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EXECUTIVE SUMMARYBackgroundThe Department of Health funded Partnerships for Older People Projects(POPPs) were designed to test out new ways of providing services to olderpeople. The aim of POPPs is to deliver and evaluate, through 29 LocalAuthority led pilots, locally innovative approaches, aimed at creating asustainable shift in resources and culture away from institutional andhospital-based crisis care for older people towards earlier, targetedinterventions within their own homes and communities. The first 19 POPPswere established in May 2006 with a second round in 2007.Rochdale POPP, launched in May 2007, set out to enable older people to havepower and control over their lives to sustain independence and well-being inolder age. The intended outcomes were: Improved quality of life for older people and their carers Improved health and fitness for older people Reducing social exclusion for older people and their carers Increased information and choice for older people and carers Reducing use of more intensive services and admissions to long-termcare Economic benefits through local enterprise and volunteering New models of local commissioning and devolved budgets New sustainable structures and partnerships between the BoroughCouncil, the public and local organisationsResearch aimsIn order to evaluate the extent to which the Rochdale POPP achieved its aims,its leaders commissioned the University of Salford to carry out an evaluationof the project. The broad aims of the evaluation were to:10

Evaluate the impact and effectiveness of initiatives Examine the structure and governance of the project Illuminate the key systems and processes at work within the projectMethodsThe research study used a mixed method approach. The methods includedinterrogation of the POPP database, interviews with staff, service users,commissioners and other key stakeholders and observations of variousactivities, such as key meetings.Key findingsPOPP activityThe POPP outreach workers conducted over 2500 interviews between May2007-March 2009 and for those interviewed social isolation and ill-health werekey factors in social exclusion. As a result of these interviews outreachworkers made over 2000 referrals for different physical and social activitiesincluding for general information, armchair exercise, luncheon club, ITlessons, gentle exercise and arts and crafts. Almost 1000 referrals were madeto key services including to health professionals, for benefits advice,equipment advice, and to Social Services and over 2000 referrals were made toPOPP funded projects. Over half of these latter referrals (1395) were fortransport services which facilitated attendance at both social and healthactivities.Eighty seven percent of all identified needs across all Townships were met.This represents a powerful indication of the outreach workers’ rigorous andsustained approach toward uncovering unmet needs, and developingeffective solutions to meet those needs through engaging constructively withboth their POPP colleagues, as well as with statutory and non-statutoryservice providers. The diverse range of needs that have been met include:Physical Activity (e.g. Armchair Exercise, Dancing, Swimming, Tai Chi and11

Walking); Social Interaction (e.g. Arts and Crafts, Luncheon Clubs and SocialActivity); and Social Support (e.g. Assisted Shopping, Equipment AccessService, Home Improvement, Ring and Ride and Transport). The keyremaining areas of unmet needs concern Armchair Exercise (117 POPPmembers identified as having their needs unmet), Luncheon Clubs (96 POPPmembers with needs unmet), Podiatry (84 POPP members with needs unmet),Gardening (49 POPP members with needs unmet), and Handy Person (with37 POPP members with needs unmet).Impact at the level of the individualMany service users revealed respect and admiration for the work of theoutreach workers in seeking to support their needs. The most importantaspect of the outreach workers’ role has been to act as a global informationresource on a variety of issues, and to be able to refer POPP members torelevant statutory and non-statutory agencies who can offer further adviceand support. The importance of acting as a conduit of vital informationcannot be overstated, as this has enabled POPP members to become aware ofservices and activities that they would otherwise have remained unaware of.Interviews also revealed a strong emphasis on transport services that havesupported social inclusion and greater independence. Those interviewedbenefited from different POPP activities, including those seeking to promotesocial engagement, physical activity and easier access to services andactivities; and all reported reduced levels of stress and worry, whichhighlights the mental health benefits that are associated with all of the variedactivities that maintain independence, promote access to services andactivities and enhance general health and well-being.Partnership organisationsIn partnership with the Rochdale Council for Voluntary Services (RochdaleCVS) nearly two hundred volunteers were recruited over the duration of the12

