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Who we can help through Connected Communities

Examples of the groups of people we want to support.

The ‘personas’ below represent different groups of people living in Elmbridge. They aren’t real individuals, but they’re based on real information gathered from local residents and partners during our engagement with the community. This includes people who are most likely to need support.

The purpose of using them is to keep people at the heart of any changes being proposed. They help us understand the different needs and experiences of people in Elmbridge, both those already using services and those who might need help but haven’t been reached yet.

Marion (68)

An independent woman living alone on a low income, Marion doesn’t currently use services but worries about rising costs and mobility issues.

About
Marion lives alone in a small rented bungalow in Hersham. She’s a retired school dinner lady, widowed three years ago. She relies solely on her state pension and has minimal savings, so she watches every penny. She stays active by walking and volunteers weekly in a local charity shop but rising costs and reduced mobility are starting to worry her.

Other useful information

  • Less mobile, car reliant
  • Has a basic smart phone, but mainly uses for calls, text and WhatsApp

Key needs and aspirations

  • Stay independent and keep her pride
  • Avoid being a burden to her daughter
  • Access affordable social activities nearby
  • Reassurance that support is there if she ever needs it

Barriers and challenges

  • Limited income restricts transport and social options
  • Feels uncomfortable seeking help — services feel “not for her”
  • Doesn’t know what she’s entitled to

Current support

  • Monthly walking group (free)
  • Attends occasional church coffee mornings
  • Daughter calls daily but lives in another county

"I'm getting by, but there’s not much wiggle room. I’d rather manage myself than ask for help — at least for now.”

How Connected Communities approach can help

  • Gets support early through a relatable community connector, improving mobility and home comfort
  • Builds friendships and routines that help her stay well and independent for longer

Jordan (19)

Jordan is a young man trying to find his way after college, struggling to access work and support.

About
Jordan lives with his mum and younger brother in a small flat in Claygate. They recently moved to the area after his mum left an abusive relationship. He left college last year with a Level 2 qualification in sports coaching but hasn’t been able to find steady work. He’s applied for dozens of jobs but hasn’t had much luck. He sometimes helps at his old youth club, but that’s voluntary. He wants to move forward but doesn’t know how.

Other useful information

  • Less mobile, car reliant
  • Has a basic smart phone, but mainly uses for calls, text and WhatsApp

Key needs and aspirations

  • Support for his mum
  • A paid job that gives him purpose and progression
  • Access to affordable places to train
  • Someone to guide him — a mentor, not a lecturer
  • Help managing money and planning for the future

Barriers and challenges

  • No connections or mentors in professional fields
  • Public transport is too expensive to get to opportunities
  • Feels anxious and stuck, but doesn’t know where to turn
  • Worried about becoming “left behind”

Current support

  • Visits the Xcel Leisure Complex when he can get a lift or can afford the buses
  • Occasionally helps out at his brother’s football training

"Everyone says you need experience to get a job — but how do you get experience if no one gives you a chance?”

How Connected Communities approach can help

  • Engages with a community connector who helps him find local activities, training, and a mentor
  • Gains confidence, skills, and a sense of purpose through consistent local support

David (34)

David lives alone with long-term depression and anxiety, digitally connected but socially isolated and unsure where to turn for support.

About
David lives alone in Weybridge. He recently took long term sick leave from work due to depression and anxiety, which he has been battling since his teens. He owns his own home but is now worried about how he will pay his mortgage and bills. His confidence is at rock bottom, and he rarely leaves the house except for essentials.

Other useful information

  • Owns a car, but doesn’t often go out
  • Confident using the internet and a smartphone
  • Avoids phone calls

Key needs and aspirations

  • Small, manageable steps to rebuild confidence
  • Somewhere safe to go that doesn’t feel like a ‘service’
  • A sense of purpose, even just a weekly routine
  • To feel seen and not judged

Barriers and challenges

  • Struggles with motivation and anxiety in unfamiliar settings
  • Feels embarrassed asking for help
  • Social circle has shrunk over time

Current support

  • GP prescribed medication but little follow-up
  • Occasionally chats to a neighbour
  • Used to go to watch football, but stopped during COVID

"Some days I think about trying something new… but I wouldn't know where to start. And I don’t want to waste anyone’s time.”

