Tag Archives: local authority

Healthy ageing: how health inequality can be tackled at the local level

Posted on by
Image: Peter Kindersley via Centre for Ageing Better

Older people make up a significant portion of our population, and projections show the proportion of people over the age of 60 within the global population is set to rise even further over the coming years. ONS data shows by 2066 there will be a further 8.6 million projected UK residents aged 65 years and over, taking the total number in this group to 20.4 million and making up 26% of the total population.

Supporting people to age well, and age healthily is something which both local and national policymakers will have to take account of in order to not only ensure good quality of life for their ageing populations but also ensure that services are not overwhelmed.

Studies show the higher levels of deprivation people face in their earlier years, the more likely they are to enter older age in poor health and die younger compared with people who experience lower levels of deprivation. This highlights the need to tackle inequality across the life course, with the preventative action having a positive knock on impact on health inequalities in later life.

Some of the main drivers of inequalities include: social exclusion and isolation; access to and awareness of health and other community services; financial difficulties including fuel poverty and housing issues; insecure or low paid employment, with reduced opportunity to save or enrol in a formal pension to prepare for retirement; a lack of transport and distance from services; low levels of physical activity; and mobility or existing poor health, often characterised by long term chronic health issues.

These inequalities often combine and overlap to create even more challenging situations as people move into older life. More recent research has shown that the Covid-19 pandemic has only exacerbated these inequalities further.

Tackling inequalities at the local level

Alongside the national discussions around ageing, local demographic change has received comparatively less attention, despite place-based policies and concepts like “ageing well in place” being used in public health conversations for a number of years.

Research from the Resolution Foundation explores the intersection between demography and place, and its implications for politics and policy while further research is looking increasingly at local level case studies to highlight pockets of best practice which could help to inform the national approach.

A review from Public Health England looked at the specific experiences of older people in coastal and rural areas and the specific challenges they face in comparison to people living urban areas, exploring local level interventions and interventions which adopt a place- based approach, responding to the specific needs of people living in the area.

Other research in this area stresses that councils have a clear leadership role in supporting an ageing society and that they are uniquely placed to create strategies which reflect the needs of their populations. Through local engagement of older people systematically and regularly, and through co-production and co-design in the production of local policies and services, councils are in a position to underpin a more positive outlook on ageing, ensuring that older people are regarded as full citizens, rather than objects of charity or pity.

Approaches to poverty reduction in Greater Manchester

In Greater Manchester, healthy ageing and age inequalities have been made mayoral priorities and the Greater Manchester Combined Authority set up the Greater Manchester Ageing Hub to respond to what policymakers there see as the opportunities and challenges of an ageing population.

In 2018 the city published an “Age Friendly Strategy” to promote increased social inclusion within the city by trying to tackle the barriers to inclusion created by poverty and inequality, including creating age friendly places which allow older people to participate within their local communities, and promoting healthy ageing through strategies like GM Active Ageing, a partnership with Sport England.

Image: Peter Kindersley via Centre for Ageing Better

Creating a consensus on healthy ageing

The Centre for Ageing Better and Public Health England established 5 principles for healthy ageing which they are urging government and other policy actors to adopt to support future healthy ageing the five principles are:

  1. Prevention
  2. Opportunities
  3. Good homes and neighbourhoods
  4. Narrowing inequalities
  5. Tackling ageism

These principles can be used as building blocks to help organisations create strategies and policies which accurately reflect the core needs of people as they age. One thing which continues to be a challenge, however, is integrating intersectionality into both research and strategies or frameworks on ageing.

Not treating “older people” as one homogenous group, but taking account of the individual experiences of specific groups and how this may impact on their experience of inequalities: this is something researchers are making efforts to resolve in their work, and while there are limited studies which look specifically at BAME or LGBT groups, in the future taking account of intersectionality in ageing and inequalities will become more commonplace.

The future of ageing

We are living longer than ever before. Taking steps to reduce inequalities and support healthy ageing will ensure that those extra years are fulfilling, both for the individual and for society.

Helping people to continue to contribute to society, to really live into old age, embrace and enjoy it – and not just exist – in old age should be a priority for everyone, Reducing inequalities to support people to age well will be a major contributor to ensuring this happens.

If you enjoyed this article you might like to read:

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

“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

Inclusive streets: from low expectations to big dreams

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

Domestic violence during quarantine: the hidden crime of lockdown

Posted on by

Domestic violence is often described as a “hidden epidemic” within the UK. Even before Coronavirus forced the country into lockdown, support services faced funding and resourcing challenges, and many people fleeing domestic abuse already faced barriers to accessing support,  but as social distancing has become the dominant policy response to suppress Covid-19, it is clear there have been unintended consequences for domestic abuse victims which have exacerbated the challenges in providing and accessing support.

