A Sure Start to Later Life Delivering proactive & seamless services Luke O’Shea Social Exclusion Unit

1. A Sure Start to Later LifeDelivering proactive & seamless servicesLuke O’Shea Social Exclusion Unit

2. Part I – Proactive servicesPart II – A new economics of empowerment Part III – Models for seamless services

3. Part I – Proactive servicesAre we getting the right people,at the right time, with the right approach?

4. Are we getting the right people?

5. The Inverse Care Law – whole population strategies and professional referrals not enough Prof D Dorling, Life in Britain. 34% of people with poor health are excluded from basic services 3% of those with excellent health are excluded from basic services = inaccurate targeting of risk & need through these strategies

6. Do we even know where excluded people live? Pensioner poverty

7. Map of loneliness • Current area based interventions will not hit whole population • The loneliest places correlate with some areas of urban deprivation, such as Inner London, Merseyside, the West Midlands and Tyne and Wear. • However, there are also many rural areas with high levels of loneliness. Source: ELSA

8. Predictive risk modelling needed for better targeting • Intelligent targeting • Use survey to get current profile • Longitudinal research to predict risk; • Understand cost of intervention/approach & outcomes • Use admin data to identify individuals (Benefits, GPs, NHS, Life checks?) Source: Barnes et al. (2006) Available at www.socialexclusion.gov.uk

9. Key risk factors for complex, multiple exclusion:allowing more accurate targeting Source: Barnes et al. (2006) Available at www.socialexclusion.gov.uk

10. Are we getting the right peopleat the right time?

11. Early intervention approaches effective at trigger and transition points What does the Keele research identify as key risk points in a person’s life? • Major risk points include the death of a carer or relative dies, loss of employment, being a victim of crime and ill health. Vulnerability is increased when living alone and when social contact declines ChildhoodGrowth and development Younger Adult LifeMaintaining highest possible level of function Older Adult LifeMaintaining independence and preventing disability Preventative, low-level services and a positive approach to ageing would maintain function across the life-course. Range of health & well-being in individuals Level of well-being “Enabling environments” such a accessible transport, home adaptations) can reduce the disability threshold (Kalache and Kickbush, 1997) Disability threshold Age Services can have a strong preventative effect if the timing is right. At these times services must join-up to meet multiple needs. Change of role(loss of job, family move away) Drop in income Decline in heath, falls etc Death of a carer or relative

12. Research on happiness supports an approach that considers life course events 1/4 of widows and widowers develop clinical depression or anxiety in the year following bereavement Impact of bereavement on well-being “My husband was only 49 when he died. And I didn’t have much time to mix with anybody, because I used to stay here with the children. And we’d say when they’re older we’ll go out together. But he died when he was 49 so I never got the chance.” For those widowed 34.5% report feeling lonely compared to only 5.9% of those that are married. Source: ELSA

13. Proactive preventative housing, health and social care services can offer economic benefits

14. Part II – A new economics of empowerment

15. A new economics of empowerment for older people- benefits the individual and society Shift from deficit to participatory model From crisis to prevention to well-being Enhancing protective factors • Public spend sensitive to age structure • Social care costs could double in 20-30 years • WHO want active ageing and prevention. • Need benefits in contributions to work, families & services. Better physical and mental health Reduced spending on intensive services Increased participation and engagement Enhanced quality of life and well-being Increased contribution to society

16. Happier, healthier older people can make a huge contribution to society In work… Many older people would rather remain in work. 39% of people aged 60-69 agreed that “the idea of retirement doesn’t make sense to me” …in families… Over 65’s contribute around 850 million hours of informal care. Increasing this by 10% would be valued at £400m at minimum wage rates …in communities. Volunteering amongst those aged 65-74 is higher than amongst any other age group. Increasing over-65s volunteer hours by 10% would be worth over £500m (valuing volunteering hours at the minimum wage)

17. Physical and social activity are protective of health… “Inactivity and isolation accelerate physical and psychological declines, creating a negative spiral towards premature, preventable ill health and dependency” [HoL select committee] Building social networks Physical activity Research in California found that those with more social ties had lower mortality rates over a nine year period. Physical activity – and particularly training to improve strength, balance and coordination – has been found to be highly effective in reducing the incidence of falls. Lost fitness can be regained with regular activity even in extreme old age. Analysis of the Australian Longitudinal Study of Aging found that after controlling for a range of demographic, health, and lifestyle variables, greater networks with friends were protective against mortality in the 10 year follow up period. 40% of the over-50s are sedentary. They don’t exercise enough to benefit their health.

