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Integrated care cuts hospital admissions in Cornwall significantly

Emergency hospital admissions are down by more than a third in Cornwall, driven by an innovative campaign that helps to decrease people’s dependency on health and care services. 

The ‘Living Well’ scheme, developed with Age UK, brings together people working in health, social care, the voluntary sector and the community to support people with two or more long-term conditions, and people receiving social care.

An evaluation of the programme by NHS Kernow revealed that it is supporting 1,572 people in Penwith, Newquay and east Cornwall. Since its inception there has been a 34% reduction in emergency hospital admissions, a 21% fall in emergency department attendances and a 32% decrease in hospital admissions overall. 

The evaluation figures are based on a cohort of 325 people supported by Living Well in Penwith from January 2014 to January 2015. 

Joy Youart, NHS Kernow’s managing director, said: “We are at the start of a journey to transform the way care is coordinated by bringing together health, social care, the voluntary sector and communities. Our vision is for an integrated system that enables people to access seamless care to help them live the lives they want. 

“We are beginning to see improvements across the entire system to support people from being admitted to hospital and, when they do, getting them home as soon as possible, with high levels of care in place to reduce their risk of being readmitted.” 

Age UK is now working with the NHS and several councils to introduce similar programmes to more than 6,000 people across eight other areas: Portsmouth; North Tyneside; Ashford and Canterbury; Sheffield; East Lancashire; Blackburn with Darwen; Guildford and Waverley; and Redbridge, Barking and Havering. 

The Living Well approach identifies what’s important to people through a ‘guided conversation’ with a voluntary sector worker and someone who has become highly dependent on formal care, often combined with social isolation. This leads to small steps that build confidence and social activity, which have a positive effect on the person’s health, independence and wellbeing. 

Pam Creaven, director of services at Age UK, said: “Continuing positive results in reducing hospital admissions prove that pioneering programmes of this nature are vital in tackling the ongoing and spiralling crisis in care. 

“By relying on conventional health and care services we’ve seen time and time again older people are being let down and having to struggle on alone or being admitted to hospital when it could be prevented.” 

 At this year’s Commissioning Show, Tracey Roose, chief executive of Age UK in the region and Living Well programme director for NHS Kernow, and two members of the CCG – Dr Tamsyn Anderson and Dr Colin Philip – spoke about progress. 

The programme is based on a proof-of-concept pilot in Newquay that demonstrated significant improvements to wellbeing, fewer emergency hospital admissions with previously dependent people now offering support to their peers. 

Roose said: “At its heart, it’s an approach about behaviour and social movement and change. We’re working to change the way that we think, we’re working to change the way that we deliver, manage and commission.” 

Community and social care minister Alistair Burt MP added that nationally the £5.3bn Better Care Fund is “getting every local NHS and council working together to prevent people from becoming ill and provide care services seven days a week so we avoid unnecessary stays in hospital”.

(Image: c. Rui Vieira/PA Wire/Press Association Images)


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