Summary of the impact

Research into participative practice and well-being with older people has contributed directly to the development and application of an ethic of care in policy and service delivery, as well as to practices in older people's participation, locally, nationally and internationally. The research has directly impacted on practitioners and practice developments in services for older people, with learning resources (co-designed with practitioners and older people) being used in professional education and training across the UK and in New Zealand. An innovative participatory methodology has both enhanced older people's participation locally and been adopted more widely by university community research collaborators working to enhance older people's citizenship and well-being (eg in Netherlands). Research has directly informed policy concerning older people's needs assessments by recognising the centrality of relationships to well-being in older age. The well-being research involving collaboration with service users and providers has been described as `exemplary' by the leading national charity Age UK.

Underpinning research

Context and origins: Recent policy on older people's involvement and participation, on active ageing and on well-being has a high profile in view of the changing demography across the globe. Policy has focused on promoting choice and independence for individual older people, in order to reduce their dependencies on health and care services in later life. At the same time, there has been continuing evidence of abuse and poor practice in the care of older people within hospitals and residential homes. The research underpinning the impact claimed in this case study builds on a body of work conducted over 20 years within the School of Applied Social Science (SASS) on user involvement, public participation, partnership working, older people and care. BARNES' appointment in 2006 strategically enhanced this work, further developing her internationally recognised research on public participation, participatory research methods and care ethics. Since the early 1990s, BARNES' work has included DH-funded evaluation of user involvement in community care, ESRC-funded case study research on public participation, and action research involving frail older people in user panels. Her reflective monograph [reference 3.1] and journal article [3.2] provide a sustained critique of the individualised, choice-based approaches dominating policy and practice. The monograph develops an alternative relational approach, based in an ethic of care that is applied to social care practice, social policies and the practice of deliberative policymaking. This internationally recognised scholarship is reflected in, and has been further developed through, a series of participative research projects involving older people as co-researchers to understand well-being in later life [3.3, 3.4, 3.5].

Participatory research and translation: The interaction of reflective work and scholarship with participatory empirical research has been central to developing the involvement of older people in the impacts of the research on practice, and critical policy thinking. Four key participative research projects involving MURRAY and WARD (see section 3 for funding details) underpin the impact:

Growing Older, Being Heard: Exploring older people's experience of and motivations for taking part in groups giving a voice to older people in local policy, drew attention to the significance of older activists' sense of themselves as community members with commitments to achieving broad rather than self-interested outcomes from their participation. It identified key issues on which older people wanted to campaign, highlighted negative experiences in relation to perceived influence and suggested how this might be improved [3.3].

Cheers!? Older People and Alcohol Use: A project with older people and a local partnership of service providers that produced a journal paper co-authored with a community partner distinguishing different models of alcohol use and emphasised the importance of relational practices in response [3.4].

Older People and Well-being: Research with older people in partnership with a local Age UK office explored what well-being means to older people and how it is generated, challenging dominant views of well-being as relating to independence and the exercise of choice. It demonstrated how relationships with family, friends, service providers, strangers and places are strongly implicated in the maintenance of well-being in old age. In a publication co-authored with a community partner, the research de-coupled the `health and well-being' link indicating that poor treatment rather than poor health may be more damaging [3.5].

Knowledge Exchange with Older People and an Ethic of Care (KEOPEC): The UoB undertook translational research using ESRC funding with local Age UK partners and partners in the statutory and voluntary sectors and applied the findings from the Older People and Well-being project to the development of learning resources, which are being used to embed an ethic of care approach to service delivery in the care of older people.

