policies impact on the lives of people using services.

Studies such as cost-benefit analyses or randomised controlled trials are also part of the evidence base although they are less common in social care/social services than in health contexts.

Research takes place in different ways, with different aims. And the outcomes of research can be communicated in different ways. Blogs such as our own at the Knowledge Exchange aim to signpost readers to recent research on particular topics. Other good sources of accessible discussion of research findings include The Conversation blog and Community Care.

Meanwhile, database services such as the Idox Information Service or Social Policy and Practice will provide more comprehensive coverage of issues, bringing together research studies from other parts of the world which are transferable.

Social Policy and Practice

Many NHS Trusts and councils subscribe to the Social Policy and Practice database as part of their package of support for learning and development.

Recent feedback from users has highlighted its strong coverage of many current priority issues in public health, such as:

  • dementia care
  • delayed discharge
  • funding of long term care
  • safeguarding of both children and adults
  • supporting resilience and well-being
  • tackling obesity
  • asset-based approaches

As a UK-produced database, Social Policy and Practice also includes information on topical policy issues such as minimum alcohol pricing, sugar taxes, and the possible impact on the health and social care workforce of Brexit.

The database is produced by a consortium of four organisations: Social Care Institute for Excellence, Centre for Policy on Ageing, Idox Information Service and the National Society for the Prevention of Cruelty to Children.

Idox Information Service

With a wider range of topics covered, the Idox Information Service has been identified as a key database by the Alliance for Useful Evidence. Cross-cutting issues which impact on health and social services, such as poverty, housing, and social exclusion are covered in depth. It also covers management and performance topics.

The Idox Information Service also offers a range of current awareness services and access to a team of expert researchers, in addition to the database. The aim is to support the continuing professional development of hard-pressed frontline staff while also supporting the sharing of research and evidence across the sector.

Meeting the needs of the social care sector

Both Social Policy and Practice, and the Idox Information Service aim to increase the social care sector’s capacity for evidence-informed practice.

As battle lines are drawn over government funding, it’s clear that these will continue to be financially challenging times for public services and that demand for services will carry on growing. Investing in learning and development is one way to ensure that staff are equipped with the skills and tools to be the best that they can be. This in turn will ultimately improve performance and outcomes for the most vulnerable in our society.


To find out more about the history of the Social Policy and Practice database and the consortium of publishers behind it, read this article from 2016 which we have been given permission to share. Trials of the database can be requested here.

Read more about the unique support offered by the Idox Information Service. More information on subscriptions can be requested via the online contact form.

Writing and recovery: creative writing as a response to mental ill health

 

“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”


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The challenge of engaging with marginalised Traveller, Gypsy and Roma communities

In March 2018, a Northern Ireland Human Rights Commission report found 13 systematic concerns about Traveller accommodation, suggesting that Traveller communities are subject to an “out of sight, out of mind” mentality from local authorities and service providers. You do not have to look far to find more research, from across the whole of the UK, which highlights similar challenges for, and attitudes towards Traveller communities. Attainment, school attendance, unemployment and community cohesion are all shown in research as being consistently lower among Traveller communities.

Research from IRISS shows that Traveller communities are subject to regular racial, social and cultural discrimination and feel isolated within a society that they feel does not respect them in the same way as other minority groups. Some even feel that it is more acceptable to make a derogatory comment about a Traveller than someone who is from another ethnic group.

Commentators repeatedly highlight that there is very little knowledge or understanding of nomadic lifestyles, and that this can contribute to the racism, abuse and stigmatisation of Traveller people. However, some projects are trying to address the view of Traveller communities and improve their treatment and engagement with other members of non-Traveller communities.

