Dr Ben Spencer

Integrated Care Systems (ICS) in England are partnerships between different health and social care organisations, to co-ordinate care and therefore provide more effective health and social care provision. The objective of this article is to explore the role of the ‘Voluntary, Community and Social Enterprise’ (VCSE) sector in integrated care systems. In particular, the paper aims to examine recent experiences of the voluntary sector in responding to the Covid-19 pandemic, and the lessons that can be learnt for integrated care provision.

The article focuses on the case of Oxfordshire (UK), using a mixed methods approach that included a series of semi-structured interviews with key informants in health and the VCSE as well as online surveys of GPs and organisations in the VCSE. These were complemented by two contrasting geographical case studies of community responses to Covid-19 (one urban, one rural). Data were collected between April and June 2021. Interviewees were recruited through professional and community networks and snowball sampling, with a total of 30 semi-structured interviews being completed. Survey participants were recruited through sector-specific networks and the research arm of doctors.net.uk, with a total of 57 survey respondents in all.

The research demonstrated the critical role of social prescribing link workers and community development workers in forging connections between the health sector and the VCSE at the hyper-local level, particularly in the urban case study. In the rural case study, the potential role of the Parish Council in bringing the two sectors together was highlighted, to support community health and wellbeing through stronger integrated working between the two sectors. The article concludes that enhanced connections between health and the VCSE will strengthen the outcomes of Integrated Care Systems.

This paper draws on data from a large UK study that aimed to understand cycling among the older population and how this affected independence, health and wellbeing. Part of the study involved an ‘e-bike trial’ where participants aged 50 and over, who were returning to cycling after a hiatus, were loaned an e-bike for an eight-week trial period. Pre-trial and post-trial cognitive tests of trial participants, reported previously Leyland et al. (2019), demonstrated how e-bikes, provide positive benefits to cognitive function and wellbeing. The paper builds on these findings, drawing specifically on the qualitative component, predominantly biographical interviews, written and visual material provided in rider diaries and a focus group discussion, to understand the reasons for this positive impact.

The findings demonstrate how power assistance can provide riders with the opportunity to extend the distance and types of area they are willing to cycle from their homes (their ‘ranging behaviour’) and how this can promote health and wellbeing. Our evidence suggests that e-bikes have the potential to support cycling for leisure as well as everyday travel and that consideration should be given to the positive effects of e-cycling on mental wellbeing in addition to physical activity. This is particularly pertinent in the context of an ageing society, the push towards zero-emission cities and the need to ensure socially inclusive mobility, particularly in the context of the Covid-19 global pandemic.

This paper explores the potential of ‘Co-Creation’ to develop new understandings of neighbourhood disadvantage in collaboration with civil society partners. It argues that there is a growing need for collaborative knowledge production with communities carrying vernacular knowledges previously invalidated by dominant epistemologies. The first part of the paper undertakes a reconceptualization of ‘co-creation’, a term usually associated with citizen involvement in neoliberal contexts, redeveloping it as a ‘critical artistic practice’ (Chantal Mouffe, 2013) in which new ways of imagining the city can be articulated. The second part of the paper examines the practice of Co-Creation as a participatory methodology involving artists, researchers and stakeholders in developing ‘agonistic spaces’ by scrutinizing a five-day workshop conducted in the Rio de Janeiro favela of Santa Marta to explore multiple understandings and meanings of this neighbourhood. Through an analysis of creative workshop activities such as photovoice and mapping exercises, the authors explore the potential of the Co-Creation approach to construct new subjectivities that can help subvert existing configurations of power. The conclusion formulates some recommendations about future strategies to maximise Co-Creation’s potential to engage communities in collaborative knowledge production about their neighbourhoods and bring about positive change. 

It has been demonstrated that, on their own, both exercise and stimulation from the environment can improve cognitive function and well-being in older adults. The combined effect of exercising in the outdoor environment on psychological function is less well studied. The aim of the current study was to investigate the effect of an outdoor cycling intervention on cognitive function and mental health and well-being in older adults. A total of 100 older adults took part in the study (aged 50–83), 26 of which were non-cycling controls, 36 were conventional pedal cyclists and 38 were participants using an e-bike (a bike fitted with an electric motor to provide assistance with pedaling), as part of a larger project (www.cycleboom.org). Participants took part in the study for an eight-week period, with cycling participants required to cycle at least three times a week for thirty minutes in duration for each cycle ride. Cognitive function and well-being were measured before and after the intervention period. For executive function, namely inhibition (the Stroop task) and updating (Letter Updating Task), both cycling groups improved in accuracy after the intervention compared to non-cycling control participants. E-bike participants also improved in processing speed (reaction times in go trials of the Stop-It task) after the intervention compared to non-cycling control participants. Finally, e-bike participants improved in their mental health score after the intervention compared to non-cycling controls as measured by the SF-36. This suggests that there may be an impact of exercising in the environment on executive function and mental health. Importantly, we showed a similar (sometimes larger) effect for the e-bike group compared to the pedal cyclists. This suggests that it is not just the physical activity component of cycling that is having an influence. Both pedal cycles and e-bikes can enable increased physical activity and engagement with the outdoor environment with e-bikes potentially providing greater benefits.

This paper explores how people aged 50 and over, who were returning to cycling as part of an eight-week health and wellbeing trial, created their own cycling microadventures. Applying a stage model of the process of adventure to qualitative data generated from personal diaries and focus groups, we examine how older people anticipated and prepared for their microadventures, the challenges and discoveries they experienced, the benefits they gained and how electrically assisted ‘e-bikes’ can provide further opportunities for adventure. We conclude that cycles are a mode uniquely placed to facilitate microadventures and that e-bikes, in particular, offer further potential to enable older people to (re-) connect with place and other people. But, while this type of activity can provide benefits in terms of health and wellbeing, we argue that more supportive physical and social infrastructure is required to provide opportunities for more people to undertake microadventures close to their homes.