Implementation: getting started

This section highlights 6 areas of the guideline that were identified as a focus for implementation and outlines activities that will support this. This section also gives information on resources and examples from practice.

Area 1: planning and partnerships

Planning is more effective when it is developed in a partnership which reflects the diversity of the local community and its local services and facilities, and makes use of local people's skills (see NICE's guideline on community engagement – recommendations 3, 4 and 6). If the aim is to improve older people's mental wellbeing and independence, it should include older people (including carers) and their representatives.

Many local authority departments and their partners could play a role in helping older people maintain and improve their independence and mental wellbeing. This could include the fire service or home improvement agencies and others who visit older people at home. (For example, such agencies could use their visits as an opportunity to identify older people at risk of a decline in mental wellbeing.)

Local authorities and the NHS could:

  • Ensure their planning partnerships include older people and their representatives and representatives from:

    • other statutory providers such as the police and fire services

    • statutory and non‑statutory housing providers

    • home improvement agencies

    • voluntary sector organisations and charities

    • community groups, for example, groups with a general neighbourhood remit, those for people with shared interests or a shared ethnic, social or religious background, or with a health condition or disability in common, such as a sensory impairment

    • local high street businesses that older people visit

    • managers of neighbourhood facilities

    • maintenance and security workers, such as estate wardens.

  • Include older people's independence and mental wellbeing as a core component of the joint strategic needs assessment and consider whether this should be included in the health and wellbeing strategy, based on local need.

  • Identify a lead person to review and update this component of the joint strategic needs assessment and, if needed, the health and wellbeing strategy.

  • Recognise the role of planning teams in helping older people maintain and improve their independence and mental wellbeing. Specifically, teams that advise on public facilities in the built and outdoor environment, such as seats and toilets, pedestrian and cycle routes and street lighting.

  • Use a local coordinator (see area 3) to share data on older people at risk with other members of the partnership, in line with information governance arrangements (see the Health and Social Care Information Centre's material on information governance).

  • Help community organisations to develop and sustain programmes of activities that maintain and improve older people's independence and mental wellbeing. This may include help with planning or providing transport to help people get involved. Or providing funding or spaces and facilities to host activities.

Area 2: local assets and needs assessment

A good understanding of local facilities and skills ('assets') and local needs will ensure services and activities are well targeted and any gaps in provision are addressed.

Local authorities could carry out a local assets and needs assessment that:

  • Takes account of:

    • the number and location of older people in the local area

    • details of services and activities that may help to maintain or improve their independence and mental wellbeing

    • any gaps in provision or groups of older people who are not getting involved

    • details of 'local assets' such as the skills and knowledge of older people and others in the local community

    • community venues (halls, places of worship, sports clubs and public houses) that could be used.

  • Uses data from sources such as health and social care services to estimate the number of older people who may be at risk of a decline in their independence and mental wellbeing. (Other sources may include market research, general practice profiles, the Projecting Older People Population Information System and the Office for National Statistics). Information could be collected on, for example, the number of older people:

    • aged 80 and older

    • who are carers

    • with long‑term health conditions or an age‑related disability

    • who live alone

    • who accept help, for example, with household tasks

    • who live in areas identified as deprived by national measures such as the indices of multiple deprivation (see English indices of deprivation 2010 Department for Communities and Local Government) and underprivileged area score.

  • Uses an identified 'local coordinator' (see area 3) to develop knowledge 'on the ground' of local needs, skills and other relevant assets.

  • Considers any differences in the groups at risk between and within local populations of older people (for example, in terms of their gender, sexuality, disability, income or ethnicity).

  • Notes any health inequalities and finds out why these exist.

  • Identifies anything that stops older people participating in local activities (such as limited access to transport or a low income) and addresses these barriers (see area 3).

  • Uses interviews, focus groups or surveys to find out what type of local activities older people like to participate in and the types of community support they need to help them to enjoy life.

  • Feeds the results into the joint strategic needs assessment and informs the local coordinator.

Area 3: local coordination

See section 1.5.

Local coordinators (sometimes called village or town agents or community navigators) know an area well. They help make it easier for older people to access community activities, social support and other non‑medical services.

Using a local coordinator can help local authorities meet their general responsibilities as set out in the Care Act 2014. By ensuring that more people have access to services that may help prevent problems needing more costly health and social care services, a local coordinator can also help local authorities make long‑term savings.

Local authorities could consider incorporating this work into existing posts. The aim would be to:

  • Identify older people who are at greater risk of a decline in their independence and mental wellbeing and tell organisations and others who can help.

  • Contact older people at greater risk to find out more about their interests, capabilities and needs and develop a relationship with them.

  • Provide information for those in contact with older people about the range of local activities and services available.

  • Coordinate support to help older people use local services. This includes help to use digital services and information technology, if necessary.

  • Offer older people advocacy support so they can say what services they need to remain independent and to maintain their mental wellbeing.

Commissioners could:

  • Look at examples of local authorities that have created local coordinator positions. For example, Poynton town council has an adult health and wellbeing coordinator (see expert testimony paper 3). Other examples include village and community agents in Gloucestershire and the Dorset PoPP Wayfinder Programme (see evidence review 3).

  • Consider using the coordinator's knowledge of local needs, the skills and other relevant 'assets' available in the local community and local services when commissioning services and activities.

  • Highlight the local authority's statutory responsibility under the Care Act 2014. The Social Care Institute for Excellence provides advice and guidance, resources including videos, training, and consultancy to help understand and implement the Care Act.

Area 4: getting older people involved in activities

Research shows that people are more likely to take part if services and activities are easy to access, and making people feel welcome encourages them to keep on taking part.

