BGS response to the Welsh Government's strategy on tackling loneliness and social isolation

24 January 2019
Primary and Community Care, Commissioning, Healthy Ageing, Health and social care policy, Mental Health

Background

Loneliness and social isolation are growing problems not just in Wales but across the UK and beyond. More of us now understand they can affect anyone, at any age, for a wide variety of reasons. They can, and do, have a significant impact on people’s physical and mental health.    

Preventing people from becoming lonely and isolated must be a national priority, because it will not only improve people’s lives, but it will also help reduce demand for health and social services in the future. 

The Welsh Government’s Programme for Government, Taking Wales Forward 2016-2021 , includes a commitment to develop a nationwide and cross-government strategy to address these issues.  
 
There is a wealth of evidence that demonstrates that loneliness and social isolation are significant issues affecting our older population. Data from the Cognitive Function and Ageing Study – Wales found that 25.3% of older people (aged 65 and over) in Wales reported being lonely and 26.9% socially isolated.  In 2017, the National Assembly for Wales’ Health, Social Services and Sport Committee undertook a valuable inquiry in to loneliness and social isolation in respect of older people. However, in its report, published in December 2017, it acknowledged that evidence received highlighted that there were many other groups of people who also experience loneliness and social isolation.  
 
The Welsh Government's National Survey undertaken in 2016-17 showed that loneliness and social isolation can be experienced by people of all ages and at many stages of their lives and this has been supported by the engagement that we have undertaken to date. While it will be important to consider the needs of older people when looking at how we address loneliness and social isolation, the final strategy intends to set out actions to address these problems across the life course.   
 
This consultation: 

  • Sets out a vision of the Wales the Welsh Government wants to see, linked to the Welsh Government’s legislative and strategic frameworks 
  • Sets out definitions of loneliness and social isolation 
  • Highlights what the evidence tells us and what has been fed back through engagement with stakeholders so far  
  • Highlights the work that the Welsh Government has done and is continuing to do to tackle loneliness and social isolation and the links to the broader policy context  
  • Sets out the Welsh Government's suggested approach for the future, and why, and where it should be focusing our efforts in partnership with others.  
  • Poses a series of questions designed to facilitate discussion among organisations and individuals about what more needs to be done to effectively tackle loneliness and social isolation, including access to services.

Please click here to read the full document that was consulted upon and scroll down for the BGS' response to the 23 questions posed in the consultation. 

BGS Response

Question 1: Do you agree with our definitions of loneliness and social isolation? If not, what would you propose instead?

Yes. No further comments.

 
Question 2: How can we help people to understand the trigger points for loneliness and social isolation and to build emotional and psychological resilience to enable them to take steps to avoid or reduce these feelings?

Ensuring that training on loneliness and social isolation, including the common trigger points, is built into curriculums for all health and social care professionals would be helpful. It must also be recognised that tackling loneliness and isolation among older people who are living with frailty is not just about a person building emotional and psychological resilience; it is also about the physical barriers that make it difficult to travel and to get beyond the front door. 

 
Question 3: How can the Welsh Government foster the right environment and create the right conditions to build resilient communities?

The approach set out in the strategy is welcome – a cohesive approach across a range of policy area is essential. Considering the impact of new policy developments on the health and wellbeing of older people is a key part of that.

 

Difficulty in accessing transport, whether because of limited public transport or fuel poverty, is likely to impact disproportionately on older people, and can present challenges in accessing primary and acute health care.

 
Question 4: How can children and young people be better equipped with the skills to establish and maintain meaningful social connections?

N/A for BGS

 
Question 5: How do we ensure that schools can better support children and young people who may be lonely and socially isolated?

N/A for BGS

 
Question 6: What more can the housing sector do to reduce loneliness and social isolation?  How can the Welsh Government support this?

Continued investment in services which support independent living within people’s homes, and simplifies access to aids and adaptations services has the potential to significantly improve health outcomes for older people. 

Question 7: What more can the Welsh Government do to support the improvement of transport services across Wales?
Recognition of the critical role of accessible affordable transport in helping to prevent loneliness and social isolation and investment in it is welcome. Difficulty in accessing transport, whether because of limited public transport or fuel poverty, is likely to impact disproportionately on older people, and can present challenges in accessing primary and acute health care.
 
Question 8: How can we try to ensure that people have access to digital technology and the ability to use it safely?
None
 
Question 9: What experience do you have of the impact of social services on addressing loneliness and isolation?
Access to social care services is essential to enabling older people who need social care to remain as independent as possible for a long as possible. For older people with multiple long term conditions carers can sometimes be their sole form of human contact.  Our members see on a daily basis the health issues that arise when there are difficulties in accessing social care and other services that social services play a key role in providing, such as aids and adaptations. 
 
