What are commissioners looking for?

As a result of analysing local priorities and engaging with commissioners, you might need to make adjustments to the design and delivery of the programme. Commissioners may challenge the approach to service design in relation to universal, targeted and personalised services.

1. Universal services are devised with the intention of being accessible and inclusive to all. Having engaged with commissioners in services such as social care and health, you may be challenged to reflect on whether your offer is universal.
2. Targeted Services focus on particular client groups or on geographical areas. Reading Friends has been designed to offer a more targeted approach in support of those who are socially isolated, lonely or those living with the early stages of dementia and their carers. 
3. Personalisation is a way of working with those in receipt of personal budgets to meet their needs. This approach requires the ability to market the Reading Friends offer to people with personal budgets and can be achieved by:
   • Building relationships with Brokerage teams in adult social care 
   • Building relationships with Support Planners (individuals who work directly with those on personal budgets)
   • Providing taster sessions for those on personal budgets and their carers/supporters

Given the body of experience working with care home providers, you may identify other new opportunities resulting from changes in the way adult social care provision is delivered.  For example, the move away from day centres for older people may have prompted some adult social care services to consider new daytime activities that might appeal to, and support those, who have previously used day centres.

Befriending services are an established part of the support landscape, but reading as a ‘hook’ may not be foremost in the minds of commissioners. Even commissioners who read for leisure, or participate in reading groups might not see the connections between reading and commissioning for better outcomes.

Pressures on budgets might also exacerbate barriers, so it is vital that you communicate the offerwith clarity.

Below are some points to consider:

• Articulate the offer in terms of outcomes and not just activities
• Present the offer in a way that is relevant for each individual commissioner – are they interested in universal services that support older people, targeted groups such as people living with dementia or looking to signpost those with personal budgets to community support services.
• Communicate both the wellbeing benefits and cost benefits

The Reading Agency has developed a Theory of Change model that illustrates a range of outcomes for participants. You can draw on this to help articulate the outcomes for older people and overall project impact.

When setting up a Reading Friends programme, you can draw on evidence of effectiveness from our bank of Reading Friends case studies, research, and evaluations.

For example, we know that:

• 88% of Reading Friends participants agreed or strongly agreed that the programme had increased opportunities for social contact.
• Over 50% of participants were either at medium risk or very high risk of loneliness according to the Age UK loneliness heat map rating methodology.

The test phase also helped people re-engage with reading after experiencing illness or visual impairment, enabled intergenerational activity, and used reading as a tool to open up conversations about mental health and different cultures.

In terms of supporting health issues, the Reading Friends test programme engaged with:

• A high percentage of people self-reporting a physical health issue or disability (53% of survey respondents)
• Those living with dementia (38% of survey respondents)
• Those experiencing hearing or sight loss/deterioration (29% of survey respondents)
• Those experiencing mental health issues (12% of survey respondents)
• Those living with learning difficulties and Down’s Syndrome (7% of survey respondents)

The programme also provided an opportunity to promote discussion around mental health, stress and anxiety, helping to remove the stigma

Commissioners may have their own measurement tools that they are familiar with and use routinely, so it may be necessary to adopt these and integrate into your working practice.

For example, the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is often used to measure wellbeing. It is based around a self-assessment process that comprises of positively phrased statements such as ‘I’ve been feeling optimistic about the future’ and ‘I’ve been interested in new things’.  It’s relatively simple to use and analyse to build your evidence base.

Other measurement tools include the Outcomes Star. This suite of tools measures change in vulnerable individuals and is often used in social care settings. Five Ways to Wellbeing has also informed local authority wellbeing evaluation frameworks: – these key elements are Connect, Be Active, Take Notice, Keep Learning and Give.

Finding out what tools commissioners use is part of the process and will enable you to consider whether it would be appropriate to adopt these measures to demonstrate evidence of impact in your local Reading Friends group.

Commissioners are looking for evidence of impact on outcomes, and evidence of reduced dependency on other services, as well as short and longer term cost benefits. Commissioners will want to know how Reading Friends can improve the health and wellbeing of participants and reduce their need for medication, GP visits and other health services.

The impact that loneliness and social isolation can have on the physical, mental and social health of people is well documented. Compelling research that is worth referring to here is:  

• Lacking social connections is as damaging to health as smoking 15 cigarettes a day^[1].
• Lonely individuals are more likely to visit their GP, use more medication and have a higher incidence of falls[2].
• Lonely individuals are more likely to enter early into residential or nursing care[3].
• The Reading Agency commissioned Demos to conduct research into the impact of reading on loneliness, social mobility, and health and wellbeing. The report can be found here.

Commissioners are tasked with ensuring value for money and are likely to want to compare the proposed befriending activity with alternative interventions. Being clear about the cost of the services you want them to support is vital; this will include having an understanding of unit costs (i.e. the approximate cost for a home visit or an individual to attend a group session)

They are also likely to be interested in the added value of the programme such as human assets (inc. volunteers), other funding and income streams, and partnership relationships which generate added value.

[1] Holt-Lunstad, J. et al. (2015) ‘Loneliness and social isolation as risk factors for mortality: a meta-analytic review’.

[2] Cohen, G.D et al (2006) ‘The impacts of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults’.

[3] Russell, D.W., Cutrona, C.E., de la Mora, A. and Wallace, R.B. (1997) ‘Loneliness and nursing home admission among rural older adults’.

Once you have taken time to understand more about priority local outcomes, you will be ready to listen to the perspectives of commissioners and contribute to discussions about the challenges and opportunities in your local area as a strategic partner.

But beware of ‘rushing’ to be commissioned, present yourself as a creative player and articulate what Reading Friends can offer in a way that will help to address some of the local challenges.