Plenary presentation from Dr Jack Bedeman and case study presentations

1. ‘To nudge, or not to nudge’
Understanding how behavioural insights can deliver
improved healthcare
Wednesday, 13 January 2016, 10.00am – 4.00pm
Radisson BLU Hotel Durham, Frankland Lane, Durham, DH1 5TA

2. Objectives:
• Enable delegates to gain an in depth understanding of the
‘Nudge’ concept and behavioural insights methodology
• Ensure participants are able to apply nudge/ behavioural
insights in a clinical setting within their organisations
• Promote participant networking to exchange and share their
learning and collaborate on potential nudge plans across
the North East and North Cumbria
• Enable participants to access a suite of resources and
materials to support them in developing these plans and
putting them in to practice.
• Encourage delegates to take their learning back in to their
organisations to share and put this learning in to practice.

3. Understanding and changing behaviour:
applying behaviour insights to health
Dr Jack Bedeman
Public Health Registrar
Department of Health

4. Understanding and changing
behaviour: applying behaviour
insights to health
DH Behavioural Insight Team

5. 5
almost all of us would
donate organs after we die
 it takes 30 seconds
high awareness of the
organ donor register

6. 6
Benefits your
health
Free of charge if on a
low income
Advice from
GP and the NHS

7. 7
Conscious, planned, reflective behaviour
Subconscious, automatic behaviour

8. 8

9. 9
Before we can change
behaviour, we must first
understand it…

10. 10
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Capability Opportunity
Motivation
Attending
hospital
appointments
Behaviour

11. 11
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Capability
Knowledge, skills and
abilities to engage in the
behaviour
Physical
Physical ability to get to
the hospital
Psychological
Understanding of why
you need to go to the
appointment
Attending
hospital
appointments

12. 12
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Opportunity
Attending
hospital
appointments
Outside factors which
make the behaviour
possible
Social
Seen as OK to attend
during work time
Physical
Availability of transport to
get to the hospital

13. 13
Michie et al (2011)
COM-B: A simple model to understand
behaviour
Motivation
Brain processes which
direct our decisions and
behaviours
Automatic
Experiencing symptoms
on the day
Reflective
Concerns about
treatment
Attending
hospital
appointments

14. 14
Task one: understanding
and specifying the target
behaviour

15. 15
Defining the behaviour and the objective

16. 16
Here’s an example of a poorly defined outcome
The objective is to reduce pressures on NHS
A&E departments.
The aim is to concisely state what you are trying to achieve.
It’s not clear what reduced pressure
means. What sort of reduction?
All NHS Emergency Departments? And
in all ways? If all (as this implies), we
might be better considering starting small
to prove the concept before rolling out.
‘Pressure’ could mean lots of things.
Better to look at specifics, even if there
are lots of them to consider in sequence.

17. 17
Define the problem you aim to solve
The objective is to reduce by 5 per cent attendance at
Medway Hospital’s A&E department from patients
presenting in non-urgent situations
Ideally start with a quantifiable objective,
even if modified later. Start thinking early
about the size of effect needed for the
project to be worthwhile.
We usually start behavioural insights
projects on a small scale, and then scale
up if we are confident that something is
working.
Try to be as clear as possible about the specific behaviour you want to change
i.e. what, by who, and when.
Most policy challenges involve more than one ‘behaviour’ – and by a variety of
people e.g. patients and staff. It is easiest to consider each separately.

18. 18
Surprise Hyperbolic Discounting Social Learning Priming
Placebo Effect Decoupling Proccrastination Availability
Impact Bias Long-Tailed Risk Social Identity / norms Habit
Anticipation of Reward Simplification Band Wagon Effect Anchoring
Optimism Bias Intertemporal Choice Business Norms Intuition
Messenger Planning Fallacy Key Influencers Hindsight Bias
Loss Aversion Attention Collapse Identity Salience
Status quo bias Hedonic Framing Cognitive Load Gaming
Sunk Costs Defaults Regret Choice Bracketing
Certainty Bias Altruism Social Proof Mental Accounting
Ambiguity Effect Reciprocity Framing Information Avoidance
Endowment Effect Inequity Aversion Commitments Representativeness
Participatory Effect Teachable moment Cognitive Dissonance Over-Extrapolation
Actor-Observer Bias Omission Bias Attribution Error Segregation Effect
Behavioural insights / concepts

19. 19
Capability
Opportunity
Behaviour
Motivation
Automatic
Motivation

20. 20
Simplify messages
Break the goal down into
simple actions
Reduce effort
Defaults
EASY

21. 21
The revised chart led to much more accurate information (and less errors)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Dose entered correctly Prescriber's contact
number entered
Frequency of medications
entered correctly
Proportionofmedicationorders
Existing chart (n=174)
Improved chart (n=163)
King et al. (2014)
Redesigning the
‘choice architecture’
of hospital
prescription charts.
Forthcoming.

