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INVOLVING OLDER PEOPLE: LESSONS FOR COMMUNITY PLANNING

CHAPTER FIVE conclusions

5.1 Bearing in mind the points noted in section 3.3, conclusions are drawn with reference to the study's four main objectives. These were:

Current picture and future plans in relation to the involvement of older people

5.2 There are numerous opportunities for older people to become involved in influencing Community Planning decision-making. Such involvement could focus on

5.3 There is also a range of well-established mechanisms in place which offer opportunities for older people to influence public services. These include generic and interest group specific mechanisms, as well as ongoing and one-off activities.

5.4 However, the degree of co-ordination and communication within agencies (across departments and between operational and strategic levels) and between Community Planning partners about these activities appears to be very variable. The study identified little evidence of a strategic or co-ordinated approach to the involvement of older people. Involvement was characterised by professionals as organic, incremental and evolutionary. This incremental approach has led to the development of some examples of innovation. However, there are a number of key issues which are not being adequately addressed in order to ensure that older people are effectively engaged in the Community Planning process.

5.5 Some thought needs to be given to the appropriateness of generic involvement and when it is necessary to involve specific communities of interest such as older people or older people from minority ethnic communities. There is evidence that older people, in particular, have been marginalised in the public involvement process (Carter and Beresford 2000) therefore there is a danger of this being perpetuated unless careful thought is given to this issue. At the same time, research undertaken by SCDC supported by the Joseph Rowntree Foundation and the Social Work Services Inspectorate (Scotland) (Barr, Stenhouse and Henderson 2001), revealed that professionals often draw artificial lines between older people and the rest of the community. It is likely that no one approach will be adequate and any strategy should take account of the community as a whole, as well as of specific interest groups within it.

5.6 There is a perception that older people are "over represented" in generic involvement activities. However, there is a lack of clarity about who is involved, on what basis they are involved and whose views are not being represented. More thought also needs to be given to the appropriateness of:

5.7 It is likely that the efforts of both agencies and individuals will be undermined if individuals or organisations are seen as 'unaccountable' or 'unrepresentative'.

5.8 It appears that most often involvement mechanisms have been put in place by single agencies or community care planning partners. There were a few examples of involvement activities undertaken jointly by the main Community Planning partners, although in some cases activities have been extended to meet the requirements of the Community Planning process or there are plans to do so. The majority of examples of involvement activities reported in this study were reported by professionals in the Local Authority and many of the examples given related to community care planning and monitoring. As a result, it appears that many of the older people who are currently involved in shaping public services are 'services users' aged 65 and over. As long as involvement is situated mainly within social work and community care there is a danger that only a very limited range of older people will be asked for their views about a limited range of subjects. Attention needs to be paid to involving a wider range of older people who are not necessarily service users, and to the basis on which they are involved.

5.9 There is a concern that where current activities are not well co-ordinated, there is a potential for increasing what has become known as 'consultation fatigue', whereby a small core of committed activists is repeatedly contacted to give opinions and feedback.

5.10 It is important that a strategic approach is taken and questions are asked about whether current mechanisms are the right ones for involving people in Community Planning, whether existing mechanisms are adequate or new mechanisms are required to involve older people. The location of groups within Community Planning activity needs to be considered as it may be appropriate for such groups to sit nearer the heart of the decision-making processes.

5.11 Within the legislation there is a duty upon Community Planning Partners to evidence how they have engaged with the community. To assist with this process some Local Authorities are already developing strategies for engaging with the community in Community Planning. There would be value in all Local Authorities doing so.

5.12 The Scottish Association of Health Councils et al (1999) identified five steps needed to develop an effective involvement strategy. These included:

5.13 These steps form a continual process of development. Such a process would be helpful in relation to Community Planning. Emphasis would need to be given to ensuring that the process is participative and iterative. There is also a need for a joined up approach to policy making, in relation to involvement within the Scottish Executive as well as within Local Authorities.

The principles of effective involvement

5.14 A number of key elements of effective involvement with older people emerged including:

5.15 It is noteworthy that work undertaken by SCDC and others (Campbell et al. 2000) has shown that these elements are not specific to older people but are transferable across communities of interest.

5.16 Although professionals and older people were able to identify key aspects of effective involvement, they were aware of the difficulties of putting these into practice. From the study, four main areas were highlighted which require attention if involvement is to be developed further. These were:

Tackling barriers to effective involvement

5.17 While there is clear evidence from this study about what older people and professionals consider constitutes effective involvement and there is much literature to support these views (see for example 'Focusing on Citizens: a guide to approaches and methods, COSLA 1998, Community Planning Advice Note 5, 'Effective Community Engagement' http://www.communityplanning.org.uk/documents/CPAdviceNotes5.pdf), the study has shown that these are not consistently applied. For example, the range of methods reported was very narrow. It appears that there are a number of barriers to the implementation of effective involvement principles. The most frequently reported of these were:

the existence of negative attitudes, within services and within society more generally, towards older people and, therefore, low expectations of older people;

older people's low expectations of involvement activities resulting in real changes;

organisational barriers.

5.18 More work is needed to understand the nature of these barriers and their impact on involvement, so that the barriers can be reduced or removed.

Widening involvement and increasing engagement

5.19 In order for a community involvement strategy to be successful it is important to have an active community of interest and infrastructure to support this activity. At present, there is a major issue about the over-reliance of public services on a small number of activists.

