Impact case study database

Collaborative research at the University of Hertfordshire and University of Exeter has played a pivotal role in bringing dementia to the attention of the national agencies, membership bodies and businesses that make up the visitor economy in the UK. Page and Connell have worked with tourism and heritage organisations and charities to translate their findings into new guidelines and practical resources. These have raised awareness across the industry of the needs of people with dementia and equipped businesses and destinations with the tools they need to become dementia friendly.

Changing industry practice through new dementia-friendly guidelines and resources

Page and Connell produced a summary report of the research in 3.1, titled Making the UK visitor economy more dementia-friendly: Lessons from the visitor attraction sector. This was used to engage a broad range of stakeholders within the visitor economy, from national agencies such as VisitEngland and VisitScotland and membership bodies including the National Trust and the Association of Scottish Visitor Attractions (ASVA), to businesses like Merlin Entertainments and government departments including the Department for Digital, Culture, Media and Sport. The report was also presented at a meeting of the Prime Minister’s Dementia Air Transport Task and Finish Group in December 2017; the group’s remit is to improve flight experiences for people with dementia and their carers [ 5.1]. This led to the Head of Innovation & Regulatory Compliance (a member of the PM’s air transport group) at OmniServ Ltd, a large airport services provider, sharing the report with colleagues and citing the recommendations during a panel discussion at the Passenger Terminal Expo and Conference (Stockholm) in March 2018 [ 5.1].

This strategic plan of engagement resulted in Page and Connell being invited to join the Dementia-Friendly Heritage Network, led by Historic Royal Palaces (HRP), and to co-author, based on their research in 3.1, new guidelines for the heritage sector (see next sub section for details). This productive partnership led to a further collaboration in 2019 with VisitEngland, VisitScotland, Alzheimer’s Society and the National Trust to develop a guide for tourism businesses on behalf of England’s Inclusive Tourism Action Group (EITAG), a policy-focused working group representing the national tourism sector. Together with these organisations, and based on their research in 3.1- 3.3, Page and Connell were invited to co-author Dementia-Friendly Tourism: A Practical Guide for Businesses [ 5.2]. The Guide was launched in October 2019 and published, in the first instance, on the VisitBritain, VisitEngland, VisitScotland, EITAG and Alzheimer’s Society websites; it forms part of VisitEngland/VisitBritain’s official inclusivity policy [ 5.3]. As an indication of the significance that VisitEngland attached to the Guide, the organisation’s head of business support said the practical resources would both improve the lives of people living with dementia and unlock additional economic benefits from tourism [ 5.4]. Alzheimer’s Society said the Guide was ‘ raising awareness of what’s possible when the right support and adjustments are put in place, so people with dementia can still get out and enjoy life while creating memories with loved ones’ [ 5.4].

Dementia-Friendly Tourism: A Practical Guide for Businesses was covered widely in the UK media, resulting in the Guide being picked up overseas (e.g. China’s Xinhua news agency) and published online (e.g. websites in Australia) in order to share best practice [ 5.3]. Within three months of its online launch, 31 organisations had adopted it within their own work or disseminated it to a wider global audience [ 5.3]. It was published by several regional DMOs, for example Welcome to Yorkshire, Northumberland Tourism and Fife Tourism Partnership; accessibility advocacy organisations like Tourism for All, the European Network for Accessible Tourism and IDEAS (national organisation in Australia); and dementia support organisations, for example the practitioner-facing Australian Journal of Dementia Care [ 5.3]. In November 2019, the Scottish trade body ASVA shared the Dementia-Friendly Tourism guide with its 500-plus member venues [ 5.5]. In early March 2020, ASVA commenced a tracking study to evaluate how businesses had responded to the Guide and the nature and extent of their plans for implementing dementia-friendly initiatives in 2020 [ 5.5]. This evaluation exercise was suspended in March 2020 due to Covid-19 but ASVA reports that they had anticipated a greater uptake of ‘Dementia Friends’ training at attractions and medium-term plans for achieving dementia-friendly status as a result of the availability of the Guide [ 5.5].

In March 2019, Page and Connell were invited to contribute to a dementia awareness training event run by Dartmoor National Park (7.8m day visits annually) for their visitor services staff [ 5.6]. Delegates were asked to complete a short questionnaire following the training. From 10 respondents, seven said they were likely to make changes to accommodate people with dementia as a result. Page and Connell produced a research-based summary report titled ‘Issues for Staff’ to support the longer-term training of Dartmoor visitor centre staff [ 5.6]. This staff training summary was also disseminated by ASVA to their 500-plus members.

