Category Archives: University of Exeter

Supporting Anticipatory Care and Ageing Well: The Anchor Project

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“In the world of social innovation research it is more pertinent than ever to be attentive to change and adapt accordingly to emerging ideas and practices when presented. This has been the experience of the Social innovation Group and our current work on the ANCHOR project.” – Tom Bailey

The University of Exeter’s Social Innovation group (SIG) has now been working on place-based, person-centred issues within the health and social care sector to promote positive change for over 10 years. The primary focus of this multi-disciplinary research group in recent years has been the HAIRE project: Healthy Ageing through Innovation in Rural Europe, which is funded by the Interreg 2Seas European Regional Development Fund. Through the use of a co-designed Guided Conversation (GC) toolkit, HAIRE aimed to reduce loneliness, isolation and improve general wellbeing in the over 60 age group across rural communities in England, Belgium, France and The Netherlands. In terms of practical objectives, the project aimed to develop and test methods that empower and enable participants to:

  • Define what support is needed;
  • Participate in the design and delivery of services;
  • Develop solutions for the individual to reduce loneliness and improve quality of life, health and wellbeing, supported by the voluntary, private and public sectors.

HAIRE’s approach to achieving these objectives included the HAIRE toolkit, which was developed by the University of Exeter with support and consultation from the project partners in adapting the materials to cater to each location site. The toolkit is person-centred and allows for people to reflect on their own needs, interests, and aspirations in order for individualised care and support to be provided. The GC encourages a wide-ranging informal conversation that takes place between volunteers and participants. With the aid of visual and conversational prompts (see Figure 1), the GC fosters an honest and open dialogue between volunteer and participant to identify how the local area, community and the person themselves influence their wellbeing.

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Figure 1; A place-based visual prompt developed for Carnon Downs, Cornwall.

Due to the success of the HAIRE project across its eight pilot sites in Northern Europe, a new opportunity to use the same methodology in a wider area arose in Cornwall, England. This was named the ANCHOR project: Supporting Anticipatory Care and Ageing Well in Cornwall. This was funded by the NHS Cornwall Partnership Ageing Well/Urgent Care Response Programme Board as well as the Duchy Health Charity and a UKRI ESRC Impact Accelerator Award.

The aim of this project was to design and develop GCs to be implemented across the Coastal Primary Care Network (PCN) to support communities and anticipate undesired health outcomes. The ‘test and learn’ approach of the project was supported by the assumption that the toolkit would fit into existing work practices without adding to health practitioners’ workloads.

However, during the lifetime of the project there have been two significant innovations to service design and delivery in Cornwall which led the team to re-think how best the GC could fulfil the desired anticipatory care outcomes. These innovations were the emergence of the Community Hub model and a pilot scheme involving Community Health Workers (CHWs). These developments are part of the rapidly changing landscape of service design and delivery involving Cornwall’s voluntary sector (which we will deal with in another article). Understanding and adapting to these changes has been an important part of our work in ANCHOR.

While working in a practical capacity with both organisations and individuals to aid in the delivery of anticipatory care within the new innovation pathways we have also worked in a conceptual capacity to understand anticipatory care as both a philosophy and process of care. As a philosophy, anticipatory care speaks to the working assumption that care (provided by individuals, the community or health services) should enable people to maintain good health and wellbeing for longer. However, for those with chronic conditions, an Anticipatory Care Plan is necessary to precisely identify how an individual should be supported to prevent a deterioration in their condition and unwarranted health outcomes.

The ANCHOR project’s original aims – such as improving the management of long-term conditions, reducing loneliness and isolation, improving general wellbeing and reducing the demand on GP surgeries – are still important but can now be considered long term goals to be achieved while working in the emerging ecosystem of care including through Community Hubs and the CHW programme. Data will continue to be collected on these impacts, but the results will likely be published after the lifetime of the project.

The project is now essentially working to build capacity and skills in the sector that both supports the philosophy and process of anticipatory care. The ANCHOR project’s timeline serves to illustrate that flexibility, resilience and persistence required in the voluntary care sector and in research generally in order to succeed.

