Inquiry into loneliness and isolation

The Committee will aim to assess the extent and impact of loneliness and isolation experienced by people in Wales, particularly older people, and how it can be addressed, by considering:

Why particularly older people???? This is a serious issue across the whole age range, particularly for vulnerable groups such as those with disabilities, especially those which affect social function such as Autism Spectrum, Mental health, and some neurological conditions. It affects people who are unemployed and living in poverty in rural areas, or areas which are otherwise wealthy, including commuter belts. It is a serious problem for new mothers, again particularly if they have moved into an area and have no social networks. In mental health we have managed to get this recognised in the Together for Mental health delivery plan as a whole age range issue. This can also be a real problem in inner city areas and where communities are not stable with houses being bought and sold, or tenants moving in and out frequently. It can particularly affect transient communities such as students, and may be a part of the reason for the onset of psychosis often first presenting in students living away from home. It can be a problem for self-employed people in jobs that don’t involve a lot of contact with people, and also for carers of any age. As an intelligent person with Aspergers I have experienced loneliness and isolation – not always from not being in the same place as others, but from not being accepted and included in those settings, from an early age. I was particularly isolated (not in contact with others for about 22 hours a day) from the end of my pregnancy and when my son was little, which contributed to peri-natal mental health problems and since I developed mental health problems again at the age of 38 following unemployment due to work-place bullying.

· the evidence for the scale and causes of the problems of isolation and loneliness, including factors such as housing, transport, community facilities, health and wellbeing services;

In my work with people with mental health problems I have not heard any stories of people’s experience that has not included loneliness and isolation, as a factor in the development of their mental health issues. I believe there is an evidence base for the destructive influence of loneliness and isolation on mental health for people of any age, although I cannot give you the references I’m sure a lit search would furnish them.

The level of stigma and discrimination at all levels of Welsh society amplifies this once mental health problems set in. The Time to Change Wales project has created even more felt stigma and discrimination for those with mental health problems expected to work for nothing to give presentations, act as champions or lead projects. It feels demeaning, exploitative and deeply unjust that the people who suffer as a result of stigma and discrimination are expected to sacrifice themselves by working for nothing to right a wrong that they did not cause. Those involved also get totally inadequate and insufficient support, creating a real risk to them in this work. The project has put many mental health service users out of work who were delivering training on mental health awareness for a fair income. The emphasis on negative experiences, rather than on showing what we can achieve, and what we have in common with those who do not have mental health problems just exacerbates the ‘poor thing’ mentality that we are trying to escape. It is deeply humiliating to be treated in this way, and leads many to shy away from social contact to avoid it. The attitude that people with mental health problems should not be paid for essential work is deeply entrenched in all levels of Welsh public life, with service user and carer representatives usually being the only people round the table in high level committees who are not being paid. The use of time banking to avoid paying a minimum wage is unacceptable, and should not be tolerated. This attitude is particularly entrenched in our biggest mental health charities, who continue to get Welsh government funding and seats on government committees despite this engrained blindness to the consequences of keeping people with mental health problems in poverty, and re-enforcing their feelings that they are not valued by society. The poverty this condemns service users to, is an added factor in isolation.

The difficulty accessing appropriate treatment, such as emotional coping skills courses and interventions for people with mild to moderate problems exacerbates the problem, and increases the number of people who go on to develop more severe problems. Stress management courses which are poorly delivered or over-crowded are putting people off seeking help. The evidence base for skills learning is that didactic courses make very little impact. Rooms full of people are not accessible to people who suffer high anxiety in large groups. If we are looking for evidence base and environments which support building relationships and friendships then the stress management model should be one with an interactive style and small group work as well as refreshment breaks where people can get to know each other.

It stuns me how new developments for leisure and health facilities are increasingly being built out of town away from public transport hubs. Many hospital facilities cannot be accessed by visitors using public transport as it is impossible to get there and back in a day. This means that people on wards cannot have visitors. In Carmarthenshire there is a persistent tendency to place mental health, and now a new health development in Llanelli, which is in the furthest South Eastern corner of the region. Hywel Dda is an area with very poor public transport links, especially between counties. The new psychotherapy service has been placed a good 20 minutes walk from the nearest bus stop, on a route that has only 5 buses a day. Great if you have money enough to have a car, but excluding anyone who doesn’t, who cannot walk an hour each way from the local station/bus station.

