 Welcome, everybody, to the Equal Opportunities Committee. It's the seventh meeting of 2015. Can I ask everyone to set their electronic devices to flight mode or switch off, please? I'd like to start with introductions. This morning, we're supported at the table by the clerking and research staff, official reporters and broadcasting services and around the room by the security office and welcome to the observer in the public gallery. My name is Margaret McCulloch and I'm the committee's convener. I'm going to ask members and witnesses to introduce themselves in turn, starting here on my right. For witnesses, can you please restrict your introduction to your name and organisation, please? Thank you, convener. It's signed by MSP Glasgow Kelvin, deputy convener. Laura O'Cock-Forgison from the campaign to win learningness. Good morning. I'm Danny Boyle, parliamentary policy officer with BMS Scotland. John Mason, I'm MSP for Glasgow Shetleston. I'm Grace Cardoso from Dumfries and Galloway LGBT+. I'm Alison Love from Royal Vaughanity Service. Annabelle Goldie, a member of the Parliament of the West of Scotland. Sheila Fletcher from Community Transport Association. Natalie McFadden-White from Impact Arts. Christian Allard, MSP for the North East. Karen Nicoll from the Aberdeenshire Sign Posting Project. Jenny Ridge from A-Science A. John Finnie, MSP Highlands and Islands. Liz Watson, befriending networks. I'm Jane Baxter, MSP for Miss Scotland and Life. Thank you very much. Agenda item 2 is an evidence session on our inquiry into age and social isolation. In fact, it's a typing error. It's an agenda item 1. I apologise, it's my fault this morning. The first agenda item is a decision on taking business in private. Members are asked to agree to take in private item 4, which is consideration of our approach to the race, ethnicity and employment inquiry. Are we all agreed? Thank you very much. Now, agenda item 2. Is an evidence session on our inquiry into age and social isolation. If witnesses or members wish to speak during this discussion, can you please indicate to either myself or my clerk on my left, Ailsa? We're restricted for time today and you appreciate we've got a really high number of witnesses. I'll do my best to ensure that people are given the opportunity to speak and can also ask you to keep your answers as focused as possible so we can get around as many people as possible. I'll begin the questions this morning. Can I ask the witnesses what you have found to be the impact of social isolation and loneliness amongst older people? Is the impact of social isolation understood in the third sector and among service providers such as health and social work services? That's a good start to the morning, isn't it? Who would like to ask the answer first? Will I just pick somebody? Karen, yes. I think that, from our perspective, there are two very definite impacts on physical health and mental health with isolation and loneliness. We find that third sector and statutory sector referers are very good at picking up on the impact and noticing it and taking steps to do something about it, whether it's referring into us or referring into someone else, but we find with an awful lot of our cases. 208 of 282 cases in 13 and 14 were identified as isolation or social contact issues by the referer, referring the client into the project. Certainly, from our perspective, it is being picked up. I certainly agree that there are serious health impacts of loneliness and isolation. Loneliness and isolation has been equated to smoking 15 cigarettes a day and being worse for us than obesity. There are links between cyclical and negative links between depression and loneliness and isolation, and increased risk of dementia, 64 per cent more likely to develop dementia. That is something that the campaign for loneliness has really been emphasising amongst statutory bodies, particularly in England. I would say that, even after three years of work on that, with a number of partners in England, we don't feel that enough is being done there. At last count, about half of the local authorities had prioritised the issue within their health and wellbeing board strategies. We focussed on England partly because we have three members of staff, so when we started four years ago, we had to narrow down. We would definitely recommend a local authority leadership role for the issue. That said, we should not forget the personal impacts and the community impacts. It is not just about health impacts. There are other problems that can be caused by the issue that need to be un-picked in order to solve it as well. Certainly, from my point of view, our organisation, ASIT, is computer training for the older person. We have been running since 2001. From my point of view, we have more of a positive sign that learning computers and the use of the internet in older people has enhanced their quality of life and their mental health and wellbeing. The more information and knowledge that they have, mental stimulation keeps people going. From our point of view, it is very much a positive sign, but I agree that there are issues that we have with another project that we run, which is Moose in the Hoose project, whereby we go into care homes and our team of volunteers help older people in residence to engage using Skype. That is a positive impact. I agree with my colleagues about the impacts that they have described for older people in terms of loneliness. I think that we must not forget the impact that loneliness has on our health and social care services and the cost financially of loneliness, when all those long-term conditions, mental health problems and so on are meaning that older people are relying more on services. That is an important point. Certainly, people are beginning to understand that loneliness is one of the major public health concerns now for older people. From our perspective, statutory and voluntary services do not fully appreciate that older people come in more shapes and sizes than just older people. For our population group, lesbian, gay, bisexual and transgender older people, there is a complete lack of understanding across all sectors and a complete lack of visibility and acknowledgement that LGBT older people are out there within our communities. Where the intersection between old age, rurality, LGBT and ethnicity, where the intersection is a lie, are sometimes places where more of a risk lies for social isolation. Everyone said that through craft cafe there is an obvious reduction in medication for depression and an increase in quality of life, but what is important about the third sector approach through the craft cafe approach is that it is open to all, so it is not for just people with existing conditions. It is a preventative approach, and it is about that community coming together and supporting one another. That is a key value of where the third sector can fit within older people. I know that there are quite a lot of people who want to come in, but we are really working to a timescale. We will move on to the next set of questions. If we get any time at the end, we can come back to issues that you want to bring up that have not been covered. We will move on to John Mason. I have three points, but I will ask them in two bits if that is okay. I will ask the first one first. I hope that this will follow on and overlap with what has already been said in other sections. My theme is about how to reach people. Do people who are isolated and lonely know about services in their area? There might be services in their area, but they are not connecting with them, or do they know about them? Is there an issue with transport? How do they engage with those services, or is it the biggest problem that the services are not there at all? I will bring Liz, then Karen and Sheila. We are the umbrella body that supports befriending services across Scotland. Our information, generally speaking, is that it is not that potential service users are unaware of such services. It is that because befriending services are, generally speaking, underfunded and overstretched, there is such a long waiting list potentially. Although the services are out there, they are patchwork, they are piecemeal, they are not always in the areas of greatest need, and most of them have really long waiting lists. The same posting project exists to link people to services, organisations and groups in their local area, which will be of benefit to them. The thing that we find quite often is that people are very unaware of the services that are available to them in their local areas, partly because they do not know how to find out about them. I am particularly with older people, I think that they may not be too IT literate and they do not know how to use the net to search for things, but also because services and groups erupt and disappear and things change and the people that you would contact have moved on. It can be very difficult for people to know where to go and then to negotiate the barriers. Transport is an issue that we see on a constant basis. We can find things for people, but we cannot necessarily get them there if there are any mobility issues or they are reliant on public transport. That is the same for a lot of rural areas in Scotland. There has always been an idea of this magic database that will contain all the information about all the local services and groups. The minute it is written, it is out of date, and we find that it is a constant updating process. People tend to come to us when either the thing that they were planning on going to find out does not exist anymore or they do not know where to go to start. A perfect example would be a local camera club that we were trying to get someone to access. They contacted the local library and gave us the contact details. It turned out that camera club had folded 15 years previously, so that it is that kind of thing that we are constantly coming up against on a day-to-day basis of finding things. There is a very piecemeal approach to some services as well. They will be available in one town, but not in another. That might involve a trip of maybe 60 miles or more for someone who desperately wants to access something. There are at least two issues in there, one that some services are patchy, but I also suggest that whether they are there or not, people do not even know. Have you got any suggestions as to how we can get over that information? That is our bread and butter. We work a lot with other organisations. We do not just take to referrals for clients. If an organisation is to contact us and ask us if we know of something that exists for a client or a patient of theirs, we will give them that information ourselves. Is your service available nationally or is that purely locally? It is purely Aberdeenshire. It covers the whole of Aberdeenshire. That service is not there elsewhere? There are variations on the theme of popping up all over Scotland, but the service that we are providing is only available in Aberdeenshire. I am from the transport side of things. One of the biggest issues that we have is short-term funding. We know that the benefits of people travelling even on the bus are significant. The build-up social networks with the people that they travel with to various different things. We have had a big loss on the island of lunch clubs, I think that it has happened across the piece, and they are being rebranded as well-being centres run by communities. Short-term funding for those is really making it problematic to keep going sometimes. Transport is the biggest issue. Transport Scotland has carried out a consultant's report, which was issued yesterday. 