!

"#$%&'()% *)+ *)%,$-%

ln response Lo quesLlons ralsed by PealLhwaLch and oLher feedback


.'/')0 1$22

wbot ls lt oll oboot?
Llvlng Well alms Lo help people who are soclally lsolaLed and hlghly dependenL on healLh and soclal
care servlces Lo lmprove Lhelr quallLy of llfe. lL sLarLs wlLh a conversaLlon Lo undersLand Lhe person's
sLory and whaL wlll make llfe beLLer. lL alms Lo reconnecL people wlLh Lhelr communlLles -
faclllLaLlng change raLher Lhan flxlng problems, bulldlng on Lhe supporL lnfrasLrucLure LhaL's already
Lhere.

aLhflnder, enwlLh loneer, Llvlng Well ln Lhe LasL - Lhese are Lhe LesL beds for wlder
lmplemenLaLlon (lnLegraLed Care CommunlLles) and are all parL of Lhe whole Llvlng Well approach.
1hls ls a parLnershlp beLween Lhe volunLary secLor, healLh, soclal care and local people. All healLh
provlders, Lhe CCC and Lhe Councll are slgned up Lo Llvlng Well.

3*-0$& 4(5(-&
nos tbe otlqlool cobott of potleots wltb two looq-tetm cooJltloos oow cbooqeJ to locloJe ftoll
potleots? uoes tbls locloJe people wltb Jemeotlo? ls tbete o set of ctltetlo?
1he crlLerla are llkely Lo lnclude people who are frall and speclflcally lncludes people wlLh demenLla:
1. A mlnlmum of 2 long Lerm condlLlons from Lhe followlng:
ulabeLes, resplraLory (CCu), hearL fallure, memory loss, demenLla, arklnson's,
PyperLenslon, sLroke, have a hlsLory of falls, osLeoporosls, rlsk of repeaL lnfecLlon (urlnary
1racL lnfecLlon or neumonla)
67
2. A soclal care package ln place where:-
! 1he value ls 30 per week or below
! 1he value ls 200 per week or above
! 1hls lncludes lunchLlme vlslLs
! 1he person has recelved supporL from Lhe Larly lnLervenLlon Servlce 3 Llmes or more
wlLhln Lhe lasL 12 monLhs.
! 1he person has been supporLed Lhrough an urgenL response or emergency duLy 3
Llmes or more wlLhln Lhe lasL 12 monLhs.
#


wbo ls lovolveJ lo lJeotlfyloq potleots to be locloJeJ lo tbe totqet oombet of 1,000?
1hls sLarLs wlLh Lhe C pracLlce revlewlng a llsL of people ldenLlfled uslng a rlsk sLraLlflcaLlon Lool.
Cs, dlsLrlcL nurses, communlLy maLrons, communlLy Lherapy Leams and oLhers also use Lhelr
knowledge of Lhelr own caseloads Lo help ldenLlfy people who are llkely Lo beneflL.

uo bospltols tefet loto tbe ptoject?
1hey can do, and Lhere ls an Age uk Cornwall worker asslgned Lo WesL Cornwall PosplLal Lo supporL
Lhe dlscharge process, whlch wlll resulL ln more people belng ldenLlfled.

Ate yoo op to tbe totqet ot ovetsobsctlbeJ?
CurrenLly Lhere are [usL over 400 people who have had a 'gulded conversaLlon', buL Lhere are many
more people ldenLlfled. 1here ls an amblLlon LhaL Lhls becomes a whole sysLem change, buL enwlLh
ls sLlll a LesL phase and we need Lo focus on provlng LhaL lL dellvers Lhe 1rlple Alms (lmproved healLh
and wellbelng, lmproved experlence of care, reduced cosL of care).