Local Authority Gym facilities are a really important way to improve life for people with mental health problems, but the prescription scheme in Carmarthenshire limits the hours of access to the gym, so that I cannot get there by public transport in the hours available. Difficulty getting benefits when you have a mental health problem – much exacerbated by PIP introduction, means even the £2 per session Gym fee for on prescription exercise is excluding.

Local education courses are also excluding people now by reducing the number of courses and only giving courses that lead to some kind of qualification – something that not all are able to achieve. They also tend to exclude people who have qualifications already, which means that these people, if they have other disadvantages can become isolated. One local lady with a mental health problem was accessing a pottery class for several years, which kept her stable. After the council introduced a rule that you could not do the course for more than two years, she was soon on an in patient psychiatric ward for several months. This was a false economy. Local education courses need to be recognised as an extremely important venue for vulnerable people of all ages to make friends and meaningful relationships.

· the impact of loneliness and isolation on older people in terms of physical and mental health and wellbeing, including whether they disproportionately affect certain groups such as those with dementia;

It is critically important that isolation and loneliness are not seen as a problem just of older people, and not even a more of a problem for older people than others. It is far harder to be isolated and alone all your life, or at a young age when you see no prospect of this improving. It has physical and mental health effects for people of all ages, with unhealthy life-styles, often addiction to digital media, other addictions, comfort eating, lack of physical exercise and all the physical consequences of that.

For people of all ages the consequences have a huge cost on the health and social services, and impact not only on the individuals but on others in their sphere of influence, such as carers, relatives, neighbours. At present there are far more facilities and community projects for older people and people with learning disabilities to have social contact and quality of life, than for disabled adults who are not in education, training or employment.

· the impact of loneliness and isolation on the use of public services, particularly health and social care;

In the first instance isolated and lonely people may be much less likely to engage with services, because it is too difficult to get there, because their social skills are so poor that they cannot engage or their behaviour is seen as unacceptable, or because they do not value themselves enough, or are too anxious. However, as a result of not getting the services they need at a time when serious problems could be prevented, they are likely to becomesoNormal" style='font-weight: bold; margin-bottom: 0cm'>

1. As the Older People’s Commissioner for Wales I welcome the opportunity to respond to the National Assembly for Wales’ Health, Social Care and Sport Committee Inquiry into loneliness and isolation[1]. This is a much needed inquiry as despite growing awareness around loneliness, urgent action is required to understand the scale of the situation and what needs to be done to address its harmful and far-reaching impacts.

2. There are almost 800,000 people aged 60 and over in Wales, over a quarter of the population; in the next twenty years, this figure is expected to exceed one million. The fact that Wales is a nation of older people should be seen as something positive.

Scale and impact of loneliness and isolation

3. Loneliness and isolation affects people of all ages, but particularly affects the ‘oldest’ old. Whilst 17% of people aged 75-79 said that they feel lonely, this figure rises to 63% for those aged over 80[2]. More than 75% of women and a third of men over the age of 65 live alone. An estimated 9,000 older people in Wales spend Christmas Day alone, and the issue of loneliness and isolation is often more pronounced at Christmas. It is important to remember, however, that loneliness affects many older people every single day of the year. Some older people can go from day to day, week to week, or, in some cases, month to month without seeing anyone, and feeling lonely and isolated can lead to a number of negative health outcomes, including mortality, morbidity, depression and suicide.

4. Financial reductions to ‘lifeline’ community services in recent years - including public buses, toilets, libraries, day centres and lifelong learning - have had a significant impact on the health and wellbeing of older people, making them more susceptible to the dangers of loneliness and isolation. In addition to changes to community services, a number of other ‘trigger points’ can cause older people to become lonely and isolated, including losing a partner, being diagnosed with a serious illness and disabilities, as well as retirement or unexpected redundancy[3].

5. I have previously stated that loneliness and isolation is a public health epidemic in the making[4]. As I highlighted ahead of the Assembly’s debate on loneliness in January 2017, loneliness and isolation are cross-cutting issues that have a serious impact on the health and wellbeing of older people. Research by the Royal Voluntary Service found, for example, that 17% of older people in Wales feel lonely at times, whilst half of all older people say their television is their main form of company. Loneliness and isolation can lead to range of detrimental physical and mental health impacts, and the impact of loneliness on health is as bad as smoking 15 cigarettes per day[5]. Furthermore, it is associated with poor mental health and conditions such as cardiovascular disease, hypertension and increases the risk of dementia by 64%[6].

