Social support for older people in East Dunbartonshire: Five year strategic direction 2023-28

In early March 2020 older people living in East Dunbartonshire were benefitting from an abundance of informal and formal social support opportunities.

Many were attending local clubs and groups, run by volunteers, taking place in a variety of settings such as Churches and Town Halls. The provision of formal Day Centres and one to one support enabled those with increased care needs to remain active members of their communities, where informal support was not appropriate.

In mid-March 2020, the world changed; we all stopped what we were doing and remained at home to fight a worldwide pandemic. Clubs and groups, Day Centres and communities were closed for the foreseeable future. Volunteers and Day Centre staff continued to support older people with doorstep visits, providing limited but extremely valuable human interaction.

It has been a long and difficult couple of years for everyone in the fight against the COVID-19 pandemic but it certainly confirmed that the majority of us are social beings, requiring human contact. Research has shown that the benefits of social support and interaction with others is wide and varied including reducing stress, alleviating anxiety and depression, reducing the risks of physical and mental health illnesses, improving memory and life longevity. Social support provides us with the opportunity to have and nurture friendships with our peers and enhances the quality of our lives. While many people turned to technology to maintain contact with the outside world, for many others, virtual means of communication did not provide that much needed interaction and social contact.

Why has East Dunbartonshire Health and Social Care Partnership (HSCP) decided to produce a five year Social Support Strategy for Older People? We want to be ambitious about the opportunities for older people in our communities; we want to rebuild the previous abundance of social opportunities that our older residents had access to and grow more of these informal supports. This Strategy comes at a time when East Dunbartonshire is experiencing a predicted increase, above average, in the number of older people living in our local communities. It is important that we provide social support opportunities at earlier stages in older people’s lives to take advantage of the benefits that it provides to prevent unsustainable demand on formal supports where these can be mitigated.

Following an extensive engagement period with all stakeholders, this Strategy articulates East Dunbartonshire HSCP’s vision for meeting the social support needs of older people in our communities through reduced reliance on building based day care and promotes the enhancement of social support at all levels for our older residents over the next five years focussed in enabling and reabling older people to remain active and independent in their communities.

Caroline Sinclair
Chief Officer, East Dunbartonshire Health and Social Care Partnership

Our Vision is that older people are supported to maximise their opportunities for social interaction for as long as possible, as independently as possible. The Strategy aims to develop a continuum model of person-centred, community-led social support that encourages a feeling of connectedness to others, a feeling of being an active participant in an individual’s own local community, social inclusion and equality.

This Strategy sets out our vision for the future of informal and formal social support, developing more flexible, responsive and sustainable models tailored to the needs of older people and their communities. This vision sees a reduction on our use of formal building based day care in favour of more informal and community led support options tailored to the aspirations of local older people and their carers.

Prior to the onset of the COVID-19 pandemic in March 2020, the HSCP had plans to undertake a full strategic review of social support for older people living in East Dunbartonshire. Due to the pandemic the HSCP’s plans for this review were placed on hold. As we move out of the pandemic, as local community assets and day centres restart and re-invigorate their memberships, the HSCP have, in partnership with all sectors, recommenced the development of this five year Strategy with a view to learning the lessons experienced during the pandemic and focusing on re-building both informal and formal social supports for older people.

The objectives of the Strategy are to:

• Review how we deliver and meet personalised outcomes for older people living in East Dunbartonshire
• Develop a continuum model of person-centred, community-led social support opportunities for older people
• Deliver formal social support opportunities for those older people who are most vulnerable in respect of physical and/or mental health, in two locality focussed centres in the East and West of East Dunbartonshire.

The HSCP intends to achieve those objectives by:

• Articulating a tiered approach to the delivery of informal social support and when applicable, formal services, in line with agreed eligibility criteria
• Developing a range of information/advice/guidance about the informal and formal social support opportunities available within local communities
• Exploring ways to deliver, in partnership with all stakeholders, social opportunities at different times of the day including weekends
• Developing a range of social support opportunities delivered by third sector organisations across East Dunbartonshire, to create opportunities for the development of innovative, and creative social opportunities through the growth of local groups with communal interests
• Producing a consistent eligibility criteria, in line with the HSCP’s Fair Access to Community Policy, for older people whose critical needs require a formal social support service.

This Strategy is designed to take forward key objectives that are set out in the East Dunbartonshire HSCP Strategic Plan 2022 – 2025. In particular it aligns to the HSCP’s strategic priorities and enablers:

• Empowering People
• Empowering Communities
• Prevention and Early Intervention
• Supporting carers and families
• Improving mental health and recovery
• Post-pandemic renewal
• Collaborative commissioning and whole system working.

The actions that are set out in this older people’s social support strategy will be taken forward as part of the overall implementation of the HSCP Strategic Plan.

Ethical Commissioning

As we progress the development and delivery of formal and informal social supports to older people in East Dunbartonshire in partnership we will adhere to the principles of Ethical Commissioning whenever we engage providers to deliver services and supports on behalf of the HSCP. Ethical Commissioning goes beyond price and cost and provides the bedrock for a fairer, rights based, improved social care support system, underpinned by a relentless focus on quality, terms and conditions of the workforce, and, provider investment in staff training, support and working environment. Inevitably, this will drive up standards and improve outcomes for people using services as well as improving staff experience. As our shift in commissioning progresses, Ethical Commissioning and fair work practice will form the cornerstone of all future contractual relationships, with a view to ensuring the commissioned workforce is engaged, valued, rewarded and supported. In return, this approach will yield a more robust, sustainable, high quality and high performing market.

Collaborative Commissioning

Building on current practice, anchored by the recommendations in the Feeley Report, and in line with the HSCP Strategic Plan 2022 – 2025, the HSCP plans to maximise opportunities for Collaborative Commissioning with the aim of improving services, outcomes, processes and efficiency.

Collaborative Commissioning essentially requires a “paradigm shift” from the traditional commissioner / provider role to one of a more joined up, integrated approach. The key aim of Collaborative Commissioning is to achieve better outcomes for people using services and improve the experience for staff delivering them. Wider benefits include pooling of knowledge and expertise to draw upon, foster innovation, reduce and/or mitigate known service risks and engage more productively with people who have lived experience, carers, local communities, providers and other professionals. Collaborative Commissioning requires this level of engagement and participation at all levels of commissioning from the strategic planning end of the spectrum through to any procurement of individual services and supports. This approach will however require providers to be more open and transparent around areas such as standards, quality, staff wellbeing and costs.

The HSCP is keen to learn, and better understand, the benefits of relatively new and un-tested commissioning models such as, Public Social Partnerships (PSP’s) and Alliancing and subsequently, is proposing, in partnership with key stakeholders, to explore these models further, with the dual aim of developing new and sustainable models of social support for older people, whilst strengthening the collaborative approach. How we move forward with the delivery of social supports for older people, in line with this Strategy, will be underpinned by a collaborative commissioning approach.

The Case for change, current and future challenges

While formal day care settings have an important role to play in supporting those individuals who are most at risk due to physical and/or mental wellbeing challenges to maintain contact in their communities, it is important that we encourage older people to adopt and/or maintain socialisation at an earlier stage in their life journey through interaction and peer support offered at informal social settings within their local community.

East Dunbartonshire experiences a higher than average number of older people living in good physical health in our local communities. This is a real positive, to be celebrated. However, demographics show an increase in the number of older people remaining in the community with increased physical frailty resulting in subsequent increases in demand. It is imperative that we start the journey of social integration and peer support at the earliest stage in the older person’s life in order to enjoy the benefits that brings both physically and mentally, and delays the need to move from informal to formal social support. The HSCP aspires to develop pathways which connect the wider social support journey that older people take through the provision of informal and formal opportunities available. Building-based Day Care can provide a short-term input to support an individual through a period of rehabilitation and confidence building until they are able to reintegrate to the wider community setting, as well as provide care on a longer term basis in line with assessed need.

The HSCP is committed to ensuring a more sustainable continuum of care with its partners and communities. To meet anticipated increased demand we recognise the importance of encouraging older people to remain active in their communities, maintaining contact with their peers, and aim to challenge the view that social support can only be provided in formal building based services.

When older people transition too early to formal support models can result in a loss of skills, confidence, interests and independence, resulting in the individual becoming dependent upon formal care too soon in their pathway. As well as the negative impacts for older people becoming over-dependent on formal care too early, there are financial implications too. There continue to be constraints on the public purse and in order to ensure that formal support is targeted to those individuals who are most vulnerable, physically and/or mentally, investment needs to be targeted towards the provision of early intervention and preventative support led by the community. This can only be achieved in partnership with the third and independent sector, and with local people themselves.

The Strategic Needs Analysis for this Strategy, Appendix 1, articulates why change is needed both from a strategic perspective but to also better meet outcomes and policy direction, and achieve best value for the public purse. There is an under-utilisation of the current available service-base across our three Day Centres. Whilst interim commissioning has been undertaken for 2022/23 and 2023/24 to ensure continuity of service, there is a need for change to ensure that future provision is better matched to forecasted need, in the content of the refreshed strategic direction set out in this Strategy.

