Physical Health Strategy 2019 to 2022

Diane Hull Chief Nurse

Bohdan Solomka Medical Director

Introduction

Physical health – improving outcomes through recognising the ‘whole person approach’ and better integrated care.

The purpose of this strategy is to provide direction and outline the key areas to ensure improved physical health outcomes for our service users.

• Prevent – the development of long-term physical health conditions with earlier recognition and response to the deteriorating patient to reduce acute hospital admissions

• Promote – embedding the ‘making every contact count’ approach where health promotion is integrated into our core care activities

• Protect – by making sure physical health screening and recording is timely, appropriate and comprehensive. Working towards the development of Integrated Care pathways with primary care and specialist care clinicians to ensure seamless care

The outcomes are underpinned by the following principles: reduction in health inequalities, joined up care delivered at the right time in the optimal care setting, empowering service users to manage their own health and embedding a culture that promotes a ‘whole person’ approach.

The urgency to address the physical health needs of people with learning disabilities and mental health conditions is widely felt by our service users and their Carers; we know this through our Learning from Deaths.

The fundamental role of NSFT in providing physical health care is for staff need to recognise when there is a physical health problem, monitor and record findings and refer / signpost to the appropriate service to maximise the health and wellbeing of our service users.

To inform the improvement outcomes of this strategy feedback came from a range of focus group events with, service users, carers and staff. Wider consultation included physical health forums, Public Health and Health Education England.

We hope that this strategy will have made a compelling case, a call to action of all. That we can utilise Trust values of working together positively, with a deep respect for the physical needs of our service users.

Key enablers of this strategy

To make sure that individuals that are being treated in our services receive the right physical health care at the right time. That we provide physical health care that is individualistic and able to embrace the needs and diversity of all our services, children, Younger persons, adults and adults in later life.

To be mindful of the context and nature of the people receiving physical health care which is wide ranging whether upon an admission ward, a secure ward or in the community, as an outpatient appointment or within the service user’s home.

To be aware of the challenges of providing services over two counties. How we come together as ‘One Trust’ to meet local commissioning priorities that may dictate variations in the design of integrated physical health care pathways.

To embed a local culture which sees physical health as ‘everyone’s business’ from maintenance staff carrying out equipment checks to the community practitioner in a supportive role as a gym buddy.

2

3 4

The Physical Health Team to work collaboratively with each NSFT Locality Care Group to raise the profile of physical health and to provide an opportunity for front line clinicians to shape the physical healthcare agenda. The Physical Health Team and Locality Care Groups will work together in developing physical health integrated pathways by forging stronger relationships with STP collaborative network groups, CCGs, Primary care and local residents.

5

NN1NN2

NN3

NN4

Great Yarmouth and Northern Villages

South Waveney

SNHIP

Ketts Oak

Mid Norfolk

Breckland

Swaffham

Fens and Brecks

Forest heath

Haverhill Sudbury Woodbridge

Saxmundham

FelixstoweIP1&IP2

South Rural

IP3&IP4

Stowmarket

Eye / North West

Bury Town

Bury Rural

King’s Lynn

Coastal

City 1 City 2

City 3

City 4

Gorleston

North Norfolkand NorwichCare Group

Gt Yarmouthand Waveney Care Group

West and South Norfolk Care Group

Lowestoft

East SuffolkCare Group

West SuffolkCare Group

Physical Healthcare Strategy 2019-2022 3

Care group boundary map

Boundary key:

NSFT Care Group coverage Primary Care Networks

T

This strategy supports the ‘Long Term Plan’ (NHS England 2019) which sets out, what it describes as, a ‘new service model for the 21st century’ with three over-arching principles.

The national picture

• More differentiated in its support offered to individuals… personalised care for individuals to take more control of how they manage their physical and mental wellbeing”

• More joined up and coordinated in its care… to support the increasing number of people with long-term

health conditions

• More proactive in the services it provides… with the move to ‘population health management’ …patient-centred care strategies based on the needs of local populations

“Behind every statistic people with mental health conditions are vulnerable, marginalise and ill served by main stream services we need to adapt services to meet needs and deliver meaningful outcomes”

2018 Conference – Improving Physical Health Outcomes for people

with Mental Health Conditions

The NHS will increasingly be:

T

Physical Healthcare Strategy 2019-2022 5

The NHS will increasingly be:

For people with mental health conditions, these principles could bring significant benefits. At least half of people with a mental health condition also have at least one long-term physical illness, and many have multiple and complex needs that current systems struggle to meet (Naylor et al., 2012).

“NSFT will need to consider the diversity of someone’s physical health needs, as no size can fit all” …Service user

Nationally, there has been increased acknowledgement of the physical health inequalities faced by people with mental health conditions and learning disabilities. These differences can be in relation to prevalence, access to, experience and quality of care and support.

