Healthy resilient communities

Using research to make it happen?Using research to make it happen?Jane Farmer

Centre for Rural Health, Inverness, Scotland

What?

•Scotland…Scotland…•Health, resilient communities?Health, resilient communities?•The role of researchers vis a visThe role of researchers vis a vis change and government policychange and government policy•Moves to doingMoves to doing•O4OO4O•Remote Service FuturesRemote Service Futures•Dilemma summaryDilemma summary•The future(s)…?The future(s)…?

A word about CRH

• Since 2000• Collaboration UHI & UoA• 14 staff/ 8 PhD students

Ways to provide rural servicesWays to provide rural services Health, care & community rolesHealth, care & community roles Community involvementCommunity involvement Tools/methods for measuringTools/methods for measuring & modelling change impacts& modelling change impacts

Academic evidence base

RURAL REAL-LIFE

APPLY TO CHALLENGES

Centre for Rural HealthUHI Millennium Institute and The University of Aberdeen working in partnership

Inverness

The policy place in Scotland

• Delivering for Remote & Rural Health• “community resilience”

• Better Health Better Care – “mutuality”

• Neo-liberalism• Globalisation• Recession• Scotland – less marketised than England… ‘good’

& ‘bad’

• (OECD rural policy review)

Higher & rising % of older people– Chronic & complex illness

Migration patterns

(Fear of?) service erosion

Security Access to A&E/ (risk)

Appropriate economic development?» Market failure

Transport issues

Infrastructure issues

Available & affordable good housing

Inconsistent weather

[Insular-ism & conflict]

Health service-related concerns of remote areas

What is a healthy, resilient community?

• Government seeks…

• Secure (new CFRs & emergency models)

• Looking after each other/ civic society• Free personal care – means – no domestic care

etc…. [so participation!!!]

• Healthy – walking clubs/ active

• Self-care…

• Anticipatory care…

=????

Fantastic visionary new opportunity?Fantastic visionary new opportunity?

OROR

Roll-back of the welfare state…?Roll-back of the welfare state…?

Where do WE stand?

• As rural academic researchers…

• Can we be objective?

• Rural advocates & developers!!!

• Yet policy agenda swings us into neo-liberalism…?

• Expectation of ‘progress’, not resistance…

• [or stick to health? And not services?]

Community ‘mediations’Community ‘mediations’

• Isle of Lismore…Isle of Lismore…

• Kinloch Rannoch – blog & news itemsKinloch Rannoch – blog & news items– Ethics…! Ethics…! (piece from Private Eye)(piece from Private Eye)

– Tacit approval? Promoting of CFRs?Tacit approval? Promoting of CFRs?– Objective?Objective?

• We are evaluatingWe are evaluating

• BUT – are we implicitly backing the new BUT – are we implicitly backing the new order…?order…?

• Rights? and Wrongs…?Rights? and Wrongs…?

Justifying it to myself…Justifying it to myself…• It is going to happen…?It is going to happen…?• If communities grasp the nettle and are If communities grasp the nettle and are

proactive…proactive…• They can make it work for them!!!They can make it work for them!!!• And it’s research/evaluationAnd it’s research/evaluation

But in Canada….!“…the central concern arising from these reforms in Canada, as elsewhere, is that

the NPM reforms place matters of efficiency above those of equity and entitlement and that the negative impacts of these reforms are felt most intensely among less well off individuals and communities…”

“…each of the 43 [institutions] is findings its own solution to the problem of meeting expanding demands with limited resources, and this is creating diversity in local capacity to respond to demands for assistance…”

“…limits to community capacity among older people to provide for themselves and each other…”

• Cloutier-Fisher, D., Joseph, A.E., 2000. Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives. Social Science & Medicine 50, 1037-45.

• Hanlon, N.T., Rosenberg, M.W., 1998. Not-so-new public management and the denial of geography: Ontario health-care reform in the 1990s. Environment and Planning C: Government and Policy 16(5), 559 – 572.

• Hanlon, N.T., Halseth, G., Clasby, R., Pow, V., 2007. The place embeddedness of social care: restructuring work and welfare in Mackenzie, BC. Health & Place 13, 466-481.

• Skinner, M.W., Rosenberg, M.W., 2006. Managing competition in the countryside: non-profit and for-profit perceptions of long-term care in rural Ontario. Social Science & Medicine, 63, 2864-76.

Simultaneous with the political dilemma…

• Is ‘research’ enough…?Is ‘research’ enough…?• The kind of research I’ve doneThe kind of research I’ve done

– Evaluation…? NHS24, PAs etc etcEvaluation…? NHS24, PAs etc etc– Political?Political?– For practice?For practice?– Example of ELA project… little useful for practiceExample of ELA project… little useful for practice

• Regional development agenda, the OECD & Regional development agenda, the OECD & EU funding (LEADER)EU funding (LEADER)– Products & services!!!!Products & services!!!!

Has led me to…

• Action research agenda

• DOING!!!!

• (in terms of previous dilemma – even worse!!!!)

• But fed up of procrastination – see vision!

