Priority 4: Support an infrastructure that fosters connections
Perspective – Jeane Freeman MSP, Cabinet Secretary for Health and Sport
I was delighted to lead the Scottish Government's early work on social isolation and loneliness in Scotland when we launched our draft strategy in January 2018 – one of the first of its kind in the world. As we move forward, I look forward to championing these important issues across the health and sport portfolio and helping contribute to building a more connected Scotland. Health and social care has a critically important role to play in this space – and as a major public health issue, tackling social isolation and loneliness will help us to improve the health and wellbeing of the people of Scotland.
Person-centred health and social care
We know that social isolation and loneliness can contribute to poor health and wellbeing and, conversely, people with poor physical and/or mental health may become more isolated due to the barriers their conditions present. That's why the Health and Social Care Standards take a human rights based approach to ensure that care services are tailored to the needs and choices of the individual experiencing care. The Standards are not only about inspection and scrutiny of services, but will help to continually improve the quality of services, social work and community justice. They are underpinned by five principles: dignity and respect; compassion; be included; responsive care and support; and wellbeing. They are complemented by a series of example statements explaining what these personal outcomes look like in practice. For example, in terms of helping to reduce social isolation and loneliness, the following descriptors may apply:
1.10 I am supported to participate fully as a citizen in my local community in the way that I want.
5.8 I experience a service as near as possible to people who are important to me and my home area if I want this and if it is safe.
The new Integration Authorities have an important role in ensuring that people in the community are supported to improve health and wellbeing, and we want to work with them to consider how they might address these issues in their localities. We know that some Authorities have included explicit references to social isolation and loneliness within their strategic plan and that other Authorities are supporting activity that helps to reduce social isolation and loneliness.
The Public Health Priorities for Scotland, published earlier this year, provide an important focus for the whole system on the things which will have the greatest potential to improve the health of the nation: healthy places and communities; the early years; mental wellbeing; harmful substances; poverty and inequality; and healthy weight and physical activity. The inclusion of place and mental wellbeing as two of our priorities are of particular relevance to addressing social isolation and loneliness, especially in terms of recognising how we build and support local communities and create the conditions that engender a sense of belonging and foster greater social connectivity.
The changing landscape around health and social care, as well as an ever greater focus on initiatives like Realistic Medicine and Social Prescribing, presents an opportunity to consider how community-based care can play a part in reducing social isolation and loneliness. It also both reflects, and creates more impetus for, health and social care support more broadly changing to take a holistic approach to improving health and wellbeing that recognises the social conditions of an individual's life. There are many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support. We funded a pilot community links worker programme in Glasgow and Dundee and have committed to introducing 250 link workers by the end of this Parliament. Following initial piloting, the first stage of recruitment began with 56 'early adopters' and Integration Authorities are now recruiting towards the overall target of 250. Nationally, implementation is focused on prioritising areas of greatest deprivation, some Integration Authorities are also exploring the possibility of extending the model to those vulnerable groups who may be most at risk of social isolation. We will work with Integration Authorities to explore what further support they may require to ensure that community link workers have access to relevant information regarding social isolation, including identification and signposting.
Spotlight: Community Link Workers in Inverclyde
Frank was struggling with low mood and becoming isolated in his home as a result. He also had worries about his finances and, in spending a lot of money heating his home, he had very little money to be able to travel to support services, access help or socialise. Frank was referred to the Community Link Worker by his Community Psychiatric Nurse. After a discussion with him, the Community Link Worker referred Frank to a local men's group in Inverclyde where he could meet new people and begin to socialise more. He was also directed to a benefits advice service who were able to support him in improving his financial situation, meaning he could afford to heat his home and still have money to get out and about. "…things are definitely on the up…I feel sunny again" – Frank
We know that the fear of falling is extremely common and can in itself lead to people becoming socially isolated. The Scottish Government-sponsored National Falls Programme has had a focus on falls prevention since 2010, and it aims to aid the prevention of falls and put in place a support network for older people who have fallen and been identified as being at risk of further unintentional harm. We are currently developing Scotland's first Falls and Fracture Prevention Strategy, which will build on previous work and will aim to create the conditions for delivering a collaborative approach across the community, primary care and secondary care to prevent harm from falls. The Strategy, due to be published in early 2019, will highlight the relationship between falls, fear of falling and keeping connected, and will align with this Strategy.
