Design and Develop

Description of the project and the local area

(Including needs assessment or/and, other data sources available for your target population and area.) Is there a history in your area of social innovation or collaborative action with communities?

This project is unique in looking strategically at needs across the whole of Norfolk, looking at needs and building on previous work in this area. There are plenty of other projects but this is a collaborative partnership with a specific aim of social innovation. It may have happened elsewhere in an organic fashion but we’re not aware of any projects with this specific aim. This project is unusual in that we’ve had a very long lead in time for development with most of the resource aimed at these phases rather than delivery. Outputs are needs based depending on partners, existing provision and consultation. Not the first time social innovation has happened in this area but not possible to identify and describe all cases for the county. 

Assets and resources

What assets or resources including expertise has your team got that helped you get started with this project?

UEA’s experience of working Mobile Me  on adapting and evaluation to meet the needs of a person living with dementia.

Active Norfolk staff - expertise on adapting PA for people with dementia. Mel Brown's specific knowledge around health walks and dementia accessible routes. Partnership links -good stakeholder network already in existence.

NCC Environment  - Project Management Experience, management of Norfolk's outdoor environments. Norfolk Trails – mapping and accessibility audits.

Geographical setting

Please describe where your project is based, is your project based in a rural or urban area, area of catchment for participants, is it on single or multiple sites?

Please see the Needs Assessment Section 6 for how the geographical area was defined.

The summary of that section states:

It is recommended that:

a. In order to target limited resources SAIL should be delivered within the shaded area indicated within the map in section 6.4 (see section 7.7. with for a note respect to district council boundaries). This is because many of the LSOAs identified as being ‘high need’ using the composite indicator fall within this area and because it forms a contiguous area that has a shared characteristic (coastal).

b. That data within this needs assessment is used to target activities for specific conditions within the SAIL area, for example, activities targeted at those with dementia.

Current situation

`What currently happens` in relation to your project problem or issue, is your project new or are you building on an existing project?

This pilot builds on the 'Fit Together' walks (see report below). . But this pilot is offering a more sustainable approach through led and non-led walks. The partners are different. Independent walks are new whereas all of the Fit Together walks were led. we are building on pre-existing work and learnings from a project that was delivered within the Norwich and central Norfolk District area i.e. outside the SAIL area and are looking to take this way of working into the relevant SAIL areas and build upon low-level pockets of physical activity that are happening for the target demographic in target SAIL areas.

Appendix I: North Norfolk Fit Together Memory Walks Report 2015-2018

A grant was received from Norfolk Public Health for Active Norfolk to deliver walks targeting people living with dementia and the funding was used to deliver the project for 3 years for over the Summer months.

What we offered:

For the 2015 programme, we came up with the idea of offering two types of walks – one called A Breath of Fresh Air for those in the later stages of Dementia and another called The Leg Stretcher for those in the early stages. We did a taster walk in May for Cromer and then began the walks every Wednesday at 10:30am alternating the two walks. Once these were established we set up a walk in North Walsham every Friday at 10:30am alternating between the two walks during August and September.

In 2016 we continued with the idea of offering two types of walks but as takers for the “leg Stretcher” were limited we welcomed either type of participant to every walk so we accommodated everyone at once. This worked well and for some of the few walks we had good numbers. Most people would be classed as in the later stages of dementia as most came through Halsey House care home, but we did have several members of the public who brought their partners in the earlier stages. We also had several people coming from the day centre at Halsey House care home who were either there just for the day or on a longer stay to give their carer respite. We produced one colour and glossy programme with large font and pictures. All registration forms were in a book format so people could easily tear them out. We made the programmes as user friendly as possible.

In 2017, rather than offer two walks for different abilities we offered one walk as we knew from previous years that no-one seemed to mind being all together. We cut the walks to once a week alternating between 3 venues and offered them all at 10:30am. We decided to run them from May to the end of August as no one came after the end of August last year. Halsey House care home again attended regularly and a new care home Clarence House at Mundesley, came towards the end. We again produced a separate programme with colour on the front and back pages and the forms included for ease. We later found out that we had to pay VAT on the programmes, however, as they included the forms. We used large font and included good representative photographs from last year on the back cover so that they were in colour and easily seen.

Walk venues:

In 2015, Cromer promenade provided us with a flat concrete surface, a meeting points suitable for mini buses and disabled parking and a multitude of cafes and toilet facilities. North Walsham Memorial Park provided us with a flat concrete path through the middle of the park and firm grass around the edge. There was plenty of parking and toilets, but we had to hire the community centre and make our own refreshments after the walks. It was hard to use the Trails network as so many variables were needed to be able to offer safe walks with the needed facilities.

