One of the core aims of the Ageing Better programme is ‘to enable people aged over 50 to be more engaged in the design of services for their communities’. As such, Brightlife has been committed from the start to ‘co-production’ – the meaningful involvement (rather than just token inclusion) of older people in designing, planning and commissioning projects and services.
Co-production at Brightlife was facilitated by the Older People’s Alliance (OPA) – a small advisory group of highly committed and enthusiastic individuals, all aged over 50 and with a wide range of skills, who were tasked with championing input from older people into all aspects of the project.
A key function of the OPA was their role in the commissioning process. To prepare them for this aspect of their work, OPA members were given training in commissioning by Hall Aitken and Brightlife, including how to score tender responses and how to incorporate the principles of the ‘test and learn’ approach. While extensive support was provided by the Brightlife team and wider partnership, final decision-making powers were retained by the older people themselves.
Although every effort was taken to ensure that its members were broadly representative of the demographics and life experiences of over-50s in Cheshire West and Chester, it would have been impossible for the individual members of the OPA to speak for every older person in the region. As such, Brightlife introduced an alternative avenue of co-production when it came to identifying the needs on which to base the design of projects and services.
To help inform and shape the specifications for its early Key Commission contracts, Brightlife held a series of ‘Community Consultations’ in areas covered by the Brightlife Social Prescribing scheme, ensuring that as many relevant older voices as possible were heard. Residents of these areas were invited to discuss what was already available and what they perceived to be the primary needs within their communities, so that any resulting offer would meet those needs.
This kind of open consultation was particularly important for identifying gaps in provision for rural areas, where the travel required to access even relatively nearby services can be prohibitive. However, community involvement in service design should not be limited to geographic communities – Brightlife placed equal importance on consulting other types of communities when designing services for that group.
For example, in developing its specification for the contract to deliver projects to address social isolation and loneliness amongst those living with dementia in Winsford and Chester, Brightlife invited people living with dementia (and their carers) to attend a co-design workshop, to help identify contributing factors to their increased risk of experiencing isolation and loneliness, and to propose a list of initiatives that might help mitigate this risk.
The Community Consultation model used by Brightlife to facilitate co-production was subsequently embraced by a number of providers; its value apparent in the success of the interventions during which it was employed.
In contrast, a number of Brightlife-funded projects encountered problems during delivery that could potentially have been avoided with more comprehensive consultation of user communities at the design stage. For example, the providers of several projects aimed at those with long-term conditions (and their carers) discovered that the parts of their services that involved meeting at regular times were inaccessible to many participants, who were likely to have limited or unpredictable availability. Had these communities been consulted at the design stage, such specific barriers to participation could have been addressed accordingly.
Consultation with these types of communities can inform more than simply logistical considerations: the complexity of the needs of some groups can also mean that participants may require specialist support. This must be taken into account when planning and budgeting for staff and volunteer recruitment – something that was acknowledged by the project delivery team for the FAB Cheshire West project (Listening Ear), after they found that many of the participants referred to their bereavement counselling service required a more intensive level of support than had been anticipated.
Consultation with representative communities during the design phase, while helpful for identifying specific group needs and barriers to engagement, should not be the only involvement that older people have in the development of the services they use. Where possible, sufficient flexibility must also be built in to adapt delivery to the wide range of tastes, preferences and needs of individual participants.
As part of the commissioning process at Brightlife, all delivery partners were required to show how they would enable older people’s voices to shape their projects and services. Many proposed co-production of activities and programmes through a participant-led ‘steering group’, while others used regular feedback sessions to facilitate this.
For example, in the Social Activity Taster project, Community Compass held informal ‘tea breaks’ throughout the delivery period to encourage participants to offer feedback and suggestions. Not only did this help to shape the format and content of their activity programme; but by helping to identify a significant need in the local community for a food-sharing service, it also informed the development of their subsequent successful proposal for Share Club.
Another example is the mini bus tours provided as part of the Great Outdoors Malpas project (delivered by Cheshire Wildlife Trust), which arose as a response to talking to residents and staff in a local residential care home, where there was a real appetite for excursions to the countryside, but where the limited mobility of residents had prevented this in the past. In response to this need being identified, Cheshire Wildlife Trust organised a number of trips for the care home residents into different parts of West Cheshire and over the border into Wales. For many residents, this was the first opportunity to be driven out into the countryside they had had for a long time. It also enabled those who had grown up locally to revisit sights familiar from their earlier life – something that was particularly valuable for participants with dementia.
Similarly, in planning activities for the care home outreach sessions that were delivered as part of their Growing Connections project, Groundwork Cheshire Lancashire and Merseyside sought significant input from participating residents. During this process, a need was identified for a wheelchair-accessible raised bed in the communal garden of one care home, which was subsequently created and used to encourage residents to grow flowers and vegetables.