6. It is in everyone’s interests to ensure that fewer older people are experiencing loneliness and isolation. A preventative approach and making sure that older people are more resilient and less susceptible to loneliness is crucial. Such an approach benefits the individual and reduces the need for costly health and social care services. An intervention such as a befriending scheme, for example, would cost £80 per person per year and can annually save around £300 per person in health and social care costs[7]. The NHS and social care providers simply cannot afford to continue with the current approach towards addressing loneliness: prevention is key.

Ageing Well in Wales and Well-being of Future Generations (Wales) Act

7. The scale of loneliness and isolation affecting older people in Wales is a cause of great concern and needs to be identified and recognised as a local and national priority. It is a priority theme in Ageing Well in Wales, the national partnership programme to improve the health and wellbeing of people aged 50+[8]. Ageing Well is a social movement that focuses on low-cost, high-impact interventions that enable and empower older people to lead healthy, active, safe and happy lives within their communities. By taking a preventative and asset-based approach, i.e. investing in older people, Ageing Well can help to reduce loneliness and isolation and develop age-friendly communities across Wales. Ageing Well provides an online resources hub to help address loneliness and isolation in communities, and a forthcoming guide will provide individuals with advice and support on how to deal with the effects of loneliness[9].

8. I am encouraged by other developments taking place at a national and local level. The national indicators under the Wellbeing of Future Generations (Wales) Act includes ‘Percentage of people who are lonely’, which should help to provide a better understanding of the extent of loneliness in Wales[10]. My recent Guidance to Public Services Boards on preparing their Local Wellbeing Plans includes a high-level aim to reduce the number of older people affected by loneliness and isolation in the Local Authority, and I welcome the recognition of loneliness as a priority within some of the draft assessments of local wellbeing[11].

9. My response to the Public Health (Wales) Bill made it clear that whilst I welcome the Welsh Government’s commitment to producing a nationwide strategy to address loneliness and isolation in its Programme for Government[12], I believe this is such an important issue, facing some of the most vulnerable people in society, that it should also be included within the Bill[13]. Its omission in the current Bill is a missed opportunity and further action is needed to elevate loneliness up the public health agenda.

Research and promoting good practice

10. The breadth, depth and impact of loneliness and isolation in Wales is significant. However, further research is needed to better understand the situation. Loneliness and isolation can affect everyone and transcends geography, ethnicity, socio-economic class, age, sexual orientation and other protected characteristics. There are research gaps and further work is needed to strengthen the evidence base, with more investment and resources to plug these gaps. For example, further work is required to understand how loneliness affects people with a lifelong or limiting chronic condition, people with an acquired disability, migrants and LGBT communities.

11. Further research is also needed to better understand how loneliness affects people across the life-course, and whether certain factors – such as shyness and introversion, or belonging to a certain socio-economic group – have an accumulative effect on people’s inability to access social networks. We need a much more nuanced understanding of why older people in all their diversity are experiencing loneliness and isolation across Wales, the different factors and accumulative effects that can cause loneliness, and a better recognition of the complexity of loneliness.

12. Ageing Well in Wales provides a platform to highlight good practice and research, such as work undertaken by the Centre for Ageing and Dementia Research (CADR)[14], to encourage partners to work together and promote positive interventions that address loneliness and isolation and keep older people active within their communities. Interventions and activities such as Contact the Elderly Tea Parties[15] and Men’s Sheds[16], which enable older people to reclaim their sense of identity and regain social skills and opportunities to re-engage with wider communities, play a crucial role in tackling loneliness and isolation amongst older people.

13. The ‘Camau Cadarn’ project is delivered by the British Red Cross and Royal Voluntary Service and supports older people to improve their resilience and live independently within their community, whilst the Silver Line provides a free confidential helpline for older people who may feel lonely[17]^,[18]. Furthermore, the Campaign to End Loneliness complements Ageing Well aims and outcomes and will deliver a Big Lottery Funded project in Wales, which includes pilots in south west Wales, to identify the root causes of loneliness amongst older people[19].

Community services and assets

14. Further schemes and programmes are needed to address the growing issue of loneliness and isolation. However, these interventions, largely delivered by the third sector, are not enough in and of themselves to address many of the issues leading to older people becoming lonely and isolated. What is needed is a renewed commitment to provide community services for older people and others in Wales. I am clear that the provision of public buses, toilets, libraries, day centres, lifelong learning, park benches, etc. keeps older people active and independent in their communities, and that removing these services exacerbates the loneliness epidemic in Wales. Meals on wheels services have also been affected by funding reductions and evidence suggests that the service is much more than just a meal for older people as it provides much needed social interaction for individuals, particularly those who may be unable to leave their home due to a lack of transport, or due to disability or ill health, and is another crucial preventative service[20].