There is a plethora of policy, which you can read more about in Appendix 2 that directs us towards the intentions described in this Strategy. In addition much has been written about the benefits of social support and the impacts on people’s physical and mental wellbeing if they experience social isolation, more so this has recently been highlighted and exacerbated by the pandemic.

All the research shows that social isolation can have adverse effects on an individual’s health and wellbeing, both physically and mentally. Studies have shown that those individuals who participate in social activities with others identified benefits not only for themselves but also for their carers.

NHS ‘Loneliness in Older People’ NHS ‘Loneliness in Older People’  highlights that older people find it hard to reach out to others when they experience loneliness and are reluctant to ask for help. Visit the NHS website for further information on loneliness in older people.

Age Scotland ‘Tackling Loneliness’ describes loneliness as a “public health crisis” highlighting that it can lead to stress, anxiety and depression and can contribute to an individual’s risk of getting dementia. The organisation states that loneliness can impact physical health similar to a person smoking 15 cigarettes per day. Visit the Age Scotland website for more information.

The published impacts of social isolation on older people’s physical and mental wellbeing underpin the need for this Strategy. The HSCP want to deliver informal and, where eligible, formal social support in a socially inclusive way with our third sector partners.

Older people in our community should, where possible, be encouraged and supported to enjoy the same opportunities as other citizens with active participation in community clubs, groups, networks and organisations.

The tiered approach and road map

The diagram and appendixes below demonstrate that the larger proportion of our local older people do not require to access formal social support and that their needs and outcomes would be best met in informal settings. However, it also demonstrates the need for a fluid approach to the delivery of social support across the continuum. We want to support people flexibly to experience that continuum so that  people can access the right type of support that best meets their needs, focussed at all times on enabling and reabling people to  maintain or regain their independence to be active in their communities for as long as possible.

The individual can travel independently on public transport and is independently mobile with or without a mobility aid.  The individual is independent in all aspects of personal care needs. The individual does not meet the Eligibility Criteria. 

The individual has difficulty travelling on public transport without support due to physical frailty, illness, sensory impairment and/or mild cognitive decline. The individual can use private transport and is independently mobile with or without a mobility aid. The individual is independent in most aspects of personal care needs. The individual does not meet the Eligibility Criteria.

The individual has difficulty travelling independently either on public or in private transport due to physical frailty, illness, sensory impairment and/or mild cognitive decline and may use a mobility aid. The individual remains independent in some aspects of personal care needs. The individual meets low level Eligibility Criteria.

The individual cannot travel independently on public or in private transport without support due to physical frailty, illness, sensory impairment and/or mild to moderate cognitive decline and may use a mobility aid. The individual requires some support with personal care and requires some practical support to participate in activities. Attending a community asset may have some indirect benefit for an unpaid carer. The individual meets low or moderate levels of the Eligibility Criteria.

The individual has moderate levels of physical frailty, physical illness, sensory impairment and/or moderate cognitive decline, may use a mobility aid and requires support with all aspects of travelling. The individual requires support with personal care and practical support to participate in activities. The individual requires lower levels of monitoring and supervision. Attending a community asset may have some indirect benefit for an unpaid carer. The individual meets moderate levels of the Eligibility Criteria.

The individual has high levels of support needs due to physical frailty, illness, sensory impairment and/or moderate to significant cognitive decline, may use a mobility aid and requires support with all aspects of travelling. The individual requires support with personal care and practical support during participation in activities. The individual requires increased levels of monitoring and supervision due to risks associated with their level of cognition. Attending a community asset or service may have significant indirect benefit to an unpaid carer. The individual meets substantial levels of the Eligibility Criteria.

The individual has high levels of support needs due to physical frailty, illness, sensory impairment and/or significant cognitive decline, may use a mobility aid or wheelchair and requires support with all aspects of travelling. The individual requires support with all personal care and practical support during participation in activities associated with their level of cognition. The individual may not be able to participate in a group setting activity. Attendance a formal support service may have a significant indirect benefit to an unpaid carer. The individual meets critical levels of the Eligibility Criteria.

The individual can travel independently on public transport and is independently mobile with or without a mobility aid.  The individual is independent in all aspects of personal care needs. The individual does not meet the Eligibility Criteria. 

The individual has difficulty travelling on public transport without support due to physical frailty, illness, sensory impairment and/or mild cognitive decline. The individual can use private transport and is independently mobile with or without a mobility aid. The individual is independent in most aspects of personal care needs. The individual does not meet the Eligibility Criteria.

The individual has difficulty travelling independently either on public or in private transport due to physical frailty, illness, sensory impairment and/or mild cognitive decline and may use a mobility aid. The individual remains independent in some aspects of personal care needs. The individual meets low level Eligibility Criteria.

The individual cannot travel independently on public or in private transport without support due to physical frailty, illness, sensory impairment and/or mild to moderate cognitive decline and may use a mobility aid. The individual requires some support with personal care and requires some practical support to participate in activities. Attending a community asset may have some indirect benefit for an unpaid carer. The individual meets low or moderate levels of the Eligibility Criteria.

The individual has moderate levels of physical frailty, physical illness, sensory impairment and/or moderate cognitive decline, may use a mobility aid and requires support with all aspects of travelling. The individual requires support with personal care and practical support to participate in activities. The individual requires lower levels of monitoring and supervision. Attending a community asset may have some indirect benefit for an unpaid carer. The individual meets moderate levels of the Eligibility Criteria.

The individual has high levels of support needs due to physical frailty, illness, sensory impairment and/or moderate to significant cognitive decline, may use a mobility aid and requires support with all aspects of travelling. The individual requires support with personal care and practical support during participation in activities. The individual requires increased levels of monitoring and supervision due to risks associated with their level of cognition. Attending a community asset or service may have significant indirect benefit to an unpaid carer. The individual meets substantial levels of the Eligibility Criteria.

The individual has high levels of support needs due to physical frailty, illness, sensory impairment and/or significant cognitive decline, may use a mobility aid or wheelchair and requires support with all aspects of travelling. The individual requires support with all personal care and practical support during participation in activities associated with their level of cognition. The individual may not be able to participate in a group setting activity. Attendance a formal support service may have a significant indirect benefit to an unpaid carer. The individual meets critical levels of the Eligibility Criteria.

Local community assets which may or may not offer access to transport. The location and venue of the asset is physically accessible. There may be volunteer support available while in attendance. There may be input from other supports including My Bus, CAB, Carers Link, East Dunbartonshire Voluntary Action, and Ceartas.

Local community assets which may or may not offer access to transport. The location and venue of the asset is physically accessible. There may be volunteer support available while in attendance. There may be input from other support services including My Bus, CAB, Carers Link, East Dunbartonshire Voluntary Action, and Ceartas.

Local community assets with access to transport, for example, bus, volunteer drivers, and volunteers to provide support on and off transport. The location and venue of the asset is physically accessible and may have dementia friendly environmental aspects. There is volunteer support available while attending. There may be input from other support services including My Bus, CAB, Carers Link, East Dunbartonshire Voluntary Action, and Ceartas.

Local community assets with access to transport, for example, bus, volunteer drivers, and volunteer support on and off transport. The location and venue of the asset is physically accessible and may have dementia friendly environmental aspects. There is volunteer support available while attending. Input from other support services including Carers Link, East Dunbartonshire Voluntary Action, and Ceartas.

Local community assets with access to transport, for example, bus, volunteer drivers, and volunteer support on and off transport. The location and venue of the asset is physically accessible and preferably has dementia friendly environmental aspects. There is volunteer support available while attending. There is formal support available for assistance with personal care if required. Both volunteers and formal support staff benefit from training which may include: communication, dementia awareness, and low level stress and distress techniques. Input from other support services including CAB, Carers Link, East Dunbartonshire Voluntary Action, Ceartas, and Community Health Resources.

Local community assets with access to transport and with support available on and off transport. The location and venue of the asset is physically accessible and preferably has dementia friendly environmental aspects. There is availability of both volunteer and formal support staff to assist with practical and personal care as well as monitor-ing and supervision for those who require this level of support. Both volunteers and formal support staff benefit from training which may include: communication, dementia awareness, and stress and distress techniques. This level of support may mean attending a formal day centre or receiving dedicated one to one support for social stimulation. Input from other support services including CAB, Carers Link, East Dunbartonshire Voluntary Action, Ceartas and Community Health Resources.

A formal day centre support service or alternative one to one support providing full personal and practical care as well as high levels of monitoring and supervision. If Centre based is registered to provide a safe and secure environment for people with high level physical needs and/or significant cognitive decline. Support is provided in venues that are physically accessible and feature dementia friendly environmental aspects. The support is provided by formal support staff who have received training which may include: SVQ in social care, communi-cation, dementia awareness, and stress and distress techniques. Input from other support services including, CAB, Carers Link, East Dunbartonshire Voluntary Action, Ceartas, Community Health Resources.