Health inequalities can mean reduced quality of life, loss of self-esteem, low expectation of self and loss of meaning, poorer health outcomes and early mortality.

Interlinking the principles of the NHS Long Term Plan with our three key areas of improvement look like this:

Prevent – long term physical health conditions and cardio metabolic risk by enabling and empowering people to look after their own health more effectively. A focus will be with service users with Severe Mental Illness (SMI) prevent poor health outcomes in the early stages of their illness and prevent further deterioration of existing physical health problems. Promote – healthier life styles with the provision of smoking cessation support for new mothers and their partners and “a new universal smoking cessation” agreement for long-term users of specialist mental health and learning disability services” a step

forward in tackling the 15-20 year mortality gap for people with a severe mental illness, 40 per cent of whom smoke (more than twice the average) targeted weight management support for people with a high BMI and additional funding for the NHS Diabetes Prevention Programme. Protect – by increasing health checks. The NHS Plan seeks to build on progress made through the Five Year Forward View for Mental Health by increasing availability of physical health national screening and annual health checks for the most vulnerable groups of people, for example, people living on the streets.

A

Physical Healthcare Strategy 2019-2022 7

A

Applying Trust values and behaviours

“How can the NHS ensure the two inextricably linked issues of the wellbeing of staff and provision of high-quality care? This means emphasising in practice, as well as in rhetoric, a commitment to high-quality care so that staff feel a link between their work values and those of their organisations.”

… Michael West Caring to Change (2017)

Applying Trust values and behaviours to deliver improved physical health outcomes by recognising the ‘whole person approach’ and better integrated care. Positively... Respectfully... Together...

Positivity

– importance of professionals being willing and able to take a ‘whole person’ perspective and having the necessary skills to do so to support integration of mental and physical health

Respectfully

– reduce inequalities by becoming more professionally curious, exploring the wider social determinants that influence health and acknowledging the unique story of our service users to help lower the incidents of diagnostic overshadowing

Together

– an organisational commitment towards proactive care by embedding the principles of “Making Every Contact Count” clinicians are confident in their role to screen and to intervene / signposting through the co-production of physical health care plans

Our Vision for Physical Health in 2019 – 2022 NSFT recognises that there is a physical, mental and social interlink when considering the health of our service users. Using the biopsychosocial model will help our understanding of health, illness and improve health care delivery outcomes within key areas of Prevent, Promote and Protect.

Mechanisms through which physical and mental health interact

Chris Naylor et al (2016), Bringing together physical and mental health: a new frontier for integrated care, London: The King’s Fund. Available at: www.kingsfund.org.uk/publications/physical-and-mental-health

“Your staff have not only help me get my mind back but also my physical health as well and I leave in several days’ time not only a happier brighter me but a smoke free man too” …Service user

Social determinants eg, poverty, social isolation, discrimination, abuse, neglect, trauma, drug dependencies

• Mental health impact of living with a chronic condition• Psychiatric side effects of medication, eg, steroids• Direct effects of hormonal imbalances on mental health• Increased risk of dementia among people with diabetes / cardiovascular disease

• Physical health side effects of psychotropic medication, eg, raised risk of obesity• Direct effects of chronic stress on the cardiovascular, nervous and immune systems• Direct effects of eating disorders or self-harm, eg, electrolyte imbalances• Higher rates of unhealthy behaviours, eg, smoking or excessive alcohol use• Reduced ability or motivation to manage physical health conditions• Less effective help-seeking• Barriers to accessing physical health care, eg, as a consequence of stigma or ‘diagnostic overshadowing’

Physical health Mental health

Physical Healthcare Strategy 2019-2022 9

• Supporting staff to improve their physical health awareness, knowledge, and skills via the development of a Prevent, Protect and Promote – Trustwide Physical Health Education Pathway incorporating the HEE The physical health competency framework, for clinicians working in Mental Health and Learning Disability services, from Health Education England

• Developing a workforce planning and recruitment model that is aligned with required physical health competencies, in collaboration with external organisations where appropriate

• Making sure that all necessary medical equipment is available, and staff are trained in its use

• Implementation of the ReSPECT process including end of life pathway within Inpatient services

• Implementation of a pressure ulcer reduction programme includes the delivery of Wound Assessment Treatment (WAT) training programme specific to mental health

• The Recruitment of Dedicated Resuscitation Lead Role to work closely with clinicians to:

– Ensure the effective implementation and use of NEWS2 within NSFT

– Develop staff’s skills and confidence in identifying the deteriorating patient

– Embed Simulation Scenario Programme for Rapid Tranquillisation into Prevention and Management Training programme

– Ensure that the a Resuscitation Assurance Practitioner (RAP) link role is fully embedded in ward and community services

– Implement a Trust-wide resuscitation ward / area scenario annual programme

– Ensure that a ‘Resuscitation Local Protocol’ to compliment Resuscitation Policy is available in ward and community services

To improve physical health outcomes:

Prevent – the development of long term physical health conditions with earlier recognition and response to the deteriorating patient to reduce acute hospital admissons by:

Mental health...