POPP pilot. These volunteers were involved in 38 different activitiesincluding the Volunteer Drivers Scheme (VDS) (in both administrative anddriving roles) and the Township Older People’s Partnerships (TOPPs) (ascommittee members).Greater Manchester Passenger Transport Executive (GMPTE) in partnershipwith POPP was phenomenally successful in achieving its targets for POPPtrips per month, and this support has enabled many older people across theBorough to take part in a range of diverse activities doing much to reducesocial isolation. The role of the POPP Transport Co-ordinator has beeninstrumental through working closely and effectively with the TOPPs, anddeveloping strategies that enabled the unmet needs of POPP members to beaddressed. Equally the POPP Transport Co-ordinator has worked effectivelywith transport operators across Rochdale Borough, as well as enabling the useof group transport vehicles to secure cost-effective solutions to transportobstacles for single or group participants in POPP activities.These flexible transport solutions included development of the VDS that hasenabled isolated, vulnerable people to access services and activities in waysthat would previously have been extremely difficult, if not impractical. Thetrips delivered by the VDS in relation to health and social activitiesdemonstrate that over two-thirds were for health purposes (i.e. to and from ahealth facility). In the long term, this kind of scheme could ease some of theburden of the local ambulance service in transporting people to and fromhospital, and reduce the length of time that older people are required to waitto be transported home.Referrals to the Carers Association have enabled POPP members with caringresponsibilities, and carers of older people, to access varying types of support.The work of the Carers Social Enterprise Development Worker has beenpivotal in developing the achievements of the Carers Association, particularly13

in relation to identifying, registering, helping and supporting over 400 carersover the life of the project. A key factor contributing to the success of theCarers Association has been the way in which it has promoted itself with avariety of different agencies, including Social Services, the local NHS, andother POPP projects.Over the period of the project, a large number of carers have accessed HealthyLiving Initiative, Formal Learning and Leisure Activities. These activities areimportant in relieving the stress from caring responsibilities, becoming lesssocially isolated and developing social ties and friendships with other carersin similar situations. In addition the success of the Carers Association indeveloping viable and wide-ranging social enterprises is particularlyimpressive.Partnership and devolved decision-makingRochdale POPP sought to enable older people to exercise greater power andcontrol over their lives, in order to sustain independence and well-being inlater years. The model developed conveys a powerful commitment to theprinciple of community empowerment, which is centred upon two keyactivities:1. Developing partnerships with older people at a Township level2. Devolving commissioning and funding to the TownshipsThe TOPPs were given responsibility for a development budget forcommissioning local activities, and promoting initiatives led or supported byolder people. This created an entirely new financial partnership with olderpeople, in that TOPPs were given greater control over resources to developlocal activities in line with local needs, which amounted to roughly one thirdof the entire POPP budget.14

Despite a slow start the TOPPs process was highly successful in directlycommissioning over 250,000 of local services. These services differed byTOPP being tailored to each location’s unmet needs and being creative indeveloping flexible solutions. The commissioned services were wide -rangingincluding allotments, IT lessons, Tai Chi, Armchair Exercise, Luncheon Clubsand Massage Therapy. A common feature of commissioning across TOPPswas transport services representing around half of the monies spent.The TOPPs’ confidence in the decision-making and commissioning processincreased over time; demonstrated by their collective ability to both articulatethe needs of older people within their communities, as well as in rigorouslyinterrogating proposals endeavouring to meet those needs in ways thatachieved best outcomes and maximum value for money for older people intheir communities. Key to the process has been the training and the supportthe TOPPs have received.Establishment of the TOPPs was slower than anticipated. This is likely to havehad a direct effect on the spending by the TOPPs. Equally POPP wassomewhat hampered in the first year by the absence of an effectivecommunication strategy, which meant that it was difficult for the project tocommunicate its presence to communities across the Borough.Assessing the impact of commissioned activitiesTwo of the POPP commissioned services were explored in greater detail inorder to assess their impact.Tai Chi classesThe routine assessments for participants in the class were indicative of healthimprovements over the period; health related quality of life showed an overallmaintenance (no deterioration) over the study period. Tai Chi classesprovided physical health benefits; mental health benefits and social benefits.15

For example, improvements mobility and balance meant fewer difficulties ineveryday activities such as walking, climbing stairs, cooking, washing andironing leading to increased confidence to go out (travel more) and toundertake leisure activities such as gardening and swimming; which in turngave them a greater sense of independence. The Tai Chi class was a relaxingand calming experience providing a forum which, for some, reduced socialisolation by providing contact with others and broadening participants’ socialbase.The financial benefits include lower cost of health and social care services inthe following three months following attendance at Tai Chi ( 1535.60). Thesesavings were higher than the cost of providing Tai Chi giving a net saving of 125.84. Indeed cost savings could be maximised if the class is delivered byappropriately trained non-professionals as intended through the RochdalePOPP model.It should be noted that the study is limited by small sample numbers, the lackof a control group and a relatively short follow up period. It is not possible tosay whether any changes are due to time rather than the Tai Chi class; orwhether changes are sustained over a longer time period. Given theselimitations, together with the heterogeneity of the physical ailments of thesample, the analysis points to potential benefits but further research isrequired.Volunteer Driver Scheme (VDS)In the development phase of the VDS, service providers were clear in theiraims for the service which were wide ranging: to develop transport solutionsfor people with mobility difficulties; enhance transport accessibility fordisabled people in line with local and national policy agendas; provide a costeffective transport service (reducing level of subsidised transport); bridgecurrent gaps in service provision and support statutory providers; use skills16

