It's good to talk
Nicky Thomson’s motto is that five conversations a day are as important to your health as five servings of fruit and veg.
Thomson is director of the Good Morning Service — a Glasgow-based charity that provides a free telephone-based befriending and alert service for older people, 365 days a year.
Its average client is female, 81 and lives alone. She is able to get out and about on her own, or with some help, but with advancing age her physical health is, inevitably, deteriorating. While living independently in her own home is important to her, her family may not live nearby and she worries about her safety and how much longer she will be able to manage. And as old friends may have passed away, she sometimes gets lonely.
Those signed up to the Good Morning Service, which also offers evening calls, will receive a phone call at a pre-arranged time. On a typical morning this might involve a blether about the day ahead, or mutual interests. The trained befriender takes an interest in the person and their wellbeing and can provide a friendly ear to listen to any troubles. However, on a more practical level, if repeated calls go unanswered the befriender will liaise with nominated contacts and local services in an attempt to locate the person and verify their safety.
One of the service’s clients had been getting a morning call five days a week for four years when one morning she failed to answer her phone. The service checked that she wasn’t at a doctor or had a hospital appointment before getting in touch with her nominated contact — a neighbour with keys — who agreed to pop round. She was found lying on the kitchen floor, unable to get up and in considerable pain, having tripped and fallen while cleaning her cupboards.
“I’ve always appreciated our conversations, I don’t know where I’d be without my phone calls,” the 70 year old told the service during its recent client evaluation survey.
“But now I appreciate the alarm side — thank you, I can’t be any more grateful. I lay there saying, ‘Don’t panic, they’ll send help.’ And you did.”
The service was originally established in 1999 after a need was identified for a service to support older people who may not have regular social contact, Thomson explains.
“It was an idea formed because an elderly gentleman who lived in Ruchill at the time had passed away and nobody had noticed until the neighbours, sadly, noticed a bad smell and got the police involved. And that is when his body was found lying behind the front door. From that catalyst it was decided that there was a real need to connect with people who don’t connect with others on a daily basis.”
Since its humble beginnings in Milton, the service has now extended across the city of Glasgow and also into South Ayrshire following investment via the Scottish Government’s Reshaping Care for Older People agenda and Change Fund. Last year the service supported 252 older people, placing over 45,000 Good Morning Calls, and it is Thomson’s ambition that every older person in Scotland will one day be offered the service.
She asserts that it is a simple, low-cost and high impact service with proven results. However, while they have been working with the public sector to demonstrate these benefits and persuade them to connect with and support the service, Thomson admits that they have found the NHS to be a particularly “hard nut to crack”.
She recalls attending a recent GP learning event where she spoke to a couple of GPs about the service.
“It was quite telling, actually. Both GPs who I spoke to said, ‘Yes, I’m sure I did get your information pack through the mail and it went straight into the bin.’ I looked at him and said, ‘But we can help you.’”
Last year the alert service identified and got timely help to four members who had fallen at home, one person who had had a stroke and another who was found in crippling pain — all of whom required hospital care. However, Thomson stresses that the service also has a preventative role as befrienders are well placed to monitor ongoing wellbeing and recognise if the person they speak with regularly isn’t coping as well. In such instances, they can refer them to statutory health and social services when they may need further assistance and having spent, in some cases, years establishing a relationship of trust with their clients, Thomson says the befrienders can have more success than most in persuading clients to accept this help. Such early interventions can reduce unplanned emergency admissions and so is a natural fit with the Scottish Government’s Reshaping Care for Older People agenda, she argues, and so she hopes that health professions will, in time, come to see it as complementary rather than as competition.
“I’ve been reading about how support at home is so important for the last few years, thinking, great, and I’ve been waiting on a call. And I still feel that way and I’m still excited about it. But it is just not happening,” she says.
However, as Claire Stevens, national director, Voluntary Health Scotland, acknowledges: “Voluntary organisations providing this kind of preventative and person-centred service within a local community often find it a real challenge to persuade local health services to recognise their value and involve them as a resource.”
