The concept: creating the second half foundation and centre




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The Second Half Foundation White Paper (Reg Charity 1141988)

June 25th 2013
Creating Community Hubs and Reducing Social Isolation amongst Older People in the Second Half of Life Yields a Net Rate of Return of over 135% to the NHS.
THE CONCEPT: CREATING THE SECOND HALF FOUNDATION AND CENTRE
In February of 2011, Jill Shaw Ruddock published The Second Half of Your Life, a book about successful ageing (Random House -now in its 9th printing). Shaw Ruddock wanted to bring her two years of research about what makes people age successfully to life. Her prescription for healthy ageing is a new “Five a Day” as detailed in her book. They are 1. Engagement with your community, friends and family 2. Regular exercise 3. Nutrition 4. Have a passion (i.e. mental stimulation) and 5. Have a purpose. Successful ageing is not a matter of luck. It is about the choices we make that will determine how we live the second half of our life.
The Second Half of Your Life Foundation (Charity Reg: 1141988) was approved by the Charities Commission in May 2011 with the purpose of doing just this - creating a place that would underpin the “Five a Day” and serve as a model for preventative and proactive care that could be rolled out and templated nationally. The future of successful ageing is to create hubs where people come together and proactively engage with their own health. This will not only serve our ageing population but our overstretched National Health Service and government. Currently there is a model of reactive care in place. Due to the ageing of the population, certain health care costs are expected to treble by 2031. (IPPR, 2011). This makes continuing with the current model unfeasible.
The Second Half Foundation signed its lease with St Charles in June 2012 and opened its doors to the community on October 29th 2012. In just nine months, The Second Half Centre has attracted over 975 members, has utilized 70 different volunteers, has on average 250 members each week taking our classes, and provides (June 2013) over 57 hours of activities each week. Although it has been confirmed by so many studies and so much has been written about the importance of tackling social isolation in our older population, many of the services in place and delivered to older people actually encourage isolation. The out of hospital strategy is correct: hospitals should become a place where people come not only when they are sick but when they are well. Building Second Half Centres in underperforming NHS or Council space in local communities and coordinating delivery of the people who need it most with local GPs, navigators and healthcare providers, Adult Social Care, pharmacies, Third party voluntary organizations who focus on ageing, and mental health providers will ensure that NHS and local CCGs are part of building and creating a sustainable solution.
There is a need for a Second Half Centre in every community. Over the next two decades, the number of people aged over 80 is set to treble and those over 90 are expected to double in Great Britain(Social Care Institute for Excellence). Preventing loneliness and Social Isolation, Oct 2011). Delivering individual classes in church halls, libraries and other venues does not create a community or tackle social isolation. The NHS and local councils have so much underperforming and empty space that could become a vibrant hub for communities throughout England.
The Second Half Centre has in a short amount of time ( just 9 months from opening our doors) created a multipurpose social hub where people can come together in a safe, welcoming home away from home. The Second Half Centre is a special place where people look forward to coming to and where they feel valued. We want to rebrand old, break pre-existing stereotypes and create an environment where the second half of life is celebrated as the beginning of a new prolific phase of life.
CREATING HUBS SUCH AS THE SECOND HALF CENTRE MAKES A DIFFERENCE IN TACKLING SOCIAL ISOLATION

Social isolation can have a severe impact on the health and well-being of older people. It leads to higher health and social care service use, and lonely and socially isolated people are more likely to have early admission to residential or nursing care (SCIE


Research Briefing 39, January 2011). A recent study also confirms that social isolation is associated with higher re-hospitalization rates (Giuli, Spazzafumo et al 2012).
At the Second Half Foundation, we created our own Second Half Scale of Happiness as a way to measure if what we are doing is making a difference. Using a random sample of our members, we found that what we provide at The Second Half Centre demonstrates a profound difference:

MONETIZING THE HEALTH CARE BENEFITS OF TACKLING ISOLATION
As the UK’s population rapidly ages, the issue of acute loneliness and social isolation is one of the biggest challenges facing our society – and it must be addressed, for the sake of both the individuals concerned and the wider community. Health issues arising from loneliness and isolation add pressure on statutory health and social care services. By intervening in this issue, we can improve older people’s quality of life, while limiting dependence on more costly services. The table below quantifies just some of the benefits in terms of costs to the NHS.