A review carried out for this guideline showed that many older people find it difficult to take part in services or activities that could help maintain their independence and mental wellbeing. This is particularly true if it involves using information and communications technologies (see evidence review 2).

To help overcome these difficulties, local authorities, service providers and community organisations could:

  • Train older people who are interested to use information and communication technologies effectively. See Promising approaches (Age UK) for case studies. This shows how technology can be used to get people socialising and to provide cost effective social support.

  • Help older people get good quality connections to the internet by identifying providers who can support them. For example, Age Action Alliance provides a range of free digital resources.

  • Help older people get financial support to participate in activities, such as help to get concessions and benefits.

  • Clearly state the objectives, location and times for each local activity or service and who they are for. Ensure this information is current, easy to access and gives a contact for each activity or service. Use outreach, community networks and social media to disseminate it (see NICE's guideline on community engagement). For an example of how a community network operates in practice see Somerset Active Living. This is a network of over 110 community, voluntary groups, clubs and statutory organisations across Somerset.

  • Think about the images used to publicise services and activities. Check whether they are representative of the people the service is trying to reach, or whether they reinforce stereotypes or risk excluding some older people. See LinkAge Plus for ideas. It ran pilots across the UK from 2006 to 2008 to explore new approaches to improving local services for older people. A DVD about the project brings together information, resources, tools, good practice and real‑life case studies.

  • Provide opportunities for older people to mix with people of all ages, for example, by providing community activities during the day.

  • Recognise the benefits of volunteering programmes for older people's mental and physical wellbeing. For example, Age UK's short guides Older people as volunteers: evidence review and Ideas for volunteering roles in health and social care provide information for commissioners, service developers and fundraisers.

  • Consider developing a plan to overcome the barriers to getting involved. This could include:

    • Providing help and advocacy for people with specific needs. For example: carers; people with mental health problems; people who have difficulties seeing or hearing; and people who have problems with their flexibility, balance or mobility.

    • Use of existing services. For example, using concessionary fares and encouraging transport services to coordinate their timetables and stops to help people get to the activities. This also includes ensuring access to suitable toilet facilities.

    • Providing a choice of activities (see sections 1.2–1.4).

  • Put pathways in place so that health and social care practitioners offer older carers activities that may help to maintain or improve their independence and mental wellbeing.

  • Provide older carers with support so they can use services. This may include arrangements for respite care. Note that some older people may not recognise that they are a 'carer' and, as such, they could become socially isolated and put their mental wellbeing at risk.

Area 5: training

See section 1.5.

Training is essential to help staff in contact with older people identify those most at risk of a decline in their independence and mental wellbeing. This includes health and social care practitioners (including those working in primary care), housing practitioners and some workers in the voluntary sector and other services.

Managers of practitioners most likely to come into contact with older people could:

  • Provide training in how to maintain and improve older people's independence and mental wellbeing.

  • Provide training on how to establish systems to identify and refer older people at risk of being lonely to services and support. Examples of the type of support that could help include initiatives like the Rotherham Social Prescribing Scheme.

  • Involve older people in developing and delivering training. Case studies from The Campaign to End Loneliness demonstrate ways in which the views and experiences of older people can be incorporated into training and strategy development.

  • Ensure course content is based on current knowledge of:

    • how independence and mental wellbeing affects the health of older people and their use of health and social care services

    • activities that may improve and maintain older people's independence and mental wellbeing

    • factors that threaten older people's independence and mental wellbeing

    • how to identify older people most at risk of decline

    • how to support and encourage older people to participate in community activities.

Area 6: evaluating effectiveness

Commissioners need evidence that public funds are being used in the most effective way. Collecting routine monitoring and outcome data for evaluation means providers can demonstrate the impact of their activities or services.

A practice mapping review carried out for this guideline showed that few local activities or services for older people have been (or are currently) the subject of a formal qualitative or quantitative evaluation. Where evaluation or monitoring has been conducted, the emphasis has been on process measures and qualitative experiences, rather than quantitative information about effectiveness and cost effectiveness (see evidence review 3).

To ensure organisations evaluate their activities and services and use the findings to improve them, local authorities could:

  • Make collecting data for evaluation a requirement for statutory funding.

  • Identify sources to help organisations carry out ongoing ('formative') evaluations along with sources of support for more formal ('summative') evaluations. (For example, the latter might be used annually to support funding applications.)

Service providers could:

  • Get older people involved in designing and presenting evaluations, using examples such as those found in the Campaign to End Loneliness.

  • Ask older people what they think about the service or activity. For example, how it is presented in publicity (web pages and posters), the activities on offer (whether there too much or not enough for specific groups, for example). Also:

    • find out what motivates older people to come along and what stops them

    • think about the timing, location and access to venues (for example, how physically accessible is it?)

    • identify other ways of getting older people involved, for example, through friends or family.

  • Collect details on the following 'process outcomes' as a basis for evaluation:

    • number of sessions offered

    • numbers attending each session

    • new attendances at each session

    • demographic data.

  • Form partnerships with academic and practice organisations (such as QaResearch and Ecorys) with the skills to help evaluate the activity or service.

  • Use validated measures of mental wellbeing to gather evidence of effectiveness. Examples of evaluation tools incorporating these measures include:

  • Consider pooling resources across localities to fund joint evaluations of similar services.

Need more help?

Further resources are available from NICE that may help to support implementation:

  • Annual indicators for use in the Quality and Outcomes Framework (QOF) for the UK. See the process and the NICE menu.

  • Uptake data about guideline recommendations and quality standard measures.

  • National Institute for Health and Care Excellence (NICE)