MAIDSTONE BOROUGH COUNCIL
Community, Environment and Housing Overview and Scrutiny Committee
Minutes of the meeting held on Tuesday 11 November 2014
Councillor J.A. Wilson (Chairman), and
Councillors Mrs Joy, D Mortimer, Round, Sargeant, Mrs Stockell and Vizzard
38. The Committee to consider whether all items on the agenda should be web-cast
RESOLVED: that all items on the agenda be webcast.
Apologies were received from:
· Councillor D Parvin
· Councillor Watson
· Councillor Munford
40. Notification of Substitute Members
The following substitute member was noted:
Councillor Vizzard for Councillor Watson.
41. Notification of Visiting Members
There were no visiting members present.
42. Disclosures by Members and Officers
There were no disclosures by member of officers.
43. To consider whether any items should be taken in private because of the possible disclosure of exempt information
RESOLVED: that all items on the agenda be taken in public as proposed.
44. Minutes of the meeting held on 9 September 2014
RESOLVED: that the minutes of the meeting held on 9 September 2014 be approved as a correct record and signed by the Chairman.
45. Minutes of the Crime and Disorder Overview and Scrutiny Committee meeting 14 October 2014
RESOLVED: that the minutes of meeting held on 14 October 2014 be approved as a correct record and signed by the Chairman.
46. Review of Loneliness and Isolation in the Over 65s of Maidstone Borough
The Chairman welcomed everyone to the meeting, including students from Oakwood Park Grammar School and Invicta Grammar School.
The Chairman invited the witnesses to introduce themselves and then went on to explain the purpose of the meeting.
The review Working Group met on 9 October 2014 to scope the aim and objectives for the review. The Working Group decided to carry out a review of Loneliness and Isolation in the over 65 age group. A revised scope for the review was attached to the agenda.
Witnesses had been invited to help the committee answer the following questions:
· How big was the issue of loneliness and isolation in the over 65s of Maidstone Borough;
· What areas was it most prevalent;
· What was the impact of the issue;
· What work was being done to combat the issue, and;
· Where were the gaps in provision.
Witnesses attending the meeting were:
· Jo Tonkin, Public Health Specialist, Kent Public Health;
· Louise Holden, Public Health Workforce Development Programme Manager, Kent County Council;
· Colin Thompson, Public Health Consultant, Kent County Council;
· Janet Greenroyd, Kent Community Warden Service, Maidstone District Supervisor;
· Samantha Sheppard, Adult Social Care, Kent County Council;
· Paul Coles, AgeUK, Maidstone;
· Sarah Robson, Community Partnerships Manager, Maidstone Borough Council;
Jo Tonkin, Public Health Specialist, Kent Public Health presented her report titled Loneliness and Social Isolation in Adults and Older People in Maidstone (attached to the minutes as Appendix A), which had been presented to the Working Group at their meeting of 9 October 2014.
Ms Tonkin explained the definitions for loneliness and social isolation:
Social Isolation – an absence of social interactions, social support structures and engagement with wider community activities or structures. It could be through choice or it could be a result of deteriorating mental capacity, discrimination, or a trigger event such as illness or bereavement.
Social Isolation could be measured quantitatively through the number of interactions a person had over a defined period of time. People who were socially isolated were more vulnerable to strokes, heart failure and coronary heart disease and were less likely to follow a treatment plan.
Loneliness – was described as more subjective and related to a person’s personal sense of a lack of connection and contact with others and the quality of the contact they had. Loneliness impacted negatively on a person’s health and wellbeing with lower life satisfaction making them more likely to suffer from alcoholism, suicide and physical ill health.
Ms Tonkin explained loneliness and isolation were difficult to measure and map and as such there was no validated data for the Maidstone borough to inform the review. She went on to explain that nationally it was estimated that 7% of the population were socially isolated. This statistic, when translated to the population of Maidstone, meant an estimated 8,693 people were possibly socially isolated.
Ms Tonkin went on to explain that Medway City Council had developed an experimental Social Isolation Index (SII)using MOSAIC types which referred to the risk factors for social isolation, such as vision loss, hearing loss, depression, urinary incontinence, dementia etc. The second map used in Ms Tonkin’s report showed where the most socially isolate people over the age of 65 may live using the SII method. The greatest concentrations of socially isolated over 65 year old residents where estimated to be in:
· Shepway North;
· Shepway South;
· East Ward;
· Fant and;
· Coxheath and Hunton Wards.