For 2016, we continued with Cromer prom and North Walsham Memorial Park and I instigated a very welcomed partnership with North Walsham library who provided the venue and allowed us to make refreshments in their kitchen with supplies we brought in. This year we also added two more venues: Felbrigg Hall and Mundesley sea front. Both these locations were good, especially Felbrigg Hall which was by far our most popular destination. A gravel path stretched about a quarter of a mile alongside the house providing stunning views. The hall also had a very nice tea room. Unfortunately, notification to the National Trust about what we were doing remains unrecognised and unanswered. I did ask if we could possibly have some passes for parking as people who were not National Trust members had to pay – but they did not respond.

During 2017 we continued with all 2016 venues except Mundesley sea front as unfortunately this proved unpopular.   Notification to the National Trust about the Felbrigg walks remains unrecognised and unanswered.

Challenges:

In 2015, working with care homes such as Halsey House in Cromer and Rose Meadow in North Walsham provided us with our audience for the Breath of Fresh Air walks.  However, visits to dementia cafes* and events and day centres did not attract anyone to our walks for people in the early stages and possibly still living at home. So that our volunteer walks leaders did not have to take responsibility for each person we made sure one-to-one carers were present. This worked well with Halsey House as rather than rely on care staff, the manager, Laura Lodge, gave the information to relatives and so we had a mix of staff and relatives acting as carers. At Rose Meadow walkers could only come if there were enough staff and because our walk coincided with their own regular activities the activity coordinator was sometimes not able to come. This limited access to the walks and so next year we will be doing them in the afternoon and I will be writing a piece for their newsletter which goes to relatives. Separating the walks between the two levels of Dementia seemed like a good idea but we ended up with no one on the Leg Stretcher walks. Talking to the people who run the dementia cafes* they agreed that this would be the hardest group to reach as people would try to continue with their normal life as long as possible and to come on a walk targeting people with dementia would mean admitting that there was a problem. For this reason, we plan to offer one type of walk next year and try and have more than two leaders, so we could have two different groups at the same time. Managers from the two care homes attended the walks and Halsey House paid staff to attend as they thought the project was so worth-while. One lady found out about the walks because she was a member of the Fit Together Walk programme who told her about it and she collected her husband from Munhaven care home in Mundesley and came on most of the North Walsham walks.

In 2016, Halsey House in Cromer again provided us with our audience for the Breath of Fresh Air walks but visits to dementia cafes* and events and day centres did not attract anyone to our walks for people in the early stages and possibly still living at home. Despite writing to every care home in the vicinity we did not get many attending.  Talks to day-centres and dementia cafes* resulted in relatively few people coming. I was invited to talk to the Patient Participation Group (PPG) at the Cromer GP Doctor’s surgery and I had a meeting with the manage

r of Paston Surgery in North Walsham. I met with the manager of a care home in North Walsham. Links for publicity with Alzheimer’s UK and local branches proved unsuccessful in attracting people. One-to-one carers were again recruited and again this worked well with relatives taking on the role from Halsey House. Walks we put on in the afternoons so we avoided times for other care home activities did not work.

For 2017, programmes and letters were sent out to all local care homes, day centres, local dementia groups and Alzheimer’s organisations. Yet again we had little response apart from Halsey House and a new care home, Clarence House. Halsey House were by far the most responsive and some residents came again from last year.  Laura Lodge, the manager, had been primarily responsible for organisation but another staff member, Jackie, organised the outing.   Laura has now left the care home, but we still have Jackie involved to provide continuity.  Again, the information was filtered to relatives and so we had a mix of staff and relatives acting as carers. The new home did not have transport and so they had to get taxis to the walks and to take 2 residents and carers cost them £40.

Volunteers: Throughout the three years we used volunteer walk leaders from the existing North Norfolk Fit Together CIO* (Charitable Incorporated Organisation) Walking for Health group. Calls and adverts requesting volunteers specifically for these walks resulted in no-one extra or new coming forward from outside the charity.

Paperwork: Throughout the three years we had both walkers and carers complete the Walking for Health registration form and in addition the carer completed a “Carer Responsibility form”. This made it clear that volunteers could not be responsible for people coming and that one-to-one carers would be responsible for getting the person to the walk and returning them home. They would also be responsible for being with the person during the walk and indeed pushing them if they were in a wheelchair.

What we found:

During 2015 and 2016 most attendees were able to walk (if only a short distance) and so received some physical benefits. The overwhelming success of the project, however, has been the mental benefits for walkers, those being wheeled in chairs, relatives and staff. Just being out of the normal surroundings proved beneficial. People only came in fair weather and so to be out with the sun and wind in their faces, to see other people, interact with others and those walking dogs gave everyone a sense that they were still a part of society. The smell of the sea, chips or fresh cut grass also provided stimulus. Those who could no longer speak were much more animated at the end of the walks and everyone really enjoyed the cups of tea and cakes at the end. Those in care homes achieved a sense of normality - being able to go out and then come home - and no doubt slept better. Relatives and staff were able to talk to other relatives and staff about issues and common issues they shared when caring for people living with dementia. Walkers were generally very excited about attending and were all very happy at the end. Many conversations were sparked by stimulus such as trees and the sea, children playing in the sand and swimming. People talked about memories they had of Cromer and North Walsham and holidays or their work life. It was nice to offer relatives something to do with the person they brought as limited conversation was needed because there was so much to see. Conversations were encouraged about experiences during the Second World War.