HEALTH ISSUES ARISING FROM ISOLATION

Cost per UNIT

Cost of dementia or cognitive decline
“People with a high degree of loneliness are twice as likely to develop Alzheimer’s than people with a low degree of loneliness” (BBC, 2007)

“Half of all older people consider the television as their main form of company” (Age UK ‘Combating Loneliness’)



£2500 -- annual NHS costs of treating one patient with mild dementia in the community (King’s Fund 2008)
The service costs associated with dementia are far higher than all other conditions put together, making up 66% of all mental health service costs. (King’s Fund, 2008)

Re-admission into hospital/ Emergency Hospital Admissions

Around one in three of all hospital admissions in England are emergencies, costing the NHS some £11 billion a year - one of the most expensive areas of the health service. (Nuffield Report 2011)
In one study of over 70s, patients who lived alone were 60% more likely to visit the emergency department than those who lived solely with their spouse (Hastings et al, 2008 p458)

Total cost £563 million - per unit £ 4,021
Rise of elderly re-admission increased 88% 2000-09/10 (Age UK 2013)
“Older people account for 40 percent i.e. £563 million of total spend of £1.42 billion. The rate in the most deprived areas is more than twice the rate in the least deprived areas in England” (The King’s Fund April 2012)

Mental Health Costs and Reducing visits to GPs

Today, the annual economic cost of mental illness in the UK is £70 Billion—equal to the entire National Health Budget ( Ruby Wax, Sane New World 2013). In 2003 (Thomas),the estimated total cost of adult depression was £9 billion of which £370 million represents direct treatment costs


‘Loneliness is strongly correlated with mental health costs; the probability of having a mental health need is 47 percentage points higher among populations of older people who are lonely’ (Social Finance, 2013)





Preventing a Integrated Care case review

£276 – INWL QIPP Team

Lowering blood pressure and subsequently risk of stroke
A recent study has positively correlated social isolation with blood pressure as well as C-reactive protein and fibrinogen levels which increases risk of heart disease and stroke (Shankhar et al, 2011)

£1628 – applicable 2008/09 PbR tariff for a Transitory Ischemic Attack (TIA) (Alzheimer Society 2009)

Reducing length of hospital stays

There has been a large and avoidable rise in the number of overnight hospital stays, which cost the NHS £330m annually. (Nuffield Report 2011)
In 2005, one in ten people aged over 50 had stayed in hospital as an inpatient in the previous 12 months (ONS, 2005).

  • Each hospital bed costs £260 per day (Age UK 2013)



  • The national average length of stay in bed for those over 65 is 9.5 days (King’s Fund, 2012)




Benefits of improved physical health

Reducing number of falls among the elderly. One third of all people aged over 65 fall each year =3 million (Age UK 2013). Age UK says evidence has shown that if elderly people take part in exercise programmes specifically designed to improve strength and balance, the risk of falls can be cut by up to 55%. (BBC, 2010)

Physical inactivity costs £8.2 billion annually (NICE 2008) Physical activity has been shown to reduce risks for cardiovascular disease, coronary disease and high blood pressure.

A recent study has demonstrated that people over 70 who exercise regularly show less brain shrinkage over a three year period, which causes problems with memory and thinking (Age UK 2012)

Another study spanning 10 years revealed that women aged 75 or over and classed as active had a death rate 68% lower than those classed as least active (Sherman et al 1994




  • Falls of the Elderly can cost the NHS £4.6mn per day (Age UK 2013)




  • The combined cost of hospitalization and social care for hip fractures (most of which are due to falls) is £2 billion a year or £6 million a day (Age UK 2013)




  • Estimated cost per hip fracture patient is now routinely set at £28,000 (Age UK 2013)

  • The only UK study cited showed that twice-weekly exercise classes led by qualified instructors are cost-effective in the UK with an incremental savings cost per QALY of £12,100 (95% CI = £5,800 to £61,400) (NICE, October 2008)




(Some of this information was provided by Inner North West London PCT -Hammersmith and Fulham, Kensington and Chelsea, Westminster)
SUMMARY OF KEY FINDINGS

