Camden Social Care 2016_ UAL by Che-Wei Hsu

DESIGNING FOR

CORPORATE AND SOCIAL INNOVATION IN

HEALTH AND SOCIAL CARE IN CAMDEN, LONDON

// Client Camden Council // Team Orange Jeffery Hsu, Chris Li, Phakthima Patumraj & Signe Bek // Supervisor Alison Prendiville // Course 16/17 Service Experience Design for Social and Corporate Innovation // London, January 2017

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Table of Content Chapter 01. Project Introduction p. 3 Chapter 02. Project Background

p. 7

Chapter 03. Research & Methodology

p. 15

Chapter 04. Research Insights

p. 29

Chapter 05. Problem Space & Design Space

p. 35

Chapter 06. Concept Solutions p. 56 Chapter 07. Discussion p. 75 Chapter 08. Conclusion p. 79 Bibliography

p. 80

Appendix. Process Chart p. 83 2

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Chapter 1

Introduction

Chapter 1

“

Introduction This is Britain, the loneliness capital of Europe. And it really is. Last week, a survey by the Office for National Statistics voted us so, finding that we are less likely to have strong friendships or know our neighbours than inhabitants of any other country in the EU. (Orr, 2014)

Loneliness and isolation, and social disconnectedness, are national problems in The United Kingdom. The public sector and the third sector are increasing their focus on the matter; and a range of services are already trying to combat the increasing problem area. The National Institute for Health and Care Excellence is encouraging the public and third sector to work across organisations and institutions to combat the problem, focusing primarily on the elderly generations (NICE, 2016).

It’s really tricky to keep up to date with what services are available in a local area, as they come and go. As a GP it is difficult to remember exactly which groups are available each day, so I’m not able to be specific in the suggestions I give to patients.

In UK 1.2 million people are feeling lonely amongst elderly people according to Age UK (2016b). Around 49% of people aged 65 and above are living alone (Age UK, 2016a). From 1972 to 2008, the number of households housing only one occupant has doubled (Orr, 2014). Services are already being provided by public and third sector institutions to accommodate the issues of isolation and loneliness.

Professor Carolyn Chew-Graham of general practice research, to National Institute for Health and Care Excellence (NICE, 2016)

We might be living longer, but, it would seem, we are increasingly doing it alone. (Orr, 2014)

”

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Chapter 1

Introduction

Following report reviews insights gained through extensive research in Northern London within the area of social and health care services, and presents two proposed services that cater to an identified core problem: many people, not only elders, tend to isolate themselves and disconnect with formal health and social care services and informal, friendly health check-ups.

Service Design to Combat Isolation, Disconnectedness and Loneliness in Camden The borough of Camden is located in the North of one of the most vibrant cities in the world. In October 2016, course participants of the MA in Service Experience Design and Innovation from University of the Arts London were briefed by Camden Council on potential and future problems, tasks and system criteria for innovating the existing social and health care service system in Camden. The following 2.5 months, extensive desk and field research were conducted within our design team of four students, focusing on three wards within the borough: St. Pancras and Somers Town, Kingâ&#x20AC;&#x2122;s Cross, and Holborn and Covent Garden. Research and design activities revealed (as well as confirmed existing research) a core problem on loneliness and isolation, as well as a disconnectedness to public and third sector health and social services.

This report presents a review of the design process and design solutions on how to accommodate the problem of social disconnectedness, isolation and loneliness in Camden. It presents the research and methodological approach, gained insights, the design rationale and learnings that guided the creative process. Finally the proposed design solutions are presented, additionally with a critical reflection upon these. 4

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Design Criteria by Camden Council The Camden Project was initially defined to focus on the wards of St. Pancras and Somers Town, Kingâ&#x20AC;&#x2122;s Cross, and Holborn and Covent Garden; hereby allowing for our design team to gain deep insight on these particular areas and potential locationbound gaps and problems.

Chapter 1

Introduction

At the design brief by Camden Council in October 2016, a set of design criterias were articulated. The objective for Camden Council is to optimize and improve health and social care services within the borough, and importantly the services should revolve around the user. Following criteria were presented: >> Should be cost and time efficient. >> Help people to better manage their health through improved information and communication. >> Stronger focus on the role of families and local communities to support citizens (benefit from the wider community). >> Prevent, reduce and delay the need for additional support. >> Systems should support other systems (integration). >> Support people/care receivers to remain independent for as long as possible. >> Support should offer people choices on where, when and how. Additional design criteria identified during contextual research and design sessions with different stakeholders, will be presented in chapter 6.

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Project Scope & Objective

We have within the design team conveyed extensive research and design activities within the area. Following chapters will take you through background information on Camden, research and design strategies, and finally present proposed solutions and furthermore discuss the scalability of these.

Chapter 1

Introduction

The project process was initially fuelled by Camden Council. After engaging with the communities in the areas, we identified a core problem - which constituted a specific design launch pad. Identifying a core problem within health and social care in Camden, created a launch pad and composed the design rationale and further project scope. Within the team we identified a gap between a hard-to-reach community and a group of disconnected people, and existing health and social care services from the public and third sector. The objective has been to design a service that caters to this identified core problem and the design objective:

â&#x20AC;&#x153;

How do we bridge the gap between a hard-toreach community, and health and social care services provided by the public and third sector, to accommodate the identified problem of isolation, disconnectedness and loneliness within the borough of Camden, London?

â&#x20AC;? 6

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Chapter 2

Background Chapter 2 will provide rele vant background information, data and existing research on the current situation in health and social care in the borough of Camden. To gain an overview, stakeholders will be presented, and additional data on the presented problem area of isolation and disconnectedness, and loneliness, will be presented.

Background

The Health and Social Care Service System in Camden: Current Situation Camden Council is focused on understanding the needs of the residents of the borough they serve. It is important to the council to work from a user-centric approach, to ensure accommodation of actual and existing needs and problems. The council is aware of the multi-faceted and diverse communities of people, and acknowledge the importance of understanding the people and the places, to tailor the most suitable health and social care services. The largest group of health and social care users, according to the council, are the elders - additionally present is a smaller group of younger people struggling with disabilities.

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Chapter 2

Background

There is a great focus on simplifying the existing system, or hiding potential system complexity. The future objective for the council is to enable people to be able to manage their health through improved information and communication - to optimally prevent, reduce and delay need for additional care support. Furthermore, the council wish to increase the role of families and local communities to support the care receivers. To enable this strategy, focus is on service system integration, assisting technology and community resources. On the following page, a model maps the stakeholders within health and social care in the borough of Camden, to get an overview of the current situation and services provided by the public and third sector.

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Chapter 2

Background

Stakeholder Map

Social Care Health Department

NHS

Carers UK

Council

GP Social Worker

GP NHS Choices

Local & National Organisations

Local Authority

District Nurse NHS Camden

Camden Care Centre

Social Service Department

Care Navigator

Camden Carers Service Assessment

Camden Age UK Citizens Advice Bureau Care Program

Social Worker

Care Receiver

Voluntary Services

AGE UK

Opening Door London

Telecare/ Telehealth/ ICES

Health / Social Care Professionals

Faith Groups

Home Care OT / Physio

Family Carer

Third Sector (Ageing Better Camden, Origin Housing etc.)

Care Agency

Private Care Home

Pharmacy

Care Provider

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Ecosystem

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The Area Project focus was on the wards of St. Pancras and Somers Town, King’s Cross, and Holborn and Covent Garden. The area of the three wards has changed radically within recent years. Due to regeneration, the area has gone through a radical development, transforming the area from what is by residents referred to as a former ‘village community’ to a ‘knowledge and business hub’. The regeneration has created breeding ground for an increasing gap between the old and the new part of the area. Old local pubs are being closed down, and are instead turned into luxury flats or student accommodation. Residents that have lived their entire life in the area refer to similarly disposed area residents, as “the originals” - underlining the gap between the old and the new. Granary Square is exemplifying this urban regeneration; the square has been transformed into a place for community get-together and socialising. Furthermore, international enterprises like Google and YouTube have moved to the area, additionally seeding for this knowledge hub and new approach to the area’s future.

Chapter 2

Background

“

The area has changed. 5 to 10 years ago, it was a very bad place, but now it’s really nice Manager at Somers Town Community Center

“

There is no youth club, they all closed down Elderly woman and Somers Town resident

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Chapter 2

Background

The Area Additional research on the area showed how there is a contrast between day and night in the area. This background information is important to understand the area’s cycle in regards to people, time and contexts. The day and night life are contrary different. During day hours tourists, commuters, business men and women, and homeless people move within the area. During night hours people travel from the outskirts of London to the area, especially around Euston Station, to deal illegal substances. According to a manager from the Somers town Community Centre, one is not safe walking the streets at night. The areas of Holborn and Covent Garden especially struggle with general community safety. The crime rates here regarding violence, burglary, theft and drug dealing are significantly worse than the average of Camden. The drug crime rate in Holborn and Covent garden is 20.5%, while the average of Camden is 9% (London Borough of Camden Council, 2016a/b/c/d).