22. 22
A surgical safety checklist reduced deaths and complications following surgery by a third.
Haynes, A et al: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England J Medicine 2009; 360:491-499

23. 23
Suicide by paracetamol in England and Wales, 1993-2009
Hawton Keith, Bergen Helen, et al. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and
liver transplant activity in England and Wales: interrupted time series analyses BMJ 2013; 346:f403
Legislation reduced the maximum size of the packages to 16 pills (or 32 if sold
at a pharmacy) i.e. less convenient to purchase and retain multiple tablets.

24. 24
Attract attention
Lotteries
Incentives &
Rewards
Images & Colour
Personalisation
ATTRACTIVE

25. 25

26. 26

27. 27
Public promises
Make a commitment
Social norms
Networks
SOCIAL

28. 28
“The great majority (80%) of practices in [NHS
Area Team] prescribe fewer antibiotics per head
than yours”.
Three simple actions…
From a trusted authority figure
Personally addressed

29. 29
Old letter ‘nudge’ letter
Bonus A, Berry D: Increasing Uptake of the NHS Health Check . Report of research with Medway Council
to optimise the invitation letter . 2013. available at www.healthcheck.nhs.uk/document.php?o=588
29
33
0
5
10
15
20
25
30
35
old letter nudge
letter
Attendance rate %
DH – Leading the nation’s health and care

30. 30
Prompts
Make a plan
RemindersImmediate costs
and benefits
TIMELY

31. 31 DH – Leading the nation’s health and care

32. 32
Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians’ responsiveness to assay
cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med
2013;173:1654–5.
DH – Leading the nation’s health and care

33. 33
Task 2:
Applying behavioural
insights to policy
problems

34. 34
The ‘Nudge Game’

35. 35
DH – Leading the nation’s health and care
CONTROL
INTERVENTION
Group is split into two
groups by random lot
Outcomes are measured
for both groups
Testing behavioural insights

36. 36

37. 37

38. 38

39. 39
1. Advice on behavioural insights and how to
apply these to your policy area
2. Support designing BI interventions
DH BI team
3. Support designing and running BI
experiments and trials

40. 40
Behavioural insights literature
Excellent
summary text
Understanding full
range of behaviours Guide for policy-
makers
COM-B: http://www.implementationscience.com/content/pdf/1748-5908-6-42.pdf
EAST framework: http://www.behaviouralinsights.co.uk/sites/default/files/BIT%20Publication%20EAST_FA_WEB.pdf

41. 41 How to infuence public behaviour
Drink Aware web site
NHS Organ Donation web site

42. Case Study: Quantifying and modifying patient
attendance in a primary care setting.
Dr Roger Dykins,
Corbridge Health Centre

43. HPCA KTP
Overview and outcomes
18th November 2015
KTP Team:
Alexander Tang Northumbria University & Corbridge Medical Group
Prof Glenda Cook Northumbria University
Julie Johnston Corbridge Medical Group
Dr Robin Hudson Corbridge Medical Group
Dr Roger Dykins Corbridge Medical Group
Dr Akhtar Ali Northumbria University
Dr Emma Barron Northumbria University
Hazel Juggins Northumbria University
John Clayton Innovate UK

44. KTP Aim & Objectives
• Data warehousing and data mining of
practice clinical information systems
• Analysing current service activity
• Designing a stratification system for the
management of chronic disease
• Redesigning systems and professional
practice for the management of chronic
conditions in the practice population
• Develop a training strategy for effective
use of the proposed system
• Develop and agree the practice service
model for chronic disease management
• Pilot model and evaluation
Service
development
grounded in
analysis of GP
practice data
30th April 2012
Clinical topics and priorities
Organisation and business
challenges