Demand

During 2021/22 there were 214 referrals for social support for older people. As at 31st March 2022 the total number of centre based day care places available, for older people, in East Dunbartonshire was 360 places. The total number of service users attending centre-based day care was 190 accessing a total number of 253 places. The figures for 2021/22 show an under-utilisation of the total places available. This was, in part, as a result of reduced numbers related to social distancing requirements. However, as at 31st March 2022, there was no waiting list for placement at any of the three Day Centres. As at 31st March 2022, there were 49 customers who could not attend a day centre building or had chosen alternative types of formal social support.

Financial framework

The financial framework underpinning this Strategy is, aligned to the HSCP’s Medium-Term Financial Strategy (MTFS) and establishes the current and projected level of resources required to support delivery of agreed priorities over the next five years.

The budget (2022/2023) for Social Supports is £1,506,436m, and extends across the following commitments:

• Building Based Day Care - £1,052,207 million
• Community Based Support - £253,047
• hird / Voluntary Sector Organisations - £125,745
• Local Area Co-ordinators - £75,437.

In Year 5 of the Strategy (2027/2028), the budget is, projected to increase to £1.6m - in line with inflationary uplifts.

Market oversight

The Older People’s social support market offers a diverse range of providers and support services spanning all sectors including third/voluntary, independent and private sectors, augmented by the HSCP’s in-house Local Area Co-ordinator (LACs) and day care provision, collectively known as a “mixed economy” market. The market includes a variety of commissioned and non-commissioned service delivery models, including centre-based day care, alternative to day care and support, voluntary support and group services, providing a combination of informal and formal social support across the authority.

The full detail of current demand for older peoples’ social support, current delivery arrangements and the existing financial framework is contained in the Strategic Needs Assessment at Appendix 1.

‘Social Support’ can mean different things to different people. People have different amounts of assets such as family, friends, and circles of support but everyone benefits from some kind of social support in their lives. It can mean having friends, family or peer support. It provides opportunities to have others to turn to in times of need or crisis. Social support can enhance one’s quality of life.

Social support can mean being part of a social network which offers companionship but social support can be emotional, offering physical comfort, a listening ear or providing empathy. It can be informational in its delivery, sharing similar issues, giving and sharing information, offering advice. It can also be about shared interests, strengthening your own and others skills, sharing those skills with others, providing mentoring and teaching opportunities to others and opportunities to learn new skills.

Both informal and formal social support opportunities provide mental and physical stimulation, feelings of independence, rehabilitation and can be the lynch pin that helps an older person remain living in their own home in their own community.

How can you improve your social support opportunities?

There are lots of ways that people can improve their social support opportunities and there are various organisations that can provide you with information and advice.

Individuals can improve their own social support opportunities by:

• Exploring the use of technology
• Following your interests
• Being pro-active, seeking out people or groups
• Getting together a group of like-minded people with similar interests
• Improving your own strengths or skills.

Informal Social Support and Community Assets

The main aim of ‘informal social support’ is to provide person-centred, community-led social support that encourages social inclusion and equality. They provide informal opportunities for socialisation and activity based support to people who are relatively independent.  Emphasis of informal support should be on building natural communities and community opportunities. 

Informal ‘social support’ is seen as early intervention and preventative opportunities to support people to maintain social contact, thereby reducing isolation and loneliness.  It can assist individuals to maintain their independence while also promoting health and wellbeing opportunities. Informal social opportunities can be more flexibly tailored to the needs and interests of the individual. 

These types of support, often referred to as Community Assets, are owned by the community; managed by community organisations and provide a wide spectrum of activities and events held in a variety of settings which could include community centres, sport centres, libraries, churches etc.  Assets are developed to create strong, vibrant and resilient communities.  They are people-led, strengths based and help to keep communities connected while promoting health and wellbeing.  They could be run by local community groups, voluntary organisations, and church groups to name but a few.  These types of activities are aimed at older people who have lower level support needs that do not meet the HSCP’s Eligibility Criteria.  These activities can be accessed independently by older people, or from referral via the Local Area Co-ordination Service or our third sector partners. 

The outcomes derived from informal social support include:

• social contact and stimulation, reducing isolation and loneliness
• opportunities for older people to increase their confidence and maintain their independence
• opportunities for older people to remain active citizens within their communities
• Increased mental wellbeing and improved physical health
• achievement of older people's goals and aspirations
• opportunities to participate in activities
• Improved wellbeing through physical and mental stimulation.

East Dunbartonshire HSCP introduced a new role of Local Area Co-ordinators in March 2019 to specifically work with older people. Part of the role was to work with individuals exploring whether community supports could meet the person’s needs or whether more formal social supports were required. The Local Area Co-ordinators were also tasked with building up a strong understanding of the challenges being faced by older people and their carers.

The Local Area Co-ordinators are committed to enhancing the lives of older people and support capacity building at an individual, family and community level. Local Area Co-ordinators identify, connect, develop and lead strong partnership working with local communities, fostering links with voluntary organisations, statutory agencies and other stakeholders to improve connections and develop pathways within local communities.

The Local Area Co-ordinators will work alongside individuals, using an enabling approach to support the person to engage with community resources. Where appropriate, they will also signpost or refer the individual to other services. The aim of local area co-ordination is to ensure that older people receive early intervention and preventative support in order to support the person’s independence within the community.

They will support the older person to identify issues that affect their ability to live well and will work with individuals to help them access services that would best meet their needs. Local Area Co-ordination focuses on moving away from a reliance on formal social support to the use of local community assets. Local Area Co-ordinators can help the person become connected into the community using local informal community resources benefiting those older people who are socially isolated and lonely.

Where an older person does not meet the eligibility criteria for formal social support, the Local Area Co-ordinator will help to identify suitable local resources and assets and connect the person to their community. This involves the Local Area Co-ordinators developing strong partnership working with local communities groups and third sector organisations. The Local Area Co-ordinator helps the older person to identify issues that affects their ability to live well and works with that individual to help them access community assets that would best meet their needs.

An example of an older person being supported to access a local community asset for social support can be found at Appendix 3.

East Dunbartonshire HSCP has a ‘Community Assets’ Map which is hosted and administrated by our third sector partners. The Community Assets Map provides details of local clubs and groups that can be accessed directly by individuals. The Asset Map provides contact details for each ‘asset’ and is arranged geographically to allow easy identification for local community groups,

The Community Asset Map can be accessed here.

If you would like more information about local community assets for older people and the Local Area Co-ordination for Older People view our webpage.

The term ‘formal day services’ covers a range of services and activities, catered to support individuals who have a range of health and social care needs. Those needs cannot be met in an informal social environment and under the HSCP’s eligibility criteria meet the critical or substantial level to require the need for formal support.

Formal social support provides highly specialised support through purpose designed services for people with high care needs. These types of services are delivered in either building-based centres or provided through one to one day opportunities support and are dedicated to people whose needs are specialised.

Formal ‘social support’ for those individuals with increased personal care and safety needs, can provide the benefits of informal support but in an environment where access to social care support staff can meet those individual needs. In many cases this also provides an indirect and important benefit for the carers. Formal social opportunities can provide more intensive support but may be less flexible where one service/centre is required to meet the needs and interests for a group of individuals attending each session.

What do we mean by ‘centre based day care’?

Centre based day care primarily provides care and support to individuals in a group within a building-based setting. It also augments the provision of personal care with opportunities to socially interact and take part in activities with peers. This type of service is designed for older people who have a range of complex care and support needs and service users who are not able due to frailty or disability/illness to access community assets with or without support. Older people accessing this type of service will have been assessed as having needs and outcomes that meet East Dunbartonshire HSCP’s Eligibility Criteria.

What do we mean by ‘social support opportunities’?

Social support opportunities can provide older people with support on a one to one basis which can help them to access social and recreational activities within the community. This could include attending sessions at a local leisure centre; attending local clubs or supporting the older person to meet up with friends in a social setting. This type of support is designed for older people who have a range of complex care and support needs and who are not able due to frailty or disability/illness, to access community assets without one to one personal social care support. Older people accessing this type of service will have been assessed as having needs and outcomes that meet the HSCP’s Eligibility Criteria.

The outcomes of formal social support include:

• To support older people at risk of institutionalisation, who have a variety of disabilities/illnesses to remain independent in their own homes
• To enhance quality of life for older people at risk of institutionalisation
• To provide help to older people at risk of institutionalisation to have access to personal care support while attending a social support activity
• To encourage older people at risk of institutionalisation to socialise whilst receiving supervision and support;
  To help older people at risk of institutionalisation to avoid social isolation
• To help older people at risk of institutionalisation to increase their mental wellbeing and improve their physical health
• To support carers to enable them to continue in their caring role
  To support older people at risk of institutionalisation to achieve their goals and aspirations
• To support older people at risk of institutionalisation to participate in activities and social stimulation
• Promote a safe, non-threatening and secure environment
• Improve wellbeing through physical and mental
• Preventing deterioration in physical and mental health through the provision of monitoring and supervision.