“

Don't walk the streets at night Manager at Somers Town Community Center

“

There used to be a hairdresser that had been here a long time, but not anymore. They are all new ones. Elderly woman and Somers Town resident

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Chapter 2

Background

The People of the Area The streets of the area are busy during the daytime; commuters and tourists walk the streets, local residents of the area go grocery shopping at the local market or visit the local pub or community center. Research revealed different groups of people that move within the area: >> Commuters / businessmen and women >> Tourists

>> Local residents: The Newcomers & The Originals >> Homeless people

>> People dealing illegal substances

The Residents of the Area Conducting additional research, sub-segments within the group of local residents were identified. Camden Open Data (London Borough of Camden Council, 2016a/b/ c/d) shows how resident ethnicities vary widely. Large ethnic groups represented are white British, Chinese, African, Bangladeshi and Irish. Less than half of the areaâ&#x20AC;&#x2122;s population is white British people. The Bangladeshi community is relatively large, and composes around 15% of the population in the area. Field research additionally revealed a large Somali community. 13

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“ “ “

It's a nice little community Manager at Somers Town Community Center There's few of The Originals left Elderly woman at boccia class

They [the young people] all stay on the corner and smoke puff - it’s not recreational Middle-aged woman, volunteer at community sports class

Chapter 2

Background

Camden Open Data (London Borough of Camden Council, 2016a/b/c/d) reveals how a large group of middle aged adults and elderlies are living alone; particularly in Holborn, King’s Cross and Somers Town, the percentages of people over 65 living alone, are higher than the average of Camden. The probability of loneliness is relatively high in the area compared to the rest of Camden, especially in Somers Town and King’s Cross: these wards are in the top 10% in England regarding loneliness amongst elders.

Use of Health and Social Care Services In Somers Town 76 % of the residents rate their health as good or very good, compared to the Camden average of 84 %. The general rating amongst residents when they assess their health and well-being, is slightly lower compared to the rest of the borough. The average amount of people registered for social care in Camden is 16.8%. In Covent Garden and Holborn, the percentage is slightly lower ranging from 12% to 14.8%. However in the area of King’s Cross and Somers Town, people registered for social care is significantly higher than the Camden average, ranging from 22.9% to 30.1% (London Borough of Camden Council, 2016a/b/c/d).

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Chapter 3

Research & Design Methods

Chapter 3 presents the research approach and methodology constituting the foundation for the project. Furthermore, research and design tools used during the project are reviewed. The research and methodology review is presented to create an understanding of the process rationale. Health and social care services constitute a complex system, involving a wide range of direct and indirect stakeholders (as the stakeholder map in the previous chapter implied): Hospitals, GPs, social workers, care receivers, Camden Council e.g. They all connect and are interlinked through different processes, patterns, rules, regulations, or assessments. In order to comprehend the relationships in this broad and complex web of stakeholders, and furthermore be able to discover an opportunity space, we within the design team planned and conveyed extensive ethnographic research within the three wards of Camden. The aims were: 1. For the design team to be able to empathize with the different stakeholders and potential users. 2. Identifying needs, wants and difficulties, and potential gaps, related to health and social care 3. To discover the potential value of different existing health and social care services from the perspectives of the different stakeholders.

Chapter 3

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Research & Methodology

Methodological Overview Within the design team, the project process was launched in quantitative data and insights, as well as a qualitative methodological approach. This mixed method approach was to ensure that gained insights truly reflected the big picture, and revealed a level of detail that told the actual (contrary to

Research planning 4th Oct

Desk research, interviews, observations 7th Oct

the assumed) story of the current situation within health and social care in the project area. This page illustrates a visual representation of the teamâ&#x20AC;&#x2122;s methodological approach and process to create an overview. In the following chapter, we will introduce our research plan, and review our methodology and actual execution.

Data analysis & core problem identification 21st Oct

Co-design sessions

Brainstorming & ideation 15th Nov

7th Dec 16

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Research Overview

Desk Research Field Research 13 informal interviews 07 formal interviews 19 miles of walk-abouts 10 hours of participatory observations 06 hours of co-design sessions

Chapter 3

Research & Design Methods

Walkabout

Participatory Observation Interview

The research was constituted by desk and field research. The desk research provided data and existing insights on the area, as well as national and international research learnings on social and health care. Conveying field research, we tried to approach the project context and stakeholders with an open mind and patience, to allow for insights, and potential problems or service system gaps, to themselves without our interference. We interviewed more than 23 different people, all representing different indirect or direct stakeholders within health and social care (from social workers to community centre volunteers to residents in the area and care receivers). In order to gain insight on the local life conditions and viewpoints, we conveyed several walkabouts, walking more than 19 miles in the streets of the area. We spent around 8 hours on participatory observations with different stakeholders. Additionally, we conducted co-design activities with future users.

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Chapter 3

Research & Design Methods

Research Overview Walkabout Participatory Observation Interview Co-design

When initiating the project we sought to keep an open mind and enter the area without any assumptions and prejudices. The research approach was kept open and research was conducted across all three wards. During field research we identified the problem of isolation, disconnectedness and isolation within one area specific. We went back to conduct additional research within the same contexts several times; through building a relationship with research participants we got access to sensitive information first hand.

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Chapter 3

Research & Design Methods

Project Timeline

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Chapter 3

Research & Design Methods

Secondary Research In the discover stage of the project process (see the project timeline for reference), secondary desk research composed the launch pad for the project. Initially we, within the design team, did not have any prior knowledge on local residentsâ&#x20AC;&#x2122; life conditions and patterns; secondary research provided guidance before entering the field from an ethnographic approach (e.g. location of community centres). Parallel with the field research, both approaches helped us scoping and narrowing in. In the beginning, we located the facilities which are related to social and health care in the areas, to allow for us to stop by. Furthermore, we accessed quantitative data on the Camden Council website, which benefited our understanding of the current situation.

During the define phase, when identified insights in the field, the secondary research learnings became a valuable point for reflection and evaluation; which allowed for us to see our learnings in a greater universal, national or international context. For example, the initial field research conducted revealed how health and social care services appear quite complex to many users, which made several users disconnect with the offered public care services. Reviewing these insights parallel to gained secondary research insights (from international universities, Age UK, Camden Council etc.), offered us a way of validating our insights as well as reflecting upon our insights and challenge them as well. Furthermore, we were able to adjust our research plan based on the outcome of comparison and iterate further.

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Chapter 3

Research & Design Methods

Benchmark Research

Elders build individual memory journeys, and share their amazing stories (Memoir Monopoly 2016)

Social housing residents enjoy their later life in Japan (World current affairs-CtiTV, 2016)

DJ Wika Szmyt throws disco and samba parties for elderly people in a Polish community (Laessig, 2012)

New model of social housing in Japan - elders live in flats and take care of each other (World current affairs-CtiTV, 2016)

The secondary research offered us to see and understand our case insights and learnings in a greater context: The aging population is an international issue in the developed countries, and is not limited to the UK. All these countries are trying to address this particular issue, but from different perspectives: E.g. the Chinese government is trying to handle the issue merely within the public sector; areas in Japan try to benefit from local communities; and Germany is emphasising its resources on the medical sector. From these cases, from different corners of the world, we created an idea of the 'Design Benchmark' within this particular field. Through this approach, these references not only benefited our brainstorming and ideation, but also promoted our final design solution to surpass these design cases.

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Chapter 3

Research & Design Methods

Field Research Walkabouts & Shadowing Initially when conducting field research, we chose to approach the context through walkabouts and observations in the area. We used our eyes and ears to observe the relationship between people, things and environments in the area. Through this method we for example saw how the pavement could be difficult to walk if having physical disabilities. Another example showing the value of this approach, was the revelation of how a local pub was more than a place for drinking and socialising. Specific condensed insights will be elaborated in chapter 4. By this kind of unstructured observation, we got to find surprising phenomena beyond expectation.

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Chapter 3

Research & Design Methods

Field Research

Participatory Observations & Informal Interviews In order to gain details about locals' life, routines and their individual view on social and health care services, we attended several local community activities; we attended local sports classes, cream tea events as well as more informal social activities in the community, e.g. in a local pub and a church. We visited local pubs, bookmaker offices, pharmacies, churches and community centres. Through the participatory observation, we were able to attend authentic subcontexts within the case context; we got to build trust and even relationships, which offered valuable informal interviews and observations from a wide range of stakeholders of both care receivers and care providers. During the process of interacting with them, it not only helped us exploring and experiencing, it also allowed for us to empathize with their life. We got access to valuable and often very sensitive information, which helped building a deeper and more profound understanding, beyond what we

learned from only the context appearance. As briefly touched upon, we experienced how this method was very useful to build trust and relationships with participants throughout the process. The problem on isolation, social disconnectedness and potential loneliness revealed itself early on in the process. Working with and addressing issues revolving around loneliness, is a delicate and sensitive matter; we found that people did not wish to disclose their potential vulnerability. To accommodate this issue, we spent a long time building trust (talking about the weather, seeing private pictures of their relatives e.g.). Additionally, we formed questions beforehand that sought to bridge this gap; questions that were relevant and also catered to this sensitive topic. For example, we asked "Do you have any plans for Christmas?" - this enabled people to share their plans in a comfortable way. 23

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Chapter 3

Research & Design Methods

Field Research

Formal Interviews Through participatory observation sessions, we got to talk to professionals from different health and social care organizations. This allowed for us to arrange interviews with e.g. Origin Housing and Aging Better Camden / Community Connectors - representing other parts of the health and social care ecosystem. At these interviews we got access to their knowledge and view on the current situation; additionally we got to evaluate our design ideas with them hereby transforming the formal interview into a more informal design session. Fortunately, we acquired a lot of helpful information through these interviews: They shared their experience on implementation within our specific design space (isolation and loneliness), and what kind of obstacles they had faced, what kind of approaches they had already tried and the impact of the services they provided.

