CVD SMI Learning Network Event 29 April 2015 full slides

NHS Improving Quality
Improving the Physical health care of people
with mental ill health:
Cardiovascular health of people with serious
mental illness
National Learning Network Event
Wednesday 29th April 2015

Welcome and Introduction
Steve Fairman
Managing Director (Interim)

Housekeeping
• There will be no fire alarm test today. If the fire
alarm does sound, please make your way to the
front of the building where hotel staff will direct
you.
• Toilets are located near the registration desk
• Please remember to turn off your mobile phone
• Follow us on Twitter @nhsiq#CVDSMI

Improvement
Programmes
• Domain 1 – Living Longer Lives
• Domain 2 – Long Term Conditions
• Domain 3 – 7 Day services & Acute
• Domain 4 – Patient Experience
• Domain 5 – Patient Safety

Living Longer Lives
Hilary Walker
• ‘Practically universal’ use of IPC sleeves in stroke units across
England
• 97% of CCGs using the GRASP suite of audit tools or
alternative (2 new tools COPD and HF) launched in-year
• 8 pilot sites preventing heart problems in patients with
diabetic foot ulcers
• Successful breathlessness symposium and 3 pilot sites
supported to test new models of care
• Four pilot sites improving the physical health of people with
serious mental illness; 200 people attending learning event

CVD Matters: Setting the Scene
Huon Gray
National Clinical Director
Cardiac

“CVD matters: setting the scene”
Huon Gray
National Clinical Director (Cardiac), NHS England
Consultant Cardiologist, University Hospital of Southampton
CVD Health in People with SMI Meeting
London, 29th April 2015

Outline
• Why is CVD important?
• Relationship between CVD & Mental Health
• CVD Outcomes Strategy
• 5 Year Forward View
• Health Checks and CVD Risk
• Conclusions

BHF Heart Stats (2012) http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002097
CVD Mortality in England (all <75 yrs)

Source: www.statistics.gov.uk/ statbase/Product.asp?vlnk=6725
Causes of Death (England, <75 yrs)
(Source: ‘Living Well for Longer’ [ONS data], 2013)

CVD………..
• 200k deaths pa (1:3 of all)
• 4.9m adults have CVD (11.7% of population)
• 1.4m hospital admissions in 2010/11
• 65% were patients under 75 yrs
• >50% were emergencies
• CVD costs NHS & UK economy £30bn pa.
• Prevalence increases with deprivation - Inequalities
“Services for the prevention of CV Disease”
NICE Commissioning Guide 45. March 2012

Deaths by Disease & Deprivation
(England <75 yrs)

Global Burden of Disease Study. Lancet 2013;381:997-1020
UK causes of Years of Life Lost (both sexes, all ages) 1990-2010

UK causes of Years of Life Lost (both sexes, all ages) 1990-2010
259 diseases and injuries & 67 risk factors

DALYs Attributable to 20 Risk Factors (UK)

“The performance of the UK in terms of premature
mortality….is below the mean of the EU15+…….further
progress will require improved public health, prevention,
early intervention and treatment activities……and
deserves an integrated and strategic response”

INTERHEART: Risk of AMI with
Multiple Risk Factors (52 countries, n≈30,000)
Yusuf et al. Lancet 2004;364:937-52

Yusuf et al. Lancet 2004;364:937-52
INTERHEART: Risk of AMI with
Multiple Risk Factors (52 countries, n≈30,000)

JAMA Psychiatry 2014; October 8th

…”people having a first schizophrenia spectrum episode were significantly
more likely to show a host of cardiovascular and endocrinologic risk
factors than the general population of a similar age.”
…”among relatively young patients enrolled (mean age 24) – half were
overweight or obese, nearly 60% had abnormal lipid levels, half have had
raised BP, and 13% had metabolic syndrome”
…”some of these findings likely related to antipsychotic Rx, but the illness
itself and associated unhealthy lifestyles also played major roles”
JAMA Psychiatry 2014; October 8th

Pyschosocial Factors & CVD
• Promotion of atherosclerosis [Circulation. 1999;99(16):2192]
– Direct effects (endothelium, platelets)
– Indirect via usual risk factors
• Depression and anger increase risk of angina
& MI[Normative Aging Study 1998-2000]
• Depression in 20-40% of people having CABG,
and poorer outcomes [Circulation. 2005;111(3):271]
• AHA (2004) recommends depression screening
for those with CHD [Circulation. 2008;118(17):1768]

Pyschosocial Factors & CVD
• EPIC-Norfolk UK Prospective cohort study
[Am J Psychiatry 2008;165(4):515]
– 19,000 people with major depressive disorder in year before
enrolment
– initially free of CHD
– Median F/U 8.5 years
• Those with depression 2.7 more likely to die from IHD
even after adjustment for traditional & other socio-
demographic risk factors

March 5th,
2013
https://www.gov.uk/government/publications/improving-cardiovascular-disease-outcomes-strategy

CVDOS Recommended Actions (10)
• Seeing CVD as one condition (‘family of diseases’)
• Integration of services
• Risk factors, NHS Health Check
• Case finding in 10 care
• Better management in, and support for, 10 Care
• Inherited cardiac conditions (incl. FH)
• Improve survival from OHCA (CPR, AEDs, First Responders,
Education, Registry)
• Raising awareness
• 24 x 7 CV Services
• Care planning (phys & psych support, self care, EOL care)
• Information (CVIN, Service Level Markers, Clinical Audit)
• Research

October 2014
http://www.england.nhs.uk/wp-
content/uploads/2014/10/5yfv-web.pdf
content/uploads/2014/12/forward-view-
plning.pdf
December 2014
Five Year Forward View

Joined-up Leadership
http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

CVDOS Recommended Actions (10)
Alignment with 5-Year Forward View
• Seeing CVD as one condition (‘family of diseases’)
• Integration of services (New Models of Care)
• Risk factors, NHS Health Check (Prevention)
• Case finding in 10 care (Prevention)
• Better management in, and support for PC (Primary Care)
• ICC (incl. FH) (Prevention & Premature Mortality)
• Improve survival from OHCA (CPR, AEDs, First Responders,
Education, Registry) (Premature Mortality)
• Raising awareness (Prevention)
• 24 x 7 CV Services (Equality, 7-Day Working)
• Care planning (Parity of Esteem, New Models of Care, EOL)
• Information (CVIN, Service Level Markers, Clinical Audit) (Intelligence)
• Research (Innovation)

NHS Health Checks
NHS Health Check: explained
The NHS Health Check programme is a national risk assessment
and management programme for those aged 40-74 years
NHS Health Check is a national risk assessment and management programme for those aged 40 to 74 living in England,
who do not have an existing vascular disease, and who are not currently being treated for certain risk factors. It is aimed at
preventing heart disease, stroke, diabetes and kidney disease and raising awareness of dementia for those aged 65-74 and
includes an alcohol risk assessment. An NHS Health Check should be offered every five years.
The programme systematically targets the top seven causes of premature mortality. It incorporates current NICE
recommended public health guidance, ensuring it has a robust evidence base. Economic modelling suggests the
programme is clinically and cost effective.
Each year NHS Health Check can on
average:
• prevent 1,600 heart attacks and
save 650 lives
• prevent 4,000 people from
developing diabetes
• detect at least 20,000 cases of
diabetes or kidney disease earlier
Burden of disease attributable to 20 leading risk factors for both sexes in 2010, expressed as a
percentage of UK disability-adjusted life-years
*The negative percentage for alcohol is the
protective effect of mild alcohol use on
ischaemic heart disease and diabetes.
*
[Ref 4]
[Ref 5]
Top seven causes of preventable
mortality: high blood pressure, smoking,
cholesterol, obesity, poor diet, physical
inactivity and alcohol consumption.
[Ref 1]

http://www.jbs3risk.com
Heart 2014;100:ii1-ii67

Example 1
Young female with significant risk factors
Effect of intensive risk factor modification
• 35-year-old female smoker
• Systolic BP of 160mmHg
• TC of 7.0mmol/L, HDL of 1.4mmol/L
(non-HDL of 5.6mmol/L)
• Family history of premature CVD

Estimated average
survival without a
CV event

Effect of intensive risk factor modification

Conclusions
• CVD still important cause of premature mortality
• CVD increases risk of mental illness
• CVD is common in those with mental illness
• In SMI, CVD Risk factors are similar to those of
people without SMI, but are more prevalent
• CVDOS highlights what can be done
• Five year Forward View emphasises the
importance of prevention and parity of esteem.

Improving the physical health of those
with severe mental health problems
– a patient perspective
Graham Morgan MBE

Updates from NHS IQ Pilot Sites and
the Royal College of Psychiatrists
2gether
Mersey Care
Northumberland, Tyne and Wear
Tees, Esk and Wear Valley
NHS Foundation Trusts
and
Royal College of Psychiatrists

Introduction
Emma Stark
Project Delivery Manager
Living Longer Lives team

Living Longer Lives Cardiovascular Disease/
Serious Mental Illness Team
Clare Beard
Senior
Improvement
Manager
Emma Stark
Project Delivery
Manager
Eleanor Kent-Dyson
Project Delivery
Support Officer
Steve Hodges
Programme
Delivery Manager

CVD Outcomes Strategy
“Action 1: NHS IQ will work with all relevant interests to develop and evaluate
service models to manage CVD as a family of diseases, in the community and in
hospital.
As part of this, NHS IQ will develop and test a standardised template that can be
used in hospitals and in the community, and incorporated into service
specifications, to assess fully patients with cardiovascular problems.”