An example of an individual service user being supported to access formal social support can be found at Appendix 3.

Transport

Access to transportation can help older people to attend local groups and clubs. Transportation can reduce social isolation and it is important to an older person’s quality of life, encourages a sense of freedom and helps to maintain independence.

Transport to social support opportunities can be provided in a variety of ways.

For those eligible customers attending formal day centre support, the centre provides access to those customers who are unable to access their own transport. This is usually in the form of a bus which transports a number of people at the same time to the Centre.

For those individuals who are accessing local community assets there are a number of different transportation methods that can be considered and explored with you:

• Private car or taxi
• My Bus
• Volunteer Driver Projects.

Engagement process

During the period 1st July to 31st October 2021, the HSCP undertook a period of engagement with all stakeholders. This was via a survey, which was available in a number of different communication methods. The survey asked participants a variety of questions about aspirations for the future of social support for older people. This stakeholder engagement provided the HSCP with an opportunity to develop potential options for designing the way forward for informal and formal social support for older people.
Social Work practitioners also, during this same period, asked newly assessed, and eligible service users, about their preferences in relation to the delivery of formal social support and why these options were important.

Analysis

The majority of the survey responses were elicited from current service users and their families / unpaid carers. The highlights of the analysis included:

• Older people want to feel safe and connected to their communities
• Older people want to meet and make new friends and take part in activities that promote their health and wellbeing
• Older people missed seeing their families and friends, and being part of their local communities during the pandemic period
• Older people and other stakeholders state that it is important that local community assets have access to funding, volunteers, and transport
• The majority of older people and their families want to attend social support opportunities during the day.

Most of the respondents stated that the HSCP’s strategic vision for social support for older people should focus on:

• Providing building based day care focussed on supporting those older people who are most vulnerable and at risk.
  
  And
  
  
• Focus on supporting older people to remain connected to their communities through opportunities to attend local community groups and clubs.

A more detailed breakdown of the analysis is located in Appendix 1: Strategic Needs Analysis.

Engagement outcomes

Following the engagement with key stakeholders (July to October 2021) and the analysis of the feedback, the HSCP was able to explore how to deliver on our vision for social support for older people in East Dunbartonshire. Three options were considered and subject to initial high level options appraisal. The details of the ‘Options Appraisal’ and approach can be located in Appendix 4: Strategic Needs Analysis.

The options considered for delivering on our vision for social supports for older people were as follows:

Option 1:

• The provision of three formal Day Centres for Older People, as per existing provision
• in partnership with third sector partners, promoting and supporting existing community led support assets
• In partnership with third sector partners, promoting and support the development of new community led support assets, exploring funding opportunities to aid establishment.

Option 2:

• The provision of two formal Day Centres for Older People, one in the West locality and another in the East locality, with opportunities for outreach support
• Establishment of two new large community led support groups with access to formal support, one in the West locality and another in the East locality
• Employment of a development worker for one year to support the BAME community to develop locally based peer support groups
• In partnership with third sector partners, promoting and supporting existing community led support assets
• In partnership with third sector partners, establishing an annual grant fund to support the development and establishment of new community led assets, whilst providing support to explore funding opportunities to aid sustainment.

Option 3:

• The provision of one large formal Day Centre for Older People
• Establishment of two new large community led support groups with access to formal support, one in the West locality and another in the East locality
• Employment of a development worker for one year to support the BAME community to develop locally based peer support groups
• In partnership with third sector partners, promoting and supporting existing community led support assets
• In partnership with third sector partners, establishing an annual grant fund to support the development and establishment of new community led assets, whilst providing support to explore funding opportunities to aid sustainment.

Following key stakeholders engagement sessions, during March to May 2022, it was determined that the HSCP, should adopt Option 2 as the preferred option to deliver on our vision for social support for older people:

• The provision of two formal building based Day Centres for Older People, one in the West locality and another in the East locality, with opportunities for outreach support – reducing from the current three centres
• The establishment of two new large community led support groups with access to formal support, one in the West locality and another in the East locality – refreshing current arrangements with community led support resources
• Employment of a development worker for one year to support the BAME community to develop locally based peer support groups for older people – in recognition of the specific needs of one cohort of current service users, and in recognition of the existence currently of a specialist resource for this group
• In partnership with third sector stakeholders, promote and support existing community led support assets
• In partnership with third sector stakeholders, establish an annual grant fund to support the development and establishment of new older people community led assets, whilst providing support to explore funding opportunities to aid sustainment.

The actions associated with implementing this option will be developed in greater detail in the Commissioning Delivery Plan and/or Service Development Plan which will be an operational document to deliver on this Strategy and which will be developed in partnership with trades unions, providers, and partners and subject to the governance processed of the IJB and East Dunbartonshire Council. The ensuing Plan will be delivered as part of the HSCP’s Annual Delivery Plan.

An Equality Impact Assessment (EIA) was undertaken in respect of the implementation of the Social Support for Older People Strategy. An EIA is a tool used by public organisations to ensure that equality, social inclusion and community cohesion issues are considered when developing or reviewing strategies and policies which affect the delivery of services.

The EIA is a systematic and evidence-based tool, which enables us to consider the likely impact of the Strategy on different groups of people. Completion of equality impact assessments is a legal requirement under race, disability and gender equality legislation.

The EIA confirms that the ‘Social Support for Older People’ Strategy recognises that the models of social support will need to support all individuals to achieve cultural integration and social contact by facilitating natural community connections. Formal social support will only be accessed by individuals whose assessed need meets eligibility criteria.

Consultation with the Equalities Officers at Greater Glasgow and Clyde Health Board and East Dunbartonshire Council, in support of the HSCP, concluded that while stakeholders have requested that members of the same faith and religion are housed together in the Day Centre, the HSCP has a legal requirement to promote inclusivity and integration amongst all of the older people communities.

Local Demographics

East Dunbartonshire has witnessed the fastest growing increase in people aged 85 years + (59%) of any local authority area in Scotland over the last ten years.

Future projections demonstrate that this growth in older people in our community will accelerate over the next ten years by a further 74%, compared to a Scottish average of 46%.

Looking even further ahead, the population of people 85 years + in East Dunbartonshire is expected to treble over the next 25 years (source: GRO population projections).

The chart below shows the change in the 85 years + population for East Dunbartonshire over the past 10 years, compared to all other HSCP areas in Scotland. In common with the demographic statistics produced in 2014, this demonstrates that East Dunbartonshire has continued to experience the largest increase in this population (by 54%)

The next chart demonstrates that in the 10 years from 2016-2026, the East Dunbartonshire 85 years + population is projected to continue to rise faster than any other HSCP area (by 52%). Looking ahead to 2041, the 85 years + population will continue to rise faster than all HSCP areas (153%), with the exception of West Lothian.

Looking ahead to the next 10 years, further increases are predicted to mirror the increases over the last 10 years, resulting in a doubling of demand over the total period. It is important to stress that this only takes account of service users over age 85 years; almost as many service users receive services between the ages of 75 years and 85 years, as receive services beyond the age of 85 years.

Key factors to consider regarding the demographics contributing to the increase in the number of older people in East Dunbartonshire:

• Longer life expectancy resulting not only in more older people, but an increasing prevalence of people surviving beyond age 85 years, with correspondingly higher prevalence of limiting illnesses
• With increased age comes increased complexity of care needs and associated costs
• The majority of health and social care services are delivered to those aged 75 years +. In 2012-13, 68% of home care customers were aged over 75 years, with most of these aged over 85 years
• Most of these statistics in this section relate to the 85 years + population, due to the intensive nature of the care often provided from this age upwards.  However, it is important to note that almost as many service users receive services between the ages of 75 years and 85 years as receive services beyond the age of 85 years
• Community Care policy promotes community-based care, which in the main means care at home, or in a homely place in the community (including care homes). Day Centres or places to provide support in a safe and secure environment are considered an important aspect in supporting individuals to remain in the community.

East Dunbartonshire has felt the impact of these increasing numbers of older people and the associated pressures, perhaps more acutely than other areas in Scotland, and this trend is expected to accelerate.

During 2015 – 2019, the number of customers receiving home care aged 65+ increased by 26%. Looking ahead to the next ten years, with continued increases in older people and most particularly the 85+ population expected to rise at a rate higher than any other Scottish local authority area, it is projected that East Dunbartonshire will experience a continued 5% year-on-year increase in home care demand. This has a direct correlation with referrals for formal day care or day opportunities support. Current eligibility for attending day care is that customers are in receipt of support of a personal care nature either from home care services or family.

