1. HSUG / LGA Housing and Health Workshop
Age UK Integrated Care
Monday 28th September

2. Age UK Integrated Care 1 2 4 3 Identified by GP Guided Conversation
Older Person referred to Local Age UK
Older Person
Age UK
Personal Independence Coordinator
Referral to I&A, (charged for) services, Voluntary Sector 1 2
Part of 500 Cohort
Guided Conversation
Person centred support plan
Age UK
Personal Independence Coordinator
Age UK Volunteer
1:1 Support 4 3

3. Identifying target groups
Older people:
Older
2 or more long term conditions
Make a difference
Benefit from community support
Reducing Cost:
Risk stratification for unplanned hospital admissions
Reducing social care costs
Aspirational 1:4 savings
, help double run and then restructure from emergency to prevention, run out of volunteers

4. Impact of the Intervention
Improved Wellbeing for older people:
Person centred smart goals
Emotional wellbeing
Physical wellbeing
Reducing Cost:
Reducing cost across the whole system
Performance Management Framework
Financial Model
Whole System Change:
Multi disciplinary team working
Shared single care plan
Loneliness and isolation

5. Evaluation Challenges
Information Governance and Data sharing
Honorary contracts, co-located, NHS s
NHS Toolkit
Local IG procedures and consent letters, phone calls and records
Skills for care video on information governance (
Attribution
Local Cornwall evaluations
Nuffield evaluation across all the sites
(not being a halth organisation)
matched control group (not RCT) and Cornwall did a local one

6. Results to Date 20% www.knowledgebucket.org
20%