SMI CVD Project
Presented by:
John Trevains – Deputy Director of Nursing
Helen Eddy – Physical Health Facilitator

What we are doing?
• Designing and implementing a simple and sustainable
process for monitoring CVD risk factors and delivering
targeted interventions
• Using health intelligence data to enhance practice
• Expanding our inpatients programme to a wider cohort
and incorporate the community teams across Trust
• Improving the communication of physical healthcare
information between secondary and primary care

Current Position
• A dedicated nurse to champion and lead this project
• An established health data intelligence system
• Improved communication with staff
o Training provided to all wards
o Clear point of contact
o Intranet
• LESTER tool care plan embedded into our clinical systems to
further support intervention

Next steps?
• Embed training into established training packages
• Establish key relationships with external providers
• Liaison with Primary Care team to work with GP’s and
offer training
• Open RiO – simplifying recording

NHS IQ Project: Improving cardiovascular
health for people with SMI
Dr Simon Tavernor- Associate Medical Director
Joanne Scoltock- Modern Matron (Physical Health)

Mersey Care Project Aims
• Embedding the Lester tool as a trust-wide
standard of care, initially in a 24-bedded acute
male inpatient ward by:
• Identifying staff training needs- medical/ nursing
• Developing specialist service pathways where
needed
• Working with service users
• Raising awareness of the importance of physical
healthcare management.

What We Have Done
• Audit
• Made links with primary care
• Engaged with Service Users
• Made changes to Clinical Information System
• Staff Training
• Revised the Trust Physical Health Policy
• Placed NHS IQ project within a broader trust
strategy for physical health

Future Priorities
• Implementation of changes to clinical
information system
• Focus on piloting on inpatient ward
• Re audit
• Look at equality issues against data
• Engagement with stakeholders
• Development of care pathways- cardiac in
primary and secondary care

Project Summary
• Train and support 96 physical health link
workers across our trust to lead the
implementation of the Lester tool (2014).
• Develop sustainable, effective and clinically
appropriate pathways to deliver the interventions
arising from the implementation of the Lester
tool (2014).

Progress so far…
• Identified 96 link workers (inpatient and community)
• 88 of those have completed foundation PH training
• PH passport being rolled out to all nursing staff
• Regular link worker meetings established across NTW
• Project manager appointed!
• High-level project plan drafted

Next steps
• Develop a detailed project plan
• Promote and ensure continued good take up of
clinical skills training
• Increase link worker confidence in their application
of clinical skills
• Improve quality of information recording on the RiO
core physical health documentation

Tees, Esk & Wear Valleys NHS
Foundation Trust
Karen Conlon, Project Lead (Physical Health/SMI)
Robert Redfern, Project Nurse (Physical Health/SMI)
Jonathan Allen, Project Facilitator (NHS IQ Project)
Mike Leonard, Clinical Pharmacist

WHAT WE ARE DOING
Project Summary:
 Implementing an electronic physical health monitoring
tool incorporating the Lester Tool.
 Educating clinical staff to ensure that physical health
expertise is accessible in one acute ward and one
rehabilitation unit and aligned community teams.
 Improving the inpatient/community/primary care
interfaces.

CURRENT POSITION
 Working group established.
 Clinical staff, service users and carers engaged in the
process.
 Baseline audit of current position submitted.
 Staff training needs identified, training commenced and
staff knowledge survey disseminated.
 Electronic tool ready to go.

NEXT STEPS
 Implement electronic recording tool.
 Continue staff training.
 Audit of service users.

Evaluation of the implementation
of Lester 2014
Alan Quirk and Sonya Chee
CVD SMI Pilot Project National
Learning Network Event
Wednesday 27th April 2015

Aims
To evaluate:
1. The impact of pilot initiatives on levels of physical
health screening and interventions for inpatients
2. How the pilot sites achieved their objectives (or
not) and the factors associated with this

Design & Methods
Design
• Realistic evaluation of pilot sites’ work
• Combines collection and analysis of data from 2 main work
packages (WPs)
WP1: Impact of initiatives on levels of screening and intervention
• Case note audit before and after pilot initiatives
• Analysis of screening and interventions data
WP2: Case studies of Lester implementation
• Site visits – interviews and observation
• How, why, at what rate does the new technology spread?; What do
people do to make the Lester workable?

Progress
• Baseline data received from sites
• Preliminary analysis of screening data
• Introductory visits to all pilot sites
• Observation of networking meeting for pilot sites
• Patient focus group at Mersey Care
• Drafting of patient questionnaire

Baseline sample
Key demographic characteristics (N=328) n (%)
% of patients who were still inpatients at the
time of data collection
91 (28%)
Average length of
stay
Mean number of days 121
Range (min – max):
days
3–2969
Average age
Median age: years 43
Range (min – max):
years
19-98
Gender
Males 252 (77%)
Females 76 (23%)
Ethnicity
White British/Irish or
any other White
background
288 (88%)

• Smoking
• Weight
• Blood pressure
• Glucose
• Cholesterol
Screening and intervention

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NTW TEWV 2gether Mersey Care Total
Patient was
pregnant/gave
birth within the
last 6 weeks
Documented
evidence of
refusal
Not documented
Yes, recorded
Blood glucose screening during inpatient stay

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NTW TEWV 2gether Mersey Care Total
Documented
evidence of
refusal
Not
documented
Yes, recorded
Cholesterol screening during inpatient stay

Best case scenario for Lester
implementation?
• Long patient stays
• Staff with ‘holistic’ philosophy of care
• Teams/specialist staff in place with skills in physical
health
• Technological skill/flexibility of IT systems
• Established links between services
Key question for case studies: how are good outcomes
achieved in different contexts – what is feasible?

Next steps
• Full analysis of baseline data (WP1)
• Site visits to pilot sites (WP2)
• Stakeholder consultation (WP3)

Breakout sessions – Round 1
Session 1: Using the patient voice to improve physical health
care for people with Serious Mental Illness – Somerville room
Session 2: Improving cardiovascular care for people with severe
mental illness - Delivering effective physical health checks in
practice – Main room
Session 3: Physical health interventions - the patient journey
from a physical health perspective from admission to discharge
– Trinity room
Session 4: Reasons for TEWVs success in the National Audit of
Schizophrenia and how we are building on this – Merton room

Breakout sessions – Round 2
Session 5: Physical health and wellbeing is everybody’s
business: embedding the Lester tool through a comprehensive
programme of training and support – Main room
Session 6: SHAPE Programme – Early Physical Health
Interventions for young people with psychosis and bipolar
disorder - Somerville room
Session 7: Screening for cardiometabolic risk factors in people
prescribed antipsychotic medication – Trinity room
Session 8: Sharing experience and expectations for physical
health care in an acute setting – Merton room

Moving beyond CVD to improve
physical health & build collaboration
between primary and specialist care -
using technology at scale across a
whole city (Bradford)
Kate Dale and Angela Moulson

Improving the Quality of
Physical Health Checks
Kate Dale, Mental/Physical Health Project Lead
BDCT
• Dr Angela Moulson
• Clinical Specialist Lead Adult Mental Health &
LD Bradford
NB all material copyright BDCT and BAPCT

Research
• Patients with Severe Mental Illness
(SMI) experience health inequalities.
• The most notable is a shorter lifespan,
reduced by around 20 years compared
to the general population
• There is considerable evidence that one
of the main causes of early death in
people with SMI is cardiovascular
disease
• Other physical causes include cancer

The Quality and
Outcomes Framework (QOF)
• Recommends:
• A physical health check within the last 12
months

Past QOF
Recommendations
• Recording Alcohol consumption
• BMI
• BP
• Cholesterol/HDL
• Blood Glucose
• Cytology Recordings
• However it does not specify
interventions

Present QOF
• BP
• Alcohol
• Cervical Screening
• Lithium

Mental/Physical Health
QoF Indicators
• The practice has a (SMI) register.
• Physical health to be reviewed at 12 monthly
intervals.
• The review includes a check on accuracy of any
prescribed medication
• Side effect monitoring
Review of physical health
Review of co-ordination arrangements with
secondary care
• Lithium monitoring

National Institute for Clinical
Excellence (NICE)
• Offers guidance for:
• bipolar disorder(CG38)
• Schizophrenia (CG82)

The Bipolar Guide
Recommends:
• Thyroid Function
• Blood Glucose
• Lipid profile in the over 40s
• Blood Pressure
• Weight/BMI
• Smoking status
• It also recommends prolactin, liver function tests, renal
function tests, full blood count and serum drug levels to
monitor certain drugs

Proposal to address health
inequalities in the SMI population in
Bradford
• A more specific standardised data entry
template based on existing mental health QOF
indicator
• Specific to areas of physical health risks
prevalent to those with SMI
• More specific tests e.g. blood tests for diabetes,
cholesterol, ECG and other appropriate tests.
• Auditable across the whole city using the
SystmOne primary care information system

First round of audits June/July
2009
• The audit tool used was based on our
proposed best practice template
• To support a proposal for (mandatory)
template locally

Audit Outcome
• 12 practices audited
• Using QOF SMI registers
• 20% of each register
• Random sample
• Total of 104 patients included
• Anonymous
• 42% female 58% male

Audit Findings
77% Had BMI Recorded 79% smoking status recorded
52% eligible patients offered weight loss
advice
87% of smokers had been given cessation
advice
70% of eligible women had a cervical
smear test
55% alcohol status recorded
39% had a cholesterol test and 38% had a
triglyceride test
78% of heavy alcohol users were offered
advice
45% had a blood glucose recorded
3% waist circumference measured
38% had a thyroid function recorded 74% Had blood pressure recorded

Audit Findings
No patients had been given a
cardiovascular risk calculation
This would be a good way to identify high risk people for prevention
No patients had a blood test for
prolactin levels
(elevated prolactin is a significant and common adverse effect of antipsychotic treatment)

Discussion
• The quality of the health checks is in part
very good, but could be improved.
• Priority should be given to calculating
cardiovascular risk.