wbot ls o qolJeJ coovetsotloo?
lL ls slmply a conversaLlon gulded by Lhe person abouL whaL's lmporLanL ln Lhelr llfe, wlLh Lhe alm of
ldenLlfylng Lhelr goals and a plan of how Lo achleve Lhem. lL ls noL scrlpLed, buL llkely Lo lnclude
dlscusslon abouL Lhe person's llfesLyle, healLh, famlly and soclal clrcumsLances. 1he volunLeers are
Lralned ln moLlvaLlonal lnLervlewlng Lechnlques as well as promoLlng self-managemenL of Lhe long
Lerm condlLlons we're focuslng on.

wbo cottles oot tbe loltlol potleot ossessmeot?
An Age uk Cornwall worker ls aLLached Lo each pracLlce and has Lhe lnlLlal gulded conversaLlon wlLh
Lhe person. 1here are 9 C pracLlces lnvolved ln Lhe enwlLh loneer. 1he flve co-coordlnaLors are
asslgned Lo speclflc pracLlces and supporLed by a Leam of volunLary workers.

now ote tbe potleots tefetteJ? ls lt stlll esseotlolly Cl tefettol ot bos lt beeo wlJeoeJ to locloJe
potleots tefetteJ ftom ocote ooJ commoolty bospltols, os pott of Jlscbotqe ploooloq?
8eferrals are comlng from a range of healLh and soclal care pracLlLloners aL presenL.

nos tbe etbos cbooqeJ ot beeo expooJeJ sloce tbe Newpooy lotbfloJet?
1here are core 'lngredlenLs' LhaL are common Lo newquay, enwlLh and now Lhe LasL of Lhe counLy,
buL how Lhey are puL LogeLher may dlffer. 1hese are Lhe gulded conversaLlon, shared escalaLlon
Lrlggers, communlLy mapplng and neLworklng, local conversaLlon group, pracLlLloner workshops and
Lhe underplnnlng values and culLure. 1he local communlLy asseLs are a vlLal parL of Lhe approach
and wlll dlffer ln each area, whlch wlll have an lmpacL on Lhe way Lhe programme Lakes shape.

wlll ossets be sboteJ eost ooJ west?
1hls lsn'L abouL lmposlng a pro[ecL onLo a communlLy, buL empowerlng a communlLy Lo connecL
Lhelr exlsLlng asseLs LogeLher and helplng people who have become lsolaLed Lo reconnecL. So lL's
noL abouL sharlng asseLs buL maklng Lhe mosL of whaL ls already ln place - for example ln enwlLh
Lhere are over 600 communlLy groups and acLlvlLles and so far we have made llnks wlLh 40 of Lhem.


$


now mooy potleots ote lo tbe leowltb ptoject oow?
1here are [usL over 400 now, and Lhe cohorL ls growlng by around 130 people each monLh.

Ate oll tbe leowltb Cls slqoeJ op to tbe ptoject, ot ote some sotqetles oot lovolveJ?
All Lhe pracLlces are lnvolved and have ldenLlfled people as parL of Lhe cohorL. 1here are ongolng
dlscusslons wlLh Lhe enwlLh locallLy and lndlvldual pracLlces abouL how Lo embed Lhls ln everyLhlng
LhaL ls done and llnk sLrongly wlLh Lhe locallLy plan.

8(2#)&$$-%
wbot ls tbe totol oombet of volooteets tectolteJ to tbe leowltb lotbfloJet ltoject?
1here are 19 volunLeers recrulLed by Age uk. volunLeer Cornwall provldes supporL ln Lerms of
recrulLmenL, u8S checklng and maklng connecLlons wlLh local volunLary organslaLlons e.g. 8rlLlsh
8ed Cross and enwlLh CommunlLy uevelopmenL 1rusL - so Lhe LoLal number of volunLeers lnvolved
ln Lhls approach ls acLually more Lhan 19.

wbot ls tbe w1 oombet?
1hls ls dlfflculL Lo quanLlfy as volunLeers offer Lhelr Llme alongslde oLher commlLmenLs e.g. carlng
roles. 1he Llme glven would cosL 1.7m aL mlnlmum wage. 1he programme supporL people who
have been hlghly dependenL Lo help Lhemselves, and Lo help oLhers - ln many cases people have
become volunLeers Lhemselves, elLher formally (Lhrough an agency llke Age uk) or lnformally
(offerlng regular supporL Lo someone who needs lL).