An increase in reporting of domestic violence

Figures show that calls to domestic abuse services have increased significantly worldwide during the Coronavirus pandemic. Calls and online enquiries to the UK’s National Domestic Abuse line increased by 25% after the UK entered lockdown in March 2020. More than 40,000 calls and contacts were made to the National Domestic Abuse Helpline during the first three months of lockdown; in June, calls and contacts were nearly 80% higher than usual, according to the charity Refuge, who runs the service.

An investigation by the BBC’s Panorama found that three-quarters of victims told them that lockdown had made it harder for them to escape their abusers and in many cases had intensified the abuse they received and research by a team at LSE showed that while the overall level of domestic abuse crimes (not calls) have remained stable when compared with the long-term trend, calls to the Metropolitan Police between March and July which related to reports of domestic abuse increased by 11% compared with the same period in 2019.

This same research from LSE also noted some changes in the characteristics of the cases being reported, with calls more likely to be made by “third parties”, such as neighbours, and that while abuse by ex-partners fell by 9.4%, abuse by current partners and family members increased significantly – by 8.5% and 16.4% respectively.

In early May, the government announced a £76m package to support the “most vulnerable in our society”, including victims of domestic violence and modern slavery, rough sleepers and vulnerable children. However, with many charities which support victims of domestic abuse struggling with the financial fallout from the COVID-19 pandemic and facing a significant rise in demand for their services, concerns are being raised that the availability of specialist support could be reduced, meaning people exposed to domestic abuse may not be able to access the help they need.

Local level support for vulnerable people fleeing violence

Lockdown offered an opportunity for local authorities to think about the support offered to vulnerable people, including those who were homeless due to fleeing violence.

In Greater Manchester GMCA formed partnerships early on to secure accommodation for women fleeing violence to ensure they would have a safe space. The accommodation was intended for women who are homeless or facing homelessness, including rough sleeping or in shared supported accommodation where the service was unable to meet public health guidelines regarding Covid-19. This included women experiencing domestic abuse, trauma, or contact with the justice system as well as other multiple disadvantages. The service delivery model was designed to be a Trauma Responsive Service Model in order to create a safe and secure environment for each resident and to avoid further traumatisation. The process marked a departure from how cases of female homelessness due to domestic abuse would typically have been handled pre lockdown.

Halls of residence at the University of Cambridge were also offered to homeless women and their children after students vacated them early due to the pandemic. St Catherine’s College formed a partnership with Cambridge Women’s Aid to provide over 1000 nights of secure supported accommodation during the lockdown period.

In both instances the partnerships allowed for practical and quick solutions to provide support to vulnerable women, filling the support gap some traditional routes like refuge shelters were unable to fill because Covid 19- restrictions on the mixing of households meant that homeless and refuge centres were operating with a limited capacity.

Final thoughts

People fleeing domestic violence already faced significant barriers to finding the safety offered by refuge services, even before the lockdown imposed by the Coronavirus pandemic. But we know now that the pandemic has made it harder for survivors to leave an abuser or to seek help, that their experiences of abuse were made worse by the conditions imposed by lockdown and that the circumstances gave abusers more control than ever. When the pandemic is over the majority of local services expect to see a spike in people looking to access their life-saving support, but at the same time the pandemic has threatened the sustainability of the network of services which makes up this support, many of whom were already experiencing a funding struggle.

The work being done to help support vulnerable people fleeing abuse and people facing barriers to accessing refuge is more important now than it has ever been, and continuing support from government and effective partnership working will be vital to ensuring these services continue in the future.

If you need help or support in the UK, call the national domestic abuse helpline on 0808 2000 247, or visit Women’s Aid online.

Follow us on Twitter to find out which topics are interesting our research officers.

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

Posted on by

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.

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

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

Counting the cost of data protection failures in local government

Posted on by

A laptop keyboard with a padlock on it.

By Steven McGinty

In August, Hampshire County Council were fined £100,000 by the Information Commissioner’s Office (ICO) after social care files and 45 bags of confidential waste were found in a building, previously occupied by the council’s adults’ and children’s services team.

Steve Eckersley, the ICO’s head of enforcement, explained that this data protection breach affected over 100 people, with much of the information “highly sensitive” and about adults and children in vulnerable circumstances.  In his view:

“The council’s failure to look after this information was irresponsible. It not only broke the law, but put vulnerable people at risk.”

A widespread problem

In 2015, Big Brother Watch, an organisation which encourages more control over personal data, published a report highlighting that local authorities commit four data breaches every day. It found that between April 2011 and April 2014 there were at least 4,236 data breaches. This included, at least:

  • 401 instances of data loss or theft
  • 159 examples of data being shared with a third party
  • 99 cases of unauthorised people accessing or disclosing data
  • 658 instances of children’s personal data being breached

In the past year, local authorities have reported a 14% increase from the previous year in security breaches to the ICO. The figures show that 64% of all reported breaches involved accidentally disclosing data. This supports research which suggests that human error is a major cause of data protection breaches.

