Evaluation of Nesta paper on Living Well, Cornwall
Letter to Iain Chorlton, KCCG
Dear Dr Chorlton
The 'Living Well' project
We are writing to follow up our questions that were tabled at KCCG's board meeting last September, and the responses that we received.
We should say at the outset that our concern with the Living Well project is not with the project itself or the use of volunteers in it, but that it appears to be being used as a propaganda vehicle by those behind the project.
As we show below, claims are being made that are provisional and tentative, yet these claims have been endorsed without qualification by KCCG in a press release1 (issued on September 29, 2015) following a visit to Newquay by Marcus Jones MP (Minister for Local Government). It is claimed that "evaluation revealed
· a 34% reduction in emergency hospital admissions
· a 21% reduction in emergency department attendances
· a 32% reduction in hospital admissions overall"
Furthermore, at the NHS Confederation Conference held at Liverpool in June this year, Jeremy Hunt MP (Secretary of State for Health) mentioned Cornwall "for saving 30% on admission costs as a result of the Living Well work".2
So somebody is spreading the word that these are established facts. Yet when we look at what we are told is their source, a paper3 by CELL consulting Ltd, we find
· It is clearly marked on every page "Draft for Discussion".
· On the final page there is a list of caveats warning of the limitations of the approach taken by CELL's study, specifically the danger of extrapolating from the results, the shortness of the post-intervention timescale and the small size of the sample.
· The phrase "If we were to assume ..." appears no fewer than six times in the CELL paper, underlining the tentative nature of the authors' conclusions.
· There is no mention in the KCCG press release of CELL's finding that "elective [hospital] activity costs rose".
· There is no mention in the KCCG press release of the reference to primary care activity (contacts with a GP practice) examined in CELL's study: these appear to have increased rather than reduced for the Living Well group.
· Crucially, the figures of 34%, 21% and 32% cited in the KCCG press release do not appear in the CELL paper. (Nor does the 30% mentioned by Jeremy Hunt.) It follows that your lengthy response to our brief question 1 (tabled for the September meeting of your board) does not actually answer it.
Thus the provisional, tentative nature of the conclusions drawn and the caveats attached, as well as certain of CELL consulting's findings, have been completely ignored by those spreading the word.
We were told, in the answer given to our questions tabled in September to the KCCG board: "The Chair and Chief Executive of NHS Kernow have reviewed the methodology and results together with Age UK national, locality GP representatives, leaders of provider organisations and local stake holders."
If it is indeed the case that the Chair and Chief Executive of NHS Kernow have reviewed the methodology and results and have acquiesced in the transmutation of tentative results into definitive conclusions, we can only conclude that this calls into question the governance of your organization.
Moreover, if, as seems likely, the yet-to-be-substantiated claims for the Living Well project are going to be used to support bids for funds from NHS Kernow – possibly on a larger scale – and those bids are successful, the outcome could be that those funds are found by cutting the funding of existing, professionally provided, health and social care services in Cornwall, and funds to the acute sector would be cut on the basis of these as yet hypothetical savings. We would regard such an outcome as extremely unsatisfactory for local people, both patients and staff.
We would welcome a statement from you acknowledging the tentative nature of the conclusions drawn from the Living Well experiment, correcting the misleading impression that they are 'factual' conveyed by your press statement and other communications, and giving a clear answer to our September question 1. We would also welcome your assurance that in the absence of the Nuffield Trust's evaluation of the Living Well experiment and similar approaches elsewhere, no undertakings have been or will be given by NHS Kernow board members or staff that funding will be made available for continuing, let alone expanding, the project.
We look forward to hearing from you.
All sources accessed 24/10/2015