Knitted River
Knitted river stretches all the way to Downing street. An independent Upstream group were proud to part of this "knitition" The knitted river (100,000 squares) stretched 250m and curved accross the Thames to Downing Street. The aim before the G8 summit was to publicise the water shortage in Africa


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What is Upstream ?

Upstream presents an innovative and successful approach to identifying and engaging isolated adults in a rural area through stimulating, creative and social activities. In particular, Upstream helps people to stay independent for longer rather than dependent on traditional day services. The project is underpinned by research and evaluation from the Peninsula Medical School that reports transformational change in mood and behaviour and clinically meaningful changes in mental well-being. Upstream has been identified as an example of good practice by national, regional and local government, by the NHS and Primary Care Trusts, and by a range of national and regional organisations from the voluntary and statutory sectors.


  • To develop a new approach to health and well-being, especially for more vulnerable and isolated people, by encouraging self improvement in health, well-being and quality of life within the context of people’s local communities.
  • To rekindle and bolster people’s passion for living by helping them to engage in stimulating creative, leisure, learning and social activities and to prolong active and independent life.
  • To trial and evaluate the approach, and to disseminate learning so that it becomes embedded in statutory and voluntary sector delivery.


The project is based on an understanding of the national and international context of ageing demographics and increasing costs of health and social care. Several key documents have been driving Public Health in recent years and these have particularly influenced the development of Upstream as well. These include The National Service Framework (NSF) for Older People (1998), The Wanless Reports (2002 and 2004), Choosing Health (2004), Supporting People with Long Term Conditions (2005), Independence, Well-Being and Choice (Green Paper, March 2005), Our Health, Our Choice, Our Say (2006), A Sure Start to Later Life (2006).

Local GPs in Mid Devon recognised that older, more isolated patients were getting caught in a downward spiral of depression and dependency. Substantial health and social care resources were going into supporting a small but significant proportion of people. In many cases, because of isolation, older people were not receiving the attention they needed and deserved. This was particularly evident in a rural area such as Mid Devon with pockets of marked social deprivation and suffering from changes in agricultural practice.

The GPs identified quality of life and social inclusion as two of the key issues to be tackled. Government and local health initiatives on exercise and healthy eating represented only one side of a balanced healthy lifestyle. Mental, creative, stimulating engagement with others was, in the doctors’ view, equally important.

It was recognised that many other schemes around the country were involving people of all ages and circumstances in arts activities of various kinds to improve their quality of life but few were working with health professionals, or had clear aims, or were rigorously evaluating the benefits of their work. If health and social care authorities were to be persuaded of the value of providing stimulating creative and social activities for older people as part of public service provision, they would need clear evidence of the benefits and cost effectiveness of such a service. Upstream set out to provide that evidence.

The project was set up by local GPs and others to respond to this perceived need by many older people for stimulating intervention that would reduce inappropriate dependency on health and social care services, reduce depression, prolong active life, motivate people to improve their own health and well-being, and build self-confidence to enable people to stay in their own homes longer.


What happens

People who are referred, or refer themselves, are visited at home by an Upstream mentor, who explores what kind of activity might interest them and what are the barriers to participation. Many of the participants are in their late 70s to 90s and have multiple physical disabilities and sensory impairments, largely associated with age, as well as high depression indices. Several have mild dementia. Mentors write brief confidential reports on all visits and activities. Mentors organise small, friendly activity groups in local venues or individually for people who are housebound.

A variety of professionals are introduced to encourage meaningful stimulating creative activities. Initially the mentors support people in their activity groups and sometimes prompt the activities themselves. The groups meet weekly or fortnightly and sessions last about two hours during daytime. People pay a nominal fee of £2 per session to cover refreshments. Upstream initiated approximately 15 groups in the first three years.

Activities often start with reminiscence as a trigger to helping the less confident feel that they have something to contribute. Creative activities build on that, with everything from painting and print-making to photography and poetry; from gardening and Tai Chi to music-making and singing; from felt-making and quilting to yoga and gentle movement; from pottery and mosaics to cookery and crafts.

Upstream promotes its activities widely through leaflets, posters, articles in parish newsletters and through regular contact with GP surgeries, health and social care professionals.

Some of Upstream’s most successful projects have involved several groups and individuals at home contributing to a large combined piece of work, such as a quilt or needlework banner, displayed in GP surgeries, hospitals and libraries throughout the area. People enjoy feeling part of something bigger and take great pride and pleasure in seeing the finished piece including their contribution.

Mentors support participants individually and in groups for about three to four months. During this time, people are encouraged to share their skills and experience and to introduce activities of their own choosing. From the beginning it is made clear to all participants that the aim is for them to continue the activities and groups independently after the first few months. Mentors gradually introduce new people to the groups and those who have been there longest begin to take responsibility for organising and encouraging others. There are now five or six groups taking responsibility for their own continued development.

People who are more active are quickly signposted onto existing activities. Others move onto existing community activities after being part of an Upstream group. The mentors play a role in signposting and in liaison with community organisations to encourage the involvement of Upstream ‘graduates’. These people are also monitored on an occasional basis.

The process of engaging people and building their confidence is often slow and needs patience and thoughtfulness. The barriers and inhibitions that people have built up can be strong. But the transformations in attitude can be dramatic and inspiring, especially among those who are often the most disadvantaged from disability or illness.


© 2016 Upstream. Upstream HLC is a registered charity no. 1087185 Company limited by guarantee no. 4114401
T: 01363 778366 E:

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