The SystmOne Physical
Health Check Template
Screenshots

Physical Health Check
Template
• The template is simply added to the GP system
• It supports a high quality check
• It helps predict risk
• It offers advice on what to do with abnormal
findings
• It is linked to a series of audit reports
• It supports QoF reporting

RIO Version
Now Live in Secondary Care
New Physical Health/Wellbeing
Clinics in 5 CMHTs Across BDCT

Second round of audits
• Using the new template in our first
practice
• 75 people were on the SMI register
• Data are available for the first 27 people
checked using new template

Body Mass Index (BMI)
27/27 BMI’s recorded (100%)
4 out of 27 patients had a Normal BMI
23 out of 27 patients had an Abnormal BMI
ALL 23 patients where offered weight loss
advice
4 BMI<25
Normal
10 BMI 25–30
Overweight
8 BMI 30-35
Obese
5 BMI >35
V. Obese

BMI 27=100%
Cervical Smears 10 of 13 eligible=77%
Blood Pressure 27=100%
Cholesterol 21 = 78%
Triglyceride 20 = 75%
Random Blood Glucose 24 (3 were fasting) = 89%
Full Blood Count 27=100%
Liver Function 27=100%
Prolactin 22 = 82%

Thyroid Function 24 = 89%
Smoking Status 27= 100% (18 smokers, 3 ex, 6 non)
Smoking Advice 18 = 100%
Weekly alcohol intake 27 = 100%
Current drug misuse 27 recorded = 100% 0 current users
On Lithium 2
ECG 23 Requested
Q Risk 13 Recorded = 48%

Quarterly Reports
April 2011
Baseline
Total SMI
Population:4,608
on CPA 811
July 2011
Quarter 1
Total SMI
Population:4,657 on
CPA 824
September 2011
Quarter 2
Total SMI
Population 4,719
on CPA 836

Further Roll out of the physical
health check template across
6 GP practices

Use of Physical Health Check Template for the annual
Review
Practice MH
Register
Annual
Review
Baseline
Annual
Review
Q1
Annual
Review
Q2
A 117 5 (4%) 14 20 (17%)
B 128 0 3 18 (14%)
C 142 0 4 13 (9%)
D 71 18 (25%) 20 22 (31%)
E 38 0 4 6 (16%)
F 60 9 (15%) 7 14 (23%)
Average 7% 18%

Blood Pressure Recordings in last 12
months
Practice MH Register Baseline Q1 Q2
A 117 84 82 86 (74%)
B 128 102 101 107 (84%)
C 142 83 87 93 (65%)
D 71 54 54 59 (83%)
E 38 24 24 25 (66%)
F 60 45 42 47 (78%)
Average (75%)

Opportunities
• Reduce health inequalities
• Reduce preventable deaths
• Improve quality of life, health and wellbeing for
patients and families
• Improve experience of health services for
patients and families
• Tailor interventions to high risk groups (age,
ethnicity, substance users)

4318
325
MH Register, No
Prolactin Level
MH Register,
Prolactin Level in
L12m
Prevalence of prolactin
measurement is low
Prolactin elevation occurs in up to 95% of people on antipsychotic medication,
depending on medication type, and has risks for sexual dysfunction, osteoporosis
and breast cancer

219
4441
QRisk2
No Qrisk2
Prevalence of Qrisk2 measurement
is low

72%
28% 0-20%
High
risk
QRisk2 shows high risk in
SMI population
The prevalence of high risk for cardiovascular death is over twice that in
the general population

The End
NB all material copyright BDCT

Mental health 2015/2016 priorities
& achieving parity of physical
health care
Geraldine Strathdee
National Clinical Director
Mental Health

NHS | Presentation to [XXXX Company] | [Type Date]
1
2
Parity of esteem : Improving the
CVD of people with SMI health
Dr. Geraldine Strathdee, National Clinical Director for Mental
Health……..@DrG_NHS
April 2015

This talk : Mental health’s time has come!
• Join the social movement of 250,000 leaders for action on mental health
• Update on the national public & political support for mental health
• The 5 year Forward View :what it means for mental health & recovery
• Update on the major commitment to parity of physical healthcare in MH
Thanking you front line leaders
• We need to to give 15 minutes of your time:
• Mind and Rethink Mental Illness are running an online survey to gather views
that can be inputted to the mental health Taskforce.
– The link is here: http://www.surveymonkey.com/s/mh2020
128

International Human Rights movement
Access to proven effective treatment delivered, in a society that provides care and not contempt for
people experiencing an episode of mental illness, has become an international Human Rights movement
129

3 new intelligence results coming soon
• Primary care QOF:
– Heart UK data
– The Atlas of Variation
• Community sample
– The National audit of Schizophrenia, 2014 community
population and now on My NHS
• All inpatients in every bed type in England
– The CQUIN inpatient
130

131
The Mental Health Taskforce of England
5 Year Forward view Lifespan mental health
Being Born well Best early years Living and working well
Growing older
well
Dying well
Building
Positive mental
health in
individuals and
communities
through raising
political & public
awareness and
reduced stigma
Prevention of
mental ill
health
through addressing
the fundamental
causes
Improving
access to
timely, effective
services for the 16
mental health
care pathways
maximizing the
potential of the
digital revolution
Transformation
of services to deliver
value, better
outcomes, quality &
personalized Right
Care
Building a
sustainable
future
Of
Leaders, intelligence
& and improvement
programmes

Access to evidence based care
7 Right Care NICE/SCIE effective care interventions
1. Right information that empowers & enables choice & self
management
2. Right Physical health care in primary care & specialist MH providers
3. Right Medication education, monitoring, support for adherence
4. Right Psychological therapies
5. Right Rehabilitation/ training/ employment
6. Right Care plan for housing, healthy lifestyles, self management
7. Right crisis relapse prevention care plan
In the Right least restrictive setting by the Right trained & supervised team
1
3
This applies to wider primary care, inpatient & community care
specialist mental health and social care providers

CQUIN: The top 8 key implementation tips
Board to
floor
commitment
• Clinical leadership by top clinical leaders
• Proper sophisticated programme management
• Co design and constant fed back of progress in a
dashboard to each clinical team so they can own the
need to improve
• Commission and employ GPs & practice nurses to come
on to wards to do immediate action, but also to train and
supervise MH staff
• Use templates for both primary and secondary care : like
any QOF activity
• Work force training , preferably practice nurses and ward
nurses and MDTs together
• Use the creativity of your staff to co run healthy lifestyle
groups

The provision of healthcare is now very challenging
smart thinking, all hands on deck, resilience needed
There is no option but to do High impact actions
• 40-60%: Tele triage ( skilled) reduces need for face to face by 40% & gets the
right care quicker
• 10% account for 40% resource: Stratification of the top 100 repeating crises,
avoidable repeat detentions, repeat admissions
• Think like a patient, behave like a taxpayer: Variation is a stupid waste of money
we have to share & learn from the best
• Early intervention means better outcomes & less demand in medium term
• Hope and optimism by MH professionals as good as the Afgistan vets
• Mobilizing service users, their supporters & communities in their care
plans & Personal health budgets
• Streamlining pathways :help identify the issues NO duplication
• Using digital to half paperwork to free up time to care……
• Staff and SUs: getting active, having fun, shared creativity
134

What are our 5 aims for lifespan mental health?
1. Building resilient individuals and communities: To continue to build public and political
support for mental health reform through increasing awareness of the individual and societal benefits of positive
mental health & awareness of the types & causes of mental illness, in order to transform attitudes to mental
health & reduce stigma. The power of social media & digital enablers are key
2. Preventing mental ill-health : To understand and maximize the opportunities for prevention of
mental ill heath, and the promotion of mentally healthy and resilient individuals and communities:
3. Introducing access standards to timely, effective care with outcome
measurement When a person develops mental illnesses, they have timely access to personalized ,
integrated, holistic, effective, high quality treatments, that optimizes the health & functional outcomes & quality
of life for individuals, their families, and, as the norm, takes place in the community or in the persons home, &
reduces unnecessary use of healthcare resources.
4. Transformation of services : When a person’s illness is complex and severe, and requires specialist
interventions, that the care provided, is personalized, culturally appropriate, delivered in the least restrictive
settings and 24/7 personalized home care services by trained and supported staff
5. Building a sustainable future :To develop & deliver the transformation needed, though creation of
an expert ‘state of the art’ leadership development, implementation & improvement programme and promotion
of a Learning Organisation model throughout all our commissioned healthcare organizations

Empowering patients
• Information- Access to information
will be improved. Within 5 years all
citizens will be able to access their
medical care records & share them
with carers or others they choose
• Provide support to people to
manage their own health- There will
be investment in evidence-based
approaches e.g. group-based
education for people with specific
conditions & self-management
educational courses
• Increase patients direct control
over the care provided to them-
Ensure that patients have choice
over where and how they receive
care
• Integrated Personal
Commissioning (IPC)- A voluntary
approach to blending health and
social care funding for individuals
with complex need
• Supporting Carers- New ways will be found to
support carers, by working with voluntary
organisations and GP practices to identify them and
provide better support
• Encouraging community volunteering- Develop
new roles for volunteers which could include family
and carer liaison workers, educating people in the
management of long-term conditions and helping with
vaccination programmes
• Stronger partnerships with charitable and
voluntary sector organisations- The NHS will try to
reduce the time and complexity associated with
securing local NHS funding by developing a short
national alternative to the standard NHS Contract
where grant funding may be more appropriate and
encourage funders to commit to multiyear funding
wherever possible
• The NHS as a local employer- The NHS is
committed to ensuring that boards and the leadership
of NHS organisations better reflect the diversity of
local communities they serve. As an employer to
ensure all staff have support and opportunities to
progress and create supported job opportunities to
‘experts by experience’ e.g. people with learning
disabilities who can help drive changes in culture and
services
Engaging communities