89 per cent of the people who responded said that they found community transport fairly important in getting to social activities. The people who are using community transport value it, and 50 per cent of the people have no alternative. That is not forgetting that there are vast areas of Scotland that do not have any transport provision at all, and we realise that there is a lot of isolation in those areas. I just wanted to shed some light on people who were not aware of services. When we asked back in 2011 whether older people were aware of any services that could help them if they were to become lonely, 42 per cent of them said that they were not aware. That is despite us reaching those people through service organisations. So you are saying that it might be worse than that? That is because there are other people who are not even aware of it. Other people who might not be being reached. Subsequent surveys with GPs—GPs do have a higher number of visits from older people, and a number of them anecdotally have said that they think that older people are visiting them primarily because they are lonely and not for health reasons. Around 50 per cent of them said that they do not have the tools necessary to help and to be able to refer on, so they would not know where to refer on for help. Organisations themselves might not actually be reaching out. Again, back in 2011, we asked over 100 organisations how they identify and reach out to those who are lonely. The lack of response has led us to start to develop a range of ways that organisations can identify those who are most at risk of loneliness. Some of those ways are working with local authorities utilising risk data, which local authorities have. That should not compromise any personal data and or targeted promotion within certain local areas so that they know that they are reaching maybe those who are more living in areas of most risk. Coupled with something that is really basic, like word of mouth, because that is one of the best ways of actually bringing people in and making sure that they stay and enjoy a service. I absolutely agree that accessible, appropriate and affordable transport is a fundamental thing if we are going to address isolation, but I am aware that in urban settings, old people can become very isolated and sometimes it is because of the design. Sheltered housing is sometimes at the back end of the village or the town where the buses never go and you cannot walk to the shops. I wonder if anyone wants to comment on whether we design in isolation, things such as benches, lighting, signage, paths, muggers alleys, all those things make people reluctant to go out. Is that a common experience? Do you think that that is a factor for older people? I think that is a valuable point. I am just back from an exchange in Japan and I asked if their environmental design was changing because they have a super-aging society, so have they taken into account that older people and how they interact with the environment is going to be more impactful going forward? They said around public toilets and things like that, they have increased and made them more user-friendly for older people. I think that things like benches and places to sit are better-lighting. From our experience of working with social housing partners, this is where we interact and connect with older people. It has been an absolutely vital link for us because they can go to people who are isolated in their home and then connect them into our service, which is craft cafe and within the sheltered housing and care home space. We actually bring the community in, so it is about having a space within the care home where people from outside the care home can access and everyone can come together, so it is breaking down isolation in that way, because you can be isolated even within a care home, not just when you are in your own home. Go back to Alison. I think that you want to come in on John's initial question. Yes, it was just agreeing with some of the other comments that have been said, but also just to highlight that it is a twofold difficulty in terms of the referral source can sometimes be difficult from changes in council and health and social care settings, where staff change, so perhaps people are referring into services quite willingly and then those changes in personnel and therefore you are not getting that continued referral process. From the purposes of the services or uptake in the service, we have found that some of the things that we have put in place is a bit of a person-centred approach, where we send in one of our specialty train volunteers to speak to the older person about what would make their life better, what would make it easier, what could we do to make their life better, and then working with other organisations in the area to put together a package of support to reduce the loneliness and isolation, so working together. So it is a bit of a twofold, and there are difficulties letting the older person know of the services that we have got, so without people referring into us to let us know that the older person is needing help, but also for the older person then being able to access the services around about them. I think that Annabelle is coming back in on referrals actually later. Will I go on to my other? Grace already mentioned LGBT and ethnic minority communities, and that was the other area that I was interested in, that other people from those backgrounds are particularly isolated, so that is thinking about the individual. I was also thinking that somebody from a Pakistani community might have a lot of Pakistani friends or friends from that community, but they do not have any friends outside of that. Is that isolation? Is that a problem, or is that something that we can be relaxed about? Thank you very much. To cover your previous question and the same answer, one of the most important things when we are working with people from ethnic minority communities who also suffer from social isolation is to take into account that not only will they receive the statutory health services that they will receive but have been in the circumstances that they are in. That is not the full picture necessarily, so when we are developing avenues to tackle social isolation that their cultural characteristics are also taken into account when doing that. Sometimes the best places to deliver that service are from within communities themselves, obviously, because they are best avowed at expressing whichever particular characteristics fits the needs of an individual to tackle social isolation. There have been some good examples. We went down to Leicestershire in the past to Leicester, which is one of Britain's only plural communities. There is no majority ethnic group. What we have seen is that areas that had high areas of immigration in our city Leicester, which then followed the patterns of immigration that have happened across Britain, i.e. the Irish community living in Leicester and areas such as Northfields, then Pakistania and so on and so forth, there has been a great crossover between local service providers and the voluntary sector in terms of whether they are aware of an individual or a pocket of a community that is existing in an area of multiple deprivation because social and economic disadvantage exacerbates the loneliness aspect of it and other health inequalities that go alongside it. There has been that partnership approach, so they get the health service provision by statutory bodies and they get the cultural aspect delivered by the community and that gives it that holistic approach. Do you think that that is not happening so much in Scotland? No, it does happen in Scotland, yes, it does. I think it was touched upon at a round table previously. There are some great examples in inner city Glasgow where there is a high concentration of ethnic minority communities where there is a lot of partnership work between mosques and temples and other community groups and organisations and others. However, touching upon your point is what you are alluding to. Is there an element of isolation within isolation of ethnic minority communities, polarising themselves in some aspect? Not from that previous example, which I have just given, also broadening and going forward from that, I have actually followed on from our previous discussions in January, I think it was. Bemis, in conjunction with the Scottish Older People's Assembly, will be looking to address the gaps that they have identified within their membership and body and the services that they have acknowledged. We are looking at the demographics of the areas that we are servicing and people from ethnic minority communities are not using this as much as good. There is a great opportunity there, I think, for a cultural crossover within this environment to progress that element of it. LGBT older adults are much more likely to live alone, be estranged from their families of origin, not to have had children, not to necessarily even have a relationship or a partner, or if they have a relationship or a partner for that partnership to be very isolated from family and communities. We have to remember that homosexuality was not decriminalised in Scotland until 1980. It was still considered a mental disorder until 1992. We are working regularly with older adults, whose reality was imprisonment and institutionalisation with electroconvulsive therapy and hormone treatment. That makes LGBT older people much more resistant to trust services because they have been brutalised by services in the past. It also makes older people much less likely to be tolerant of homosexuality because they grew up in an era where homosexuality was criminalised. That makes LGBT older adults significantly isolated. Add the rurality of Dumfries and Galloway, for example, on the top of all that, and it becomes even worse. Do you have a