One important aim, when undertaking formal interviews, was that we could experience the intervieweesâ&#x20AC;&#x2122; motivation and attitude towards the health and social care system. Furthermore, the trust and relationships we got to build to these people, representing care provider stakeholders, was valuable throughout the process, as we could evaluate insights and ideas during the process. This was important and beneficial to both our research process as well as during development of a service solution. Additionally, our final ideas were presented to different stakeholders; a local pub, Origin Housing and Ageing Better Camden/Camden Community Connectors, to test, validate and adapt the concepts. 24

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Chapter 3

Research & Design Methods

Field Research

Focus Group Interview We also conducted and facilitated one focus group interview which is a method that benefits from the dynamics of a group and the interaction between people. A focus group is a group of people assembled to participate in a discussion about the issue related to them. We used this method to interview different stakeholders within the health and social care system, for example: the carers (people who are taking care of their relatives or friends), social workers, and the residents who are living in sheltered housing e.g. Through this method, we got access to their reasoning about a specific issue, and got to discover the diversity between these stakeholders. We got to collect general reflections from interview participants by comparing and classifying their opinions. Furthermore we explored the different situations or backgrounds of these different stakeholder representatives, through the interaction between them.

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Chapter 3

Research & Design Methods

Data Synthesis

[1]

[2]

[3]

Data and gathered knowledge were continuously shared within the team and made accessible and visible in our design studio throughout the whole project. We sought to gain meaning of the data through synthesis and clustering. All the data were made accessible for all team members; notes, photos, sketches, leaflets, posters etc. were all brought for each clustering session. The clustering of data was done in group settings; we kept switching from team to individual mode, to allow knowledge sharing and validation of insights, but to also allow individual immersion in the data. The clustering of data was inspired by the affinity diagramming approach. Image 1 shows a clustering session after conducting initial field and desk research. Image 3 shows a later stage in the process; here we identified the knowledge we had obtained, and we also identified what we did not yet know, and potential approaches to gain that knowledge. Additionally, we used the methods Learn â&#x20AC;&#x2DC;nâ&#x20AC;&#x2122; Link, Zine (image 2) and The Narrative Tool-kit (image 3 and 4) to process knowledge and generate initial ideas about the potential design space. Storyboarding (image 5) was also continuously used to gain a shared understanding of situations within the field context.

[4]

[5] 26

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Chapter 3

Research & Design Methods

Co-Design Sessions We conveyed two co-design sessions within our design context (the context will be clarified further in the following chapter). It was important to keep it simple and visual, to enable people to participate. To build trust and ease the session, we had spent time building a relationship with the participants before conducting the codesign sessions, as we conducted participatory observations within the same space. The objective of the first co-design session (image 1 and 3) was to gain insight on what motivates this hard-toreach segment to socialise. Visualisations of activities and potential partcipants of that activity (friend, relative, carer, care provider, pet etc.) were matched and puzzled together by the participant. The second co-design session was held with different participants, within the same segment and location. By this stage in the design process, we had identified that there was an opportunity within designing for a local pub - and together with potential future users we through visual representations created "The Ideal Future Pub" (image 2 and 4).

[1]

[2]

[3]

[4] 27

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Chapter 3

Research & Design Methods

Ideation We have used a range of different tools for fuelling the iterative and creative process: Brainstorming, roleplaying/enactment, storyboards e.g. We formed a diagram with two spectra (image 1), to review our design ideas according to the design brief, client criteria and identified criteria from additional stakeholders. Brainstorming sessions were continuously conducted in the design studio, to share knowledge and ideas throughout the process. After a brainstorming session we voted for ideas that should be explored further. To additionally fuel the design process, we also used a hybrid approach where ideas from the brainstorming session were combined. The criteria set by the Camden Council and the additionally identified design criteria together posed the design rationale for the decision making through the entire decision process (e.g. when voting for ideas to pursue).

[1]

[2]

We used storyboards (image 2) and roleplaying (image 3 and 4) both as an ideation method as well as a means to gain empathy with the future user and to picture current and future scenarios.

[3]

[4] 28

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Chapter 4

Insights

Chapter 4

Insights In the following chapter, we will review gained insights and learnings on social and health care from conducted field research in the area of St. Pancras and Somers Town, King’s Cross, and Holborn and Covent Garden in Camden. Research showed how Camden has changed radically during the last 5-10 years, which has created a gap between old and new Camden. The chapter reviews how this societal change has influenced people’s life, and how it indirectly also has had, and still has, a crucial influence on people’s health and well-being.

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The Regeneration of the Area has Influenced How People Socialise We found a correlation between the environment where people live and the locals’ life pattern. In the last 5-10 years, Camden has changed due to regeneration of the area. Camden has gradually become a diverse place where numerous groups of people live (as touched upon in the background chapter). This significant change has influenced the community feeling and the locals' life pattern and routines. Exemplifying this specific insight is a quote by an elderly woman from Somers Town: “[Before] you could go to the pub. All the family pubs are gone. They made it to flats. Before you could go to the pub and you knew everyone. Now a lot of people don’t go out”. This is one example of the impact the area regeneration has had to the community feeling. The elders who have lived their entire life in Camden (the “originals” as they call themselves) feel they have fewer places to go to meet up with friends informally, and also that the regeneration has had a negative and vital effect on the community feeling.

Chapter 4

Children can’t play on the streets anymore Elderly man, Somers Town

This used to be a village community Middle aged woman, Somers Town

People used to have parties - we don’t have that anymore [...] It was more about families. Now with social housings, you get a mixture of people - but it’s not a community of people [...] you don’t mix that much. You don’t have people come and join you, which is a shame, Middle aged woman, Somers Town

Insights

Not only the physical environment has influenced locals' habits and behaviour, also the change of the family structure has influenced how people socialise. Today women are part of the job market, and are no longer culturally inclined to stay at home. This has indirectly influenced the way people socialise within the area: “They would use it [the community hall] for weddings and parties, but not anymore. It was the mums that arranged it [...] they were home all day,” middle age woman, Somers Town.Several local residents, more specific “originals” that have lived their entire life in Camden, are troubling with coming to terms with this change in their local community. More and more people gradually isolate themselves at home in order to avoid interaction with the community they are not familiar with anymore. To the public and third sector within health and social care, this isolation and disconnectedness, creates a gap between formal services provided and people who might need these services. Isolation and disconnectedness are increasing societal problems within the area, as numerous people in need of social care or health care, are unreachable for the public and third sector.

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Chapter 4

Insights

Strong Community Feeling vs. Social Isolation An interesting phenomenon, discovered when conducting walkabouts in the focus area within Camden, is how fences separate private and public areas everywhere. Fences are dividing public and private properties; letting strangers know where the exact borders are, and where you are not welcome. These fences reflected the issues on safety and the high crime rate – but it also became a symbol of the insight on a decreasing community feeling and isolation, and the increasing cleft between the old and the new parts of the area.

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I don’t know what I’m doing for Christmas Elderly man, local pub

“

I guess people don’t come [to planned community activities] because of their health. Or they’re like ‘that’s too far away’. It’s a challenge to get people to come Middle aged woman on why people do not participate in planned community events, at Cream Tea event.

However, behind these fences and tall brick walls, we found that a strong community feeling is still alive and present. “It's a nice and lovely community” was stated by a manager at Somers Town Community Centre, which was also said by an elderly resident from the area. Research revealed how residents create a strong sense of identity related to living in Camden; especially if you have lived your entire life in the area, then you are entitled to being referred to as an “original”. Despite this strong community feeling, a lot of people isolate themselves at home; they keep going out to a minimum – and they do not participate in planned community events (sports classes, cream tea e.g.) or simply disconnect with social and health care services. We got to meet Dolly, a middle aged woman in a local pub. Dolly has struggled with mental problems and drinking for several years, and therefore got connected with a social worker. However, Dolly has not been in contact with her social worker for 2-3 months, as the social worker told her to call her when needed – but as Dolly puts it, this is too big of a task for her. Therefore, Dolly does not call. If Dolly might need help or guidance, she prefer to go to her friends at the local pub; especially the pub manager is her confidant. The pub manager is someone Dolly trusts, and becomes her connection to society. Our research indicated that trust is a locally bound force within small social spaces (like pubs, pharmacies, bakeries e.g.); and they seem isolated and disconnected to the overall societal context. 31

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Chapter 4

Insights

Social Activities are Used for Informal Health Check-ups Through continuous research and interaction with the same research participants, we saw how social events create a platform for informal health check-ups. People concern about their friends and relatives, and how they are doing. Even if accidents happen, your friends will notice if you are missing from the regular cream tea event or the local pub. We found how socialising not only facilitates people’s mental well-being, it also seeds for a network of people that take care of each other’s physical and psychological health. A local pub manager appeared to be extraordinary in checking up on other local residents. When the pub manager interacts with regular local guests at the pub, she concerns and checks up on their general health and well-being by talking to them. If their condition to her appear critical, she guides the potential care receivers to social or health care service providers; e.g. sheltered housing services. Another example was a story that was shared with the team during a participatory observation session at a local pub: Paul is a frequent customer at the local pub; he likes to socialise with the pub manager and other customers. One day, the pub manager noticed that Paul had not shown up at the pub for a long time and decided to visit him at home. When she got to his home, she found that Paul had fallen 4 days prior to her visit, and that he could not get up by himself. The pub manager made sure that Paul got an ambulance and was sent to the hospital and received the care he needed.