Transforming Mental health care in England 2020
to achieve parity of access, effective care, quality & value across the Lifespan: 5YFV
Communities:
•Building informed, collaborative resilient communities Training every leader in intelligence
•Maximizing prevention
Introduction of access & integrated, effective care standards & measured outcomes for
•the 16 mental health conditions /pathways from primary care to specialized commissioned provision
•Starting with early intervention psychosis, perinatal mental health , eating disorders, liaison and CYP
Integration of clinical practice and pathways through transformation of
•Primary care: Integrated assessment, treatment, skillmix, federations, digital, stratification approaches
•Acute care: Liaison services to Acute care: A/E &
•Integrated care pathways in LTC clinics in acute trusts & community provider services
•Vanguards, and new models of commissioning & payments
Crisis Care transformation: Inverting the triangle & achieving fidelity models
•No more CYP in police cells, stratification
Transforming specialist mental health services through transformation of
•Psychosis care: 60% spend & needs: improving access, Right Care, reducing major efficiency variation, stratification
•Maximizing use of current resources to community based, multidisciplinary, multi agency teams and recovery
Enablers: Leadership, Workforce, Networks, digital, scientific revolution, payment systems

Care planning : 21st century Recovery style
– Identifying the social & friends & family support & knowledge network
– Coproduced formulation, agreeing the issues, offering Choices
– Shared decision making in care planning ( Newcastle)
– Personalization, including Personal Health Budgets
– ‘I” first person singular coproduced care plans
– NICE/SCIE evidence based integrated care to deliver Outcomes
– Using technology to reduce bureaucracy & free up time to care
– Service users, their networks & staff: coaching model & having fun
138

Baseline: What was the starting problem with mental
health crisis services in England in 2014
If I have a physical health
crisis I ring 999 or 111 and
get expert help
If I am in mental health crisis
, I don’t know what number
to ring or where I should go
to get help
If I have a physical health
crisis and I go to my GP or
A/E, staff are trained to
manage my acute care
If I go to my GP surgery in a
mental health crisis, I have a
1: 3 chance of being assessed
and treated in line with NICE
basic standards
I may end up in any of 14
different places to get help in
crisis including police cells,
transport police, duty
systems in mental health and
acute care, A/E, home care.
I may be brought to a police
cell for a mental health
assessment rather than a
hospital
If I go to A/E I have only a
45% chance or being
assessed by staff trained to
do mental health
assessments
I am more likely to keep
having to come back to A/E
in crisis when I don’t get a
trained response and am
more likely to go on to
commit suicide
I have just a 45% chance of
being seen by a trained
mental health liaison team in
A/E so I am more likely to be
admitted to a bed in a
hospital or care home
If I am seen by a crisis home
treatment team they are so
busy that they can give me
and my family less support
than I need
If I need admission to a
mental health bed in a crisis,
I may have to travel
hundreds of miles
If I am from a BAME
community my crisis is likely
to be responded to by police,
not healthcare

The MH crisis concordat / UEA care model
8. Adequate beds when needed
7. Alternatives to Hospital beds e.g.
day treatments and crisis houses
6. 24/7 Liaison mental health teams in
A/E & acute trusts all ages
5. 24/7 Crisis Home Treatment Teams
4. Places of safety for S 135/136
3. Trained tele triage & tele health
2. Single number access ? 111
1. CCGs & HWWBs tackle causes
1. Identify Causes & Prevent by all agencies :
• Identify the causes of MH crises & prevent
• Public health, Health & Wellbeing Boards, CCGs, transport systems,
police, housing, social care, primary care
2. Single coordinated access number & system
• single access number to ring ? 111
• all agency response, GPs, social care, NHS
3. Tele triage and tele health well trained staff
• Reduce suicide & face to face need by 40%
• Respond to police & other referrers
4. S 136 places of safety/ street triage
5. Crisis Home treatment teams with fidelity
• reduce admissions and LOS by 50%
• ? Could coordinate street triage etc
6. Liaison mental health teams
• in A/E & acute trusts reduce admissions to acute beds and
care homes by 50% & reduced LOS
7. Crisis houses & day care for as alternatives
8. Adequate acute beds when needed

CCG/ LA area local characteristics City/urban/rural/deprivation descile
Hot spots for crisis events, e.g suicides, transport hub, mobile populations
Governance
Do u have in place:
Crisis Concordat multi agency programme board established
System resilience Board: MH lead on it
Urgent care networks: MH lead?
Concordat action plan developed
Access standards agreed
Have you agreed local standards
Have you waiting times in line with national standards
What has each agency committed to in the Action plan
Directory of Services Have you got a DOS with the key Local Govt, 3rd sector, NHS & other CQC
registered services: helplines, psychological therapies, bereavement, relationship in and out of
hours Benchmarked in & out of hours the reasons for crisis calls
111 / Single point of access Yes/ No
Tele triage & tele health
Service with trained workforce
Yes/No: Does your single point of access include :
GP in & out of hours MH crisis response
Social care, Housing , Carer crisis response
Street triage police and / or Transport hub triage services
Ambulance hub triage
Liaison & diversion triage for custody
Alcohol and drug services
Crisis Home treatment team Is the team commissioned in line with local need
Does the team operate to the ‘Fidelity’ criteria
Liaison to acute trust/ primary care Is the team Core, Core Plus, enhanced, comprehensive
Was the person a 4 hour breach
What is the team’s RCPsych peer accreditation PLAN network standard
Crisis houses / day treatment Yes/NO
Beds when needed of the right type Beds of all types

Best practice & UEA Cquin needed
• Identify and code the common causes of crisis
• JSNA: is a good crisis section in your local JSNA
• Directory of services and NHS Choices: what’s in your area
• Clinical team dashboard for continuous feedback to teams
• Caseload zoning including NICE Clinical care
• Where are the highest performing teams
• What competencies are needed to work in CHTT
Please add to Crisis Concordat best practice
http://www.crisiscareconcordat.org.uk/inspiration/
• The new UEA CQUIN :Help your frequent users and trust
content/uploads/2015/03/9-cquin-guid-2015-16.pdf

Elective care system in mental health 2015-2020: we are building personalized, recovery
orientated, high quality care, home based 24/7 care & reduction of suicide at every level
High secure
beds
Medium secure
beds
Low secure beds
Intensive rehabilitation closed
unit
for complex dual diagnosis
Open rehabilitation units
Locally authority Residential rehabilitation
Supported accommodation with care package
Own tenancy plus personalized budget
24/7 Assertive outreach/ community forensic team multi
agency teams
24/7 Assertive outreach /rehabilitation & recovery,
multiagency teams
24/7 Assertive outreach /rehabilitation & recovery
multi agency teams
Rehabilitation / recovery team: multi
agency
Rehabilitation / recovery team
CMHT/ Enhanced primary care SMI with
3rd sector outreach
CMHT/ Enhanced primary care SMI with
3rd sector outreach
Design Principle :It is vital to understand that in mental health our ‘technology’ and ‘care model design principle’ is that in order to
provide safe, NICE concordant , efficient services, we need proven effective care teams to link with beds
In mental health we are expert at using case managers to triage all admissions & work early on the discharge plans
The beds The teams

Will you Wo (Man) up for mental health
We have 250,000 mental health leaders
who Speak up & Move to Action for mental health
Will you join that social movement ?
On social media, & from the Crisis concordat and networks we have experts by experience, families,
mothers, teachers, carers, 3rd sector skilled activists, WeNurses, We Docs, WeMH commissioners,
CCG MH leads, BPS, MIND, Rethink, AHSNs, SCNs, Clarhs, maternal mental health alliance, the
leading active communication savvy mental health trusts, HFMA, We AMHPs, pharmacists, Royal
colleges, and other professional bodies, PMs. DPMs, cabinet office, MPs, DWP etc etc and FTN, NHD
Confed, Kings fund, Nuffield foundation, artists, poets, musicians, and many many more in England
We get the leading edge new data, research findings, front running innovations alerts
We share state of the art quality improvement top tips, we share best practice
We now are linked to a growing international mental health social movement aiming to build
Collaborative , compassionate resilience individuals and communities….@DrG_NHS
144

The 15/16 Access & Waiting Time Standards
145
New access standards
• Access to psychological therapies: 75% of people referred to the Improved
Access to Psychological Therapies programme will be treated within 6
weeks of referral, and 95% will be treated within 18 weeks of referral.
• Access to early intervention for psychosis: More than 50% of people
experiencing a first episode of psychosis will be treated with a NICE
approved care package within two weeks of referral.
• Access to eating disorder services for CYP
• Access to perinatal care
• £30m targeted investment on effective models of liaison psychiatry in a
greater number of acute hospitals. Availability of liaison psychiatry will
inform CQC inspection and therefore contribute to ratings.

Next steps : What are the enablers
• The voice of the people & communities & government
• Leadership development
• Information, data, intelligence, improvement
programme
• Identifying what good looks like & leading edge 5YFV
• Communication strategy
• Workforce strategy
• Development of economic modeling tools
• Pricing & Value based commissioning models
• Reducing waste & bureaucracy
• Digital to fast track improvement & access
146

Event Close
Hilary Walker
Head of Living Longer Lives
hilary.walker@nhsiq.nhs.uk
@hilarywalkerNHS

Webinar programme
• Evaluation of Service Improvement in Mental
Health – Tuesday 19th May, 12.30 -13.30
• Demand and Capacity in Mental Health Services –
Friday 26th June, 12.30 – 13.30
• 3 Dimensions of Care for Diabetes (3DFD):
Integrating psychological, social and diabetes care
for patients with poor diabetes control -
Thursday 18th June, 12.30 – 13.30

NHS IQ Website
Further information on NHS Improving Quality’s work
programmes can be found at http://www.nhsiq.nhs.uk/

Slideshare
Slides from today’s event will be available at
http:www.slideshare.net/NHSIQ

Event Evaluation
An email containing a link to an evaluation survey
of today’s event will be sent to all delegates.
Please do take the time to complete the survey as it
will help us design the next event.