Between 2003 and 2013, East Dunbartonshire experienced the fastest growing increase in people aged 85+ of any local authority in Scotland (from 1,672 to 2,660: an increase of 59%), with steepening future projections

(East Dunbartonshire HSCP: Demand Older People, 2019)

The majority of social care services were delivered to people aged over 75 years; around 70% of home care customers were over 75 years, with the majority of these customers aged 85 years +.

• With approximately 40% of people 85 years+ in receipt of at least one social care service in the community in 2014 (including the meals on wheels service), based on population projections at that time it was estimated that population changes would equate to up to 81 additional service users per year age 85 years+
• The predicted rise in the population of people aged 85 years + in East Dunbartonshire has come to pass, with consequential pressure on services and resources. In the period 2008-2018, East Dunbartonshire has continued to experience the largest national increase in the 85 years + population from 2,086 in 2008 to 3203 in 2018
• From 2016-2026, the 85 years + population is projected to continue to rise faster than any other HSCP area by 52% to 4,567. Looking ahead to 2041, the 85 years + population will continue to rise faster than all HSCP areas to 7,582 (an increase of 153% from 2016), with the exception of West Lothian (p20)
• Analysis of the Burden of Disease study indicates that years of life lost to disability and premature mortality in East Dunbartonshire is the second lowest in Scotland
• Care at home demand (hours of service) has increased by 5% per year between 2015 and 2019, exactly in line with the increase in 85 years + population. Of 1,335 home care customers per week over the age of 65 years, 639 are aged over 85 years (48%), constituting 20% of our 85 years + population
• With the direct relationship between demographic changes and cost pressures demonstrated in these areas, it can be reasonably anticipated that we will see continued 5% year-on-year increases in demand, reflecting population projections for the 85 years + age-group
• These pressures are found to be exceptionally the case in East Dunbartonshire, which has experienced the steepest increases in the 85 years + population in the country over the past 10 years and will continue to be the steepest over the next 10 years. The analyses indicate therefore that the demand and cost challenges are going to continue to increase exponentially over the next 10 years and beyond.

(East Dunbartonshire HSCP: Older People Demand Supplementary Report 2019)

The statistical data for each type of formal social support is correct as 31st March 2022.

Local Area Co-ordination for Older People:

The Local Area Co-ordination (LAC) Team for Older People has received 214 referrals during the period of 1st April 2021 to 31st March 2022. The majority of customer referrals received during that period resided in Bearsden and Kirkintilloch and had a main health diagnosis of Dementia/Alzheimer’s.

Number of referrals to LAC Team broken down by geographical area

• Torrance/Bardowie 1
• Bearsden 64
• Bishopbriggs 39
• Kirkintilloch 42
• Twechar 2
• Lennoxtown 5
• Lenzie 16
• Milngavie 41
• Milton of Campsie 4

Number of referrals to LAC Team broken down by main health category

• Dementia/Mental Health Illness 119
• Physical Frailty 95

As at 31st March 2022 there are 99 service users attending Birdston Day Centre, mostly falling into the 85 – 94 years old category. Of those attending the majority are female, living in Kirkintilloch, and suffering from Dementia/Alzheimer’s. Most of those attending the Centre live with an unpaid carer. All those attending the Centre have been assessed as meeting the HSCP’s Eligibility Criteria.

Birdston Day Centre = Total number of service users broken down by age and gender

• 65-74yrs,  8 female, 3 male
• 75-84yrs, 23 female, 14 male
• 85-94yrs, 29 female, 19 male
• 95 yrs, 1 female, 2 male.

Birdston Day Centre = Total number of service users broken down by East Locality Geographical area

• Kirkintilloch 40
• Bishopbriggs 34
• Milton of Campsie 5
• Lenzie 12
  
• Lennoxtown 4
• Twechar 2
• Torrance 2.

Birdston Day Centre = Total number of service users broken down by main healthy category living composition

• Dementia 25 lives alone, 43 lives with carer
• Physical Frailty 23 lives alone, 8 lives with carer.

Birdston Day Centre = Total number of service users broken down by social carer services received

• Home Care 71
• Carer Support 6 
• Supported Living 9
• None 24
  

Birdston Day Centre = Percentage occupancy rate (usage) April 2021 to March 2022

• April 36
• May 46
• June 52
• July 54
• August 52
• September 51
• October 58
• November 59
• December 64
• January 49
• February 62
• March 63

N.B: Reduced number of attendees due to social distancing.

As at 31st March 2022 there are 68 service users attending Oakburn Park Day Centre, mostly falling into the 85 – 94 years old category. Of those attending there was an even split between the numbers of males and females, however most service users lived in the Bearsden area, suffered with Dementia/Alzheimer’s and lived with an unpaid carer. All those individuals attending the Centre have been assessed as meeting the HSCP’s Eligibility Criteria.

Oakburn Park Day Centre = Total number of service users broken down by age and gender

• 65-74yrs,  7 female, 3 male
• 75-84yrs, 13 female, 12 male
• 85-94yrs, 14 female, 17 male
• 95 yrs, 1 female, 1 male.

Oakburn Park Day Centre = ToGeographical area

• Bearsden 54
• Milngavie 14

Oakburn Park Day Centre = Total number of service users broken down by main healthy category living composition

• Dementia 17 lives alone, 31 lives with carer
• Physical Frailty 13 lives alone, 7 lives with carer.

Oakburn Park Day Centre = Total number of service users broken down by social carer services received

• Home Care 47
• Carer Support 5 
• Supported Living 11
• None 19
  

Oakburn Park Day Centre = Percentage occupancy rate (usage) April 2021 to March 2022

• April 30
• May 37
• June 43
• July 47
• August 53
• September 53
• October 51
• November 54
• December 54
• January 54
• February 66
• March 61

N.B: Reduced number of attendees due to social distancing requirements

As at 31st March 2022 there are 23 service users from the Black, Asian, Minority Ethnic (BAME) community attending Milan Day Centre. The majority of those attending fell into the 75 – 84 years old category, however, unlike Birdston and Oakburn Day Centres, the majority of the attendees suffered from physical frailty. The majority of those attending were female, lived with unpaid carers and lived in the Bearsden and Bishopbriggs areas of East Dunbartonshire. All those attending the Centre have been assessed as meeting the HSCP’s Eligibility Criteria.

Milan Day Centre = Total number of service users broken down by age and gender

• 65-74yrs,  2 female, 0 male
• 75-84yrs, 8 female, 4 male
• 85-94yrs, 7 female, 1 male
• 95 yrs, 1 female, 0 male.

Milan Day Centre = Total number of service users broken down by East Locality Geographical area

• Kirkintilloch 2
• Bearsden 9
• Bishopbriggs 9
• Lenzie 3.

Milan Day Centre = Total number of service users broken down by main healthy category living composition

• Dementia 1 lives alone, 2 lives with carer
• Physical Disability 3 lives alone, 17 lives with carer.

Milan Day Centre = Total number of service users broken down by social carer services received

• Home Care 2
• Carer Support 0 
• Supported Living 2
• None 20
  

Milan Day Centre = Percentage occupancy rate (Allocated places - May 2021 to February 2022, Usage - March 2022) May 2021 to March 2022

• May 66
• June 65
• July 65
• August 65
• September 65
• October 65
• November 65
• December 65
• January 65
• February 65
• March 48

N.B: Reduced number of attendees due to social distancing breakdown
N.B: Actual occupancy levels unavailable from May 2021 to February 2022, the percentage used was based on number of places allocated. Actual usage figures commenced March 2022.

While a previous needs analysis evidenced that those service users, who met the eligibility criteria for social support, largely chose a formal building based day centre support to meet those needs and outcomes (Self Directed Support Option 3). There were a significant number of service users, which increases each month, who chose to explore alternative ways of meeting social support needs via Self Directed Support Options 1 and/or 2. There can also be situations where the service user would not benefit from attending social care support in a group setting. In these situations, alternative to day care support can be provided under Self Directed Support Option 3.

As at 31st March 2022 there are 49 service users who could not attend a day centre building or had chosen alternative types of formal social support. The majority of these service users fell into the 75 – 84 years old category, lived with unpaid carers and lived in Milngavie.

Total number of customers broken down by gender and chosen self directed support option.

• Option 1  4 female, 5 male
• Option 2  5 female, 4 male
• Option 3  21 female, 9 male

Total number of customers broken down by age and health category

• 65-74yrs 8 physical frailty, dementia 0
• 75-84yrs 17 physical frailty, dementia 5
• 85-94yrs 8 physical frailty, dementia 8
• 95yrs+  2 physical frailty, dementia 0

Total number of customers broken down by geographical area

• Bearsden 13
• Bishopbriggs 11
• Kirkintilloch 9
• Milngavie 15
  

Total number of customers broken down by living composition

• Lives with Carer 16 yes, 32 no

Total number of customers broken down by receipt of additional services

• Home Care 40
• Supported Living 14
• None 7

Total number of customers broken down by hours of support for alternative to day centre

Series 1

• 0<2 hrs  4
• 2<4 hrs  24
• 4<6 hrs  14
• 6<8 hrs   0
• 8<10 hrs 2
• 10+ hrs   4

The financial framework underpinning this Strategy is, aligned to the HSCP’s Medium-Term Financial Strategy (MTFS) and establishes the current and projected level of resources required to support delivery of agreed priorities over the next five years.