question about, are we isolating communities even further by pigeonholing them into LGBT or Pakistani? In some ways, we probably are. Our best case scenario is where an LGBT or a Pakistani older adult can go into any lunch club, any daycare centre, any opportunity for an older person and feel integrated and happy and welcomed and supported. The fact is that we are not there yet, and it will be several decades until we are there. We are making huge legislative changes and cultural changes in Scotland with the equal marriage bill, etc. However, we still have a hearts and minds shift, not least for the older generation. Specialist services such as LGBT services for older adults or other LGBT members of the community, I see them very much as a stepping stone that should be in tandem with mainstreaming work to make the rest of communities in the sector as inclusive as they possibly can be. We are now finding that the older adults that we are investing time and support in bringing them together with a social group and making friends are now feeling as a group more confident to access the social culture and leisure opportunities of Dumfries and Galloway, but without the LGBT handholding bit first, they wouldn't necessarily have done that. I just wanted to pick up on the point about being isolated in a care home, and I think, again agreeing with you there, Grace, we, in our most in the hoose project where we help residents use the internet, but we had an awareness training which was run by LGBT for our volunteers, and we found that very interesting and as much that the, some of the residents in care are gay and they might have had a partner who has died and they might have to hide their photographs because they're embarrassed, and it was a very, it was a great learning curve for our volunteers to understand, you know, that there's other people in care who are isolated, and I think the more we have training awareness from LGBT folks like yourselves, the better it is, and I'd just like to quickly comment on also what Liz and Sheila said, going back to John's original question, if about attracting more people, I think if we, ASIT, had more funding, because it's a funding issue, we could do more, but as you say, it's the funding which is the restriction for us, certainly. Thank you. Thank you, John. We'll now move on to Annabelle. Thank you, convener. One issue that the committee is very interested in is where referrals come from, because you're all doing a power of work in your own spheres of activity. So the question is relatively simple, the answer may be a little less straightforward, but we've heard that the majority of referrals are probably self-referos, and I just want to know very briefly where do most of your referrals come from. Now I realise that, as a signposting organisation, this is maybe less relevant to you, and until I listened to you a moment ago in Atelier, I thought maybe it was less relevant to you, but I realised that you are getting referrals from maybe social housing landlords or something like that. So we just want to know where do the people come from, are they self-referos, do they come from social work, do they come from GPs, do they come from housing professionals, or do they come from somewhere else? Because we partner with social housing to deliver craft cafe, the majority will come through that, but what we ask from all partners is that they commit to being open to the whole community and not just their tenants. So there's a focus around doctor referrals, and in Govan we were part of the Alice pilot around the therapeutic prescription, which we've not really had time to analyse yet, but it'll be interesting to sort of see if that has had increased our referrals from the NHS. Also organisations like Cargom as well refer through a mental health approach and other localised services within each specific area, but the main one, the majority is through the social housing, and then that generates word of mouth, which I think is the biggest key to success. I think that the fringing services across Scotland find that they get a really mixed bag of referrals. We at Befrending Networks don't run Befrending services ourselves, but because our phone numbers up there when somebody googles Befrending, we do get a lot of enquiries from people who are lonely, who just want to befrender for themselves. That would lead us to believe that people are aware that Befrending is out there. They can't necessarily get the services that they want. There are a lot of self-referos, then there are a lot of referrals from family members who maybe have to move away from their elderly relatives for work or for other reasons, who feel deeply guilty about leaving that person isolated. Quite often again we get anguished phone calls saying, please is there something out there for my mum or my dad who is 90 something and living on their own. Befrending services also get referrals from health and social care, from social work, and our evidence recently has been taking soundings from such services, not exclusively for older people but for mental health services, for example, learning disability. Referrals are becoming increasingly more complex that a social worker will lift the phone and ask for a befrender for somebody who really has very complex needs, maybe quite complicated mental health issues or is a sex offender or really something that is probably beyond the scope of the average Befrending service, because, after all, Befrendies are supported by Befrenders who are volunteers. They are well trained volunteers, but those services are not set up to cope with such complex cases necessarily. I just want to clarify that the majority of referrals that we get are from self-referos. The majority of referrals that we get are from primary care health staff, GPs, practice nurses, community nurses. We also get a lot of referrals from local area coordinators and care managers. Community hospital staff refer patients who are about to be discharged so that we can put things in place before they get home. Other council services such as visual impairment teams, community psychiatric nurses, mental health social work teams, social workers and other voluntary organisations as well. We have been steadily growing our referral base over the past few years and we get a vast range of referrals in now, but the definite minority is through self-referos. Alison Johnstone I just want to point out that it is very similar that we are all volunteer service, but, in addition, we also receive referrals from housing officers, housing associations, occupational therapists as well. The charge seems to be within hospitals, so I just want to add on to that as well. Fyngwell Rhoda I might be throwing a spanner in here and I apologise. I just want to be clear about the definition of isolation and loneliness. It has been coming to me through some other questions, but I think that when we are talking about referrals, it is really useful to keep in mind, especially when people are referring others, it is useful to keep in mind that someone can be isolated and not lonely, and someone can be lonely and not physically isolated. Talking about loneliness is a really stigmatising thing for a lot of people. I apologise for pulling us back to something that I probably should have said right at the beginning. It is just that when we are thinking about all those wonderful avenues for referrals, some of the investigation that we have done into whether first contact schemes, which is a scheme for people like GPs and fire services as well who I do not think have been mentioned yet, could have direct contact with people who are isolated and could very easily see the isolation. We have found that those first contact schemes are very thorough in identifying some practical needs of older people, but not necessarily. They are not geared up, they do not have the depth of questioning to find out whether someone is lonely, and that is whether they feel unhappy with the quality of the relationships that they have, and both isolation and loneliness are problematic. They can overlap, but they do not necessarily lead to each other. Some of our analysis in two reports, one that has been published called Promising Approaches, identifies the need for referrals and identification, and another that is about to be published called Hidden Citizens, does talk about first contact schemes. That gap of helping GPs or occupational therapists to talk about loneliness in a way that will help them overcome the stigma, so we will hopefully be moving along that path and offering some tools in that space quite soon. We have heard, as a committee, some evidence that older people may be slightly apprehensive about seeking support from either social work services or their GPs because they fear that they might lose their independence or that they may be potentially ending up in a residential home. All I want to know is whether any of you have any evidence to support that view. I also work as a trustee for a community centre, which has a wellbeing centre, and there is a great fear among the people there that they have to prove that they are independent. Going back to the deferral thing, one of the deferrals is for false prevention, and there is a big move towards training people preventing falls, which is really important if you are living independently. The other thing that has come out in some of the work that I have been doing recently is that it is the language that you use when you ask about isolation. You have to sort of go round it carefully and maybe just say, are you fed up? The outcome of some of that work has been that it is better to offer than to expect the people to actually ask for help. I think that, yes, they are very frightened of being put into a box and expected to do something or go down the road of being referred to things that they do not really want to do, and they value that they are independent very, very much. Would anybody else like to comment? No? Annabelle, have you finished now? I think that that is quite interesting. Really, with the exception of Sheila and no one else, is there any evidence of that scenario? We do not have specific evidence on that, but what we have found is that when we do our evaluation work with our members, they are very unwilling at first to talk about their medical conditions, their money, if they smoke or if they drink. It takes a long time to build up a trust, and quite often it is when we go back and redo the paperwork for six months on, people feel more relaxed and they feel more able to talk about what is troubling them and what issues they have. At that point, they are able to support them in what they need, but it takes time. It is about trusting. It is about the trust that you have