How Connected Communities approach can help

  • Start to rebuild confidence through informal activities in safe spaces, without feeling judged
  • Feels better able to deal with his anxiety and depression and to push for better mental health support with the support of a Local Area Coordinator

Amina (45)

Amina is a mother of three, including a son with autism. She finds it difficult to access support that’s clearly explained and easy to engage.

About
Amina lives in Walton with her husband and three children, aged 9, 13, and 17. Her middle child, Yasir, is autistic and struggles with anxiety and sensory processing. Amina moved to the UK from Pakistan 20 years ago and speaks English but still feels more comfortable in her first language. Her husband works long hours as a minicab driver. Amina manages the household and supports all three children, but Yasir’s needs often take priority.

Other useful information

  • Mainly stays local as her husband has the car for work
  • Comfortable using the phone, struggles with written English

Key needs and aspirations

  • Ensure Yasir gets the right support at school
  • Help her other children thrive
  • Access activities that are inclusive, affordable, and welcoming
  • Services that understand both her culture and her son’s needs

Barriers and challenges

  • Feels isolated — doesn’t know many other parents with similar experiences
  • Transport and cost make it hard to access specialist services
  • Some professionals make assumptions based on her ethnicity or language
  • Energy spent navigating SEND

Current support

  • Strong community support from her mosque
  • Keeps in touch with a parent support worker at school
  • Has heard of wider community events but often doesn’t have the time or energy

"’I'm exhausted. Sometimes I just want someone to understand without me having to explain everything again.”

How Connected Communities approach can help

  • Gets support through a trusted local connector who explains things clearly and respects her context
  • Engages with inclusive, nearby activities that benefit the whole family — not just her son

John (52)

John is currently homeless, sleeping on sofas or the streets, doing his best to stay afloat while navigating stigma and fragmented support.

About
John has been without a stable home for over a year following job loss and then a relationship breakdown. He no longer sees his children and has been sofa-surfing with friends when he can, but their kindness is running thin — and some nights he ends up sleeping rough. He has had struggles with drink and drugs in the past and while he tries to stay hopeful, it’s getting harder.

Other useful information

  • Relies on walking
  • Has an old phone, but often out of credit or battery

Key needs and aspirations

  • Be able to see his children again
  • A safe, stable place to stay —somewhere to start rebuilding
  • Support that doesn’t come with judgment or endless paperwork
  • Help finding work, even part-time, to feel useful again
  • Somewhere to shower, eat, and rest without being moved on

Barriers and challenges

  • No fixed address means he struggles to access services or benefits
  • Pride and past experiences make him reluctant to ask for help
  • Constant insecurity makes it hard to plan or follow up
  • Feels invisible and excluded — even when services are technically available

Current support

  • Friends sometimes offer a night on the sofa when they can, but it’s unpredictable
  • Gets food and a shower from a local drop-in centre
  • Sleeps in parks or car parks when there’s no other option

"People see you on the street and they think you’ve given up. But I haven’t. I just need a door that opens.”

How Connected Communities approach can help

  • Receives joined-up support through outreach and partnership between council and voluntary organisations
  • Feels more hopeful for the future

Chloe (26)

Chloe is a care-experienced young single mum doing everything she can for her one-year-old daughter while facing housing insecurity and limited support.

About
Chloe grew up in care. She’s been moving between temporary flats, supported housing, and short private lets. She’s currently living in a private one-bed flat in Molesey which the Council found, with her one-year-old daughter, Lily. It’s cold and noisy, and she worries about their future. Chloe wants to build a better life for Lily, but without family to lean on, she often feels completely alone.