Now dangers of…

• Am I a researcher…?• Or an entrepreneur using public money?• Why are my ideas any good?• What happens when (!!!!) fail!!!!• ‘all these projects…jobs for the boys… if you fail,

you will never get a sniff of money again…’• [isn’t jobs for the girls/boys the point…?]• Regional development!!!!!!• Can short projects ‘succeed’? Is it more about

moving the paradigm?

A Project aboutA Project aboutolder people as aolder people as a

positive force, doingpositive force, doingthings for communities, things for communities,

doing things for doing things for themselvesthemselves

O4O:Older people for Older people

O4O is about

• Responding to population change• Sustaining remote communities• Changing the way people think• Making a start on seeing older

people as a positive force

What is O4O?• Mechanism to involve (older) people in basic

level service provision for older people• Different models of doing this in different

partners & communities– Volunteering– Social enterprise

• Work with communities• Involve ‘business’ development• Built on local needs & resources• Cross-generational

What sorts of services?• Good neighbour / social support• Domestic help• Meals, shopping• Lifts/ transport• Educational support• Support for self care• First response/triage• Support for community alarm

schemes• Snow clearing & wood-chopping

Partners

• Highland – growing ageing population• Dumfries & Galloway – employment

opportunities• Northern Ireland – post-conflict• North Karelia – heavy demand for older people’s

services• Lulea – develop volunteering• Kainuu – learn from the project• Sommersooq, Greenland

The O4O modelThe O4O model

• Local citizens explore their needsLocal citizens explore their needs• What would help keep older people living What would help keep older people living

healthily in their own homes & communities?healthily in their own homes & communities?• What would most help?What would most help?

• Process…Process…• Develop a social organisation…Develop a social organisation…• Social enterpriseSocial enterprise• Voluntary organisationVoluntary organisation• Co-operativeCo-operative

• O4O doesn’t give them moneyO4O doesn’t give them money

At first that required…At first that required…

• CoheringCohering

• SupportingSupporting

• MentoringMentoring

• Looking for fundingLooking for funding

• Supporting bidsSupporting bids

Now that’s involvingNow that’s involving

• Education for capacity buildingEducation for capacity building

• Business planning & developmentBusiness planning & development

• Developing local social entrepreneursDeveloping local social entrepreneurs

Why social organisations?

• Policy says…

• Social organisations/ civic society makes…– Social capital– Psychological health & wellbeing– Physical health & wellbeing

• Low evidence base!

What are communities doing?Highland….•Transport scheme•Supported housing•Helping•Heritage-identity-meeting place-cafe

Dumfries & Galloway….•Extending Foodtrain and other…

N.Ireland….•Shaping social enterprise ideas

Lulea, Sweden….•Village co-operatives•Inter-generational IT•Cafe

Karelia, Finland….•Volunteering

Greenland….•Needs & activities of older people

Researching the impact of O4Os

1. Individual impacts• Health• Helping

2. Community impacts

• Health• Participation • Volunteering

3. Service provider impacts

• Costs• Activity• Falls, care packages,

emergency admissions

CRH community mediation projects:Involving citizens in service design

Remote Service Futures Project

Needs

Self-care/volunteering

Telehealth

Nursing models

First responders

NHS 24

Ways of providing services

etc

Budget

Planning game

Needs

Skills

Roles & support

Budget

remotecommunity

2 year project: 4 remote communities: 2 islands, 2 peninsulas (partnership with NHS Highland & HIE)

Isle of Colonsay

Population: 126

No. of children at primary school: 10

No. of families with young children:5

Partners & partnership workingPartners & partnership working

Not changed the world… but moved (with) the culture?

• Medical Manager: “nothing ever changes…”

• John Beard: “don’t waste a good crisis…”

Still dilemma about role…?

• Researcher? Rural developer? Social engineer?

“Civic engagement is no ‘cinderella’ activity and must become a priority: scholar says community work should be part of teaching and research”

Times Higher Education, 1 Oct 2009, p.11

The future

• Community budget holding…– ‘teaching’ communities to make decisions

• Community development (resilience) as a role for service professionals

• Engaging communities in designing and doing research

• Anticipatory service design

Add-onsAdd-onsCommunity-run

Housing, café, bunkhouse, etc

TransportTransportConnected to SAS, community bus

Wellbeing Wellbeing Exercise & nutrition

Connected to health & soc care

Popping-in Popping-in Community nurse/soc care team +

volunteers

A future model?

Rural CommunityRural Community

RetainedRetainedFirst Responder /Fire Brigade/Coastguard

connected to health & soc team

Facilitated/’led’ by LOCALFacilitated/’led’ by LOCALHealth/social care professional(s)

Generic health/soc care workersGeneric health/soc care workers

Key messages

• What is our position vis a vis the political agenda – awareness?– We must not be party to destroying the very thing we are

passionate about!

• What is our position re action..?– Is there a valid place for researchers/ academics

• Can we provide more useful information for practice?• Can and should we do things that public services

cannot?• Can we improve rural service delivery simultaneous with

community resilience?• Can we work together more – internationally…

Centre for Rural Centre for Rural HealthHealthjane.farmer@uhi.ac.jane.farmer@uhi.ac.ukukwww.abdn.ac.uk/crhwww.abdn.ac.uk/crh