The budget (2022/2023) for Social Supports is £1,506,436m, and extends across the following commitments:

• Building Based Day Care - £1,052,207 million
• Community Based Support - £253,047
• Third / Voluntary Sector Organisations - £125,745
• Local Area Co-ordinators - £75,437

In Year 5 of the Strategy (2027/2028), the budget is, projected to increase to £1.6m - in line with inflationary uplifts.

East Dunbartonshire HSCP Strategic Plan – 2022 - 2025

Shifting the balance of care has been a priority for national and local government for a number of years. Shifting the balance means moving away from support being provided in institutional building based settings to the support being delivered in community or home based environments.

East Dunbartonshire Health and Social Care Partnership Strategic Plan (2022 – 2025) realises the main challenges facing the HSCP over the next three years including:

• Post Pandemic Recovery and Consequences
• Population and Demographics Changes
• Financial Constraints and Public Sector Reform.

The HSCP’s Strategic Plan lists a number of themes that it intends to concentrate on over a three year period. The themes relevant to this Strategy include:

• Empowering People
• Empowering Communities
• Prevention and Early Intervention
• Post Pandemic Renewal.

Reshaping care for older people

NHS: Reshaping Care for Older People (2011 to 2021) recognises that both nationally and locally we have to continue to aim to improve services for older people by shifting the balance of care towards anticipatory care and prevention. It recognises that in order to reshape care for older people we need to adopt:

• Personalisation: service users and carers must be at the centre of HSCP activities, embracing different cultures, needs and choices
• Independence: ensuring that older people are supported to
• Control: older people make their own decisions about their care and support services live independently in community settings, introducing choice and giving the individual involvement and ownership of any decisions.

Christie commission on the future delivery of public services

The Christie Report (June 2011)  provides an earlier debate on the future direction of public services whereby it presented a radical roadmap to better public services. Some of the key messages from the Christie Report relevant to this Strategy were:

• Recognising that effective services must be designed with and for people and communities
• Maximising scarce resources by utilising all available resources form the public, private and third sectors, individuals, groups and communities
• Work closely with individuals and communities to understand their needs, maximise talents and resources, support self-reliance and build resilience
• Concentrate the efforts of all services on delivering integrated services that deliver results
• Prioritise preventative measures to reduce demand and lessen inequalities.

Independent review of adult social care in Scotland

The Feeley Report (March 2021) highlights that the majority of social care support is given to people in their own houses or in local community settings and that we need to ensure that this community support continues. It suggests that the role that communities play in supporting adults to remain active is extremely important.Community based supports can provide socialisation opportunities, advice, information and breaks for unpaid carers. These community based activities can make a big difference to an older person’s quality of life. “Social connections are important to everyone’s wellbeing” (Feeley, March 2021). Some of the key messages from the Feeley Report relevant to this Strategy were:

• Social care support should focus on enabling people to stay in their own homes and communities. This will help them to make social connections and to have control over their lives
• People must be able to access support at the point they feel they need it, including for advice and signposting to local community-based resources and help, and for barriers to this, such as the current eligibility criteria and charging regime, to be fundamentally reformed and removed, to allow a greater emphasis on prevention and early intervention
• Informal, community based services and supports must be encouraged, supported and funded to respond appropriately to the needs of local citizens, including for preventative and low level support.
• Investment in alternative social care support models should prioritise approaches that enable people to stay in their own homes and communities, to maintain and develop rich social connections and to exercise as much autonomy as possible in decisions about their lives.

National Health and Social Care Strategy for Older People

In May 2022, the Scottish Government published a consultation to seek people’s view in relation to older people’s health and social care service. The purpose of the consultation is to inform the development of a national integrated health and social care strategy for older people.

The consultation and impending Strategy will focus on four main themes

• Place and Wellbeing
• Preventative and Proactive Care
• Integrated Planned Care
• Integrated Unscheduled Care.

The Scottish Government is seeking people’s views in relation to older people’s health and social care services in order to inform the development of a new integrated health and social care strategy for older people. The consultation is based around the four main themes of:

• Place and Wellbeing
• Preventative and Proactive Care
• Integrated Planned Care
• Integrated Unscheduled Care.

East Dunbartonshire HSCP’s Social Support for Older People Strategy will support the themes focused on ‘Place and Wellbeing’ and ‘Preventative and Proactive Care’.

Self directed support

The Social Care (Self Directed Support) (Scotland) Act 2013 implemented in 2014 enabled individuals and their carers to have as much choice and control as they would wish or are capable of in relation to their support. This has seen some changes over the last seven years in the way that some older people have chosen, in relation to the model, to meet their social support needs.

Any individual who has been assessed as eligible for formal social care support will be offered the Self Directed Support options. Some people can manage their support on their own, whilst others need help either  from family, friends or a support organisation.

Self Directed Support Options:

Option 1:

You can choose to receive your individual budget as a payment directly into your bank account. With this money, you can choose to become an employer where you employ your own Personal Assistant (PA) or you can purchase services/ support from an agency or other organisation.

Option 2:

Your individual budget can be held and managed by the HSCP or a third-party organisation and would be used to pay for the support that you have chosen.

Option 3:

With this option discussions will take place with you regarding your individual budget and the support you require to meet your outcomes, but you may have decided that the arrangement regarding who provides this support and when will be made by the HSCP, using their own services or services commissioned from another organisation.

Option 4:

You may choose to use several Self Directed Support options to meet the different parts of your support plan.

Information about Self Directed Support in East Dunbartonshire can be found on our Self Directed Support webpage.

Customer contributions

East Dunbartonshire Council ‘Charges for Non Residential Services’ Policy means that people in receipt of formal social support may be subject to a customer contribution.

The amount of customer contribution will be dependent upon the older person’s income however those customers in receipt of disability benefits i.e. Attendance Allowance and Personal Independence Payment will usually be eligible to pay the full customer contribution. The contribution levels are reviewed annually.

The customer contribution is applied irrespective of the type of formal social support service that the individual is receiving. However, customer attending a formal day centre based service may also be subject to transport costs and will also contribute to the provision of a meal at lunchtime.

Examples of community assets arranged by the local area coordination team

• A national older people’s charity run afternoon tea and chat sessions for people aged over 75 years who are at risk of social isolation. Due to an increase in the number of referrals from Local Area Co-ordination in East Dunbartonshire, the organisation worked jointly with the HSCP to establish two new sessions in the West locality of East Dunbartonshire
• A local third sector organisation who provide befriending opportunities for older people in the form of one to one, group or telephone sessions worked closely with the Local Area Co-ordinator to increase the volunteering opportunities and identified additional group sessions in areas where a higher proportion of befriending needs had been identified
• A new Men’s Shed in the West locality was officially opened in the summer of 2019. It took over a year for a dedicated group of men, alongside a member of the HSCP staff, to establish a formal committee and source a venue within the local area. The venue required significant refurbishment which was undertaken by both the members of the Shed alongside offers of support from local businesses and contractors. The Shed is now a warm, welcoming place for a number of men in the area offering a variety of activities, a chat and peer support.

Case study – informal social support

Mrs A is a lady in her 90s who lives alone at home. She is independent in all daily living activities, keeps in good health and remains relatively active. Mrs A does not receive any formal social carte support. However, Mrs A uses a walking stick and has difficulty managing and negotiating stairs and uneven surfaces resulting in her feeling less confident about walking outside without support.

Mrs A became socially isolated at home and did not have any family living locally who were able to visit on a regular basis.

The Local Area Co-ordinator for Older People introduced Mrs A to a number of different clubs and groups in her local community, negotiating transport and support from the volunteers who assisted in the clubs. The groups that Mrs A attended provided transport and volunteers were available to assist Mrs A in and out of the venues. Mrs A was also supported to link in with a volunteer at her local church who assisted her to attend the service on a weekly basis.

Mrs A describes the experience of being supported to access her local community clubs as “life changing”. Mrs A thoroughly enjoys the experience of being out in her local community and meeting new friends. Mrs A’s family are encouraged that she is enjoying a better social life and that she is no longer isolated at home.

The OPLAC team received a letter from Mrs A thanking us for the effort and encouragement to support her accessing community assets. She describes her experience as being "life changing" advising that, "her prayers had been answered". Mrs A is thoroughly enjoying the experience of being out within her community, she was able to meet new friends and catch up with the local gossip enjoying the chat and experience of being out of her home a few days per week. Mrs A was encouraged to remain independent living at home being supported by the third sector.