The Preventative Care Model: This assumes there are 14 million people over the age of 55 in the UK today and The Second Half Centre has over 950 members and an average of over 250 people each week coming to the Second Half Centre. The table below shows the possible savings represented by just one Second Half Centre to the local CCG




Hospitalization from osteoporosis: Cost per patient £12,000-£28,000

(Fall Prevention April 2012 Issue 234) Avg £20,000/patient




Assumes just ten people avoid fractures from regular exercise

£ 200,000

Preventing cognitive decline in ten regular users

£ 120,500

Preventing re-admission into hospital in ten regular users

£ 40,021

Reducing visits to GPs in half of our regular users by at least




once per month

£ 170,500

Preventing at least five ICP case reviews

£1,380

Preventing ten diagnoses of depression

£20,850

Preventing one TIA

£1,628

Reducing excess day tariff in ten regular users

£2,250

Improve Mental Wellbeing : reducing contact with mental




health services

£ 90,000

TOTAL SAVINGS TO THE NHS FROM ONE COMMUNITY HUB

£ 647, 129

To run one Second Half Centre costs just £275,000. This is not including any savings that would be received from the scaling of this project throughout London and the rest of England. The net rate of return for this investment to the National Health Service is a staggering 135 per cent. Initial analysis by Social Finance suggests that effective intervention to reduce isolation among a cohort of 1000 older people could produce returns of over 200 percent (over £1 million). (Social Finance, 2013)



THE SECOND HALF CENTRE: DIRECT ECONOMIC BENEFITS TO HEALTHCARE SERVICES AND LOCAL CCGS

Improving mental and physical wellbeing actually has direct benefits and savings costs associated with it as:



  • Costs of caring for elderly will treble by 2050 (OECD)

  • Angel Gurría, OECD Secretary-General, said: "With costs rising fast, countries must get better value for money from their spending on long-term care. “Caring for Britain's growing elderly population could cost up to £106bn a year, equivalent to paying for a second NHS, according to research from the (Policy Exchange Think Tank 2011).

  • The Nuffield Trust’s “Care for Older People” report published Dec 2012 states that policy makers need to plan for a significant increase in demand for social care and continuing health care for older people over the coming decade. This

may be challenging in the current economic climate, especially if the quality of care rise and or prevalence rates of disability rises. Measures to seek to reduce disability in old age will be as important as ever.

  • Those aged 50 or over are key users of the health services. In 2002/3, 21% of people aged 50 and over consulted a GP in the two weeks before interview. In the same age group, one in five people had attended an outpatient or casualty department in the last three months. (ONS, 2005)


TACKLING ISOLATION
Both the NWL Shaping a Healthier Future Report (January 2012) and the West London CCG’s Out of Hospital Strategy place emphasis on reducing the demand on acute services and preventing ill health in the first place. The evidence summarised above is clearly complementary to the aims of these key policy aims.
The Marmot Review on Health Inequalities (2010) concluded that social isolation impacts on health: social networks and social participation act as protective factors against dementia or cognitive decline over the age of 65. Individuals who are socially excluded are between two and five times more likely than those who have strong social ties to become depressed.
Social networks have a larger impact on the risk of mortality than on the risk of developing disease. That is, it is not so much that social networks stop you from getting ill, but that they help you recover when you do get ill (Marmot Review page 138). There is good evidence that reducing social isolation has tangible health benefits, with research highlighting the influence of social relationships on the risk of death as comparable to well-established risks such as smoking and alcohol consumption. Weak social connections carry a health risk that is more harmful than not exercising, that is twice as harmful as obesity, and is equivalent to smoking 15 cigarettes a day or being an alcoholic. (Bolton, 2012)
Other studies indicate that socially isolated older adults have longer stays in hospital, a greater number of physician visits and are more dependent on homecare services (BC Ministry of Health, 2004, Age UK 2013). Dr Aumran Tahir, Head of The Barlby Surgery located at St Charles has stated that, in his view, social isolation is the main reason that a sizeable minority of his older patients present at his surgery - to be able to come and talk to another human being.

