Upstream's mission is to rekindle and bolster people's passion for living, by helping them to engage in stimulating creative, leisure, learning and social activities, thereby promoting their own health and well-being and that of their communities. The Upstream concept arose from the need perceived by a small group of doctors working in General Practice, together with colleagues working in the arts and education. The project won the support of the National Lottery New Opportunities Fund in a substantial five-year programme for a Healthy Living Centre 'without walls'. Upstream also has the support of key strategic partners, including the Mid Devon Primary Care Trust, Devon County Council, Social Services, Adult and Continuing Learning, Mid Devon District Council, Arts Council South West, voluntary organisations, and many others.

A rigorous research programme runs alongside the provision of stimulating activities for older people. Research, monitoring and evaluation are fundamental to the project, in order to achieve long-term sustainability. With the help of Mid-Devon Research Group, the Public Health Department of Mid Devon Primary Care Trust, and Exeter University School of Education, Upstream will closely monitor and evaluate the process of intervention and its impact on participants and communities, to prove the effectiveness of the service and the cost-efficient benefits of early intervention.

This will be an 'action research' model, looking at the barriers to uptake and sustainability, what participants respond to best, how to improve the experience, and how investment 'upstream', at an early stage, stimulates health and well-being and prevents premature decline. The evidence will be a powerful tool in determining future service delivery strategies. In addition, the process itself will be carefully recorded in a manual to guide other areas of the country that might wish to follow suit without having to 'reinvent the wheel'.

Participants will be identified with the help of local GP practices and Primary Health Care Teams, through social and volunteer networks and through family and self-referral. Upstream mentors will help participants choose and attend creative, leisure, learning and social activities in which they would like to become involved. These activities will be individually tailored and provided with the help of local tutors, artists and existing community groups. About 25% of activities will be delivered in people's homes; other activities will be delivered in small groups in local venues.

The emphasis throughout is on activities that will stimulate the mind and engage the interest of participants not only during the activity but also between sessions. The project is concerned with restoring self-confidence and a feeling of self-worth. Social engagement is important to reinforce these feelings and to create sustainable activity.

Upstream will provide regular sessions for approximately three months. During that time, mentors will explore ways to ensure that the activities are sustained beyond the period of Upstream intervention. Local communities will be encouraged to take responsibility for long-term inclusion of more isolated members and those most at risk of becoming forgotten or dependent on statutory services.

The Upstream vision encompasses the well-being of communities as well as individuals. Increasingly, experience suggests that, to achieve its objectives, Upstream's fundamental concern must be the well-being of the community, with particular emphasis on the inclusion of those 'at risk', so that it has an interest in the community as a whole and all the components that make up its statutory, voluntary and social structure, including education, health and the arts. Upstream is concerned with the 'culture' of the community, the networks and activities that bind the community together and inspire a sense of community responsibility. An important measure of the well-being of any community is the health and well-being of its weakest members.

Social inclusion, an ageing population, increasing dependence on statutory services, the rising cost of health and social services, holistic response to health and well-being, greater emphasis on prevention, integration of service delivery - all these concerns rank high in the priorities of Upstream's strategic partners. To be sure that resources are well-directed and effective, statutory and voluntary agencies must do more than repeatedly rescue individuals and communities whenever they fall into the swift current of disadvantage.

Agencies must tackle the problem 'upstream', at source. By making the connection between the health of a community and its culture, Upstream has a part to play in focusing attention on the key to that transformation.

Contact:
Simon Goodenough, Upstream,
Tel: 01363 777575
e-mail: simon@goodenough.co.uk