Article by Tom Bailey, Research Assistant on the Anchor Project

Cross-border Learning: Belgian and UK partners exchange experiences

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In early November, SIG‘s HAIRE team were delighted to welcome our Belgian partners Sofie Schepers and Katrien Serroyen who were visiting Cornwall from Laakdal. After a weekend of cultural and historical activities – taking in Guy Fawkes’ night and a tour of Falmouth’s Tudor castle, Pendennis – they spent a day exchanging experiences with Feock (one of our pilot sites) before travelling to East Sussex pilot sites and meeting our partners at Rother Voluntary Action and East Sussex County Council.

The East Sussex team were keen to give as broad a picture as possible of their locality and took our Belgian colleagues on a tour that took in the quaint beauty of Rye (cobbled streets and the fifteenth century Mermaid Inn), Tilling Green social housing estate, new housing in Winchelsea, and a relatively new community hub – The Hub on the Hill – which runs many classes and services for the community with an emphasis on older residents.

Katrien and Sofie are smiling, standing in front of Pendennis Castle in Falmouth, Cornwall

Katrien and Sofie at Pendennis Castle, Falmouth, Cornwall

The cultural exhange and sharing is important for Interreg2Seas funded projects. They promote cooperation between regions and countries to enhance economic and social development in our own countries and across borders. Our HAIRE 2Seas partners share the common challenge of supporting people to age well in rural areas, where loneliness and isolation and mobility problems are just some of the themes being tackled. Having had very few opportunities to meet due to restrictions brought about by the Covid pandemic, it was inspiring to share experiences and perspectives from nearly three years of HAIRE action and learning in our respective locations.

The HAIRE teams from East Sussex and Belgium are looking over a vista of housing and fields near Rye

Steve, Sue and Naomi from East Sussex taking the Belgians on a tour of their locality

At the initial meeting in Devoran, the village in Feock parish where the council offices are located, the difference between locations felt quite stark to our Belgian colleagues: Laakdal is a municipality with a population of around 16,000, whereas the population in Feock Parish numbers around 3,700. The larger East Sussex pilot sites felt more familar to the Belgian team. Yet one of the most difficult challenges for all locations has been reaching members of the community who may be in need, or may benefit from HAIRE’s activities, but who are almost “hidden.”

The extended HAIRE team pictured in the "warm space" at Feock parish council

The extended HAIRE team pictured in a community space at Feock parish council

However, as a result of the emphasis the HAIRE toolkit placed on listening to residents, the needs of the older population as a whole can be better taken into account. Now that HAIRE and its ethos of co-creation and listening is familiar to each department and area of responsibility, the views, opinions, needs and ideas of residents are being heard, and this has led to subtle changes in the system. Different methods to listen and co-create products and services have been introduced in all of our pilot sites to ensure their older residents are included in important decisions.

Feock now has an information and help line, originating out of the Covid pandemic, but which has become a staple of the parish. A legacy of HAIRE is that parish-based decisions take into account any impact on the older population in a way that they may not have been so obviously before. It is the same in Laakdal: the planning department, for example, is aware of the way its decisions impact the elderly – and they are now prepared to consult the HAIRE team for information about how they might best move forward with their works.

East Sussex partners have done an excellent job by instigating local and national design innovations after working with the RSA, the royal society for arts, manufactures and commerce (“committed to a world that is resilient, rebalanced and regenerative, where everyone can fulfil their potential.”) Their Hastings and Rother Ageing Network meets monthly to network with local organisations, groups and individuals with a focus on how they can work together to make Rother and Hastings healthy and supportive places to grow older in.

From a longer term, strategic standpoint, Feock has made the decision to work with partners to develop a formal age-friendly community as our partners in East Sussex have done. The Guided Conversations in pilot sites illustrated the multiple dimensions of ageing well, which prompted the need for a holistic system response, and the UK arm of the World Health Organisation’s Age Friendly Communities programme is well aligned with the aims of the HAIRE project.

