29 July 2021

What is the physical health check target?

CNWL’s Jameson Division, which runs the Trust’s Central London mental health services, have been working closely with vulnerable patients to improve their physical healthcare and reduce premature mortality in people with Serious Mental Illness (SMI).

In 2016, the Government set a mandatory target that 60% of mental health patients should receive at least an annual physical health check. This was in response to a 25-year gap in life expectancy between those with mental health problems or a learning disability and those without.

It is well known that people with schizophrenia have a life expectancy which is approximately 20 per cent shorter than that of the general population. Among other risk factors, such as poor diet, physical inactivity, and high rates of smoking, the harmful effects of anti-psychotic medications have been found to increase the risk of metabolic syndrome (a cluster of conditions that occur together increasing the risk of heart disease, stroke and type 2 diabetes). This can easily be detected through regular monitoring.

In July, Harrow surpassed its target and reached a figure of 73 per cent (above the 65 percent target set in the division). This has been an enormous improvement for Harrow made over the past six months.

How have Harrow Teams achieved this?

Cyrille Tchatchet II, Physical Health Lead Nurse for Harrow Inpatient and Community Mental Health Team, has worked hard to develop physical health awareness across the teams in Harrow by:

  • Promoting the importance of physical health in various business meetings.
  • Talking to colleagues individually and guiding them through the relevant forms and processes.
  • Going through caseloads with staff and teaching them how to carry out proper physical health checks.
  • Training colleagues on the SystmOne Community Hub Dashboard so staff can access essential health records to improve patient care.

Because Harrow doesn’t share the same clinical system as other boroughs, lots of physical health information wasn’t captured previously. Therefore, the teams found creative ways of getting staff the information they needed to perform effective and responsible physical health checks. The teams have achieved this by reaching out to GPs directly and using physical health dashboards to collate information more effectively. Better technology and access to systems such as ICE (blood tests) and WSIC (integrated summary of patient’s health) means they can now review blood results. Training has also been provided which allows teams to offer more comprehensive physical health assessments.

How will they maintain this?

Occupational therapists, psychologists and staff from numerous other disciplines across Harrow are continuing to meet monthly and work creatively to keep physical health checks high on the agenda.

Carrie Whelan, Team Manager for Harrow Collaborative Sphere Community Mental Health Hub and Harrow Psychotropic Medication and Physical Health Team, says: “it’s been great having so many different people at these meetings – it’s no longer just Cyrille and I banging on about physical health! We’re seeing a collective response. The doctors who have come on board are asking questions, seeking advice from our physical health leads, and then passing on this awareness to their colleagues. The goal was to make physical health matter to everyone – not just our nurses. This new culture has become very well embedded now.”

Faasia Osman has recently been recruited as a Nursing Associate. She will work specifically on physical health assessments and will support Cyrille to drive the increase of physical health checks.

How will this learning be applied to other teams and boroughs?

Harrow Community Teams have reached this target as a collective. By working together, as if they were a single service, they have been able to achieve these brilliant results. There will be an opportunity to share these learnings at a bi-monthly Trustwide Physical Health strategy meeting chaired by CNWL’s Chief Nurse, Maria O’Brien. This is an opportunity for the boroughs to share their progress and learn from one another.  

How is this benefitting patients?

Thanks to the rising number of physical health assessments, patients can expect a more holistic approach to their care. Staff are able to incorporate things like dietary advice, smoking cessation and lifestyle advice relating to diabetes; all in service of supporting the patient’s mental health. Patients can also expect quicker access to new medications if needed. For example, staff can start using antipsychotic treatment much quicker by doing their own electrocardiograms (ECGs) and accessing the blood test system. This in turn leads to quicker responses and improvement in wellbeing.

Carrie Whelan says: “We have many patients who might not go to their GP or hospital so physical health checks in a mental health setting are a lot more accessible for them. This process has also improved our engagement with GPs – this means patients have a mental health team and their GPs working more closely together on the same care plan. It’s starting to give our patients a more well-rounded care package.”

What’s the next target?

The Trust has set a 90% target but Harrow love a challenge. Their dream achievement would be to reach 95% in 6 months’ time.