To a lot of people that was their socialising [...] People knew they [their friends] were safe. If something was wrong with them - if people didn’t turn up - you’d call them, and check up on them Elderly woman and Somers Town resident

- How are you Martin? - Alright. I’m getting better now. - Oh that’s good to hear. Glad you’re getting better Elderly community volunteer at cream tea event asking an elderly resident and friend of her’s about his bronchitis.

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Chapter 4

Insights

Drivers for Socialising We found how socializing is composed by two key factors: People and topics. People tend to visit a place due to a certain motivator; for example, people who like to have a pint of beer and watch football with their friends go to the pub – or people who like to see friends while being physical active go to community sports classes. A general driver for socialising was the issue of trust; where can residents go to talk to like-minded people with whom they feel comfortable talking to. We have classified places we identified people in the area visited outside their homes regularly, into three categories in terms of their drivers: Habit: Pub, bookmaker’s office, and café. Drivers: Talking to like-minded people that knows you and whom you trust. Trust is key here. Living: Supermarket, street market, bakeries, pharmacy, and restaurant. Drivers: Incidental socialising, as residents are likely to run into friends from the community. E.g. they go to the pharmacy to have a chat with the local pharmacists whom they trust. Trust is an important factor here. Religion: Church, mosque, and temple. Drivers: Culture and religious belief system are the main drivers for visiting religious places. Especially the driver of habit appeared interesting as it both contains a social aspect and also an aspect concerning routine and habit. A lot of residents in the area visit specific places or take part of specific events,

because that is what they have always done: e.g. every Tuesday Kate goes to boccia class with her friends – she goes to see her friends and to stay physical active, but also because this is what she always does on Tuesdays. Similar is the situation with the men and women visiting the local pub; they go everyday, because that is what they have always done – they get to chat with their friends, have a pint of beer, and watch horse races. We identified how people that move within these social spaces start to interact with each other, and that their topics for interaction and conversation were based on the drivers for visiting the place, and expanded further to other fields of interest. 33

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Chapter 4

Insights

Barriers for Socialising A common barrier for socialising is the lack of motivation for engaging in social activities in the area. A root cause is potentially a lack of confidence and self-esteem, which leads people to withdraw themselves from community activities. They create barriers for socialising within their mind-set; these barriers revolve around the following rationalising: “It’s not for me”-mindset: It often has to do with a lack of confidence or knowledge about the activity. Distance: “It is too far away from my home”. The perception of gender specific events:“Events without alcohol is for women only”. A stereotypical view amongst local men is that they consider a lot of the planned community activities being for women only. A manager from Ageing Better Camden explained how a lot of the elderly men think non-alcoholic activities are for women. Bad health is an additional barrier for going out; it ranges from people being housebound and unable to go out, to people who struggle with physical or mental disabilities that causes for them to be insecure about leaving their home and where they feel safe. Events are primarily for seniors: Most formal community events targets people aged 65 and above. There is not many events for people between 40 and 65. Community Connectors stated how they are often in contact with people that feel isolated, and even lonely, within this age group, and that there is only few recommendations on community activities to give them. Additionally, most community activities are held by heavily branded organisations, like Ageing Better Camden and Age UK. Unfortunately, some people have a negative view on these organisations. Furthermore, attending their events and engaging with their service offers, would be the same as labelling yourself as ‘old’. This contributes to a low attendance rate at the community events. Activities cover a narrow field of interests: From another perspective, theses activities are not fully covering the various interests of people in the area. Most activities revolve around sport, however not everyone is interested in sport. 34

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Chapter 5

Problem Space & Design Space

Chapter 5

Problem Space & Design Space The condensed insights gained through the field research was linked with the secondary research learnings, that led us to a more holistic and clear understanding of the potential problem space regarding isolation, disconnectedness and loneliness. The insights gained through our field research helped us articulating and validating the design space. We discovered a gap and the projectâ&#x20AC;&#x2DC;s opportunity existing within informal and incidental socialising. This process will be more thoroughly reviewed in the following chapter.

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Chapter 5

Problem Space & Design Space

Problem Space: Isolation, Disconnectedness and Loneliness

The ethnographic research allowed us to gather valuable insights on localsâ&#x20AC;&#x2122; daily life patterns. Synthesising the data, we crossed upon a recurring theme and problem in the community: several people tend to isolate themselves and do not wish to participate in community activities. Inherent in the situation is a range of different problems. First, if people do not socialise with other people they are not offered the informal health and social check up from friends and relatives. Second, public and third sector institutions are having trouble reaching the isolated and disconnected people, as they tend to disconnect with formal community activities and established services. Third, research indicates a strong link between social isolation and loneliness. 36

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Problem Space & Design Space

Problem Space： Social Isolation and Disconnectedness Can Lead to Loneliness Isolation is not the same as loneliness, however research shows that social isolation and disconnection potentially can lead to the subjective state of feeling lonely (Age UK, 2010). As the first chapter argued, almost every second senior citizen in the UK is living alone - and around 2.9 million elderly people feel they have no one to go to; 39% of these are registered as feeling lonely and 20% even feels forgotten (Age UK, 2014; Age UK, 2016a; Age UK, 2016b).

Social Isolation Can Affect the Health

Social Isolation Can Lead to Decreasing Resource and Information Sharing

Research shows how loneliness can lead to worse health; loneliness can lead to depression and severe physical health issues (Cornwell & Waite, 2009; NHS, 2015). A study showed how loneliness can increase the risk of mortality by 26% (Harris, 2015). Another study from University of Chicago indicated how people that feel isolated have 14% higher risk to have an early death: “(...) feeling lonely increased the risk of heart attacks, dementia, depression, and could disrupt sleep, raise blood pressure and lower the immune system. Those who felt isolated from others were 14 per cent more likely to have an early death,” (Orr, 2014).

As indicated, field research showed how social activities are a way to provide informal health check-ups amongst friends and relatives; social isolation can preclude a person from this informal check-up on health and general well-being. Social isolation becomes a crucial barrier for personal information and resources sharing. Relevant resource sharing could be public service guidance, transportation to the GP e.g.: “(...) social connectedness, indicated by one's social network and level of social participation, can provide access to material resources such as information, transportation, financial loans, or emotional support,” (Cornwell and Waite, 2009).

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Problem Space & Design Space

The Design Space

We sought to understand the design space through a range of different approaches and methods: We conveyed two codesign sessions with potential future users. We did roleplay / enactment sessions in the design studio, and continuously prototyped the user journey through storyboards, visualisations, product sketches e.g.

Exploration and Validation of the Design Space After identifying the potential design space, we sought to elaborate and investigate it even further - and furthermore also validate our initial findings. Rooted in our initial findings, we framed additional questions on whether these findings were time and location dependent, planned or incidental. We went back to context areas to convey more informal interviews with stakeholders from both the user segment as well as representatives from the Third Sector. Two areas of socialising was identified: formal socialising and informal socialising. When re-visiting existing data and conveying additional research, further contextual areas emerged: planned socialising and incidental socialising.

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Chapter 5

Problem Space & Design Space

Articulation of the Design Space

â&#x20AC;&#x153;

How do we bridge the gap between a hard-to-reach community, and health and social care services provided by the public and third sector, to accommodate the identified problem of isolation, disconnectedness and loneliness within the borough of Camden, London?

Planned Socialising

Formal Socialising

Informal Socialising

Incidental Socialising

Local pub as a social hub for informal and incidental socialising.

The pub manager does informal health and social check-ups.

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Chapter 5

Problem Space & Design Space

The Opportunity Within Incidental and Informal Socialising Identifying Places for Informal and Incidental Socialising

Areas for informal and incidental socialising: Bookmaking offices, local pubs, supermarkets, pharmacies and bakeries. Interviewing a local bookie, offered the insight that several local men come by regularly. They only spend ÂŁ 2-3; as the manager said it is about the interaction and not necessarily the betting: â&#x20AC;&#x153;They wanna talk to you. They would even bring you coffee.â&#x20AC;?

Surprisingly, according to conducted field research, hairdressers in the area do not appear to be social hubs; most of the hairdressers are new, and have not become integrated in the community as places for informal socialising like the other places identified.

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Problem Space & Design Space

The Opportunity Within Incidental and Informal Socialising entering and leaving; but when entering the pub, the place is vibrant. The pub has been there for more than 150 years. Ex-

tensive research, both within the pub premises, but also through

engaging with other parts of the community, it appeared how this

particular pub is an extraordinary and valuable example of our insight

regarding these hubs for informal and incidental socialising. Many of the

same qualities, we experienced in terms of planned community activities,

also appeared here: it is a place for creating and maintaining social ties, as

well as a place for informal health check-ups between trusted friends. Locals

from the area come by on a regular basis, some even every day. The Cock Tav-

ern is to many people an extension of their own home. Nationalities represented

were primarily from UK, with an Irish majority.

