Person Centred

Health Improvement

In this section:

Photo: Skye Centre Atrium

The Board recognises that the relationship between physical health, mental health and nutritional status is unequivocal. The State Hospital is a smoke free environment.

The therapeutic, vocational, social and physical wellbeing needs of patients is met through a range of on-site therapies and activities, including a Health Centre, which meets the primary healthcare needs of patients.

Patients are encouraged and supported to adopt a healthy lifestyle particularly in relation to smoking, activity, and nutrition. As in previous years, the management of levels of obesity and physical activity remain a significant challenge.

The Supporting Healthy Choices initiative undertaken at The State Hospital was presented as a workshop at the RCPsych Forensic Faculty Conference in March 2019 in Vienna. A summary of the work and future direction was captured in a YouTube video for easy access by staff.

Mental Health

Over the last 12 months (2018/19), 36 guidelines / standards were reviewed by the Mental Health Practice Steering Group (MHPSG). Of these, seven were deemed to be either not relevant or were covered by a similar guideline. Of the remaining 29 guidelines / standards, 26 had varying degrees of relevancy to mental health services within The State Hospital and were sent out for information purposes. Further review regarding compliance is being conducted for the remaining three guidelines / standards in relation to Personality Disorder / Borderline Personality Disorder and Post Traumatic Stress Disorder.

Physical Health

The Physical Health Steering Group (PHSG) governs food, fluid and nutrition, weight management, physical activity and physical health services on behalf of the Board.

The PHSG Annual Report covers the period 1 October 2016 to 30 September 2017. Activity undertaken during the year related to six key areas. For each of these areas (outlined below), all Local Delivery Plan (LDP) targets were met:

Primary Care Service (including long term conditions)

All patients are offered an Annual Health Review (AHR). This screening intervention has many dimensions and opportunities that promote health, identify early stages of disease and opportunities to manage and improve existing health conditions. Of the 93 eligible patients in 2018/19, 83 attended, seven declined, and three had their review rescheduled.

The number of patients accepting the Seasonal Flu Vaccination rose to 77; a slight increase of 4% compared to 66% the previous year. Twenty eight of the 37 patients who fall into the additional “at risk” group consented to flu vaccination. This is a significant rise from last year and meets uptake targets for the ‘65 years and over’ group, and the under 65s ‘at-risk’ population of 75%, in line with World Health Organisation (WHO) targets.

The year saw a good update of Colorectal Screening. In September 2018, 29 patients were identified as aged 50-74, and of these, 18 (62%) participated in bowel screening within the two year screening period. The most recent Scottish figures (2017) report an uptake of screening for males in Lanarkshire as 52.3% and within the most deprived areas uptake of below 50%.

As of March 2018, there were 17 patients (15.5%) with Diabetes, 11 (10%) with Asthma and six (5.5%) with Chronic Obstructive Pulmonary Disease (COPD).

Key Performance Indicator (KPI)
Annual Physical Health Review and Access to Primary Care.

The Health Centre consistently meets its targets. In 2018/19, 93% of patients were offered an annual physical health review within 12 months of their last review. The 48-hour access statistics are based on contact with an appropriate healthcare professional. Currently this would include the Practice Nurse, General Practitioners, Physiotherapist, Optician, and NHS24. All patients requiring primary care services had access within 48 hours in both 2017/18 and 2018/19.

Key Performance Indicator (KPI)
Healthier BMI.

On average over the year, the percentage of patients who had a healthier BMI decreased from 15.8% in 2017/18 to 13.7% in 2018/19. The target is 25%. There was a notably dip in Quarter 3 (October to December 2018) when patients with healthy BMIs were discharged and patients with unhealthy BMIs were admitted.

Weight Management and Food, Fluid and Nutritional (FFN) Care

The physical health of patients continues to be a major area of concern.

The Physical Health Education Plan continues to be delivered, and the roles of the Physical Health Steering Group and Health Champions are well established.

Obesity figures, despite much ongoing intervention, are over 20% higher than the national average. At December 2018, 31.5% of patients were overweight compared to 27.7% the previous year. The number of obese patients remained relatively stable at 55.8% (56.5% in December 2017).

Ongoing input and review supporting the Food, Fluid and Nutritional Care standards (2014) highlighted a positive approach to supporting care in this area. An audit of Nutritional Screening Tools (NSTs) and Nutritional Care Plans (NCPs) took place in July 2018; 99% of patients had a NST and 96.1% had an NCP which is a slight decline in the previous year’s figures of 100% and 99% respectively. Health and Wellbeing Plans are replacing NCPs, and will be rolled out across the Hospital in due course.

Physical Activity

The Board sees physical activity as an extremely important part of overall physical healthcare. There is a target for all patients to engage in 90 minutes of activity per week.

Key Performance Indicator (KPI)
Patients will undertake 90 minutes of exercise each week.

The average figure for 2018/19 was 80% against a target of 90%; a slight improvement on the previous year’s figure of 78.7%.

Per week, 56.3% of patients were engaged in 90 minutes or more of physical activity against a target of 60%. This is an improvement on the 2017/18 figure of 48.7%.

National Clinical Guidelines and Standards

Over the last 12 months, 93 guidelines / standards were reviewed by the Physical Health Steering Group. Of these, 82 were deemed to be either not relevant or were covered by a similar guideline. The remaining 11 guidelines / standards had varying degrees of relevancy to physical health services within The State Hospital and were sent out for information purposes.

Training

A slight increase in staff training was noted over the year. The ‘Guide to Healthy Eating’ online training module was completed by 40 staff (38 previously), and the ‘Healthy Eating in a Forensic Setting’ online training module by 28 staff (18 the previous year).

Education and Patient Learning

Patient learning can significantly contribute to care, treatment and longer-term rehabilitation.

Photo: Patient Learning Centre Within The State Hospital learning provision includes accredited and non-certificated programmes and the Hospital has ‘approved centre’ status with a number of qualification awarding bodies.

The Patient Learning Annual Report 2018/19 details service activity levels and key achievements. During the year, 72 patients were engaged in formal learning programmes, 77 formal qualifications were attained including 39 core skill qualifications, 36 vocational qualifications, and two Open University qualifications.

In support of improvement in patients’ educational attainment and life skills through enhancement of literacy and numeracy skill levels, during 2018 there were nine core skill progressions.

The Patient Learning Achievement Awards took place in March 2019.

Health Improvement Publications

Cholesterol and Heart Disease (patient information - Dietetics) (April 2019)