Health Improvement
In this section:
Within The State Hospital, patients are encouraged and supported to adopt a healthy lifestyle particularly in relation to smoking, activity, and nutrition. The State Hospital is a smoke free environment and has its own on-site Health Centre to meet the primary healthcare needs of patients, and a Sports & Fitness Centre which
includes a sports hall and gym. The Supporting Healthy Choices group is well established and drives forward improvement.
As in previous years, the greatest challenge during 2019/20 related to the management of levels of obesity and its related physical health problems.
Improving mental health is The State Hospital’s core business within the requirements of the Mental Health (Care and Treatment) (Scotland) Act 2003 / 2015. The ultimate aim is to meet patients’ mental health needs, enabling, when appropriate, a move onto another setting.
Diagnosis is through assessment and formulation of patient risks and needs (psychological, physical, functional, social and spiritual). Each member of the multi-disciplinary clinical team contributes. The aim is to address identified treatment needs to support recovery from mental disorder and reduce the risk of future offending.
Partnership working with South Lanarkshire Council is well established and provides social work services for patients and their families in addition to liaising with patients’ designated Mental Health Officers (MHOs) across the country. Well-developed relationships exist with the Mental Health Tribunal Service for Scotland and the Mental Welfare Commission for Scotland, and
good partnership working is in place across the Forensic Network to ensure patients are transferred as required. As an organisation committed to learning, The State Hospital continues to share its experience with other NHS mental health services and interested groups.
A strong relationship with the Open University was maintained, with five State Hospital Nursing Assistants enrolling in OU Mental Health Nursing qualifications in 2019. This is not only an excellent career and personal development opportunity for staff, but also contributes to the supply of Registered Nurses nationally. Interest in the programme is high, with four more successful applications for the 2020 intake.
Work-streams from the Scottish Patient Safety Programme (Mental Health) continued to be implemented across
the Hospital, patient Integrated Care Pathways (ICPs) brought about improvements in patient care, standards and guidelines continued to be reviewed, and through psychological therapies patients were helped to improve their mental health, and to reduce and manage any future risk they may present to others (and / or themselves).
Over the reporting period of 1 November 2018 to 31 October 2019, key pieces of work delivered by the Mental Health Practice Steering Group (MHPSG) included:
- Monitoring of the outcome measures with improvement plans agreed where appropriate.
- Implementing updated patients’ admission guidance aimed at supporting the earliest possible engagement in activity for all newly admitted patients.
- A small scale test of change (as part of the TSH3030 quality improvement initiative) to trial a process to more effectively tailor Care Programme Approach (CPA) meetings to the needs of patients.
- A shift from quality assurance to quality improvement in terms of Advance Statements for patients.
- Supporting the delivery of Realistic Medicine within the Hospital.
- Ensuring that the development of any clinical practice takes cognises of the ‘What Matters to Me’ feedback.
Focus from 1 November 2019 included identifying opportunities to support continuity of clinically relevant 2019 TSH3030 projects, informing the development of the Implementation Plan for the new Clinical Care Model, contributing to the development of the new Carers’ Policy, and supporting the Triangle of Care assessment and emerging work-streams.
Patients often have very significant physical health needs related to risk taking behaviours such as substance misuse; or consequences of treatment over a prolonged time in institutional care; or are living with the effect of long term conditions.
The Physical Health Steering Group (PHSG) is responsible for the delivery of five key work-streams. Developments and progress against these work-streams are captured in the PHSG 12 month rolling report covering the period of 1 October 2018 to 30 September 2019.
Highlights are provided below:
1. Primary Care Service (including long term conditions)
The Health Centre provides patients with a range of clinics and services focusing on health, disease prevention, and the monitoring and management of physical health conditions including:
- GP Service
- Optician Service
- Podiatry Service
- Blood Monitoring
- Dental Service
- ECG Clinic
- Physiotherapy Service
- Practice Nurse and Triage Clinics
As per routine practice, all patients were offered an Annual Health Review (AHR), the Seasonal Flu Vaccination, and Colorectal Screening for patients aged between 50-74.
The number of days from patient admission to Sports & Fitness Induction decreased over the year, with 50% of admitted patients receiving their induction between 21 and 50 days. Although this is above the pathway target for access to Sports & Fitness, there has been a steady increase over the last two years in the number of patients able to complete the induction within one to 10 days following admission.
Key Performance Indicator (KPI)
Annual Physical Health Review and Access to Primary Care.
Patients requiring primary care services will have access within 48 hours.
The Health Centre consistently meets its targets. In 2019/20 the annual physical health review averaged at 98.48% and access to primary care was 100%. The 48-hour access statistics are based on access to the appropriate healthcare professional, not solely the GP. Currently this would include the Practice Nurse, General Practitioners, Junior Doctors, Physiotherapist, Optician, Dental Team and NHS24.
Key Performance Indicator (KPI)
Healthier BMI.
The percentage of patients who have a healthier BMI decreased to 8.75% in 2019/20 from 13.7% the previous year.
2. Weight Management and Food, Fluid and Nutritional Care (FFCN)
In December 2019, rates of overweight and obesity were 89%. This data represents an ongoing decline in those patients who have and maintain a healthy weight (87.3% in 2018). Electronic monitoring of weight statistics is now in place through RiO and the Tableau database. Phase 2 of the Supporting Healthy Choices initiative commenced in January 2020.
