Physical Health in Mental Health ServicesStrategic Group

19thDecember 2013 10.00-12.30

Thistle House, 2nd Floor, Room 1

Attendees: Wendy Halliday (NHS HS) Chair

Clare Hyatt (NHS HS) Minute

Lorna Smith (HPHS @ NHS HS)

Emma Lyon (MH @ NHS HS)

Flora Jackson (PA@ NHS HS)

Jo Gordon (Napier University)

Beth Hamilton (Scottish Government)

Moira Connolly (ScottishGovernment)

Catriona Hayes (Scottish Government)

Chris Kelly (NHS GG&C)

Tommy Harrison (NHS GG&C)

Kevin Lyle (NHS A&A) via VC

Craig Stewart (NHS A&A) via VC

Apologies:Jim Crabb (NHS Forth Valley)

Linda Milne (NHS Forth Valley)

Shirley Hamilton (NHS Forth Valley)

Lyn Speed (NHS Forth Valley)

Susan Fleming (NHS GG&C)

  1. Welcome, Introductions and Apologies

Wendy welcomed everyone to the meeting.A special welcome was extended to Jo Gordon from Napier University who has just started a PhD looking at adherence to physical activity in mental health and borderline learning disabilities. She is also an advanced physio practitioner working in Lothian mental health services.

At Wendy’s request, introductions included personal reflections of the members’ own physical activity and health experiences over the previous week. These ranged from DIYand spinning classes to running marathons.

The attendees were then encouraged to consider the restrictions to accessing physical activity services experienced by those with mental health conditions.

The minutes from 28th October 2013 were reviewed and approved as an accurate record of the meeting. The following action was carried forward from these minutes:

ACTION - Catriona to send on details of Patient Safety Coordinators

  1. National Update

2.1 Scottish Government Update

Moira reminded the group of thepromise made in Commitment 28 to patients on Clozapine; to counteract the side effects of weight gain and sedation with safe physical activity. Since the last meeting, SG have agreed to work with Health Scotland to look at the cost of implementing these standards around Clozapine.

Beth then fed back about a pilot taking place in Inverness involvinga major Pharmacy & GP practice; it is looking at the consistency of physical health assessments for patients at the point of discharge from MHS and also screening their readiness to engage in physical activity in the future. The pilot willbe completed in March and SG will keep this group up to date.

Wendy then shared that there was recently a cross-party meeting at SG on mental health inequalities. She was unable to attend but understood that Alasdair Cook (Scottish Chair of the Royal College of Psychiatrists and based in Lanarkshire) presented a piece focused on the physical health of those with severe and enduring mental illness. He presented a large volume of data on gender differences currently being tracked in Lanarkshire and also highlighted MH’s relationship with substance misuse; particularly the way in which alcohol abuse exacerbates MH conditions.

ACTION – Wendy to make contact with Alasdair Cook and also ask him to present to/attend this group at some point in the near future and circulate the information/data he presented

2.2 Health Promoting Health Service Update

Lorna explained that the only significant CEL1 development was the revisions made to annual reporting templates. These should improve the quality of the reports by tightening the perimeters; boards will have to specify which site/location they are reporting from e.g. mental health facility. The final report for 2013-14 will be submitted at the end of April 2014. The raw data will be published along with a high level paper detailing collaboration work. However, it still must be emphasised that there is often more being done than is reported.

ACTION – Local boards to contact their mental health, health promotion and health promoting health service leads and check local recording methods (Tommy noted that NHS GG&C mental health & learning disabilities data is already being recorded)

Secondly, aministerial-led Group has now been formed to drive forward the HPHS policy (chaired by Michael Matheson). On this group sits a representative from the following professional groups:

  1. Scottish Association of Medical Directors
  2. Scottish Executive Nurse Directors
  3. Scottish Directors of Public Health
  4. Scottish Chair’s Group
  5. Scottish Facilities Group
  6. AHP Directors Group
  7. HPHS National Network
  8. Area Clinical Forum Chairs Group
  9. NHS Chief Executives Group

The 5th December saw the first meeting of this group and the second is scheduled for 25thFebruary. At the second meeting, each professional group must provide the minister with their plans of action.Lornais keen to feed information from this PH in MHS group into the ministerial-led group.

Thirdly, Lorna signposted the group to the PA Promotion Learning Exchange Event in January which will provide a space to discuss how PA is being promoted (solution focussed). Lorna then ran through the initial programme for the day and encouraged the group to share good practice in MHS through this event; there is space on the agenda if anyone would like to present.Wendy agreed and welcomed the boards to share across the four areas of PA in HPHS 1. Planning 2. Training 3.Delivery 4.Evaluation.

ACTION – Local boards to identify staff that would most benefit from this event signpost them towards it (those who haven’t yet engaged in the policy should be given priority for places) and consider presenting at the event

2.3Further Updates

Flora discussed Health Scotland’s involvement in PA promotion work supporting the PA pathway in primary care settings. She suggested that for this PH in MHS project, there are lessons to be learned from the Primary CareFeasibility Study which is now coming to an end (December 2014). The final report will be published at the end of the financial year (2013-14). Aneed to level out variation across practicehas already been identified from this study; detecting which elements of implementation need to be kept and those which need to be discarded is essential. HS are keen for the SCOT-PASQ screening toolto be used across the boards and across healthcare settings. The toolidentifies a patient’s PA status and readiness to be active.

