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Jo Moriarty (KCL) Jill Manthorpe (KCL) Michelle Cornes (KCL) Roger Clough (Independent researcher)

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FROM MARGIN TO MAINSTREAM: CHALLENGES IN CONSIDERING THE VIEWS OF ALL OLDER PEOPLE IN THE EVALUATION OF THE NATIONAL SERVICE FRAMEWORK FOR OLDER PEOPLE IN ENGLAND. Jo Moriarty (KCL) Jill Manthorpe (KCL) Michelle Cornes (KCL) Roger Clough (Independent researcher)

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FROM MARGIN TO MAINSTREAM: CHALLENGES IN CONSIDERING THE VIEWS OF ALL OLDER PEOPLE IN THE EVALUATION OF THE NATIONAL SERVICE FRAMEWORK FOR OLDER PEOPLE IN ENGLAND

Jo Moriarty (KCL)

Jill Manthorpe (KCL)

Michelle Cornes (KCL)

Roger Clough (Independent researcher)

Les Bright (Independent consultant)

Steve Iliffe (UCL)

Older People Researching Social Issues (OPRSI)

outline
Outline
  • Context
  • Methods
    • Challenges in recruiting LGBT participants
  • Results
    • Shared and unique issues
  • Discussion

2

IAGG July 2009

background
Background
  • Healthcare Commission, Commission for Social Care Inspection and Audit Commission undertook joint inspections of services for older people 2005-6
  • Aimed to measure progress in implementing National Service Framework for Older People (NSFOP)
  • Produced report: Living Well in Later Life. A Review of Progress against the National Service Framework for Older People (2006)

3

IAGG July 2009

themes of the review
Themes of the review
  • Tackling ageism and promoting equality
  • Involving older people
  • Designing and delivering services around older people
  • Living well in later life
  • Leading organisations through change

4

IAGG July 2009

role of research team
Role of research team
  • Research team asked to obtain the views of:
    • Older people (defined as those aged 50 and over)
    • Their caregivers
    • Local voluntary and community sector (VCS)
  • Views to be used in informing inspections

5

IAGG July 2009

methods 1
Methods (1)
  • Rapid appraisal approach
    • Listening events
      • Large public events advertised locally
    • Focus groups
      • Shared interest or characteristic
    • Individual interviews
      • Face to face or telephone
    • Postal survey

6

IAGG July 2009

methods 2
Methods (2)
  • Multidisciplinary
  • Older People Researching Social Issues (OPRSI)
    • Collective of older people actively involved in research (Clough et al. 2006)

7

IAGG July 2009

what was new
What was new
  • National Service Framework referred to age discrimination and racial discrimination
    • Silent in relation to sexuality (Clover 2006)
  • Review was first time that English regulatory bodies had made an explicit attempt to tackle a wider span of diversity issues
    • Context of heteronormativity in gerontology (Cronin, 2004)

8

IAGG July 2009

exemplified in
Exemplified in…….
  • Discrimination can have profound and far reaching consequences on the lives of older people. They may experience discrimination and disadvantage for a variety of reasons apart from their age. It may be on grounds of faith or sexual orientation, because they are black or disabled, or combinations of these (Living Well in Later Life, p24)

9

IAGG July 2009

results
Results
  • 1839 people took part in listening events, focus groups or interviews
    • More diverse ethnically
    • Older
  • 4170 people returned questionnaires
    • Less ethnically diverse
    • Younger

10

IAGG July 2009

lgbt participants
LGBT participants
  • Specifically recruited via:
  • Older gay and lesbian group
    • Six individual telephone interviews
  • Specialist centre for LGBT people
    • Two focus groups and one interview (15 participants) and discussion with staff

11

IAGG July 2009

discrimination
Discrimination
  • HIV+ status affecting ability to find NHS dentist
  • [Rights worker] Similarly the guys I’ve spoken to have experienced homophobia in terms of if they’re homosexual they must have AIDS and therefore, you know, skull and crossbones, stay away from me

12

IAGG July 2009

some improvements noted
Some improvements noted
  • Some noted change in attitudes
      • Younger doctors are more understanding
      • My partner’s pre transsexual and my GP is very good
      • My GP came out and visited me ‘as a bereaved person’ and I was treated ‘the same as heterosexuals’
    • But
      • on hospital ward treatment was not good but not because of sexuality – everyone was receiving same poor level of care!

13

IAGG July 2009

intersectionality
Intersectionality
  • Looks at inter relationships of gender, class, race and ethnicity and other social divisions
    • One man described how he was sexually assaulted and robbed of his disability living allowance (DLA) but did not feel he could complain to police
      • People take advantage of you because they know you are on DLA
    • One transgendered person felt being a mental health service user was more stigmatising
      • I have problems with people’s definitions of me but it’s more of a stigma to have mental health problems

14

IAGG July 2009

integrating lgbt issues
Integrating LGBT issues
  • Two examples where ‘blanket’ approaches fail to take account of whether LGBT people have different needs, wants and preferences:
    • Social networks and leisure
    • Caregivers

15

IAGG July 2009

social networks and leisure
Social networks and leisure
  • Increasing recognition of role played by social networks and leisure in maintaining wellbeing
    • Us older ones don’t like going to pubs and clubs and we want something else to do with our (time), you know, we want to socialise in a different way
    • [Our centre] is not so much body conscious – there’s no backstabbing’

16

IAGG July 2009

recognition of caregivers needs
Recognition of caregivers’ needs
  • Rights agenda for caregivers fails to recognise inequalities among different carers (Manthorpe & Price, 2006)
    • Pre civil partnership legislation
      • [I] was told [my partner] needed residential care, but this would have meant having to fund the care by selling our house and home and business because of the lack of clarity around the status of gay and lesbian couples. I wanted her home anyway.

17

IAGG July 2009

discussion 1
Discussion 1
  • Need to recognise that some issues will be common to almost all older people
    • Transport & mobility problems
    • Fear of crime
    • Reliable and accessible services
  • Some issues will be different
    • Role of specialist versus generic provision?

18

IAGG July 2009

discussion 2
Discussion 2
  • Need to acknowledge difficulties in recruitment in research studies
    • Extent to which older LGBT people self-identify or wish to be identified (Langley, 2001)
    • Overcoming mistrust of authorities
      • One man described being sent to a mental health unit before the Sexual Offences Act 1967
      • ‘[Mental health units are] terrible. They drag you in and inject you. Nurses can treat you bad’.

19

IAGG July 2009

discussion 3
Discussion 3
  • Extent to which professional training addresses homophobia & heterosexism and equips professionals with skills and confidence to address them (Hardman, 1997; Langley 2001)
  • Applies to regulators/inspectors
  • And to researchers as well !

20

IAGG July 2009

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