How to… tackle loneliness and social isolation

With one million people aged 65 and over in the UK reporting they are often or always lonely, few would refute the need to tackle this issue.

However, loneliness and social isolation are conditions that are difficult to identify, complex to address and hard to resolve. The evidence base for interventions to address the problems of loneliness and social isolation is emerging but inconclusive at this stage.

In September 2017, the Social Care Institute for Excellence and Renaisi organised a seminar with commissioners, local authorities and third sector representatives to explore the opportunities and barriers faced by commissioners seeking to address social isolation in older people.

It recently published a briefing paper drawing on the discussions from the seminar, and previous research and evaluations in this field. This is an edited version of that paper.

The impact of loneliness and social isolation
Loneliness can affect people at any age, but the focus of this report is on older people. There are many ways to define, and differentiate between, loneliness and social isolation.

The impact that loneliness and social isolation can have on the physical, mental and social health of isolated older people is well documented. The Campaign to End Loneliness points to research which shows that lacking social connections is as damaging to health as smoking 15 cigarettes a day. Lonely individuals are more likely to visit their GP, use more medication and have a higher incidence of falls. They are also more likely to enter early into residential or nursing care.

Holistic approach is required
The main message from the seminar was that it is impossible to identify one ‘magic’ intervention for all lonely adults. The states of loneliness and isolation may be context-specific, so while an intervention in one setting works for one person, in another it might fail them completely. Also, individuals often respond differently depending on their circumstances. A ‘holistic approach’ is required when designing and commissioning services focused on individuals. Solutions need to be flexible enough to respond to individual preferences, expectations and aspirations.

Challenges faced  by commissioners and those delivering interventions:
The importance of a ‘smorgasbord’ of interventions for use in primary, secondary and tertiary settings has been emphasised. The Campaign to End Loneliness has developed a framework which sets out the full range of interventions needed from stakeholders across the community, health and social care sector to support older people experiencing, or at risk of experiencing, loneliness. It suggests a strategic approach that combines identifying and using community assets, at neighbourhood level, using volunteers and fostering a positive attitude to ageing.

However, this has inherent challenges for commissioners in local authorities and clinical commissioning groups (CCGs) in a context where the drive to be cost effective can take precedence. Commissioners need to feel confident that the services they commission avoid duplication and are efficient. Many organisations working to address social isolation are operating at a small scale and are funded for short-term projects, and may not even be on a commissioner’s radar. While services offered by larger national charities are undoubtedly a crucial part of the picture, the current system risks excluding smaller providers, and missing out on innovation and the chance to take a risk on pilot approaches.

Challenges and barriers experienced by commissioners
Commissioning challenges:

• Local authority systems are set up with the expectation that the activity under contract can be monitored against agreed benchmarks.
• Commissioners require evidence of effectiveness that summarises impact and enables them to demonstrate how they are helping to grow the local market in line with Care Act requirements.
• Systems may not be flexible enough to enable the commissioning of small amounts of service provision – ‘block procurement’ is often a more practical solution.
• Local authorities may have certain requirements for insurance cover or health and safety procedures.

Challenges and barriers experienced by smaller organisations in the current system

Provider challenges:

• A smaller organisation may be unable to respond as required as their monitoring and accounting procedures may fall short of public sector expectations – and they lack time above project delivery to fulfil the requirements.
• Smaller organisations may not have knowledge and data that commissioners need to inform their commissioning decisions – particularly on longer-term outcomes.
• Volunteers often primarily staff small services and schemes, making it hard for them to promote their services and to respond quickly and comprehensively to project proposals.
• Smaller providers may struggle to consider or prioritise these requirements due to lack of funding above and beyond project activities.

How can these challenges be overcome?

Despite some of the wider challenges in the commissioning landscape, there are numerous examples of ‘brave commissioning’ of services.

Some of the commonly identified enablers that help commissioners to overcome barriers and support different approaches include:

• Political and leadership support – where there is commitment from the top, and existing structures such as Health and Wellbeing Boards support joint approaches across local authorities, the NHS and other parts of the public sector.
• Honest dialogue – co-producing services and solutions with local residents to ensure that a range of interventions are in place that meet people’s needs.
• Using Better Care Funding (and other financial levers) to prioritise preventative approaches to loneliness and social isolation.
• Committed individuals with the flexibility and support to push through different approaches.
• Being pragmatic – accepting that some new initiatives need longer-term funding to give them time to embed.

Examples of good practice include:

• Lambeth Council Community Connectors. These posts, jointly funded by the council and the CCG, are managed by Age UK and supported by volunteers. People self-refer or come via their GP or a social worker to access services. Community Connectors link people in their local community with activities and organisations that can help improve their quality of life. This can include connecting people with relevant wellbeing and health services, local community groups and organisations and social groups.
• Social Finance Reconnections Project. Reconnections is aimed at reducing loneliness and isolation for 3,000 people over the age of 50 in Worcestershire. It provides one-to-one tailored support for lonely older people who co-develop an action plan to establish ways in which they can (re)connect with a variety of local support networks. It is funded by a Social Impact Bond, and is being evaluated as part of the Commissioning Better Outcomes Fund evaluation. Find more information from Worcestershire Reconnections Social Impact Bond .
• Friends of the Elderly (FOTE) provide a range of services including befriending in the Woking area. A paid worker coordinates the service. Volunteers commit to a one hour weekly visit, although in practice many do more and build sustained relationships. For the past three years, they have held coffee mornings in a sheltered housing scheme where there are no longer wardens to support older residents. The local authority is looking to recommission the service.
• Local area coordination is a long-term, asset-based approach where people are supported to stay connected, build links, find practical solutions and pursue their goals. There are no eligibility criteria and coordinators have time to work with people in depth. Wigan was mentioned as one example of good practice where an asset-based approach extends across the whole area. Find more information from the Local Area Coordination Network .

• Read the full briefing here.