Formal social support – case study

Mrs B is an 85 year old lady living alone. In her 70s, Mrs B dedicated much of her time to her family, visiting her grandchildren on a daily basis, preparing lunch for the school dinner break. Mrs B enjoyed this contact because was part of the family and the routine gave a good structure to her week. At the weekends, Mrs B would often meet with her daughter and go for short walks and visit local restaurants and cafes. Mrs B also attended some local groups in the community including a music group and a club where she played cards with her peers.

When Mrs B was 81 years old, she was diagnosed with cancer which severely affected her mobility and she was no longer able to drive. Mrs B became confined to the house and began to experience some level of confusion.

Mrs B became increasingly isolated at home, reliant on family support, which was limited due to work commitments. As an outcome of the social work assessment, Mrs B began to attend the local Day Centre two days per week. However, following discussions with Mrs B, her family and the Day Centre it was agreed that the group setting at the Centre was not benefitting Mrs B.

The Social Worker met with Mrs B and her family to discuss her future aspirations. Mrs B wanted to be supported to take part in activities that she participated in previously. Mrs B and her family compiled a list of different places she liked to visit including cafes, historical sights, local attractions, streets and towns which were meaningful to her. Mrs B was assessed and allocated an individual budget. Mrs B chose a support provider organisation who would provide a support worker to assist her to visit her chosen places. After each visit, a date was set for the following week to visit a different place and dates were placed on the list so that her family could see where she had been each week.

The support was extremely beneficial to Mrs B and allowed her to remain involved in her community and reduced social isolation. The supported was personalised and tailored to Mrs B and her memories. These were places that held significance for her. The support was used flexible so that if she wished to visit a place further afield, rather than two visits per week, this was reduced to one longer visit.

Mrs B’s main carer, her daughter, stayed locally but continued to work fulltime. This reduced the pressure on Mrs B’s daughter significantly and also met Mrs B’s so cial support needs. The support started when Mrs B was 82 years old and was provided for two years, until Mrs B unfortunately passed away. Mrs B was able to access the social support she needed to live the life she would have wanted.

Engagement methods

During the period 1st July to 31st October 2021, the HSCP undertook a period of engagement with our stakeholders.

Following a benchmarking exercise across Scotland, a survey was developed which focused on gathering views about future models of social support for older people in East Dunbartonshire.

The survey comprised of nine questions:

1. In what capacity the person was participating in the survey i.e. service user, carer, etc
2. What principles and values were associated with the provision of social support for older people?
3. What aspirations older people associated with receiving social support?
4. What types of social support and activities can make a difference?
5. What activities did older people miss during the pandemic period?
6. What can community groups and clubs offer older people?
7. What help should be given to community groups and clubs to assist them to continue to support older people?
8. When do older people wish to attend social activities i.e. days, evenings, weekends?
9. What should be the future vision for social support for older people?

The survey was available in a variety of formats: a web version, a paper version, via telephone interview or by participating in a virtual focus group.

An invitation to participate in the engagement process was sent to local community clubs and groups, churches, local village/town halls, current Social Work customers in receipt of social support via day centres or alternative types of formal social support. The survey was also made available to all other key stakeholders including staff working within East Dunbartonshire HSCP.

The survey was advertised on the Council’s and HSCP’s social media pages so that any interested party could participate.

Social Work practitioners also invited customers and carers who, following assessment were eligible to receive formal social support, to participate in a survey about what type of social support they had chosen and why.

The survey comprised of ten questions:

1. In what capacity the person was participating in the survey i.e. service user or carer
2. What prompted the person to choose Day Centre support (if applicable)
3. What prompted the person to choose Alternative to Day Centre support (if applicable)?
4. Whether the person had attended any community groups in the past and what benefits they received from attending community led assets
5. Why the person felt that attending a local community group would not benefit them now
6. What was the person’s expectations from receiving formal social support?
7. What activities the person likes participating in
8. Whether the person would attend a Centre or activities in the evenings or weekends
9. What the person thinks will be the impact of attending formal social support
10. What the carer thinks will be the impact on the person attending formal social support (if applicable).

This survey was carried out with customers and carers in person or via the telephone following the assessment process.

It was imperative that in order to develop a five year strategy which focused on developing models of both informal and formal social support that the HSCP provided an opportunity for as many stakeholders as possible to participate in the engagement process.

Reference was also made to the consultation survey that took place in 2020 by the Council’s Housing Department, in partnership with the HSCP. The ‘Older People and Specialist Housing Research’ was published in September 2020.

Feedback and analysis

‘Social Support for Older People Survey’ – July to October 2021:
174 people participated in the ‘Social Support for Older People’ Survey:

The majority of respondents (78%) chose to complete paper copies of the survey whilst 22% opted to complete the web version. No one requested a telephone interview. One person did nominate themselves to participate in an online focus group however this did not take place due to lack of nominations.

When asked “What principles and values were associated with the provision of social support for older people?” the majority of answers included:

• Emotional, physical and mental wellbeing
• Support to maintain and promote independence
• Dignity, equality, respect, caring, honesty and diversity
• To give older people a safe place to enjoy the company of others and to help them engage in activities
• Keeping people safe
• Feeling included
• To receive culturally aware support.

Participants were asked “What aspirations older people associated with receiving social support?” The majority of answers included:

• Meeting people from the local community and keeping connected
• Develop social skills and confidence
• To support mental, physical and emotional wellbeing
• Be creative and participate in activities that stimulate the mind and physical wellbeing
• Social interaction with peers
• Dignity, companionship and inclusiveness
• Make new friends and promote independence
• Opportunities for the local Black, Asian, Minority Ethnic (BAME) community to meet.

We asked participants what types of activities were of benefit when attending local community led clubs and groups. The answers were varied but in the main included:

• Activities the stimulated the mind and gave a sense of inclusiveness
• Singing, dancing and music
• Quizzes and games
• Light exercise and activities that stimulate physical wellbeing
• Eating a meal with other people
• Making new friends
• Chatting and reminiscing.

The respondents from the BAME community felt that there were no local community assets that met their cultural needs or allowed them to connect with the community.

Participants were asked “What activities did older people miss during the pandemic period?” The majority of respondents all agreed that the following aspects of social support were greatly missed for the last 18 months:

• Social contact and company
• Seeing friends and family
• Eating with others
• Getting out in the local community
• Lack of mental, physical and emotional support.

Many respondents cited feeling lonely, depressed and anxious during the pandemic period.
We asked participants “What community groups and local clubs could offer older people”. The majority of respondents stated:

• Social interaction
• A sense of belonging
• A sense of community
• Peer support
• Opportunities to make new friends
• A sense of purpose
• A structured programme of activities.

The majority of respondents from the BAME community felt that this question was not eligible to their circumstances and advised that, apart from the day centre, there were no local community assets that met their cultural needs or allowed them to connect with the community.

We asked what “…would help local clubs and groups continue to offer support to older people…” Most responded with:

• Funding
• Staff support
• Increased Volunteers
• Transport
• Greater awareness of what is going on in the community
• Accessible accommodation and venues.

The BAME community respondents advised that the continuation of a day centre dedicated to their cultural needs was extremely important.

The HSCP wants to ensure that investment in and support for older people social support, both of an informal and formal nature, is delivered at times when older people and their families feel would be of most benefit. We asked participants when they would prefer that social support opportunities took place:

Some additional suggestions were received:

• Evenings and weekends on special occasions such as Christmas
• Evenings during the summer months.

We asked participants “What should East Dunbartonshire Health and Social Care Partnership’s vision for older people’s social support be?” We provided five suggested focus areas for the future of social support for older people over the next five years

1. focus on supporting older people to remain connected to their community through opportunities to attend local community groups and clubs
2. Local community groups and clubs have access to volunteer support for older people who require practical assistance while in attendance
3. Local community groups and clubs have access to formal support for older people who require personal assistance while in attendance
4. An outreach support service for people who are eligible for formal support to support them to attend local community groups/activities
5. A day centre which focuses on supporting those older people who are most vulnerable/at risk.

Some other suggestions were received which included:

• Supported referral pathways to local clubs and groups’
• A person centred approach within local community led resources
• Different sessions at the Day Centre for people with advanced dementia.

The BAME community respondents advised that:

• The Day Centre is a unique service which provides a lifeline for its service users who are unable to communicate within other community groups or local clubs
• The HSCP requires to support the BAME community in respect of social support.

This means that the outcome of the engagement survey is that the HSCP should focus and fund the priorities relating to:

1. A day centre which focuses on supporting those older people who are most vulnerable/at risk
   AND
2. A focus on supporting older people to remain connected to their community through opportunities to attend local community groups and clubs.

Twelve people participated in the ‘new customer’ engagement survey, of which 80% was answered by the customer’s unpaid carer and/or legal representative.

All 12 new customers, eligible for formal social support, had chosen to attend a formal Day Centre rather than receive one to one alternative to day centre support. When asked why customers would prefer to attend a Day Centre type setting most advised that the Centre provided a safe and secure venue, offering peer interaction with other older people. Many indicated that that they or the customer were no longer able to access the outdoors without support and that the Centre provided a structure and routine to their week.