with that person, and it is about that person-centred approach, because it is not just a doctor in office, or it is someone that you can talk to and trust. That may be more of personal pride than fear, but it is still inhibiting. Exactly. It is interesting that, when we did our SROI, the topics that most often people did not want to talk about were money and alcohol, everything else, pretty much at that stage, were like, yes, yes, I have got this wrong with me, but they were the two ones that people were like. You have to respect that and understand it. I mean, our service users have not specifically said that they are frightened about speaking to their GP for fear that they would be putting a care home, but we do know that our service users are frightened of what might happen if they were in a care home, because they do not feel comfortable that care home staff would be able to deal appropriately with their issues, not least of our transgender individuals, where intimate care might be a particular issue if their gender presentation does not match the genitals that they still have. In terms of the referral thing, briefly, the vast majority of hours are self-referral, and part of that is because 99 per cent of services will never ask an older person about their sexual orientation or gender identity, so that will never be picked up. Interestingly, we have self-referrals and people accessing our services from Ayrshire, Scottish Borders, Kendall—someone comes up regularly from and others from Cumbria—and that is partly because there are, in Scotland, four very underfunded groups for LGBT older people, Glasgow, Edinburgh, Inverness and Dumfries and Galloway, and that is all. It is a wide net that we are having to catch in terms of the people who are trying to access our services. We are regularly contacted by different departments at the NHS who are concerned about the lack of engagement with minority ethnic communities across a whole range of policy areas. It may well be the case that this is reflected within the area or the question that we have just asked, and that might be most likely due to cultural reasons or the prevalence to place the emphasis on family and local community. I am glad that you have brought it to the committee, and it is certainly something that we will give more consideration to as we progress our own work in this area. I want to look at the bigger picture following on from what Annabelle has said about health and social care and the integration that we are looking at past yesterday, 1 April, coming into law. I was really quite surprised when you mentioned the fact that most of your referals—not just word of mouth—but came from the health service. Previous witnesses said that GPs did not have enough time to spend with people who came to see them and did not recognise the loneliness. There is a bigger role for GPs' social work services to prescribe not necessarily medicine but to go along with some of your clubs on that. Should that be part of the integration model that we are looking at under social work and health and care, they can actually send them there. The evidence that you have given seems to be that we are touching on people who already are in the system, whereas the people who are not in the system, who really are isolated and lonely, are not able to access the services. I just wondered your thoughts on that particular one. As I briefly mentioned, we are part of the pilot scheme in Govan around therapeutic prescriptions. That is really valuable. GPs are rightly quite locked doors from us coming in as a third sector community programme. We are not really able to get access to the GPs and say that this is what we want to do. That is absolutely right in terms of patient confidentiality, but for the GPs to have that ability to go, there is a service that is around the corner from you. It is perfect. You should go to it. I think that it would be greatly empowering to both the patient and to the doctor. I would agree. We have been trying very hard to work with GPs across Scotland in terms of trying to get GPs to work much more closely with the voluntary sector and to refer into the services. A number of people present to GPs on a Monday because they do not have anything to do with the company. If we have interjection in there, those referrals could come to us to provide those services. That would reduce the times for GPs and the stresses that GPs go through with having so many to deal with. We had our conference last November, a presentation from somebody in the deep end group of GPs at the most deprived communities in the country. The GPs were from Drumchapel. He was talking about social prescribing. As you have said, GPs are extremely busy, and there is such a turnover of third sector organisations. It is very hard for them to keep up with exactly what is available in their community. The GPs from Drumchapel that we heard from was talking about a link worker that was located within their surgery, whose job it was to go and connect with community groups and refer patients to them and inform patients to them. That is possibly a bit more of a realistic model than GPs themselves keeping up with absolutely everything that is going on in their community. I absolutely agree that social prescribing is really important. We have had a quite successful pilot in Dumfries and Galloway around that as well. Another interesting initiative that I heard about because one of my other roles as a non-exec director on the NHS board in Dumfries and Galloway is the new chaplain listening service. The new scheme, as far as I understand it, is not necessarily about religious figures becoming chaplains, but about any skilled person in the community becoming an expert listener and could be based in GP practices. Those individuals might have much more time to spend with people when they are feeling lonely and isolated, perhaps just after a bereavement and so forth, and then be able to link into social prescribing. Again, we must not forget that older people do not just have to be passive recipients of these services, but they can then volunteer their time in those services, which also reduces isolation and bring in schemes such as time banking, where they can bank voluntary hours and gain things back from people. All those things can work really well in tandem, but the third sector has to have a hugely critical part in integration of health and social care. That is clear, and we need to make sure that all the joint delivery plans and so forth have a really big focus on third sector organisations supporting all that. The importance of recognising what is out there works very well in small communities where the doctor's surgery is close to the community centre where the activities take place. Again, it is a big thing about actually making known what is out there and the point that Karen made about sometimes things that are on a website or thought about until you go and try and access the service, you find out that it is long gone and that it is no longer there. I was thinking, as you were talking about, that maybe there is a place for advertising in doctor's surgeries of activities that are available in the community. I know that there is a little bit of reluctance in some doctor's surgeries for that to happen, but it might be the way of helping to raise awareness of what is out there. I would definitely recommend a more strategic approach across health and social care, so looking at not just raising awareness but commitments to action from the NHS regional boards and that should flow through down to GPs and other front-line health and social care workers. I would also recommend, as well as GPs social prescribing, other navigator schemes within communities—I think that someone mentioned one earlier. Health in Mind is an organisation. The campaign to online illness has about 1,000 organisations who are our supporters, and we welcome everyone here to join us if you haven't already—even MSPs. Health in Mind is one such organisation offering a range of services. It is also offering a navigator role, which is basically a volunteer who knows about activities in a local area and is able to point not just within their own organisation but to others. It is that type of partnership between statutory and voluntary organisations that really starts to open up and overcome some of the knowing about what is current and the 15-year-old camera clubs that might still be preventing people from really getting into activities that they could enjoy. When our project started, we solely took referrals from primary care, and the project limped along very small. One or two GPs in Aberdeinhire—there are, I think, 63 GP practices in Aberdeinhire—one or two GPs referring and the rest didn't. Trying to get GPs to engage is very, very difficult, and I think that anyone who has tried around this table will say that it is very, very difficult to get GPs to buy in. However, if you are lucky enough to get one GP within a practice who gets it and uses it, they will tell their colleagues and they will buy in. We are now at the stage after opening the project up to other services within the NHS, within the local councils, voluntary sector. The GP started to take notice, and I actually had one GP whose service had been available to his practice for about four years at a meeting where someone mentioned our project and asked why the project was not available in his surgery, and we had been for four years, but he had never used us and he did not know, even though I had spoken to him in person four years before. However, once they get it, they really get it and they realise that the amount of time that it can save. I understand what you are saying about people who are hard to reach, and one of the things that we have found is that the self-referos that we get tend to be the hard to reach people who are not really engaged with any services, but they find out about us from other places, such as libraries, keep stocks of our leaflets and things like that, and other community groups do, and they will hear about it maybe through word of mouth, and they will contact us then, and that is the ones that we find who really need the help with isolation and social contact. However, the GPs in the Shire and the other statutory services workers seem to be really good at picking up on it, and we have a really good close working relationship. I can honestly say that, in working with the NHS and Aberdeenshire Council, we have at no time felt like the junior partner when working with them. We are very much treated on a par with their colleagues at the same level of respect and the same level of regard, and it makes for a very successful working relationship, which is why our referral base doubles year on year. Just