Francis Report 2013:



  • The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. (Francis Report 2013)

  • The report highlights that we urgently need a comprehensive plan of action to transform culture and practice, as well as policy and systems, to ensure good care is delivered to every patient every time

FACTS ABOUT THE ELDERLY IN THE UNITED KINGDOM

If you are a healthy adult today at 50, if you are a woman your life expectancy is 96 and if you are a man 91 (Oxford Institute of Aging)


Isolation:

  • 1000 old people die alone and unnoticed every month in United Kingdom (True Vision)

  • Overall, about 10% of the general population aged over 65 in the UK is lonely all or most of the time. This increases to 15% among ethnic minority elders. (Bolton, 2012)

  • 60 percent of people over the age of 70 years old experience acute loneliness ( SAGA)

  • About 3.8million older people live alone, 70% are women (Age UK 2013)

  • One in five people with an elderly father is not in contact ( MIND)

  • Over 180,000 older people are physically abused in their own homes every year ( True Vision)

  • 300,000 British pensioners say they go an entire month without speaking to family or neighbours (SAGA)

  • 50 percent of children with aged parents said their main concern for their parents is loneliness (SAGA)

  • 500,000 pensioners only leave home once a week ( BBC)


Physical Health:

  • People aged 75-plus are much less likely to report taking the minimum levels of physical activity necessary to achieve health benefits. Only 7% of 75+ adults meet this level.45 (Age UK 2013)

  • Lonely people are four times more likely to suffer a heart attack and more times more likely to die in the event of one than those who are not. Further, lonely people are twice as likely to suffer from colds (Geller et al, 1999)

  • Forty per cent of all cancers are caused by things we have the power to change

Professor Parkin of Queen Mary, University of London

Mental Health

  • Over 2 million people aged 65+ in England are affected by depression

  • Worse general health can be associated with depression among older adults, and other risk factors include not living close to friends and family, poor satisfaction with accommodation, and poor satisfaction with finances (Age UK 2013)

  • “Ageing is not a matter of luck. The choices we make will impact how we live the second half of our lives.” Jill Shaw Ruddock, The Second Half of Your Life



SERVICES OFFERED BY THE SECOND HALF CENTRE
THE SECOND HALF CENTRE is a place that fosters a sense of belonging and community. Our aim is to empower our ageing population to live full and independent lives by giving them an opportunity to proactively look after their own care by encouraging them to learn, teach and volunteer.
It is necessary to provide a place where men and women can come that will encourage and enables them to get out of their home and start living their new “Five a Day”. The first Second Half Centre membership was created by the outreach work of our staff and volunteers. There were no member or patient referrals from The West London CCG, Public Health, K and C Mental Health Services, Age UK K and C, RBKC Adult Social Care or the Royal Borough of K and C. This will need to be coordinated in future to effectively template these across communities to ensure the people who need these services know about them, have access to them, and are encouraged to use them.
The Second Half Centre is a hub of activity where older adults can come to rediscover old hobbies, create new interests, learn new skills, exercise and make new friends. Weekly classes on offer range from gardening( we have our own allotment), to a comprehensive arts programme to computing classes catering to all skill levels, a Retooling for Life and Work workshop to enable those who wish to go back to work with the skills need; cooking classes (2x/week), a nutrition class, to 13 different exercise classes, drama, history of art and literature( see the Attached Schedule).
The Centre hosts a range of activities for older adults with the overall goal being to reduce social isolation and promote proactive care.

  • The Second Half Centre currently offers 57 hours of activities each week. Members can either drop in or book in advance for classes. Classes currently run from 1- 2 1/2 hours with the cost of a class ranging from £2-5. All classes are taught by fully qualified and highly trained tutors and teachers.

  • Digital Inclusion and Computer training – A dedicated IT room with 12 stations ( BTC qualifications on offer after completion of the 4 different courses); Our four different computer classes range from Basic Computing to Excel. Our goal is to Bridge the Digital divide, Improve Financial literacy. These 2 ½ classes are subsidized at £2 to ensure that our members have 21st century tools to communicate with their friends, family and community. The Office of National Statistics(2012) 5.3 million people aged 65 have never been on line.

  • Retooling for Life and Work: this weekly workshop run by the leading Executive Coaches and Recruiters help members return back to work by Providing Skills from CV writing, Bios, Cover Letters, and Interview Techniques. Each Friday from 10-

12-30 we run a Confidence Workshop which helps our members understand themselves and what may be holding them back.