wbot lofotmotloo ls qlveo to o poteotlol volooteet?
Many people have shown an lnLeresL and have sLarLed by havlng a conversaLlon wlLh Lhe Leam
leader or a member of sLaff aL Lhe C pracLlce, Lo geL a beLLer feel for Lhe role. 1here ls a formal
recrulLmenL and lnducLlon process managed by volunLeer Cornwall.

uoes tbe volooteetloq tosk voty occotJloq to volooteets wlsbes/copobllltles?
1he lnLervlew process draws ouL Lhe sorLs of skllls LhaL a volunLeer has Lo offer and Lhey can be
maLched Lo a range of opporLunlLles, lncludlng Llvlng Well. lnLeresLlngly, a number of volunLeers ln
newquay have sald LhaL regardless of fuLure fundlng, Lhey wlll carry on, now Lhey know whaL Lo do.

wbo ls ossessloq, sopetvlsloq, soppottloq volooteets ooJ bow Joes tbe sopetvlsloo wotk lo ptoctlce?
Lach volunLeer ls under Lhe supervlslon of Lhe co-ordlnaLor asslgned Lo Lhe C pracLlce. 1here are
volunLeer Leam meeLlngs, plus regular conLacL and feedback.

wbo bocks op tbe volooteets ot weekeoJs/book bollJoys?
AL Lhe momenL, Lhe supporL ls offered Monday Lo lrlday durlng offlce hours. Powever, some
volunLeers glve Lhelr Llme ouLslde of Lhose hours.

Ate tbe volooteets oble to clolm ttovel ooJ otbet teloteJ expeoses?
?es, Lhese expenses are relmbursed.

%


ls tbe olm tbot volooteets sboolJ oct os oo oJjooct to tbe cotteot beoltb/soclol setvlces bot tbeo
eveotoolly toke ovet some of tbe tosks tbot ote cotteotly Jooe by polJ stoff?
no. 1hls ls noL a cheaper verslon of whaL we already have, nor ls lL an add-on servlce Lo refer Lo.
1hls ls a fundamenLal change ln pracLlce by every member of Lhe care Leam, ln whlch Lhe volunLeer
worker ls an equal parLner and each member has skllls and experLlse Lo offer. 1hls lsn'L abouL
shlfLlng [obs from one Leam Lo anoLher buL abouL creaLlng unlque supporL for each lndlvldual, based
on whaL maLLers mosL Lo Lhem.

wbot Jo tbe volooteets octoolly Jo?
1hls depends enLlrely on whaL Lhe person ldenLlfles as Lhe Lhlngs Lhey wanL Lo achleve, Lhe Lhlngs
LhaL maLLer mosL Lo Lhem, Lhrough Lhe gulded conversaLlon. 1o glve an example, ln Lhe words of
one of Lhe volunLeers:

1he co-ordlnaLor lnLroduced me Lo a lady wlLh severely ulceraLed legs who may have had gangrene
- Lhere was a quesLlon abouL wheLher her fooL or Loes should be ampuLaLed. She'd been rushed Lo
hosplLal prevlously. She'd goL ln Lrouble for non-paymenL of councll Lax and her house needed deep
cleanlng. We managed Lo geL her a bank accounL esLabllshed and her bllls are belng pald. She ls
beglnnlng Lo Lake an lnLeresL. She had cancelled 2 operaLlons ln Lhe pasL because she couldn'L flnd
anyone Lo look afLer her caLs. l Look her Lo hosplLal because she was asked Lo be Lhere aL 7.30 ln Lhe
mornlng. l wenL and goL her and Look her ln. lL Look an hour and a half for someone Lo come and
Lalk Lo her. 1hen Lhey wouldn'L do Lhe op because she hadn'L arranged for someone Lo look afLer
her overnlghL, so l Look her home agaln. She's now goL anoLher daLe - Lhls Llme she's agreed Lo
sLay ln overnlghL because we've found a way Lo look afLer her caLs and l've arranged a rellef carer
for my wlfe so LhaL l can Lake her ln agaln. 1he co-ordlnaLor arranged for an advocaLe Lo deal wlLh
her councll Lax - she had had balllffs around several Llmes buL Lhey'd gone agaln because Lhere was
noLhlng Lhere of any value. 1he forms Lo flll ln Lo clalm exempLlon due Lo her depresslon were 42
pages long. 1he form lLself frlghLens her, lL llLerally frlghLens her. Per hands are Lrembllng - LhaL's
why she doesn'L open her posL. She ls now worrled LhaL Lhe C wlll noL slgn Lhe form because Lhe
form says 'severe menLal lmpalrmenL', buL she doesn'L wanL Lo say LhaL she ls severely menLally
lmpalred because she's worrled LhaL Lhey wlll puL her away somewhere. We're Lrylng Lo be Lhe
caLalysL Lo connecL blLs of Lhe sysLem around her, Lo deal wlLh Lhe councll and geL Lhe operaLlon
done. no-one was oLherwlse helplng her ln a way LhaL would help her deal wlLh all Lhose problems,
and she couldn'L deal wlLh Lhem herself."

ls tbe leowltb llooeet tesoltloq lo o teJoctloo lo soclol ooJ/ot beoltbcote lovolvemeot ot ls lt
qeoetotloq mote wotk?
1he flrsL daLa run ls scheduled for early CcLober. We are already seelng a 23 lncrease ln quallLy of
llfe uslng a naLlonally valldaLed Lool (ShorL Warwlckshlre & Ldlnburgh MenLal Wellbelng Scale).

As tbe lotbfloJet/llvloq well ptoject moves loto tbe test of cotowoll, bow mlqbt tbls offect tbe wotk
beloq cottleJ oot lo tbe leowltb oteo?
1he Llvlng Well programme ls now runnlng ln newquay, enwlLh and ls [usL movlng lnLo Lhe LasL.
We would need Lo ldenLlfy fundlng Lo expand lL any furLher. We are ln Lhe mlddle of a deLalled
learnlng exerclse aL Lhe momenL and wlll soon be ln a poslLlon Lo share LhaL.

&


now ls tbe ptoject moooqloq sboteJ cote ploos wltb tebobllltotloo teoms ooJ / ot 51l5 setvlces?
arL of Lhe pro[ecL ls Lhe lmplemenLaLlon of an l1 soluLlon LhaL wlll llnk LogeLher all Lhe dlfferenL
sysLems sLaff use ln Lhelr organslaLlons Lo make sure LhaL fronLllne sLaff have Lhe lnformaLlon Lhey
need Lo supporL people aL Lhe rlghL Llme. 1hls wlll have sLrlcL governance around lL Lo ensure LhaL
only people who need Lo have access Lo Lhe lnformaLlon. 8y deflnlLlon, Lhe people ln Lhe cohorL are
already ln recelpL of nPS care and have care records LhaL Lhe coordlnaLor feeds lnLo. 1he
volunLeer's work ls reporLed back Lo Lhe co-ordlnaLor and logged. Alongslde Lhls, regular
pracLlLloner workshops are helplng local Leams and lndlvlduals Lo undersLand each oLher's' roles
and Lo ldenLlfy beLLer worklng pracLlces.

9/*2#*&'()
wbot meosotes ote beloq oseJ to evoloote tbe ptoject?
1he 1rlple Alms are: lmproved healLh and wellbelng, lmproved experlence of care, and reduced cosL
of care. 1he evaluaLlon framework has been agreed across all parLners and lncludes a quallLy of llfe
Lool, pracLlLloner survey and flnanclal modellng Lo undersLand Lhe cosL lmpacL.

