Age UK
Cheshire East
Improving later life for the people of Cheshire East
Cheshire East
Wellbeing Coordinators
Dominic Anderson
Deputy Chief Executive
Age UK Cheshire East
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Local charity providing services around health and
wellbeing, knowledge and practical support
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Work with people aged 50+
Won the IMPACT Award from King’s Fund in 2012
Objective to develop the role of the voluntary and
community sector in implementation of Caring Together
Cheshire East
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Cheshire East has the fastest growing ageing population
in the North West - by 2033 more than 45% of the
population will be over 50 years of age. *
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Life expectancy for males and females in Cheshire East
is the highest in the North West and higher than the
England average.*
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The number of people over 65 classified as being obese
in Cheshire East is set to rise from 18,300 in 2010 to
26,900 in 2030.*
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The number of people aged over 50 with dementia living
in Cheshire East is set to almost double by 2030, from
5,300 in 2009 to 9,100 in 2030.*
* Ageing Well in Cheshire East Programme; A plan for people aged 50 and over 2012-17 (CECPCT2012)
‘Ageing Well in Cheshire East’
The Ageing Well Programme aims to ensure that services
are planned in such away that they will continue to meet
the needs of the population. Priorities include :
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making Cheshire East a place where, independence ,
wellbeing and participation of older people is supported
and developed, *
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expanding the range of low-level prevention and early
intervention services through partnerships with third
sector organisations, (including volunteer and befriending
services), *
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improving links between health and social care integrated
teams, GPs and hospital services - integrating services
and to coordinate better care. *
* Ageing Well in Cheshire East Programme; A plan for people aged 50 and over 2012-17 (CECPCT2012)
Wellbeing Coordinators
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Background to development with East Cheshire NHS Trust
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Role redesign project with Skills for Health
Funding
5 Wellbeing Coordinators based with Caring Together
Integrated Neighbourhood teams
Wellbeing Coordinators
A partnership between Age UK Cheshire East, East
Cheshire NHS Trust, Eastern Cheshire, South & Vale Royal
CCGs has developed the role of the Wellbeing
Coordinators, in response to a number of priorities:
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to complement the Community Nursing Workforce Review
and to develop a more prevention-oriented service
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to create a focus for health improvement within the newly
established integrated neighbourhood teams
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to create pathways into voluntary and community sector
services and support
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to enable people with long-term conditions to access brief
interventions to support them to manage those conditions
and reduce their reliance on health and social care
services in the future
Wellbeing Coordinators
The role of the Wellbeing Coordinator:
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to support self-care for people with long term conditions
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assessment and review of individual needs
build personal resilience in self managing their health and
wellbeing
development of individual wellbeing plans
motivating behavioural change
Wellbeing Coordinators
Wellbeing Coordinators
Evaluation – establishing a baseline
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Wellbeing parameters – this captures a range of health
related data such as; weight, BMI, blood pressure,
cholesterol, whether the client has diabetes, smokes,
drinks alcohol, eats fruit and vegetables, has any allergies
and medicine adherence.
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Wellbeing measures – this short questionnaire captures
information relating to the client’s feelings and thoughts,
their satisfaction and happiness with their life currently as
well as a question relating to social trust
Wellbeing Coordinators
Evaluation – additional measures
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Reduction in GP visits for emotional issues
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Improvements in LTC parameters including things like
reduction in BMI, reduction in insulin dependence etc.
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Reduction in unplanned hospital admissions
Improvement in measures of wellbeing using patient
questionnaires
More effective discharge/reducing re-admissions
Successes
 The increasing development of local service
integration
 WBCs seen as ‘equal partners’ – input and work
is valued and respected
 Numerous client achievements to date
 Flexibility to manage change
 Transferable role template
 Additional funding secured through Big Lottery
Challenges
 Organisational change (community nursing
review)
 Different levels of engagement
 Information Governance
 IT – access/non-compatible systems
 ‘Short term-ism’
Hints and Tips in Role
Design
 Learn from other projects
 Take risks/action
 Review and make changes
 Communication is key
 It can be slow – a step at a time
 Focus on the outcomes
Case Study
 Mr P, 80 year old gentleman who lives alone.
 Long-term conditions - heart failure and
osteoarthritis.
 Referred from Community Heart Failure Nurse as
he showed an interest in losing weight, but was
finding it difficult due to his long term conditions.
He did, however, understand that losing weight
would greatly improve his symptoms.
Case Study
 On the initial visit, the WBC spent time getting to
know Mr P, and discussing his needs, goals, and
his past attempts at losing weight
 Mr P told the WBC that he had had dealings with
dieticians in the past, but that he did not find them
particularly helpful. He said he would “dearly
love to lose weight” but wasn’t sure how to go
about it, short of “starving” himself. The WBC
advised Mr P on the importance of eating a
healthy, balanced diet, and taking part in regular
physical activity, as evidenced in NICE Clinical
Guidance (43) on Obesity, 2006.
Case Study
 Interventions – food diary, seated exercise plan
 Mr P identified two short term wellbeing goals:
 To complete exercise plan three times per week,
for four weeks
 To learn how to use the internet, particularly
Skype, in order to keep in touch with family
across the country
Case Study
Outcomes
 Increased physical activity – does home exercise
programme every other day, swims twice a week,
attends Tai Chi
 Increased fruit and vegetable consumption and
lost 7 pounds
 Attended IT classes and bought a tablet to
communicate with family
Case Study
Outcomes
 Reports improved mobility, general wellbeing and
reduced breathlessness
 Feels part of the community
 Wider impacts on partner agencies
Questions/
Discussion