“This programme is a real opportunity to improve the life expectancy and quality of life of people with serious mental illness”
Kate Dale, developer of the template

Overview

The Yorkshire & Humber Academic Health Science Network (AHSN) has led the scaling up and adoption of the ‘Bradford Physical Health Review Template’ to improve the quality of health checks for people with a serious mental illness (SMI) who are at risk of dying prematurely due to preventable physical conditions.

The template, developed at Bradford District Care Foundation Trust, supports healthcare professionals to identify patients with conditions including high blood pressure, diabetes and cardiovascular problems.

With 47,713 health checks, potential cost savings in the Yorkshire and Humber region alone are estimated to be £11.3 million over the next 10 years.

The AHSN piloted an initial rollout across two Mental Health Trusts and two Clinical Commissioning Groups (CCGs). It has supported organisations nationally including Imperial Health College Partners, Cumbria Mental Health Services and a prison to implement/pilot the template.

The template is available through the SystmOne, EMIS and RIO web platforms and has been used by 74 CCGs. An eLearning module produced by the AHSN went live in January 2017.

The template has been cited as a good practice case study in national reports including the MINDSet website and NHS England’s ‘Improving physical Health of people with serious mental illness’.

Challenge/problem identified

People with a serious mental illness (SMI) are at risk of dying prematurely, in some cases 20 years earlier than the general population.  Many of these deaths are preventable if conditions like high blood pressure, diabetes and cardiovascular problems are identified and treated early. Estimates suggest there would be up to 12,000 fewer deaths from cardiovascular disease (CVD) if people with SMI had the same outcomes as the general population. The Five Year Forward View for Mental Health recognises the need to address this.

The National Institute for Health and Care Excellence (NICE) recommends that annual physical health checks should be conducted in people with SMI.  Such health checks are designed to look at the six domains; Smoking, Lifestyle, Body Mass Index (BMI), Blood pressure, Glucose regulation, Blood lipids.

People with severe mental health problems receive variable levels of physical care in both primary and secondary care settings. The ‘Bradford Physical Health Review Template’ aims to reduce the variability of care by systematically guiding healthcare professionals through appropriate physical health checks to support the diagnosis of conditions and identify the need for appropriate interventions to achieve improved physical health and wellbeing.

Actions taken

Two Mental Health Trusts and two CCGS across the Yorkshire & Humber region were supported by the AHSN to pilot the use of the template and take a joined-up approach between primary and secondary care to improve the physical health of the patients.

The Yorkshire & Humber AHSN commissioned an independent cost-effectiveness evaluation of the tool and commissioned an eLearning module to support uptake of the template in different CCGs.

Promotional resources including a video of the learning of one Mental Health Trust who adopted the template have also been developed by the Yorkshire & Humber AHSN and tweetchats, blogs and speaker slots at events have also taken place with key stakeholders across NHS England and Public Health England, including the former national clinical director for Mental Health, Geraldine Strathdee.

An independent cost-effectiveness evaluation of the tool by York Health Economic Consortium (YHEC) has shown the cost of each health check is around £68 (including staff time to deliver the check, administration time to support the health check and training costs for the staff).  The evaluation showed the incremental benefit of the health check intervention over 10 years to be £236.68 per patient, hence for a cohort of 1,000 patients, the impact will be a saving of £236,680 over 10 years.

Impacts/outcomes

Yorkshire & Humber 11.3mil in 10 yearsWith 47,713 health checks, potential cost savings in the Yorkshire and Humber region alone are estimated to be £11.3 million over the next 10 years.

“The Yorkshire and Humber AHSN is a shining example of an AHSN that has worked to the best of implementation science and has tackled one of the largest science to floor gaps: bringing access to physical health care for people with mental illness.”
Dr Geraldine Strathdee, former NHS England National Clinical Director for Mental Health

The Yorkshire & Humber AHSN is providing training and pathway guidance to pilots in primary and secondary care in West Yorkshire as well as promoting and supporting the rollout of the template nationally. A free eLearning module has been developed in partnership with Virtual College. This is now available to healthcare professionals working in primary care through the Yorkshire & Humber AHSN’s website

Implementation of the template has resulted in a 372% increase in checks in one Trust alone, 610 organisations and 74 CCGs adopting the template and delivery of 2,600 health checks.

For one patient, the health check identified profound tachycardia resulting in a medicines review and a revised care plan with a reduced clozapine dosage.

The success of the Physical Health Review Template and the Shared Care Recommendations in preventing ill health in this high-risk group and in promoting ‘parity of esteem’ has resulted in national interest and the project has received the following recognition:

  • Shortlisted for the HSJ Awards 2012
  • Winner of the National Patients Safety Award in 2013
  • Project evaluation published in the Psychiatrist Bulletin 2014
  • Project published in the Independent Nurse 2015
  • Received Highly Commended for the Positive Practice Collaborative in 2015
  • Cited as good practice in the Nuffield Report ‘Reshaping the Workforce’ May 2016
  • The project lead has been appointed as the national lead for the Positive Practice Collaborative for Physical Health within Mental Health
  • Project endorsed by Dr Geraldine Strathdee, former NHS England National Clinical Director for Mental Health
  • Referenced as positive practice in NHS England’s IMPROVING THE PHYSICAL HEALTH OF PEOPLE WITH SERIOUS MENTAL ILLNESS: A PRACTICAL TOOLKIT

Plans for the future

The Yorkshire & Humber AHSN continues to support pilots in primary and secondary care in adopting the template and shared care protocols across West Yorkshire as well as promoting the adoption of the template nationally. The Yorkshire & Humber AHSN is also promoting the free availability of a new eLearning module for healthcare professionals working in primary care. This module is accessed through the Yorkshire & Humber AHSN’s website.

Which national clinical or policy priorities does this example address?

  • Care and Quality
  • Health and Well Being.

Start and end date

This work commenced in April 2015 when the Physical Health Review Template had only been adopted by Bradford District NHS Foundation Trust. Promoting the resources and outcomes of this work programme will continue in 2017/18.

Contact us for help and advice

Stephen Stericker, Head of Programmes
E: Stephen.stericker@yhahsn.com

Shaun Lockwood, Head of Marketing & Communications
E: Shaun.lockwood@yhahsn.com

Find out more

Physical health/wellbeing clinics from Geoff Fox on Vimeo.