Due to the subjectivity of loneliness it had been measured through self-reporting surveys using validated sets of questions. Using these surveys it was estimated that nationally 5% of the adult population were ‘highly lonely’. Applying this statistic to Maidstone resulted in an estimated 6,200 adults were possibly ‘highly lonely’. This figure had not been broken down to identify the estimated number of ‘highly lonely’ people in the over 65 year old age group. However, it was estimated this would be high due to the risk factors for social isolation being more prevalent in this age group.
The factors thought to be the biggest risk factors contributing to loneliness included; poor health; being disabled; not having access to a car; living in a smaller household; not being a parent.
Ms Tonkin described the third map within her report which showed the highest concentration of people at risk of loneliness due to ill health and disability were concentrated in the central and urban wards of Maidstone, for example:
· High Street;
· Shepway North;
· Shepway South, and;
All described as the four most deprived wards in the Borough.
Other areas showing high levels of loneliness due to poor health and disability were North, Bridge, Fant and Coxheath and Hunton.
Ms Tonkin outlined effective interventions to help ease loneliness and isolation, which included:
· One to One services – befriending, mentoring, community navigators;
· Group interventions – lunch clubs, self-support groups, hobby groups;
· Built environment – can be a barrier or a facilitator of social connectedness;
· Community and voluntary sector – who developed many interventions, although funding is a concern.
During discussion regarding Ms Tonkin’s report the following points were raised:
· It was suggested the data presented outlined what the problem should be and not what it actually was. However, it was felt this should not mean the data was not used to design interventions. Public Health regularly used this type of data to influence the services they provided.
· It was agreed that as loneliness and isolation were difficult to quantify it highlighted the need for a service such as Community Wardens, who were in regular contact with individual people within communities. This service could help to pin point exactly where the most lonely and isolated people were.
· The importance of maintaining existing relationships was emphasised.
· It was explained a useful way of gathering data from individuals was to establish how many times they met people in the space of a day/week/month and establish how satisfied they were with those interactions.
Colin Thompson, Public Health Consultant, Kent County Council explained the work he had been doing with Medway City Council with their strategy for tackling social isolation.
Mr Thompson explained establishing data to inform the Medway strategy proved challenging. Medway had decided that a random sampled survey proved too costly.
Mr Thompson went on to explain how he compiled data for use in Ms Tonkin’s report by using National Census data to establish the number of over 65 year old people who were living on their own. It was noted that just because they were living on their own did not necessarily mean they were lonely.
Mr Thompson then developed the Social Isolation Index (SII) using MOSAIC data which held 69 types of population groups taken from consumer data, national survey data and census data. The data was then broken down by identified risk factors, which were established by interviewing stakeholders. The stakeholders had listed factors such as not having the use of a car and not seeing family and friends as being high on their list.
Mr Thompson accepted the data was not perfect but it was the best available at this point in time.
Mr Thompson informed the committee that focus groups with elderly residents, carers, mental health service users etc. had also been used as a way of gathering data to inform the strategy.
The themes developed regarding factors that created social isolation included; lack of awareness of what was available; transport (lack of and cost of); lack of involvement in the community; being consulted but not involved in developing the interventions. Another finding from the focus groups was geographically isolated communities such as the Isle of Grain, tended to create its own support networks.
Mr Thompson advised that key to the success of the strategy was the involvement of the relevant Cabinet Member, Health and Wellbeing Board and Clinical Commissioning Group. This had resulted in many of the interventions already being implemented.
The draft strategy on social isolation in the Medway area concentrated on social isolation in the whole of the community rather than one particular group. The key themes within the strategy included; raising awareness of what was available to residents; action for individuals and action for communities. The draft strategy was due to go before Medway City Council’s cabinet on 25 November 2014.
During discussion the following points were raised:
· Loneliness and isolation affected a variety of groups in society and the people best placed to identify those ‘hidden’ people who were not engaging were doctors and those working within the community. In their strategy Medway City Council had prioritised the introduction of Community Navigators to help identify these people.
· From the data gathered in the Medway area a fear of crime was not picked up as a factor creating loneliness and isolation, but committee agreed it would make sense if it were.
· Medway had decided to base their strategy on Social Isolation and not loneliness. This decision was guided by a piece of research carried out by Steptoe (2013) which stated that interventions concentrating on social isolation (and not loneliness) were seen to have a significant impact on health improvement.
Paul Coles from AgeUK Maidstone addressed the committee and explained AgeUK had carried out research on the prevention of loneliness in the over 65 year olds.
The AgeUK research had found that those over 65 years old who were interviewed said having friends was more important than having frequent contact with their friends to ward off loneliness.