to reiterate, I think that I made the point earlier about the experience of what is happening in Leicester, so I would agree completely with what has been said here for diverse communities and diverse citizens. We need diverse services, and that is the best way done via a partnership approach. There is just one other thing. I think that the harder to reach thing is absolutely critical as well, particularly when we consider that the potential for an exacerbation of loneliness and isolation will be more prevalent within areas of social and economic disadvantage. When we have a place-based approach to tackling any policy issue that looks at driving towards areas of multiple deprivation, that is all well and good, but we have to take into consideration, and taking the harder to reach line that the Equality and Human Rights Commission released a report, Harder to Reach, which pointed out from our ethnicity and race perspective that Chinese, Indian and Pakistani communities are much more likely to live generally in poverty outside of areas of multiple deprivation. That co-ordinated partnership approach across the country in both areas of multiple deprivation and outside is needed to tackle potential problems in terms of isolation. Do you think that the third sector should be involved much more closely in the new integration boards, should perhaps have a place on there or be able to directly speak into it and possibly something more controversial that can be yet to know as well, in regard to funding? We know that funding is a big issue. One integration takes part and we have got the boards. Do you think that some funding should come from this new integration board and not always just from the lottery or whatever it may be? I know that that is controversial, but I will just put it out there. I just wanted to back Sheila and Laura's point about strategic planning for advertising within GP surgeries. Most of our learners are self-referos, and we also have a few referrals from OTs, but we had a targeted marketing campaign where we produced leaflets into doctor surgeries. That was something that we did of our own back, and Laura clearly pointed out that that should be part of the strategic planning that doctor surgeries should have some sort of package whereby they can see that ASIT or organisations like us and services that we are offering are available, as opposed to a marketing campaign from ASIT. I have a reply to Sandra's very last question, but it is very short because we have other three members that want to come in, Natalie. Just around that challenge of funding, the biggest issue that we have is that we have free-drilling craft café, and it has come up in lots and lots of different guys' risk discussion is how to continue that service. Older people's services are not short-term fixes, they are long-term programmes, and the need sometimes does not go away, it does not go away, it grows. Unfortunately, three-year funding packages do not support us or anything like that to carry on and do the work that it needs to do. There is always a fear of that programme falling away like the camera club that disappeared after 15 years. If anything that can be done to address how older people's programmes are funded is a fantastic leap forward. I am interested in the witnesses' views about the use of IT. There has been a lot of mention in there to understand what the benefits are. Clearly, it has been laid out in many of the statements that we have had, but it would be good to have it on the record. If I could maybe extend it with the conveners' indulgence a bit beyond that, the use of telecare, telehealth and whether that compounds feelings of isolation rather than physical contact. We all want to embrace the technology. Are there any downsides that would be good to hear? I think that one of the issues, especially in the more rural areas, is access to a signal, but for globally, the biggest issue is the cost of having those services in place. The new iPhones and new smartphones are really very expensive, especially in the transport field. A lot of operators are saying, I have an app for this or I have. It is losing a lot of the older people who are not understanding and are not really able to use that technology and not able to pay for that technology. A lot of work has to be done on it. On the telehealth issue, usually the telehealth is going to be offered in a centre not directly into their own home, so there is still a transport issue of the person getting from home to wherever the telehealth is available. It is early days. I do not really know if it will isolate people from travelling on a bus as important as reaching the destination, especially if they are doing it on a regular basis, because they build up a group of friends that they travel with. If we go down the road of having everything telehealth, I think that it will cause more isolation. I have Laura and I can ask you to keep your answers quite short, because we are running short of time as well. We recently brought together around 30 front-line organisations to talk about how they use technology and how they would want to use technology in the future to help their beneficiaries and the people that they work with come together. Some of the conclusions from that workshop were almost common sense in terms of technology. Technology is not a replacement for real face-to-face contact, but it can enhance it, particularly for keeping contacts with current friends and family, but the ability to come together or through IT training, for example, can enable you to make new friends. However, there is a caution there about replacing. We would say that there is probably not enough evidence around telecare at the moment to know whether that is pushing loneliness either way. I would also throw in a future, I feel like a futureology type question, about the use of technology by people in their 60s, 70s and 80s now would be very different to those who are in those age groups in 10 or 20 years' time, and the technology itself will, of course, change. Those co-hort coming through are more likely to be technology themes, if you like, and how to encourage them to balance that would be another challenge that we do not necessarily have now. I think that the positive notes that surround older people in IT have been pretty well documented. I would just like to pick up what Sheila was saying, that I cannot speak for all the people that we have not talked to, as opposed to all the thousands of people that we have talked to, but there are definitely barriers, one of which is cost for an older person. The other thing is about for an older person to see the benefit of using technology. I have a little quote here from one of our learners who says, I think I've bought too many friends going on about the advantages of having a computer. I love skyping my family members, which picks up on Laura's point again, that things like Skype and email are so important, but it's a getting that message across to the heart to reach groups, like we've mentioned before. But I agree with Laura that technology doesn't replace a face as such. Christian? I was just asking a little point on this. Technology did replace face to face when we had the introduction of the telephone and a lot of this generation used the telephone very extensively. Unfortunately, the new generations are not using the phone anymore. Has the telephone become obsolete and therefore creating more isolation? Is that some comment you received? If I could just come back to befriending services, there are a large number, I would say, a growing number of telephone befriending services in the country. That's partly driven by resources, but it's also found to meet a need among people who can't leave the house, won't leave the house, or in some circumstances people who are a bit nervous about face to face, face to face befriending and actually satisfied the need in them. So, I think certainly among older people, the telephone is still as long as you can hear, you know, as long as people haven't got a hearing problem, then anybody can benefit from a telephone befriending service. Only people who do telephone nowadays are people who try to sell you something. Families don't phone anymore. It's what you hear all the time. Yes, that's very true. But, as I said, telephone befriending services are expanding. So, you know, the telephone is perhaps not quite there yet. I want to talk a little bit about how services anticipate and identify where loneliness or isolation might be an issue and how they work out to intervene or went to intervene and how we can intervene earlier and more appropriately. We've heard that health and social work agencies are very important. Are there any other agencies that are on the front line when it comes to identifying where individuals might be lonely or feeling isolated? Bus drivers, for example, people on the bus, the bus driver might be aware of that. Sheila, I was thinking when Jane was speaking about churches because sometimes just going to church makes people aware that there is an issue. Sometimes, within the church, that is solved, but they do refer on to other activities where they can. I would also say that the other side of it is that, where churches are creating services, there is sometimes a problem because people are still very, their sectarianism going on, that they will not go if it's in the wrong church. I've come across this very recently in my local area that it's very, very difficult then to persuade people to go to an activity that's been put on by the community because of where it's actually situated. Sorry, that's not really answered your question, Jane, but it's very difficult. It's given food for thought. Anybody else? I would say local shops quite often before coming to craft cafe are a lot of our members. We'd just go to the shop once a day just to have a chat really, just to, they didn't really need anything. It was just they were buying their pint of milk just to really have contact. I think around the bus scenario we had a member who prior to coming on would just sit on the bus all day and just travel around the city because that's all he had to do if he's day and it was free because he had his bus pass. In the third sector, tap into all that knowledge and awareness. Is a scope for local partnerships? What can councils and integration partnerships do about that? How do you make those connections? To partly answer your past question as well, there's been an interesting trial run between local chemists and the third sector in a number of places. They integrated quite basic questions and questionnaire into prescriptions and it generated some interesting results. The thing that I'd flag with most of the services that we've already identified is