Overall, this body of research has identified how diverse relationships are necessary to achieve individual and collective well-being for older people. The research's collaborative and participatory methods have contributed to the development and application of an ethic of care, designed to promote good care as a value in policy and service delivery, as well as to influence practice in older people's participation and involvement.The participatory methods were a key process underpinning the impacts as the research was co-designed and undertaken with older people as co-researchers. The latest project (KEOPEC) adopted a `cascade model' to Knowledge Exchange in which intense participatory work involving researchers, practitioners and older people had a direct influence on those taking part. The participants then shared this experience and learning in their educational and service provider settings, further influencing a wider network of practitioners and practices, ensuring that the learning resources produced in the KE are used nationally and internationally to stimulate impact.

Key researchers:

Marian Barnes:	Professor of Social Policy (Sept 2006–to date).
Lesley Murray:	Lecturer (July 2007–Feb 2012), Senior Lecturer (Mar 2012–to date).
Elizabeth Ward:	Research Officer (Sept 2007–Sept 2008), Research Fellow (Oct 2008–Feb 2012), Senior Research Fellow (Mar 2012–to date).

References to the research

Key research grants:

BARNES (CoI), Harrison (PI at University of Sussex) and MURRAY, Growing Older, Being Heard. Brighton and Sussex Community Knowledge, 2007-8, total funding: £25k.

BARNES (PI) with WARD (Research Fellow), Cheers!? Older People and Alcohol Use. Brighton and Sussex Community Knowledge Exchange, 2007-9, total funding: £24k.

BARNES (PI) with WARD, Older People and Well-being, Age UK, 2008-12, £46k, with matched funding from the University of Brighton.

BARNES (PI) and WARD (CoI), Knowledge Exchange with Older People and an Ethic of Care (KEOPEC). ESRC follow on funding, 2011-2013, £85.4k.

Details of the impact

Influencing practitioners and practice developments: Practitioners from statutory and voluntary sectors (occupational therapists (OTs), social workers and voluntary sector workers) involved in the research and knowledge exchange have been impacted directly through experience of working with older people, exposure to research findings, and opportunity for reflection provided through the KE approach. Commenting on how this had made a difference, one voluntary sector practitioner contrasted this `REAL' involvement with more familiar `tokenism' (source 5.1). Practitioners have adopted the learning resources in their own organisations across West and East Sussex as well as in Brighton. An Operations Manager in OT claimed that they are `invaluable to our organisation as it is an area that is relatively underdeveloped and I have had difficulty finding suitable material' (5.2). Between January 2013, when the resources were launched at Age UK headquarters, and July 2013, the six films (5.3) were accessed a total of 486 times and the accompanying handbook downloaded 696 times; 100 DVD versions have been distributed.

The local Age UK research partner has described how the research has benefited the development of professional practice, service delivery and enabled the organisation to raise its profile. Findings and learning resources are being used in staff training, impacting on its capacity to contribute to local planning regarding older people's services, and to national consultations and campaigns — for example on dignity and safeguarding (5.4). Research is also impacting on practice via its uptake in professional education courses. There is evidence of use in social work education in, for example Nottingham and Cambridge, psychologists training in NHS Wales and in nurse training in New Zealand (5.5). Website evidence shows that, during the impact period, the learning resources had been accessed in 31 countries.

Enhancing older people's participation: The well-being research has been acclaimed as `exemplary' by Age UK nationally (5.6) in terms of university/Age UK collaboration and of working with older people in research and development. More locally, research findings and innovations in ways of working with older people are being drawn on directly in developing Brighton and Hove Council's bid to become a World Health Organisation (WHO) Age Friendly City; a series of `age-friendly' indicators, based on the research, have been developed to be used in assessing the council's progress towards the WHO criteria (5.7). In the wider Sussex area, the Chair of the Meridian Mature Citizen's Forum (Newhaven) states that participation in the Growing Older, Being Heard research `gave the Forum confidence and a sense of purpose' regarding involvement in debates with local authorities about the need for community transport. Councillors from three towns affected by poor transport connections now meet regularly to further this agenda (5.8).