An erosion of traditional lifestyles and cultures

A lack of flexibility around housing arrangements means that, to a large extent, Traveller families are often forced to choose between either poor accommodation sites which allow them to maintain their traditional way of living, or giving up this traditional lifestyle (which is not just a way of living, but also an entrenched part of their heritage and culture) to live in mainstream traditional social housing. One major criticism of local authority and central government supported services is that they are very inflexible to nomadic living; health, education, housing and employment support are all usually reliant on a fixed address. As a result, third sector organisations, charities and specific engagement bodies usually end up taking the bulk of the pressure and responsibility for supporting Traveller families, or Travellers are left to fend for themselves. This can lead to them becoming isolated or reluctant to engage.

Those who make attempts to assimilate often do so at the cost of their traditional way of life, with some even commenting that there is a level of cultural erosion and almost cleansing, and that Travellers are being forced to choose between suitable accommodation and living standards, and their heritage and traditions.

Challenges span generations, and create entrenched barriers

Many Traveller families have poor education and health experiences and there are multiple barriers to Traveller families accessing these services. In schools, it has been well documented that Traveller children have lower levels of attendance and attainment, with higher levels of exclusion and a higher incidence of bullying, discrimination and racist abuse while at school.

In social work, Traveller children are more likely to be engaged with a social worker and taken into care. It is clear that professionals working within these environments need to be trained to react and respond to the needs of Traveller children in a culturally sensitive way.

Practitioners need to be sensitive, aware and flexible where possible to accommodate needs, but this is not always the case and it can make Traveller communities reluctant to engage directly with local authorities on issues. However, there is a growing body of research which looks at art and culture-centred practice to try and engage Traveller communities with their wider community, and to enlighten other members of the community in a positive way about Traveller culture.

Could art be the bridge to build understanding between communities?

Many Traveller communities do not readily have access to art and do not participate in “cultural activities” like attending the theatre or museums or using libraries. They also don’t have any relationship to most art produced. There is very little Traveller representation in art, music, theatre or museum exhibitions and it can be the case that Travellers feel art and culture in the mainstream is not representative of them or their culture, which can also hinder them from engaging.

However, using art and art-based interventions can help to break down entrenched stereotypes and can create a level playing field for people to participate and contribute, particularly among children who may not be as effective at communicating using words or language.

Engaging young children (and their families) through play and cultural activities can help break down some of the barriers and mistrust that communities feel towards one another. Community engagement initiatives enhance trust and can improve relations, but this must be done in a sensitive and inclusive manner. Traditional crafts and arts are something that can be shared across the whole community, not just within Traveller communities.

Non-Traveller children also are at a cultural disadvantage from not having Traveller communities portrayed in mainstream cultural activities. Greater representation in art, TV and books would help integration, help to break barriers, reduce stereotypes, increase understanding of a unique culture in Britain and (it is hoped) lead to greater integration and less hate crime.

Art also has the potential to be used as a tool to engage adults within the community. Using art as part of consultation exercises can make the process accessible and can allow people to be involved who may not usually contribute, helping them to feel they have had a say in decisions made within their community. Art can also be a useful strategy in community cohesion and neighbourhood building activities, with people able to express their opinions and fears through other mediums such as painting, drawing or acting – although establishing the initial engagement can be challenging.

Final thoughts

Art-based practice can be an accessible way to engage and create a dialogue between communities, and help to build a level of trust between Traveller communities and local services. However the activities must be culturally sensitive, and staff within local services must be willing to be flexible and creative with how they engage if they are to create meaningful relationships with Traveller communities.


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How low can they go? Cities are taking action to reduce air pollution and save lives

Air pollution is a bigger killer in Europe than obesity or alcohol: nearly half a million Europeans die each year from its effects.

Particulate matter (a complex mixture of extremely small dust particles and liquid droplets) and nitrogen dioxide (an invisible, but foul smelling gas) are particularly harmful to health.  As the New Scientist has explained:

“…nitrogen dioxide lowers birthweight, stunts lung growth in children and increases the risk of respiratory infections and cardiovascular disease. Particulate pollutants like soot cause a wider range of problems, including lung cancer.”

