Shared learning database
Type and Title of Submission
Hearty Lives Bolsover; Improving standards of care for the primary and secondary prevention of cardiovascular disease for people with severe mental illness.Description:
Hearty Lives Bolsover is an innovative partnership project between the British Heart Foundation, NHS Derbyshire and Derbyshire Healthcare NHS Foundation Trust to promote physical health care amongst a vulnerable group in a deprived area with the aim of reducing health inequalities. The project was successful in improving pathways of care and communication between primary and secondary care according to NICE recommendations.Does the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
CG82/CG38 - Schizophrenia (update) / Bipolar DisorderIs the submission industry-sponsored in any way?
Description of submission
Aims and objectives
The aim of the project is to reduce health inequalities and improve morbidity from cardiovascular disease (CVD), through primary and secondary prevention, for people with mental health problems living in Bolsover District. Bolsover was identified as a Spearhead area which means it is in the 20% most health deprived areas in England.Context
Research shows that users of mental health services experience poorer physical health, including higher rates of CVD, than the general population (No Health Without Mental Health: A cross-government mental health outcomes strategy for people of all ages (Department of Health, February 2011). As part of the Choosing Health - Mental Health programme in Derbyshire, a scoping exercise was conducted in Bolsover District in 2008 which highlighted concerns about access for mental health patients to services to improve their physical health and wellbeing. Evidence suggests that it is possible to improve the physical health of this vulnerable group by integrating care pathways between mental health services and primary care services so that people are empowered and supported to address these needs.Methods
1. We worked within primary care to identify patients on the severe mental illness (SMI) register who are aged 40-74 and audited their attendance at physical health check appointments. Linking in with secondary care we are in the process of supporting patients to attend their SMI annual review and the NHS Health Check or secondary prevention reviews depending on the presence of a CVD diagnosis. Compliance with Information Governance recommendations was ensured through confidentiality agreements with the practices and an implied consent model with the patients. 2. Pathways of communication between primary and secondary care were improved to ensure accurate sharing of information regarding patient care plans and physical health check results in accordance with the NICE guidelines for schizophrenia (CG82) and bipolar disorder (CG38). 3. Training and resources were provided in mental health awareness for primary care staff, and CVD for mental health professionals to enable them to work effectively with mental health patients on CVD. 4. A number of events were held to raise awareness amongst patients, staff and carers for the increased risk of CVD amongst people with severe mental health problems, for example healthy cooking course, art day on heart disease and project launch with information stands and activities. The project was fully funded by the British Heart Foundation as part of their Hearty Lives programme.Results and evaluation
The notes of 243 patients were audited in primary care from eleven different GP practices. The results are in agreement with the earlier work indicating a reduced access to treatment and services for people with mental health problems. 83% of those patients on the SMI register who were eligible for an NHS Health Check had either not yet been invited or not responded to an invite. The practices are systematically inviting patients in over a five year period in accordance with NICE CG67 which may account for some of the discrepancy. The numbers are slightly better for non-attendance at the SMI annual review and CVD secondary prevention reviews being 25% and 36% respectively. The project is currently working across primary and secondary care to ensure the remainder are invited and supported to attend. Alongside this missing care plan documentation has been re-supplied and primary care encouraged to share health check results with secondary care in accordance with NICE guidelines CG82 and CG38. Almost every mental health team throughout Derbyshire has had at least one member trained in CVD and equipped to cascade the training to their teams and Health Care Assistants from the GP practices involved in the project trained in mental health awareness. Approximately 200 staff, patients and carers have been involved in events. It is hoped and anticipated that through these those that have been influenced will in turn subsequently influence others with the knowledge they have gained.Key learning points
The project primarily achieved its objectives through the building of a network of effective working relationships with key personnel from primary and secondary care. This was important in motivating staff to 'think outside the box' and afford the right priority for the improvement of the physical care of people with mental health problems in accordance with NICE guidelines. Ensuring at the start that the project met Information Governance recommendations was paramount and enabled required documentation to be prepared. The nature of mental health problems is such that people can lack confidence and enthusiasm to engage with new initiatives. This was overcome through effective publicity and relationship building across mental health services as well as individual patients and carers. Continual awareness raising through relationship building, training and event running served to ensure the heart health of this vulnerable group remained the focus.
|Job Title:||Hearty Lives Bolsover Project Co-ordinator|
|Address:||Public Health, NHS Derbyshire, Scarsdale, Nightingale Close, Off Newbold Road|
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This page was last updated: 30 January 2012