Pivotal

Isolation and loneliness can be emotionally devastating for older adults. They are also a trigger for high levels of demand on health services, including on GPs and A&E. Reducing loneliness can cut costs for the NHS, as well as improve the quality of life for the people involved.

Loneliness has a negative health impact comparable to smoking up to 15 cigarettes a day, according to one study. It is associated with an increased risk of heart disease and depression, as well as cognitive decline that can trigger worsening physical and mental health. Tackling loneliness and isolation as part of an ageing–well strategy is essential not just to support the emotional and physical health of the population, but also as part of an effective approach to best manage resources.

An innovative project in Mid and East Antrim, IMPACTAgewell, addresses loneliness amongst older adults. It has been recognised as a demonstration project of best practice in social care, with a recommendation that its operations are replicated across Northern Ireland and the rest of the UK. 

IMPACTAgewell connects individuals with services provided by various community groups, including befriending, walking groups, lunch clubs, ‘good morning’ calls, decluttering, benefits reviews, meal deliveries and bereavement counselling. Empathy and strong communication skills from IMPACTAgewell staff are equally important. Isolation, especially after the death of a partner, needs a sympathetic ear.

Relationships between IMPACTAgewell and partner agencies are facilitated by social prescribing, with fees attached to each referral. Social prescribing is at the heart of the delivery of health and social care services in the rest of the UK, yet Northern Ireland has neither a statutory funding stream for social prescribing, nor any policy supporting it. Other social prescribing projects in Northern Ireland have been financed by the National Lottery rather than government, as is the case in England and Wales. 

Referrals to IMPACTAgewell come from GPs, social workers, pharmacists and other agencies – as well as family members – and IMPACTAgewell facilitates close relationships between members of these disciplines.

There is clear evidence of cost–effectiveness from the operations of IMPACTAgewell, which operates across Ballymena, Larne, Carrickfergus and their large neighbouring rural area, where parts of the population are at particular risk of social isolation. Every £1 spent has generated savings of £2.38, through fewer GP appointments and admissions to A&E. 

Even greater savings were achieved when the service enabled community pharmacists to make home visits. These checked that the correct medications had been dispensed, are being used correctly and not alongside other drugs that together produce negative side effects. Those reviews produced a saving of £5.81 for every £1 spent. Sadly, home visits by community pharmacists ended when their funding in Northern Ireland ceased at the end of 2022. 

At present, funding for IMPACTAgewell is in place only until the end of the 2024/25 financial year, with the risk that a proven model of care that saves money could cease operation beyond that time. Without advance funding certainty, projects in the VCS are always vulnerable to the loss of key staff. 

Government in Northern Ireland claims to be committed to evidence–based policy making and co–production with service users. Continued funding of this model of care, and its replication across NI, represents a test of those commitments.

While recommendations from the project have been made for use across the UK, specific recommendations have been made for Northern Ireland arising from IMPACTAgewell.

1. Tackling isolation and loneliness is core to improving health outcomes and quality of life, especially for older adults.
2. The IMPACTAgewell demonstrator model for supporting elderly adults works well and should continue and be replicated across Northern Ireland.
3. Social prescribing is a valuable process for supporting the VCS delivery of care services, yet there is no policy, strategy or statutory funding for social prescribing in Northern Ireland. This needs to be corrected.
4. The Integrated Care System (ICS) is the new structure in Northern Ireland for taking a coherent approach to planning and delivery of care, recognising the wide range of services and departments that impact on care. The VCS is integral to delivery of social care. It requires funding certainty and strategic influence, including through ICS boards.
5. There needs to be a clearer strategy in relation to pharmacy provision, including the re–establishment of funding for community pharmacies.
6. Community transport is a core service for health and social care outcomes for vulnerable people without personal transport. Its importance for the Department of Health will increase as the programme of hospital reforms accelerates, yet the services are funded by another department.
7. Ethnic minority arrivals into the UK would benefit from explanations soon after arrival with regard to the health, social care, social housing and welfare benefits systems.
8. Government value for money service assessments should consider inputs and outcomes across the public funding spectrum, not limited to a single departmental budget.
9. Staff morale, churn, vacancies, recruitment and pay need to be addressed in the public and related health and social care sectors as a matter of urgency.
10. The absence of government and forward budget certainty undermines confidence, planning and efficiency in the public and voluntary and community sectors.

IMPACTAgewell is the first Northern Ireland Demonstrator in a UK wide programme – IMPACT (Improving Adult Care Together)– which is based at the University of Birmingham, with Ulster University as the Northern Ireland partner. The programme is financed by the Economic and Social Research Council and the Health Foundation with the objective of embedding best practice in social care delivery. IMPACTAgewell has also received financial support from the Dunhill Medical Trust.

Further details of IMPACTAgewell and the Demonstrator

Paul Gosling has been employed by Ulster University since March 2023 as Strategic Improvement Coach to support IMPACTAgewell and IMPACT.