Living Well – a medical student’s view

Introduction

‘Living Well’ is a simple yet revolutionary concept which helps vulnerable or socially isolated individuals that our society and health care system otherwise ignores. This project was originally introduced from Newquay and due to its success and influence has now been adopted by the rest of Cornwall including the Penwith region. The Living Well programme intricately co-ordinates areas of the active community, the voluntary sector and most importantly the elderly patient together to help every participant. The goal of the project is to re-humanize community care, prioritize the patients and reduce organisational complexity by utilising our own common sense. The promise doesn’t just arise from its ideology but there is proof within the recent statistics released in July 20151 which states there has been a decrease in hospital admissions by 31.8 per cent, increase in Primary Care activity by 12.8 per cent and a 20 per cent improvement in mental well-being for all participants involved. These statistics have proven that this programme is economically viable and transfers patient contact from strained secondary care to the prepared primary care. This essay is going to look into the organisation of ‘Living Well’ within the Penwith Region using my own personal experiences and reflection to describe the functionality of the project and what positive effects it has on vulnerable individuals and the wider community.

Age UK representatives

Age UK are currently funding full-time representatives that are currently a central extremity to the Living Well programme. Vulnerable patients are referred by primary, secondary or even self-referral as long as they meet the criteria that they can benefit from the service and have two significant co-morbidities such as COPD, dementia or hypertension etc. They are invited to a ‘guided conversation’ which is where it is led by the patient to delve into their lives and to find out what is important to them. This is to uncover any issues or goals they want to overcome then to work with them in formulating a plan to achieve them. This approach is unlike anywhere else in the NHS and as far as I’ve experienced, is the only approach which puts the patient truly first in this way.

A great example of the effectiveness of this approach is through the case-study of Mrs P, who is an 85 year old lady currently living in a residential home. For reasons relating to confidentiality, I have kept her full name out of this essay. She was referred to Age UK by her general practitioner on the grounds of social isolation and depression. Through the guided conversation it appeared that a prominent proportion of her depression stemmed from the fact she could no longer be creative, with a desire to make decorations, which she cannot do due to not having the resources supplied by the residential home. She is and always has been an incredibly energetic and talkative lady who has always been innately creative, but recently this outlet has been repressed. The Age UK representative listened to these issues then together they came to the conclusion that she will provide the materials to create Christmas decorations with her before the Christmas period was due to arrive. A week later we arrived with paper cut-out snowflakes, glue and glitter. As we did her face elated to the idea of creating once again with company, this was the highlight of her week which almost instantly brought her out of what low emotional mood she was previously in and gave her the priceless feeling of appreciation once again. This interaction isn’t just a once off, as the Age UK representative will come again until the responsibility is handed over to one of many volunteers. This type of befriending has been proven to improve health-related quality of life in lonely individuals2.

The use of the voluntary sector

Often the Age UK representatives will refer the patients to one of over 670 community active groups and services that are otherwise un-tapped that can be beneficial to them. A common example often seen can be that an elderly person is feeling lonely, not being able to be connected to what services will help even though there are many coffee mornings, memory cafes, willing volunteers, day-centres and groups that have the organised infrastructure to get them there and socially entertained. This satisfies the wants and needs of the isolated individual and can also improve health outcomes.

Through my shadowing and observing of the Living Well programme I witnessed first-hand the efficacy that can be achieved through the voluntary sector and how easily accessed this resource can be. I participated in events which were organised to allow lonely and vulnerable people the freedom of social interaction once again. Immediately as I stepped into the Penzance Memory Café, where every member was equipped with a hand-made personalised wood crafted name-tag created by one of the attendees, you couldn’t help but feel the warm comfortable feeling of comradery. Everybody there were welcoming and encompassing of each other as they freely played games, joyously sang and joked any stresses they had away whilst reminiscing over favourite memories they had with exceptional clarity. This unifying encounter will fuel each individual for days and leave them with that one thing to look forward to each week that will otherwise keep them active and ultimately healthy. Depending on the needs and wants of the individual there is almost certainly a voluntary group within the large multiplicity out of the Penwith selection that will cater for their needs. Great examples of local groups and projects are the Living Well coffee mornings and the Pengarth Day Centre which gives transport, a healthy meal and entertainment to so many daily that otherwise are unable to access it for themselves.

A well-structured systemic review3 which has taken 30 studies into account with 6,556 participants has looked into different ways in preventing social isolation and loneliness among older people by collating all those studies and extracting common themes. The most effective outcome was for those vulnerable individuals to be allowed regular and organised access to group activities with an educational input, five out of nine people found a significant reduction in their feelings of loneliness. This can also equate to an improvement in health outcomes for the elderly.