As Katrien and Sofie pointed out, the pilot site comparisons were useful, showing commonalities and differences and making them reflect on what went well in their own communities – and how “HAIRE thinking” could be built into longer term planning.

“Feock felt very isolated in comparison to Laakdal. The lack of public transport, the lack of shops, the very rural environment, the huge amount of second homes … I would think that building the community would be very difficult. Yet they succeed to organise meetings where 80 people attend and they make the most of small things (the red phone booths made into small libraries). Well done Feock! Rye felt more like Laakdal. What stood out was that both pilot sites are much more in contact with the church. In Belgium the church doesn’t organise much and in our pilot site the church isn’t involved. What was also different is the health part. I think that in the UK the health partners and health “input” is bigger than in Belgium. In Laakdal it’s more community building and well being than health. What I think both pilot sites did very well is thinking about life after HAIRE right from the beginning of the project. I believe that that will make it possible to continue and embed HAIRE better.”

The Belgian team are pictured with people from Feock and the University of Exeter - and the HAIRE mascot, a Corgi called Treacle

The Belgian team with Feock and the University of Exeter – and the HAIRE mascot, Treacle

Extending the HAIRE toolkit: Guided Conversations with In The Mix Project

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Over the past couple of months, a small team from the University of Exeter’s Social Innovation Group has been working on adapting HAIRE’s Guided Conversation tool for use in youth work. Two interns, Matilda Ferguson and Lewi Connor, have been involved in this process, and Matilda very kindly agreed to write a blog about it. Read on…

The HAIRE project aims to support older people in rural areas. One of the systems tested by the HAIRE project is Guided Conversations. These take the shape of a semi-structured discussion, prompted by images, general themes and talking points such as the local area, relationships, interests and community. Using the Guided Conversation tool, the HAIRE project has been able to explore the isolated situation of older people in rural areas, and identify their needs and desires. The Guided Conversations became not only part of a study into the rural isolation experienced by older people, but a tool for combatting it.

We have been working alongside In The Mix to explore implementing the Guided Conversations tool into youth work in rural areas. The In The Mix Project (ITMP) is based in the small town of Wiveliscombe, Taunton Deane. However, the charity provides youth and community services across Somerset. ITMP offers informal educational, activities and positive opportunities programmes to provide learning, skills and experiences, which supports young people’s personal, social, emotional and professional development, as well as boosting self-esteem and confidence. Their approach to youth work is flexible and based on issues and values prevalent to young people, their communities and their environment.

Image taken from In the Mix Project website

Working alongside the charity’s project manager John Hellier, we have tailored the prompts and structure of the HAIRE Guided Conversation to fit the focus of ITMP and context of youth work. Our version of the Guided Conversation covers three themes: place-based’, ‘people-centred’ and ‘empowerment’. We have also adapted the tool into a new format: an app. The app shows participants these themes, as well as some sub-topics, image prompts and radars which shows how positively they rate the topics discussed.

We hope that the Guided Conversations will help us to understand the situation of young people living in rural places in terms of the issues and relationships they have with their areas. This research will help youth work in rural areas to be responsive to young people’s needs. As well as this, we hope that like we have found in the HAIRE project, the Guided Conversations themselves will not just be research tools. The discussion provides opportunity for people to open up, share, connect and be heard. This itself will combat isolation and prompt discussion about solutions. The app also provides the opportunity for action through its ‘signposting’ feature, which will allow young people to find existing services to support them.

Over the last week, Lewi and Matilda went up to Exeter to meet with John to try it out. Our practice guided conversation lasted almost three hours and was a great way to understand how the tool would work in practice. After a few adjustments, the app is ready to be tested and we look forward to trying it out at ITMP sessions over the next couple of weeks.