45. 0
50
100
150
200
250
300
NumberofPatients
Age Group of Patients on 31-Aug-2014
CMG Registered Patients Demographics (2013)
Male Female Male Trendline Female Trendline
0
50
100
150
200
250
300
350
NumberofPatients
Age Group of Patients on Date of Death
CMG Deceased Patients Demographics
Male Female Male Trendline Female Trendline

46. 0
10000
20000
30000NumberofConsultations
Age Group of Patients on Date of Consultation
CMG Activity Type Consultations for Current Patients (2013)
Home Visit Telephone GP Surgery
0
4000
8000
12000
16000
NumberofConsultations
Age Group of Patients on Date of Consultation
CMG Activity Type Consultations for Deceased Patients (2013)
Telephone Home Visit GP Surgery

47. 0
5000
10000
15000
20000
25000
NumberofConsultations
Age Group of Patients on Date of Consultation
CMG Clinician Type Consultations for Current Patients (2013)
Healthcare Assistant Nurse General Medical Practitioner

48. 0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2009 2010 2011 2012 2013
Consultations
Year
CMG Activity Types Consultation between 2009 - 2013
Total Cons GP/ Surgery GP/ Telephone GP/ Home Visit Nurse/ Surgery HCA/ Surgery
GP/Surgery
Nurse/Surgery
Total
GP/Home
GP/Tele
HCA/Surgery

49. Key Messages from the Analysis of Practice Activity
• Increase in total number of consultations per year over 2009 - 2013
• Steady increase in the number of patients having consultations
each year (4.4% increase)
• 1065 (16%) patients with no consultations in 2013
• 41% registered patients on a QOF register
– 61% of the overall 2013 consultation workload
– 53% of GP surgery consultations, and 92% of GP home visits in
2013
• Patients with high consultation activity is not only accounted for by
those on the QOF registers and 80+ population
• 20 patients not on any QOF, HRPP or Housebound register yet they
are in the Top 200 Consultees between 2009 – 2013
– 2.1% of the overall 2013 consultation workload

50. cluster5
cluster1
cluster9
CMG Workload Clusters
Clusters 1, 5 and 9 include 377 patients (6% of the registered practice population)
accounting for 24% of the total consultations in 2013.
Numberofconsultations(2013)
Age

51. 6.6
32.7
5.4
9.6
7.2
33.6
6.3
3.1
10.3
20.4
0
5
10
15
20
25
30
35
cluster0 cluster1 cluster2 cluster3 cluster4 cluster5 cluster6 cluster7 cluster8 cluster9
NumberofConsultationsoverNumberofPatientsseen
Cluster Name
Average number of Consultations per Patient in each Cluster (2013)
Clustering Analysis

52. Practice A Workload Clusters
Clusters 0, 2 and 7 include 393 patients (7% of the registered practice population)
accounting for 28% of the total consultations in 2013.

53. Practice B Workload Clusters
Clusters 3, 5 and 7 include 314 patients (4% of the registered practice population)
accounting for 19% of the total consultations in 2013.

54. 0 5000 10000 15000 20000 25000
GP/Surgery
GP/Telephone
GP/Home Visit
Nurse/Surgery
Nurse/Telephone
HCA/Surgery
Number of Consultations
ActivityType
Activity Type Consultation Comparison between HPCA Practices (2013)
Corbridge Medical Group Practice A Practice B
• On average High Users account for 6% of population and 22% of the overall workload
Practice Registered Patients
CMG 6592
A 5650
B 7131

55. 55
Extremely
High Users
20+ cons
Very High
Users
15 - 20 cons
Moderate
High Users
10 - 14 cons
341 patients
4986 GP surgery and
home visit consultations
43.1% workload in 2013
39 patients
1108 cons
9.6% of workload in 2013
122 patients
1388 cons
12% of workload in 2013
219 patients
2490 cons
21.5% of workload in 2013
Traffic Light Thresholds

56. High Users Consultation Alert – EMIS Web
• Limitations with EMIS Web
Protocols & Concepts to
identify difference in
consultation types (surgery,
telephone, home, admin etc.)
• Feasibility to alert user based
on certain read codes only
• How does this or could
change consultations with
patients?
• Across HPCA: Could different
approaches/services be
offered to high user patients?