Allowing greater information connectivity

Another basic concept and success underlying the effectivity of the Living Well programme was to allow a greater flow of information between all participating bodies with similar intentions for the patient’s well-being. The main one is to allow Age UK representatives, who have a comprehensive understanding of the patient’s background into multidisciplinary team (MDT) meetings within general practices and the geriatric wards of hospitals. This is for a thorough exchange of relevant information to contribute to a more precise and tailored plan of care for the patient or even uncover information that was otherwise unknown and crucial to treatment. There has even been involvement through entities such as the police force whereby Police Community Support Officers have got involved in general practices multidisciplinary team meetings to present what relevant information they have accumulated for a better understanding of the patient and to allow a more unified multidisciplinary approach to their care.

After meeting with PSCO Andy Sells who commented “It works so well, I don’t understand why we haven’t done this any sooner, through sharing information just once a month we can help the most complicated cases and save time.” The community support officer’s involvement with general practices MDT’s is something which has been scrutinised due to the delicate confidential information that both sides possess. Within the current age whereby the presence of litigation is always apparent, this scrutiny is understandable as neither side could be sure as to what they can say and share. On the other side of the argument removing such unnecessary barriers where both sides are supporting the same people and can offer so much to everybody involved, I personally can only view this as a step forward.

To me, one of the most impressive and well-organised MDT groups is one called ‘Bloom’. This weekly group is set out to discuss, assess and formulate a plan to all young adults, kids and the associated carers that have been rejected by the Child and Adolescent Mental Health Service (CAMHS). This is based on the idea that those vulnerable young adults are requiring some form of psychiatric or supportive help that they are otherwise not accessing through the declination of their referral. It is also there to help reassure and encourage the carers and individuals that have been rejected by suggesting to them a plan of care allowing them to feel listened to. I sat in on the meeting and found it inspiring as it was purely voluntary effort from such a width and breadth of healthcare professionals attending. They discussed intricate cases and used their knowledge of the local community to provide effective but not necessarily state or private help. A good example of this was the case of a particularly energetic and aggressive child who was living in a house which was otherwise disruptive and may have contained abuse. So a Thrive assessment was suggested, familial group therapy and a free sports club for him to expend energy at.

A case study which is particularly moving and proves its worth is the case of a 15-year old girl. A referral was rejected by CAMHS which stated that a young girl wasn’t eating solid foods anymore, so Bloom took it up to investigate it further by going to her house to perform an assessment on her and the family to see if there were any undiscovered issues. When talking with the child it became apparent that she clearly had social difficulties as her communication skills such as eye-contact and speech weren’t level with those of her age. Then talking to the mother she stated that due to previous issues of abuse 13 years ago, her child has never been to school nor has she ever had a friend which caused this current social exclusion, there was also suspected domestic abuse within the household. This went through the Bloom MDT and a plan to try and re-socialise her was formulated and to try and slowly extract the truth upon the abuse suspicions.

As another part of this movement to try and allow basic intuition to help dictate relevant information exchange West Cornwall Hospital, the local hospital to Penwith, has also got involved. They have allowed and encouraged a representative from Volunteer Cornwall to be regularly placed within the Medical Admissions Wards to give that extra yard of holistic care by asking that simple and often forgotten question, what do you want? Along with that they are there to give further background at MDT’s, collect referrals for further care under Living Well and to carry out those obvious tasks that are essential for the safe return of a frail elderly patient. This can be as simple as filling up the fridge for their return or even just being that friend that offers that extra bit of re-assurance and encouragement. This positional role is almost directly responsible for the reduced length of stay for hospital admitted patients which is freeing up bed-space which we as a nation so desperately need.

Conclusion

As I was approaching my two weeks shadowing the Penzance arm of Living Well, I held my own apprehensions towards how well it can actually work. The statistics almost seemed too good to be true for something so simplistic. But after seeing it all for myself, putting the patient truly first and allowing them to dictate their wants and needs and having the time and resources to listen is truly something we should all admire and aspire to achieve. The statistics prove that its influence should spread nationally but the re-humanized patient-centred approach is the reason I believe Living Well can truly be greatly beneficial to the NHS.

A medical student

References

  1. Living Well infographic, 29/11/2015, Age UK – Living Well, July 2015
  2. Age UK, evidence review of loneliness and isolation , 29/11/2015
  3. Preventing Social Isolation and Loneliness among older people, M Cattan, M White, J Bond, and A Learmouth, 12005008193, 30/06/2006, Ageing and Society 2005; 25: 41-67.