Motor vehicles are the main source of these emissions in urban areas. For this reason, European Union regulations introduced in 2010 set down that nitrogen oxide should average no more than 40 micrograms per cubic metre over a year. These limits are regularly breached. By the end of January this year, London had reached its legal air pollution limit for the whole of 2018. Scientists say that even these limits are unsafe: the 30,000 deaths each year attributed to particulate pollution are due to exposure levels below the legal limit.

Getting into the zone

Many local authorities have been trying to tackle the issue by getting the most polluting vehicles out of their city centres.  As Traffic Technology International has noted:

“From Athens to Aberdeen, and from London to Ljubljana, there is an eclectic smorgasbord of initiatives with over 200 low emission zones (LEZ) around Europe excluding more polluting vehicles, and some cities employing road-user charging to deter vehicles from entering.”

In the UK, Glasgow is set to become Scotland’s first low emissions zone, while Oxford could become the world’s first zero emissions zone, which would exclude all non-electric vehicles from the city centre by 2035.

T Time in London

London has adopted especially ambitious goals to clean up the capital’s air. As of October 2017, older vehicles driving in London between 7am and 6pm have needed either to meet the minimum toxic emission standards (Euro 4/IV for both petrol and diesel vehicles and Euro 3 for motorised tricycles and quadricycles) or to pay an extra daily charge of £10.00 (in addition to the £11.50 Congestion Charge).

Air quality campaigners have welcomed this “T Charge”, but not everyone is happy. The Federation of Small Businesses has voiced concern that the charge will have a negative impact on small and micro-businesses that are already struggling with high property, employment and logistics costs. Shaun Bailey, a Conservative member of the Greater London Assembly, has described the T Charge – and the mayor’s plan to bring forward to 2019 the launch of London’s ultra-low emission zone (ULEZ) – as “vanity projects” that will have little effect on air quality.

National demands and local plans

London’s T Charge is one way of tackling air pollution, but there are other methods, such as retrofitting bus fleets, improving concessionary travel and supporting cyclists. Some UK cities are already taking action, while in Germany and Belgium, even more radical ideas are being mooted.

Last summer, the UK government set out its plan for tackling roadside nitrogen dioxide concentrations. The document made it clear that local authorities have a leading role to play in achieving improvements in air quality.

By the end of this month, local authorities were expected to submit their own initial schemes for tackling the issue, with final plans to be submitted by December. The government promised support for councils, including a £255m Implementation Fund to help them prepare and deliver their plans, and the opportunity to bid for additional money from a Clean Air Fund.

It was hoped that these measures would lower the poisonous emissions. However, last month the High Court ruled that the government’s approach to tackling pollution was not sufficient, and ordered urgent changes. Even if the subsequent plan is accepted, many feel that the only sure way to solve the problem is to eliminate traffic from our cities. Others counter that this will damage the economy.

The battle of Britain’s air quality has only just begun.


Our previous articles on air quality include:

Walk this way- the benefits of walking for people and cities

In a quality city, a person should be able to live their entire life without a car, and not feel deprived” – Paul Bedford, City of Toronto Planning Director (2014)

Improvements to the design and layouts of streets and cities can have a significant impact on encouraging more of us to walk. However, many people living in cities face a significant number of barriers to being physically active where they live, particularly in relation to walking. Pathways and public spaces such as parks and throughways are often unappealing, unsafe, congested, traffic filled, noisy or for some completely inaccessible, which leads to a reliance on vehicular travel and a reluctance to be physically active within the city environment.

Walkable environments consider not only the physical design of routes, but also features and facilities that are inclusive of the widest possible range of needs; for example, places for people to rest along their journeys (including well designed seats and benches), accessible toilet facilities, signage and street design that is sensitive to a range of needs and that can help with orientation and wayfinding. However, the benefits are clear across the board when it comes to trying to make our cities more walkable (and as a result healthier). This blog post outlines a few of these potential benefits, and considers how planners can get involved in realising some of them through effective planning and design in their own cities.