Older people themselves, working as co-researchers, have benefited directly through their participation in the research, developing skills and confidence and an enhanced sense of pride in what they can achieve, particularly regarding advocating for the rights and interests of older people, as Film 6 in the film-based learning resources demonstrates (5.3). Their enhanced confidence and skills are further reflected in a booklet they produced — As time goes by: thoughts on well-being in later years, which offers guidance to older people on strategies for well-being (5.9); 2,000 copies of this publication have been distributed via community organisations. Co-researchers have also presented research findings at local and national conferences and seminars, including: INVOLVE (a leading charity promoting participation); ESRC Social Science Festival seminar, `Looking at Ageing Differently'; Civil Service Pensioners Association, and; Older People's Council, Brighton and Hove.

Informing policy and stimulating policy debate: Research has informed local policy, as indicated in Brighton and Hove's Joint Strategic Needs Assessment, where sections on both `Ageing well' and `Older People-Social Care' make explicit reference to the importance of the well-being research and the centrality of relationships to well-being in older age (5.10).

The research has stimulated policy debate by challenging assumptions about well-being. The well-being project report was launched at an event in April 2012 attended by 70 older people, practitioners from local statutory and voluntary agencies, Age UK and the Social Care Institute for Excellence; 62% of feedback forms said the research had added to understanding or changed attendees' points of view. Responses from those attending the national launch of learning resources were enthusiastic about the ethic of care framework and, at a local launch in April 2013, discussion reflected the contribution this research is making to debate on independence versus relationality and the implications of this for policy.

International impacts: Researchers seeking to develop similar ways of working with older people in research, policy and practice development from the Netherlands, France, Spain and Australia are drawing directly on this research. The professor of Client Participation in Elderly Care at the VU University Medical Centre in Amsterdam has confirmed that the research and collaboration with researchers has fed directly into their own methods of working with older people, stating that: `We developed and evaluated a work format for participation of older people in long-term care institutions in which an ethic of care approach is central (enhancing relational empowerment amongst older people) and building more equal collaboration between older people and professionals'. They are also using the learning resources directly in their collaborative work with older people and practitioners, building explicitly on the approach developed at UoB (5.11).

Sources to corroborate the impact

5.1 Testimonial of Community Services Manager, Guild Care, Worthing, providing evidence of the impact of an alternative approach.

5.2. Reflective log from Operations Manager, Occupational Therapy and Sensory Impairment, Reablement Service, East Sussex County Council, that confirms the use within their organisation in an underdeveloped area.

5.3 University of Brighton/Brighton and Hove Age UK (2013) Older people, well-being and participation: learning resources based on collaborative research. Handbook and video resources. Available at: http://www.ageuk.org.uk/brightonandhove/about-age-uk-brighton-and-hove/research/ [Accessed: 8 November 2013] This includes evidence of the effect on the older people themselves.

5.4 Agenda item from Age UK meeting, 7 June 2011 confirming the benefit to Age UK.

5.5 Testimonial from Senior Lecturer, School of Nursing, Massey University, Wellington, New Zealand, confirming the use of this within training.

5.6 Age UK national newsletter that confirms the exemplary nature of the UoB/Age UK collaboration. Available on request.

5.7 Testimonial available from Public Health Programme Manager, Brighton and Hove City Council, that attests to the use of the research in the bid to become a WHO `age-friendly' city.

5.8 Testimonial from Chair, Meridian Mature Citizens Forum, testifying to the impact on its approach to working with the local authorities.

5.9 As time goes by: thoughts on well-being in later years. Collected and written by a group of older people. Available at: http://www.ageuk.org.uk/brightonandhove/about-age-uk-brighton-and-hove/research/ [Accessed: 8 November 2013].

5.10 Brighton and Hove, Joint Strategic Needs Assessment (2012). Research appears in sections 7.3.9 (p.2 and `further Information') and 7.3.12 (`references'). Available on request.

5.11 Testimonial from Professor of Client Participation in Elderly Care at the VU Medical Centre in Amsterdam confirming the use of the research model in their own methods and within their own learning resources.