Other useful information

  • Uses buses and walks -  no car; public transport is a stretch financially
  • Has a smartphone, but low data allowance

Key needs and aspirations

  • A safe and stable home for her and Lily
  • Practical, no-judgement support - especially with parenting
  • Free or affordable activities to meet other parents
  • A real chance at building skills or finding work in future

Barriers and challenges

  • No family or informal support network
  • Struggling to find affordable childcare which would allow her to work
  • Distrust of “the system” due to past experiences in care
  • Low confidence and high anxiety in unfamiliar settings

Current support

  • Has a couple of close friends from school
  • Occasionally attends a baby group at the local community centre
  • Has a health visitor who she sometimes finds helpful
  • Tries to avoid services unless absolutely necessary

"I want to do things right for Lily… but sometimes I just don’t know where to start.”

How Connected Communities approach can help

  • Receives practical, non-judgemental help from someone who gets to know her situation and aspirations
  • Connects with other young parents and care experienced peers through local, welcoming hubs

Current clients

Geoff (82)

Geoff is a devoted husband and carer to his wife who has dementia, attending support services but feeling emotionally isolated and unsure how to cope with the future.

About
Geoff lives in Cobham with his wife, Margaret, who has dementia. They’ve been married for over 60 years. Geoff is her main carer, supporting her day and night. He still drives and manages the household, but caring is taking a toll — physically, mentally, and emotionally. They are relatively well off and used to be very active in the local community, but their world has become much smaller.

Other useful information

  • Drives own car - still able to get around independently
  • Comfortable with calls or letters
  • Does not have a smartphone

Key needs and aspirations

  • To keep Margaret safe, comfortable, and ensure she’s treated with dignity
  • Emotional support and respite, without feeling like a failure
  • Better understanding of what’s ahead and what help is available
  • Opportunities for social connection that still feel “normal”

Barriers and challenges

  • Feels reluctant to ask for help —believes others need it more
  • Afraid of Margaret being treated like a “case” rather than a person
  • Social circle has faded as friends also age or pass away
  • Finds navigating fragmented health and social care frustrating

Current support

  • Margaret attends dementia services once a week
  • Chats to other carers at the sessions
  • Has a kind neighbour who checks in every so often
  • Still does the shopping and errands himself

"We’ve always managed ourselves — but now, I don’t know what’s coming next. Some days I just feel lost.”

How Connected Communities approach can help

  • Gains emotional and social support through integrated creative programmes 
  • Feels recognised as a carer and person, not just a helper, through peer connection and accessible activities

Eileen (90)

Eileen lives alone and relies on Meals on Wheels and community transport to stay socially connected, continuing to live independently with the help of familiar routines and relationships.

About
Eileen lives alone in the same home she’s been in for 50 years in Esher. Her husband passed away 12 years ago, and most of her friends have either passed or moved away. Eileen has arthritis and finds cooking and standing for long periods difficult, so she receives Meals on Wheels most weekdays. She uses community transport once or twice a month to visit the Centre, which she enjoys but finds tiring. Her son lives up north and visits when he can.

Other useful information

  • No longer able to drive or use public transport
  • Relies on Community Transport
  • Needs information explained

Key needs and aspirations

  • Stay in her own home for as long as possible
  • Maintain a sense of dignity and independence
  • See familiar faces and stay connected to others
  • Clear, consistent services that don’t keep changing

Barriers and challenges

  • Physical frailty limits what she can do alone
  • Can get confused by letters and forms — needs things explained simply
  • Long gaps between visits can leave her feeling forgotten
  • Worried about losing the little support she has

Current support

  • Speaks to her son everyday on the phone
  • Receives Meals on Wheels 5 days a week
  • Occasional visits from a community volunteer
  • Uses community transport to attend Centre activities twice a month

"It’s nice to see a friendly face with the meals or when I go to the Centre. That makes a difference.”

How Connected Communities approach can help

  • Seeing people more frequently throughout the week
  • Continues to access community spaces, community transport and food delivery (provided in a different way)

 

Read more on how building a connected community can help more people in Elmbridge live well

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