Shared learning database

Type and Title of Submission


Implementing Physical Health Policy in Islington Residential and Rehabilitation Services


A well-being Advisor was appointed to implement the Physical health policy in Islington Residential and Rehabilitation Services (within Camden and Islington Foundation Trust). This submission relates to the challenges faced and the work that was achieved whilst implementing the policy.



Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG1 - Schizophrenia (replaced by CG82)

Category(s) that most closely reflects the nature of the submission:

Implementation policy

Is the submission industry-sponsored in any way?


Description of submission


People with severe and enduring mental health difficulties continue to be at increased risk of developing many physical health problems including coronary heart disease, diabetes, respiratory disease, obesity and smoking related illnesses. They are almost twice as likely to die from coronary heart disease as the general population and four times more likely to die from respiratory disease. The White Paper (2006), choosing health: Making healthy choices easier consequently identified mental health as a priority area for health improvement in England. In line with the above and other Government initiatives, the Physical Health Policy for Islington Residential and Rehabilitation Services states: *Service users in residential services should be offered an annual physical health check by their GP, and assisted in this by their individual key worker, who should *Assist their clients in arranging and attending the annual check according to their individual needs. *Assist clients to engage with specialist medical or primary health care services when they have a health need. *Support client in health promotion and health preventative strategies. *Carry out a physical health assessment and work with clients on physical health issues. *Physical health needs always to be considered as part of a holistic care plan throughout a service user's placement. However there were concerns about the above Policy being implemented. Consequently a well-being advisor was temporarily appointed to implement the policy and in doing so identify areas of difficulties and helping to solve them. Therefore the overall aim of the initiative was to ensure the Physical health policy was implemented across Islington Residential and Rehabilitation Services. Residential and Rehabilitation Services consist of 11 projects part residential, part outreach, serving approximately 120 service users with severe and enduring mental health difficulties living in the community.


*To ensure increased take up of physical health assessments. *To ensure increased numbers of service users have annual health check *To ensure service users are supported and encouraged to make a behaviour change.


To identify what the difficulties were in implementing the policy and to examine current practices, the post holder carried an audit. This audit looked at how many service users were offered a physical health assessment, how many support/care plans addressed physical health, how many service users had annual health check and how many service users were utilising health promotion services. The findings of the audit: Physical health assessment offered - 32% Care/support plan addressing physical health- 65% Annual health check - 15% Health promotion 14% The findings of the audit were rather concerning but highlighted the difficulties teams were experiencing in addressing physical health. These included: - Some projects did not have an assessment tool hence no assessments were carried out. - Some projects felt the existing tool did not reflect the needs of their service users and were consequently in the process of developing their own tool in time of carrying out the audit. - Some projects were unclear about how to follow the policy, unclear about their responsibilities and unsure how to carry out a physical health assessment. Issues that emerged from audit: - Issues around how information is gathered when doing support/care plans as more support/care plans (65%) address physical health although physical health assessments were not always carried out (32%) - Some projects addressed physical health in support/care plans only if there was a diagnosed health problem e.g. diabetes, despite the fact that service users may have various risk factors for developing many illnesses such as smoking related illnesses. Hence there was little evidence of health promotion activities taking place. - In some cases even if a physical health assessment was carried out, there was no evidence that the outcome of the assessments were acted upon (see report)


Following the findings of the initial audit, the post holder addressed the identified difficulties in the following ways: - Visited teams and clarified expectations in addressing physical health e.g. how often a physical health assessment should take place, what to do with the outcome of the assessment and how this then forms support/care plan. An example of a support/care plan was also devised and given to each team. - The post holder shared the findings of the audit with each team and discussed areas of improvement. - For those teams who did not have an assessment tool, this was provided. - Staff members who lacked confidence in carrying out a physical health assessment, they observed and shadowed the post holder whilst carrying out a physical health assessment. - A smoking cessation advisor and physical health champion was identified in each project. - The post holder worked intensively with the champions and supported the champions on how to address physical health needs and how to do health promotion. - Developed a protocol (physical health champions? responsibilities) and presented this to the champions as well as the managers in order that the champions receive appropriate support in carrying out their roles and duties as physical health champions. The post holder also carried out a second audit to evaluate the above work. This audit showed: Physical health assessment offered - 32% (pre) 87% (post) Care/support plan addressing physical health- 65% (pre) 83% (post) Annual health check - 15% (pre) 62% (post) Health promotion 14% (pre) 57% (post)

Results and evaluation

It is clear that a significant improvement has been achieved. There is an improvement in every area audited; more physical health assessments are offered, more annual health checks are taken up, more support/care plans address physical health and more service users are receiving support internally or externally to improve their health. This includes smoking cessation, weight loss, mammogram, exercise, dental, football, diabetes management and alcohol management. The audit also shows that when physical health is actively addressed and support is provided, service users can make a behaviour change and engage in activities that improve their health. The audit areas of annual health check and health promotion are exceptionally good results and significant achievement as it is through having regular review of physical health needs that detection can take place and treatment offered. Examining the data further and looking at what facilitates engagement with primary care services e.g. GPs and other health professionals, it appears as though service users in Residential projects are more likely to have regular contact with their GP. Most service users in residential projects were registered with one GP surgery and staff had close links with the surgery. In some cases, when service users declined to have any checks, their GP had come out to see them. It is therefore essential that close links with primary care services are developed and maintained not only in residential projects but also in outreach projects. Similarly, health promotion (smoking cessation, losing weight) has also been provided internally. It is argued that this has facilitated behaviour change. Unlike other specialist services who have criteria of for example readiness to change, internal staff have been employing flexible approaches and have been working with ambivalence and other challenges. It is therefore essential that appropriate support around health promotion continue to be available to staff.

Key learning points

Please see results section In order that the already achieved high standard of physical health intervention is maintained, it is recommended that a permanent post is considered as staff and champions are likely to need ongoing support in implementing the physical health policy. The champions are also likely to need ongoing support particularly in providing health promotion. The champions and staff have reported they would like training on how to address physical health particularly when dealing with sensitive issues and how to interpret for example results of blood tests. It is therefore recommended that a permanent post is considered to oversee current work of champions and offer support, training and advice where this might be needed. Main responsibilities of the post holder may include: - To take the lead on implementing new/future developments such as the recent introduction of health pods. - To provide ongoing training, support and supervision on health promotion strategies for staff and champions. - To carry out ongoing audit, reviewing current practices and helping to solve any possible identified difficulties - To be involved in various research/audit projects - To promote holistic approach and share good practice with other services.

View the supporting material

Contact Details

Name:Nazareth Abraha
Job Title:well-being Advisor
Organisation:Camden and Islington Foundation Trust
Address:17-23 Beaumont Rise
Postcode:N19 3AA
Phone:0207 527 7345
Fax:0207 527 7393


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This page was last updated: 28 September 2009

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.