5.20 Agencies and older people can each take a role in ensuring that their communities are active. Older people will need resources and may need support to achieve this.

5.21 Improving community involvement demands a multi-level strategy:

(Atherton et al. 2002)

5.22 Community groups at all levels of sophistication should be supported but Local Authorities and their Community Planning partners should in addition aim for both 'horizontal' and 'vertical' growth, that is, growth of activities outwards to include more people and more effective activity, and growth of activities 'upward and downward' to create mutually beneficial interactions between the different levels of activity such as small community groups, well-established voluntary organisations and community representatives on formal committees, for example, within the Local Authority (Chanan, Garrett and West 2002 and Atherton et al. 2002).

5.23 In addition, particular attention needs to be given to the inclusion of people from 'hard to reach' groups. The study did uncover some examples of innovation in this area, many of which were in a narrow field of practice, that is, community care. Less is known about involvement in wider issues, what approaches are effective and 'hard to reach' groups' preferences in relation to how they are involved. Existing members of community groups wish take a role in identifying, supporting and maintaining the involvement of older people who are 'hard to reach'.

Capacity building for professionals

5.24 During the study there were very few examples of education opportunities about involvement for professionals which had taken place or were planned. A need was identified for professionals to hear directly from older people about their expectations of involvement and to undertake education which explores attitudes towards working in partnership with older people.

5.25 Although education needs were not identified during telephone interviews, we are aware that a number of needs analyses are currently being conducted. For example, SCDC are undertaking a capacity building training needs analysis. The Involving People Team at the Scottish Executive Health Department are conducting a training needs analysis of all NHS staff in the area of public involvement. In addition, there are also resources available to structure learning such as the Capacity Building for Community Planning study (Eglinton 2002) which suggested a Learning Development Framework for Community Planning practitioners which incorporates: values and visioning, partnership working, practitioner skills, engaging communities.

5.26 There would be value in undertaking an exercise to develop an overview of the implications of the findings of the current needs analyses and existing guidance on capacity building for professionals in relation to the involvement of older people. These should be considered in conjunction with the findings of this study.

Capacity building for older people

5.27 Few examples of capacity building for older people were mentioned in the course of the study. The examples valued by older people emphasised self-development, confidence building and empowerment. Older people also wanted to define their development needs themselves rather than having training topics decided by professionals.

5.28 There is growing evidence of the value of providing education and support to enable older people to participate as active citizens (Dewar, Dickie and Morrison 2003). Older people were interested in using creative approaches to build their capacity for effective involvement such as buddying and mentoring. Shared development opportunities for professionals and older people were also welcomed.

5.29 Often older people felt that their expertise and knowledge was not acknowledged and used. They suggested that more structured approaches need to be considered to achieve this such as issuing job descriptions for activists who act as representatives on behalf of a group. There is also value in putting in place formal arrangements with voluntary organisations to support capacity building, for example, a service level agreement between a Local Authority and voluntary organisations to provide education, awareness raising and support to activists to be available for consultation and planning. This allows capacity to be built over time and ensures that potential activists have a mechanism by which to become involved.

5.30 Participants in this study had difficulty articulating the outcomes of educational opportunities. To assist in resource allocation for capacity building systematic, evaluation research needs to be carried out to determine the value of these programmes.

Examples of good practice

5.31 The study has identified a number of examples of good practice across Scotland. Examples of good practice have been discovered in relation to hard to reach groups, methods of involvement, capacity building and widening participation.

5.32 Involvement in Community Planning is a developing activity and there needs to be a mechanism for those within agencies and within communities who are active in this area to reflect and learn from each other. The Community Planning Team within the Scottish Executive are encouraging Community Planning Partnerships to bring forward examples of good practice and are using the Community Planning website ( http://www.communityplanning.org.uk/index.html) as a tool for dissemination. They are planning to develop additional means of dissemination. There may be a range of other ways of sharing good practice. These could include:

Improved outcomes

5.33 There were a few examples of improved outcomes of involving older people in shaping public services. However, this study highlighted a need for systematic monitoring, evaluation and reporting of involvement activities. Older people identified a real need to find out about the outcomes of their input as this often prompted enthusiasm for further involvement. Evaluation needs to detail these outcomes but in addition needs to explore process if we are to develop our understanding of effective involvement. Any mechanism for evaluation should be built into the Community Planning process rather than being undertaken post hoc (Thornton 2000). It is also important that older people themselves are involved both in developing the criteria against which success is to be judged and taking part in the evaluation (ibid). Both older people and professionals may need support and education to carrying out the evaluation of both process and outcomes.

5.34 'Communities Scotland - Standards for Community Engagement' is a project which is underway to develop and pilot a set of national standards for community engagement for both agencies and community organizations (for more information, see http://www.communitiesscotland.gov.uk/web/FILES/StdsCommunicationNote.pdf and http://www.communitiesscotland.gov.uk/web/FILES/StandardsNo2.pdf .

5.35 These standards are to be welcomed as they will inform participants of good practice with regard to community engagement and will provide a benchmark against which to measure their own experiences.

Using the lessons learned

5.36 The study has identified a wide range of involvement activities for older people currently in place throughout Scotland. While these initiatives are to be welcomed, Community Planning, as it develops, will undoubtedly provide increased opportunities for dialogue between public services and older people. The challenge will be to take on board the complexities of involvement that have been highlighted by professionals and older people in this report. These include:

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