AgeUK found in 2013 there were 29,319 people over the age of 65 living in Maidstone with 3650 of them being 85 years old or older.
47.9% of those over 65 had a long term limiting health problem which had been described as having an impact on loneliness and isolation.
Nationally it was estimated 6-13% of over 65 year olds reported being lonely and isolated most of the time and 33% reporting being lonely and isolated some of the time. This equated to 2052 lonely and isolated people over the age of 65 in the Maidstone borough and 9,000 to 10,000 sometimes lonely and isolated.
Mr Coles went on to say that the British Longitudinal Study of Aging concluded that mortality rates were higher in participants who reported being lonely and isolated.
Mr Coles informed the committee of the services offered by AgeUK in Maidstone which included:
· Day care centres;
· Transport to Day Care centres;
· Dementia Day Care – catered for carers too;
· Home and Settle service – delivered by AgeUK East Sussex sub contracted to provide the service at Pembury and Maidstone hospitals. This service started recently and offered help when going home from hospital and sign posting to other services;
· Befriending service – funded by Kent County Council;
· Wii and Tea in Bearsted;
· Independent Living Services – working with the client in their homes for a minimum of one hour, helping with house work etc.
· Dementia Art Therapy;
· Information and advice service.
Mr Coles then advised the committee of where he saw gaps in services. These included:
· Community hubs – for example cafes or somewhere where hot food and community meals could be served;
· Activities for early stage dementia – matching people with similar hobby interests;
· Support to use IT and social media - 87% of 16 to 24 year olds were said to use social media. Support to help the over 65s to use social media or develop a bespoke equivalent of Facebook for the over 65s;
· Good neighbour strategies, Know Your Neighbour Days to help build friendship connections.
After some discussion the following points were raised:
· Charges for the services offered by Age UK were a potential barrier to those living in the more deprived areas where it was reported there were the greatest density of potentially lonely and isolated over 65 year olds;
· With the befriending service, if a client was unable to pay then AgeUK were committed to meeting the cost through their funds.
· It was important to engage with ethnic groups within the community. AgeUK in Maidstone had recently engaged with the local Nepalese community to establish a project offering cultural trips to historical places that demonstrated what it meant to be British.
· Maidstone had a BME Forum, which was new and increasing in numbers and had established that people wanted to be more involved in the design of the interventions offered.
· Work on making Maidstone a Dementia Friendly Town had started with training Maidstone Borough Council officers and members to be Dementia Friends. The next step was to take it forward and promote it to other organisations.
· AgeUK predictions for the future were:
o An 18% increase in 65-74 year olds living alone in Maidstone by 2030;
o A 42% increase in over 75 year olds living alone in Maidstone by 2030.
· The chronic loneliness statistic was clarified. On average 7% of over 65 year olds in the UK were lonely. This figure had remained static for over 30 years. In some areas the figure can go up to 13% of the over 65 year olds in population. However the population was aging so the actual number of over 65 year olds who were lonely would increase although the percentage remained unchanged.
Samantha Sheppard, Adult Social Care, Kent County Council addressed the committee and offered to share a MOSAIC profile for Maidstone from 2011. This data profiled high risk factor groups in Maidstone.
Ms Sheppard went on to explain that Adult Social Care (ASC) focussed on supporting those in the community who had been assessed to have eligible social needs. Loneliness and isolation was a primary risk factor for people being referred to ASC.
Ms Sheppard informed the committee that ASC were looking at ways of reducing demand with an aging population and how resources could be targeted to those who really needed them by not drawing people into the system who did not actually need social care.
ASC provided support through two particular methods:
· Direct support and services to those assessed as having eligible social care needs. This was delivered through contractors who provided services such as day care and domiciliary care.
· Investment in preventative services through communities and the voluntary sector. These serviced focussed on maintaining independence.
Ms Sheppard went on to explain there were a range of people who needed the service; those who have been assessed as eligible for the service and were funded; those who have been assessed as eligible for the service and were self-funded, and; those who the service were unaware of.
Ms Sheppard informed the committee that Maidstone received an estimated £372,000 of funding from ASC. This focused on community based services supporting the older population of the borough. Services provided through this funding included:
· Day care;
· Dementia cafes;
· Peer support groups.
Ms Sheppard went on to say that ASC was dealing with historical funding commitments which were not necessarily fit for purpose. People were not accessing the services provided. This was found to be partly due to people who were assessed as being able to make a contribution to the service choosing not to access it because they felt it did not suit their needs.
ASC were looking at the services provided and working on making them fit for the future demand.
Ms Sheppard explained to the committee ASC were faced with two challenges; The Care Act information, advice and guidance, and; a significant workforce that delivered services but not in a standardised, co-ordinated way.
