Healthy resilient communities 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 policy change 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 services  Ways to provide rural services  Health, care & community roles  Community involvement  Tools/methods for measuring & modelling change impacts & modelling change impacts Academic evidence base RURAL REAL-LIFE APPLY TO CHALLENGES Centre for Rural Health UHI 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? OR 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’ Isle of Lismore…Isle of Lismore… Kinloch Rannoch – blog & news itemsKinloch Rannoch – blog & news items –Ethics…! (piece from Private Eye) –Tacit approval? Promoting of CFRs? –Objective? We are evaluatingWe are evaluating BUT – are we implicitly backing the new order…?BUT – are we implicitly backing the new order…? Rights? and Wrongs…?Rights? and Wrongs…?

Justifying it to myself… It is going to happen…?It is going to happen…? If communities grasp the nettle and are proactive…If communities grasp the nettle and are 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., Long-term care restructuring in rural Ontario: retrieving community service user and provider narratives. Social Science & Medicine 50, Hanlon, N.T., Rosenberg, M.W., 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., The place embeddedness of social care: restructuring work and welfare in Mackenzie, BC. Health & Place 13, Skinner, M.W., Rosenberg, M.W., Managing competition in the countryside: non-profit and for-profit perceptions of long-term care in rural Ontario. Social Science & Medicine, 63,

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 etc –Political? –For practice? –Example of ELA project… little useful for practice Regional development agenda, the OECD & EU funding (LEADER)Regional development agenda, the OECD & EU funding (LEADER) –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 about older people as a positive force, doing things for communities, doing things for themselves

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 model Local citizens explore their needsLocal citizens explore their needs What would help keep older people living healthily in their own homes & communities?What would help keep older people living 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… CoheringCohering SupportingSupporting MentoringMentoring Looking for fundingLooking for funding Supporting bidsSupporting bids

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