that they might not reach men. Men are less likely to go to GPs, for example. Different tax might be needed. I'm not trying to cast dispersions but pubs, bookies, other places where men are more likely to gather and then of course it's back to the how do you bring this up in that type of situation and setting especially. It's a very delicate thing to be talking about. I'm thinking as well with my hat on for towns and town centres. We've also got the post offices as well when I went to speak to the post office. They developed a relationship with the people coming in and out and they were saying that if somebody didn't turn up one day they would worry about what happened to them and that's possible. I place in also your local supermarkets, your small local independent supermarkets as well that tends to get to know people as well. I'm wondering if that is a possible source as well for contacts from the ferals as well. The heads are nodding so it seems to be yes. Grace? In some of the weird places as well, community councils could play a potentially important role and it would sure be more important than just talking about potholes all the time. Anybody else? Nope. Back to you, Jen. I think there is a role for people like local councillors and community councils to take on board a responsibility to develop that knowledge and feed it in when they get the chance to. They're well placed to do that but they don't often remember to do that. I'm also interested in the point about services for men and women because I was going to ask about that. The men's shed was spoken about before in the committee and we're getting a new men's shed in five so I'm quite excited about that although I'm not a man. That's a different meeting. I was going to ask about how you tailor services for men and women. Is that something that you take on board actively or is it help? For some reason and we're still trying to figure this one out, craft café is equally popular with men as with women which from my time in this kind of field is quite unusual. I need to research this more but I think it's because it's around people do what they want to do and there's no one telling people what to do. It's like what do you want to do today and if that's build something or listen to music or have a cup of tea then that's your choice and I think that's quite an important factor in why it's quite equal across the genders for us in our experience. In terms of services being tailored differently for men and women speaking for befriending services it's not necessarily the service that's delivered differently but it has to be advertised differently. We have to coax men in sometimes. I did an evaluation in a sheltered housing scheme last year where there was a group befriending service really really successful but it didn't touch any of the men in the sheltered housing. I spoke to the ladies who were in that group and they all said that the men just wouldn't join because I think it's just women knitting and gossiping. It was a little bit more than that but there's a bit of an image problem. We also find with, in terms of volunteer befrienders, if there is a good cohort of male volunteer befrienders then it's easier to get more men because volunteering for befriending develops by word of mouth. Once there's a hard core of men it's a bit more easy to get additional men in. A few years ago we had a cluster of clients in an urban setting in a local town who were all in almost identical circumstances. They were bereaved in the last 12 months. They had no friends, no social contacts outwith the relationship that they had and they were all desperately lonely and very very isolated and needed some form of social contact and wanted to build friendships. They had tried pretty much between them everything that was available to them in their local area and none of it suited and we looked about for something different and couldn't find anything so we approached our local change fund for older people and asked for funding to set up a project which offered them the ability to contact with people who had experience the same sort of things that they had experienced who had similar life experiences. Some similar likes and dislikes but would offer them a chance to make friends not just someone that they met at a club but actual friendships. That started in January 2012. The initial group has grown to six established groups and three fledgling groups throughout Aberdeenshire. The original group in Inverrory now has 18 members who regularly come along and is starting to take over the venue that they meet in. The majority of them are men which surprised us and men who didn't go to their GP very often didn't really have much contact with statutory services, didn't really have very much contact with anyone at all but by various means had ended up coming to the project to be seen and we were ecstatic that these were what we would class as hard-to-reach men and we managed to get them together and genuine friendships have formed within that group and they meet as a group once a week but they also go off and do things together by themselves as they feel like. Some of them have introduced the other ones to casinos, they've gone to restaurants, they've done all sorts of things. Two of them went on holiday to Australia. It's been a hugely successful venture but what it does is it offers them friendship. It doesn't offer them something prescriptive, they can dip in and out as they want, they can do what they want, we don't tell them what to do, we don't tell them where to go. It's very much about forming friendships in a natural way and not a forced way and it's been a real learning curve for us because this is people that it's extremely hard to connect with and we are seeing them connecting with each other which is the ideal, the lesson put we have to have to that, the better. It's an organic thing with it and it really, really works and it's something that we are incredibly proud of and trying to grow throughout Aberdeenshire and are having quite a bit of success with. I just wanted to come in and say in regard to reaching out into communities, we've found it in my area in Glasgow in Partick for instance, when it was hard to reach men, rather than anything that was health related, we brought that into the local community, whether it be the local cafes who had an open day with the men and others used it, so therefore that was the easiest way to reach them. On another point, I was just thinking when you're talking about leaflets or a directory where you can go, the amount of local shops and charity shops where people and lots in my area as well as other areas where people go and spend hours because they're lonely and they wonder about, wonder if that would be anywhere where you could put the leaflets etc into the charity shops, just reaching out to people that's able to pick them up as they're wandering about there. John, sorry, it was an observation. Some of the things that Karen said there have found quite interesting and maybe I don't know if you could give us a one page summary of that particular project and how it worked, because I'm interested that you went to the change fund, was that interesting, that process, was that easy and I mean therefore have you got a worker or something, is that who's enabling all this to happen and is that sustainable and how long is that for? We couldn't find anything to suit and we couldn't put the clients in contact with each other because of the data protection act so we decided that because we couldn't find anything we had to create something ourselves so we were already funded by the Aberdeenshire change fund for older people for signposting for older people so we went to them with a funding proposal, with the evidence to back up why it was necessary and they accepted that and they funded that. It was incredible easy, the Aberdeenshire council have been very supportive of us, we've been really lucky and we're actually now being funded through the integrated care fund for the next 12 months so we have a really really good strong relationship with Aberdeenshire council because we've always been able to demonstrate that we're working, we're value for money and that we're doing good work. The project didn't at all grow as we thought it would because our initial idea was that we would match people with other similar minded people and they would go off in pairs but because we had such a large group to begin with we decided to get them all together to see what kind of pairs naturally formed but the group formed and has stayed formed and has just kind of taken everyone in as time has went along and it wasn't what we thought was going to happen at all but we're really pleased with it because all of them have at some point in the past after they were briefed tried to join something and were put off because they felt that they were excluded or the group was cliquey or no one was there to greet them where they weren't, you know, things weren't explained to them, every one of them had a reason why they had tried to do something and were put off and just retreated that little bit further so every single person in that group knows what it's like to come along to a group where you don't know anyone else and you're the stranger so they're very very conscious of that and they will always, all of them, take the responsibility for welcoming new people in so it's an extremely strong group and we're very very proud of it and through that we've generated other spin-off groups throughout Aberdeenshire. We still have people who come to the group because we only had the one group to start with when it was piloted. We have people who come to the group from 20, 30 miles away and because they like the group that they joined they stay in that group but a couple of them have also spun off to the group that's more local to them as well and some of them are actually good recruiters for their groups because they go and tell people about it as well and it's been a very organic process because we've tried to have as little intervention as possible with the exception of having someone there to make sure that everything goes okay and that people are welcomed in and things like that. It's been allowed to develop or naturally and we don't interfere. It's the out and about project. That's what it is, right? Sorry, I should have said that. I think it was mentioned earlier last week. Thanks very much. Jane, are you... I think that this has been covered but I'm wondering, we've heard about the voluntary sector facing barriers around funding, knowledge, awareness. Are there any other things that prevent the third sector from doing more or working more together to address social isolation? I think it might have been covered, it's just