Four mental health trusts almost doubled the number of people getting five key physical health checks during a pilot scheme now being shared for adoption across the NHS.
Hundreds of patients with serious mental illness (SMI) were part of the two-year improvement programme to improve physical care in mental health inpatient units. This saw 86 per cent get five recommended Cardiovascular screens compared to 46 per cent at the start.
It used the ‘Lester tool’, a poster and electronic clinical prompt system to support clinical teams to screen and intervene for cardiovascular conditions such as diabetes and high blood pressure, as well as smoking, lifestyle and weight. The programme was independently evaluated by the Royal College of Psychiatrists Clinical Care Quality Improvement Unit ( CCQI) .
Professor Huon Grey, National Clinical Director for cardio vascular disorders at NHS England, Prof Jonathan Valabhji, NCD for Diabetes, and Dr Geraldine Strathdee, while NCD for Mental Health directed the programme.
Dr Strathdee said: “It is a major cause for concern that people with a serious mental illness have a life expectancy of the 20 years less, the same as for the rest of the population in the 1950s, because they so often suffer from lack of treatment of these physical illnesses.
“We have been very pleased by the results from this pilot which have shown that physical health care in mental health in-patient settings can be improved, as well as treating their mental health. We recommend that trusts and primary care teams, mental health trusts and commissioners use the Lester tool. This is now available as a poster for all clinical areas, as a clinician decision support template (the Bradford tool) for primary care, with roll commenced in leading specialist mental health electronic care records systems.
“We can no longer see patients with serious mental illness only through the prism of their mental health; we must ensure an integrated physical and mental health, as well as social care, approach to monitoring and treating equally.”
SMI patients die on average 20 years earlier than the general population due to preventable physical health problems – a life expectancy similar to the 1950s.
Around 12,000 fewer people would die from cardiovascular disease (CVD) if people with SMI had the same outcomes as the general population.
Factors such as poverty, side effects of anti-psychotic medication, lifestyle and difficulty accessing mainstream GP, acute and mental health services can all contribute to this.
The recent Five Year Forward View for Mental Health recognised the need to address this.
2gether NHS Foundation Trust, Northumberland Tyne and Wear NHS Foundation Trust, Mersey Care NHS Foundation Trust (Mersey Care) and Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) implemented the Lester tool (2014) which was updated for use in the UK by the Royal College of Psychiatrists and the Royal College of GPs and supported by the National CQUIN programme and National Audit of Schizophrenia in collaboration with NHS England and Public Health England.
They took different approaches to the problem and final evaluation has shown across the four sites:
- inpatients receiving all five recommended CVD screens increased from 46% across all sites at baseline to 83% at follow up.
- Interventions delivered to those who needed them as a result of appropriate screening increased from 79% to 94%.
- 89% of service users surveyed reported wanting one or more tests or support when in mental health hospital.
The main themes for bringing about change which are highlighted and addressed in the toolkit are:
- Motivating and engaging staff
- Clarity of roles and responsibilities
- Skills and confidence
- Recording, monitoring and communicating information
- Communicating with service users to inspire action
- Interfaces with other services
- Equality and health inequalities
The new toolkit shares practical materials such as example health policies, example job descriptions and lists of equipment to help others. Other trusts will now be able to use these as the basis for their own materials without needing to start from scratch.
The Lester tool has also been aligned as part of this project with the Bradford tool, an IT template system which supports physical health screening.