The most vulnerable groups are often the ones least able to access services. These are also the groups most likely to be suffering from social isolation and loneliness.
Access to services is influenced by both structural service characteristics (the structure, organisation and delivery of services; service characteristics such as location and opening times) and the characteristics of the population being served (demographic characteristics, for example being an asylum seeker, being homeless, having a learning difficulty, or living in a rural area; cultural characteristics, for example if the person does not speak English as their first language or lives in a Gypsy or Traveller community; behavioural characteristics, for example illicit drug use or commercial sex work, that people may want to actively conceal; attitudinal characteristics, for example being suspicious of the services offered or being unaware of the health benefits that might be gained; lifestyle characteristics, for example being a carer). People who do not routinely access standard health and social care services in particular are at increased risk of poor health, which can accumulate through life and lead to increased demand on services and increased health and social care costs.
Loneliness can affect anyone – regardless of the individual’s age. However, as we age, the risk factors that can lead to feelings of loneliness increase and converge. These factors include[i]:
Lack of public transport
Physical environment, for example, lack of public toilets
Concerns about crime
Advances in technology
High population turnover
Other changes (such as giving up driving)
Research identified in the current North Wales Population Assessment (required under the Social Services and Well-being (Wales) Act) suggests that:
higher loneliness and isolation barriers for men, people who live by themselves, recently bereaved individuals, and the most elderly people in our communities.
disability or illness can trigger loneliness, as this changes how people access their social networks
people aged 50 and over socialise less due to the economic situation, with almost a third (32%) of people aged 50 and over and a quarter of people aged 65 and over cutting back on going out to socialise.
a high number of men have experienced loneliness after losing their partner (62%) or losing friends of the same age as them (54%). Men were also less likely to admit their feelings to family or friends (11% of men and 24% of women). In a Women’s Royal Voluntary Service survey it was found that men were less likely to keep in contact over the phone with family or relatives who live away (71% of women compared to 29% of men).
there is a greater risk that people who have received care and assistance know how it feels to experience social isolation as they usually only have 1 or 2 close friends.
There are different types of loneliness; emotional loneliness and social loneliness. Emotional loneliness is the feeling of losing the companionship of one specific person; very often a partner, sibling or best friend. Social loneliness derives from a lack of broader social network or group of friends. Loneliness can be a feeling which comes and goes, and individuals can suffer from loneliness at specific times of the year, for example at Christmas. Loneliness can be chronic where a person can feel alone most of the time. Feeling lonely is subjective; if a person feels lonely then they are lonely.
Social isolation and loneliness have been identified as risk factors for poor health (especially poor mental health) and lower well-being, including morbidity and mortality, depression and cognitive decline. Research identified in the North Wales Population Assessment suggests that:
loneliness has an impact on death rates equal to smoking 15 cigarettes per day.
loneliness increases the risk of high blood pressure
individuals are also at risk of physical deterioration
loneliness places individuals at more risk of cognitive decline
one study concluded that lonely individuals were 64% more likely to develop clinical dementia
lonely individuals are more likely to suffer from depression
loneliness and lack of social networks are predictors of suicide in older age groups
Older people who are socially isolated are also more vulnerable to the complicating effects of unforeseen events such as falls. Because older people who are isolated have smaller networks of relatives, neighbours and friends, they have less unpaid or informal support to fall back on to help meet their social care or other needs; and they may not access the appropriate formal health and social care services, which in turn could have harmful longer-term consequences[ii].
The North Wales Population Assessment identifies the importance of preventing or mitigating loneliness to enable older people to remain as independent as possible. In terms of the impact of loneliness on public services, lonely individuals are more likely to:
visit their GP, use more medication, at more risk of falls and an increase in the risk factors of being in need of long-term care
gain early access to residential or nursing care
use accident and emergency services independently of chronic illness
according to the WRVS, lonely individuals are less likely to use preventative services (specifically health services).
Social isolation is also a problem for both children and adults who are carers. The time commitment given to the cared for often means that the social and emotional needs of carer are set aside. Figures show that the number of carers in the community is increasing and therefore the number of socially isolated people in our communities will increase as well.
Isolation within the rural community is a particular issue for those who are older, younger or on lower incomes, and can contribute to other health and well-being problems. Isolation for the elderly is, of course, not limited to rural communities with almost one in five households in Conwy County Borough and one in six households in Denbighshire occupied by a single pensioner. A significant number of these lone pensioners do not have local family support, due to having moved to the area to retire or having children who have moved out of the area.
Geographical access to key services forms part of the Welsh Index of Multiple Deprivation 2014 (WIMD 2014), which is the official measure of deprivation in Wales. This domain of the WIMD considers the average travelling time to access a range of services considered necessary for day-to-day living. These include:
pharmacy & GP surgery
Nine lower super output areas (LSOAs) in Conwy County Borough and eight LSOAs in Denbighshire feature in the 10% most deprived in Wales for access to services, as shown in the map below (those coloured in dark blue). These areas cover a population of about 29,000 people[iii]. These data tell us primarily about travel times to physically access services and indicate a significant population who are likely to suffer poor physical access to services or to be significantly reliant on private transport. Information from the census also shows a substantial minority of households who do not have access to a private car or van.