...Making every contact count!

Physical A

cti v

ity.

.. an

d...

Staff trainingsessions

?

?

?

?

?

?

Improving staff confidence, knowledge and skills through dedicated physical health training sessions, to improve our service users’ mental health.

• Making Improvements in the way physical health information is recorded internally, linked to other NHS electronic care systems and to show locality performance for assurance purposes by:

– providing an easy to use, purposeful and clear physical health electronic care record which is linked with existing mental health documentation

– ensure end point of data collection systems show performance by dashboard and identify trends to improve safe and quality care

– developing systems through technology in all areas of the Trust to increase efficacy in accessing information from external providers

• Making sure we design our care activities to support our service users to access national health screening programmes

• Making significant improvements in the levels of screening and care planning interventions for modifiable cardiovascular risk factors for service users with Serious Mental Health (SMI) utilising the Lester Tool

• Partnership working to deliver joined-up physical and mental health care; via STP / collaborative group’s to co-produce whole system pathways for health conditions across organistional boundaries e.g. Diabetes, Nutrition and Hydration, Palliative care and End-of-Life care

• Building on relationship with GPs to establish care and treatment interventions for service users once discharged from our care or through shared care arrangements

Protect – by making sure physical health screening and recording is timely, appropriate and comprehensive. Working towards the development of Integrated Care pathways with primary care and specialist care clinicians to ensure seamless care by:

3

• Ensuring the co-production of physical health and wellbeing care plans / goals – by training staff in the ‘Making Every Contact’ approach – which will help to empower front line clinicians by enabling them to create opportunities within their contact and conversations to make a positive influence with service users’ health and wellbeing

• Providing advice, interventions, and signposting to reduce risky health behaviours: through the development of the ‘Be Healthy, Stay Healthy’ booklet co-produced with service users for services users and carers

• Implement a locality-based health promotion ‘resource library’ for signposting to appropriate local services

• Developing IT services to improve communication and sharing utilising aps to help promote the physical health of our service users

• Achieving year on year continuous improvement with respect to promoting smoking cessation services within each locality – increasing the confidence and awareness of our staff to create a culture of ‘making every contact count’ Trustwide

Promote – embedding ‘making every contact count’ approach where health promotion is integrated into our core care activities by

2

© J

une

2019

. NSF

T. L

eafle

t co

de 1

9/07

0. G

FX65

48.

Physical Healthcare Strategy 2019-2022 11

Responsibility for delivery The Medical Director and the Chief Nurse are the Executive Leads for the Physical Healthcare Strategy. The Medical Physical Health Lead and Physical Health Team Lead are responsible for the development of this strategy.

ocality based Care Groups will support the delivery of this strategy. The practical implementation will be supported

via individual milestone plans. Progress will be monitored and shared in monthly Quality Committee meetings. This will provide opportunites to highlight local barriers to implementation, talked through and solutions generated.

Audit data and qualitative feedback from staff, service users and carers will inform and provide evaluation of this strategy.

All feedback will be considered and made available for comment through care group meetings in order to achieve both clinical and service user assurance.

L

Physical Healthcare Strategy 2019-2022 11

Getting involved

Responsibility for delivery

The Medical Director and the Chief Nurse are the Executive Leads for the Physical Healthcare Strategy. The Medical Lead and Physical Health Lead are responsible for the development of the strategy.

Locality based Care Groups will support the delivery of this strategy. The practical implementation will be supported via individual milestone plans. Progress will be monitored and shared in monthly Quality Committee. This will provide opportunity for local barriers to implementation to be highlighted, talked through and solutions generated.

Audit data and qualitative feedback from staff, service users and carers will inform and provide evaluation of this strategy.

All feedback will be considered and made available for comment through care group meetings in order to achieve both clinical and service user assurance.

Norfolk and Suffolk NHS Foundation Trust values and celebrates the diversity of all the communities we serve. We are fully committed to ensuring that all people have equality of opportunity to access our service, irrespective of their age, gender, ethnicity, race, disability, religion or belief, sexual orientation, marital or civil partnership or social and economic status.

NSFTrust

@NSFTtweets

nsft.nhs.uk

01603 421421Trust Headquarters: Hellesdon HospitalDrayton High RoadNorwich NR6 5BE

Patient Advice and Liaison Service (PALS)

NSFT PALS provides confidential advice, information and support, helping you to answer any questions you have about our services or about any health matters.

If you would like this leaflet in large print, audio, Braille, alternative format or a

different language, please contact PALS and we will do our best to help. Email: PALS@nsft.nhs.ukor call PALS Freephone 0800 279 7257