A Local Pub as Design Context A particular place for informal and incidental socialising stood out during our field research; not only for its strong social bonds amongst guests and staff - but also for its deep roots in the community and its diverse usage. It is an old, traditional British pub in Somers Town: The Cock Tavern. From the outside it looks closed, with only regular locals 41

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Problem Space & Design Space

Current Situation in the Design Context Regular customers stop by the pub on a daily basis.

The pub manager chats with her customers and friends; she checks up on their well-being. Sometimes she gets them affordable food deals; e.g. a steak.

Reads the newspaper Customers eat fast food from other cafĂŠs / restaurants in the pub.

The Cock Tavern is more than just a pub; it is an informal community and social hub for local residents in the area. Most of the guests are regulars, and they stop by for a drink and a chat every day. The customers like to watch football, horse racing, or other sports on the TV. They often do not focus too much on the TV, but chat with other regular customers and friends over a pint of beer or a can of orange soda. Some customers bring a newspaper to the pub, and read it by the bar counter with a pint.

Watches sports, horse racing or football e.g. in the pub while chatting.

Customers chat with their friends over a pint.

There is a very strong relationship between the pub manager and her customers. She has worked there for around 17 years, and knows the local community and its people very well. She treats her guests like family and helps them if needed; e.g. financially so they can visit their family. She concerns for people, and is always open for listening if anyone is feeling troubled. If she assesses that one of her customers is in need of actual professional help, she either reaches out to the specific professional service or health care institution or guide the customer there. 42

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Problem Space & Design Space

Current Ecosystem in the Design Context

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Chapter 5

Problem Space & Design Space

Current Situation in the Design Context

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Chapter 5

Problem Space & Design Space

Stakeholders Identifying The User The community feeling is strong, and the relationships between locals often go decades back; many of the now elderly people grew up together - and still today live on the same road, and stop for a chat when going grocery shopping.

The process of identifying the user group went from identification of a hard-to-reach group of people to exploration and validation of the actual user. Initially, the user group was identified as elderly single men, however during further research and co-design sessions in the context, we experience how

the user group appeared more varied and diverse than that. Not only was it not as age specific as initial research indicated, also, it was not as gender specific as initial insights suggested. After identification, exploration and validation we identified the user group as being from around 45 years of age and above, but with a majority of elderly men.

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Problem Space & Design Space

Stakeholders An additional stakeholder emerged: The Community Assets Additionally, we identified a valuable stakeholder in the area; a group of people that all are deeply involved in the community and work for relationship building across areas, and encourage people to participate actively in the community activities. A key learning emerged regarding how these people feed the community feeling, and also the opportunities for socialising. We label them as ‘the community assets’, ranging from community center employees to volunteers. We identified at least three characters within this stakeholder unit: >> A manager at a local community center: He initiated sports activities in the Somers Town area, and helped spreading these activities to other Camden wards as well. Through the experience of his wide scope of work, but also through the articulation of his kind being and his hard work for the community by local residents, we found this passionate manager being of vital value for the community feeling and general socialising. >> Community activity volunteers: Two ladies turn up every week to do a senior boccia class. They do not appear to view themselves as “just” volunteers; instead we found how they saw it as an opportunity to be with their friends and get moving. Every week they show genuine care and affection for the participating elderly residents. They even collect money to ensure a monthly trip to go out for fish and chips, and they arrange trips to local Christmas markets e.g. >> A local pub manager: She does not just serve her guests drinks; she also refers people to health and social services, checks up on them in their home if they do not show up, offers financial support if needed, cooks Christmas dinner for the ones that has no one to spend Christmas with e.g. The common factor for all of these ‘community assets’ are the passion for the community and genuine human empathy. The above list is not to be seen as an exclusive list; surely more community assets exists, but has not been identified through this project.

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Chapter 5

Problem Space & Design Space

Personas Within the problem space of isolation and loneliness, we have condensed characteristics and developed 4 different personas. Three of them usually go to their local pub (the design context) to get out and socialise. The last one is the local pub manager. They have different backgrounds, habits and daily routines, but for all of them, their local pub plays a vital role in their life.

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Persona #1

John Care receiver

Personal details

Personal Network & Contact

Age : 74 Occupation: Retired Home: Lives in Somers Town with his adult son - close to the local pub.

»» »» »» »»

View on Socialising

Interests, Activities & Places

Formal socialising: »» “This is not for me, I’m not interested” Informal socialising: »» “I have come to the pub to talk with the bartender everyday for several years. We used to have breakfast together; she cooked for me.” »» “I will go to the pub on Christmas”

»» »» »» »» »» »» »» »» »» »»

Family: Lives with his son who often goes traveling. “My son has educated me more than I have educated him” Friends: “I don’t have friends, I have acquaintances, haha”. Close relationship with other pub customers. Pub manager/waiters/waitresses: Close relationship with the waiters/waitresses and the pub manager. “Mary is looking after everyone; she helps everyone“

Chats with bartender and other customers in the pub. Watches horse race and football in the pub. Puts bets in the pub. Mary does it on her phone. Usually reads his newspaper in the pub. Very interested in sports, used to play football and swim when he was younger. “I used to swim and bike but now I can’t.. but I walk everyday - I also go for walks in the park with my friend’s kids.” Have meals at a café just across the road from the pub. Favourite food: British food, like liver, lamb, and a good roast. Goes to the supermarket to do his grocery shopping, he runs into familiar faces there. Likes listening to old music. Likes reading sports books, autobiographies and history books. 48

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Persona #1 - Daily routine

John Care receiver

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Problem Space & Design Space

Persona #2

Dolly Care receiver

Personal details

Personal Network & Contact

Age : 55 Occupation: Receives disability benefits Former alcoholic, has not been drinking for 8 months. Home: Social housing

»» Family: Lives alone »» Pub manager/bartender/waitress: Close relationship with the waitresses and the pub manager. “I trust her. I love her. You can talk to her about everything” »» Social worker: Social worker has not called for 2-3 months. Dolly has a lack of trust in the system. “The social worker said to just call her when I needed to, but I don’t do that. I talk to Mary - I love her and I trust her. I didn’t feel comfortable talking to my social worker”

View on Socialising

Interests, Activities & Places

Formal socialising: »» Does not attend. Informal socialising: »» Dolly goes to the pub every other day; to see Mary and other local customers who are her friends.

»» The pub - here she is amongst friends she trusts.

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Problem Space & Design Space

Persona #2 - Daily routine

Dolly Care receiver

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Problem Space & Design Space

Persona #3

Paul Potential care receiver in the future

Personal details

Personal Network & Contact

Age : 47 Occupation: Casino inspector, wort both night and day shifts. Home: From Manchester, has lived in London 5 years.

»» Family: Single. Lives alone. Ex-wife and daughter live in Manchester. He goes to see his daughter every few months. »» Friends: Friends are primarily from work or locals from the pub.

View on Socialising

Interests, Activities & Places

Formal socialising: »» Does not attend any events. There are not many relevant for his age. Informal socialising: »» “I’m normally here if I’m not home” »» “It’s more like a social hub the pub”

»» Goes to the pub by himself »» Hangs out at the pub after work and on his days off. »» Routine: “I sleep - wake up - and go to work”

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Problem Space & Design Space

Persona #3

Paul Potential care receiver in the future

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Persona #4

Mary Care provider

Personal details

Personal Network & Contact

Age: 58 Occupation: Pub manager for more than 17 years. »» She acts like a connecter and helps her customers and treats them like family. »» Helps connect customers in need of care with social and health care services. »» She is an informal care provider and service connector.

»» »»

View on Socialising

Interests, Activities & Places

Formal socialising: »» Does not attend. Informal socialising: »» She knows the community and its people; she relies on informal, incidental socialising within the pub.

»» Mary primarily stays in the pub - it is more than work to her; it is also here she gets to see the people she cares for.

Customers have a great trust in her; they love her like a relative. Mary has a close relationship with her customers; she knows all about them; where they live, their history, if they struggle with any health issues etc. »» She checks up on her customers if they are missing at the pub.

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Problem Space & Design Space

Persona #4 - Daily routine

Mary Care provider

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Chapter 6

Concept Solutions

Chapter 6

Concept Solutions Rooted in gained insights, two service interventions were developed through a range of design sessions and user involvement. Following chapter presents the two proposed solutions that seeks to cater to the initially established question on how we can bridge between a hard-to-reach community, focusing on the group of users represented at The Cock Tavern, and health and social care services provided by the public and third sector, to accommodate the problem of isolation, disconnectedness and loneliness within Camden.

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Concept Solutions

Design Criteria Design Criteria and Rationale for Designing within The Cock Tavern: Criteria for guiding the decision making, was posed by the initially established design criteria presented by Camden Council - as well as the following design criteria that were identified throughout the research and design process. A general learning was that very few people within the user group had trust in the system. Camden Council wishes to design a service solution that caters to the health and social care system. Throughout the design process, field research and co-design activities have further informed these design criteria to enable decision making during the design process. These criteria were: Avoid to intervene with the sanctuary and sacred place that the pub is to people. Avoid complexity; preferably hide the perceived complexity within public and third sector services. Do not take trust for granted; trust needs to be gained and takes time to build. It is about people and relations: it is about creating breeding ground for relationships between people across organisations and social hubs.

