Physical Health Action at Last! by Karen Conlon, SMI Project Lead, Mike Leonard, clinical Pharmacist and Pauline Smith, Physical Healthcare Project Nurse

1. Physical Health:
Action at Last!
Karen Conlon, SMI Project Lead
Mike Leonard, Clinical Pharmacist
Pauline Smith, Physical Healthcare Project Nurse

2. 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.

3. 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

4. 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

5. • 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

6. Physical Healthcare Project
2014-16
Business Plan priority to develop
standards required for the
assessment and monitoring of
physical health.
Local CQUIN 2014/15
Health 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 2014/15
Improving physical healthcare to
reduce premature mortality in
people with SMI.
TEWV Physical Health Agenda
Smoke Free Project
TEWV aims to go smoke free
on 9th March 2016 (National No
Smoking Day).

7. Participating in NHS IQ CVD Project:
Context in TEWV in Pilot Sites
 Variability 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.

8. TEWV Pilot Wards
Acute Ward: Farnham, Lanchester Road Hospital, Durham
Rehabilitation Unit: Primrose Lodge, Chester-le-Street

9. 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

10. 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

11. Pilot Wards Monitoring Tool

12. RCP Evaluation Results: Screening
From 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

13. 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.

14. Service User Voice
How 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 hospital
73% (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.

15. 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)

16. 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”

17. Critical Success Factors
Board 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.

18. NHS IQ CVD Project– Key Message
People 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”

19. The Final Word
Professor Helen Lester: Bothering about Billy
“ it costs little: is based on simple
observations: it’s not rocket science”

20. Thank you for listening
We are happy to take questions ????