Physical Health: Action at Last!

Karen Conlon, SMI Project LeadMike Leonard, Clinical Pharmacist

Pauline Smith, Physical Healthcare Project Nurse

Aims of the session:To hear the TEWV response to the growing national

physical healthcare agenda within mental health and learning disability services.

To learn about the contribution of the NHS IQ Improving CVD Project in relation to meeting the national agenda.

Clinical Guidelines NICE: Guidelines for Schizophrenia

(2002 & 2009) NICE: Smoking cessation in

secondary care: acute, maternity and mental health services (November 2013)

NICE: Psychosis & Schizophrenia in Adults (February 2014)

NICE: Physical Health, Obesity, Lipid Modification, Preventing Type 2 Diabetes, Hypertension (Various dates)

Government Policy National Service Framework

(DoH 1999) > SMI Registers No Health without Mental

Health (DoH 2012) NHS Outcomes Framework

(DoH 2012) The Abandoned Illness

(Schizophrenia Commission 2012)

National Audit of Schizophrenia (2012)

Cardiovascular Outcome Strategy (2013)

The National Agenda

People with a SMI die on

average 15-20 years sooner

than the general population

Approximately 40% of these service users are obese, compared to 25% of the general population

(The NHS Information Centre 2014).

Type 2 diabetes – prevalence 2-3 times higher.

People with a SMI are twice as likely to die from heart disease.

61% of people with schizophrenia smoke (33% of general population).

(The Abandoned Illness, Schizophrenia Commission 2012)

NOW DECREASED TO 20%

People with schizophrenia who develop cancer are 3 times

more likely to die.

Service User Context

• TEWV provides a range of mental health, learning disability and eating disorders services for the 1.9 million people living in County Durham, the Tees Valley, Scarborough, Whitby, Ryedale, Harrogate, Hambleton, Richmondshire, York and Selby.

• TEWV has over 6,700 staff operating an annual income of over £330 million.  

• The services are spread over a wide geographical area which includes coastal, rural and industrial areas.

Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust

Physical Healthcare Project 2014-16

Business Plan priority to develop standards required for the

assessment and monitoring of physical health.

Local CQUIN 2014/15Health promotion for people with psychosis accessing community

services focussing on weight management and smoking

cessation.

GP Engagement Project 2014-17

Aims to improve clinical communication with GPs using

standardised electronic referrals and discharge letters.

National CQUIN 2014/15Improving physical healthcare to

reduce premature mortality in people with SMI.

TEWV Physical Health Agenda

Smoke Free ProjectTEWV aims to go smoke free on 9th March 2016 (National No Smoking Day).

Participating in NHS IQ CVD Project: Context in TEWV in Pilot SitesVariability in approach to improving physical health in

adult mental health: Kaizen Event (September 2014).Inconsistency and difficulty recording and accessing

clinical information about physical health.Variability in knowledge and skills of clinical staff in

relation to physical health.Different approaches to physical health in an acute

admissions ward vs rehabilitation unit.

TEWV Pilot Wards

Acute Ward: Farnham, Lanchester Road Hospital, Durham

Rehabilitation Unit: Primrose Lodge, Chester-le-Street

NHS IQ Improving Cardiovascular Health of People with SMI Project 2015/16

1. To implement TEWV Electronic Physical Health Monitoring Tool, incorporating Lester Tool.

2. To provide physical health expertise and staff training to support implementation.

3. To improve sharing of information at the inpatient/community/ primary care interface.

4. To increase service user awareness of the importance of physical wellbeing and healthy lifestyle.

Acute Male Admission Ward

and Rehabilitation Unit

Increased dialogue with community teams

Standardise GP Communication

RCP Service User Survey

Looking after your physical health and wellbeing booklet

Phys Obs, ECG, Smoking Cessation, Weight Management

Survey Monkey to identify training needs

Standard Process Descriptions and

training on use of tool

Test the tool and incorporate into PARIS

The Lester Tool is a tool used to assess the cardiometabolic health of people experiencing psychosis and schizophrenia, enabling staff to deliver safe and effective care to improve the physical health of people with serious mental illness.

