EPICS
EPIC Networks: scale-up, spread and sustain
Funded by the Helen Hamlyn Trust
Co-funding for the PIC Network Development by UKRI
UKRI MRC Grant Person-centred Integrated Care (PIC) Networks supporting Healthy Ageing in Place (2023-25)
The Elderly People’s Integrated Care System (EPICS) was initiated by The Helen Hamlyn Foundation in the 1980s in partnership with statutory authorities in Kensington and Chelsea, Derbyshire and Shropshire. EPICS was inspired by On Lok in San Francisco’s Chinatown. The concept of person-centred-care, at the heart of EPICS, is now the basis of healthy ageing and long term care across Europe and elsewhere (WHO 2019). The legacy of EPICS is significant. Building on this we wished to develop the model the light of current approaches to healthy ageing in place, which emphasize the importance of sustained community connections between generations and across the life course. Public Health England highlights community-centred interventions as a fundamental element of place-based approaches for reducing health inequalities.
The collection of EPICS material held by Lady Hamlyn provided insight into the EPICS centres which preceded and informed current ideas of integrated care, where multiple service providers work together to support older people through a co-located network. Financial and organizational integration were key to the success of EPICS, which provided a single process and place for accessing support. Primary care has a central role to play in supporting older people, particularly those who are less able to access a physical centre and would benefit from home-based care.
While novel for its time, the EPICS model focused on access to multiple services provided exclusively for older people at a single building (the local ‘EPICS centre’). There is a growing evidence base on the role that locallevel support, for example through voluntary organisations and connection services, play in supporting people’s health and well-being as they age.
Our EPIC Networks model builds on the core principles of person-centredness and integration but takes an asset-based approach to implementation, drawing on existing networks of caring relationships and locally-based resources to support healthy ageing.
During the year we held an international workshop exploring different communities of care, undertook stakeholder interviews and older person focus groups, and ran a seminar series on aspects of person centred care.
a. International Workshop
The Best Practice Workshop explored several case examples which our research had identified as providing excellent examples of aspects of networked care. These included Intergenerational engagement: AGE UK Oldham; Digital Technology: etxeTIC ICT HOME service in Biscay; Integrating health and social care: Bromley by Bow Centre; Older Person Empowerment: Birmingham neighbourhood network; Public/ Private: Hallmark Care Homes Foundation; Social engagement: Leeds Neighbourhood Network and Social prescribing: Brussels. (see attached programme)
b. Seminar series
Building on current work at the Institute, funded by the Helen Hamlyn Trust this series explores how the health and wellbeing of older people may be supported through networks of caring relationships and locally-based assets. The speakers highlight a range of contextual factors that might facilitate healthy ageing in place, defined as living well in one’s chosen home and minimizing transitions to higher-intensity care needs. Convenor: Dr Caroline Potter
27 Apr 2023 The role of community-based support for improving quality-of-life outcomes
04 May 2023 Ethnicity, culture and dementia care
11 May 2023 Practices of navigation and bricolage: the difficulties of accessing “integrated” care
18 May 2023 Nature and ageing well in towns and cities: why the natural environment matters for healthy ageing
25 May 2023 Deinstitutionalization and the caring community: building belonging to counter social isolation and uphold the rights of older people
01 Jun 2023 Ageing playfully: play for community connection and wellbeing in old age
08 Jun 2023 Desperately seeking intersectionality in digital health disparities research
15 Jun 2023 Social prescribing and its role in supporting the health and well-being of older people
c. Stakeholder interviews
Our research included a series of interview with key stakeholders to inform the developme ntof the new model. These were undertaken in in person by the project Research Fellows, recorded and transcribed. They included international examples to explore best practice.
- Professor Liesbeth De Donder (Vrije Universiteit Brussels)- Active Caring Communities in Brussels
- Professor Christopher Dayson (Sheffield Hallam University)- Leeds Neighbourhood Network
- Stephen Burke (United for all Ages) Intergenerational Communities of Care
- Emily Greenfield (Associate Professor of Social Work at Rutgers, the State University of New Jersey) - Village to village model, EPICS and NORC
- Maggie Hurley (Age UK – Oldham)- Intergenerational Communities
- Sue Read (Beth Johnson Foundation)- Intergenerational Communities
- Bromley by Bow- volunteer lead
- Emil Prysak- Birmingham Neighbourhood Network
- Brendan Martin- Buurtzorg Model
- Karla Zimpel -Leal (Brooks University)– Homecare models that have emerged in the UK
- Kate Hodson (Programme Director of Magic Me)- Intergenerational Communities.
