Person Centred

Health Improvement

In this section:

Photo: Skye Centre Atrium

State Hospital patients have very significant physical health needs. Lack of exercise, obesity, consequences of a self-selected poor diet perhaps complicated by the effects of medication, all require monitoring.

Health improvement is undertaken through a range of onsite therapies and activities including a Health Centre which meets the primary healthcare needs of patients. The State Hospital remains a smoke free environment.

Patients are provided with more information and support than ever before, and they are encouraged to become more involved in making choices about their own health and lifestyle.

The Supporting Healthy Choices group is well established and drives forward improvement. A draft workplan was developed during the year adopting a Quality Improvement (QI) approach to prevention, reduction and the management of obesity. Options to consider how groups and ward-based weight loss interventions may be delivered were included.

Health improvement activities were taken forward by way of three key strands: mental health practice development, physical health and patient learning. Health improvement related training continues to be embedded within all three areas

Mental Health Practice

During the year, the monitoring and driving forward of improvements in the effectiveness andefficiency of overall service delivery for mental health needs, progressed as a nationalclinical priority. This involved promoting continuous improvement in the mental health of patients incorporating the highest standards of clinical care.

The Forensic Mental Health Managed Care Network (Forensic Network) and regional medium secure forensic psychiatric services are well established across Scotland. The State Hospital continues to be the national resource operating in a high secure environment.

Work of The State Hospital’s Mental Health Practice Steering Group (MHPSG) group supports the delivery of safe, effective, person-centred care in the context of reviewing clinical practice within the Hospital. This includes Psychological Services input data, risk assessment completion, Relational Approaches to Care, Trauma Informed Care, intelligence emerging from stakeholder feedback and trend reports, and person centred improvement projects.

Over the reporting period of October 2019 to September 2020 the group:

Actively engaged in supporting the Board’s commitment to ensuring that clinical services were designed to address potential health inequalities, particularly in respect of health literacy.
Was involved in the review of 22 national guidelines / standards. Of these, 13 had varying degrees of relevancy within The State Hospital.
Continued to engage Clinical Teams in utilising the Clinical Outcomes monitoring process to inform practice.
Maintained “Motivation of New patients and ensuring Positive Engagement” as a standing agenda item. This is linked to several ongoing areas of work including the review of Grounds Access protocols.
Submitted a proposal which was subsequently approved by the Clinical Governance Group to review the Care Programme Approach (CPA) processes within the Hospital.
Monitored Advance Statements every six months, noting a slight decrease in the percentage of patients with an Advance Statement in year.
Supported the delivery of Realistic Medicine workstreams and development of the local Realistic Medicine Action Plan.
Through the Person Centred Improvement Lead (PCIL) received feedback from patients, carers and volunteers, ensuring the development of clinical practice took account of ‘What Matters’ to these stakeholders in terms of their role as partners in supporting the recovery journey.

Physical Health

Physical Health The State Hospital continues to recognise the importance of health improvement and disease prevention programmes that target the main causes of morbidity and premature mortality with attention to obesity and reducing cardiovascular risk.

Physical activity is an extremely important part of overall physical healthcare. The Physical Health Steering Group (PHSG) governs Food, Fluid and Nutrition Care, Weight Management, Physical Activity and Physical Health workstreams.

The PHSG 12 month update report covering 1 October 2019 to 30 September 2020 provided assurance that physical health remained a top priority:

The Supporting Healthy Choices agenda was developed, supported and monitored.
Abdominal Aortic Aneurysm Screening, Urinalysis Screening, and annual Retinopathy Screening (for patients with diabetes) continued in year.
Cardiovascular Risk Assessments were undertaken.
Chronic disease monitoring clinics continued as did Clozapine monitoring.
59 external referrals for specialist review by GP and Dental Services were processed for 44 patients.
156 external clinical outings were planned for 121 patients.
13 patients attended Accident & Emergency on 16 occasions.
Eight telephone advice calls were made to NHS24 and NHS Lanarkshire Out of Hours Service.
The Service Level Agreement (SLA) with NHS Lanarkshire provided ongoing patient podiatry care.
Requirements for special diets increased due to changes in the physical health needs of patients.
The Food in Hospitals (FiH) review was delayed due to the Covid-19 pandemic, with the exception of December 2020.
A new Trainee Health Psychologist was appointed in March 2020 to focus on training around barriers and facilitators to weight loss maintenance in a secure setting as well as the health and wellbeing of staff.