  • Weekly class on Health and Nutrition, as well as two Cooking Classes( International Cooking and Thai ( lunch included)

  • Weekly Employment, Confidence and Well being workshop

  • Weekly gardening class. Including trips to conservation reserves. Weekly Practical Gardening classes in the spring and summer where we grow our own vegetables, herbs and flowers occur weekend in our own allotment at St Charles.

  • Weekly Drama ( including 3 West End Visits each term) History of Art( including 3 curated museum visits each term), Medieval History of Art( including 3 curated museum visits each term), History of Literature, ESOL, Current Affairs, Adult Parenting etc ( see attached schedule)

  • Weekly Creative Arts workshops: Weekly painting, life drawing, tapestry, mosaics, beading and crafts( all supplies included)

  • Exercise Classes: 13 different weekly including tailored exercise classes for the over 50s including relevant Bone Density Workout, Stretch and Tone, Yoga, Pilates and Mediation. We also have a member led Walking Group that meets monthly. A Department of Health report recently published said: "Physical activity and regular exercise is one of the best ways for older

people to prevent falls and fractures”. We are actively promoting a healthy lifestyle for people of all ages. Furthermore, weight bearing exercise and a balanced diet can help to increase bone mineral density and protect against osteoporosis and the risk of fractures later in life. At the Second Half Centre we have created a tailored and extensive exercise programme to improve bone density, increase mobility and balance and improve muscle tone

  • Lending Library: We currently have over 1000 books on offer to lend to members. Books have been generously donated by Random House, Penguin and our members.

  • Life Cafe- open daily from 9 30-11 30; 2-4 where members can come to meet up before and after classes and enjoy a cuppa tea or cappuccino and freshly made on the premises banana, courgette and carrot breads

  • Special one off workshops

  • Membership is currently FREE

  • THE CHRISTINA SMITH BURSARY is currently available for those who can’t afford to pay the already subsidized £2, £3 £ 4 and £5

The Second Half Foundation intends to serve both men and women who are aged 50 plus( the average age of our members is 73 years of age) to ensure that our growing ageing population will continue to learn and have a place to develop more meaningful connections. The Second Half Centre has been created with purpose of tackling loneliness and isolation for any person over the age of 50 affected by age, illness or disability. Isolation does not just affect the underprivileged and people living in deprived circumstances. At The Second Half Centre, we wish to serve those affected by isolation from any background and reduce social exclusion: from the underprivileged to ethnic minorities to those who are just isolated .


The NW London Primary Care Trust provided funding for the renovation of The Second Half Centre space in an empty and underperforming old renal care ward in St Charles Centre for Health and Wellbeing. The Second Half Foundation signed their lease with The NW Primary Care Trust in June 2012, and on October 29th 2012, THE SECOND HALF CENTRE opened its doors to the community. We were advised by RBKC Adult Social Care and the then Mayor of RBKC Cllr Julie Mills that there was a great need for a Centre in the North of the Borough. The Second Half Centre is located in the ward of St Charles in North Kensington, one of the most deprived wards, not only in the Borough of Kensington and Chelsea, and in all of England. The Second Half Centre currently receives no funding from the West London CCG, RBKC Adult Social Care, RBKC Social Council, the Dept of Health, The Triborough Public Health or The Big Lottery .
For more information or to discuss these findings in more detail, please contact

Jill Shaw Ruddock, Founder and Chairman

The Second Half Centre

jill@thesecondhalfcentre.com 07770 470 506


SOURCES FOR CREATING THE SECOND HALF FOUNDATION WHITE PAPER
The Second Half Foundation: www.thesecondhalfcentre.com
Ruddock, Jill Shaw , The Second of Your Life, Random House 2011
Age UK: http://www.ageuk.org.uk/


  • 2013: ‘Later Life in the United Kingdom’

http://www.ageuk.org.uk/Documents/EGB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true

  • Combating Loneliness:

http://www.ageuk.org.uk/health-wellbeing/relationships-and-family/befriending-services-combating-loneliness/

  • 2012: ‘Exercise keeps the brain healthy’ http://www.ageuk.org.uk/latest-news/archive/exercise-the-body-to-keep- the-brain-healthy-study-suggests/

