‘To nudge, or not to nudge’

Understanding how behavioural insights can deliver

improved healthcare

Wednesday, 13 January 2016, 10.00am – 4.00pm

Radisson BLU Hotel Durham, Frankland Lane, Durham, DH1 5TA

Objectives:

• Enable delegates to gain an in depth understanding of the ‘Nudge’ concept and behavioural insights methodology

• Ensure participants are able to apply nudge/ behavioural insights in a clinical setting within their organisations

• Promote participant networking to exchange and share their learning and collaborate on potential nudge plans across the North East and North Cumbria

• Enable participants to access a suite of resources and materials to support them in developing these plans and putting them in to practice.

• Encourage delegates to take their learning back in to their organisations to share and put this learning in to practice.

Understanding and changing behaviour:

applying behaviour insights to health

Dr Jack Bedeman

Public Health Registrar

Department of Health

Understanding and changing behaviour: applying behaviour insights to health

DH Behavioural Insight Team

5

almost all of us would

donate organs after we die

it takes 30 seconds

high awareness of the

organ donor register

6

Benefits your

health

Free of charge if on a

low income

Advice from

GP and the NHS

7

Conscious, planned, reflective behaviour

Subconscious, automatic behaviour

8

9

Before we can change

behaviour, we must first

understand it…

10

Michie et al (2011)

COM-B: A simple model to understand

behaviour

Capability Opportunity

Motivation

Attending

hospital

appointments

Behaviour

11

Michie et al (2011)

COM-B: A simple model to understand

behaviour

Capability

Knowledge, skills and

abilities to engage in the

behaviour

Physical

Physical ability to get to

the hospital

Psychological

Understanding of why

you need to go to the

appointment

Attending

hospital

appointments

12

Michie et al (2011)

COM-B: A simple model to understand

behaviour

Opportunity

Attending

hospital

appointments

Outside factors which

make the behaviour

possible

Social

Seen as OK to attend

during work time

Physical

Availability of transport to

get to the hospital

13

Michie et al (2011)

COM-B: A simple model to understand

behaviour

Motivation

Brain processes which

direct our decisions and

behaviours

Automatic

Experiencing symptoms

on the day

Reflective

Concerns about

treatment

Attending

hospital

appointments

14

Task one: understanding

and specifying the target

behaviour

15

Defining the behaviour and the objective

16

Here’s an example of a poorly defined outcome

The objective is to reduce pressures on NHS

A&E departments.

The aim is to concisely state what you are trying to achieve.

It’s not clear what reduced pressure

means. What sort of reduction?

All NHS Emergency Departments? And

in all ways? If all (as this implies), we

might be better considering starting small

to prove the concept before rolling out.

‘Pressure’ could mean lots of things.

Better to look at specifics, even if there

are lots of them to consider in sequence.

17

Define the problem you aim to solve

The objective is to reduce by 5 per cent attendance at

Medway Hospital’s A&E department from patients

presenting in non-urgent situations

Ideally start with a quantifiable objective,

even if modified later. Start thinking early

about the size of effect needed for the

project to be worthwhile.

We usually start behavioural insights

projects on a small scale, and then scale

up if we are confident that something is

working.

Try to be as clear as possible about the specific behaviour you want to change

i.e. what, by who, and when.

Most policy challenges involve more than one ‘behaviour’ – and by a variety of

people e.g. patients and staff. It is easiest to consider each separately.

18

Surprise Hyperbolic Discounting Social Learning Priming

Placebo Effect Decoupling Proccrastination Availability

Impact Bias Long-Tailed Risk Social Identity / norms Habit

Anticipation of Reward Simplification Band Wagon Effect Anchoring

Optimism Bias Intertemporal Choice Business Norms Intuition

Messenger Planning Fallacy Key Influencers Hindsight Bias

Loss Aversion Attention Collapse Identity Salience

Status quo bias Hedonic Framing Cognitive Load Gaming

Sunk Costs Defaults Regret Choice Bracketing

Certainty Bias Altruism Social Proof Mental Accounting

Ambiguity Effect Reciprocity Framing Information Avoidance

Endowment Effect Inequity Aversion Commitments Representativeness

Participatory Effect Teachable moment Cognitive Dissonance Over-Extrapolation

Actor-Observer Bias Omission Bias Attribution Error Segregation Effect

Behavioural insights / concepts

19

CapabilityOpportunity

Behaviour

MotivationAutomatic

Motivation

20

Simplify messages

Break the goal down into

simple actions

Reduce effort

Defaults

EASY

21

The revised chart led to much more accurate information (and less errors)

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Dose entered correctly Prescriber's contactnumber entered

Frequency of medicationsentered correctly

Pro

po

rtio

n o

f m

ed

ica

tio

n o

rde

rs

Existing chart (n=174)

Improved chart (n=163)

King et al. (2014)

Redesigning the

‘choice architecture’

of hospital

prescription charts.

Forthcoming.

22

A surgical safety checklist reduced deaths and complications following surgery by a third.