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Concept Solutions

Design Proposals >> Overview and Objectives

[1]

To connect people who are hard to reach with Camden's social and health care services provided by the public and third sector.

Public Sector

[2]

To create a catalyst for more incidental or/and informal socialising to combat the problem of loneliness and seed for more informal health check-ups.

Third Sector

Incidental socialising

Pub manager as community connector (tool: iPad) Social & health care services

The Social Exchange Table in the pub (tool: table incl. shelves)

Informal socialising

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Chapter 6

Concept Solutions

Ecosystem for Proposed Design Concepts

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Chapter 6

Concept Solutions

Service #1: Pub Manager as Community Connector When disconnected and isolated people struggle with health issues, our research showed that they tend to ask a trusted friend for help or guidance rather than contact the public health and social care system. This is caused by several factors; three important factors are a lack of trust in the system, the complexity of services provided, and a general lack of social connection and thereby referral to the system. In this local pub, the customers who are living alone go to the pub and chat with the pub manager, and share their thoughts and health concerns with her. The pub manager is not only providing a place for local people to have a drink and watch football or horse racing; she also provides a kind of community and belonging for her customers. Therefore, we saw her as valuable asset for connecting the disconnected people and potential care receivers to public and third sector services. Through an iPad, as a platform and tool, we wish to bridge between a hard-to-reach community and the health and social care system. Present prototype on this page, of a potential interface, examplifies how a potential use-situation could look like.

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Concept Solutions

Communication Model Emergency contacts

Recommended Activities

Health Information

»» Provide contact informations for urgent matters.

»» Provide information on formal and informal socialising in Camden; Origin Housiing, Ageing Better etc.

»» Provide information about general health; e.g. NHS.uk, netdoctor. co.uk

Health & Social Care Facilities

Health & Social Care Services Information

Others

»» Information about GP, hospitals, pharmacies, third sector etc.

»» Introduction of health care services, and contact information on relevant personnel.

»» Latest news etc.

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Chapter 6

Concept Solutions

Service #1: Stakeholder Map >> Pub Manager as Community Connector

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Concept Solutions

Service #1: Pub Manager as Community Connector >> Scenario #1

Paul lives alone, and tends to feel quite isolated. He does not play football or go for a walk with his friends. He mostly stays in or go to the pub.

He likes going to his local pub to have a pint of beer and a chat with Mary, the pub manager.

Paul trusts Mary. They have known each other for a long time. He shares his thoughts and concerns with her about feeling alone.

Mary asks Paul if she can introduce him to Maureen from Camden Community Connectors that sometimes pop into the pub.

Mary texts Maureen on behalf of Robert, and sends his contact information.

Mary informs Paul that Maureen will reach out to him. She knows a lot of people in the community and also about relevant activities based on his interests.

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Concept Solutions

Service #1: Pub Manager as Community Connector >> Scenario #2

Dolly goes to the pub every day to see her friends from the local area and Mary the pub manager.

Dolly struggles with mental issues, and does not feel comfortable around other people than her friends at the pub.

One day Dolly trips and falls down the stairs in her house. Dolly lives alone, so nobody knows that she has fallen.

Mary, the pub manager, is concerned and wonders why Dolly has not showed up in the pub.

Mary stops by Dolly's house, and finds Dolly. Mary uses the iPad to reach out to health care services that can help Dolly urgently.

Dolly is doing better, and is back in the pub to thank Mary for her help.

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Concept Solutions

Service #1: Pub Manager as Community Connector >> Blueprint Blueprint example w. third sector Camden Community Connectors

Physical Evidence

Care Receivers Actions

Front Stage Interactions

(pub manager & community connector)

Word of mouth (pub manager), posters, leaflets. Information on public and third sectors and contact information on people to contact. Goes to the pub manager and shares concerns and thoughts.

Receives advice from the pub manager that recommends to talk to a professional.

Pub manager socialise and conducts informal check-ups on customers' (care receivers) health and well-being. Pub manager introduces a community connector to her customers (care receivers).

Back Stage Interactions

Decides to allow the pub manager to give personal details, health/social situation to community connector.

Pub manager asks care receiver if she can share his/her contact information and health/social situation with e.g. the community connector.

Community connector visits pub manager for them to both keep updated on potential new care receivers or service offers.

(pub manager & community connector)

Support Process

Contact information on the iPad on social and health care facilities and services: Nearest hospital, GP, Origin Housing, Ageing Better Camden, Community Connectors.

Community connector meets the pub manager in informal surroundings. They get to know each other. The connector introduces the iPad and its functions.

Word of mouth (pub manager), email on iPad.

Word of mouth (community connector), leaflets, websites about formal social activities, and health and social care services.

Word of mouth (pub manager), contact information on people from third sector activities or public sector health and social care services.

Gives personal contact information and availability (dates and times) to the pub manager).

Receive a phone call from a community connector. They agree on a face to face meeting.

Through getting to know personnel from health and social care services, public and third sector institutions appears more approachable and trustworthy.

Meet with the community connector that knows about provided third and public sector health and social care services and social events.

Gain broader knowledge on existing health and social care services.

Pub manager emails care receiver's information (health/social situation, phone number, availability etc.) to community connector.

The community connector calls and meets with care receiver. Asks about situation, e.g. his/her interests. Based upon interests the connector introduces formal social activities - or connects the care receiver with other local residents with the same interest.

Pub manager shares information on community activities and potential relevant information on health and social care with the customers in the pub.

Community connector receives information. Registers the new care receivers.

Community connector puts in meeting with care receiver in the calendar. Meets with care receiver. Has brought relevant information (leaflets etc.) for the meeting.

Community connector updates health and social care service information and contacts on the iPad.

Community connector leaves information (leaflets, posters e.g.) in the pub on ongoing activities and services.

Community connector meets with pub manager to update her on services and activities in the community.

Community connector provides leaflets, posters etc. for the pub manager to share in the pub.

Community connector asks for insights from the pub manager on the current situation and potential care receivers that could benefit from health or social services.

Leaflets, posters etc. are shared in the pub; put in and hung on the Exchange Table.

Recommends other locals, disconnected from public and third sector services, to go to the pub manager.

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Concept Solutions

Service #1: Pub Manager as Community Connector >> Service Wheel

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Concept Solutions

Service #1: The Pub Manager as Community Connector >> Implementation Model

Short Term

Middle Term

Long Term

Tasks: »»Design team: Introduce the pub manager to personnel from the third sector; Origin Housing, Camden Community Connectors, Ageing Better Camden etc. »»S e e k f o r f u n d i n g amongst public or third sector organisations to get the iPad; potentially as a donation or a used one. »»Third sector representative: Introduce the pub manager to the iPad as a tool; contact information, information access etc.

Tasks: »»Third sector representatives pop by the pub to ensure a familiar and good relationship, that reaches beyond the technology of an iPad. »»U p d a t e s o f t w a r e continuously (pub manager). »»Update contact and service information about health and social care services and providers (third sector representatives). »»Third sector reaches out to public sector departments to introduce the new system: have an introductory meeting.

Tasks: »»Regular communication between public and third sector departments. »»Pub manager and third sector representative have continuous contact, often face to face meetings in informal settings at the pub. »»Pub manager gets introduced through her existing contacts to the third sector to other relevant personnel from the third sector.

2 weeks

Goals: »»Seed for relationships between third sector personnel and the pub manager. »»Pub manager can navigate iPad easily. »»Pub manager gets to know key people from the third sector.

2 months

Goals: »»Create relationship between people beyond branded organisations. »»All information available is accurate and updated. »»Establish a working relationship between third sector organisations and public sector departments.

6 months

Goals: »»Connect a hard-toreach community with formal health and social care provided by both the public and third sector. »»D i r e c t p e o p l e i n need of social or health care to either the third or the public sector. »»Gain familiarity between third sector and the pub manager and her customers. »»Build trust in third and public sectors, and health and social care services amongst people in the hard-to-reach community.

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Chapter 6

Concept Solutions

Service #2: The Social Exchange Table The Exchange Table solution is seeking to cater to the group of people that are hard to reach and isolated. The physical artefact seeks to create a social gathering point and work as a motivating driver for people to pop in at the pub and see their friends. Thereby,

we, in the design team, seek to cater to the issue of isolation and loneliness, and increase the frequence of informal health check-ups that happens between friends. Through codesign sessions with the future users, and additional interviews with stakeholders from

both the user segment and the third sector, we iterated the idea and customized it to expressed needs and interests; reading, watching sports etc.

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Chapter 6

Concept Solutions

Service #2: The Social Exchange Table >> Prototype

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Concept Solutions

Service #2: The Social Exchange Table >> Scenario #1

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Concept Solutions

Service #2: The Social Exchange Table >> Scenario #2

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Chapter 6

Concept Solutions

Service #2: The Social Exchange Table >> Blueprint Physical Evidence

The Exchange Table

Care Receivers Actions

Have a seat at The Social Exchange Table

Books, magazines, newspapers, DVDs, board games, photos of locals and friends, third sector event posters and leaflets etc.