Good quality, person-centred social care can go a long way to alleviating social isolation and loneliness by enabling people to continue living independently within their communities and participate in society in a full and meaningful way. The Social Care (Self-directed Support) (Scotland) Act 2013 enshrines in law that people who are eligible for social care support must be involved in decisions about what their support looks like and how it is delivered. This re-balancing of power between the practitioner and the individual seeks to ensure that the supported person can direct their care in a way that focuses on the aspects of life that matter to them. Maintaining social relationships and contributing to their community are strong drivers for many people as they consider the outcomes they wish to achieve.
Scotland is working towards this self-directed approach becoming the mainstream way in which Scotland delivers social care. This requires change across a range of partners, and a renewed focus on the assets and potential within our communities to complement formal social care provision. In 2019, after extensive discussion with a wide range of stakeholders, we will publish a new National Implementation Plan to drive the changes we wish to see at national and local level. The refreshed Implementation Plan is part of a national programme of work to support local reform of adult social care that is being developed collectively with people who use social care support, local organisations, Health and Social Care partnerships, COSLA and Scottish Government. This work will allow us to together create and realise a vision for social care which focuses on the whole person, which supports people to live as independently as possible, and enables them to participate in society in a full and meaningful way.
Building safer communities
Through our ambition to build safer communities we recognise the connection between social isolation and loneliness and community safety. The fear and risk of intentional and unintentional harm both in our homes and in our communities can impact on how willing and able people are to engage with others and with their local area. Through our ambition to reduce unintentional harm we are working with key stakeholders to share messages and support initiatives and approaches that focus on reducing unintentional harm. Looking ahead, we are working in partnership to develop and deliver an unintentional harm online hub that will gather and share examples of local activity that is directly reducing unintentional harm. This online tool is due to be launched in 2019 and will be available to partnerships in the first instance. In recognising the link between social isolation and loneliness and in keeping safe, the hub will provide a number of examples that can help reduce isolation.
As part of its Service Transformation programme, the Scottish Fire and Rescue Service are moving towards delivering Safe & Well visits across Scotland. These build upon the success of the Service's prevention based Home Fire Safety Visit programme, which has contributed to a significant reduction of fires in the home, and fire related casualties. Various aspects of wellbeing are being considered, including how such visits can recognise the signs of loneliness and isolation, how visits can include referrals on to local health professionals to provide appropriate support, and enhancing referral pathways to support access to local community groups and initiatives working to tackle social isolation and loneliness.
A growing third sector and social economy
The third sector has an important dual role to play in tackling social isolation and loneliness. Third sector organisations are generally rooted within their communities and are well positioned to offer interventions and support in a different way to statutory services. They also help to ensure that the voices of individuals and communities are heard in the design and development of services. We continue to protect our core investment into the third sector to support organisations in their work with individuals and communities. This funding also supports our work to provide the third sector with greater funding stability and the opportunity for longer term planning and development of its role in supporting communities and tackling inequality.
Social enterprises, as businesses that trade for the common good, provide support to people traditional sectors can struggle to reach. Because of this, social enterprises have a key role to play in strengthening social capital in our local communities and tackling social isolation and loneliness. To ensure that social enterprises continue to play an increasingly significant role, the Scottish Government has developed a world-leading eco-system of support for social enterprise: developing a ten-year national strategy and action plan, and providing free business support for individual social entrepreneurs.
Spotlight: Lingo Flamingo
Lingo Flamingo is a social enterprise that delivers professional-standard foreign language classes to older adults in care homes and day centres to increase well-being, stimulate the brain and slow the progress of dementia. Their projects bring people who might normally be socially isolated into a fun, lively class atmosphere, providing a platform to build a social network.