Mel Brown was not directly involved with the delivery of walks in 2017 so these are two Volunteer Testimonials. 

“Being the new to the work, I cannot comment or compare with previous years, but from my observations there was only benefit to be taken from the walks.  The regular Halsey House people liked to reminisce and just loved to be in the fresh air, those who didn't talk were animated and enjoyed their refreshments. Both Cromer and Felbrigg were extremely popular but North Walsham did not get off the ground.  Sometimes the carer to participants ratio was low but I enjoyed being able to assist one person at a time and engage with them.  Clarence House in Mundesley joined in later with the walks and those that came enthused about the feeling of freedom from their normal day to day routines.  Their major problem was lack of helpers and cost of transport as they don't have their own, otherwise they would participate more. All concerned would have liked the walks to continue into September. From a personal perspective I found them most rewarding and enjoyable and will be happy to be involved again.”

Brenda Shields (volunteer).

“Everybody says the walks are excellent, wonderful and are enthusiastic about them.  I wonder though - do all walkers need one to one carers and does this stop homes coming on the walks? Could we run two walks simultaneously, one for Carers with more able walkers, and one for wheelchairs, finishing for coffee at the same time?  Paul (another walk leader) has said he could adapt walks to enable this, at Felbrigg, Cromer Prom and Overstrand.  The Sea Marge hotel at Overstrand have said we could use them for tea/coffee, and of course the facilities we need are there.  Paul also said he would research a walk there. It's difficult to identify one person who particularly benefitted, I would say they all did in their own individual way.  Those who were able to articulate their feelings certainly really enjoyed them. “

Christine Joyce (volunteer).

Who came in 2015:

·                    People living with Dementia – 17

·                    Staff – 8

·                    Relatives – 9

·                    Fit Together staff and Volunteers: Mel Brown, Christine Joyce, Brenda Stibbons, Pat Logan

Funding:

·                    Management and set up costs to Mel Brown for half a day for 6 months: £1,250

·                    Printing: £120.25

·                    Float: £43

·                    Hall Hire: £80

·                    Total: £1,493.25

2016: What we offered and who came:

·                    36 walks – 15 of which went ahead

·                    People living with Dementia – 17

·                    Carers - 16

·                    Fit Together staff and Volunteers - 10

Funding: 2016

·                    NNDC (North Norfolk District Council) printing of 200 b/w copies Memory Walks 2016                                                                                                               £40.76

·                    NNDC printing of 200 A4 full colour booklets Memory Walks 2016     223.92

o       -----------

o       264.68

2017: What we offered and who came:

o       13 walks every Wednesday at 10:30am alternating between Cromer Prom, Felbrigg and North Walsham. 7 walks went ahead with 4 at Felbrigg and 3 on Cromer Prom.

o       In total we had the following attend:

o       People living with Dementia – 28 (4 from last year)

o       Carers – 13 (2 from last year)

o       North Norfolk Fit Together Volunteers - 5

Funding: 2017

o       NNDC printing of 200 A4 colour covered booklets Memory Walks 2017     £167.94

Total funding

o      Spent in 2016                                                                                           £285.18

o      Spent in 2015                                                                                            £1974.69

o      Total spent to date                                                                                  £2427.81

Learning from 2015 for 2016:

One colour easy to read brochure will be produced for the two June to the end of September periods (2015 saw a number of flyers produced as we learnt as we went along and so planned one month at a time).

The brochure will be distributed Jan/Feb 2016 and 2017 so that targeted groups know about the walks. As we started May many care homes and day centres had already come up with their activities for the summer – our walk could then be on their programmes as a regular event.

One walk will be offered each week alternating between Cromer and North Walsham with more volunteers to cater for if two groups were needed.

Look for one more possible venue for a third walk.

We did get the flyers into the local doctors’ surgeries, but we need to try and sit down with the nurse or doctor at each local surgery in charge of dementia to tell them in person what we are doing – as we did in the care homes.

Learning from 2016 for 2017:

This report will be sent to all involved in February 2017 to get any views or/and ideas and any changes needed to the 2017 programme. Recommendations are that we stick to once a week and alternate between three venues: Cromer prom, North Walsham and Felbrigg. The programme will be widely circulated, and Age UK have requested programmes for the first time to distribute. As we did not get anyone attending in the later part of the we are considering running the walks from May to the end of August? We are also considering using the funding not only to continue the walks in the summer but to also try and get a volunteer to run some art classes. Art classes have been funded and proved successfully by the CCG (Clinical Commissioning Group) in Portsmouth.  The walks are very cost effective as the only expenditure is the programmes.  All volunteers involved did not claim any mileage costs.  We will talk to Public Health Norfolk to discuss the continued use of funds, a possible art class and the use of this model across Norfolk.