After some discussion the following points were raised:
· ASC’s primary relationships were with those organisations who were funded to provide services. ASC work with some faith groups including the Trinity Resource Centre in Thanet providing a Dementia Café.
· Kent County Council (KCC) were looking at how to build community capacity to enable communities to become almost self sufficient to support their vulnerable residents. The work involved representatives from across KCC directorates and representatives from external organisations such as churches and voluntary groups. The main aim to begin with was to understand how things worked before investing in them.
Janet Greenroyd, Kent Community Warden Service, Maidstone District Supervisor was invited by the Chairman to address the committee.
Ms Greenroyd explained to the committee she had been a Community Warden for the past 12 years and had worked mainly in rural communities doing a role similar to the Community Navigator role described as being in the Medway City strategy.
Ms Greenroyd went on to explain the Community Wardens had set up several clubs and activities in rural areas and were best placed to identify residents who were suffering from loneliness and isolation.
Ms Greenroyd confirmed, in her experience, many people are lonely and isolated due to a fear of crime which prevented them going out. A lack of sufficient street lighting was an issue creating perceptions of being unsafe also led to people avoiding going out.
Lonely and isolated people tend to be at greater risk of scams, where the scammer befriends them.
Ms Greenroyde considered that many people would not pay for a befriending service because it made them feel humiliated.
Ms Greenroyde explained it could take up to a year to establish a trusting relationship with someone who was lonely and isolated and time should be spent finding out what would help individuals and what they wanted.
The Chairman invited the students present to ask questions or make any points they may have.
One student raised concerns regarding the safety of the elderly using social media. The same issues faced by young people using social media would apply to vulnerable elderly people. The committee agreed this was a potential issue and raising awareness of these issues would need to be considered in any intervention designed around social media.
It was agreed an intergenerational project where younger people in the community shared their IT skills with older people in the community would be valuable. The committee were informed that research showed face to face interaction was really important, IT had a role but was not the whole solution.
Sarah Robson, Community Partnerships Manager advised the committee in her opinion the best services to help identify were health services, voluntary and community groups and Community Wardens.
Ms Robson told the committee the key areas to focus on would be raising the awareness of the support available to the community and agencies within it.
Ms Robson suggested a piece of work should be carried out to develop a model where Wards were targeted by the Community Development Team. Agencies such as the police, fire and rescue service, community safety teams, housing providers, bereavement services and GPs could be brought together to establish a model where staff in contact with people as part of their job could report back any concerns. This would require improved workforce development and better coordination of referrals.
The committee asked what bereavement services were provided by MBC. Ms Robson agreed to find out and report back to the committee.
Ms Robson informed the committee Kent Chief Executives had written to KCC expressing their concern should the Community Warden Service be reduced. The letter suggested the service be moved into the management of the Community Safety Team. This would give the wardens more opportunity to target areas where there were numbers of lonely and isolated residents.
The committee agreed Community Wardens were an important resource which should be maintained and expanded into Maidstone town and other rural areas and not reduced. It was agree the Chairman would write a letter to KCC raising the committees concerns should the service was reduced. (This recommendation had already been agreed at the committee’s meeting of 14 October 2014). Sarah Robson agreed to assist with writing the letter.
Note – Councillor Round left the meeting at 7:28pm.
1 The Overview and Scrutiny Officer obtain copies of the following and pass on to all members of the committee:
a. The Maidstone MOSAIC data:
b. Details of AgeUKs Neighbour Day, and:
c. The Medway Social Isolation Strategy.
2 The Community Partnership Manager be asked to assist the Chairman of the committee in writing a letter to Kent County Council expressing the committees concerns regarding plans to reduce the Community Warden service.
3 The Community Partnership Manager be asked to provide an update to the committee at their meeting of 13 January 2015 on bereavement counselling services offered by Maidstone Borough Council and other organisations.
4 The Community Partnership Manager be asked to co-ordinate existing resources to develop a model to identify where the greatest number of lonely and isolated over 65 years olds resided in the borough of Maidstone. When developing the model elderly residents be involved, together with representatives from ethnic and other minority groups. A report to be presented to committee at their meeting of 13 January 2014.
47. Future Work Programme and SCRAIP update report
· The updates to the committees Future Work Programme be noted;
· The updates for SCRAIPs issued by the committee be noted;
· The information concerning the Questioning and Influencing Skills workshop programmed for 3 December 2014 (Getting the Most Out of Your Meetings) be noted.
48. Duration of meeting
6:30pm to 8:45pm