57. High user alert – GP views/actions
• Surprise when a patient who they did not
expect to be a high user comes into the
surgery
• Patients often see different GP’s and the
alert has supported identification of
these patients
• For some patients the GPs are arranging
telephone reviews in order to move
workload from face to face appointments
into telephone work
• GP suggesting review periods to patients
• GPs have decided to take a closer look at
their top 10 surgery consultees and top
10 home visit consultees to investigate if
there are interventions that may have an
impact on consultations whilst enhancing
quality care

58. Why do patients seek consultations Analysis of
presenting problem titles
GP Surgery & Home Visit consultations (Aug 2014 – July 2015)
Common Presenting Problem Title Patients Occurrence Ratio
Musculoskeletal problems 183 592 3.23
Acute Respiratory 158 370 2.34
Digestive System 155 366 2.36
Dermatology 159 342 2.15
Depression and Anxiety 92 300 3.26
Ear / Nose / Throat 103 190 1.84
Cardiovascular Disease and Stroke 62 188 3.03
Neurological and Nervous System 85 171 2.01
Symptoms / signs and ill-defined conditions 75 132 1.76
Chronic Obstructive Respiratory Disease 36 132 3.67
Urinary Tract Infection - Suspected and Actual 66 108 1.64
Genitourinary 59 104 1.76
Women's Health / Gynaecological / Pregnancy 51 96 1.88
Hypertension 41 88 2.15
Infectious and parasitic diseases 51 87 1.71
Neoplasms 32 86 2.69
Operations / procedures / sites 51 83 1.63
Circulatory system diseases 40 82 2.05
Mental disorders 28 71 2.54
Eye and Sight problems 50 66 1.32
Respiratory system diseases 31 65 2.1
Medication Review and Advice 43 55 1.28
Alcohol 3 25 8.33
10+ Consultations

59. Can future consultation activity be
forecasted?

60. Risk Stratification: GP Consultations
High Risk
Patient
Pathway
Depression
Atrial
Fibrillation
Group 1
(AIC 746)
10
**
Depression 7
Stroke/TIA 5
PAD 5
CHD 3
Heart Failure 3
Female 3
Housebound -3
Rheumatoid Arth. -5
No No
Y
e
s
Y
e
s
Group 2
(AIC 1707)
5
**
Diabetes 6
CKD 4
Female 1
Meds*** 0
Group 3
(AIC 360)
6
**
Dementia 13
Atrial Fibrillation 8
PAD 7
Asthma 6
Age 70-80 yrs.* 5
Group 4
(AIC 938)
5
**
Housebound 6
CKD 3
Stroke/TIA 3
Group 5
(AIC 9138)
5
**
Palliative Care 4
Rheumatoid Arth. 2
Dementia 1
Female 1
Stroke/TIA 1
PAD 1
COPD 1
Meds*** 0
Age 60-70 yrs.* -1
Age 50-60 yrs.* -1
Below 50 yrs.* -1109
275
56
137
160
3
*Age coefficients relative to 50-60 age group; **Numbers roughly equate to extra number of visits and title number in each table is roughly baseline number of
visits; *** Meds is per medication; Consultations are GP Surgery and Home Visits, totalling 11579 in 2013.
Hypertension
Y
e
s
Patients
Consultation
s
5% (616)
11% (1218)
3% (392)
7% (868)
73% (8485)
Key:

61. Presentation suggestive of UTI in
adult
Consider face to face assessment if:
 Systemically unwell eg fever
 Frail / elderly
 Sx of upper urinary tract infection eg flank
pain
 Recurrent UTI ?clinical examination - ?Need
for further investigation
If >1+ haematuria repeat urine
dip 2w post treatment (refer if
ongoing sterile microscopic
haematuria on 3 x urine dips over
1 month period)
MSU should be sent when
possible
Treatment of UTI :
3 days of trimethoprim or nitrofurantoin [If GFR >45] - (guided by previous MSU sensitivities) - for Simple UTI
7 days if:
 Upper UTI (use coamoxiclav)
 Complicated (constipation associated, structurally abnormal urinary tract, urinary retention)
 Male
 Catheter UTI
 Pregnancy (use cephalexin)
Clinical assessment – face to face or
telephone
Urinalysis
• HCA/Nurse dips urine and creates
externally entered consultation to
record result.
• Pass slip to doctor with result
• Retain sample for MSU
• Reception to ascertain from
patient whether suspected UTI
(not cystitis)
• Ask patient to bring urine sample
• pass to HCA/nurse (or duty
doctor if not available) using
protocol with slip
Notes:
 Consider self management plan if recurrent
 Consider further investigation in repeat sterile MSU eg ?overactive bladder ?malignancy
 Consider sexually transmitted pathogens in patients with sterile MSU eg chlamydia / gonorrhea