Original stuff in the Exchange Table

Find new information on local activities and events.

Take an item, share an item or exchange an item. The item can be used in the pub, but can also, when exchanging, be taken home.

Go to get pool balls. Go to exchange an old book with a new one.

Front Stage Interactions

Pub manager introduce The Social Exchange Table to the customers.

Back Stage Interactions

Support Process

Manage the items in the table. Get new items (books, clothes etc.) primarily from third sector institutions.

Customer's stuff (e.g. pint, food, book).

Start a conversation with other people around the table and share interests, potentially as the item as a conversation starter, e.g. a history book.

News papers, informative leaftlets or posters are added by the pub manager or third sector personnel. Customers exchange books and DVDs; and the content of the table has changed. Someone hangs up a picture on the board on the side of the table.

Find people with mutual interests.

Create relationships, potentially friendships, based on shared interests. Join activities together.

Creating and building tighter relationships.

Go to the pub to check out the content at the table.

Pub manager informs customers e.g. if a board game has been added.

Pub manager helps put items in the table's shelves, and keep it tidy.

Pub manager promotes events/activities using the table to put leaflets, posters etc. about social events and social/health care services.

Pub manager coordinates with community connector to share and update information about third sector activities.

Pub manager talks to third sector organisations, Age UK e.g., about sharing information or items at the table.

Pub manager coordinates with representative from Camden Community Connectors to leave informative leaftlets and posters on the table.

Pub manager can share posters either under the glass top surface on the table, or on the board on the side of the table.

Provide information on formal and informal social events through leaflets, posters etc. The echange of items, books or DVDs e.g., motivates people to stop by.

TEAM ORANGE

Chapter 6

Concept Solutions

Service #2: The Exchange Table >> Service Wheel

TEAM ORANGE

Chapter 6

Concept Solutions

Service #2: The Social Exchange Table >> Implementation Model

Short Term

Middle Term

Long Term

Tasks: »»Cabinet maker or potentially a handy local guest: Build the table (in recycled materials to ensure low costs) »»Establish contact to third sector organisations for funding. »»Establish contact to third sector to receive donations (second-hand books, clothes, DVDs etc.) »»Introduce third sector organisations to the pub manager; seed for a relationship.

Tasks: »»Service advert: Invite journalist from local newspaper to write about the initiative. »»E n c o u r a g e p u b manager to introduce people from third sector organisations to her customers. »»Seed for word-ofmouth recommendations. »»Pub manager: hang pictures already in the pub on the table board to include it as part of the social hub.

Tasks: »»Pub manager: Encourage customers to put in old books, board games etc. - potentially in exchange for new ones. »»Pub manager: Encourage people to hang photos on the board or play a board game. »»Pub manager: Work closely with third sector personnel. Allow them to leave leaflets, posters etc. under the glass surface or on the board.

1 month

Goals: »»Build and place a final Exchange Table incl. shelves, board, glass surface in The Cock Tavern. »»Ensure the table fits in scale with the existing pub space. »»Promote the idea amongst third sector institutions to enable potential funding and donations of books, clothes, DVD’s etc.

2 months

Goals: »»Introduce isolated and potentially lonely people to the service; gain familiarity with its existence. »»M a k e t h e t a b l e a part of the pub; and avoid it being a intruding product misplaced in the pub.

Goals: »»G a i n f a m i l i a r i t y amongst potential users. »»Make more people visit the pub »»Optimize revenue streams for the pub manager. »»Expand the function of the pub, and amplify its social hub character.

TEAM ORANGE

Chapter 7

Discussion

The local people here have been consultated to death [...] Give the people ownership, so they can steer it. The idea is fantastic; itâ&#x20AC;&#x2122;s the cultural sensitivity Interviewee, Origin Housing

Chapter 7

Discussion

Research & Design methods The project process has been people dependent; initially we were introduced to a set of different stakeholders and from those we got referred to a wide web of people; participating in research and design sessions. Validity and Reliability When conducting field research, the first question that was raised within the design team was: 'how does one scope the field research and insure the data that were collected could fuel the development of suitable design ideas?' From a geography perspective, we focused on three wards in Camden, and sought to explore all details within these areas; approaching the areas with an open and patient mind. It helped us emphasize with the local situation and ensured that our design interventions cater to actual context specific needs and issues. On the other hand, we utilized the secondary research to help us frame the scope of our field research. Before entering the field, we already had a brief understanding, and we could target specific locations and objectives for further discovery. Navigating between desk research and field research offered us to validate and put insights in a more universal perspective; social isolation and disconnectedness as well as loneliness are national problems within the UK. Desk research provided a reflection of the problem area on a national level, which validated our articulation of the problem space. Two general concerns through the process were to differ between own assumptions and actual reality, as well as own assumptions and actual client and stakeholder values. To accommodate this potential issue and bias, when launching the process we identified a list of client criteria that were vital for value creation and success. All team members speak English as a second language, which did mean that we, when conducting research, and design sessions especially with the elderly Irish community, did struggle with understanding some accents and the use of slang. In the situation we tried to manage it by asking clarifying questions to the participants; however we must acknowledge potential lose of data due to this. Coping With Sensitivity and Building Trust What we found as the biggest task to manage, was the sensitivity of the research and design field: balancing between asking the right questions and being patient, without offending and potentially gaining a fruitful dialogue with research and design participants. This was particularly a concern when interviewing and designing with care re75

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Discussion

Chapter 7

Discussion

ceivers. Gaining and building trust was a general issue during the project. We accommodated this from primarily two perspectives. One approach was patience; we took our time to get to know people. We talked to them about the weather, about a son living in Australia, about which Christmas markets was the best etc. Furthermore, we went back to the same research contexts to follow up, seeding for actual relationships between the design team and participants. We held two co-design sessions within the context we designed for; the local pub. Doing ethnographic research within the same context beforehand, was vital to gain access to people’s thoughts and people actually engaging in the sessions.

We don’t want to intrude too much [...] There is the danger that you tread too heavily [...] It’s really sensitive. Massively, Interviewee, Ageing Better Camden & Camden Community Connectors

The second approach emerged, when we identified the issue of social isolation and disconnectedness, and loneliness, within the area. This matter is very sensitive and tabooed. To encounter the stigma, we framed questions and approaches that indirectly approached the problem field without being insensitive; we would ask them what their plans were for Christmas, or have them map hobbies and who they would pursue these hobbies with. ‘Say vs. Do’ and the Revelation of Tacit Knowledge An additional topic for discussion is the potential conflict between ‘say’ and ‘do’ when conducting ethnographic research. Especially working with a sensitive topic like isolation and loneliness, one thing is what the participating actor says, another might be what the person actually does. We were continuously aware of that; and tried to accommodate to any potential say-do-conflicts by asking validating or clarifying questions during research or design sessions. This also relates to the issue of whether all relevant tacit knowledge amongst participants has been identified and acknowledged throughout the process. Design Thinking for Improving Adult Public Health and Social Care Systems In the service design process, the design team should look at both the big picture as well as immerse themselves in the details. Reflecting upon our process and gained insights, we can now see how we can classify the insights into two categories: general and individualistic. The general insights represent the atmosphere, history, trends, societal discourses, culture etc. The individualistic insights represent behaviours, habits, motivation, feelings, identity, nationality, gender, and so on. It was important to us, to keep switching between zooming in and zooming out; we zoomed in on individuals within the design context, and reflected upon these insights from a general approach. The repetitive comparing of and reflecting on insights on different levels, also allowed us to validate our insights and identifying a reliable core problem, which was crucial to identify the design space. Design thinking allowed us to comprehend the current health and social care situation with the design context and 76

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Discussion

Chapter 7

Discussion

identify actual needs and problems. We focused on a local ecosystem, and sought to re-organise existing current roles and resources in Camden to cater to the hard-to-reach community of people to ensure they receive proper health and social care. Also we wanted to utilize the power of NGOs (third sector organisations) to spur for people dependent work and resource sharing across public and third sector institutions. Testing of the Service Concepts A tasks that was widely discussed within the team, was an issue occurring close to the project deadline. We had developed two service concepts; we had done some raw testing with different stakeholders. However we would like to be able to validate our idea in context and gain insight from actual interaction with some prototypes. We did experience that the participating people within the pub and third sector were starting to rely on us; and some had even grown fond of us and likewise. It was difficult to balance between designing for and with people - but also knowing that we would have to withdraw us from the context in late December.

