The Knowledge Exchange Blog

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

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

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

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

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

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

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

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

Policy and practice

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

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

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

Involving people with dementia in service design

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

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

Use of technology

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

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

Improved awareness of dementia among travel staff

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

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

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

Future developments

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

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

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


Rural transport: connecting communities

By Rebecca Jackson

For many people the buses which run through rural towns and villages in the UK are a lifeline.  However, with councils under increasing pressure to reduce costs and deal with significant budget cuts, some communities are being cut off by the loss of local services. A cycle of low passenger numbers, rising costs of running services and a reduction in the frequency of services is hitting rural communities the hardest.

 

Community-wide impact

Often, when rural buses are discussed, it is their role in enabling elderly people to remain active and involved in community life that is emphasised. However, younger people within rural communities are also increasingly feeling the impacts of cuts to services. Such restrictions can influence their social life and can limit their opportunities to find employment.

According to statistics, two-thirds of job-seekers in the UK have no access to a vehicle or cannot drive, meaning that they are reliant on public transport not only to find work but then to travel to and from work each day. But rising costs are putting some off even finding work in the first instance; and with some modern apprenticeships paying less than £130 a week, and the cost of transport  being as much as £100 a week, it is not surprising to see why some don’t think it’s worth it.

Practical solutions

Councils and members of the public will have to come to terms with the fact that there is just less to spend, and transport, in many instances, is not top of the spending agenda (despite generating £5 for every £1 invested for local economies). This is particularly the case when up to 70% of the councils’ already-reduced budget is pre-allocated to fund statutory services. This means that councils and communities have to be smarter with how they spend their money and look at alternative methods to fund and run bus services within rural communities. Potential strategies which have been considered by local authorities already are:

  • Focusing on key routes and securing funding for them
  • Putting routes out to tender for private firms to run (although they tend to only take on the most profitable routes, leaving people even more isolated – of the 56 million miles which have been lost in rural bus services, only 13 million miles of that has subsequently been taken up and run by private bus companies)
  • Increasing fares, which has its limitations due to the number of bus users who are exempt from paying fares through the use of a concessions card.
  • Providing an on demand mini bus service which only runs and stops when required
  • Promoting or supporting the creation of a community bus service

Digital solutions

In addition to this, despite funding difficulties, advances in digital transportation technology are making rural routes more and more accessible and cheaper to run in the long term. The proposed roll out of contactless technology by 2020, described by the Transport Secretary as the “smart ticketing revolution”, is helping to build a modern, affordable transport network that provides better, more cost efficient journeys for bus users. It is possible that this can be used in rural areas to promote the remaining bus services, and increase their accessibility to all users. The long term savings made by going “contactless” could then be reinvested into routes.

Real-time passenger information provided by companies like Cloud Amber can be another particularly effective solution for increasing passenger usage in rural areas where buses are less frequent. This increases passenger confidence that a bus is on its way and therefore use increases, leading to a more robust service requiring fewer subsidies.

There is a recognition that bus services in rural communities can have a positive environmental and economic impact. Effective saving without cutting services may be possible, whether that is through: long term strategic or community based planning; flexible services, able to integrate digital technology to drive passenger use; or the development of services and routes which are robust enough to run on reduced funding.

Final thoughts

The effect of transport cuts on rural communities shows us that transport is about more than vehicles and logistics; it is about connections: allowing people to form and maintain them; allowing communities to be sustainable and to grow; giving young people the chance to maximize potential; enabling older people to remain engaged and active, with a reduced risk of social isolation. Potential solutions are available and councils now faced with reduced funding will have to consider the best of these options for their local areas.


Read our other recent blogs on transport:

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

Cloud Amber is a member of the Idox group of companies. Its smart solutions enable traffic managers to model, monitor and control the environmental effects of travel as well as reducing congestion to maximise the use of a limited road network.

Social prescribing – just what the doctor ordered?

blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

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

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.

Why the future of public transport has to be green

Image by flickr user Justin Pickard via Creative Commons

Image by flickr user Justin Pickard via Creative Commons

By Morwen Johnson

Ending our use of oil, coal and natural gas by the end of the century? It seems an impossible task, but this week’s G7 Summit closed with the announcement that the leaders of 7 leading industrial nations had agreed to phase out the use of fossil fuels. As one of the G7, the UK is part of this long-term commitment to reduce greenhouse gas emissions. It is also legally-bound, via The Climate Change Act (2008), to cut carbon emissions by 80% by 2050.