These statistics are both positive and negative for the ICO. Peter Woollacott, CEO of Huntsman Security, suggests that it could show that local government is becoming better at identifying security breaches. However, he also acknowledges that most organisations are subject to multiple attacks, with only some being detected.

Areas for improvement

In 2014, the ICO conducted nine advisory visits and four audits of social housing organisations. It found that improvements could be made in ten areas, including:

  • Data sharing – organisations regularly share personal data but few have formal policies and procedures to govern this sharing.
  • Data retention – few organisations have data retention schedules for personal data, which provide details on when records should be disposed of, although most only extend to physical records. Data protection legislation sets out that data must not be stored for ‘longer than necessary’.
  • Monitoring – there is little evidence that organisations monitor their compliance with data protection policies.
  • Homeworking – where organisations allow staff to work flexibly, it often wasn’t formalised.
  • Training – there are varying levels of data protection training found in organisations.

Public confidence

Unsurprisingly, high-profile data breaches, such as the loss of 25,000,000 child benefit claimants’ details in the post by HM Revenue and Customs (HMRC), have left the public concerned about their data.

In October, a YouGov poll showed that 57% of people believed that government departments could not share personal data securely. And 78% of people didn’t believe or didn’t know whether the government had the resources and technology to stop cyber-attacks.

A poll by Ipsos Mori has also shown that 60% of the public are more concerned about online privacy than a year ago. The three main reasons given were: private companies sharing data; private companies tracking data; and the reporting of government surveillance programmes.

The cost of data protection failures   

The implications of failing to protect the public’s data are serious. Not only could local government be heavily fined by the ICO, but it could also have an emotional or economic impact on individuals if their data enters the wrong hands and is used maliciously (e.g. to commit an act of fraud).  However, there are wider issues for government.

At the moment, both local and central government are undergoing digital transformation programmes, digitising their own operations and moving public services online. Examples include social workers using electronic social care records and the public paying council tax or booking appointments through their local council’s website.

If the public buy into ‘digital by default’ (the policy of ensuring online is the most convenient way of interacting with government), then services could be delivered a lot more efficiently, resulting in significant savings. However, if the public are concerned over the security of their personal data, they may be less willing to consent to its use by government.

We’ve already seen this in some areas. In 2014, the Scottish Government announced plans to expand an NHS register to cover all residents and share access with more than 100 public bodies, including HMRC. This year, the Scottish Government attempted to bring into effect the ‘Named Person Scheme’, where every child in Scotland would be assigned a state guardian, such as a teacher or health visitor.

With both of these schemes concerns have been raised over privacy, including from the ICO in Scotland. The Supreme Court has also ruled against the Named Person Scheme, over the data sharing proposals.

Final thoughts

Local government needs to be robust in ensuring compliance with data protection legislation. The financial costs could be great for local government, but the bigger concern should be public trust. If councils fail to meet their legal obligations, they may find it challenging to implement policies that use public data, even if it brings the public benefits.

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 data related articles. 

Assistive digital technology and older people: technology “bricolage” in dementia care

Posted on by

A key focus of social care teams today is helping people to grow old at home, safely, with dignity and with appropriate levels of care if needed, without breaking the budget. Increasingly, local authorities are looking to advances in technology to facilitate this “growing old in place”.

Telecare packages and assistive technologies are often the preferred way for care teams to deliver social care in a home setting. And in situations where care is required around the clock (for example, support for people with dementia and other life limiting degenerative diseases), families and carers are adapting everyday technology and integrating it into their care-giving in order to supplement the telecare provided by local authorities.

Notruf und Hilfe für Rentner und Kranke

 

Bricolage in dementia and elderly care

Bricolage means adapting an object to allow it to carry out a function which was not necessarily its original intended function. Relatives who care for loved ones with dementia, often adapt everyday objects to help them with their day-to-day caring. They find new, innovative and often non-conventional ways to use technology in diverse ways.

dementia post it

One example from dementia care was a man who bought a chicken ornament with a sensor which “crowed” whenever anyone walked past it. He placed it beside the front door so that if his wife, who suffered from dementia, walked up to the door to go out, he would hear and be able to go to her.

Other examples of technology being adapted include: setting alarms and reminders on mobile devices to remind people to take medication, or using webcams to act as personal CCTV so familly carers can monitor loved ones when they go out, or go into the next room.

These examples show that objects don’t have to be digital in order to be effective. The rise in capability of digital technologies and the relative decrease in cost, however, means it is often quicker and easier for families to invest in additional technologies themselves, rather than waiting for an assessment and an allocation of additional technology from their council.

