Physical Health Strategy

Transcription

1 Item 8.1 BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST Physical Health Strategy TRUST BOARD TO BE HELD ON WEDNESDAY 27 JANUARY 2016 Strategic or Regulatory Requirement to which the paper reports - Continuously improving quality by putting service users at the heart of everything the Trust does to deliver excellence ACTION: The Board is asked to note the contents of the report Executive Summary The Physical Health Strategy is attached for approval. The strategy has been developed by Dr J Kennedy and S Coffee and discussed in detail at the Physical Health Committee The aim of the strategy is to outline how we will focus on and discharge our responsibilities to service users in respect of their physical health care needs. This will be done through work with partners such as GP s, GP mental health leaders, Birmingham Community Health care services and the third sector. Working together we should aim to achieve: 1. Improved life style risk detection and sign posting and/or brief advise 2. Improved health and mental well being through implementing a smoke free trust across all sites and services 3. Improved information sharing to reduce duplication and improve base line understanding of our service users health risks at the earliest opportunity. 4. Improved supported access to GP care to ensure a patients risks to their health are well managed. 5. Mutual support and collaboration to put patients first. 6. Improved screening for falls vulnerability, and care planning to prevent falls risks from materialising. 7. An awareness of Venous Thrombo Embolism (VTE) and ensure that our staff have knowledge of screening and care planning to manage the risks. 8. Improved tissue viability management and pressure ulcer prevention. 9. Reduction of urinary tract infections and supported routes for catheter care optimisation. 10. Improved nutrition and hydration management and screening for those who are at risk. 11. Improved surveillance and monitoring of HbA1c and blood glucose monitoring in our

2 community patients to prevent the risks associated with diabetes mellitus. BOARD DIRECTOR SPONSOR: Peter Lewis, Medical Director REPORT AUTHOR: Dr J Kennedy and Sue Coffee APPENDIX: Appendix 1: Physical Health Strategy PREVIOUSLY DISCUSSED: The information has not been previously discussed at the CGC and Physical Health Committee.

3 A Strategy to enable service users to access the physical health care that meets their needs Reducing health inequalities together. With our partners, which include GP s, GP mental health leaders, Birmingham Community Health care services and the third sector we will continue to work together with a common purpose to reduce the health inequalities and preventable disease burden in people with enduring mental health needs. Physical healthcare is a core component of trust services. The aims of this strategy are to set out how we focus on and discharge our responsibility to our service users and to address any variabilities of care our service users might face across the geographical patch served by Birmingham and Solihull Mental health Trust. With clarity of responsibility more service users will have their health risks supported and acted upon by the most appropriate agency. Working together we should aim to achieve: 1. Improved life style risk detection and sign posting and/or brief advise 2. Improved health and mental well being through implementing a smoke free trust across all sites and services 3. Improved information sharing to reduce duplication and improve base line understanding of our service users health risks at the earliest opportunity. 4. Improved supported access to GP care to ensure a patients risks to their health are well managed. 5. Mutual support and collaboration to put patients first. 6. Improved screening for falls vulnerability, and care planning to prevent falls risks from materialising. 7. An awareness of Venous Thrombo Embolism (VTE) and ensure that our staff have knowledge of screening and care planning to manage the risks. 8. Improved tissue viability management and pressure ulcer prevention. 9. Reduction of urinary tract infections and supported routes for catheter care optimisation. 10. Improved nutrition and hydration management and screening for those who are at risk. 11. Improved surveillance and monitoring of HbA1c and blood glucose monitoring in our community patients to prevent the risks associated with diabetes mellitus. Why should we do this? Through real time feedback and annual patient surveys our patients have expressed a clear desire to have more attention paid to their physical health needs. The impact of mental illness and comorbidities on physical health puts our patients at a higher risk of cardiometabolic disorders compared to the general population. This increased risk is contributed to chaotic/sedentary