Screen

Intervene

Pilot Wards Monitoring Tool

RCP Evaluation Results: ScreeningFrom baseline to follow-up, an improvement in rates of screening was observed in all 5 domains.

Few refusals of screening were observed either at baseline and follow-up.

At baseline, a quarter (25%) of patients were screened for all 5 domains; at follow-up, three quarters (75%) of patients were screened for all 5 domains.

All patients received screening in at least three domains at follow up, with 93% receiving screening in four domains or more.

14

21

11

4 2

Screening at baseline

22

5

2

Screening at follow-up

  5 screenings  4 screenings  3 screenings  2 screenings  1 screening

RCP Evaluation Results: Intervention

“Training for staff on the two Pilot wards was also considered likely to have contributed to improvement,

particularly in relation to screening but also to have informed intervention

delivery”

• At follow-up, 100% of smokers were offered an intervention compared to 33% at baseline.

• There was no change in the proportion of people offered an intervention for glucose.• Some minor improvements were seen in interventions offered for hypertension and

weight.

GP support into rehab unit is a key factor in supporting screening and

intervention, coupled with ease of access to information held in the electronic tool.

Service User VoiceHow concerned are you about your physical health?74% (N61) indicated some level of concern about their physical health from a little concerned to a lot concerned.

Inpatient Community Patient

Smoking cessation support

N30 (36.6%) N28 (36.4%)

Support to improve diet and exercise

N46 (56.1%) N43 (55.8%)

Weight monitoring N44 (53.7%) N39 (50.6%)

Blood pressure tests

N41 (50%) N28 (36.4%)

Blood tests for diabetes risk

N36 (43.9%) N30 (39%)

Blood tests for cholesterol level

N35 (42.7%) N30 (39%)

How confident are you that your mental health care team takes your physical health concerns seriously?85% (N69) indicated some level of confidence that their physical health was taken seriously from somewhat confident to very confident.

Which types of support or testing would you want?

One or more tests wanted?81% (N66) when in hospital73% (N56) when in the community

Breakdown of results indicated a higher % of service users on an Acute/PICU Ward would like one or more tests as both an inpatient and community patient than service users on a Rehab Ward.

How often do your mental health conditions stop you from being physically fit and healthy?72% (N58) indicated that on some level their mental health condition prevents them from being physically fit and healthy from sometimes to always.

How does being an inpatient affect you keeping fit?67% (N52) indicated that being an inpatient either makes no difference or makes it easier to keep fit. Breakdown of the results indicated a higher % of service users in Acute/PICU Wards found being an inpatient had an effect on them keeping fit. Qualitative feedback indicates this is due to sectioning restrictions, medication and lack of motivation.

Service User Voice

Which healthcare professional would you speak to if you thought your mental health was having a bad effect on your physical health?

Care Coordinator 63% (N51)Psychiatrist 54% (N44)GP 54% (N44)

Project Impact in TEWV

Access to information in one place to support

better decision making

“Physical healthcare ingrained as part of the

ward thinking”

Campaigning and raising awareness to change hearts and

minds

“Training improved confidence and led to

more appropriate interventions”

Electronic tool contributed to

understanding what is needed on PARIS

“The Trust has a real appetite for improving physical healthcare”

Changing attitudes leading to more

engagement in all physical health initiatives

“Impressed by enthusiasm of project team despite capacity

issues”

Critical Success FactorsBoard level commitment to improving physical health

for all TEWV patients.Alignment of all TEWV physical health initiatives.Enthusiasm and responsiveness of clinical staff.Engagement and communication .Involvement of the PARIS Team in developing an

electronic monitoring tool for physical health recording.Be Organised: Be Clear: Be Realistic: when delivering a national project.

NHS IQ CVD Project– Key MessagePeople with a SMI are twice as likely to die from heart disease

which could be prevented !!People with a SMI today have the same life expectancy that

the average population had in the 1950s !!

Are your staff and service users aware of the risks?

Don’t just SCREEN-INTERVENE

for all patients in the “red zone”

The Final Word Professor Helen Lester: Bothering about Billy

“ it costs little: is based on simple observations: it’s not rocket science”

Thank you for listening

We are happy to take questions ????