These national and international targets will only be met however if we all make practical changes to our patterns of energy consumption. Organisations like the Energy Saving Trust Foundation and NESTA have pointed out that providing new technologies is not enough to increase public engagement with alternative energy. Success is dependent on getting real people to use these technologies in everyday situations.

Use of renewable energy in public transport

Earlier this week I attended an event on the use of renewable energy in public transport. Not being a transport specialist, but interested from the point of view of community development and social exclusion, it was a useful introduction to some of the innovative work that is underway in Europe.

Organised to present the results of the REPUTE (Renewable Energy in Public Transport Enterprise) project, the event explored the challenges of ensuring accessible public transport in rural areas. People in rural areas typically travel 50% further than people living in urban areas. Travel which is essential to daily life such as going to school or work, going shopping or getting to doctors and hospitals all requires longer journeys, mostly by car or bus. A lack of integration between different modes of transport also makes travel by car more convenient in rural areas.

Pilot projects showcased at the event included personal travel planning in Fort William; solar-powered real-time bus information signs in the Highlands and Islands region; and electric vehicle rental in rural towns in Portugal.

A new guide written by Oxford Brookes University was also launched at the event and includes lots of examples of community-based transport and energy schemes.

Signs of progress

I picked up on a few heartening signs of a shift in attitudes. Many local authorities are publicly supporting alternative energy use in their fleets and providing charging points. A recent survey showed that Scottish councils in particular are leading the way in the UK in the adoption of electric vehicles, with Dundee placed in the number 1 spot and South Lanarkshire, Glasgow and Fife also in the top 5.

  • Aberdeen now has the largest fleet of hydrogen fuel buses of any authority in Europe.
  • 2 of Edinburgh’s bus routes have switched completely to low carbon hybrid vehicles.
  • There are more electric vehicles in Scottish car clubs than the total in car clubs in the rest of the UK.
  • Elsewhere in Europe, Oslo’s initiative to open up bus lanes to electric vehicles has become a victim of its own success with the announcement in May that the law is being changed. A fifth of new cars bought in Norway in the last 3 years have been electric.

A key aspect of pilot schemes is to introduce the public to new energy solutions in a way that is engaging. For example, visitors to the Brecon Beacons National Park can hire electric cars to travel around the area, turning eco travel into a fun activity in itself. A new ‘poo bus’ which runs in Bristol and is fuelled by bio-waste, is a witty way to spark debate about alternative fuel sources. And in Oxford, the city is transforming into a Living Lab for integrated transport experimentation.

Public transport as eco-transport

The need for a transport system which is cleaner and less-energy dependent is clear – the transport sector is the fastest growing source of greenhouse gas emissions.

However investing in innovative renewable energy technologies at a time of budget constraints, requires government and local authorities to show leadership and vision. More importantly, there won’t be a step change in behaviour and attitudes without imaginative approaches to community engagement. Locally-led projects such as those highlighted by REPUTE’s guide are a great way to do this.


The Knowledge Exchange specialises in public and social policy. To gain an insight into the commentary it offers, please explore our publications page on the Knowledge Exchange website.

To find out more on how to become a member, contact us.

Shedding light on a serious issue: how Men’s Sheds are tackling social exclusion

by Stacey Dingwall

Promoting awareness of health and social issues among men, and particularly older men, has always been a tricky challenge. According to research, the longstanding stereotype of men who actively avoid visiting the doctor is true: significant numbers of older men may be experiencing loneliness and isolation due to their reluctance to join clubs for older people, a fact which may explain why suicide rates are higher among middle-aged and older (white) men.

One initiative that has tried to tackle this issue is the Men’s Sheds movement, which originated in Australia in the 1990s after concerns were raised over the lack of opportunities for older men to socialise and discuss any issues they were having with their peers. This led to the emergence of numerous Men’s Sheds across the country, in the form of workshops where men could come together to engage in traditional shed-orientated activities such as woodwork, as well as form new social connections and access health information.