Image by Buddi

Image by Buddi

Ethical challenges

Although there may be practical motivations, some charities have expressed concern about the ethics of some of the practices regarding adaptation of digital technology to form part of an assistive care package. While they recognise the strain of caring is significant for many people, rigging up a webcam in each room to allow you to “monitor” a loved one, or attaching a GPS tracking bracelet, for example, while often done with the best of intentions, could be interpreted as a breach of human rights.

Active assistive technology (technology which requires an active call for assistance) rather than passive technology (which is constantly monitoring) may be a better way of using technology ethically. It may also be used as an additional stimulant or interactive tool to allow patients to communicate. Apps and interactive devices, such as tablet computers, can inform a carer or loved one that someone had been using the app (providing a type of reassurance and monitoring) and the activities the app promotes might also be a visual stimulant and a communicative tool. The Dementia Citizens project has adopted this method and aims to help people with dementia and those who care for them, using apps on smartphones and tablets.

Dementia Citizens from Nesta UK on Vimeo.

Final thoughts

If we are mindful of the ethical challenges of integrating more technology into care, it might be possible for families and carers to work with social care and assistive technology development teams to adapt the tools available in a more empowering way. It might also mean that the onus is not on carers and their loved ones to build what they can from the standardised telecare provided by local authorities.

Bricolage in assistive care has, for many families, become the norm without them realising it. By adapting and supplementing assistive technology, like telecare packages, with non-assistive technologies or adapted additional digital technologies, families and carers can create a bespoke and personalised care package.

In future, understanding the extent to which families and carers adapt the technology given to them, could help creat more flexible care packages which can be more easily adapted to suit individual needs.

What is Reablement in healthcare and how is it done?

Posted on by

By Rebecca Jackson

Reablement, or enablement is the process of rehabilitating people to allow them to regain some or all of their independence. Often promoted as a form of intermediary care, reablement programmes are recommended for patients who have had a stay in hospital, in order to reduce dependence on the local social care system or traditional ‘care at home’ programmes.

They often result in longer periods of one-to-one contact than ‘care at home’ programmes  – trained professionals work with patients and their family to encourage and promote the achievement of personal goals. It also provides an intermediary stage between health care and social care, which can help the patient transition. Effective reablement programmes are an example of health and social care bodies working together to deliver holistic, person-centred care.

Cooking Together

What makes an effective reablement programme?

Reablement programmes cover a range of everyday tasks such as how to tackle stairs, how to wash and dress and how to prepare and cook meals. It encourages service users to develop the confidence and skills to carry out these activities themselves in order to continue to live at home.

The programmes are planned and delivered by trained reablement professionals – they involve home care staff working in tandem with physiotherapists, occupational therapists and other health professionals.

Much of the literature around reablement (enablement) practice centres on core issues which are vital to ensure success:

  • focus on early intervention and prevention;
  • a positive, enabling, co-productive approach adopted by all;
  • a workforce with an ethos of working with people, rather than doing something to them;
  • the active participation of the service user and their family in reablement;
  • ongoing training for staff;
  • information and support for families and carers;
  • integration and collaborative working between health, housing and social services;
  • strong leadership in commissioning, and adequate funding of services to deliver sustainable outcomes;
  • evaluation that incorporates both social and financial service outcomes to demonstrate value;
  • good quality assessment by a practitioner with the right skills and abilities to determine an effective programme.

Senior resting in a wheelchair

Reablement in local authorities

Research has shown that these intensive programmes are effective. A 2007 study for the Department of Health’s Care Services Efficiency Delivery Network found that up to 68% of people no longer needed a home care package after a period of reablement, and up to 48% continued not to need home care two years later.

Almost all of England’s councils are planning, implementing or running a reablement service. One driver is that it is seen as a tool for managing the costs of an ageing population. In the UK, reablement programmes usually last for 6 weeks, at which time care is either passed to a social worker, adult social care team, or patients are asked to pay for the continuation of the programme themselves.

Reablement has been criticised as expensive, and time- and resource-intensive. Like any service working with vulnerable people, it can also be difficult to demonstrate value as there are differing success rates for different patients. However, interviews conducted with people who have received reablement packages have suggested the emotional and long term benefits are significant as are potential savings to care budgets in the future. This is especially the case in terms of the cost of readmission to hospital, which studies have found is reduced in cases where people received effective reablement care.

The local authority in Croydon was recognised in 2013 for its work in promoting and expanding reablement practices. They also developed a programme of pre-ablement, which saw training delivered to vulnerable people before they became unable to carry out tasks. By showing them alternative ways to do tasks, they were able to change things before being forced to. This preventative approach worked within the local authority and is something which could be considered more widely as pressure increases on local authority funding and care capacity.

There is a growing consensus that properly funded and effective preventative services, such as reablement, can deliver cost-savings to health and social care services, as well as improving the lives of patients.

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

Read some of our other bogs on health and social care: