BGS response to call for evidence on tackling loneliness

The Loneliness Strategy is Government’s first step in tackling the long-term challenge of loneliness. Loneliness is a complex issue that affects many different groups of people, and the evidence base on it is still developing. 

BGS members’ experience of working on issues around loneliness includes people in poor health, carers and bereaved people.

BGS members’ position on institutional initiatives to tackle loneliness amongst older people

We welcome the cross-departmental approach that Government is taking to developing its strategy for tackling loneliness and social isolation.  We hope very much that the strategy will be widely promoted and adopted across Government departments.  

Before commenting on specific projects or initiatives we believe it is important to highlight the critical role that access to high quality health and social care plays in enabling older people to engage in society, and thereby reducing the risks of loneliness and social isolation.  

Effective Health interventions.  BGS’s view is that it is essential that steps to tackle the causes of loneliness are built into the strategy.  This means that in terms of evidence for what works we wish to highlight the following health interventions:

• The King’s Fund report, Making our health and care systems fit for an ageing population provides strong evidence of what we know works well.  This includes both major and minor interventions, for example, “adequate treatment for ‘minor’ needs that limit independence such as foot health, chronic pain, visual and hearing impairment, incontinence, malnutrition and oral health … have significant benefits on older people’s well-being and independence” .  Without such interventions the risks of loneliness and social isolation are higher. 
• Providing the support required to promote health and wellbeing in older people, particularly those with complex and multiple health conditions is essential to maintaining independence and the ability to continue to participate in society.  Two key ways of doing this are through the provision of:
  • Comprehensive Geriatric Assessment (CGA), which is an interdisciplinary process focused on diagnosing an older person’s medical, psychological and functional capability.  It includes as a core element an assessment of the social support networks available to the person, and their level of participation in activities which are significant to them. There is strong evidence which shows that use of CGA enhances an older person’s overall resilience and that when used following an emergency admission to hospital the patient’s likelihood of being able to live in their own home six months later increases by 25%.  
  • A regular holistic medical review by GPs – the introduction in 2017 of the requirement for GPs to practice routine frailty identification for patients who are 65 and over is a development which we warmly welcomed; there is now an increasingly strong evidence-base to inform service design, and to enable interventions to be adapted to better met individual need.  

Effective voluntary sector initiatives.  We are aware of the wide range of effective projects and initiatives that voluntary sector organisations are delivering.  We know that they will be responding to this consultation themselves, but would like to highlight the work of three charities where BGS members know from their own experience that they are working well and making an effective contribution to tackling loneliness among older people.  These are:

• Alzheimer’s Society’s work in establishing the role of Dementia Friends, and taking a lead in help to create dementia friendly societies  
• British Red Cross’s work in i) in supporting lonely or socially isolated older people at times of need – accompanying an older person when they are admitted to hospital or accompanying them and helping them to settle back at home when they are discharged are invaluable services that make a significant difference to people and their likelihood of being re-admitted to hospital  and, ii) creating local ‘connecting communities teams’ which support people in meeting new friends, rediscovering interests and building confidence
• Royal Voluntary Service’s work in providing volunteers who help older people to get out of their homes; this is vital.  Many of the older people our members work with are unable to leave their own home without support to do so.  We are also aware that RVS are currently developing a new initiative for volunteers on hospital wards to become befrienders to patients who either have no visitors, or would like a visit in the daytime if their friends and family are unable to visit then.  In terms of addressing loneliness among people who have been admitted to an acute hospital ward this has the potential to make a significant difference to their emotional health and wellbeing.  

Social prescribing.  BGS recognises and welcomes the benefits that social prescribing is bringing to older people experiencing loneliness. We support the Royal College of General Practitioners Action Plan  which calls for every GP surgery to be able to access a ‘social prescriber’ and for better information about voluntary sector projects and schemes that could benefit people who are experiencing loneliness.  At the same time we have some concerns about: i) the risk of social prescribing being used inappropriately in place of a thorough medical assessment of a patient, and ii) the variable capacity of the voluntary sector and its ability to meet needs.  

Final comments.  BGS would like to support the development and delivery of the strategy for tackling loneliness as much as possible.  Last year we set ourselves a new strategic objective to ‘raise awareness among healthcare professionals of the role of ‘living well’ in preventing disease in old age’.  In June this year we held a conference on the health impacts of loneliness which included sessions on the epidemiology and mental and physical health impacts of loneliness on older people: there is growing evidence that loneliness in older people can have a major negative impact on both mental and physical health and on increasingly mortality.  

We welcome the development of a national strategy for tackling loneliness and the recent announcement of £20million investment in supporting work in this field.  We continue to call for greater financial investment in health and social care, and believe that ensuring older people receive the right care at the right time is an important means of tackling loneliness (while recognising this is outside the direct remit of loneliness strategy).  

BGS comments on projects or initiatives that we feel have not been effective

A concern we have about the initiatives that have developed recently is that many of them rely on people being able to leave their own home in order to engage with them.  For older people living with several long term health conditions this can exclude them, and BGS would like to see a greater focus on how to tackle loneliness among this group of people.  

Main challenges encountered when assessing the impact of our members’ work on loneliness

BGS members who may refer their patients on to services that help to tackle loneliness are not usually in a position to then directly assess the impact.  

BGS comments on a plan to develop a cross-government strategy that combines some policies that reduce the risk of loneliness across society and some that focus on reducing the risk at specific trigger points 

We support the proposed approach and believe tackling the risk at a society-wide level as well as at specific trigger points is essential. 

We would like to see one of the trigger points being the point at which an older person first needs to access social care services.  At this point the risk of loneliness and social isolation increases because the likelihood of someone being able to leave their own home independently has usually increased, and getting out to see friends and engage in activities they have previously enjoyed becomes more difficult.  Investing in training of social care professionals to identify loneliness and signpost to services could be helpful in this respect.  More widely, investing in simple steps such as awareness-raising and training for a wider range of professionals could have a significant positive impact in addressing and reducing loneliness.

BGS believes it is also crucial that the likelihood of either increasing or reducing loneliness is something that all government departments and local authorities should be encouraged to consider as part of any new policy development.  While individual projects and initiatives can go a long way, changes to society’s infrastructure and, most fundamentally, changes which address the social determinants of health, have the power to impact positively on the journey that we need to go on to tackle and reduce loneliness in our society.