She continues: “Too many of our members find their experience at local level is at odds with national messages about the voluntary sector being a key partner in the transformational change of public services. However, we also know that health boards can genuinely struggle to make sense of and engage with the third sector for all sorts of reasons.”
As the national intermediary for the voluntary health sector, VHS is working with partners across the sectors to develop practical ways to improve communication, understanding and meaningful engagement between health boards and the voluntary sector, she says, and adds that there is progress to report.
“We think that our sector should be encouraged by the fact that every health board now has a named lead officer for the third sector and that these leads were all actively involved in the co-production of the Engagement Matrix, the new tool that the Scottish Government is asking each board to use to help improve their engagement with voluntary organisations. Over the coming months we will be supporting boards, voluntary health organisations and third sector interfaces to start to use the tool and we hope to promote and showcase those areas where there is already good practice.”
As one of its members, Stevens feels the Good Morning Service is one such example of good practice that deserves to be shared.
The service hasn’t stood still and Thomson says it has continued to learn and grow. In addition to the telephone befriending service, the Good Morning community now also holds a monthly Good Afternoon get-together where members and staff go and visit places of interest, and its annual AGM and Christmas party is also well-attended.
The events provide a chance to put faces to voices and, given their popularity, Thomson explains that the service decided to experiment with offering a home befriending service as an alternative to the telephone service. However, she says the clients told them they preferred the light-touch service and so they listened and refocused on their core service.
“We asked our clients, would you like us to do this and to a person, they said, ‘No. Thanks. But no. We like the fact that it is a light touch telephone system. I don’t need to clean my house or put on my gladrags to talk to you. And if you come to visit me then I’m going to expect that you are going to be there for at least half an hour, and I won’t want to say thanks very much after ten minutes but really I’m exhausted and want some peace.’
“So I felt very heartened when the results came back saying a home befriending service wasn’t for them. That the telephone befriending service met all their needs,” Thomson says.
Last year the service surveyed its clients to find out what difference the service had made and the result was a resounding vote of confidence. All of the 121 clients surveyed unanimously said that the service reduced their feelings of isolation and loneliness and made them feel safer at home. While 99 per cent said they felt it had boosted their self-confidence and selfesteem, improved their health and wellbeing and made them feel better connected to the community.
Thomson explains that it works because they listen and respond to what their clients tell them. At the service’s base in Glasgow, it is mid-morning and her team are still cheerily making calls. Some might take no longer than ten, fifteen minutes to share a few laughs and update each other on their lives. However, earlier she and one of her team spent just under an hour consoling and counselling a client whose husband has dementia and finally persuading her, after a year of her holding everyone else away, to agree to accept some formal help.
“That is the beauty of our service,” she says.
“Because you are there for them and you know them. So when their husband or they themselves do take ill, you are the trusted person that they speak to.”
On an average day, however, she says they are just there to make them feel better and brighten their day.
“The value of the service is in the friendships that are built — and I deliberately use the word friendships because that is what clients say. We are lucky enough that clients call us their friends and we gladly accept that.”
In their own words: Client feedback
“My life has inevitably slowed down, but Good Morning has helped me feel re-connected to life as it used to be. My children live abroad, old friends are mostly no longer alive and so I find Good Morning has opened up a lovely new world for me.” Dorothy, 87
“It’s like having an extended family. The mornings are the loneliest part of the day, as I am a very early riser so I look forward to that call. Living in my own home means a lot to me and Good Morning helps give me that choice as I know they’re looking out for me.” Annie, 80
“The team have taken the time to get to know me and they’re interested in what’s happening in my life. As they actually ask me my opinion and seek my views. I feel listened to, and also valued.” Catherine, 81.
“My call boosts me up and makes me want to get ready and go out, even if it’s just a wee walk round the shops. I’ve made a lot of new friends to blether to. And it’s a great feeling to go to bed and know if I took ill during the night you are always there to help — it’s security.” Nancy, 76
“It makes you live your life because you are never really on your own. They make me feel like a person — not an old woman. I can discuss things like politics and keep in touch with the world — you just keep me going!” Charlotte, 94