18. And can directly improve wellbeing Having a role Social engagement The effects of unemployment on happiness are as big the effect of marriage break-up. Research has found a significant association between social engagement and happiness. Monthly club meetings, church attendance, volunteering and entertaining each have the happiness equivalents of a doubling of income. Physical activity Physical activityis associated with reduced risk of developing depressive symptoms and can be effective in treating depression and enhancing mood. Maintaining independence Civil engagement Keepinga well-maintained house is central to many older people's sense of well-being and of being part of society, as well as to their confidence about coping at home. Research in Switzerland found a link between happiness and the degree of civil engagement

19. Health, wellbeing and participation can become self-reinforcing Positive well-being has been found to have a bigger effect on health than the effects from body mass, smoking and exercise Analysis of ELSA shows those with better self-reported health participate more Increased participation Increased ability, confidence and opportunities Increased personal health and wellbeing and social networks

20. More creative and interactive services and activities are likely to have the biggest benefits Participative, creative Most valuable quadrant? Painting/ writing alone Perform in a play Textile crafts Dancing* Art volunteer *Arts Council survey Based on ippr diagram Sport volunteer Walking Arts club Arts class Swimming Visiting historical monument Collective Individual Visiting libraries Reading a book Visiting museums Watching TV Watching a film Attending arts event Size gives very rough indication of popularity for older people Member of organisation Listening to radio frequently Passive

21. Declining participation is not inevitable with age – not even in competitive sport Source: Compass 1999 in DCMS/ Strategy Unit (2002) Game Plan

22. Poor health and lack of transport seem to be obstacles to participation As people age, poor health and lack of transport become increasingly significant barriers to attending arts events. Cost becomes less important but remains one of the main factors. “Unless you’ve got transport you’re beat before you start … and if you can’t walk very well, and you haven’t got the best health … well, it can be a soul destroying experience, stuck out in the sticks” Providing transport could be key in enabling access to services and activities. 91% of single pensioners and 53% of pensioner couples do not own a car, whilst public transport can be infrequent and inaccessible. Research in rural areas shows that this is particularly important.

23. Part III – Models for seamless services

24. Start with the individual not the service Older people and service providers have told us about the factors which they consider to be important to improve well-being and the quality of life of excluded older people. Material well being Social relations A better quality of life Improved services Early Intervention and low level services Joined up and co-ordinated services Empowerment: Promoting user involvement and choice

25. A Sure Start to Later Life model piloted through Link-Age Plus Programme, LAAs and POPP… • Services for all • Joined-up • Flexible • Accessible • Preventative • Co-located • Community driven • Working with older people • Capacity building

26. TYPE OF SERVICES SERVICES FOR ALL, BUT NOT THE SAME SERVICES INCREASING LEVEL OF RISK OBJECTIVE Transport, education, IT, leisure, information, health etc Many people using universal services participation and quality of life People using universal services & at risk of needing more intensive services Comprehensive advice, support and information. Single services such as benefits claims. Targeted low level services. Prevention People using single services& at risk of needing more intensive services People with multiple needs Joined up solutions. Complex care packages Joined up services. Specialised care/support provision advocacy A Shift from Crisis to Prevention & Quality of Life- targeting tailored services within a universal model

27. Our 30 point action plan • New Pilot to give older people the leisure, learning, volunteering, and social opportunities they need all in one place - delivered through a £10m • programme to test the 'Sure Start to Later Life' approach for older people's services. • ODPM, DH and DEFRA to develop a strategy for housing and older people • Greater effort to tackle poverty in old age - starting with new action to make sure older people know about and get the benefits they need - including making entitlement as automatic as possible, to reduce red tape. • Increasing participation in leisure activities – starting with analysis of participation rates and examines way to promote participation rates in cultural, sporting and leisure activities. • Develop opportunities for volunteering, life-long learning and leisure activities as part of the LinkAge plus pilots.

28. Our 30 point action plan • More flexible and appropriate transport - freedoms for local authorities to offer alternatives to a free bus pass for those who can’t use it. This will enable the creation of more flexible, individualised transport services which can allow older people to retain their independence within their local community. • Tackling age discrimination: DTI are now legislating against age discrimination in employment and will consult this spring on whether to extend this to goods and services. Also manifesto commitment to introduce a Single Equality Bill and will consult on whether age should be included to promote age equality. • Ministerial review to consider an Office for Older People and Ageing; • Directors of Adult Social Services will be given a strong role in tackling social exclusion and isolation among older people.

29. www.socialexclusion.gov.uk “…you want to feel that you are of some use to society. That you’re not just shoved on the scrap heap and that nobody cares about you or the things that you’ve done.”