8 March 2021

A CNWL project to better record the physical health of service users with mental health and/or learning disabilities is showing signs of success.

The project within CNWL’s Jameson Division is ahead of most other London trusts in terms of numbers of service users to have received a physical health check and is now trying to work out how to make this sustainable. 

In 2016, Government targets mandated that 60 per cent of mental health service users particularly those on the Serious Mental Illness (SMI) register who are treated in both primary and secondary care services receive an annual health check in a bid to help improve a shockingly low life expectancy with a 25-year gap of those with mental health problems or a learning disability compared to those without. Services across the UK struggled to meet this target.

The Jameson project, which began in September, set itself an ambitious target of 90 per cent of service users to have had a health check by December 2020 but at the time it found that on average 13 per cent had had a check in the past year across Westminster, Kensington and Chelsea, Harrow and Brent – equating to 473 people out of a total service user population of 3,829.

Physical health check rates are traditionally low among those with a mental health problem or a learning disability.

And during the pandemic, health check rates worsened with service users confused about whether they should attend clinics or not, given the messaging about reducing pressure on the NHS. 

But the project has shown signs of success. As of March, just 223 service users hadn’t a health check – equating to about 4.52 per cent while more than half, 2,301 have had a phone assessment and 1,946 people have had a full assessment, equating to about 45 per cent.

Within these overall figures the boroughs of Kensington and Chelsea and Harrow have done really well with everyone having had some form of health check.

The project worked out that for a quick result, the most convenient way to improve numbers of health checks is to actively contact service users and to invite them for a full health check during a service user’s regular Depot or Clozapine clinic sessions.

Many service users said they hadn’t been contacted by anyone for a while so were grateful just to have someone to talk to.

The project also took advantage of conducting a check when service users attended the service for their regular mental health review appointment with their care team and in inviting service users to wellbeing clinics for checks. Home visits to see service users who are not able to attend clinics are also being utilised.

Physical Health Lead Nurse for Jameson Division, Faith Lubimbi, said: “We know that 90 per cent is massive but why not reach high and the results we have so far is an amazing achievement. Credit to everyone – without the support of the dedicated borough leads - this would not have been achieved. An incredible amount of work has gone into this project to make it work – and there’s still so much more to do but we know we’re on the right track.

“We looked at where the service user was likely to be in the next week or month and then looked at the capacity of the Depot and Clozapine clinics and realised that if we worked with the staff there, we’d be able to support service users with full physical health checks, so it was a quick win for us and for the service user. The engagement was then extended to the rest of the service users on the SMI register.

“The other area we concentrated on was phone assessments and for this we used students and rotational nurses, training them fully in use of the systems and understanding what questions to ask.

“We found a number of concerning things relating to service users; either the service user hasn’t attended his or her GP much or we’ve found a number of undiagnosed conditions – we pass on what we find to the service user’s GP. We also examine the data and if we find that, for instance, we have a number of people with diabetes concentrated in a certain area, then we can make a case for having a dietitian in that area.

“Now we are targeting those that need a full physical health check, while also exploring what interventions we can offer without them having to come into a clinic and also looking at how we can make this sustainable and business as usual.”

* CNWL services are governed locally by three divisions: Jameson, Goodall and Diggory.