15. Protecting and improving community services has been a longstanding priority of mine and is a priority area within my Framework for Action. As I made clear in my community services report in 2014[21], I am well aware of the huge financial challenges facing Local Authorities and that non-statutory services, the very services that older people rely on to get out and about, have been closed or reduced in provision as a result of decreasing budgets and dwindling resources. By early 2017, and in the context of Ageing Well in Wales and the Wellbeing of Future Generations Act, action is needed on how to protect and reintroduce sustainable community services so that older people are less likely to experience loneliness and isolation.

16. Building up community assets and delivering low-cost, high-impact services is essential, and new, creative and innovative solutions are required that strengthen older people’s resilience and help reduce the detrimental impacts of loneliness and isolation amongst older people. Local Authorities and others are already delivering innovative, cost-effective schemes that help to ensure that older people are not ‘housebound’ and can get out and about, visit services, friends and family, and participate in social activities.

17. Through the Local Authority Ageing Well plans I am aware of good practice, such as the development of a ‘heatmap’ in Flintshire to help identify people at risk of experiencing loneliness, the introduction of pop-up cafes in rural parts of Anglesey, and activity programmes to address loneliness within extra care schemes and care homes in Carmarthenshire, and further examples are required across Wales. I have previously stated that we need to recognise and utilise our wealth of social capital in Wales and identify ways to make better use of our existing skills, knowledge, experience and infrastructure that keeps older people healthy and active within our communities.

Life skills and improving older people’s resilience

18. In addition to building and protecting community services and assets, the development of life skills in later life should be recognised as another way of addressing loneliness and isolation. The ‘trigger events’ in people’s lives can lead to sudden changes, increasing their vulnerability and making them more susceptible to loneliness. Losing a partner, for example, can have a devastating impact on someone’s life, forcing them to deal with financial or legal matters previously dealt with by their partner, rapidly exposing them to loneliness and isolation and associated impacts. Older people who have been made redundant can also feel the impact of loneliness and isolation very quickly, as a job not only means employment but also a social network that keeps people active within a particular community.

19. Following the Assembly’s Inquiry into Employment Opportunities for People over 50 in 2015[22], I have called for the development of a life skills learning agenda for older people via Ageing Well in Wales. A ‘curriculum’ approach for older people would include the development of financial, digital and wellbeing skills, improving older people’s resilience and enabling individuals to be better prepared for ‘trigger events’ in later life.

20. Improving older people’s financial skills, capability and resilience is an Ageing Well in Wales priority, and this focus should help to reduce the impact of poverty amongst older people and keep them participating in social activities, reducing the likelihood of feeling lonely or isolated as a consequence. Increasing the number of older people who are digitally included is another effective way of reducing loneliness, and I am aware of how iPads, for example, can connect older people with friends and family, improving connections and the sense of inclusion in an increasingly globalised world[23].

21. Whilst digital skills are important to engage with the estimated 35% of older people in Wales who are digitally excluded[24], it is no substitute to human interaction and the development of ‘soft’ skills that enable and empower older people to remain active in their communities. Improving older people’s confidence, after a bereavement or long-term illness, for example, and signposting people to local self-help groups, befriending schemes for older people and/or intergenerational networks can be simple yet effective ways of reducing the impact of loneliness and isolation. Reducing the stigma associated with loneliness is also important and encouraging older people to describe their feelings and identify appropriate help and support is also crucial.

Conclusion

22. This is a much needed Inquiry and I am clear that urgent action is now required to address loneliness and isolation, a growing public health epidemic that is affecting an increasing number of older people across Wales. Tackling loneliness and isolation is slowly being recognised as a priority, however much more action is needed to understand its causes and develop proactive, preventative interventions that help to ensure that older people do not experience loneliness and isolation in the first place, helping the individual and the public purse in the process and recognise that investing in services that reduce and alleviate loneliness and isolation will be fundamental to the delivery of our wellbeing ambitions within Wales. In short, Wales simply cannot afford to have a generation of older place at risk of the harmful, devastating and far-reaching effects of loneliness and isolation.