Social benefits
Safe, walkable, environments can provide opportunities for people of all ages and abilities to stay socially connected and engaged. This can be particularly helpful in communities with a lot of children, older people or vulnerable adults. Having areas that are known to be safe can help to encourage people to leave their homes, reducing the impact of loneliness and social isolation, and improving their sense and feeling of community in their local area, which in turn can help with health and wellbeing and community cohesion.

Health benefits
Walking is good for us! In August this year a survey by Public Health England revealed that four in 10 middle-aged adults fail to manage even one brisk 10-minute walk a month. This despite research showing that walking each day can rapidly reduce risk of health conditions such as stroke and heart attack. Promoting active lifestyles through encouraging walking has also been shown to help tackle the growing issue of obesity, particularly among younger people. Walking can also be good for mental health, particularly when it is done as a group. Increasingly, walking interventions are being prescribed as part of social prescription initiatives to help people regain health, fitness and confidence. But in order for these to be effective, spaces and suitable environments for walking need to be made available.

Environmental benefits
For many cities, London, Manchester and Glasgow included, congestion and air pollution are major issues. Creating walkable cities, and encouraging walking, cycling and other more environmentally friendly modes of transport can have a significant impact on the levels of pollution within an area. Reducing vehicle use can also have an impact on noise, water, thermal and light pollution in our cities too. Some attempts are being made to reduce the level of pollution in our cities – vehicles in central London have been subject to a congestion charge for a number of years. However, recent developments and attempts to reduce the high levels of air pollution in the city have led to the introduction of the “T-Charge”. It has been suggested that the money raised from this charge could be used to fund green transport initiatives, and this includes improving cycle and walkways and making streets more easy to navigate on foot.

Economic benefits
Walkable spaces can act as a catalyst for local economic vitality, regeneration and tourism. Research has shown that improving public spaces, and creating an environment which encourages more people to walk safely, (and free from the noise, smell and feelings of claustrophobia that can come with high levels of car traffic) has a significant and positive impact on businesses, resulting in people spending more time, but also more money in shops and town centres.

Creating walkable cities: what can be done to help
Planners and city officials are increasingly aware of the need to promote more open, safe and accessible public spaces in new development areas. However, some cities have already implemented practices that could be taken forward in the future. Organisations like Living Streets have produced road maps and blueprints of how cities can use planning to improve public spaces, make them walker friendly and reduce reliance on vehicles. Consultancies like Arup have also produced research on the benefits of creating “walkable cities” and in 2014 RTPI launched their own report on the benefits of planning for “healthier cities” (which includes provision for making cities more walkable). In 2017 the World Health Organisation (WHO) published a briefing on transforming public spaces to promote physical activity in cities. There are a number of ways in which planners and city planning teams can have a positive impact on promoting change to encourage more walking in our cities including:

  • Create walkable neighbourhoods – In Melbourne a “local connectivity plan” was introduced in 2014. The plan was used to build a network of neighbourhoods which had social, leisure and retail facilities within a 20 minute walk of people’s homes.
  • Prioritise walking, and “walkable spaces” in development and regeneration plans – The mayor of London appointed a walking and cycling commissioner in 2017, whose role is to make walking and cycling easier and safer across the capital. The mayor’s new ‘healthy streets’ approach is a commitment to a system of healthy streets and strategies that will help Londoners use cars less and walk, cycle and use public transport more.
  • Make walking safe – Designing walkways and footpaths that incorporate wide, well lit pathways, well signposted and nicely designed and maintained routes has been shown to be one of the main factors in encouraging people to walk more within their local area.
  • Make walking easy (and fun) – Go Jauntly is a new walking app that uses photographs rather than maps to guide users on routes around woods and byways. Walkers can add their own routes, and it is hoped that it the app will “increase the social appeal of people walking together” coming up with new routes within their own neighbourhoods, or areas they like to walk in.

If you found this article interesting, you might also like to read our previous blogs:

It’s a kind of magic: how green infrastructure is changing landscapes and lives

Hidden in plain sight – the value of green spaces

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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.

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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.


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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.