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The future for rural health services is the topic for the first in the new series of free public lectures at UHI, the prospective University of the Highlands and Islands. Professor Jane Farmer, UHI co-director of the Inverness-based Centre for Rural Health, is joined at the lectern next week by two of her researchers, Amy Nimegeer and Artur Steinerowski. The centre has carried out two years of concentrated research with rural communities in the region about their health services. Amy has been working on a project looking at ways to involve communities in planning services, while Artur is looking at the role of social enterprises in community sustainability and working on the centre’s O4O (Older for Older) scheme. In collaboration with local people, the O4O team is devising initiatives to enable elderly people to live happily and healthily in remote and rural areas. Professor Farmer said: "Our research has shown what rural communities want from health services and how that might be provided. We also speak about the changes required from managers, professions and community members themselves - and how everyone may have to think and act in much more radical ways to have services provided in the future."
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O4O – Older people for older people. Can the people do it
themselves?
Artur SteinerowskiO4O team member
Centre for Rural Health
What is O4O?
The O4O project - Older People for Older People
Demographic changes and apocalyptic scenarios
Challenges relating to service provision in remote and rural areas
Government policies about service provision e.g. social enterprise
Testing these policies through O4O
Social Enterprises as Service Providers
• Policy interest in social enterprise (not for profit social organisations); economic, social and environmental development
• Additional benefits e.g. participation, well-being, social capital; empowering communities; tackling social exclusion
• Social enterprises have a role in delivering health and social care
Current policy represents social enterprises as a panacea. Is it really?
• Limits to current evidence base, e.g. measurement of benefits
Policy view on social enterprise
Perception of older people
Changing perception of older people
- To promote older people as a positive force
Aims of O4O
- To involve older people in producing O4O organisations and services
- To help maintain people living in their own communities for as long as possible
O4O theory
Engagement of older people
in O4O
Older people remain active
for longer
Trust and social networks
develop
Increased community
capacity
Positive impact on physical and mental health
O4O organisations deliver services for other older people
Reduced dependence on the State as a provider
Community Action
- Meet community
- Publicity
- Generate confidence/ enthusiasm
Community engage in O4O concept
- Discussion with community
- Building trust
Community identify needs
Initiatives selected to take forward
Support from O4O:
- Building capacity
- Building confidence
- Avoiding duplication
- Accessing finance
- Accessing information
- Skills needed
- Community capacity
- Models of social organisation
Community action/ entrepreneurshipSocial
organisation model established
- Community takes on roles
-Business planning
- Resources
- TrainingO4O delivers services
Process of O4Os creation
T4T: Transport for Tongue Provides Transport services including:
- Informal connecting of people to share lifts
- Formal volunteering for the car scheme
- Demand responsive service / minibus hire (planned)
O4O examples
Ardersier
- Oral history DVD
- Development of community buildings
O4O examples
Taste of the reality?
Why should we support O4Os? (community perspective)
- The State should provide services
- Capacity issue
- Equality issues (rural vs. urban)
Why should we support O4Os? (service providers perspective)
- How much money can we save?
- What are the tangible outcomes?
- Social enterprise is a good idea BUT …
Evaluating O4O impact
Establishing cost of the service delivery
In 2009 nearly 2,500 questionnaires were sent to people aged 55 and over in six O4O Highland communities (58% response rate)
• Informal helping e.g. 87.7% of respondents said they had done a favour for a neighbour in the past 6 months• Formal helping e.g. 32.9 % have taken part in the community projects in the past 3 years• There is connection between participation and self assessed health, age, level of education and access to a vehicle.
… is very challenging and in majority of cases impossible. Many service providers do not possess exact data relating to the cost of service provision.
Key inputs to governmental policy
1. The assumption that all communities might be ready to do things for themselves is unrealistic.
2. Many communities need structural support to develop social enterprises.
3. Communities need external support to overcome bureaucracy and a model of a successful social enterprise that could be copied.
4. Remote and rural communities need special approach due to specific characteristics.
5. Government wants social enterprise to grow. Yet, there is lack of understanding that creation of social enterprises is a process that requires time, persistence and tailored support.
Artur Steinerowski, Research Assistant, Centre for Rural Healthartur.steinerowski@uhi.ac.uk
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