Question 10: What more can the social care sector do to tackle loneliness and isolation? 
Supporting care providers to know it is appropriate to flag up loneliness and isolation and where to signpost to would be helpful.   
Question 11: What more can we do to encourage people who are at risk of becoming lonely and isolated to get involved in local groups that promote physical activity?
No comment
 
Question 12: In what other ways can health services play their part in reducing loneliness and social isolation?
Please see our comments under Q19.
 
Question 13: What more can the Welsh Government do to encourage people to volunteer?
None
 
BGS supports the approach set out in the consultation: tackling loneliness before it becomes chronic is key and avoiding the detrimental effects to health and wellbeing that arise from chronic loneliness, and increasing the support available to those who are already chronically lonely.
 
Question 14: How can the Third sector play a stronger role in helping to tackle loneliness and social isolation? What can the Welsh Government and other public bodies do to support this?
The third sector can be supported by ensuring that contract funding for those organisations that provide direct services for older people fully meets the costs, and contracts are of a length that is sufficient to ensure continuity of service. 
 
Question 15:  How can employers and businesses play their part in reducing loneliness and social isolation?
Employers and businesses can help by providing age-friendly and accessible services by staff who have been trained in how best to meet the needs of people who have hearing and visual impairments and mobility issues.  This helps to enable older people to engage in their local community for longer.
 
Question 16:  What more can the Welsh Government do to support those who experience poverty alongside loneliness and social isolation?
It is important to recognise that people who experience poverty alongside loneliness and social isolation are at greater risk of experiencing the onset of frailty at a younger age.   Ensuring a strategy for loneliness is aligned with and supports strategies across health, housing and education is essential.
 
Question 18:  Do you agree with our proposed approach?  If not, what would you otherwise suggest?
BGS supports the approach set out in the consultation: tackling loneliness before it becomes chronic is key and avoiding the detrimental effects to health and wellbeing that arise from chronic loneliness, and increasing the support available to those who are already chronically lonely. Targeting interventions at key groups and recognising the key triggers is key.   
 
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%.  
 
Question 19:  Are you aware of examples of successful interventions within Wales, or beyond, that you think we should be looking at? 
 

1. Health interventions
Access to the right health interventions at the right time is key.  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 which includes routine frailty identification for patients who are 65 and over is a key way of building a strong evidence-base to inform service design and enable interventions to be adapted to better meet individual need.
     
2. Voluntary sector interventions
We are aware of a range of effective projects and initiatives that voluntary sector organisations are delivering in Wales.  We would like to highlight the work of three charities that BGS members know from their own experience are working well and making an effective contribution to tackling loneliness among older people:
  • Alzheimer’s Society work in establish the role of Dementia Friends, and taking a lead in helping to create dementia friendly societies
  • British Red Cross’s work in supporting loneliness or socially isolated older people at times of need.  We are pleased to see that the consultation has highlighted the Connecting Communities partnership work by British Red Cross and Co-op.  We would also like to highlight the support provided by Red Cross volunteers in 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.  These are invaluable services that make a significant different to people and their likelihood of being re-admitted to hospital 
  • The work of Royal Voluntary Services volunteers who help older people to get out of their homes 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 them.  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.  
Question 20: Are there other ways in which we can measure loneliness and social isolation? 
It would be useful to consider the role of GPs in identifying and measuring loneliness and social isolation.  Using data collected through annual health checks and frailty reviews would provide an opportunity to measure progress both locally and nationally. 
 
Question 21: We would like to know your views on the effects that our proposed approach to tackling loneliness and social isolation would have on the Welsh language, specifically on opportunities for people to use Welsh and on treating the Welsh language no less favourably than English.What effects do you think there would be? How could positive effects be increased, or negative effects be mitigated?
Loneliness interventions in Wales must meet the needs of Welsh language speakers. It is important to recognise that for people with dementia this is a clinical need rather than a preference.
 
 
Question 22: Please also explain how you believe the proposed approach could be formulated or changed so as to have positive effects or increased positive effects on opportunities for people to use the Welsh language and on treating the Welsh language no less favourably than the English language, and no adverse effects on opportunities for people to use the Welsh language and on treating the Welsh language no less favourably than the English language.  
None
 
Question 23: We have asked a number of specific questions. If you have any related issues which we have not specifically addressed, please use this space to report them:
None