The extent to which people interact is heavily determined by their lived environment. Living in the right home with the right advice and support can enable people to live safely and independently for as long as they choose to do so. We know that Registered Social Landlords already do a lot of work with tenants to ensure their wellbeing. Community Connectors in Glasgow can link older people and their carers to activities, services and support in their local community thereby reducing social isolation and loneliness.
In August 2018, Scottish Government and COSLA jointly published Age, Home and Community – The Next Phase. This is a refresh of the original strategy published in 2011 and has been updated with input from partners in health, housing and third sectors. The refreshed strategy continues to highlight the importance of housing in the lives of older people not least its impact on social isolation. We recognise that the majority of older people live in ordinary homes in their local communities. As part of the refreshed strategy we will explore various housing options to meet the needs of a broader range of purchasers including alternative models such as self-build, co-housing and intergenerational living. The Programme for Government 2018-19 reaffirms this commitment stating that in the coming year we will pilot innovative housing solutions for older people, testing intergenerational and other co-living arrangements to meet housing needs and reduce loneliness.
Many of the housing issues that impact on older people are also particularly relevant to disabled people. A Fairer Scotland for Disabled People – Our Delivery Plan to 2021 set out our commitment to increasing the supply of wheelchair accessible housing across all tenures by requiring all authorities to set a realistic target for delivery within its Local Housing Strategy and reporting annually on progress. This was reaffirmed in Programme for Government along with a commitment to bring forward guidance in 2019.
The planning system also has a vital role to play in delivering high-quality places for Scotland. Delivering high-quality buildings, infrastructure and spaces in the right locations helps provide choice over where to live, style of home, access to amenities and services, and choice to live more active, engaged, independent and healthy lifestyles. We have undertaken a review of the planning system and are proposing a range of measures to give communities a stronger voice in decisions about the future of their places through our 2017 Planning Bill. We will commence a review of Scotland's National Planning Framework following the Planning Bill's passage through Parliament. The National Planning Framework has a critical role to play in bringing together national policies and programmes, such as this one, to provide a coherent, long-term plan for Scotland as a place. We will therefore consider this strategy as we develop NPF4 (National Planning Framework 4) to see how national planning policy can also encourage local development plans to consider how our future places can better support vibrant communities with opportunities for greater social interaction for people of all ages.
We've also developed the Place Standard tool in partnership with NHS Health Scotland and Architecture & Design Scotland which allows communities to work together constructively to assess the quality of their place and to prioritise areas for action. The tool is structured around 14 themes which focus on physical and social issues. It encourages users to consider whether a place provides a variety of spaces to meet, either formally or informally, and contains specific themes looking at Social Contact and Feeling Safe within neighbourhoods. The Place Standard is already being used widely across Scotland as well as internationally, and we have committed to scale up the use of the tool in Scotland, investigating how it can help to reduce inequalities, build social capital, and encourage active participation in community life from all parts of the community. We will look to roll out this initiative further, as well as develop our thinking on how the lived environment both helps and hinders efforts to socially connect.
Spotlight: Digital Scotland Superfast Broadband
Silver City Surfers is an innovative charity bringing digital skills to people aged over 55 in Aberdeen and the North East of Scotland. The organisation runs five free sessions a week in the city, where people can gain confidence in using IT, with one to one tuition from instructors at their own pace, all in a relaxed, social setting. Silver City Surfers are now benefiting from a high speed fibre connection at the Salvation Army Citadel in Aberdeen, where hundreds of people attend their sessions each year.
We're investing heavily to extend superfast broadband access to all premises in Scotland by the end of 2021, and over that period we will be developing prototype affordable internet access at home and in other trusted settings. Emerging technology presents both opportunities and challenges, and we will look at how to harness different opportunities that allow people to connect with each other.