62. One-Stop-Shop Pilot
Patient
Disease review
Medication
review/med
issue
Current
problems/issues
Managing acute
illness
Skill sharing and
planning more
powerful with 2
clinicians in room
Patient felt cared for
and able to talk about
things that were
important to them
but not normally
discussed
Joint consulting
very helpful
Summary
document about
patient is useful.
Patient: A reminder
of the care plan and
life plan.
Care Plan in some
cases has also had
a real impact
Questionnaire may
have had a
influence on how
patients feel about
their condition
and/or state of
health

63. ‘GPs are amazed at the impact the One Stop Shop chronic disease
review clinic seems to have had on the timelines – genuine changes
seem to have been achieved even though we are uncertain what has
made the difference.’

64. Overall Key Issues
• High service users are not necessarily those with
multimorbidity and older
• There are high services users not included on any registers
• GP consultation thresholds of 10+; 15+;21+ can be used to
identify clusters of intense service users
• Clinical predictors can be used to identify risk for increased
consultation levels
• Increasing consultation levels is not sustainable within
existing service delivery models
• Transformation of service delivery could involve
development of workforce roles; redesign of clinical
pathways for common presenting problems (UTI);
consideration of the workforce skill mix or economies of
scale achieved across practices for intense service users
• Practice data can be used to inform transformation of
service delivery

65. How “Nudge” is Being Used in the Telehealth
Programme North East and Cumbria
Paul Marriott
Independent TECS Consultant (Paul Marriott TECS Ltd)
AHSN NENC Telehealth Programme Lead
TECS Lead Consultant NHS England Strategic Clinical Networks
TECS Clinical Advocate NHS England

66. South of Tyne & Wear
Northumberland
Durham
The South of Tyne &
Wear PCT Telehealth
Project ran from May
2011 to March 2013
Population of around 644,000
3 - Foundation Trusts
3 - PCT’s / CCG
3 - Metropolitan Councils
Sunderland, Gateshead and South
Tyneside
The Origins of Telehealth In Tyne & Wear

67. “The headline findings of Telehealth were mixed. The good news was that
mortality of Telehealth patients over the year of the trial was 46% less
than the control group. Hospital admissions were 18% lower. To me,
these figures should be enough to justify an immediate rollout. I fancy the
idea of increasing my chances of staying alive. But it won't happen –
because the third big finding of the report was that Telehealth would not
save money.”
The Guardian 2nd July 2012
Headlines on the Whole System Demonstrator
Only 3 Conditions were Included in the Trial

68. 1st Generation Telehealth

69. 2nd Generation Telehealth

70. 3rd and Now 4th Generation Telehealth

71. Annual Average Cost Per Patient by Generation of Equipment
Equipment
Type
1st Year
Capital
Purchase
Cost
Annual
Leasing
Cost
Annual
Maintenance
Cost
Total
1st Generation
Purchased System
£2000 £1000 £3000
2nd Generation
Leased System
£1150 £1150
3rd & 4th Generation
Rapid Deployment
Leased System
£365 £365
SMS Florence
System
NHS Owned
£45 £29 £74

72. Optimum Health
Good Health
Average Health
Signs of Illness
Chronic Illness
Irreversible Illness
Death
WholeLifePerspective
Conception
Death
The Multi Matrix Model Seeks to Cross “The Whole Life Perspective”

73. NHS Florence SMS Simple Telehealth System
SMS
Prompts and
advice
GP Practices
Specialist Clinicians
Community and
Specialist
Nursing
Public Health
And the 3rd Sector
Local Authority Control Room and Adult Social Care

74. Example of Flo Messages
A quick reminder that your Blood Glucose
Reading is due e.g. “BG 6”. Thanks Flo
Your blood glucose reading is fine. Take care
Flo
Your blood glucose reading is a little high
today. Please refer to your management
plan and follow the advice provided. Take
care Flo
Your reading indicates that you might need a
change to your treatment.
Please ring . . . immediately.
Take care Flo

75. RESEARCH ARTICLE
Randomised Trial of Text Messaging on
Adherence to Cardiovascular Preventive
Treatment (INTERACT Trial)
David S. Wald*, Jonathan P. Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J. Wald
Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ,
United Kingdom
*d.s.wald@qmul.ac.uk
Conclusions:
In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular
disease, text messaging significantly improved medication adherence compared with no text
messaging.
Trial Registration: Controlled-Trials.com ISRCTN74757601