ACTION- Beth to pass details on to Flora then the wider group

  1. Local Updates: test of change proposals and developments

3.1 NHS Forth Valley

As apologies were given by all NHS Forth Valley members, Wendy clarified that they would be invited to update on progress at the next meeting .

3.2 NHS Ayrshire & Arran

Kevin explained that since the last PH in MHS meeting, the NHS A&A members met up and started the planning process for implementing the Physical Activity Pathway into Mental Health Services in Ayrshire & Arran. It is clear there is a great deal of good work already in place in MHS but reporting will be the main barrier; MHS are currently using an online tool/questionnaire. Kevin and his colleagues identified a need to embed the PA pathway in this tool. Further ideas included, updating online physical activity modulesfor staff, implementing a system of PA champions on each ward and putting PA goals into eKSF objectives. Kevin will be presenting on the PH in MHS topic at the next NHS A&A Mental Health Working Group in January to spread the word.

Craig then explained that PDSAs will be used to test these changes. However, essentially A&A will be looking to build on the good practice that already exists and look to change the mind-set of staff rather than give them extra work. He then made a passionate plea regarding the integral nature of this work.

A request was then made for a number of places at the PA HPHS Learning Exchange event on 23rd January to be reserved for mental health workers. Lorna agreed that she could arrange this but also explained that due to technical difficulties at previous events, VC would not be available. Instead, film clips illustrating nuggets of good practice unearthed at the event will be available online. Wendy and Lorna agreed that a PH in MHS event could also be a possibility after the HPHS reports have been made available in the summer.

Wendy confirmed NHS A&A’s news was encouraging and was particularly impressed by the partnership focus and idea of integrating the agenda into the ongoing systems which she believed would provide sustainability. Wendy then questioned whether there is something that could be done nationally to articulate these messages and connect to WRAP & SRI. Beth pointed to ‘mainstream mental health’ and Moira pointed to the Royal College of Psychiatrists group chaired by Alasdair Cook.

3.3 NHS Greater Glasgow & Clyde

Moira explained that her discussion with Chris & Tommy had led them to plan improvements to staff training and confidence in talking with patients about PA; expanding on Chris’s training for mental health nurses. Tommy has identified a senior manager, Colin McCormack, who has agreed to pilot the PA work on the wards in Gartnavel Hospital; ideally on an IPCU (intensive psychiatric care unit).Further plans included, making connections with community programmes e.g. Live Active,developing a communications strategy, PDSA work on the ground, building on Tommy’s previous work at Leverndale and considering how to help patients with addictions (following the Scottish Government 1 day audit of inpatients).

Chris explained that like NHS AA, NHSGG&C are not starting from scratch and plan to work with existing systems such as the ‘Art in the Gart’walking route atGartnavel Hospital. The NHSGG&C members plan to meet in January and feedback data in 6 months. Wendy confirmed that this was encouraging news.

Tommy then talked through NHS GG&C’s Directorate of Forensic Mental Health and Learning Disabilities “Patient Health Improvement Record”. In particular, he suggested this may be useful in MHS for the elderly. MHS in Glasgow are relatively new so staff were very enthusiastic about the tool; it may be harder to implement in existing services. However, it certainly helps if senior management is behind the tool. Craig requested that the tool as a whole be shared with the group once fully ready. Lorna confirmed that the case study using this tool has been sent out to this group. Tommy revealed that an older version with 10 groups was also available (if anyone is interested). Jo suggested that AHPs may be untouched resources and could be champions of the tool.

ACTION: Lorna to re-send link final tool to be shared with group when it is ready

  1. Key Learning Points

Wendy asked the group whether there were any key learning points they wanted to take away. The following points were agreed on:

  • The importance of management by-in
  • The need to tap in to inpatient services
  • Requirement for consistency e.g. minimum data set (could be part of tests of change)
  • The need to consider data collection in more depth to maximise impact
  • Lanarkshire & Lothian model of social prescribing
  1. Support Needs

Wendy encouraged the group to share any information and asked the group to consider any support they may require nationally.Moira indicated that a briefing note would be useful. It was also agreed that existing national training should be investigated.

ACTION – Wendy to link with Suzanne Forrest(lead NES contact for MH) at NES to discuss existing PH education

ACTION – Flora to check in with Sonya Lamb (lead NES contact for PH)

ACTION – Lorna/Wendy to initiate briefing note

  1. Next Steps

ACTION – Lorna to set up HPHS page for Mental Health and provide the link to disseminate information to those not involved in the pilot

ACTION (carried forward) – Wendyto invite members of the voluntary sector to join the group e.g. SAMH, MIND, Scottish Recovery Network (Beth from SG happy to be conduit for this)

ACTION (carried forward) – NHS FV, GG&C and A&A to consider how they would like to implement the pathway in their local board:

  • Clarify data collection methods at local board level
  • Look at existing services and consider what could be shared nationally to reduce duplication
  • Check whether materials are applicable to local areas (e.g. A&A use electronic files only)
  • Consider the technology needed e.g. pedometers
  • Consider a patient’s transition from in-patient to out-patient; link with other local services
  • Focus on ensuring that mental health patients aren’t excluded from mainstream services
  1. Date of Next Meeting

It was agreed that the next meeting should be held end of February/beginning of March2014; a doodle poll will be sent out by Clare.