Putting Patients First
The NHS England Business Plan 2013/14-2015/16
‘Patients, professionals and citizens need far better information on local
services and need to be able to take control of their health when they want
to. They need to be able to offer feedback on local services and know that
those comments will be acted upon.’
Experience of Care
‘The involvement of patients, carers and the public in shaping and improving
the way in which services are designed, delivered and improved is crucial.’
NHS Constitution
‘Foster a common culture shared by all in the service of putting the patient
first’ and ‘… patients must be the first priority in all of what the NHS does.’
Robert Francis QC

EDNA
Entirely
Demanding of
Nothing
At all

DORA
Demanding
Of
Regular
Attention

Next?
• High expectations
• Have never known a time before the NHS
• Very assertive
• Can research things on the internet
• May film or record their experiences
• User of social media
• Not afraid to challenge authority
• Care and treatment seen as a right and an entitlement when
and where they choose
• May approach the local/national media

What are the benefits?
• Improve healthcare
• Inform and educate
• Build confidence with the public
• Make better use of resources
• Improve how services are evaluated

Think of all the ways we ask
patients, carers and
members of the public for
feedback

How is the NHS currently using feedback?
- asking the right questions before engagement
• Seven day services
• End of life care
• Cancer patient experience survey
• Friends and Family test
• Complaints
• Working with individual trusts
• Mental Health Services (parity of esteem)
• Cardio-vascular projects

Improving cardiovascular care for
people with severe mentalillness:
delivering effective physical health
checks in practice
Dr Sheila Hardy
Senior Research Fellow, Northamptonshire Healthcare NHS Foundation
Trust; Postgraduate Nurse Educator for the Charlie Waller Memorial Trust;
Honorary Senior Lecturer, UCL; Visiting Fellow, University of Northampton

Overview
• Ensuring everyone with severe mental illness receives
screening and lifestyle advice
• How we have implemented physical health checks and the
results we have seen
• Monitoring improvement in practice

Ensuring everyone with severe mental illness
receives screening and lifestyle advice
Why?
• More likely to:
oDie early
oHave a number of modifiable risk factors for cardiovascular disease
oHave a comorbid physical condition
• Less likely to have:
oMonitoring of their physical health
oPhysical examination
oPrompt diagnosis for a physical problem
oIntervention to help change unhealthy behaviour (e.g. smoking)
oScreening for cancer (e.g. mammography)
oSurgical intervention (e.g. following an MI)

Ensuring everyone with severe mental illness
receives screening and lifestyle advice
How?
• Provide financial incentives
• Prepare clinicians, support workers, carers
• Provide appropriate guidance and tools

Payment incentives – primary care
2014/15 QOF ID Indicator wording Changes
MH001
The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other
psychoses and other patients on lithium therapy -
MH002
The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive
care plan documented in the record, (in the preceding 12 months) agreed between individuals, their family and/or carers as
appropriate -
MH003
The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood
pressure in the preceding 12 months -
MH004
The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a
record of total cholesterol:hdl ratio in the preceding 12 months Retired
MH005
The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a
record of blood glucose or HbA1c in the preceding 12 months Retired
MH006
The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in
the preceding 12 months Retired
MH007
The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol
consumption in the preceding 12 months -
MH008
The percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective
disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5
years
-
MH009
The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months
-
MH010
The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4
months -

Monitoring - primary care (pre specific payment incentive for SMI)
Hardy et al. (2013) Journal of Mental Health.

Diabetes
Tested
Diabetes
% tested
Severe mental
illness Tested
Severe mental
illness %Tested
Chi 2 Statistic P value
Blood Pressure 2,298,767 96.1% 355,834 84.1% Chi² = 205712 p <.001
BMI 2,329,552 97.5% 335,652 79.4% Chi² = 691072 p<.001
Cholesterol 2,378,115 98.4% 218,539 71.7% Chi² = 262020 p <.001
HBA1c or glucose 2,363,485 94.9% 197,494 64.8% Chi² = 495257 p <.001
Monitoring - primary care (post specific payment incentive for SMI)
Mitchell and Hardy. (2013) Psychiatric Services.

Locally Enhanced Service (LES)
Enhanced services plug a gap in essential services or deliver higher than
specified standards, with the aim of helping PCTs (now CCGs) reduce
demand on secondary care. Enhanced services expand the range of
services to meet local need, improve convenience and extend choice (DH
2010).
Payment Incentives

Inpatients – Physical Health CQUIN 2014/15
INDICATORS
Indicator 1: 65 per cent of funding for demonstrating, through a national
audit process similar to the National Audit of Schizophrenia, full
implementation of appropriate processes for assessing, documenting and
acting on cardio metabolic risk factors in patients with psychoses, including
schizophrenia.
Indicator 2: 35 per cent of funding for completion of a programme of local
audit of communication with patients’ GPs, focusing on patients on the
CPA, demonstrating by Quarter 4 that, for 90 per cent of patients, an up-to-
date care plan has been shared with the GP, including the holistic
components set out in the CPA guidance.
Payment incentives

Primary Care
38% of practice nurses would like training to carry out physical health
checks for people with SMI (Hardy 2014). 23% currently doing it without
having had training (Hardy 2014).
Secondary care
Over 80% of mental health nurses reported they would like training for the
management of diabetes, cardiovascular health, and nutrition. Sixty-nine
percent would like education about smoking and 67% reproductive health
(Robson et al 2012). A survey carried out on behalf of UCLPartners (March
2015) found 92% of mental health nurses wanted training in how to deliver
a health check and 83% in how to monitor cardiovascular risk.
Prepare staff

Prepare staff – primary care
Hardy and Huber (2014)

175
HENCEL and UCLPartners: Practice nurse masterclasses
Ten modules:
Compulsory
Module 1 – Mental health awareness (classroom)
Optional
Module 2 – Behaviour change (classroom)
Module 3 – Physical health of people with mental illness (classroom)
Module 4 – Wellbeing (classroom)
Module 5 - Co-morbidities: using a psychological approach (classroom)
Module 6 - Alcohol and drug awareness (e-learning)
Module 7 - Medications used in mental illness (e-learning)
Module 8 - Your patient’s journey (e-learning)
Module 9 - Care planning (e-learning)
Module 10 - Specific conditions (e-learning)

Practice nurse training
• The Charlie Waller Memorial Trust have been granted
permission by Health Education England to use these
materials.
• Training can be provided free of charge to identified
healthcare trainers from individual organisations.
www.cwmt.org.uk | email: admin@cwmt.org

177
HENCEL and UCLPartners:
Training for mental health clinicians in preparation
Prepare staff – secondary care

Appropriate guidance and tools
Guidance for all

Tools for all

http://physicalsmi.webeden.co.uk/
Guidance and tools for practice nurses

Guidance and tools for mental health nurses
The HIP

Results from implementation
Monitoring - primary care (post training)
Hardy et al. (2014) International Journal of Social Psychiatry.

Offering lifestyle advice – following training
Hardy et al. (2014) International Journal of Social Psychiatry.

• ~[Title/Initial/Surname]
• ~[Patient Address Block]
• ~[Post Code]
• Dear ~[Title] ~[Surname]
• You are invited to …………..Medical Centre, on…………….at………….for a health
• check.
• The purpose of the appointment is to check that you are physically well and review
• the medications that you are taking. You will be offered a blood test and may be
• offered an ECG (examination of your heart). You can refuse any of the
examinations
• offered to you if you so wish. Please bring a specimen of urine.
• If you have any medical problems these can be dealt with during this appointment.
• If you have any questions or concerns, please contact the surgery by
ringing…………
• Yours sincerely
• Name of Practitioner

Present
• Evaluation of training sessions have shown improvements in clinician’s
knowledge and attitudes (Hardy and Kingsnorth 2015, Hardy and Huber
2014).
• Audits (QoF, NAS can show increase in activity but not quality)
Need for research including qualitative elements to find out impact on
patients (Hardy et al 2013)
Monitoring improvement in practice

Department of Health. (2010) Enhanced Services.
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/DH_4126088
Hardy S. (2014) Mental health and wellbeing survey: A snapshot of practice nurses’ views regarding responsibility and training.
http://uclpstorneuuat.blob.core.windows.net/cmsassets/Mental%20health%20and%20wellbeing%20survey%2020%20Jan%202014.pdf
Hardy S, Deane K and Gray R. (2013) The Northampton Physical Health and Wellbeing Project: The views of patients with severe mental illness
regarding their physical health check. Mental Health in Family Medicine. 9 (4) 233-240.
Hardy S and Gray R. (2012) Is the use of an invitation letter effective in prompting patients with severe mental illness to attend a primary care physical
health check? Primary Health Care Research & Development. 13 (4) 347-352.
Hardy S, Hinks P and Gray R. (2013) Screening for cardiovascular risk in patients with severe mental illness in primary care: a comparison with patients
with diabetes. Journal of Mental Health. 22 (1) 42-50.
Hardy S, Hinks P and Gray R. (2014) Does training practice nurses to carry out physical health checks for people with severe mental illness increase the
level of screening for cardiovascular risk? International Journal of Social Psychiatry. 60 (3) 236-242.
Hardy S and Huber J. (2014) Training practice nurses to care for people with severe mental illness. Primary Healthcare. 24 (3) 18-23.
Hardy and Kingsnorth. (2015) Mental health nurses can increase capability and capacity in primary care by educating practice nurses. Journal of
Psychiatric and Mental Health Nursing. (in press).
Harvey S, Newton A and Moye G. (2005) Physical health monitoring in schizophrenia: the use of an invitational letter in a primary care setting. Primary
Care & Community Psychiatry. 10 (2) 71-4.
Mitchell A and Hardy S. (2013) Surveillance for metabolic risk factors in patients with severe mental illness vs diabetes: National Comparison of
Screening Practices. Psychiatric Services. 64 (10) 1060-1063.
Norman P and Conner M. (1993) The role of social cognition models in predicting attendance at health checks. Psychology & Health 8 (6) 447 – 462.
References

Please feel free to contact me:
Sheila.Hardy@nhft.nhs.uk

Laura Parker, Project Manager UCLPartners
CVD SMI work within
UCLPartners

190
UCLPartners CVD/SMI Projects
• PRIMROSE Trial- Prediction and management of cardiovascular risk for people
with severe mental illnesses. A research programme and trial in primary care
carried out by UCL.
• ERIC-D - a feasibility study of a cardiovascular risk reduction programme in an
at risk population with mental health problems which developed a training
programme for mental health professions in primary care.
• Access to detailed baseline data. Certain CCGs within the UCLPartners
geography have completed a ‘deep dive’ into their data surrounding CVD and
SMI through the UCLPartners Mental Health Informatics Platform. This
platform gives access to the spectrum of mental health illness and data
surrounding CVD risk. It also has the capability to obtain health economics
data.

