Innovation: Living Well (Cornwall)

United Kingdom

AAI Domains:

• Independent, healthy and secure living (improving access to health and care services, financial security, independent living, mental well-being)

• Participation in society (voluntary activity, social connectedness)

Cornwall is one of the most deprived counties in the United Kingdom with an ageing population and facing greater demands on health and social care services due to the increasing number of people with long-term conditions. People with long-term conditions such as type 2 diabetes, chronic obstructive pulmonary disease or heart failure are frequent users of high cost hospital services that may treat their medical needs but not address the wider social causes for their illness.

Living Well is an integrated health and social care innovation that is a partnership between the local National Health Service, municipality and Age UK, the largest national voluntary organisation for older people, that has been operating since 2014. It targets people with two long-term conditions, who are usually but far from exclusively people over the age of 50 years, through referrals from general practitioners and hospital services.

People are invited to have a ‘guided conversation’ with one of twelve Age UK co-ordinators that cover the three pilot areas of Newquay, Penwith and east Cornwall. The ‘guided conversation’ covers what is happening in the patient’s life, what is important to them and how they can make lifestyle changes that will help them to more effectively self-manage their condition. They can then receive support from a local volunteer in the community or when they engage with health care services.

The three aims of Living Well are to improve the health and well-being of people with long-term conditions, to improve the experience of care service and to reduce the cost of care by preventing emergency hospital admissions. More than 800 patients with long-term conditions have engaged with the Living Well programme and compared to a matched cohort of patients there has been a reduction in emergency hospital admissions of 34 per cent and a 21 per cent reduction in emergency department attendances.

More than 60 volunteers have been recruited to support people with long-term conditions and a community mapping exercise has been undertaken to identify the opportunities that people have to build stronger social connections in the community. The mental well-being of patients who have engaged with Living Well has improved by 20 per cent according to the validated Short Warwick and Edinburgh Well being Scale. The innovation is being evaluated by a range of partners including Age UK and local universities as well as health and social care organisations to assess its impact on patients and the cost of care.

Patients who engage with Living Well cost approximately £400 per case and the estimated return on this investment is three times that amount due to the reduction in emergency hospital attendances and admissions. This is a pilot project that is being funded from the pooling of public budgets, the Duchy of Cornwall Health Charity and Age UK with a view to learning from this experience to roll it out in other areas where integrated health and social care would benefit patients and lower costs by preventing frequent emergency use of health care services.

There are multiple active ageing domains that the Living Well initiative is likely to influence and improve. These include improving access to health and care services that will enable people with long-term conditions to live independently in their own home while receiving a modest level of social support from volunteers. It is worthwhile noting that around 20% of patients who are being supported by Living Well go on to become volunteers themselves and provide guidance and support to people in a similar situation.

There is evidence of improvements in mental well-being and the community mapping exercise is building strong social connections in communities that is likely to reduce social isolation and loneliness and thus improve health and well-being.