Healthy resilient communities

1. Healthy resilient communities Using research to make it happen? Jane Farmer Centre for Rural Health, Inverness, Scotland

2. What? • Scotland… • Health, resilient communities? • The role of researchers vis a vis • change and government policy • Moves to doing • O4O • Remote Service Futures • Dilemma summary • The future(s)…?

3. Centre for Rural Health A word about CRH UHI Millennium Institute and The University of Aberdeen working in partnership • Since 2000 • Collaboration UHI & UoA • 14 staff/ 8 PhD students Academic evidence base • Ways to provide rural services • Health, care & community roles • Community involvement • Tools/methods for measuring • & modelling change impacts RURAL REAL-LIFE APPLY TO CHALLENGES

4. Inverness

5. 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)

6. Health service-related concerns of remote areas 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]

8. 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…

9. =???? Fantastic visionary new opportunity? OR Roll-back of the welfare state…?

10. 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?]

11. Community ‘mediations’ • Isle of Lismore… • Kinloch Rannoch – blog & news items • Ethics…! (piece from Private Eye) • Tacit approval? Promoting of CFRs? • Objective? • We are evaluating • BUT – are we implicitly backing the new order…? • Rights? and Wrongs…?

12. Justifying it to myself… • It is going to happen…? • If communities grasp the nettle and are proactive… • They can make it work for them!!! • And it’s research/evaluation

13. 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.

14. Simultaneous with the political dilemma… • Is ‘research’ enough…? • The kind of research I’ve done • Evaluation…? NHS24, PAs etc etc • Political? • For practice? • Example of ELA project… little useful for practice • Regional development agenda, the OECD & EU funding (LEADER) • Products & services!!!!

15. Has led me to… • Action research agenda • DOING!!!! • (in terms of previous dilemma – even worse!!!!) • But fed up of procrastination – see vision!

16. 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?

17. A Project about older people as a positive force, doing things for communities, doing things for themselves

18. O4O:Older people for Older people

19. 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

20. 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

21. 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

22. 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

23. The O4O model Local citizens explore their needs What would help keep older people living healthily in their own homes & communities? What would most help? Process… Develop a social organisation… Social enterprise Voluntary organisation Co-operative O4O doesn’t give them money

24. At first that required… Cohering Supporting Mentoring Looking for funding Supporting bids

25. Now that’s involving Education for capacity building Business planning & development Developing local social entrepreneurs

26. Why social organisations? Policy says… Social organisations/ civic society makes… Social capital Psychological health & wellbeing Physical health & wellbeing Low evidence base!

27. What are communities doing? • Highland…. • Transport scheme • Supported housing • Helping • Heritage-identity-meeting place-cafe • Karelia, Finland…. • Volunteering • Dumfries & Galloway…. • Extending Foodtrain and other… • Greenland…. • Needs & activities of older people • N.Ireland…. • Shaping social enterprise ideas • Lulea, Sweden…. • Village co-operatives • Inter-generational IT • Cafe

28. Researching the impact of O4Os Individual impacts Health Helping 2. Community impacts Health Participation Volunteering 3. Service provider impacts Costs Activity Falls, care packages, emergency admissions

29. CRH community mediation projects: Involving citizens in service design

30. Remote Service Futures Project 2 year project: 4 remote communities: 2 islands, 2 peninsulas (partnership with NHS Highland & HIE) Ways of providing services Planning game Needs Skills Roles & support Budget Self-care/volunteering Needs Budget Telehealth remote community Nursing models First responders NHS 24 etc

31. Isle of Colonsay Population: 126 No. of children at primary school: 10 No. of families with young children:5

32. Partners & partnership working

33. Not changed the world… but moved (with) the culture? • Medical Manager: “nothing ever changes…” • John Beard: “don’t waste a good crisis…”

35. 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

36. 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

37. A future model? Retained First Responder /Fire Brigade/Coastguard connected to health & soc team Rural Community Popping-in Community nurse/soc care team + volunteers Facilitated/’led’ by LOCAL Health/social care professional(s) Wellbeing Exercise & nutrition Connected to health & soc care Generic health/soc care workers Transport Connected to SAS, community bus Add-ons Community-run Housing, café, bunkhouse, etc

38. 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…

39. Centre for Rural Health jane.farmer@uhi.ac.uk www.abdn.ac.uk/crh