191
UCLPartners CVD/SMI Projects
• UCLP hosts the CCG Mental Health Leadership Network with the SCN. This
represents an opportunity for engagement in Primary Care.
• The QMUL Clinical Effectiveness Group has produced an SMI Template and
SMI in primary care guide that highlights the codes and approach to screening
used within 3 East London CCGs who use EMIS.

192
Proposed UCLPartners Project
• AIM- to increase the uptake of screening for CVD risk in those with SMI and
ensure that where risk is identified, an intervention is offered.
• HOW?
• Learn from best practice in CVD and SMI within the UCLPartners geography
and from national work that has taken place.
• Use the available data to scrutinise for the true impact of mental health on
mortality rates and current CVD risk. Although we have Standardised
Mortality Ratios for SMI available at borough level as a hard outcome, there is
a lack of info on coverage or outcomes of interventions. We would aim to
improve coverage/ outcomes of interventions we know work to address
causes of premature mortality in this group.

193
Proposed UCLPartners project
• Ensure that where appropriate there is patient engagement in the process to
co-create pathways and interventions, as required.
• Implement a full screening tool for CVD risk (such as the Bradford tool, with
adaptation/testing where required) into primary care within an interested
CCG.
• Ensure that all high impact interventions for exercise, diet, smoking cessation
and alcohol support are embedded in the tool (based on the Lester model.)
• Support GP practices to deliver the required interventions perhaps utilising
services in secondary care depending on what the gap analysis of service
provision is.
• Utilise capability across the system to deliver interventions through the
collection of data from primary and secondary care.

194
Proposed UCLPartners Project
• Link with UCL research that has informed the development of QoF and NICE
guidance.
• Ensure a whole pathway approach to sharing key information between
relevant stakeholders.
• WHERE?
• In order to deliver this potential project, UCLPartners would gather
expressions of interest for involvement from CCGs (and MHTs where
appropriate.)
• We will select a pilot site with the intention to roll out learning to other
interested areas
• WHEN?
• Awaiting the outcome of a business case approval

195
For more information please contact:
www.uclpartners.com
@uclpartners
Laura Parker
Project Manager
Laura.parker@uclpartners.com

Physical health interventions
The patient journey from a physical health
perspective from admission to discharge at Wotton
Lawn Hospital.

Introductions
• Lloyd Andrews (Exercise and Health Practitioner).
• Sophie Lucas (Exercise and Health Practitioner).
• Karen Dawe (Lead Physiotherapist for the Trust).
• Damon Coombs (Ward Manager).

Wotton Lawn Hospital
• 80 bed unit plus a 12 bed low secure unit for working age
adult patients.
• Approximately 630 acute admissions over the 2014-2015
period.

PHYSICAL HEALTH in SMI
• Association between physical co-morbidity and mental ill-health has
long been established. In his 1897 text, The Pathology of Mind, Sir
Henry Maudsley noted: ‘Diabetes often shows itself in families in
which insanity prevails’.
• People with severe and enduring mental health conditions (SMI)
experience worse physical health.
• Reduced life expectancy compared to the general population.
• There is an excess of over 40,000 deaths among SMI patients which
could be reduced if SMI patients received the same healthcare
interventions as the general population.

Physical Health at Wotton Lawn
Hospital (WLH)
• Staff recognise increase in co morbidities.
LESTER tool Red zone ‘high risk’
Smoker 58%
Alcohol misuse 22%
Substance Misuse 31%
BMI ^25 67%
High BP 27%
Abnormal Glucose 13%
Abnormal Lipids 18%

Physiotherapy and the Exercise and
Health Team
• 3.0 WTE Exercise and Health Practitioners (Band 5 and
Band 6).
• 3.0 WTE Physiotherapists (Band 5).
• 1.0 WTE Physiotherapy Assistants (Band 4).
Offering a seven day service 8am-8pm

Physiotherapy intervention as part
of the initial patient journey
• Falls assessment, which may include additional assessment
e.g. Berg Balance.
• VTE assessment
• Further specific assessment. For example; neurological,
musculo-skeletal, respiratory.
• Development of specific treatment and intervention
programmes.

Exercise and Health intervention as
part of the initial patient journey
• MUST assessment (Malnutrition Universal Screening
Tool)
• LESTER tool
• Prioritisation analysis
• PAR-Q
• Development of specific treatment and intervention
programmes/care plans.
• Physical health enquiries within MDT setting – working
in-line with EoC and NEWS scores

Ward based interventions
• Essence of Care screening on admission and minimum
of every 28 days thereafter
• Physical examination by admitting Doctor
• ECG on admission and as indicated
• National Early Warning Score (NEWS) completed for all
service once a week and as clinically indicated.
• Physical health discussed at the MDT meeting each
week for all service users
• Activities coordinator and activities programme

LESTER tool
• The Lester Tool helps to identify mental health patients
at risk of Cardiometabolic conditions and allows for early
intervention. Smoking
Poor
lifestyles
BMI over 25
Hypertension
Raised blood
sugars
Raised blood
Lipids
Substance
misuse
Alcohol use

How we prevent/reduce the risk factors
• Offer a gym within the hospital, swimming and walking groups, hydrotherapy, 1:1 running session,
circuits, Pilates, dance, box fit.
• Healthy living sessions
• Smoking cessation nurses within the physiotherapy/exercise and health department – commencing NRT
• 1:1 health education
• Leaflets
• Liaison and joint working with OT’s, nursing staff, dietician’s, doctors, kitchen staff, turning point, external
government led organisations e.g. change4life
• Offer healthy meal options and food diaries
• Physical health monitoring including weight, BP, pulse, BM’s.
• Address motivation and mental health
• Physical health leads/champions
• Activity coordinators
• Healthy social activities
• Inclusion for all

Case study
Ms B –
54 years old, diagnosed with bipolar disorder as a teenager.
Never married and lived with brother who suffered with alcohol
abuse and unfortunately passed away last year.
Ms B has one friend who she goes on holiday with yearly and will
meet for coffee once a week. Other than this, Ms B leads a
secluded life
Ms B used to be admitted to Wotton Lawn approximately 3 times
per year.
On this admission, Ms B had presented with low mood and low
levels of motivation which resulted in her spending prolonged
periods of time in bed and self neglect.

Assessments completed:- Problems identified:-
• MUST assessment
• LESTER tool completed
• Falls and VTE completed
• PAR-Q
• Waterlow
• Risk assessments for use of profiling bed and
mattress
• Poor knowledge regarding healthy diet and
wellbeing
• Poor sleep hygiene
• Poor house hygiene
• Believed that she had no money
• Required carers for initiation of tasks so to prevent
self-neglect
• On lithium medication
• Obese
• Not meeting the 150 minutes of exercise per week
• Lonely
• Raised blood sugars
• HTN
• Previous breast cancer
• Oedema in lower limbs
• Poor mobility
• Pressure areas of concern

Actions taken:-
• Turning rota and provision of specialist equipment
• VTE monitoring
• Circulatory exercise
• Mobility work and Extend sessions
• Timetabled physical activity to provide structure
• Gym x3 per week (as willing)
• Swimming once per week
• Daily walking for 30 minutes
• Healthy eating advice/food shopping
• Well being advice – sleep hygiene, breast cancer awareness
• Weekly weighing
• Food diaries
• Dr medication review for HTN and diabetes
• Offered support when going to follow up appointments at the breast clinic
• OT intervention for daily living tasks
• Outpatient walk4life every Wednesday morning

Results
• Has not been admitted to Wotton Lawn Hospital for over 1 year and half
• Weight loss of 5kg during 2 month admission
• Continues to attend community walking group every Wednesday and carers also
help with maintaining a healthy diet
• Continues to lose weight in the community and has more structure to her week
• Able to identify signs or concerns regarding breast care
• Regular visits to GP for diabetes and HTN control
• Also seen by recovery team in the community and has asked that she goes for
walks with the team rather than going for coffee

References
1. Lester H, Shiers D, Rafi I et al (2012). Positive
cardiometabolic health resource: an intervention
framework for patients with psychosis on antipsychotic
medication. Royal College of Psychiatrists, London.
2. Holt R (2012). Cardiovascular disease and diabetes in
people with severe mental illness: causes,
consequences and pragmatic management. PCCJ
Practice Review E-publication ahead of print;
doi:10.3132/pccj.2011.085.
3. NICE. Preventing Type 2 diabetes (recommendation
19) http://guidance.nice. co.uk/PH38.

Dr Sally Wise
Consultant Psychosis Team
Clinical Director

Resistance to change
Lithium deaths
QTc sudden deaths

Silos of excellence
• Lithium register
• HDAT
• Both run and monitored by Pharmacy
• Quick, simple, cost neutral solution

Only Applies to Specific Groups

Lean thinking
• Applied to specific patient groups only
• Standard work
• Continuous process
• Visual control
• Monitored through POMH audits
• Clozapine clinics

Now for all patients!
• Specialisation of teams – significant enabler
Vehicle of change and willing to change
• Transparency of problems and obstacles
• Psychosis pathway regulated specific interventions at
time points eg blood test 6mthly etc
• But no sense of patient journey!

Superflow to Model Lines
• Mega event – three groups
• Front, middle and end of pathway
“Standards for all for physical health,
incorporating Lithium, Clozapine and HDAT ”

Timeline
• Houston we have a problem 2007
• Psychosis pathway never worked
• Developing Quality improvement
methodology 2007/8 ongoing
• Specialisation of teams 2008/9
• Electronic case notes 2008/9
• Superflow 2011
• Model Lines 2014
Trust
divided
into 3
localities

Sustain and next steps
• Needs enthusiasm and lots of manual
hard work
• Integrated systems with path labs
• Physical health notes
• Electronic prescribing
• Smoking cessation
• Recovery and wellbeing.

