Tackling isolation

Isolation and loneliness amongst older people are serious problems that worsened during the pandemic. While people are living longer, often this involves one partner surviving the other. Sometimes the result can be not only unhappiness, but also additional pressures on GPs and hospitals, as the person has nowhere else to turn.

Loneliness has such far-reaching consequences that the health impact is comparable to smoking up to 15 cigarettes a day, according to one study, and is associated with an increased risk of heart disease and depression, as well as cognitive decline that can trigger worsening physical and mental health.

Solutions can involve strengthening community cohesion, building social connections for older adults who live on their own. A model of care in Co. Antrim has demonstrated this not only works in improving health outcomes, but also saves money by reducing demand on the NHS. Every £1 spent generates a saving of £2.38, through fewer GP appointments and admissions to A&E.

Even greater savings can be achieved when the service is connected to community pharmacists making home visits to check that the correct medications have been dispensed, are being used correctly and not alongside other drugs that together produce negative side effects. Those reviews produced a saving of £5.81 for every £1 spent. Sadly, the involvement of community pharmacists ended when their funding in Northern Ireland ceased last year.

The model of care emerged from older persons’ charity Mid and East Antrim Agewell Partnership (MEAAP), which works in collaboration with health and social care professionals and the voluntary and community sector. Joint work sits at the heart of the work of IMPACTAgewell®, not only improving access to health care services, but also connecting individuals with the services provided by various community groups.
Those connected services include befriending, walking groups, lunch clubs, ‘good morning’ calls, decluttering, benefits reviews, meal deliveries, bereavement counselling and a range of other supports that improve the quality of life of the individual. Empathy and strong communication skills from IMPACTAgewell® staff are equally important. Isolation, especially after the death of a partner, needs a sympathetic ear.

It is the quality of the relationships established between IMPACTAgewell® staff and service users that is core to providing high quality outcomes. These connections have proven especially important post-Covid, with many older people struggling to rebuild social lives after the lockdown. Those relationships are built gradually through trusted conversations within the homes. It is only from those home visits that the officer can work with the older person to determine what matters most to them and help them find solutions.

Relationships between IMPACTAgewell® and partner agencies are facilitated by social prescribing, with fees attached to each referral. Social prescribing is at the heart of the delivery of health and social care services in the rest of the UK, yet Northern Ireland has neither a statutory funding stream for social prescribing, nor any policy supporting it. Referrals to IMPACTAgewell® come from GPs, social workers, pharmacists and other agencies, as well as family members.

IMPACTAgewell® has been recognised as a demonstration model of best practice by the UK Centre to Improve Adult Social Care. Lessons from it are being recommended for embedding in care services across the UK. However, there are many learnings from its work that have a particular relevance for Northern Ireland.

It has become self-evident that the absence of government in Northern Ireland creates very serious challenges and weaknesses across the public sector. Nowhere is this clearer than in health and social care, illustrated by staffing shortages and low morale in GP practices, hospitals and social work teams.

But even when government does work, it is not sufficiently integrated and coherent. Social care is one of the ‘wicked issues’, with a range of different services delivered by various providers affecting the quality of care and outcomes.

One example among many is that community transport is an essential service for isolated adults in rural areas, supporting their physical and mental health and enabling them to access medical appointments. Yet this service, necessary for the functioning of health and care services, is funded by the Department for Infrastructure.

An Integrated Care System is being created in Northern Ireland, which provides an opportunity to greatly improve service co-ordination and planning. It is essential that voluntary and community sector organisations, along with a range of public bodies, are closely involved through this in service delivery, planning and co-ordination. The public sector cannot do everything, nor should it try to.

IMPACTAgewell® is a model of best practice that benefits the older person, supports health and social care professionals and has saved costs for the health service, something which the new Integrated Care System needs to recognise. It is an opportunity that must be grasped.

• IMPACTAgewell® operates across the Mid and East Antrim district, including Ballymena, Larne and Carrickfergus. It is the Northern Ireland partner in a UK wide programme seeking to embed best practice in adult care. The programme is led by the University of Birmingham, with funding from the Economic and Social Research Council and the Health Foundation, with support in Northern Ireland from Ulster University. IMPACTAgewell® also received funding from the Dunhill Trust. Paul Gosling was engaged by Ulster University as a strategic improvement coach to support the IMPACT programme.
• Additional information on IMPACTAgewell® and the UK IMPACT programme are available here.

Paul Gosling

Paul Gosling is author of ‘A New Ireland’; ‘A New Ireland – A Five Year Review’; editor of ‘Lessons from the Troubles and an Unsettled Peace’; author of ‘The Fall of the Ethical Bank’; and co-author of ‘Abuse of Trust’, the story of a child abuse scandal in Leicestershire.

www.paulgosling.net/