Areas of Conwy County Borough and Denbighshire in the 10% most deprived in Wales for access to key services (coloured in dark blue)
Source: Welsh Government 2014
The National Survey for Wales [iv] measured loneliness for the first time in 2016-17. Whilst it is not possible to drill down to local authority level, these findings are available for Wales as a whole. These results challenge some of the conclusions of earlier research, which have found that older people are more likely to be lonely than young people; however loneliness is often due to of impact of a number of factors on a person’s life.
The National Survey analysis found the following results for their respondents:
17% of people were classed as lonely and 54% experienced some feelings of loneliness.
Younger people were more likely to be lonely than older people: 20% of 16-24 year olds were lonely, compared with 10% of those aged 75 or over.
Poor general health, limiting long-term illness, low mental well-being and low subjective well-being were associated with being lonely. The impact of having a limiting long-term illness on loneliness was stronger for younger people.
37% of people who were in material deprivation were lonely.
People who felt safe after dark, who felt a strong sense of community and/or were satisfied with their area, were less lonely.
20% of people experienced loneliness related to the absence of close personal relationships, and 34% of people were lonely due to a lack of wider social contacts.
Some of the groups which are recognised as being most at risk of social isolation have grown significantly in recent years. Though this is not direct evidence of increasing social isolation the numbers of single person households (particularly lone pensioner households); carers, and people with chronic illnesses have all risen in recent years.
Between 2001 and 2016 the number of single person households in Conwy CB and Denbighshire increased by 2,300
Between 2001 and 2011 the number of carers increased by 2,300
Projections show that some groups that are particularly vulnerable to social isolation are likely to increase in the next two decades.
The number of lone pensioner households will increase by 3,870 in Conwy CB and by 3,233 in Denbighshire between 2017 and 2035.
The number of people suffering with poor mental health is predicted to increase by about 1,000 across the area between 2017 and 2035
The number of carers providing 50+ hours of care a week will increase by approximately 630 between 2017 and 2035[v].
Reducing loneliness and isolation is one of the main challenges identified in consultation and engagement work undertaken for the North Wales Population Assessment and is a priority for Welsh Government’s Ageing Well in Wales Programme. Having strong social networks of family and friends and having a sense of belonging to the local community is important in order to reduce social isolation and loneliness for people who need care and support and carers who need support.
Improving access to services for the local population can help local authorities work towards achieving the aim of Welsh Government’s public health strategy ‘Our Healthy Future’ of reducing differences in life expectancy and healthy life expectancy between communities, by improving those of people in more disadvantaged communities.
A cost/benefit analysis undertaken in 2015 has estimated increased service usage at costs of c.£12,000 per lonely individual [vi], Existing data indicates good returns on investment. Given the high cost of the health, social care and other services required by lonely individuals if their circumstances are not addressed, there is a strong case for shifting investment in this area, particularly given the relatively low cost of many effective interventions. In a case study in identified by the Local Government Association, savings totalling £1.2 million were made over a two year period. With every £1 that the scheme cost, the return on investment was calculated to be £3.10 [vii], and savings of £900 per person from a £480 intervention through community navigators who work with individual older people to link them into local services[viii].
The physical isolation of some of our communities is a direct consequence of their geographical location. Further threats to wellbeing may arise if the availability of sustainable public and private transport cannot be maintained. Current identified risks include decreasing public sector resources, the market implications of a reduction in public transport providers, and the threat to the sustainability of both public and private transport due to the current reliance on fossil fuel resources, which are being depleted and are harmful to the environment. Concerns about the availability and sustainability of transport have been raised in engagement work with the public and officers within the public agencies in each county.
Potential mitigation or enhancement of wellbeing may be possible through the dispersal of services to local centres or mobile service options. However such approaches are likely to require significant investment. Alternatives to physically accessing services also need to be considered.
Increasingly many services and social connections are made digitally, a trend that looks set to continue. Engagement in both counties has stressed the need to ensure digital access to services are available to all. There have been infrastructure barriers to achieving this.
Figures from January 2018 show that 4.8% of premises in Conwy and 6.8% of premises in Denbighshire cannot get broadband with a download speed of at least 10Mbit/s and an upload speed of at least 1Mbit/s; which is the specification for the UK Government’s proposed broadband Universal Service Obligation (USO). This is higher the UK average 3% of premises unable to achieve these speeds. Superfast coverage, based on the definition of having a download speed of at least 30Mbits/s is 88.4% in Conwy and 84.1% in Denbighshire, compared to an availability of 93% for UK premises overall.
Mobile telephone coverage has also been poor with 1.4% of premises in Conwy currently receiving no reliable signal from any operator and 1.5% in Denbighshire. Outside, 20.49% of Conwy’s geographical area and 10.6% of Denbighshire’s receive no reliable signal[ix].
Poor infrastructure is not the only cause of digital isolation. There is evidence of lower levels of digital access among older age groups, those on low incomes, those with disabilities and some ethnic groups.[x]
People want the delivery of services with no access problems, and which prevent social isolation. This is expected to include a mixture of local delivery, improved accessible and affordable transport and improved digital access.
People would like to see:
Information that is easily accessed and communicated in a clear and consistent way, including better use of digital technology
Access to amenities through improved transport, including bus services, that benefits from advances in technology
Services delivered locally in your communities (i.e. not centralised)