The benefits of Men’s Sheds

Evaluations of Men’s Sheds have identified a range of benefits for the men who participate in them, as well as for the wider community. Older men and social activity: a scoping review of Men’s Sheds and other gendered interventions published in Ageing and Society in April 2015 identified a range of positive effects of the initiative on older men, particularly in terms of improvements in their mental health and wellbeing status. While limited evidence was found of a positive impact on the men’s physical health, the review did find that belonging to a Men’s Shed provided participants with both a personal and social sense of accomplishment – through learning and sharing skills and contributing to their local community – as well as a sense of purpose, through social engagement with their peers which enabled opportunities for fun and camaraderie.

Men’s Sheds in the UK

Between 2010 and 2012, Age UK ran a ‘Men in Sheds’ pilot project, initially limited to Kendal, Bildworth and South London. The popularity of the pilot saw it covered in the national press and other ‘Men in Sheds’ projects soon opened in other areas, with one participant expressing his regret that the initiative had not been established in his area years ago.

In 2013, the UK Men’s Sheds Association was launched. They provide information on how to start a new Men’s Shed, or develop an existing organisation, and have helped form regional networks of Sheds.

One of these networks is in Glasgow, which is now home to the Glasgow Area Men’s Sheds (GAMS) group. We spoke to current GAMS secretary Charlie, who became involved in Men’s Sheds after illness led to him experiencing unemployment and social isolation. After coming across the UK Men’s Sheds Association website, he met up with six other men who were also interested in starting a Shed in Glasgow. Fast forward a year, and there are now at least six separate Sheds in the Glasgow area, at which Charlie estimates there are around 80 regular attendees. For Charlie personally, involvement with Men’s Sheds has allowed him to “build a portfolio of work experience, gain possible references, meet new people, go to new places and do new things”.

Charlie also pointed to research published by the Joint Improvement Team (JIT) in February 2015 which highlights the rapid spread of Men’s Sheds throughout Scotland over the last two years, with Sheds now in 18 of the country’s 32 local authority areas. The report also looks at the development paths of Men’s Sheds, as well as drawing out lessons for other community capacity building initiatives and outlining the local and community support needed to develop a Shed.

What about the women!

According to GAMS, the question of why the Sheds are men-only affairs is a common one. Their response is that “Men’s Sheds address specifically male issues involving male social isolation, men’s health both physical and psychological, re-defining of masculinity in modern society […] women have much more and highly developed socialising group opportunities”.

As well as highlighting a tendency towards loneliness among older men, research has also indicated another trend – the decline of men’s social networks as they age, particularly after the death of a partner. Thus, the importance of Men’s Sheds in “promoting social engagement and healthy, active ageing among older men” is perfectly demonstrated.


The Idox Information Service can give you access to a wealth of further information on active and healthy ageing. To find out more on how to become a member, contact us.

Further reading:

The experiences of older male adults throughout their involvement in a community programme for men, IN Ageing and Society, Vol 35 No 3 Mar 2015, pp531-551

Tackling men’s health: implementation of a male health service in a rugby stadium setting, IN Community Practitioner, Vol 84 No 4 Apr 2011, pp29-32

One hundred not out: resilience and active ageing

Active ageing: live longer and prosper – realising the benefits of extended healthy life expectancy and ‘disability compression’ in Europe

Ageing, health and innovation: policy reforms to facilitate health and active ageing in OECD countries

How should we address loneliness and social isolation among older people?

For elderly men sitting on a bench

Image courtesy of http://goo.gl/A8ykMA using a Creative Commons licence.

By Steven McGinty

“Loneliness and the feeling of being unwanted, is the most terrible poverty“– Mother Teresa

Yet, for many older people, loneliness and social isolation are the normal state of affairs. A recent study by the Office for National Statistics (ONS) found that 34% of people aged 52 and over felt lonely often or sometimes, with this figure reaching 46% for people aged 80 or over. Rather worryingly, a report by Age UK also suggested that over half of older people consider the television as their main source of company.

In many respects, these figures may not be too surprising, with some arguing that this is simply the by-product of changing societal attitudes. Conversely, it could also be said that these changes are a response to the demands of busy modern life. For example, a report published by the Royal Voluntary Service highlights that, because of uncertainty in the job market, many children have to move away from their parents for work reasons. The impact of this is that many older people are seeing their families less and less, with 48% of parents only seeing their children once every two to six months. Continue reading

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