Changing policy and practice for dementia readiness in the heritage sector

Page and Connell were invited by Historic Royal Palaces (HRP) and Alzheimer’s Society to co-author (with three others) a 60-page, dementia-friendly guide for heritage managers: Rethinking Heritage: A guide to help make your site more dementia-friendly [ 5.7, 5.8]. The invitation was made on the strength of the research [ 3.1] and the recommendation of Alzheimer’s Society [ 5.9]. Their remit was to increase understanding of the issues experienced by people with dementia when visiting a heritage site and to offer insights into practical, affordable solutions, for example changes to signage and way finding, and training for staff and managers. At the launch of the Guide at Hampton Court Palace in November 2017, Alzheimer’s Society used it to highlight the importance of the need to ensure that heritage sites are welcoming spaces for people with dementia: ‘ Visiting a heritage site can promote activity and stimulation of the mind, improving physical and mental health by keeping active. The importance of such venues increases as we get older, as a place to relax, recover and engage through multi-sensory stimulation of the space around us [ 5.10].’ HRP disseminated 610 hard copies of the Guide across the heritage sector; 275 downloads of the PDF report from the HRP website and 200 downloads from the Alzheimer’s Society website were recorded within three months [ 5.11]. The Guide was also published online by the Collections Trust, an organisation that develops standards and resources used around the world to make museum collections more accessible.

Page and Connell undertook a formal evaluation of the impact on practice of Rethinking Heritage (completed February 2019) [ 5.11]. This was based on a short survey and in-depth interviews with users of the Guide and produced as a 50-page evaluation for the HRP Dementia Network. The evaluation demonstrated the following impact outcomes. The Guide further increased awareness of those respondents who were already ‘very aware’ and ‘somewhat aware’ of dementia-friendly practices. Those who were ‘somewhat unaware’ and ‘not at all aware’ before reading the Guide mostly became ‘much more aware’ [ 5.11, pp10-12]. One user summed up the value of the resource to practice: ‘ The Guide is user-friendly, as it is a mix of good practice examples, case studies and examples for simple changes that can make a significant difference to visitors [ 5.11, p31].’ Another user reported: ‘ In my XXXX role, I have shared the Guide with XXXXX as a training resource and highlighted the resource to [other] heritage stakeholders [ 5.11, p33].’ The Guide helped enhance the visitor experience at one heritage site: ‘ Being able to identify/recognize signs of dementia or Alzheimer's can help visitor-facing staff and volunteers to deal with situations accordingly [ 5.11, p39].’

Users were able to evidence changes and adaptations to their existing practices as a result of increased awareness after engaging with the Guide. For attractions seeking to become dementia-friendly, it helped them build the case for dementia work and links to resources both internally and externally [ 5.11, p24]. A wide range of new activities undertaken after reading the Guide illustrated the ‘ sector [was] ahead of the game’ [ 5.11, p47] in addressing the issue of dementia compared to other areas of the visitor economy. End-users were ‘ able to evidence changes and adaptations to their existing practices as a result of increased awareness after reading the Guide’ [ 5.11, p3]. The following excerpts from interviews with heritage organisations demonstrate the usefulness of the Guide as a reflective tool and working document [ 5.11]:

‘A good advocacy tool’ [p3]; ‘ Flexible high-quality resource but not an end in itself. I think it is part of a process of how we think about choices and opportunities in terms of a broader equalities agenda’ [p24]; ‘ Case studies were really, really useful because they give practical advice and also advice on how to get the rest of your organisation on board with the new initiative’ [p24]; ‘ there’s reference to the dementia pound and the idea of the business case and I think that’s really useful…[a]…business case for thinking about inclusion’ [p24]; ‘ I think just on a really simple fundamental level it’s positive, it’s creative, it’s the art of the possible which, you know, is what the heritage sector needs’ [p24].

The Guide’s recommendations for how to overcome obstacles to implementing new practices was considered a strength. For example, the Guide is used by the Visitor Learning team at Kew Gardens when writing briefings for Dementia Friendly events; copies of the Guide have been made available at both the volunteer resource room reference library and volunteer tour guides lending library [ 5.12]. Kew advocates use of the Guide to colleagues and industry partners [ 5.12]. The Guide was launched at Beamish, The Living Museum of the North in December 2017 and has since influenced a major dementia-friendly redesign programme at the open-air museum, which is considered a beacon of best practice in the heritage sector [ 5.11, p35].

Rethinking Heritage is referenced and specifically endorsed as best practice in the Guidance for Inclusion section of the Heritage Lottery Fund (HLF) funding framework (January 2019), which sets out funding criteria for organisations applying for grants [ 5.13].

In October 2019, the National Trust announced a major new three-year policy initiative in partnership with Alzheimer’s Society: Working together for a dementia-friendly future [ 5.14]. The National Trust receives 26 million visits a year and estimates 7% (around 150,000) of its members may be living with dementia. It aims to make its 500 properties dementia-friendly and train 74,000 staff and volunteers [ 5.14]. Alzheimer’s Society confirmed that Page’s research had shaped thinking around the launch of the new initiative [ 5.9]. The National Trust policy announcement directly cited Page’s research that was included in the Rethinking Heritage guide. It read [ 5.14]: ‘ Research from Alzheimer’s Society shows that day trips are one of the most likely and regular activities for people living with the condition and their carers [taken from 5.7, p.21], and ‘ In comparison to other visitor attractions, people living with dementia also view heritage sites as ‘safe’ and familiar spaces’ [taken from 5.7, p.20].