Matilda Ferguson

Image taken from In The Mix Project website

 

 

 

 

Talking Deck to help people with life and health issues

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The Talking Deck is a new resource that has been co-designed by researchers from the University of Exeter, staff and volunteers at CoLab Exeter’s wellbeing hub, people with lived experience of homelessness, and artist Hugh McCann. The project is aligned with Project HAIRE and is based on the Guided Conversation model, showing how the HAIRE toolkit can be customised for different target groups.

The Talking Deck aims to facilitate conversations that are led and shaped by individuals seeking support. Sometimes the purpose of a conversation is simply to allow individuals to share their experiences with staff and volunteers at CoLab Exeter. As seen below, the cards in the deck include a collection of symbols, words and place-based images. They are carefully curated to help people speak about the issues that are important to them.

A variety of Talking Deck cards are in the photo, e.g. a key, a heart, trainers, animals, pictures of Exeter and words such as 'yesterday', 'future' and 'fear'.

Over a series of workshops, staff, volunteers, researchers and people with lived experiences came together to co-design the Talking Deck pack.

“Listening and co-production has been at the heart of this project. We’ve created these together with people from all sectors and walks of life. The cards are a way to facilitate conversations and help people find a way forward without getting to crisis point. People want to be listened to, first and foremost. To be seen and be validated.”  — CoLab Joint CEO Fiona Carden

The project was a partnership between researchers from the University of Exeter (Catherine Leyshon and Shukru Esmene from the Social Innovation Group‘s HAIRE team and Lorraine Hansford from the Wellcome Centre for Cultures and Environments of Health), CoLab Exeter and Devon Mind, funded through HAIRE and an ESRC Impact Accelerator Account (IAA) award. The IAA helped to translate the main principle of HAIRE’s Guided Conversation tool into a resource that suited CoLab Exeter’s working culture and the individuals who use their wellbeing hub. The principle here being the use of meaningfully co-designed visuals to facilitate wellbeing-related conversations.

“Seeing the Guided Conversation transform into the Talking Deck has been an incredibly exciting and rewarding process. Transferring our tools into new settings to help different groups and organisations always depends on successful co-design. We have worked alongside staff from CoLab and people with lived experience to produce something that can genuinely help people to have more in-depth, productive conversations about their needs, aspirations, hopes and fears.” — University of Exeter researcher Professor Catherine Leyshon

CoLab Exeter’s wellbeing hub hosts around 30 voluntary sector and statutory organisations who support people in Exeter with experiences of homelessness, addiction, the criminal justice system, the care system and domestic abuse. Over a series of workshops, staff, volunteers, researchers and people with lived experiences came together to co-design the Talking Deck pack. The packs are currently being trialled by staff and volunteers at CoLab and in other organisations, for example Julian House have experimented with using the Talking Deck in key worker support sessions with young adults in supported accommodation. So far, feedback from users of the Talking Deck has focused on how the cards help facilitate conversations that are led by the individual, rather than the staff member.

“It’s been really exciting to hear people’s reactions to the new cards. Support workers who have tried them out reported back that they were surprised how well such a simple tool opened up conversations, and helped people to talk about things that were important to them that they hadn’t raised before.” — University of Exeter researcher Lorraine Hansford

Workers commented that using the cards had given them more insight into people’s interests and concerns, and ‘opened different doors’ for people to talk about what is important to them, with issues sometimes emerging that would not necessarily come up in standard assessments used by the organisations:

“I was sceptical at first… I was quite surprised at how it was more powerful than I thought.”

“It’s another way of communicating with people, pictures have a connection to memories. For people who are vulnerable, talking can be intimidating, and it can bypass that in a gentle way.”

There is still work to be done, as the project does not intend to be prescriptive about how the resource is used. Ways of using the cards need to consider how some individuals may find engaging with the entire Talking Deck overwhelming and/or feel unsure about where to start. Continued exchanges between organisations that use the cards will be valuable in promoting the flexibility of the resource and in sharing new practices. Importantly, a Mental Health Alliance, including CoLab Exeter and Devon Mind, can potentially provide a platform for practice-led exchanges and skills sharing to take place. The Talking Deck’s launch will engage members of the Mental Health Alliance in scoping the coordination of such a platform.