Learning from 2017 for 2018:

As we have not been able to raise external funding, we are now using our revenue funding for the project, but this is not sustainable.    Pricing will be worked out to see if a separate book is feasible or whether the walks will be included in the main North Norfolk Fit Together programme.  If the latter is the case, then more regular members will see the walks who may have family members or friends who would benefit.

Mel Brown, Active Norfolk  December 2017

Contacts of those involved with the project:

Mel Brown: Active Norfolk Development Officer for walking - [[1]] - 07766259999

Halsey House: Laura Lodge - lodge1979@gmail.com

Volunteer - Christine Joyce: (01263) 519405/Christine-joyce@sky.com

Volunteer - Brenda Stibbons: (01263) 510969/brenstib@yahoo.co.uk

Volunteer - Pat Logan: (01692) 403816

Volunteer – Brenda Shields (01263) 715705/brendashields759@btinternet.com

Volunteer – Paul Ebsworth (01263) 512259/paulebsworth@btinternet.com

Volunteer – Jenny Hull (01263) 761243/jenny4hull@gmail.com

Clarence House care home  - Nicole Tatum or Diana Gardener: (01263) 721490

The local newspaper The Eastern Daily Press who came out and did a story on the Cromer walks – this can be found at http://www.edp24.co.uk/news/health/a_walk_along_the_cromer_seaside_for_dementia_patients_1_4163822

*Dementia Cafes were supported by Alzheimers UK – however the funding has now finished and most of them in Norfolk have been unable to continue offering support to people with dementia.

*Walking for Health is a national programme of walks for people with health issues using trained volunteer walk leaders. Local groups were funded by a combination of Public Health, Lottery programmes and private sponsorship.  This funding has also now ended and where they have capacity the local walks groups are setting themselves up as individual charities. North Norfolk Fit Together CIO and West Norfolk Walking for Health are examples of this.

Demand

What would you anticipate the demand might be for your proposed project at this stage and what are you basing that forecast on?

Answered in Design Phase report

Expansion

Are you planning to expand an already-successful project with a different population or in a different setting? Please describe your reasons for this and what information you used to inform your decision?

Building upon projects that worked with the same audience  / demographic but are adapting the method of how the project is delivered through up-scaling of local workforce to enable them to become physical activity deliverers. Based upon the learnings of the Mobile Me project that told us for successful sustainability of physical activity it is beneficial to work with relevant stakeholders and partners around increasing their knowledge on the health benefits of physical activity to help them meet their outcomes and agendas.

Information capture for your project

Please make a plan and decide what strategies you are going to use and when. As a minimum everyone needs to keep their meeting minutes/notes and attendance details. Other ideas are photos/videos/diaries/attendance numbers/participant feedback/log book. In relation to the SAIL feasibility study you will need to be able to say who attended your project and when also including the participants age and gender if possible.

Continue to keep notes of relevant meetings, sign in sheets and photos will be taken and completed where appropriate. Will work with relevant partners around keeping registers and attendance of physical activity sessions. Age, gender and any other relevant information will be collected as part of the consent form for the evaluation. If people do not consent, this will not be collected. 

Acceptability

How was the project proposal recieved by a) your team members/organisational partners b) your target community/potential participants? Evidence would include: participant observation at initial project meetings, qualitative interviews with participants and project staff or correspondence related to the proposal ie emails exchanges?

A)   Everyone has been supportive

B)   DFW more consultation needed. Well received so far but this is ongoing. Local organisations, due to the nature of the project have been embedded and involved in the design so are on board. Key local community figures such as Mayors, Local Authorities have been aware of the project throughout and are supportive. They have had the opportunity to guide how the project is designed. They have been supportive in terms of how the project meets local issues and priorities. 

Adaptation

Have you made any changes to your original plans, why did you make the change and what information did you base your new plans on?

Based on learnings from Mobile Me, we have decided to take a more strategic cultural change approach with partners than a purely delivery-led pilot project. 

Key stakeholders and relations

Are there key individuals, (including participants) organisations or relationships who are central to your project, and in what way do they benefit your project?

The Current Fit Together Community Walking Groups are integral to our delivery of dementia accessible walks as they already deliver group led walks in the SAIL geographical area. Sheringham Dementia Friendly Community has a lot of experience with people living with dementia and will act as experts when we are designing our pilot. Sport England and the Alzheimer's Society already have a range of activities and expertise for those living with dementia and have agreed to work with us to feed back about our process, method and output.