The Rehabilitation Therapies Annual Report produced November 2020 for the previous 12 months highlighted that Allied Health Professionals (AHPs) continued to deliver high quality interventions for patients. ‘Near Me’ a video-based service was installed in the Health Centre for patient health consultations with the GP and was also used to deliver physiotherapy assessment and treatment. There was a greater demand for the provision of speech and language therapy. The percentage of reviews attended by Occupational Therapists and Dietitians improved, and reports available by Occupational Therapists increased.

Patients can exercise and walk within the Hospital's grounds if granted grounds access which is subject to a rigorous risk assessment process. Grounds access can be withdrawn for reasons such as guidelines not being followed or deterioration of a patient’s health. As at July 2021, around 65 patients had ground access each day – of these, circa 43 had unescorted grounds access and 22 had escorted walks in the grounds.

Key Performance Indicator (KPI)
Patrients will be offered an Annual Physical Health Review.

This indicator is linked to the National Health and Social Care Standards produced by Healthcare Improvement Scotland (HIS). The indicator currently measures the offer of an annual health review and not the uptake. This is being reviewed to ensure that the KPI accurately captures physical health reviews carried out.

The overall average during 2020/21 was 56.67% - a significant decrease of 41.81% from 2019/20 which averaged at 98.48%. This was due to the absence of GP services in the last two quarters of the year. The offering of annual physical health reviews will recommence in 2021/22. Notwithstanding this, all physical health issues of patients in 2020/21 were actioned within 48 hours via the Health Centre and liaison with Junior Doctors.

Key Performance Indicator (KPI)
Patients requiring primary care services will have access within 48 hours.

This indicator (which has consistently stayed at full compliance of 100%) is linked to National Health and Social Care Standards as published by Healthcare improvement Scotland (HIS). Primary care services include any service at the Health Centre including triage.

Key Performance Indicator (KPI)
Patients will have a healthy BMI.

This correlates towards the national target from the care standards as well as a local corporate objective. This is an aspirational target and a local priority due to the obesity issue of The State Hospital patient group. The average percentage of patients who had a healthier BMI increased to 10.50% in year compared to 8.75% in 2019/20.

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 the year 2020/21 was 75%.

During the first two quarters of the year, staff resources were focused on supporting patients through 1:1 walks as other timetable sessions were cancelled due to Covid-19 restrictions. As the Skye Centre Activity Centres reopened, there was a decline in the physical activity data as patients were engaging in activities not related to any physical means of exercise.

Patient Learning

For patients within The State Hospital, participation in education and learning can be an empowering and socialising process and can make a significant contribution to care, treatment and longer-term recovery and rehabilitation.

Patient learning programmes were mainly delivered within a range of Skye Centre activity centres including the Patient Learning Centre (PLC), Patient Library, Gardens & Animal Assisted Therapy Centre, Sports & Fitness Centre and the Craft Centre. Outreach learning was also available as required.

Photo: Patient Learning Centre Despite the impact of the continuing Covid-19 pandemic, there were 21 new referrals to the Patient Learning Centre during 2020 and 71 patients engaged in formal or accredited learning.

Achievements in year include:

88% of the 94% of the patient population approached, completed the core skills screening process.
Six Core Skill national qualifications were completed; a reduction of 85% from the previous year.
Eight patients engaged in the literacy programme.
One patient participated in ‘English for Speakers of Other Languages’ (ESOL) learning.
One patient participated in open / distance learning programmes.
Six vocational programmes were delivered - a decrease of two from 2019.
24 vocational qualifications were successfully achieved - a decrease of 19 from 2019.
The national ‘Bikeability’ programme was delivered over a four to six-week period with 18 patients participating.
Six patients regularly participated in the Patient Reading Group.
The City Phonics course (which helps learners who have very limited knowledge or exposure to learning to read) was piloted with great success.
Patient feedback was sought on an ongoing basis.

The Patient Learning Annual Report 2020 provides full details of activities and achievements over the 12 month period covering January to December 2020.

Health Improvement Publications

Cholesterol and Heart Disease (patient information - Dietetics) (February 2021)