76. Condition Clinical Lead
 Heart Failure, Angina etc. FT, GP
 COPD and Respiratory etc. FT, GP
 Hypertension GP
 Diabetes FT, GP
 Gestational Diabetes FT
 Type 1 Kids T1KZ FT, GP and 3rd Sector
 Parkinson’s FT
 Rapid Discharge FT
 Carers Pathway GP, LA & PH and 3rd Sector
 Acquired Head Injury and Stroke FT, GP
 Primary Care Step Up Step Down GP
 Care and Nursing Home GP, LA
 Weight Management FT, GP, LA & PH
 Smoking Cessation LA & PH
 Remote Wound Dressing Monitoring FT
 Community Matron Case Load FT
 Alcohol Induced Morbidity FT, GP
FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health
Some of the Current Pathways within the North East and Cumbria (there are
now over 220)
Expand and Widen the Number of Telehealth Pathways and Clinicians

77. Florence Usage across the NHS in the UK and the DVA in the USA

78. Patient Outcomes
COPD Patient “I am
much better now as I am
using 02 readings to
prompt using oxygen I
feel my condition is more
controlled now.”
COPD Patient “I like the
reminder text as I would
forget. Prompts me to
think about doing my
breathing exercises
when readings are low. I
like the freedom of doing
the reading more often.”
Heart Patient “Its easy to
use and my son helps
with the readings. Its
great we can now go to
family members for
example at Christmas
and continue to do
readings.”
Young Diabetic “I Don’t
have to come in every
week now which is much
better I have a busy life
and that helps as I have
a another child which I
needed to get looked
after. Costs me £8 on
bus to attend each
appointment at clinic.”
Middle Aged Diabetic
“Really happy with the
service. It’s a
combination of exercise
Programme and
monitoring my health my
control is far better now”
Community Nursing Patients
Feed Back

79. Telehealth with a human touch
Florence Patient Video

80. Contact Details
Paul Marriott
Independent TECS Consultant (Paul Marriott TECS Ltd)
AHSN NENC Telehealth Programme Lead
TECS Lead Consultant NHS England Strategic Clinical Networks
TECS Clinical Advocate NHS England
NHS England Northern Senate
Waterfront 4, Goldcrest Way
Newcastle upon Tyne, NE15 8NY
Mob: 07779816519
paul.marriott@nhs.net
marriott.p1@sky.com
www.england.nhs.uk
AHSN North East North Cumbria
Biomedical Research Building
Campus for Ageing and Vitality
Nuns’ Moor Road
Newcastle upon Tyne
NE4 5PL
www.ahsn-nenc.org.uk

81. A Nudge in the Right Direction for Physical
Healthcare within Mental Health and Learning
Disability Services
Alexia Hardy, Physical Healthcare Project Lead
Pauline Smith, Physical Healthcare Project Nurse

82. 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.
Context

83. Clinical Guidelines
 NICE: Guidelines for Schizophrenia
(2009 & 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

84. 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).

85. Physical
Healthcare
Project 2014-16
EWS
• Bespoke training offered to services
Trust-wide.
• Additional support post training.
EWS audit across all service areas to
monitoring compliance of new procedure
and identify where staff may need further
support.
• EWS Procedure
• Diabetes Management Guideline
• Cardiovascular Guideline
• Staff Engagement Events/Workshops
• Staff and Student Induction
• Patient workshops
• Patient and carer meetings/focus groups
Engagement and
communication
Development of
standards
Training
Audit
• Project Newsletter for staff
• Project update for patients and carers
• Social Media
• Page on Trust intranet
Diabetes Management
• E-learning in line with new guideline.
• Pilot of face to face training.

86. • Involved and engaged staff by asking ‘What
does physical healthcare mean to you?’
• Used staff thoughts and ideas to produce
project banner to emphasise the whole body
in mind.
• National ‘nudge’ and interpretation of NICE.
• Development of standards in a language
suitable for mental health and learning
disability settings.
• EWS Quick Reference Guide to support
recognition and response to the
deteriorating patient.
• Bespoke EWS training delivered within
service areas across the Trust.
Staff Nudge

87. Patient and Carer Nudge
Empowerment
Thought
provoking
Increased
awareness
Informative

88. Thank you