Physical health and wellbeing
is everybody’s business
Embedding the Lester tool through a
comprehensive programme of training and
support

 People with a mental health problem are at greater risk of poor
physical health
 People with severe mental health problems die on average 15-
25 years younger than general population
 Co-morbid physical and mental health problems delay
recovery
 National CQUIN in place as part of NHS
England’s commitment to address this

Second National Audit for Schizophrenia
100 audit of practice
200 service users
Audit of Practice 89
Service User Survey
56
Carer Survey
(surveys passed to
carer via service
user) 16

Your physical health TNS
n (%)
TNS
n (%)
TNS
n (%)
TNS
n (%)
Yes, I have been
weighed and my weight
has been discussed with
me
Yes, I have been
weighed but I do not
know the result
No, I have not been
weighed
No, I did not wish to be
weighed
Q18 Has your weight been
checked by a nurse or doctor in
the last 12 months?
2,470 (74) 44 (80) 315 (10) 5 (9) 462 (14) 5 (9) 75 (2) 1 (2)
Yes, I have had my
blood pressure checked
and the result was
discussed with me
Yes, I have had my
blood pressure checked
but I do not know the
result
No, I have not had my
blood pressure
checked
No, I did not wish to
have my blood pressure
checked
Q19 Has your blood pressure
been checked by a nurse or doctor
in the last 12 months?
2,590 (78) 41 (75) 420 (13) 6 (11) 272 (8) 7 (13) 46 (1) 1 (2)
Yes, I have and the
results were discussed
with me
Yes, I have had a blood
test but I do not know
the results
No, I have not had
blood tests in the past
12 months
No, I did not wish to
have a blood test
Q20 Have you had blood tests
carried out in the last 12months?
2,250 (68) 36 (65) 664 (20) 14 (25) 304 (9) 5 (9) 97 (3) 0 (0)
I smoke and I am
getting help to stop
smoking
I smoke and I am not
getting help to stop
smoking
I smoke and I do not
want help to stop
I do not smoke
Q21 In relation to smoking
cigarettes:
262 (8) 4 (7) 430 (13) 4 (7) 888 (27) 16 (29) 1,727 (52) 31 (56)

Our results
 Monitoring of physical health risk factors = average, but still
below what should be provided.
 Below average for intervention for abnormal blood pressure

What are we doing to
address this?

Improving
Health
Outcomes
Local
Strategies
Physical Health
& Wellbeing
Group
PHWB
conference
Physical Health
Link Workers
&
Champions
Pilot site -
implementing
Cardio-vascular
health
strategies
Transformation
Programmes
Non-Medical
Prescribing
Trust Policies
Monitor
Record
Communicate

RiO Documentation
 Physical health monitoring form
 Medicines, allergies and sensitivities form
 GP summary care plan letter

Physical Health Lead Nurse
 Support the implementation and development of physical
health priorities
 Project manage, coordinate and support development of
physical health link workers across the Trust
 Develop sustainable, effective and clinically appropriate
clinical pathways
 Key role in ensuring all inpatient clinical areas have
suitably trained and resourced link workers

Physical Health Link Workers and
Champions

Physical health skills passport
Physical health skills self-assessment

Two levels of physical health skills training
Foundation
• Meets CQUIN requirements
• Focus on understanding body systems and physiological
observations needed to assess physical health status
Intermediate & Advanced
• Focus factors influencing health
• Intervention frameworks and interpretation of results
• Understanding principles of ‘NEWS’
• Relate to underpinning health indicators
• Other factors indicating deterioration in health status
• Demonstrate proficiency in a skills lab environment

Some positive examples
Learning disability service
• Triage and GP clinics
• Health Action Plans and Hospital Passports
• Liaison Nurses
Forensic unit
• One to one and Group based gym sessions
• Football, tennis and badminton
• Community gym and swimming sessions
• Healthy lifestyle education
• Adult cycling proficiency
Exercise Therapy service
• Exercise Therapy Health Checker

Children and Young People’s Service
• Primary prevention in inpatient and community settings
• Reduce Obesity and improving nutrition and lifestyle
Community Based Physical Health Clinics
• Blood testing, ECG, side effect monitoring, height, weight, waist
measurement, blood pressure, temperature, urine testing, and
increasingly NMP
Building Resilience and Well-being through Sport Conference –
‘Super Mac’
‘Olympics’ style events
Topics of the month

Any Questions?
Thanks for listening

SHAPE (Supporting Health And Promoting
Exercise) Project for Young People with
Psychosis and Bipolar Disorder:
First UK ‘real world’ service model

SHAPE Project Team
Project partners:
• Worcestershire EI in Psychosis
Service (WEIS)
• McClelland Health and
Wellbeing Centre, University of
Worcester
• The University of Worcester
• Public Health trainers
• Smoking cessation
• Sexual health
• South Worcestershire Clinical
Commissioning Group (CCG)

kg
Months
12 240 4836
Established
psychosis
RCT
10
5
20
15
12 kg
4 kg
3 kg
Young People with Psychosis are on a path to obesity, type 2 diabetes,
cardiovascular disease and premature death
Start
HERE
NOW! STOP
natural
history
Established
psychosis
RCT
First episode
of psychosis
12 kg
Antipsychotic-Induced Weight Gain
Alvarez-Jimenez et al (2008)

The same life expectancy and expectations of life
as peers without psychosis

SHAPE Programme: Aims
• To support young people experiencing a First Early
Psychosis to make treatment and lifestyle choices
informed by an understanding of their greater risk
for future obesity, CVD and diabetes
• To provide access to healthcare in a positive and
socially inclusive environment which embraces the
importance of ‘ordinary lives’
• Offered as part of holistic care package to young
people accessing the Worcestershire EIP Service:
• 12-20 individuals per 12 week SHAPE programme
• Rolling programme running 5x over the year
• 60 young people with psychosis will have access to the SHAPE
programme during the 12 month piloting and evaluation
phase

SHAPE programme
• A physical health and wellbeing
intervention programme developed
with an EI service user group
• Structured intensive bespoke
physical health group intervention:
• Delivered over 12 weeks with a
years free gym membership
• Nutritionists, exercise
physiologists, sports therapists
and health trainers expertise
• Utilising student (EAYL) and peer
group support
• Located in a youth focused,
socially inclusive University gym
setting
• Monitoring and evaluation at pre-
intervention, baseline week 1, week
12 and 12 months post intervention.

SHAPE Programme Objectives
• Engage young people with psychosis in relation to
their physical health needs through a structured
health and wellbeing programme
– Improve cost efficiency of physical health
monitoring and intervention via a ‘one stop shop’
– Improve access to health advice
– Reduce tobacco smoking, substance use and
improve diet and healthy lifestyle behaviours
• Enhance quality of care plans addressing physical
health concerns
– Review medication and side effects regularly to
minimise the development of complications
– Complete a documented physical health
assessment within 6 weeks of initiating anti-
psychotic medication
• Maintain pre-illness weight levels or support
weight loss to within 7% of pre-illness weight
levels over 12 months
• Maintain/reduce BMI, blood glucose, lipid profile
and blood pressure within the normal range

SHAPE Programme Elements
• Physical health ‘MOT ‘ assessment at baseline, 12 weeks and 12
months
• Health educational programme on healthy eating, smoking
cessation, substance misuse, dental care, sexual health care
and stress management.
• Group cardiovascular exercise and use of exercise suite gym
sessions
• Personalised nutritional advice.
• Smoking cessation advice.
• Mindfulness and relaxation training.
• Motivational goal setting to review goals and maintain focus
• SHAPE workbook summarising content and practical tasks for
each week to allow the participants to keep a progress record
and use as a learning resource
• Carers evening to engage support from family members
• Collaboration with primary care practitioners to reduce physical
health risks
• Referral for specialist assessment and treatment where
required.

Group Exercise Component
• Evidence based: literature review to inform content/ duration of the group
exercise/gym session components.
• Exercise prescription based on ‘Physical Activity and Mental Health National
Consensus’ (Biddle et al. 2000):
– exercise 2-4 days per week for a duration of 20-30 minutes.
– at a moderate intensity and engaging in a wide range of exercises
– total exercise duration (incl. warm-up and cool-down) approx. 45-60 mins.
• Group cardiovascular exercise and exercise suite gym sessions include aerobic
exercise (badminton, basketball, walking), gym circuits and resistance training
(gym induction/equipment introduction, individualised programmes in open gym
sessions) and other low impact exercise activities (Tai Chi, Pilates).
• Level 3 exercise referral fitness coach leading exercise sessions to gauge
participants exercise intensity/duration to ensure within correct exercise
prescription for the programme, monitor and adapt programme in response to any
exercise related health concerns and for patients with known medical conditions
such as hypertension.