- Phillippa Carnemolla (Associate Professor, University of Technology Sidney)– Using Technology in Models
- Judith Ish- Horowicz (Intergenerational Communities)- Apples and Nightingale Programme in London
- Mhorag Goff (University of Manchester)- Village Model in Manchester
d. Older person focus groups
Following the stakeholder workshop in January 2023, we engaged with the Oxford 50+ network (older citizens living in neighbourhoods across Oxford city) to explore challenges and opportunities of developing local EPIC networks to support healthy ageing. Key insights from this initial engagement were the need to define a size of ‘community’ that was meaningful and practical for local-level engagement; the presence of potential assets (such as former day centres) that were no longer in use because of changes in funding and management; and the lack of longer-term commitment by a designated body (government, NHS, etc.) that led to the ongoing reduction of services.
From planned re-engaging with OX50+ over summer 2023, we have continued to build links with local communities through initial fieldwork ahead of formal focus groups. We have attended sessions with
- Silver Threads and Donnington 50+ (organisations that provide structured social activities for older people through regular weekly sessions),
- Zumba Gold (exercise and strength training for older people), Community Larder (low-cost food support),
- Age Friendly Creative Oxfordshire (promoting creative and cultural activities for older people), and
- Intergenerational activity sessions (arts and movement done together by older people and pre-school children with their parents).
Insights gained from this fieldwork include:
- Importance of subsidization and/or management support of community centres by local government. Restricted access and higher hire costs can limit older people’s efforts to initiate daytime activities and peer support.
- Interaction from primary care teams where necessary.
- Tensions within communities over the range of support on offer. Some older people are explicitly not interested in activities with children, while others would like to see much more of this. There can also be conflict over the extent to which activities are structured versus purely social (e.g. exercise classes versus bar/social club), with venue design potentially supporting some types of activities over others.
- While visibility of local hubs is important, many of the older people we spoke to became aware of or engaged in activities through word of mouth or personal encouragement to attend.
- Coordination of local services potentially broadened appeal and got more people engaged, for example scheduling the intergenerational group over lunchtime and including a free hot meal provided by a local food charity.
A significant public engagement event will be the annual Older People’s Day held in Oxford Town Hall in early October, where we will run stall throughout the day to share emerging findings of the research and to recruit participants into a series of focus groups planned for the autumn.
After assessment of various examples, Leeds Neighbourhood Networks was selected as an exemplar case that could inform practical implementation of EPIC Networks at scale. Each defined neighbourhood in the city of Leeds (37) has had its own dedicated neighbourhood network (LNN) which operates as a form of independent community organisation that supports older people to stay healthy, age in place, and delay their entry into the formal care system.
- older people are not merely recipients of care but are involved in design and delivery of the networks;
- activities typically include a combination of information, advice, advocacy, activities and social opportunities.
- linked into formal health and care services
An evaluation of the LNN model by the Centre for Ageing Better concluded that the number of people receiving homecare and taking up places in residential homes in Leeds is falling, and LNNs are reducing the pressure on local NHS and the social care services. We believe there is a strong economic case for this research into the scale-up, spead, sustainability of the model.
UKRI MRC Grant Person-centred Integrated Care (PIC) Networks supporting Healthy Ageing in Place (2023-25)
We were delighted to be awarded co-funding from the MRC for the project. This will support our colleagues from outside Oxford working with us on the Leeds Neighbourhood Network and our policy and practice partners: Sheffield Hallam University, Oxford Brookes University, local government (Leeds City Council, Birmingham City Council, Oxfordshire County Council), digital health (CONNECT Care), public engagement (VOICE, Oxford 50+ Network), and advocacy (Centre for Ageing Better) to work with the Oxford EPICS team.