“…greatly benefit from social interaction within a group setting…”
…isolated due to mobility impairment and frailty…”
“…can no longer access outdoors…”
“…heard good things about the Day Centres and the services they provide…”
“…surrounded by peers to encourage stimulation and chat…”
“…social stimulation in a safe and secure environment…”

When people were asked whether they had attended community groups in the past and the benefits that they experienced from attending, most of the survey participants (95%) had previously attended community led assets and enjoyed meeting their friends.

“…my father attended various groups…”
“…my mother enjoyed attending various venues…”
“…she was a sociable person so this helped keep her active and involved in her community…”
“…a member of the local golf club…enjoyed the social aspects of being surrounded by friends and other golfers…”
“…attended a local resource…prior to COVID-19 lockdown…”
“…attended Centres prior to COVID-19…”
“…played golf and bridge…enjoyed the company and the competition…”

Survey participants were asked if they had previously attended community resources, why they felt that these assets were no longer suitable, 100% responded that they or the customer had seen a significant decline in their physical health, mobility and/or confusion caused by Alzheimer’s or Dementia.
Many indicated that the provision of formal social support in a Centre setting would mean that they or the customer would receive support with their personal care and supervision whilst enjoying the company of other older people.

“…cognitive decline and poor mobility travelling outdoors…”
“…requires support with her personal care, mobility…requires to be cared for within a formal care setting…”
“…general health is very poor and there is a marked decline in her memory…”
“…little concept of danger and risk…”
“…requires a wheelchair when outdoors due to poor mobility…”

The survey then asked what their expectations were from attending a formal social support setting. The majority of participants stated that they or the customer would receive social stimulation with other older people in a safe and secure environment, whilst some carers acknowledged that this would also provide them with a break from their caring role.

“…social stimulation and peer support to encourage chat and interaction in a safe environment…”
“…enjoy social chat amongst her peers reducing social isolation…”
“…will enjoy the company of others…share the same interests”
“…I will enjoy time away from my caring role…”
“…attending day care will reduce social isolation…”

When participants were asked what activities they or the customer liked taking part in there were a number of variations including: amateur dramatics, martial arts, reading, singing, dancing, chatting, listening to music, and quizzes.

When participants were asked whether they would attend a Centre or social activities in the evenings or at the weekends, 8% of those surveyed advised that they would not wish to attend Centres or activities outwith Monday to Friday daytime. While 92% of those surveyed were open to attending social support outwith daytime hours, 63% stated that they would not wish to attend in the evenings.

The customers, who would be attending the formal social support, were asked what the impact for them. Many responses cited no longer feeling socially isolated and having a better quality of life.

“…quality of life will improve….something to look forward to…”
“…enjoying social chat and activities in a safe environment…”
“…improve her social life and break up her week…”
“…bit more structure to the week…”
“…not feel so isolated…”

When unpaid carers were asked what the impact would be for them when the cared for person attends the social support activities, many responses talked about knowing the person was in a safe environment with people to support them, whilst also providing the unpaid carer with a break from their caring role.

“…relax in the understanding that my father is being cared for within a safe environment…”
“…I can relax and not worry at work…”
“…give me piece of mind to know she was getting out as well as receiving the care she requires…”
“…time away from my caring role…”
“…receiving the socialisation and company that he misses so much…”
“…a break to recharge and have a bit of time for myself…”

The survey of older people regarding their current and future housing needs also identified issues relating to social support and community capacity.

When older people were asked about potential problems with their current home, 6% of the respondents states that ‘not being close enough to local amenities’ was a serious issues, as was ‘not having good transport links’ (6%), and ‘feeling isolated and lonely at home’ (5%).

42% of the older people responding to this survey, aged between 65 and 74 years old advised that their household included someone who had a health condition and/or long term disability. This percentage rose to 67% for the respondents aged 75 years and over.

Participants were asked whether they needed any support or care to help them to live independently. 9% of older people who responded confirmed that they received care provided by family and/or friends, while 6.4% received support from a care agency arranged via Housing, Health or Social Work. 1.4% of the respondents advised that they organise their support using a direct payment, and 1% arrange their support via a care agency, arranged by the respondent themselves. 1.4% of the respondents stated that they felt they needed support but that it was not provided at that moment while 82.2% advised that they did not have any support needs.

When respondents were asked what the main reason was for not receiving support or care via Housing, Health or Social Work, 8.1% advised that they did not know what help was available and were unsure how to find out about support services. Some of the older people who participate in the survey advised that they were considering moving out of their current home and when asked for the main reason leading to this decision, 2% stated that it was due to a lack of facilities nearby.

Participants were asked to consider what they felt were important facilities/amenities in respect of where they live, 29.8% stated that it was essential to have access to leisure services, and 19.8% of the respondents stated that it was essential to have communal areas and organised activities (sheltered housing).

When asked about what older people felt were the most important factors when considering where to live, 37% of the respondents felt that it was essential to be ‘part of a community’ and 34% stated that it was essential to have contact with ‘people their own age’.

What is an ‘Options Appraisal’ and why do we undertake an Options Appraisal?

An Options Appraisal is a way of ensuring that you maximise the chances of securing the strategic objectives by identifying the most appropriate set of actions or outcomes

An Options Appraisal provides the opportunity to help the HSCP and its key stakeholders make an informed and evidence based decision on how to deliver social support for older people. It does this by considering the relative advantages and disadvantages of a number of different delivery model options (including the current way in which the service is delivered).

The methodology assists the HSCP and its key stakeholders to consider the relative desirability, viability and feasibility of the different options, and to explore if there are:

• Better ways to achieve the vision and objectives
• Better ways to align to the HSCP’s strategic priorities
• Better ways to use the resources available
• Better ways to achieve the desired.

The Options Appraisal can provide a clear outcome by identifying the preferred model of delivery which can then be developed in greater detail in a Commissioning Delivery Plan (if determined the service should be purchased) and/or a Service Development Plan, if the preferred model is in-house provision. The process engages the key stakeholders and identifies the priorities for their perspectives. Whilst the Options Appraisal is important in assisting to identify the preferred option, the HSCP and its key stakeholders will not necessarily resolve all of the questions at this stage.

The HSCP and its stakeholders, in considering the desirability, viability and feasibility, needs to consider whether:

• Each option meets the strategic objectives and priorities of the stakeholders
• Each option is financially viable and sustainable
• And the degree to which each option can be implemented within budget, resources and timescales.

By following these themes, the HSCP and its stakeholders can reach a final recommendation about the preferred delivery model. The actions required to implement the preferred model will be captured in the Commissioning Delivery Plan and/or Service Development Plan.

The options

Each of the options were considered using the following criteria:

Desirability:

• Promotes the objectives of the HSCP and its stakeholders
• Helps older people to enjoy opportunities for social and peer support in their local communities
• Promotes integrated working.

Viability:

• Delivers value for money
• Allows funding to be invested in promoting community led support for older people
• Aligns with market conditions
• Allows services/groups to develop and access external funding.

Feasibility:

• Can be implemented within required tolerances (i.e. budget, time etc.)
• Allows HSCP to manage reputational risk
• Allows HSCP and its partners to discharge relevant statutory functions
• Exposes the HSCP to risk of challenge.

The factors within each of the three criteria categories were given a weighting score and each option assessed against these categories

The Options considered in the appraisal:

1. The provision of three formal Day Centres for Older People, as per existing provision;
   In partnership with third sector partners, promoting and supporting existing community led support assets;
   In partnership with third sector partners, promoting and support the development of new community led support assets, exploring funding opportunities to aid establishment.
2. The provision of two formal Day Centres for Older People, one in the West locality and another in the East locality, with opportunities for outreach support;
   Establishment of two new large community led support groups with access to formal support, one in the West locality and another in the East locality;
   Employment of a development worker for one year to support the BAME community to develop locally based peer support groups;
   In partnership with third sector partners, promoting and supporting existing community led support assets;
   In partnership with third sector partners, establishing an annual grant fund to support the development and establishment of new community led assets, whilst providing support to explore funding opportunities to aid sustainment.
3. The provision of one large formal Day Centre for Older People;
   Establishment of two new large community led support groups with access to formal support, one in the West locality and another in the East locality;
   Employment of a development worker for one year to support the BAME community to develop locally based peer support groups;
   In partnership with third sector partners, promoting and supporting existing community led support assets;
   In partnership with third sector partners, establishing an annual grant fund to support the development and establishment of new community led assets, whilst providing support to explore funding opportunities to aid sustainment.

Options appraisal scoring

Criteria/Options

Maximum Score Available
Desirability  216
Viability       216
Feasibility    216
Total Score   648

Option 1
Desirability  142
Viability        52
Feasibility    188 
Total Score  382

Option 2
Desirability  208
Viability       196
Feasibility    170
Total Score  574

Option 3
Desirability  196
Viability       176  
Feasibility      88
Total Score   460