Alzheimer Society 2009



http://www.alzheimers.org.uk/statistics
BBC

http://www.bbc.co.uk/

  • 2007, ‘Loneliness link with Alzheimer’s’ http://news.bbc.co.uk/1/hi/health/6332883.stm

  • 2010, ‘Falls amongst the elderly cost the NHS millions daily’ http://www.bbc.co.uk/news/10353642

British Columbia Ministry of Health ‘Social Isolation Among Seniors: An Emerging Issue’ March 2004



http://www.health.gov.bc.ca/library/publications/year/2004/Social_Isolation_Among_Seniors.pdf
Bolton, M ‘Loneliness – the state we’re in’ Age UK Oxfordshire, 2012 pp.5-6

http://www.campaigntoendloneliness.org.uk/information-on-loneliness/loneliness-research/
The Francis Report, February 2013.
Geller, J: Janson, P: McGovern, E: Valdini, A ‘Loneliness as a Predictor of Hospital Emergency Department Use’ The Journal of Family Practice, 1999, Vol 48(10) pp.801-804
Giuli, C: Spazzafumo, L: Sirolla, C: Abbatecola, AM: Lattanzio,F: Postacchini, D ‘Social isolation risk factors in older hospitalized individuals’ Arch Gerontol Geriatr. 2012, Vol 55(3) pp.580-5
Hastings, S: George, L: Fillenbaum, G: Park, R: Burchett. ‘Do lack of social support lead to more ED visits for older adults?’ The American Journal of Emergency Medicine’ 2008, Vol 26 (4) pp.454-461
Inner North West London QIPP team
Institute for Public Policy Research (IPPR)

http://www.ippr.org/
King’s Fund,

http://www.kingsfund.org.uk/
Marmot Reviews on Health Inequalities (2010)

http://www.health-inequalities.eu/HEALTHEQUITY/EN/about_hi/marmot_reviews/
MIND: http://www.mind.org.uk/
NHS West London Clinical Commissioning Group ‘Better Care, Closer to Home: Our strategy for co-ordinated, high quality care’ 17th May 2012

http://www.westlondonccg.nhs.uk/media/16/NHS%20West%20London%20Better%20Care,%20Closer%20to%20Home.pdf
NICE public health guidance ‘Mental wellbeing and older people’ October 2008, Appendix C

http://publications.nice.org.uk/mental-wellbeing-and-older-people-ph16/appendix-c-the-evidence
NICE ‘Physical activity and the environment – Costing report’ January 2008

http://www.nice.org.uk/nicemedia/live/11917/38990/38990.pdf
North West London Shaping a Healthier Future Report (January 2012)

http://www.healthiernorthwestlondon.nhs.uk/sites/default/files/documents/shaping-a-healthier-future-15-feb-event-report.pdf
Nuffield Trust ‘Trends in emergency admissions in England 2004-2009’ July 2010

http://www.nuffieldtrust.org.uk/publications/trends-emergency-admissions-england-2004-2009
OECD ‘Help Wanted? Providing and Paying for Long Term Care’, June 2011

http://www.oecd.org/health/health-systems/helpwantedprovidingandpayingforlong-termcare.htm
ONS ‘Focus on: Older People’ 2005

http://www.ons.gov.uk/ons/rel/mortality-ageing/focus-on-older-people/2005-edition/index.html
Oxford Institute of Ageing:

http://www.ageing.ox.ac.uk/research
Policy Exchange ‘Careless: Funding long-term care for the elderly’ 27 July 2010

http://www.policyexchange.org.uk/publications/category/item/careless-funding-long-term-care-for-the-elderly
SAGA

http://www.saga.co.uk/
Shankar, A; McMunn, A; Banks, J; Steptoe, A ‘Loneliness, social isolation, and behavioural and biological health indicators in older adults’ American Psychological Association, 2011, Vol 30(4) pp.377-85
Sherman, S: D’Agostino: Cobb, J: Kannel, W ‘Does exercise reduce mortality rates in the elderly? Experience from the Framingham Heart Study’ American Heart Journal, 1994, Vol 128 (5) pp.965-972
Social Finance, 2013

http://www.socialfinance.org.uk/
Thomas, CM: Morris, S ‘Cost of depression among adults in England in 2000’ Br J Psychiatry, 2003 Dec
True Vision

http://www.report-it.org.uk/home
Appendix A





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