of outreach workers for multi-agency partnership working; tackle socialisolation and promote inclusivity; provide reassurance to wider familynetworks on vital transportation; use volunteers to drive vehicles suitable tothe needs of disabled people, and so deliver appropriate transport solutions;and promote potential paid employment opportunities for volunteers.Factors that might limit the effectiveness of the service were thought toinclude obtaining sustainable support of volunteers; balancing the cost oftransport provision with social benefits; the potential for creating long termdependency on door to door transport and the challenge of multi-agencyworking.Volunteers, interviewed in the early days of the VDS displayed anappreciation of the challenges confronting older people that includedfinancial difficulties in the light of limited pension provision. They showed acompassionate approach with a keen sense of putting something back into thecommunity and in return reporting satisfaction in their volunteering.The VDS users were typically 70 years of age or over and, when comparedwith a representative sample of the UK population had lower self reportedhealth suggesting the users are more likely to be more dependent/lessindependent than is typical of their age group. The service users highlightedtheir difficulties in using public transport which had led them to turn to theVDS. They found the strengths of the service were its immense comparativecost effectiveness in relation to using private hire taxis; the kindness ofvolunteers; the volunteer drivers’ disability awareness; greater sense of safetyand security through using vehicles and equipment suitable to the needs ofdisabled people and the compassionate culture of volunteering for the pursuitof altruistic, rather than pecuniary, gains. In respect of health related qualityof life, this in turn led to reduced sense of stress, particularly when attendinghospital appointments and on occasion having drivers wait for service users’appointments to be concluded so that they could take them home, reduced17

sense of social isolation and greater level of companionship and enhancedpersonal independence.The estimated cost of setting up the VDS was 28,000 with continuing costs of 38,000 per annum. In addition cost savings were identified as accruing toservice users (cost to them of VDS journeys was lower than private taxis),their family and friends (use of VDS instead of asking family and friends) andto statutory transport services (where the VDS replaces these services).Looking back; and to the future of Rochdale POPPThe main successes of the POPP initiative according to key stakeholders havebeen the Outreach Service, transport schemes, TOPPs and projectmanagement by the voluntary sector. A number of challenges were alsoidentified by participants, some of which have been actual challenges and inthe main have been successfully addressed within the project.The structures and processes of POPP and TOPPs were viewed as excellentstarting approaches that had resulted in a significant number and quality ofoutcomes. Considerable numbers of older people are being reached andregistered with Rochdale POPP prior to being referred on to services andactivities they may otherwise not have received. TOPPs are valued as a meansof engaging older people and influencing Township arrangements andprocesses. In addition TOPPs were viewed as a key strength to the Rochdalemodel of POPP that may also be a valuable way forward in other localauthorities.Suggestions were made to promote the future independence of TOPPs,perhaps exploring social enterprise models and similar. Useful caution wasgiven to ensure that TOPPs were facilitated to manage any additional fundingthey received, perhaps from Townships, in any future model. A similarconcern was that both POPP and TOPPs achieved the capacity necessary to18

meet future demand. However, the POPP model was evolving to-date in linewith Government goals around voluntary working which was viewedpositively.POPP transport was highly praised as being innovative and effective atmeeting many older people’s needs. Transport initiatives were also viewed asinstrumental in supporting POPP work to reduce social exclusion andisolation. It was acknowledged by participants that much work needed to bedone to further reach these groups and especially Black and Ethnic Minority(BME) groups to reflect the diversity of the Rochdale Borough population.Finally, views around optimising sustainability of POPP included maximisingthe input of the voluntary sector in any future arrangements; promotion ofPOPP successes; spreading the word about POPP, not least through olderpeople themselves; and POPP arrangements to be more open to scrutiny andreview.Conclusions and recommendationsRochdale POPP set out to enable older people to have power and control overtheir lives to sustain independence and well being in older age. Over the pilotperiod the outreach workers interviewed over 2500 older people across theBorough with around three quarters being over 70 years of age. Over 2000referrals were made for different physical and social activities; almost 1000referrals were made to key services including to health professionals, forbenefits advice, equipment advice, and to Social Services and over 2000referrals were made to POPP initiatives. Over half of these latter referrals(1395) were for transport services which facilitated attendance at both socialand health activities. This represents considerable success. However, it shouldbe noted that amongst those accessing POPP, males were significantly underrepresented when compared with local demographics. Although participationof BME communities (of which South Asian communities form the largest)19

was commensurate with local demographics, a much smaller proportion ofthose had all of their needs met in comparison with

Management and delivery of POPP 325 Redesign of service development and delivery 329 Impact of POPP on involvement of older people 330 Social exclusion/social isolation 331 Optimising sustainability 334 Key findings 340 CHAPTER NINE: Summary and Conclusions 343 Introduction 343 Overview of activity 343 Impact at the level of the individual 345