Central North West London NHS Foundation Trust (CNWL), one of the largest providers of acute and community mental and physical healthcare worked alongside NIHR CLAHRC Northwest London (CLAHRC NWL) on a Health Foundation funded project. The project brought together a team of service users, quality improvement experts and healthcare professionals, to systematically improve the assessment of physical healthcare needs of patients admitted to a mental health ward by focussing on cardio vascular disease risk. Service users have been pivotal in developing a patient physical health plan, which offers patients individualised advice about their physical health, developed using process mapping and tested through plan, do, study, act cycles, before roll out on a wider scale at the Trust.
“As a service user I felt that being involved in the project has given me more confidence to work with professionals, and the project itself has helped me understand my own continuous battle with my physical health.” Sandra Jayacodi, project team member with lived experience of mental health problems.
People with serious mental illness have a significantly reduced life expectancy and a higher prevalence of physical health disorders than the general population. Assessing the physical health of patients when they are in hospital offers an opportunity to identify risk factors for developing conditions such as cardiovascular disease or diabetes and provide advice and support on services that can be accessed on discharge.
Unfortunately, this is rarely done for patients with serious mental illness when they are in hospital, despite numerous national guidelines recommending such an approach.
“We know that this group of our patients have significantly worse physical health, including higher risk of stroke and heart attack and shorter life expectancy. Like many other trusts in London and elsewhere, we know that physical health monitoring is an area we need to improve on—as shown in last year’s National Audit of Schizophrenia.” Ed Beveridge, project team member and psychiatrist.
The Project Purpose
CNWL, CLAHRC NWL and Service Users has decided to proactively work with patients to manage their own physical health by providing easier to understand assessments and lifestyle advice, all held together with their medical history in a passport-style document.
The objectives of the project were to identify gaps in systems and process supporting the assessment of the physical health of those with serious mental illness, improve these and co-design a patient centred tool to support improvement in physical health and to test and refine solutions on a small scale before rolling out across the trust. All the while keeping sight of the overall shared aim to improve the physical healthcare of patients admitted to a mental health ward.
Aside from a unified nursing and medical physical assessment to be used with patients admitted to the ward the project has led to the co-production of a patient held physical health booklet called “My Physical Health Record Explained” as a tool for shared decision-making around physical health.
The booklet uses a traffic light system to explain risks and enable patients to take some responsibility for improving their physical wellbeing. The project team have also been provided with the ‘Long Term Success’ tool, designed by CLAHRC Northwest London, to support them to reflect on progress and identify challenges to sustaining improvements in the clinical setting.
The project is currently being implemented on just one ward of the mental health unit and will be rolled out further within CNWL with plans to the unified health assessment to be integrated into the new electronic patient record system in the Trust. The physical healthcare plan has the potential for use more widely across the organisation, including in community clinics.
“I’ve been involved in many projects over the years, but this is the first time I’ve really felt part of a team.” Jenny Trite, project team member and service user.
The success of the project in engaging service users is due to be highlighted in the journal, “The Lancet Psychiatry”, to help share the practice nationally.
For more information on this project please contact:
Liz Evans – Mental and Physical Wellbeing Lead NIHR CLAHRC Northwest London – firstname.lastname@example.org
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