Accessible transport is vital to people being able to meet face-to-face and stay socially active, particularly for those in rural areas or later in life. We're taking forward a review of our National Transport Strategy, with accessibility identified early on as an important theme an important theme of national stakeholder groups charged with producing policy proposals to underpin the new strategy. We'll also bring forward a new Transport Bill to lock in improvements to the system. We're investing in bus services to keep fares affordable, and are continuing to support the National Concessionary Travel Scheme to allow older and disabled people improved access to services, facilities and social networks by free scheduled bus services. We're also supporting local community transport in Scotland, and this includes funding for the Community Transport Association Scotland to support the sector and provide help and advice to community transport groups across the country.
In rural areas and the Islands, we recognise that high air fares pose a challenge and we are committed to addressing this through the Air Discounts Scheme. We've also introduced Road Equivalent Tariff fares on Clyde and Hebrides which includes discounts for those with mobility needs.
We are also modernising our Accessible Travel Framework to speed up delivery by moving to an annual delivery programme. The Framework will continue to make journeys easier for disabled people and those with accessibility issues whether temporary or permanent.
The provisions within our wide-ranging Transport Bill aim to ensure Scotland's transport network operates with greater efficiency, better accessibility and with improved air quality in its towns and cities. These legislative measures will help to empower Scotland's local authorities and establish consistent standards to make transport easier, cleaner and smarter than ever before, therefore supporting the Scottish Government's aspirations to deliver a safe, efficient, cost-effective and sustainable transport system for the benefit of the people of Scotland. These measures will also support tackling social isolation, as improvements to transport provision benefit everyone.
Culture and historic environment
Scotland's culture and heritage provides an opportunity for people to come together, appreciate the arts and connect through shared interests. To make the most of our assets, we're developing a culture strategy for Scotland to build on the existing strengths of the cultural and creative sectors, highlighting the intrinsic value these areas have in promoting societal cohesion and aiding integration. We want to look at increasing access to culture and making sure everyone has an equal opportunity to take part in or contribute to culture in Scotland.
Spotlight: Danderhall Library Film Club
Danderhall Library Film Club started in 2016, using equipment and licences secured through a successful funding bid to the Film Education in Libraries project, administered by Creative Scotland and the Scottish Library and Information Council. The club was set up specifically to address loneliness amongst older men living by themselves in the community. The club has screenings monthly and shows a range of films with an emphasis on westerns, thrillers and war movies, with a mixture of classics and modern productions. It is still going strong two years on. The cup of tea and chat before and after the film is an important part of the experience, with discussion of the stars in the film, and often a reminiscence about the first time they saw it in their youth.
Voluntary Arts Scotland, one of the network of Creative Scotland Regularly Funded organisations, is increasingly focusing on social isolation and loneliness as part of their core work. The National Performing Companies have education and outreach projects which strive to bring communities together, and we are providing the National Galleries of Scotland, National Library of Scotland and National Museums Scotland with funding to enable them to maintain free access to the permanent collections for people to enjoy at their leisure.
Our historic environment has the power to change lives for the better – to make us feel happier, more informed and better connected, to encourage us to get outdoors and get active, to feel that we belong, and to speak to the wide diversity of our nation. Scotland's historic environment sector has made a commitment to grow the number of volunteers, and at the same time to increasing diversity. Evidence suggests that visiting sites of cultural interest as a form of cultural engagement can positively contribute to life satisfaction and examples of work to remove barriers to access by tailoring provision to meet the specific needs of, for example, people with dementia or autism is helping to address issues of social isolation and loneliness. The historic environment is also key to reclaiming a sense of place and belonging which is seen as a potential solution to social isolation. Historic places, as cultural assets, can be used to bring people together for therapeutic or other social purposes, providing a common point of interest or experience that can contribute towards social cohesion.
In recognising the importance of libraries, we're investing in the Public Library Improvement Fund to support innovative ways for people to use public libraries, and are also taking forward the implementation of the first strategy for public libraries in Scotland. We will work to ensure that our approach to increasing access includes hard to reach groups, and considers further how to build on what libraries already offer as community hubs with a role in tackling these issues.
Email: Trevor Owen
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