Leicestershire Partnership NHS Trust – One Year on from the Mental Health Taskforce

Leicestershire Partnership NHS Trust (LPT) continues to break new ground in ensuring the physical health of its patients and service users is cared for as well as their mental health, the ultimate aim of which is to achieve parity of esteem.

The trust  provides mental health, community health and learning disability services for a population of 1.1 million people. It has developed a physical health register to cut the risk of people with severe mental ill health developing life-threatening physical conditions.

People who are prescribed anti-psychotic drugs for severe conditions such as schizophrenia and bipolar disorder  are at much higher risk of developing serious conditions such as diabetes and heart disease – lifespan can be reduced by up to 20 years as a result.

The Leicestershire Physical Health Register was developed and trialled in 2013 by a team from the trust:specialist mental health pharmacist Dolly Sud, consultant psychiatrist Dr Manjunath Minajagi and consultant pathologist Dr James Falconer Smith.

The register helps clinicians to ensure they undergo close physical health monitoring by triggering key checks such as key blood test results, weight/BMI, blood pressure and to ask them about smoking, alcohol consumption, substance misuse, diet and exercise.

The results are followed up making sure, for example, that if a patient is overweight they receive advice about diet and exercise and if necessary are referred to or seen by a hospital dietician to talk them through lifestyle options and give advice.

LPT developed the work as part of a national Commissioning for Quality and Innovation (CQUIN) (quality improvement project) across all its adult mental health inpatient units and in 2014-2015 achieved 97% compliance. In 2015-16 the trust  rolled the register CQUIN out to include people receiving care from the its Psychosis Intervention and Early Recovery (PIER) team which helps people aged from 14 to 64 who have experienced a first episode of psychosis. They achieved 99% CQUIN compliance, the highest nationally for the second successive year.

This year the programme has been expanded to include adult mental health service users being cared for by community mental health teams under the Care Programme Approach. A total of 2,300 people have now been screened since the register was launched.

LPT has also invested in the service, as part of the 2016-17 CQUIN, to support the expansion of this work.

Dolly Sud explained: “We now have a dedicated team comprising two administrators and a senior technician who collect and audit the relevant data, and I complete a final clinical screening and contact the relevant clinician to put any needed interventions into place. Since the register was launched the trust has implemented RiO, an electronic patient record system across adult mental health services and this has enhanced the whole process.

“We have the full support of the pharmacy team, who have helped me to dedicate my time  to lead this work, and the backing of our trust medical director, Dr Satheesh Kumar, and support of one of our clinical directors – Dr Fabida Noushad as well as nursing staff, CPA coordinators and consultants.

“We are now developing a trust level steering group for developing and implementing a trust-wide physical health care pathway for mental health in our inpatient services. Over the next two years we will be focusing further on measuring the outcomes of this work.”

Dr Pete Miller, chief executive of the trust, said: “We believe that this simple but innovative approach could have a significant positive impact on the physical health and wellbeing, and ultimately life expectancy of people with mental ill health not just here in Leicester, Leicestershire and Rutland but potentially across the country.”

Anthony Oxley, LPT’s head of pharmacy, said: “As the emerging risk of physical health problems such as diabetes and cardiovascular disease in patients with SMI  has become apparent it is vital that mental health trusts take this seriously and ensure their patients are properly monitored and interventions undertaken to minimise and manage such risks.

“Whilst manual systems have a place in this, an automated system that does not rely on an individual remembering to carry out a test is the optimum system.

“This is what we in Leicestershire have been working on. A multidisciplinary team has led the project with all project leaders actively engaging with system users to ensure they understand their responsibilities.

“The successful CQUIN achievement was possible due to a combination of the computerised system and the team’s relentless focus on ensuring that all patients benefited from it.  At the end of the day this CQUIN is about patient safety and improving outcomes and I am incredibly proud that the LPT team achieved the very high standard  they did. “