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Volunteers and social care: A multi-agency approach

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Living Well explains how volunteers work with health practitioners to improve the health and wellbeing of older people in the south-west.

Background

Living Well takes a partnership approach to supporting people over 50 to live life their way. Its driving principle is to develop relationships between people, practitioners and communities.  

The approach of Living Well is simple – it is based on:

  • conversations, not pathways 
  • goals and aspirations, not need
  •  contribution, not dependency. 

A survey by Age UK found 2.9m people aged 65 and over feel they have no one to go to. Of these, 39 per cent said they felt lonely.

Living Well is supporting people to become better connected to communities and is designed to increase levels of physical and social activity to improve mental and physical health and wellbeing.

A Living Well volunteer says, “Living Well spoke to me of a latent energy in the community that I have felt but never seen tapped – a willingness in the community to help people”.

The issues we faced

There were three main challenges:

  1. scepticism about the ability of volunteers to significantly improve the lives of people with complex needs 
  2. ‘project fatigue’ of practitioners who have seen a lot of new ideas fizzle out
  3. the financial context within health and care commissioning that requires in-year financial benefits to be demonstrated.

The first and third challenges were linked and we were obliged to target our project at people with complex needs to address an area of high spending within the system, and demonstrate a return on investment.

The actions we took

We developed criteria to include people with long-term conditions for which evidence showed supported self-management makes a difference.

Volunteers were trained, with input from clinical specialists, to identify ‘red flag’ signs of deterioration and there was a clear escalation and de-escalation process in place.

Trained volunteers had conversations with those most at risk of becoming frail and vulnerable. They worked with the multi-agency team to shape care and to support the needs of the service user.

  • We worked in teams with the voluntary sector, district nurses, general practitioners, community matrons and social workers, to provide wrap-around support targeted at those most at risk of increased dependency and hospitalisation. 
  • We worked with approximately 70 Age UK volunteers, as well as volunteers from other charities, to offer care coordination, confidence building and connections to groups.
  • We held workshops with local people to develop a mutual understanding of what we were trying to achieve and how we might do that together.
  • We started with cohort criteria then used a risk stratification tool, combined with local knowledge about the practice population, to identify people who are at risk of having a crisis.
  • We placed great emphasis on multi-disciplinary teams (MDTs). These are crucial to integrating and coordinating care. This helps everyone, including volunteers, to be clear on their role and responsibilities.
  • We found ways of information sharing so MDT team accessed and updated information. We worked with Skills for Care to share our experience.
  • We held regular discussions with front line staff to agree improved ways of working and change practice.

In Newquay and Penwith we are measuring improvements for people. In the east of the county we are rolling out the programme to a further 1,000 people. We are refining the approach, responding to local characteristics of place and people.

Positive outcomes

We focussed on our three aims:

  1. improved health and wellbeing 
  2. improved experience of care
  3. reductions in the cost of care.

We have developed a financial model that has been referred to by HM Treasury as an example of good practice and we continue to work with the Cabinet Office on the development of social impact investment bonds.

We are most proud of the stories of people whose lives have been improved, as well as the fact that approximately 20 per cent of people we’ve supported have become volunteers. As volunteers working in Newquay put it, “We’re not worried if the funding runs out. We know what to do now”.

We have gathered many stories – from people receiving support, to volunteers and practitioners. Making these stories accessible has helped others to understand what we’re trying to do and to be inspired to get involved. You can see some examples in our Knowledge Bucket and on YouTube.

Negative outcomes

As we have rolled-out from a small-scale pilot in Newquay to larger sites, we have discovered new approaches to suit each location.

  • GP commissioner buy-in. We came to GP commissioner buy-in a little later in the day. Local groups run by GPs are drivers for the Living Well approach and need to be involved from the start. We are finding ways of aligning local priorities with Living Well delivery. 
  • Internal communication. We learned that we need to keep our partner organisations engaged and informed. We need to improve how Living Well is relevant to everyone who works in the health and care sector. 
  • Keeping it together. We have learned that there is a delicate balance between keeping the approach flexible and making sure it is sufficiently robust to hold the various threads together and provide assurances we are achieving our aims. For a whole system approach, there must be a mandate to act and permission to test.

Lessons learnt

We have found there has been:

  • increased self-disclosure of mental wellbeing
  • a reduction in hospital admissions
  • increased numbers of participants who went on to become volunteers.

A full report is expected shortly.The programme is to be evaluated by the University of Exeter, Public Health England, Public Health Cornwall, the Academic Health Science Network and The Nuffield Trust. 

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Page last edited Sep 08, 2015

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