Loneliness and isolation are public health issues on a par with smoking

With all too regular reports of services failing to ensure even the most basic levels of care and safety, some might argue that loneliness is not the most important problem we face. But loneliness and isolation are public health issues with an impact and cost on a par with smoking.

Alex Fox is CEO of Shared Lives Plus, the UK network for small community services for older and disabled people. The RSA is publishing six short ‘think pieces’ entitled The New Social Care: Strength Based Approaches.

Which is the service that fixes loneliness?

With all too regular reports of services failing to ensure even the most basic levels of care and safety, some might argue that loneliness is not the most important problem we face. However, loneliness and isolation are public health issues with an impact and cost on a par with smoking.

It is a sign of economic progress that many can afford to live in a place of their own, even in later life. But the other side of that coin is that our greater mobility and freedom of choice have helped us to opt out of bonds which used to tie us more rigidly to family and community.

We do not wish to recreate those bonds as they were, but we feel their absence.

It is still early days in the internet connectivity revolution which has allowed us to make shallow connections with people on the other side of the planet, but not yet to reconnect with our neighbour’s neighbour, or to help individuals, family carers and professionals to work as a team.

The challenges of modern life

There should be no competition between investing in tackling the challenges of modern family and community life and investing in services. Many councils have made single digit savings through ‘efficiencies’, but many report needing savings of thirty or more per cent.

It is not realistic to aim to do the same things at two thirds the cost. Instead we must reform the relationship between the state, family and community, enabling people to use their creativity, resources and relationships to the full, without abandoning those who do not already have the ‘social capital’ to do so.

In fact, most of our care and support resource has always been found in families and communities and not the state, whose care budget is around a tenth the value of unpaid family care. So adult services, instead of trying to fit people into service ‘boxes’, should align their interventions with people’s ‘real’ relationships and avoid at all costs undermining them.

This approach is not supported by the current legislative framework. The Bill in its draft form goes some way to address this, but the Joint Committee makes important recommendations on going further.

Shared Lives Plus, Community Catalysts, In Control, Inclusive Neighbourhoods, Inclusion North and Partners in Policymaking based our submission to the Committee on the observation that the current legislative framework creates two very separate worlds: the ‘ordinary’ world of family and community life and what some have termed ‘service land’.

In using ‘gatekeeping’ to reduce demand on services, the current system reserves its resources for reactive and crisis services, not early interventions designed to prevent greater need. So, despite the best efforts of many caring and dedicated professionals, people’s first experience of social care can feel disempowering:

1. Eligibility assessments ask, “Are you vulnerable and needy enough for us to talk to you?”

2. Up-front means-tests ask, “Are you poor enough for us to offer you something?”

3. Complex planning and resource allocation systems suggest, “Our experts have decided upon your category. You’ll need a professional guide to negotiate our care pathway.”

Barriers to support

Even if a person can prove their high level of need, their low level of income and a lack of family care, they may find themselves receiving maintenance-only support and needing to demonstrate their continued dependence to remain eligible.

Given this route into ‘service land’, it’s not surprising that ‘personalisation’ system reforms, designed to be proactive, empowering and creative, have not always had their desired impact. The greatest impact of Self Directed Support – giving people new choices and putting them in control of their support – has often been felt by those with well-established entitlements to significant budgets who can manage a team of personal assistants, or have a relative who can.

Those with smaller entitlements, or fluctuating needs, or who have support needs which are more social than physical, have found life on the borders of ‘service land’ harder.

Current ‘preventative’ interventions are not always the answer. Few early interventions are tested for the risk they may undermine informal networks of support. Many information and advice services only signpost people into ‘service land’.

A ‘strengths-based’ (or ‘asset-based’) approach rejects the exclusive focus upon need, looking first for potential, skills, relationships and community resources. To embed a strengths-based approach, we need the route towards services to start with an easy-access conversation with someone whose job is to inform, empower and connect people, with services as the last not first resort. Australia’s extensively evaluated Local Area Coordination model aims to produce not an assessment but a plan.

We think that this kind of support to plan is so vital to transformation it should be a commissioning duty, which could be discharged by councils through re-focusing their contracts with existing information, advice, navigation, advocacy and brokerage providers. These organisations would become clearer about their shared purpose: to help people to help themselves and each other and to reduce the risk of increasing dependence.

To inform their plan, the individual’s needs would be recorded, but also their strengths and the current and potential sources of support. Rather than eligibility tests being ‘up front’, they would be reserved for those whose needs could not be met in any other way except by services.

A system of this kind may not be able to identify a service to fix loneliness. But it would have the potential to help people to connect with each other to fix their own isolation, whilst also accessing the essential support that they needed to live safely and with dignity in their own homes.

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