In the context of the Brightlife Social Prescribing scheme, the involvement of older people in decisions was built in: participants had control over the types of activities they were referred to. This often required tailoring existing activities to participants’ needs, or in some cases creating new opportunities. For example, one Social Prescriber had a participant with serious health problems that wanted to go swimming. When coordinating transport to the public pool did not work, she found a private pool for hire and arranged for a befriender to take him.
Older people are not the only group that needed to be involved from the very earliest stages of design in order for an intervention to be a success: potential delivery partners, including existing service providers, are often well-placed to identify (and create innovative solutions for) specific challenges in their communities.
This was the principle behind Bright Ideas, the Brightlife funding strand for individuals and groups who are based in, or work with, a community of interest. Groups were invited to apply for funding of up to £20,000, with awards made to those whose ideas had the most potential to provide valuable evidence about what works.
This approach facilitated the delivery of many innovative projects and services to a diverse range of older people, including those from marginalised groups whose needs might not otherwise have been catered for. Over the course of five years, Brightlife commissioned 35 Bright Ideas projects, with a total value in excess of £600,000.
Involving potential providers in service design also helps to avoid duplication of existing provision. For example, the Brightlife Social Prescribing scheme was established following research showing that no such provision existed in Cheshire West and Chester. However, early on in the delivery of the scheme, the coordinators found that in fact many other agencies already provided services to support vulnerable older people to find and engage with local activities, but because these were not labelled as ‘social prescribing’, they had been overlooked.
In the case of the Social Prescribing scheme, the duplication of services was not an issue, as the Brightlife scheme was targeted at those in specific areas not necessarily covered by other agencies. However, it is easy to see how a failure to involve a wide range of providers in the earliest stages of service development may result in inadvertent duplication or overlap.
Of course, before any conversation with potential service providers can even begin, it is necessary to get the right people ‘into the room’. Effective promotion of opportunities for consultation, collaboration and funding is crucial to making sure that the right providers come forward, both in response to formal tenders and to informal calls for views, ideas and proposals.
But who are the ‘right providers’? Often, projects and services for older people end up being delivered by the same few organisations. This is partly by virtue of experience: these organisations are often well-placed to identify and accommodate the needs of older people. However, part of the core ethos of commissioning at Brightlife was to look beyond the ‘usual suspects’, to harness innovation from those who might not ordinarily apply for such funding.
From the very earliest stages of its involvement with the Ageing Better programme, the Brightlife partnership prioritised the development of a distinct brand and clear, targeted messaging to better reach (and more effectively engage with) a wide range of potential delivery partners.
As a result of this significant investment in marketing and communications, Brightlife successfully engaged an enormous range of delivery partners over the course of five years, resulting in some innovative, enduring partnerships with organisations from all sectors.
In particular, Brightlife found that engaging delivery partners from outside the third sector brought valuable innovation to project design, while also facilitating integration of participants with their wider community and promoting positive messages to other local businesses.
When designing projects and services for older people, it is important to consider that as many as three generations could be included in the term ‘over-50s’, with the needs of each individual strongly dependent on their health, past experience and current situation. For example, a fit, healthy 80-year-old might be far more able and adventurous than a recently-bereaved 60-year-old with limited mobility.
Similarly, older people are just as different to each other in terms of their interests, skills and preferences as younger people are to each other. In failing to take this diversity into account, interventions that use age-based targeting are often ineffective.
Several Brightlife project delivery partners discovered this independently, acknowledging that any social events or clubs that were based and promoted on the age of participants (rather than on an activity or a shared interest) tended to be less popular. Such targeting was also questioned by potential participants, many of whom were reluctant to join a group specifically for ‘older people’ as they did not consider themselves to be ‘old’.
Some of the most successful Brightlife projects involved participation in activities and interests such as gardening, exercise, art, wildlife or photography. These projects were more effective in building participants’ confidence and encouraging meaningful social interaction, with friendships that had initially formed over a common interest being more likely to continue outside the project environment. Activities involving the arts were found to be particularly successful.
For projects based in residential care homes, expanding recruitment to include participants from the local community can also help residents to feel more connected. Another element that was particularly successful for encouraging participation and engagement (particularly from those who live alone) was meal-sharing.
Several delivery partners experienced difficulties engaging male participants in projects involving non-specific activities. In line with existing research in this area, Brightlife found that offering structured, skill-based activities, such as digital photography or construction, was important for attracting older men.
However, projects and services do not have to be targeted exclusively at men to achieve this: adding skill-based options into more general activity programmes can be equally effective.
Interestingly, in delivering the social activities taster project in Winsford, Community Compass found that while men were more likely to take part in activities which involved both exercise and socialising, such as gardening and outdoor crafts, this was only the case for new participants – once they had become comfortable in a group, they were more willing to try purely ‘social’ activities.