Response from the Older People’s Commissioner for Wales
to the
National Assembly for Wales Health, Social Care and Sport Committee Inquiry into loneliness and isolation
March 2017
For more information regarding this response please contact:
Older People’s Commissioner for Wales,
Cambrian Buildings,
Mount Stuart Square,
Cardiff, CF10 5FL
02920 445030
About the Commissioner
The Older People’s Commissioner for Wales is an independent voice and champion for older people across Wales, standing up and speaking out on their behalf. She works to ensure that those who are vulnerable and at risk are kept safe and ensures that all older people have a voice that is heard, that they have choice and control, that they don’t feel isolated or discriminated against and that they receive the support and services they need. The Commissioner's work is driven by what older people say matters most to them and their voices are at the heart of all that she does. The Commissioner works to make Wales a good place to grow older - not just for some but for everyone.
The Older People’s Commissioner:
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· Promotes awareness of the rights and interests of older people in Wales. |
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· Challenges discrimination against older people in Wales. |
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· Encourages best practice in the treatment of older people in Wales. |
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· Reviews the law affecting the interests of older people in Wales. |
National Assembly for Wales Inquiry into loneliness and isolation
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.