As part of the FFNC standards, all patients need to be nutritionally screened and have a nutritional care plan in place - the latter approach has developed into holistic Health and Wellbeing Plans (HWP) for patients. In December 2019, 99% of patients had a Nutritional Screening Tool completed and 91% a HWP.
By 31 March 2020, patients newly admitted during 2018/19 gained on average 18.1% of their initial weight in the first year of admission, compared with 13.1% the previous year.
Various strands of weight management interventions exist. New for 2019 was the delivery of the adapted Healthy Living Group for patients with an intellectual disability, and the initiation of a Counterweight programme.
3. Physical Activity
Physical health inequalities for State Hospital patients is significant. Reducing obesity and increasing physical activity are key outcomes in addressing these inequalities.
Throughout 2019/20, the Sports & Fitness Centre facilitated a range of both indoor and outdoor physical activities including table tennis, bowling, football and badminton. These were enhanced with the introduction of four challenges such as ‘cross bar’ and ‘high jump’ to maintain patient motivation and increase both interest and variety. Patients were also supported to use the gym equipment in the Sports & Fitness Centre and within ward areas.
Patient inductions took place both on the ward and within the Sports & Fitness Centre with every effort being made to encourage and involve ‘hard to reach’ patients.
There was an increase in the number of patients participating in moderate physical activity through the month of November 2019. This was due to numerous TSH3030 quality improvement initiatives focused on increasing patient physical activity levels. The majority of these activities took place in the evenings and at the weekends.
Certificates and trophies were presented to patients at the end of the year as part of the annual Sports & Fitness Awards.
Additionally, during the year, six patients completed Level 4 of the Sports Leadership Course and three patients completed Level 5. Nine patients participated in the ‘Bikeability’ cycling proficiency programme and three patients became Sports Volunteers thus providing peer to peer patient support.
Key Performance Indicator (KPI)
Patients will undertake 90 minutes of exercise each week.
The target for this indicator is 80% and the overall average for 2019/20 was 60.7%.
Quarter 1 saw the activity levels average at 64.2% which was an increase from the end of 2018/19 Quarter 4 data being 59.3%. Quarter 2 increased again to 66.4%, however there was a steady reduction through Quarters 3 and 4 being 59.2% and 53% respectively. Contributing factors to this decrease related to department closures over the Christmas public holidays and reduced grounds access due to diminishing light.
4. National Clinical Guidelines and Standards
Over 2019/20 the Physical Health Steering Group was involved in the review of 77 guidelines / standards of which 59 were deemed to be either not relevant or were covered by a similar guideline. Of the remaining 18, 15 had varying degrees of relevancy to physical health services within The State Hospital and were sent out for information purposes, two awaited feedback from the GP, and one was subject of a recommendation review.
5. Training
The following provides an overview of health improvement related training completed in 2019/20 by staff:
6. Education and Patient Learning
Within The State Hospital education and learning are widely recognised as important elements in promoting individual health and wellbeing, e.g. improvements in self-confidence and self-esteem, personal development and self-fulfilment, enhanced life and social skills, social inclusion and behavioural change.
Learning provision includes both accredited and non- certificated programmes and the Hospital has ‘approved centre’ status with a number of qualification awarding bodies including the Scottish Qualification Authority (SQA), the British Computer Society (BCS), the Royal Environmental Health Institute of Scotland (REHIS), and Sports Leaders UK.
At 31 December 2019:
- 72 patients had engaged in formal or accredited learning.
- 24 new referrals to the Patient Learning Centre were processed.
- 23 patients ceased attendance (mainly due to leaving the Hospital).
- 100 patients (95% of the patient population) had been invited to complete the core skills screening process. Of these, 87 patients (87%) completed the screening process, nine declined to take part (9%) and four were unable to participate due to poor mental health (4%).
- Seven patients engaged in the literacy programme.
- Two patients participated in open / distance learning programmes.
- One patient was awarded a ‘Certificate of Higher Education in Psychology’.
- Eight vocational programmes were delivered and 43 vocational qualifications were successfully achieved.
- 12 patients regularly took part in the weekly Patient Reading Group.
- Six patients took part in the Reading Ahead national library initiative.
- 52 patients completed a learning evaluation questionnaire (an increase of 24% from the previous year).
At the Staff and Volunteer Excellence Awards Ceremony in October 2019, three individuals were recognised by both staff and patients for their commitment to providing patient learning activities: one staff member from the Craft and Design Centre and two volunteers from the Patient Learning Centre.
The Patient Learning Annual Report 2019 provides full details of activities and achievements over the 12-month period covering January to December 2019.
Health Improvement Publications
Cholesterol and Heart Disease (patient information - Dietetics) (February 2021)
Weight Gain and Medication used in Mental Health (patient information - Dietetics) (February 2021)
Tinto View Health Centre (patient information - Health Centre) (February 2021)
Podiatry Service (staff information - Health Centre) (February 2021) and Looking After Your Feet (patient information - Health Centre) (February 2021)
Physiotherapy Service (patient information - Health Centre) (February 2021)
Stay Safe in the Sun (patient information - Health Centre) (February 2021)
Vitamin D (staff information - Health Centre) (February 2021)
Vomiting and Diarrhoea (patient information - Infection Control) (February 2021)
Patient Library (patient information - Learning and Development) (February 2021)
Named Person (patient information - Social Work) (April 2019)
Occupational Therapy leaflet (patient information- OT) (February 2021)
Speech and Language Therapy leaflet (patient information) (February 2021)
Animals as Therapy booklet (general information) (February 2021)