This group shared that they viewed social isolation as someone who is lonely in their house, but identified many factors that contribute to isolation, and many different situations, that they are now of the opinion that every case of social isolation is incredibly individual. However, this group also set out their stall by saying that it can be difficult to identify social isolation before it happens and people may not believe that they are isolated.

What this group learned:

- Money and legalities are always a factor.
- Some services can approach social isolation quite bureaucratically and more flexibility may be needed in service provision.
- Workers are given tasks when they are working in people’s homes, which tends not to involve engaging socially with people, generally due to time constraints.
- How different sectors engage with people and other services.
- Identified lots of different problems (see slides) and realised that lots of people’s first port of call is a GP.
- There does not seem to be a consistent way of keeping people active and engaged in their community to prevent social isolation in the first place.
- The group saw one way BUPA address social isolation by bringing older people and children together in a garden.

So what does social isolation mean and feel like?

Working with older people and carers, this group also built profiles of people and what social isolation means to them. They mapped who they were connecting with, how they did this, and what the purpose of these connections were (see slides). The group identified archetypes of people who become socially isolated: these were self managed, physical isolation, mental, fear based, care induced and knowledge (for more information see slides).

It was also interesting to see that when carers and older people were asked to choose which thematic group to talk to in the afternoon, the carers mainly wanted to talk about this issue.

Insights from this group included:

- There isn’t a way to identify people who are at risk of social isolation.
- One of the causes of isolation is a lack of confidence.
- There is a lack of knowledge about services available to people.

Feedback from the audience included:

This is an incredibly hard issue to address in terms of identifying who is socially isolated.

The group need to look at how the voluntary sector is involved in social isolation.

Develop the process to support someone who is socially isolated ready, rather than focus on the person. There are bits missing in the current system to have this process ready.

Something that already exists is the HUB which gives advice about services that support people not to become socially isolated.

Police and housing are obliged to report instances of social isolation.

You need to consider whether a person has capacity to be able to be provided services that deal with social isolation.’Capacity’ can be difficult to identify.

It can be difficult for all GPs to know what is available in their community, but if they are able to pass on information, the person still needs the confidence to phone or attend a service.

Remember older people are the same as all of us – they want friends not services.

Some people choose to be isolated and personal choices also need to be respected.

This group defined their approach as ‘Interaction between different stakeholders in the system’. These stakeholders include older people, carers, service staff and family and friends. The group tried to map this system (see slides) but conceded that doing that created a ‘mess’ and stated that the system is incredibly complex for someone who has never experienced the system. Not only was there complexity in the navigation of services, but also confusion around identifying where to enter the system. The implications of this were difficult to comprehend. It seems the students, on looking at the system for the first time, are actually experiencing what it would be like for anyone else trying to navigate their way through the system for the first time.

This group went to a BUPA care home for people who have dementia – a NHS unit and a social work services – to consider partnership working and communication from different perspectives. They also met with older people and carers, which they said was useful because it revealed that older people were not all that different from themselves. They wanted basic things the student believed they would want when they are older, such as being safe, and being independent enough to take a shower on their own (‘the shower of life’ as one older person called it).

The group created detailed maps of how people have approached and experienced services, and how they have navigated through them (see slides). The group extrapolated this to look at how this interaction might impact upon a person’s life and their health.

Problems expressed by people in these experiences were that navigating the system was quite intimidating, especially when people didn’t understand who, what and why services were involved in their lives. They asked people where they thought the problems lay in the services they had experienced and took their lead from the insights they gathered. One issue that was specifically mentioned was around how pride can affect people’s willingness to engage with services.

Key problems the group identified:

- Lack of a transparent system or service structure for people
- No obvious first point of contact
- That carers suitability and support was not always assessed
- Connection between social work and health is problematic
- Conflicting pace of work

This group presented the bud of a few ideas, which included: the development of a ‘super social worker’ which still needed to be thought about and fleshed out, trying to reduce the gap between certain stakeholders and providing a clear view of the system and its connection to other services, resources and people.

There was a lot of discussion about assessments after this group presented, as well as feedback from the audience which included:

Super social worker – could be a GP, someone who is already naturally connected in the community to people.

Patients – clients – people: need to think about how these words are used. One practitioner shared that she does not think of people as sick, but rather that they are her clients that she is providing an assessment for so they can access a service.

Pride and respect need to be considered – knowing what your entitlement is and how you prefer to learn about this.

First group up is anticipatory care

They told us how they had gone about their research and their learning about the sectors. They talked to older people about how they felt about services and what would make them happy and mapped and overlaid the responses on a matrix (see slides). They also talked about what is important to older people. Things that came up were food, relaxation and cultural activities. However, the group said that whether they talked with carers or older people one of the issues that came up again and again was time and money.

The group also explored the question – what does anticipatory care mean? To do this they created a timeline of what anticipatory care may look like (see slides) and, focusing upon specific parts of this life journey, looked at what service interactions looked like on this timeline. They also created profiles of older people and carers which they are referring their learning and ideas back too (see slides).

Some interesting things in the presentations were the conceptualising of a person’s life journey and where anticipatory care could fit into this (see slides). The use of terminology – patient, client and person – was also interesting in terms of the perspective the language can ‘spin’ on the kind of approach people may, or may not, take. The conceptualisation of a family chain of people looking after each other was also interesting, and the thought about time left for carers to be able to look after themselves was noted (see slides).

The three issues this group identified were:

Education – proposing educational services that prepare people for older life. Considering how to deal with older life/illness in advance.

Relationships – try to increase relationships within the community and with service providers in order to have more people taking care of others.

Participation – promote the participation of older people in society and enable them to be active, give/take mentality.

Feedback from the audience:

- Discussion about illness and wellness and how we use those concepts.

- A story was shared about 3 older people who have the early onset dementia and are being given support to live their daily lives (e.g. washing, buying shopping), but financial cuts mean they are not being supported socially. For this reason, residential care was being touted as an option which is  more financially draining in the long run than social support services (e.g. bowling, cinema, massage) and not a personalised response to what older people have identified they need or want.

- Budgets – social care and health budgets pull against one another. In some instances this may look like services are saving money on paper but in the long term they are not.

- The harsh reality is budgets have been cut and are going to be cut even more.

- Personalisation is what is being talked about, and people know they want certain services, however, the budget needs to be made available to realise these services.

- There was a discussion about forward planning or seeking help when things have gone wrong. Lots of families like to keep support within a family unit. How does this perspective relate to anticipatory care?

View the full Anticipatory Care Team Presentation