to give people the chance to see... I think it's coming back to that strategic view and there being a leadership role. I know we've touched on that but I wanted to answer in relation to your question and that this whole range of amazing services we're hearing about needs a view of what those pieces look like when they fit together and so it will help with things like referrals and it will help with things like word of mouth where people within a service know that there's somewhere else if someone has come in doesn't necessarily want that particular service. We'd definitely say that there's four levels if you like, enablers that wrap around the whole community. Things like age-friendly views and the touch on stigma, the direct services that we've talked a lot about but that can also include things about changing people's mindsets and we haven't really touched on that, things like mindfulness which is a way of enabling people to be more present with their current experience and so that basically loneliness could be seen as a difference between the level and quality of relationships that you have down here and the level that you want and often services are trying to increase the level you have to the level you want but actually there might be an element of helping people to become more accepting of their current reality as trying to be diplomatic as possible about it but basically helping people be at peace with what they've currently got so there are a number of levels and we would say there's a leadership role that's needed and that's outwith any one third sector organisation's role we'd say that's with I think health and social care. Very very briefly Grace and then I need to move on to next person. It was just a brief thing about funding. The change fund was great but it was all about innovation and I think sometimes that can be the death of the third sector. We know what we do, we do it well but we cannot get money to continue to do it because we've got to do it differently somehow so I think innovation is really important and we need to stay ahead of the game but we can't forget that third sector really good workers will leave because they know their contract comes to an end in three months and they've got to find another job and we have a start all over again so just a wee word of warning with that I think. Thank you and we'll move on now to Christian. Yes my question will be about what's the possible action you know Laura talked about the strategic need to plan for for example for advertising. We talked about in the previous evidence about the national campaign. We heard a lot about this morning about community boards being in GPs maybe in bookies for men because of course men is quite important to reach, difficult to reach very often men. I want to hear what we could do in the future and then what I want to take the example of Karen because I know that in Abedin Shire it's maybe one of the reason we are so well placed as a man shed with your services is because you've got that kind of priority we've got people coming from everywhere because there's a high level of of employment and we've got a great mix of people already. We've got people who live a lot longer and people have been very active during their life so this people wants to be empowered to make sure that they are not lonely and they maybe understand they are a lot more aware of the situation than other places maybe won't be because they know they are separated from their own families they are separated from from they are a lot more isolated automatically than other people will be so that would maybe be what Scotland would look like in the future in every community so how can we do to address this what's a possible action and do we need a national camping? Okay, how would you like to go first? Nobody? Okay, Natalie and then will I pick Laura? I don't know if that answers the question but I think something that's working really well in other countries is around people who have just retired because people who have just retired are not old they are you know they are healthy they have a lot to give and there's a lot of schemes running around those people who've just retired who are not ready to sort of just sit back they still want to be really active and for them to take on quite an active role for the community to support people who are older than them and if that's for volunteering if it's through being just a friend if it's taking them out if it's doing their washing if it's doing you know and kind of those localised community and I think that's the absolute key is it's not removing people from where they're familiar it's keeping people where they are feel comfortable and where they where is their home where they have existing networks of friends and even familiarity with space and so that's happening really well and I kind of want to explore that through our projects in terms of how we do that for voluntary workers who are just retired and is that then a way of sustainability for these kind of projects? We think what needs to happen next is is that bigger picture stuff it's about creating a positive image despite our name a positive image of keeping connected in older age so it's changing attitudes within wider society but we also need that leadership role within health and social care and also local authorities who have responsibility for things like transport I've touched on what people who are themselves currently lonely could be helped with more something around changing their thinking as well as supporting them practically and personally one to one and then finally we're definitely saying we're helping front line organisations to better reach out so they're kind of four levels within our promising approaches framework which we published in January where we will be working national campaign yes there absolutely should be a national campaign particularly on those areas we would recommend and to be very cheeky we would love to work with as many Scottish organisations as possible and Welsh and English and Northern Irish to develop that campaign over the coming years. It's really just about the transport issue it's not a statutory requirement to provide public transport or any other form of transport apart from school transport so on the transport issue when local authorities budgets are being cut they're not really the first thing they draw back from is the provision of transport for social activities I was also going to say something else but I've actually forgotten what it was when I get started on transport I usually spend a lot of time speaking about it we do have a problem the change fund has been very very good but what we said earlier we need to find ways of continuing that funding do you want me to go to Danieline factory? Just two points here I think we've taken into consideration the fact that we need a much broader holistic approach in terms of organising and making a coherent drive with all of these services which exist but I'd also agree and chime with Laura here about the need for a national campaign but like any campaign just to caution that it's not to reinforce stereotypes but to completely change the image and the discourse and the rhetoric and the culture in which we're interpreting and engaging with diverse citizens in which we include people who are elderly you know they're still citizens they still have potential they still have a lot to give to their local communities they're not a burden and to change that you know that image and the way we talk about them and if that national campaign was able to achieve that and have that trickle down effect and start to create that cultural shift alongside a more holistic approach across voluntary and statutory services then that would be at least to some measure the next stage we believe in progressing this agenda. The other point I was going to make was about Natalie saying that the younger older people are able to help but the problem is that we're now having a pension age increase so we're not seeing as many younger older people coming along to volunteer and I think there's actually beginning to be a crisis in this because the we are seeing an awful lot of older people presenting for help but we're not really seeing so many volunteers coming along who are able to help and I'd really like round the room to try and find out how we are going to address this because it could be having time of work to more time of work to volunteer but at the moment we're about to hit a crisis I think. Just as well building on what Sheila was saying before about the churches, the churches play a massive role at the moment in terms of supporting isolated older people but for how much longer is my question I think you know we don't quite know what the churches will look like in 20 years they're emptying by the droves so and who will take responsibility for our older adults within communities apart from funded services and so what I'd like to see as well as as well as the kind of younger older person where are young people in this and where is intergenerational working in general within this because I think we need to narrow that chasm that now exists between older people and younger people because that will you know help both groups. Do you think that that should be part of the national campaign but not only address the national campaign should it be towards only the older people but old generations and making sure that we've got a discussion about it and people are aware of what's happening in society today? Absolutely I mean you know how many young people regularly visit their grandparents these days and you know or phone exactly things are things are changing and and it's going to you know lead to real problems so I think that it needs to be targeted to all members of society yet. First of all in terms of national campaign I would absolutely echo what Laura has to say and if I may say so you know there already is a national campaign in England called the campaign to end loneliness and it's absolutely fantastic and certainly we have we at BeFriendly networks have taken a lot of tools and tips from the campaign so if we're looking at a national campaign please let's not reinvent wheels please let's learn from what works elsewhere and you know what's already established good practice and sweeter resources and all the rest of it. We at BeFriendly networks are doing two tiny things on zero budget. We've got BeFrending week which is in November which is a national campaign for BeFrending services trying to get more volunteers on board and trying to support small BeFrending services in particular to be able to trumpet about what they do and currently we are also we've embarked on a what we're calling grandly a roadshow health and loneliness