Relevance, Implementation and Scalability of Proposed Service Design Solutions Designing for health and social care within the public sector has been a complex matter, involving a broad spectrum of stakeholders with different agendas and objectives. Research and design sessions revealed how important it is - when designing a service for this specific hard-to-reach community - that the service is people dependent. It appeared how it was about more than connecting institutions and organisations - and instead seed for relationships and trust between people representing different part of the ecosystem. The incentives for implementing and using both services, are genuine care and empathy amongst people; already existing within this social hub that The Cock Tavern is. When presenting the design proposals to Ageing Better Camden and Camden Community Connectors, they expressed interest in the solution. Furthermore they were very interested in getting to know this community of people, moving under their radar, and benefit from the design teamâ&#x20AC;&#x2122;s relationship with them - without intervening. Service #1: The Pub Manager as a Community Connector As initially stated, we wanted to avoid to intervene and interrupt with the social hub that the pub is. This is why we have not connected the pub directly to the public sector - but indirectly through the third sector. However the pub manager is still able to reach out to public health and social care services by her own initiative. However focus in the existing service proposal is to create a work relationship between third sector institutions like Ageing Better Camden and Origin Housing, and the pub manager. Furthermore, as desk research also suggested, we wish to seed for 77

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Discussion

Chapter 7

Discussion

tighter collaboration between third sector organisations and public sector departments. We tested the design concept with both the pub manager and two future users, as well as with two representatives from the third sector. The pub manager showed great interest in the service concepts. When discussing potential intrusion to the social hub that the pub is, she stated that she was not too concerned at this point and would be keen to meet with third sector personnel. For this service to succeed, it is crucial that the pub manager choose to adopt the service and use it actively. A manager at Origin Housing suggested, how we need to replicate the service concept and identify another “Mary” to test its validity and scalability outside this specific design context. This is key to define the service design concept’s actual scalability. This would be interesting for future work; as touched upon in chapter 5, we identified a stakeholder labelled as “community assets” - people that work for and engage with the community very passionately. Their key drivers are empathy and honest care about people and the area; these would be interesting to collaborate with in the future - and also identify more existing community assets within the area.

Replicate the idea. You need to identify a new “Mary” [the pub manager]

Interviewee, Origin Housing

Service #2: The Social Exchange Table We wish to create a people dependent service system; we cannot force trust, but hopefully we can seed for it. Working with a very sensitive design context and group of users, care receivers, during the design process, we realised through research that a people dependent design solution potentially would cater to this particular issue. The Social Exchange table is in itself a product; a table with embedded shelves for storing of items. The table is a physical product, thematically composed by fragments: the hard-to-reach people’s actual interests. This table is to work as a social gathering point. The artefacts (books, DVDs, informative leaflets etc.) are the embodiment of the motivational drivers that should make people go more regularly to the pub. Potentially this free to use service in the local pub will also draw other people’s attention besides the regular customers. This would also benefit the revenue stream of the pub in general, which is much needed. However, these points of reflection are only speculative. This table service can be build and implemented for very low costs; potentially even free. We have tested and reflected upon its level of intrusion with the social hub, which is also considered low. It is easy to replicate, and the service idea could easily be implemented within other informal social hubs, e.g. local community centres. 78

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Chapter 8

Conclusion

Chapter 8

Conclusion The two design solution caters to the initially presented aim by Camden Council on a stronger focus on the role of families and local communities to support citizens. The first service design solution caters to bridge the gap between isolated and disconnected people, and existing public and third sector health and social services, through an assistive technology tool; the iPad. The second proposed design solution seeks to motivate people to expand the idea of the what kind of social hub, this local pub is. The solution seeks to motivate people to go see their friends in the pub, to ensure more socialising and more informal health check-ups amongst trusted friends. We wish to benefit from the trust existing amongst people within the community, and thereby benefit from existing community resources; people. We embedded two properties into our design concepts: scalability and cohesiveness. The relationship between local people is the key thing in this project. The idea of letting the pub manager be a touch point of connection is a starting point of building a relationship between isolated people and public and third sector health and social care services. The Social Exchange Table-idea is a new communication touch-point, for facilitating interactions between people. Through these two proposed design interventions, we expect to re-tailor the web of relationships between a hard-to-reach community and the public and third sector, thereby optimizing the current health and social care system and to further create social value to the users.

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Bibliography Age UK (2010) Loneliness and Isolation Evidence Review [Online] Available from: http://www.ageuk. org.uk/documents/en-gb/for-professionals/evidence_review_loneliness_and_isolation.pdf?dtrk=true [Accessed: 13th December 2016] Age UK (2016a) Policy Position Paper: Tackling Loneliness and Isolation (UK) [Online] Avaialble from: http://www.ageuk.org.uk/documents/en-gb/for-professionals/policy/health-and-wellbeing/ppp_loneliness_ and_isolation_uk.pdf?dtrk=true [Accessed: 13th December 2016] Age UK (2016b) No one should have no one at Christmas [Online] Available from: http://www.ageuk.org. uk/no-one/ [Accessed: 15th December 2016] Cornwell, E.Y & Waite, L.J (2009) Social Disconnectedness, Perceived Isolation, and Health among Older Adults [Online] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756979/ [Accessed: 13th December 2016] Harris, R. (2015). The Loneliness Epidemic: Weâ&#x20AC;&#x2122;re more connected than ever - but are we feeling alone? The Independent. Available from: http://www.independent.co.uk/life-style/health-and-families/features/theloneliness-epidemic-more-connected-than-ever-but-feeling-more-alone-10143206.html [Accessed: 14th December 2016] Holley-Moore, G. & Beach, B (2016). Innovate To Innovate to Alleviate:Exploring how the role of an enhanced care worker could address skills shortages in the social care sector. International Logevity Centre - UK [Online] Available from: http://www.ilcuk.org.uk/index.php/publications/publication_details/ innovate_to_alleviate [Accessed: 6th January 2017] I&DEA (2010) A Glass Half-full: How an Asset Approach Can Improve Community Health and Wellbeing [Online] Available from: http://www.gloucesterpartnership.org.uk/Docs/Glass%20Half%20Full.pdf [Accessed: 6th January 2017]

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Bibliography Laessig, G. (2012) DJ Granny Throws Elderly Disco Party. Buzzfeed [Online] Available from: https:// www.buzzfeed.com/gavon/dj-granny-throws-elderly-disco-party?utm_term=.ylopxM26kN#.unJ3D7WgJb [Accessed: 23rd December 2016] London Borough of Camden Council, (2016a). Camden Neighbourhood Profile - Holborn | Open Data Portal [Online] Opendata.camden.gov.uk. Available at: https://opendata.camden.gov.uk/Community/ Camden-Neighbourhood-Profile-Holborn/dxtk-h5sv [Accessed: 7 Oct. 2016]. London Borough of Camden Council, (2016b). Camden Neighbourhood Profile - Covent Garden | Open Data Portal. [Online] Opendata.camden.gov.uk. Available at: https://opendata.camden.gov.uk/ Community/Camden-Neighbourhood-Profile-Covent-Garden/vsr7-t44g [Accessed: 7 Oct. 2016]. London Borough of Camden Council, (2016c). Camden Neighbourhood Profile - Kings Cross | Open Data Portal. [Online] Opendata.camden.gov.uk. Available at: https://opendata.camden.gov.uk/ Community/Camden-Neighbourhood-Profile-Kings-Cross/9egs-2yf7 [Accessed: 7 Oct. 2016]. London Borough of Camden Council, (2016d). Camden Neighbourhood Profile - Somers Towns | Open Data Portal. [Online] Opendata.camden.gov.uk. Available at: https://opendata.camden.gov.uk/ Community/Camden-Neighbourhood-Profile-Somers-Towns/dv62-dsg9 [Accessed: 7 Oct. 2016]. Memoir Monopoly (2016). Build up individual memory journey, share your amazing story [Online] Available at: https://readymag.com/MemoirMonopoly/h [Accessed: 6th January 2017] NHS (2015) Loneliness in older people. [Online] Available from: http://www.nhs.uk/Livewell/women60plus/Pages/Loneliness-in-older-people.aspx [Accessed: 13th December 2016] NICE (2016) NICE Calls on Third Sector and Public Bodies to Work Together to Prevent Loneliness in Older People [Online] Available from: https://www.nice.org.uk/news/article/nice-calls-on-third-sector-andpublic-bodies-to-work-together-to-prevent-loneliness-in-older-people [Accessed: 15th December 2016] 81

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Bibliography OPM Group (2012) Ageing Well - An Asset Approach [Online] Available from: http://www.opm.co.uk/ publications/ageing-well-an-asset-based-approach/ [Accessed: 6th January 2017] Orr, G. (2014) Britain has Been Voted the Loneliness Capital of Europe - so How Did We Become so Isolated? The Independent. Available from: http://www.independent.co.uk/life-style/health-andfamilies/features/britain-has-been-voted-the-loneliness-capital-of-europe-so-how-did-we-become-soisolated-9566617.html [Accessed: 14th December 2016] Sisy's World News (2016a). Elders are not lonely, new lifestyle in later life [Online] Available from: https:// www.facebook.com/tvbstalk/videos/666075830221531 [Accessed: 6th January 2017] Sisy's World News (2016b). Recruit Alzheimer's Elderly People as a Clerk, Experience the Joy of Being Needed [Online] Available from: https://www.facebook.com/SisyWorldNews/videos/1147288672015476 [Accessed: 6th January 2017] Social Enterprise Insights (2016a). Netherlands introduces new social housing; young and old people live together [Online] Available at: http://www.seinsights.asia/article/3289/3324/4403 [Accessed: 6th January 2017] Social Enterprise Insights (2016b). The health care centre, which takes care children and elderly people [Online] Available from: http://www.seinsights.asia/article/3290/3324/4300 [Accessed: 6th January 2017]

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Appendix: Process Chart

ORANGE

When life gives you lemons, ask for Orange.