Nutritional Support: Background
• Healthy eating advice offered as part of the
integrated 12 week programme
• Enable participants to make healthier food &
drink choices
• Help off-set weight gain often associated with
medication
• Try to give practical advice & offer access to
one to one support

Week 3: Introduction to Healthy Eating
• Introduction to Healthy Eating
• Review food groups
• What makes a balanced diet
• Talk about fruits & vegetables
– 5 a day (80g is a portion,
potatoes don’t count)
• Review resources:
– Eatwell plate
– Harvard food plate
• Portion sizes for meats, cheese,
saturated fat

Week 7: Menu Planning & Shopping Lists
• Review list of healthy store
cupboard items that can make it
easier to eat healthier at home
– Long life
– Convenience
– Economical
• Tips for health menu planning over
a week
• Tips for healthy eating if buying
food out

Week 11: Healthy Snack tasting
• Session after the gym session
• Tasting session focusing on snacks
– Combination of sweet & savoury snacks to
try
– Gives participants the opportunity to try
new things without spending money in
case they don’t like them
– Hopefully this will help change behaviours
– Review food labels & cost
– Look at calorie content, sugar, salt &
saturated fat content
– Opportunity to talk to peers and nutrition
lecturers, ask questions and get input on
menu planning ideas

Other Resources and 1:1 nutritional support
• Participants offered a range of
leaflets including some with
menu planning tips & shopping
lists & advice re. portion sizes
– NHS Change for Life
– British Heart Foundation
• Free cookbook
• After the 12 weeks participants
can also access a 1:1 nutritional
consultation in the McClelland
centre – 1 hr 15 min session
– Tailored programme can be
developed

SHAPE Location
• McClelland Centre for Health and
Wellbeing, University of Worcester City
Centre Campus
• In Worcester City, 5 minutes away from
main bus and rail stations
• Exercise suite with gym equipment and
weights room
• Group meeting room for educational
sessions
• Clinic room to carry out health MOT’s,
weight and fitness assessments
• Individual consultation rooms for
smoking cessation, sexual health and
nutritional therapy individual
appointments

2
1
9
4
3
2
1
2
SHAPE Attendance by Locality (cohorts 1 and 2)

Monitoring and Evaluation
(baseline (within 6 wks medication initiation), week 1, week 12 and 12 months follow up)
•Key physical health risk markers including BMI, waist circumference, resting
blood pressure, blood glucose and total serum cholesterol
•Weight, fitness levels, readiness to exercise
•Self-reported lifestyle behaviours and healthy coping strategies in relation to
target health behaviours.
•Patient related experience engagement with and acceptability of/satisfaction
with the programme and challenges/barriers to programme adherence.
•Engagement (enrolment, utilisation, adherence) and dropout rates
•Clinical outcomes in terms of recovery, changes in functioning and symptom
improvements
•Cost-efficiency: service usage data, staff time, use of personal budgets

Table 1. Baseline characteristics of SHAPE participants. Data are presented as mean and standard
deviation (SD).
Variable N Mean ± SD Normal range
Age (years) 52 26.3 ± 4.8
Males (%) 42 62%
Cardiometabolic Health Measures
Body mass index 51 29.0 ± 6.1 < 30
Waist circumference (cm)
Males 32
Females 16
90.8 ± 25.4
99.9 ± 12.8
< 102
< 88
Systolic blood pressure (mmHg) 42 124.4 ± 19.5 < 140
Diastolic blood pressure (mmHg) 41 77.0 ± 14.2 < 90
Resting heart rate (beats.min-1) 37 84.9 ± 21.7 < 80
Total cholesterol (mmol.L-1) 36 4.8 ± 1.0 < 5
Triglycerides (mmol.L-1) 16 8.2 ± 24.2 < 1.7
Glucose (mmol.L-1) 26 5.0 ± 0.8 < 6.1
HbA1C (mmol.mol) 23 31.5 ± 11.1 < 41
Prolactin (mIU/L-1) 28 507.4 ± 365.6 < 400

Table 2. Baseline characteristics of SHAPE participants.
Variable N % of SHAPE Participants
Smoking* 47 45%
Alcohol 45 40%
Drug use 44 16%
Sedentary 46 37%
Healthy Eating* 46 30.4%
Medications
Aripiprazole 44 18%
Clozapine 44 23%
Olanzapine 44 27%
Paliperidone 44 2.3%
Quetiapine 44 23%
Risperidone 44 7%

Cohort 1: Outcomes
(June-Sept 2014)
Baseline Physical Measures (n=12 enrolled)
• 6 participants with a BMI>30.0 (Obese)
• 5 participants with a BMI 25.0 – 29.9
(Overweight)
12 week Physical Measures (n=7
completed programme):
• No statistically significant change in
weight, BMI or waist circumference
• 5 participants maintained weight
– 1 had a 6cm decrease in waist
circumference
• 2 participants increased weight by 4kg

Cohort 2 Outcomes
Baseline Physical Measures
• 4 participants with a BMI>30.0 (Obese)
• 4 participants with a BMI 25.0 – 29.9
(Overweight)
12 week Physical Measures (n=7):
• No statistically significant change in
weight, BMI or waist circumference
• 3 participants maintained weight (+/- 1kg)
• 4 participants lost weight (-2 to -8.4kg)
• 3 participants increased weight (+2.4 to
+9.6kg)

Mean within-group change (95% CI)
Paired T-
test
UK
SHAPE (n=17)
SHAPE
Paired T-test
from Pre-post
Bondi
KBIM (n=16)
Bondi
Standard
Care (n=12)
Weight (kg)
0.4
(2.6 to -1.9)
t = -0.342,
p = 0.737
1.8
(-0.4 to 2.8)
7.8
(4.8 to 10.7)*
t = -1.121,
p = 0.31
BMI (kg/m2)
-0.01
(0.7 to -0.7)
t = 0.045
p = 0.965
0.4
(-0.1 to 0.9)
2.6
(1.6 to 3.6)*
t = -0.543.
p = 0.61
Waist
circumference
(cm)
1.0
(4.6 to -2.7)
t = -0.562
p = 0.582
0.1
(-2.1 to 2.2)
7.1
(4.8 to 9.4)*
t = 0.733,
p = 0.51
SHAPE 12 week Outcome Data: Cohorts 1 and 2 (Combined)
(results compared with Bondi ‘Keeping Body in Mind’ (KBIM) Programme data)

Focus Group Evaluations Initial Themes
(Cohorts 1 and 2)
Getting Started
• Social Support: feeling safe (gym environment and location,
welcoming and supportive staff, shown how to use
equipment), pre-existing relationships, group
identity/cohesion, peer friendships.
• ‘Why not!’: nothing to lose, feeling excited and highly
anxious prior to attending.
• Motivation: learning something new, self motivation, group
commitment, gaining confidence, seeing benefits,
integration into weekly routine.
• Normalising: feeling normal identity as ‘a gym user and
someone who exercises’, valued University setting with other
young people/students.

Focus Group comments: Getting Started
• Social support:
“…when people started to talk to me, and I started to talk back to them, it
was easier because I felt like I’d made a friend, and then more friends, and it
was easier than just being on your own, because you felt like you were going
with somebody.”(Focus Group 1)
• Why not!:
“I was suffering from really bad anxiety and panic attacks, and I really didn’t
want to go. I really had to force myself to go, but I survived the first time,
which made me persevere.”(Focus Group 1)
• Motivation
“Yes. Sometimes I wake up and I don’t feel like doing anything, but
because I’m committed to coming I force myself to go”(Focus Group 1)
• Normalising
“I think it’s quite good because there’s other people that come at the same
time, so you don’t feel like you’re here for a specific activity, and there’s
other people working out as well, so you feel like you’re in a normal
environment.” (Focus Group 2)
“Because it’s a Uni- it’s got that extra edge to it. All the students walking
around, learning, smart.”(Focus Group 2)

Focus Group Evaluations Initial Themes
(Cohorts 1 and 2)
Maintaining New Behaviours
 Structured Activities: workbook guidance (mixed
feedback), variation in programme activities, new
knowledge from education sessions
 Gaining Confidence: self identity as ‘active’ and
‘someone who does exercise’, benefits in terms of
fitness levels, new possibilities in relation to
exercise and activities
 Applying new knowledge: lifestyle changes, new
friendships, personal goal setting

Focus Group comments: Maintaining new behaviours
• Structured activities
“Every week was different, I’ll give it that. It wasn’t the same old thing,
it was very varied.” (Focus Group 2)
“I like the talking and nutrition parts. I also liked learning about drugs, I
found it interesting.”(Focus Group 1)
• Gaining confidence
“The sessions have been worthwhile and I have gotten more fit and
I have lost weight” (Focus group 1)
“Easier to move around without getting out of breath” Focus Group 1)
• Applying new knowledge
“It has made me change my routine on other days as well. Before I
wouldn’t want to go out or do anything, like walk my dog. Or I would do
it, but because it was so late in the day that I’d have no choice but to do
it, whereas I’ve started doing it in the morning, then setting up my day
with it, just to get that level of activity and to make me feel just a little
bit better. So it has helped me to know how to exercise.”
(Focus Group 1)
• Family support
“Dad noticed I had lost weight” .”(Focus Group 1)
“my husband helped – we changed our diet together” .”(Focus Group 1)

SHAPE Funding and Support
• Health Foundation 2014 SHINE award
• Funded from June 2014 to September 2015
• Ongoing access funded from personal budgets
• Drinks bottles and step counters sponsored by Postcode
Anywhere
• Logo and design work gifted by Concept Advertising and
Public Relations Ltd

SHAPE website:
www.hacw.nhs.uk/shape

Screening for cardiometabolic risk factors in
people prescribed antipsychotic medication
Lessons from a national, 6-year, audit-based, quality
improvement programme
Improving the cardiovascular health of people with serious mental illness
29th April 2015
Carol Paton & Thomas R. E. Barnes

LIFE EXPECTANCY OF PEOPLE WITH SCHIZOPHRENIA REDUCED BY 20%
60% OF THE EXCESS MORTALITY DUE TO PHYSICAL ILLNESS
Survival curve as a graphic presentation of age at death
Schizophrenia Bipolar disorder No psychiatric illness
Laursen et al. Annual Review of Clinical Psychology 2014;10:425-448. Saha et al. Arch Gen Psychiatry 2007; 64: 1123–1131.
Laursen et al Curr Opin Psychiatry 2012; 25: 83-8. Vancampfort et al. World Psychiatry 2013;12:240-50.

CVD SMI Learning Network Event 29 April 2015 full slides

CVD SMI Learning Network Event 29 April 2015 full slides

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (6)

Semelhante a CVD SMI Learning Network Event 29 April 2015 full slides

Semelhante a CVD SMI Learning Network Event 29 April 2015 full slides (20)

Mais de NHS Improving Quality

Mais de NHS Improving Quality (20)

Último

Último (20)

CVD SMI Learning Network Event 29 April 2015 full slides