4 lifestyles, poor nutrition, housing or self-neglect that may make our patients more vulnerable to long term conditions such as diabetes and cardiovascular disease. Psychotropic medication can, in itself, cause metabolic and cardiovascular abnormalities. Recent research in China however demonstrated that those patients who have never received treatment for schizophrenia die sooner than those who have been treated. Life style factors may, in some cases, increase susceptibility to infectious conditions hence the need to be alert to and aware of these vulnerabilities, screen patients and refer them to appropriate agencies for effective management of conditions such as HIV, Hepatitis and TB. Vulnerable groups include the homeless, those visiting south east Asian or African countries, people who have gone through the prison system or have a history of substance abuse. TB is increasing in incidence and the impact of austerity measures on the vulnerable may be associated with a further increase in incidence. The NICE Guidance and evidence base for patients with mental illness highlight the need to monitor physical health, including recommendations for the monitoring of those taking psychotropic medications. Safe prescribing includes monitoring of physical health indices. The national CQUIN role over from last year and the National Audit for Schizophrenia provide significant direction to secondary mental health services. The authors aim is to highlight and identify preventable long term conditions and reduce premature mortality by addressing cardio-metabolic risk factors. Serious Incident reports have highlighted areas in need of improvement. The delivery of action plans arising from these needs to be monitored robustly and reported through the governance and assurance structures. How can we do this? 1. Basic life style risk assessment of the 4 main areas at defined points in the admission process to a team or ward. These key areas are Smoking habits and substance misuse, alcohol consumption, diet and physical activities. By doing this we can allow opportunities for intervention. 2. Robust physical assessment- to include detailed history taking, base line measures and a physical examination where appropriate upon admission to a new service ( see policy for Specifics). The identification of comorbidities is an essential element of the initial health assessment process. 3. Discussion and joint care planning with patients to address health risks and gains at entry points to all services in secondary care. 4. Inspection of pressure areas at admission and at intervals throughout care.

5 5. Shared planning to ensure that communication with GPs maximises information flow, this should include details of ; a. Core health indicator measures b. Underlying cardiovascular or systemic conditions c. Any conditions which impact on access, mobility or health. In the event of inpatient transfer to hospital beds, information needs to go with the patient that is relevant, clear and in a format which is readily integrated into the receiving organisations care record. 6. Agreed pathways which ensure both interventions by trust staff where appropriate and sign posting to the most appropriate agency to address the health risks identified. 7. Clear third sector and services in BCHC directory which is maintained and updated accessible to GP and secondary care staff. Measures of success- how will we know when we have got there? Fewer patients will say their health is the top issue for which they would like more support and a 5% improvement in the patient survey by April 2016 A full directory of services to support health is available through the trust external web site by Jan 2016 Smoking prevalence across service users in 5 years time will have declined by a further 10% from 44% by November 2016 Following treatment reviews, all letters to GP s will have clear monitoring requirements along with life style risks identified, to be shared. There will be an increased level of communication to GP s by: 30% from in patient consultants and increase by 20% for community by January 2016 Significant lifestyle risks will be documented and shared with the GP. GP s will be asked to reciprocate information. This will be consistent across 70% of care records by April 2016 By MARCH 31 ST 2016 All MHSOP staff WILL HAVE received a combined supertraining relating to VTE Continence care Nutrition and

6 Inpatient services focus Communication with GP s Increasing physical activities access and participation on all wards Smoke free services Life style risk assessment and support through brief advice and education. Harm reduction approach addressing staff training needs identified from feedback and SI themes. MHSOP focus on reduction of harms in care. Integrated training for falls prevention, deterioration of respiratory function and neurological observations. Community hub focus Life style risk assessment and sign posting Brief advice and support to patients to address their health risks. Communication with GP s about physical health anomalies Improved monitoring of HbA1c and blood glucose, allowing more robust diagnosis and management of diabetes mellitus; The desired outcome is a reduction in acute and long term complications of type 2 diabetes. Systems improvement 1. Adaptations to RiO to support individuals practice. These include monitoring how whether appropriate indices are measured and reminders to clinicians via prompts 2. Pull through of pathology results direct into RiO to populate individual care records and enable trend analysis. 3. Thematic review of incidents leading to serious morbidity or death from non- accidental causes. 4. Harm reduction monitoring of falls and falls with injuries. 5. Tools enabling safe transfer of patients between BSMHFT and acute care providers. 6. The physical health committee to facilitate and oversee the review of incident data and audit activity and the development of new training or support packages.