Overall, the Talking Deck can be used informally in different settings to help guide conversations. The cards predominantly intend to give people choice about the topics that they wish to discuss, whilst helping to start conversations that may be difficult for people to raise.

After collating a last round of feedback, the finalised Talking Deck was launched at an event at CoLab Exeter on 3rd May 2022.

For more information, contact: Professor Catherine Leyshon (c.brace@exeter.ac.uk) or Lorraine Hansford ().

Picture of collaborators from MIND, CoLab and the University of Exeter

Left to Right: Tom Cox (Devon MIND), Fiona Carden (CoLab), Lorraine Hansford and Catherine Leyshon (University of Exeter)

 

 

New Perspectives on Geography and Loneliness: Introduction

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Jo Little, Shuks Esmene, Catherine Leyshon and Michael Leyshon, researchers at the University of Exeter, have been working on a new paper about loneliness which we introduce below. It’s one of the key issues for the rural ageing population in our study, and it’s particularly on our minds as we post, as it was recently Mental Health Awareness Week in the UK, and loneliness was the theme. For some practical tips on coping with loneliness in later life, the Mental Health Foundation has created a toolkit which you can access here.

Over recent years there has been growing recognition from government, policy makers, academics and the public of the significance of loneliness within contemporary society and with the associated deep and enduring negative consequences for wellbeing and quality of life. For example, a recent study characterises loneliness’s societal impact as follows: “Social isolation and loneliness has been classed as a major public health concern due to its negative physical and mental health implications, and living in a remote or rural area is a prominent contributing risk factor”. Loneliness has been referred to by the UK Minister for Loneliness as one of the greatest challenges of our time.

While the visibility of loneliness has increased substantially, and more understanding exists concerning its links to health, there are still important gaps in current research which we will explain and develop in our paper. We aim to develop critical scholarly understandings of loneliness that go beyond measurable indicators and risk factors (such as living in rural settings and mobility issues). While such indicators and risk factors are important in producing an overview of loneliness’s causes and impacts, loneliness is increasingly seen as not simply an individual problem and an issue that manifests due to a combination of risk factors, but as more inherently social, cultural and relational. As Geographers we are mindful of the difference that space and place make in both conceptual understandings of loneliness and its manifestation as a lived experience.

As we write, we begin with a review of the study of loneliness, summarizing some of the findings of what have been perhaps more traditional attempts to identify and measure experiences of loneliness. This provides an understanding of key trends but acts more as a springboard for the next part of the paper in which we, first, provide an improved conceptual understanding of loneliness as a dynamic part of the human condition, the definition of which derives from a set of cultural expectations as much as a lived experience which is embodied and performed in everyday life. We ask what is the connection between the apparent ‘epidemic’ of loneliness and the human condition in a world characterised by endless connection?

Second, and in a linked point, we call for more work on the multiple, shifting ways in which loneliness forms part of the lived experience. Much research implies a somewhat uncritical view of loneliness as a binary condition of being or not being lonely. This has implications for the sorts of solutions that are provided by governments, charities, communities, and individuals, which sometimes tackle ‘aloneness’ rather than ‘loneliness’. Loneliness has temporal and spatial dimensions, it comes and goes, can be experienced in a crowded place or when alone, has causes that are both identifiable and elusive, is linked to a sense of self and the place of the self in the community and wider society. Ultimately, loneliness should be understood as a profoundly subjective experience. Building on and developing Franklin’s 2009 paper, ‘On Loneliness’, we provide a critical examination of the key ‘taken for granted’ characteristics of loneliness. This will explore how loneliness is felt and experienced in contemporary society – and in particular how it relates to social bonds.

Our paper argues that a focus on space is a critical part of the complex jigsaw of loneliness – not simply that loneliness occurs more in some places than others – rather, that place can be central to the ways in which loneliness ‘sticks’ to identity. To explore these issues, we take as our focus rural spaces and the particular relationship between the constructions and contradictions of rurality and loneliness as part of its lived reality.