HEALTHY AGEING COMMUNITY HUBS 

Introduction

The Elderly People’s Integrated Care System (EPICS) was initiated by The Helen Hamlyn Foundation in the 1980s. The current research (2020-2026) has been funded by the Helen Hamlyn Trust and the MRC.  The lead academic for this research programme  is Professor Sarah Harper; Professor of Gerontology at the University of Oxford, a Fellow at University College and Director of the Oxford Institute of Population Ageing.

Challenges

Demographic and economic trends in recent decades have put unrelenting pressure on health and care systems. At the same time, financial austerity policies and the ongoing impacts of the Covid-19 pandemic have reduced resources for health and social care services, despite the increased prevalence of long-term conditions associated with ageing (e.g. dementia, diabetes and chronic pain). Reducing service needs by older people is a strategic priority for the sustainability of health and care systems.

In January 2019, the NHS published its LongTerm Plan Health infrastructure plan: a new, strategic approach to improving our hospitals and health infrastructure.  Pivotal to the delivery of more personalised, preventative healthcare in the NHS Long Term Plan is more community and primary care away from hospitals. This sits alongside various initiatives including the People at the Heart of Care: adult social care reform white paper (2021), and the follow-on reports: Accelerating reform in adult social care in England: priorities for innovation and scaling (Nov 2023) and Adult social care system reform: next steps to put People at the Heart of Care: A plan for adult social care system reform 2023 to 2024 and 2024 to 2025 financial years (April 2023), all grappling with Social Care in a post-covid UK. 

Conceptual Model

The NHS Long Term Plan has a strong focus on the treatment and prevention of illness by supporting people to adopt improved healthy behaviours. At the heart of this plan is a new ambition for integrating primary care, improving the access, experience and outcomes for our communities, with a particular emphasis on helping people to stay well for longer as part of a more ambitious and joined-up approach to prevention. 

The extensive literature around healthy ageing and well-being has identified the following 6 key factors 

We believe that if every older person had access to each of the above 6 pyramids within their local community their health and wellbeing would measurably improve and their transitions to ill health and dependency be delayed. 

Aims of Healthy Ageing Hub

To facilitate healthy ageing and wellbeing through supporting community services to enable older adults to remain in their homes for longer, thus delaying transitions from independence to dependence, and therefore reducing demands on local authority and health services, family and other forms of support and care. 

Objectives

To enable neighbourhood networks and other community assets in achieving this aim.

Diet: The role of nutrition and diet is now seen as one of the key factors promoting healthy longevity. This pyramid includes access to healthy foods (avoiding food deserts), diet advice and community support to eat well.

Exercise: There is increasing evidence that physical activity helps prevent many long term conditions such as cancer, heart disease, stroke, diabetes, dementia etc. and increases general mental wellbeing.

Social: social interaction has been identified as a key component of healthy longevity, while loneliness has a key detractor. Through supporting meaningful community relationships, enabling social inclusion, and tackling loneliness, this pyramid also includes involving the Voice of older people and providing information, advice, advocacy, activities and social opportunities.

Health Care: Through integrating local and community integration of primary health care, social services, voluntary organisation and private enterprises at the grassroots and community level, enabling multiple service providers – public, private and voluntary – working together to support older people through a co-located network.

Built Environment: Places play a vital role in our health and our local environment is an important influence on our health behaviours.

Natural Environment:  There is evidence that high exposure to natural environments such as green space and gardens in communities is  associated with higher wellbeing amongst older people.

Here we explain the rationale and purpose of new work on Healthy Ageing Hubs, the distinctive contribution of each Hub, and the manner in which the evaluation will occur.  

Context

Facilitating integrated care to enable frail older adults to remain in the community

It is now recognised that a priority is to enable frail older people to stay at home for as long as they wish. The keeping and caring for frail elderly people within the community is thus of importance. However, the ability of frail older adults to maintain good health, high quality of life, and independence is often predicated on enabling environments and access to support from families and communities.  Policy discourse and health systems have been slow to catch up, with resources still concentrated on acute care in hospitals and care homes. The economic case for preventive care delivered in or near citizens’ homes is strong. However, effective and consistent delivery of community-based care to the frail to enable them to remain in their own homes remains elusive.  

The Healthy Ageing Hubs will enable older frailer adults to remain in the community through:

• Facilitating person-centred integrated care enabling easier access to statutory services,
• Providing information guidance on the range of options available,
• Co-ordinating activities to promote wellbeing,
• Ensuring professional support to care workers both formal and informal (family and volunteers).

Using unique access to Oxfordshire County Council health and social care data, and policy makers,  we have  identified 4 different socio-economic and geographic communities  within Oxfordshire, with the potential to support a healthy ageing hub. 

We  engaged with county and local stakeholders including  primary health and care service providers, voluntary sector stakeholders and local authorities to identify the communities  in which we undertook the research.

We drew upon  local initiatives such as  NHS Social Prescribing led by Primary Care Networks  and initiatives built on healthy place shaping, to inform our thinking. 

We undertook extensive mapping of existing local assets and  engaged in-depth with residents in the selected pilot site areas to understand their experience of care in both physical and virtual spaces.

We interviewed  a diverse range of participants, gaining  multiple perspectives from those with different levels of engagement with formal and informal care services, different familiarity and engagement with technology, and different opportunities for physical mobility linked to health status.  

This  in-depth qualitative approach  enabled insights about people’s relationships to a range of spaces at various scales: from buildings (e.g. home or healthcare setting) to open environments (e.g. public spaces) including the institutional, domestic, familial, community, public, voluntary and private contexts. 

We used  the go-along interview method to gain deeper insights into the everyday experiences of ageing and the impact of the environment, including neighbourhood and social infrastructure, on older adults. 

We studied the working activities of local link workers, and health and social care providers.

Allowing older participants to navigate their local surroundings and highlight areas of significance or challenge, we  captured nuanced person-place interactions and cultural dynamics. This included the accessibility of neighbourhood amenities, the quality of social infrastructure, and the extent to which these factors influence older adults' daily lives.

Three Healthy Ageing Hubs

After undertaking exploratory research in four Oxfordshire   communities, it became clear that three of the communities were appropriate for taking this idea forward. In collaboration with the 3 selected communities, we have been able over the past three months to develop an agreed template, which all three are willing to support, and adapt to their specific needs. All three communities are willing to work with us, employ facilitators, connect with health and social care services, and develop activities  for three years. They also confirmed that they had strong existing relationships with their local Health Centres. They agreed to provide healthy ageing services for 4 days a week, and to ensure that frail, housebound older adults were specifically bought into the centre.

Community One
This is a poor disadvantaged community in the city of Oxford; the healthy ageing hub is based around an existing food bank and community centre.

Community Two

A market town; the healthy ageing hub is a community-funded centre supporting  those in rural isolation, poverty, loneliness, debt, and mental health challenges, with a strong focus on older adults.

Community Three

A large rural village;  the healthy ageing hub  is based on two existing facilities serving the interests of both active older adults and frailer housebound rural adults.