wbo ls lovolveJ lo evolootloq tbe ptoject ooJ wbot loJepeoJeot sctotloy ls lo ploce?
1he followlng bodles are lnvolved ln evaluaLlng and overseelng Llvlng Well:
! ubllc PealLh Cornwall, overseen by ubllc PealLh Lngland
! PealLhwaLch Cornwall
! nPS lmprovlng CuallLy
! 1he nuffleld 1rusL
! Academlc PealLh Sclence neLwork
! unlverslLy of LxeLer
! unlverslLy of lymouLh
! lus lndependenL flnanclal modellng.

ls tbe ptoject bovloq o Jltect effect oo teJocloq emetqeocy ooJ otbet bospltol oJmlssloos fot
leowltb potleots?
1he daLa run we're currenLly dolng looks aL Lrends of admlsslon raLes, before and afLer a person's
lnvolvemenL ln Lhe programme.

ls tbete o coottol qtoop of potleots?
1here ls a 'maLched conLrol' group ldenLlfled Lhrough a geneLlc Lyplng Lechnlque.

ls tbe Newpooy ptoject stlll ooqoloq ooJ bove tbe otlqlool oombet of volooteets beeo molotoloeJ?
?es. 1he orlglnal cohorL was 128 people and Lhe volunLeers are now able Lo supporL more. Around
10 of Lhose orlglnally supporLed have become volunLeers Lhemselves. 1here ls a mlnlmal drop-ouL
raLe among volunLeers - some have dropped ouL ln order Lo go on Lo employmenL. Cornwall has Lhe
hlghesL raLe of volunLeerlng ln Lhe counLy - around 30 of Lhe populaLlon volunLeers compared Lo
22 naLlonally.


'

west cotowoll neoltbwotcb wos oskeJ to be lovolveJ wltb locolly Jeslqoloq o woy of meosotloq
people ooJ cotets expetleoce of tbe leowltb ptoject, bot JeclloeJ to be lovolveJ os we JlJot tblok
we wete tbe opptoptlote boJy. nos tbls beeo tokeo oo by oootbet otqoolsotloo?
1hls has gone Lo PealLhwaLch Cornwall.

ls tbe ptoject eoboocloq tbe exlstloq setvlce to potleots? Ot teplocloq potts of lt?
8oLh - Lhe evldence from newquay demonsLraLed a reducLlon ln acLlvlLy overall across healLh and
soclal care, pracLlLloners are very poslLlve abouL Lhelr ablllLy Lo have a greaLer lmpacL as parL of an
lnLegraLed Leam approach, Lhe people Lhemselves have reporLed slgnlflcanLly lmproved wellbelng.

:#)+')0

wblcb mootb JlJ tbe ptoject stott lo ooJ wbeo Joes lt eoJ?
enwlLh began ln March 2014 and wlll run unLll CcLober 2013. newquay ls ongolng and Lhe LasL
sLarLed Laklng referrals aL Lhe beglnnlng of CcLober 2014.

wbots tbe boJqet?
lundlng has come from Lhe uuchy PealLh charlLy, Age uk reserves and Lhe CablneL Cfflce, wlLh local
healLh and soclal care organslaLlons commlLLlng resources ln Lerms of sLaff Llme. 1he cosL per
person ls approxlmaLely 400.

wbot boppeos lf ooJ wbeo tbe leowltb fooJloq toos oot?
1o be honesL - we don'L know. 1he currenL fundlng ls a 'mlxed bag' and LhaL mlghL be Lhe way Lo
proceed. lL's a chlcken and egg slLuaLlon - we need Lo provlde Lhe evldence LhaL Lhls approach
works on a large scale buL LhaL also needs a commlLmenL Lo fundlng ln Lhe meanLlme.

ls fotote Aqe uk fooJloq JepeoJeot oo o posltlve evolootloo?
?es.

wbot ls tbe cotteot stote of ploy teqotJloq tbe ptlvote sectot (l.e. Jomlcllloty cote ptovlJets)?
1hrough Lhe local auLhorlLy we are worklng wlLh local provlders buL lL ls sLlll early days. Cne of Lhe
learnlng polnLs for us has been LhaL we need Lo sLarL Lhls conversaLlon earller nexL Llme.