How does change happen?

Earlier this year, academics from the University of Exeter were commissioned by Nesta to undertake a qualitative evaluation of Living Well. Nesta is ‘an innovation charity with a mission to help people and organisations bring great ideas to life’ (nesta.org.uk). The aim was to understand how Living Well has been carried out and embedded in Cornwall, as well as to show how change has been achieved, and determine what can be learnt and improved upon in order to successfully develop the approach in other locations.

Several approaches were used to do this: one-to-one semi structured interviews, small group interviews, personal observations, and participatory tea parties. The data collected was analysed using content and discourse analysis, providing insight into the day-to-day working of Living Well, revealing aspects that were working really well, as well as identifying opportunities for improving and progressing this philosophy of care. These changes and improvements are structured around around three aspects of the delivery of health and social care: referral, relationships, and routine.

Paramount to the success of Living Well is the social capital that has been built. The evaluation showed a significant impact on the elderly people, such as increased levels of confidence, the feeling of having something to look forward to, new friendships being formed, reduced loneliness and, ultimately, integration into the community. The evaluation suggested that this could be done even better by creating clear pathways of progression which are informally recorded, so that the older person is able to reflect on the changes in their life. Volunteers are fundamental to the facilitation of this change, yet can experience similar benefits in that they feel good about what they are doing and feel more connected to their community.

Despite the huge impact that volunteering has had on the older people, the recruitment and retention of volunteers was found to need a bit more thought. There are low levels of recruitment and a high turnover of volunteers, and the impact of this is only accentuated by the tendency of volunteers to work with the same few people, due to bonds and friendships being formed. Furthermore, due to structural issues, volunteers are often doing things for the older people that don’t necessarily fall within their roles. Particularly in Cornwall, transport a massive structural issue, due to isolated villages and poor transport links. If the older people are required to use public transport, the cost may be too high and they may be forced to stay at home by themselves. Volunteers and co-ordinators often end up providing this transport.

Nevertheless, the report suggests several ways to overcome these problems:

  • A change in advertising from the domination of local media adverts (which may be intimidating) to taster days has the potential to increase levels of recruitment. This is also more likely to create a culture of volunteering, as opposed to those that always volunteer carrying out roles again and again.
  • Targeting and enlisting older volunteers, including those who have previously worked in the care sector, is thought to have long-term benefits, due to their diverse set of relevant transferrable skills
  • The need for clearer job descriptions and more specified roles is highlighted. This would create a more efficient team, better equipped to meet the varied needs of the elderly
  • Local community groups are a great resource for Living Well, as they are an existing place for older people to gather and socialise, and can help overcome a lack of volunteers.
  • The evaluation encourages a greater emphasis on skills reviews and training, reflecting the aspirations of the volunteers and those they are helping, as well as meeting the requirements of the 2014 Care Act. Succession planning and peer mentoring would allow skills to be passed on to future volunteers rather than being lost amidst the volunteer turnover.

The co-location of a Living Well co-ordinator within GP surgeries was considered successful, as it made the referral process much smoother. Having a co-ordinator in the surgery makes it really straight-forward for anyone, from GP to receptionist, to raise a concern for an elderly patient. This is most commonly done in monthly ‘multi-disciplinary team’ meetings, although can be flagged up simply in conversation with the co-ordinator. As a result of this, GPs reported a reduced workload and felt that they worried less about being unable to meet the needs of their elderly patients.

However, the report did suggest possible improvements in this area. Interviews showed that GPs and surgery staff don’t always recognise Living Well and the changes it has made, even if they are part of the monthly meetings. With such a wide range of schemes and programmes available, it is easy for Living Well to become overshadowed. One example of this is the GPs common use of the Personal Care Plan, instead. This can be overcome by ensuring that Living Well is branded strongly and effectively to maintain a high profile. Contact lists, opportunities and good news stories that are regularly updated and kept visible to all staff are several ways of ensuring GPs are making use of and referring patients to the service.

To conclude, the report reflects on the key factors of success and barriers to delivery. Changes to the three operational aspects of health and social care delivery – referral, relationships, and routine – are considered the key factors of success. This includes things such as the introduction of the Living Well coordinators, the referral routes within the surgeries, the relationships formed between all the different groups of people involved, the establishment of the philosophy into GPs’ ‘toolboxes’, and the changes to the routines of the elderly people. The key barriers are considered to be the following: insufficient recruitment, lack of involvement with community groups, invisibility of Living Well in everyday practices, and transport.