roadshow which has been in planning for a couple of years now which means that we're basically schlepping around every health service area in Scotland talking to anybody who'll turn up within a three hour lunchtime slot about health and loneliness and the connections and the response has been incredible so far. There's another one if anybody's not doing anything in Edinburgh next Tuesday there's another one at lunchtime but you know so we're finding you know organised professionals are really really engaged with this once they know about the issue they're really engaged and you know keen to do something and to take action just very quickly though we need to know in tandem with a national campaign we need to know actually where we want to be so there's something I think to be had in the conversation about assessment tools and measuring tools loneliness I think needs to be in performance performance frameworks possibly under the well as a well-being indicator so I think there's some work to be done at looking at that so that we know when we get there you know so that we know we can describe the picture as it is and also know what we're aiming for. Go on. Thank you convener well it's actually touched on it there just laterally and that is words like performance framework prevented of spend because we heard from Laura earlier and indeed in your own evidence and from others we hear about the significant impact that your interventions can have do you feel that and there's mentioned made in certainly in your submission list sorry about a us study and there's other evidence do you think enough has been made of that because you know appreciate that third sector organisations come here and they will say that funding is an issue and that's the key but whoever forms the administration here has pressures too and if it can be persuaded that interventions can have a preventative implication do you think there's enough been made of that or is it understood enough even by not sorry if I may say not just by politicians but by general practitioners because it would seem to me that if you are improving the well-being of someone then you're reducing the likelihood that they're going to be medicated and so on and so on. Yes quickly I think that I think you're absolutely right to you know these are really important points the third sector has a bit of a problem in terms of evaluation because robust evaluation is expensive it costs money to evaluate services it takes time and sometimes you know even then it's really difficult to prove attribution but we going back to the example that I put in our written submission about King Cardin and decide befriending for example as a home from hospital service that very small pilot service you know I think demonstrates that there is a considerable amount of money to be saved by NHS if you can get for example a befriender to support someone to go home from hospital on a Friday instead of a Monday that's three bed nights you've saved already right there there's further evidence to indicate that having a befriender or some other person coming to the house prevents slips trips and falls by elderly people which is obviously another major stressor on the health services purse and the reason that's that's the case is because somebody can actually physically escort somebody to the shops if that's what they need or down the garden path or just something as simple as reaching into a high cupboard to get a tin or changing a light bulb so all these tiny tiny little interventions can really save huge amounts of money the difficulty is to absolutely prove attribution and I think some befriending services certainly have been asked to you know jump through extraordinary hoops to prove that they've saved their local NHS x amount of pounds and it's true it's not that simple I have to add on this and this side it's particularly good I think what the national a national campaign could do is to go out there and to show everybody I remember them singing in the shows in the local shows and we are really not only talking to older people but talking to different generation and making and understanding everybody but it's an issue we tackle so again the blueprint is very much in Aberdyn Sharia the best place to leave maybe thank you can we very briefly bring in Laura just now we think there are two ways we can measure performance we are launching a tool for frontline organizations to help them measure whether they are reducing loneliness because there aren't many usable tools frankly that don't make people cry because they're very harsh often the other opportunity is the the currently development of a Scottish longitudinal study on aging and we believe that that needs to include a recognised measure probably a more robust recognised measure of loneliness like the Diyongae of Eldescale and we'd say that those two opportunities are ones that we'd recommend and we'd certainly we'll certainly be taking up the measurement tool across the whole of the UK including Scotland because our frontline work does extend to Scotland as well. Do any members have any final very brief questions they'd like to ask John? I really enjoyed the paper from Laura's organization campaign tend loneliness and I was particularly interested Sandra and I were talking about it earlier on about a kind of third paragraph in your report because it says there's relatively little data comparing levels of loneliness in urban and rural areas then it says admittedly in England Wales tends to show that high levels of loneliness can be found in urban deprived communities with lower levels in rural areas and then later on it goes on to say that while some areas of high deprivation also have high risk of loneliness there is no correlation overall between levels of deprivation and levels of loneliness could you just give us a short comment on that? Laura, do you want to think about it and maybe write in to us about it if you feel that it will probably be a longer answer? I think that it will probably be a longer answer but we can certainly delve into that. I think that it's better for a written answer. I just wanted to ask one question and I feel as though I'm being controversial to the answer. This is the second controversial question. There are a number of groups, a great number of groups who are doing a fantastic job. Do you see duplication in anything that is being done? Liz talked about the befriending service. We had evidence last week from Age Concern Scotland who are taking forward Silverline, which is an English-based charity, but the money is coming from the Scottish Government to Age Concern to Silverline and we have other people here. It's something that I've often thought about. I could name right away 10 organisations in my area in Glasgow, Kelvin, who do a phone befriending service. Is it something that we should be looking at? Duplication? Too many small groups or big groups all doing the same job? It may sound controversial but the pot is only that size. I'd just like to know what you think about that. Sheila, can I ask you, because I know that there's quite a few community transport services out there, maybe you could answer it from that point of view? I would say that the spread of community transport isn't totally across Scotland and there are, I don't think, very many areas of duplication. We've been recently in a project in Sutherland, a Scottish Ambulance Service wanted the groups there to work more closely together, but they're all very isolated from each other and all working in a very local area. Very very few actually work beyond their local area, so I think that it may appear that there is duplication. The other thing that Annabelle whispered to me just now was sometimes people want to use more than one service, so you may find that. I know you're specifically talking about befriending, telephone befriending. All of the organisations give a service, apart from a number that are dedicated. I think that a lot of them want to use something on a Monday, something on a Tuesday, something on a Wednesday rather than, and they will make the choice which ones they want to use. I think that it's very good that we have a lot of people doing the same or similar things. They've all got the same aim, and the ones that aren't successful will collapse, so it's market forces really in a way. Laura, I didn't whisper that by the way. No. Research shows that Annabelle has been picked up really eloquently through case studies explained today. Research shows that people are more likely to stay involved in a group if it's something that they're interested in. If you think about everything that we're interested in around this table, if we laid bare all of our interests outside of work, then they'll be running to the hundreds probably. To keep people connected, we think that we need a great proliferation of activities and services. Services are probably for more, more for those who are extremely lonely, but activities certainly, and I think that duplication is probably not the best word to describe that. It's about Joad Riva and Choice. Just very quickly, yes, I think that while it might seem that there are lots of, for example, befriending services, our experience, well, what we know is that there are befriending services not only for older people, but for people with disabilities, people, you know, cot, death, dementia, there's a whole spectrum. So when you look at the number of befriending services throughout Scotland, you think, gosh, that's quite a lot, including possibly some, you know, several in your constituency, you may find that they are for different service groups, and they're probably all run on a shoestring. So there wouldn't necessarily be economies of scale in attempting to join these, you know, join these services together. Thank you very much. That ends agenda item 2. Agenda item 3 is an item on witness expenses. In keeping with the usual practice, members are invited to delegate to me as convenient responsibility for arranging for the Scottish Parliament corporate body to pay under rule 12.4.3 of the standing orders. Any expenses incurred by witnesses into our inquiry into race, ethnicity and employment, do members agree? Thank you very much. That concludes the public part of today's meeting. Our next meeting will take place on 23 April, when we'll take evidence from health and social work services on our inquiry into age and social isolation. I can thank every single one of the nine witnesses that came today for a fantastic input and evidence to you of actually giving us. It's all been very, very relevant, and I apologise for having to keep it pretty tight, but thank you very much again. We got a lot of information from you, so thank you. That ends the formal part of today's meeting.