Haynes, A et al: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England J Medicine 2009; 360:491-499

23

Suicide by paracetamol in England and Wales, 1993-2009

Hawton Keith, Bergen Helen, et al. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and

liver transplant activity in England and Wales: interrupted time series analyses BMJ 2013; 346:f403

Legislation reduced the maximum size of the packages to 16 pills (or 32 if sold

at a pharmacy) i.e. less convenient to purchase and retain multiple tablets.

24

Attract attention

Lotteries

Incentives &

Rewards

Images & Colour

Personalisation

ATTRACTIVE

25

26

27

Public promisesMake a commitment

Social normsNetworks

SOCIAL

28

“The great majority (80%) of practices in [NHS

Area Team] prescribe fewer antibiotics per head

than yours”.

Three simple actions…

From a trusted authority figure

Personally addressed

29

Old letter ‘nudge’ letter

Bonus A, Berry D: Increasing Uptake of the NHS Health Check . Report of research with Medway Council

to optimise the invitation letter . 2013. available at www.healthcheck.nhs.uk/document.php?o=588

29

33

0

5

10

15

20

25

30

35

old letter nudgeletter

Attendance rate %

DH – Leading the nation’s health and care

30

PromptsMake a plan

RemindersImmediate costs

and benefits

TIMELY

31 DH – Leading the nation’s health and care

32

Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians’ responsiveness to assay

cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med

2013;173:1654–5.

DH – Leading the nation’s health and care

33

Task 2:

Applying behavioural

insights to policy

problems

34

The ‘Nudge Game’

35DH – Leading the nation’s health and care

CONTROL

INTERVENTION

Group is split into two groups by random lot

Outcomes are measured for both groups

Testing behavioural insights

36

37

38

39

1. Advice on behavioural insights and how to

apply these to your policy area

2. Support designing BI interventions

DH BI team

3. Support designing and running BI

experiments and trials

40

Behavioural insights literature

Excellent

summary text

Understanding full

range of behaviours Guide for policy-

makers

COM-B: http://www.implementationscience.com/content/pdf/1748-5908-6-42.pdf

EAST framework: http://www.behaviouralinsights.co.uk/sites/default/files/BIT%20Publication%20EAST_FA_WEB.pdf

41 How to infuence public behaviour

Drink Aware web site

NHS Organ Donation web site

Case Study: Quantifying and modifying patient

attendance in a primary care setting.

Dr Roger Dykins,

Corbridge Health Centre

HPCA KTP Overview and outcomes

18th November 2015

KTP Team:

Alexander Tang Northumbria University & Corbridge Medical Group

Prof Glenda Cook Northumbria University

Julie Johnston Corbridge Medical Group

Dr Robin Hudson Corbridge Medical Group

Dr Roger Dykins Corbridge Medical Group

Dr Akhtar Ali Northumbria University

Dr Emma Barron Northumbria University

Hazel Juggins Northumbria University

John Clayton Innovate UK

KTP Aim & Objectives• Data warehousing and data mining of

practice clinical information systems

• Analysing current service activity

• Designing a stratification system for the

management of chronic disease

• Redesigning systems and professional

practice for the management of chronic

conditions in the practice population

• Develop a training strategy for effective

use of the proposed system

• Develop and agree the practice service

model for chronic disease management

• Pilot model and evaluation

Service

development

grounded in

analysis of GP

practice data

30th April 2012

Clinical topics and priorities

Organisation and business

challenges

0

50

100

150

200

250

300

Nu

mb

er

of

Pat

ien

ts

Age Group of Patients on 31-Aug-2014

CMG Registered Patients Demographics (2013)

Male Female Male Trendline Female Trendline

0

50

100

150

200

250

300

350

Nu

mb

er

of

Pat

ien

ts

Age Group of Patients on Date of Death

CMG Deceased Patients Demographics

Male Female Male Trendline Female Trendline

0

10000

20000

30000N

um

be

r o

f C

on

sult

atio

ns

Age Group of Patients on Date of Consultation

CMG Activity Type Consultations for Current Patients (2013)

Home Visit Telephone GP Surgery

0

4000

8000

12000

16000

Nu

mb

er

of

Co

nsu

ltat

ion

s

Age Group of Patients on Date of Consultation

CMG Activity Type Consultations for Deceased Patients (2013)

Telephone Home Visit GP Surgery

0

5000

10000

15000

20000

25000

Nu

mb

er

of

Co

nsu

ltat

ion

s

Age Group of Patients on Date of Consultation

CMG Clinician Type Consultations for Current Patients (2013)

Healthcare Assistant Nurse General Medical Practitioner

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2009 2010 2011 2012 2013

Co

nsu

ltat

ion

s

Year

CMG Activity Types Consultation between 2009 - 2013

Total Cons GP/ Surgery GP/ Telephone GP/ Home Visit Nurse/ Surgery HCA/ Surgery

GP/Surgery

Nurse/Surgery

Total

GP/Home

GP/Tele

HCA/Surgery

Key Messages from the Analysis of Practice Activity

• Increase in total number of consultations per year over 2009 - 2013

• Steady increase in the number of patients having consultations each year (4.4% increase)

• 1065 (16%) patients with no consultations in 2013

• 41% registered patients on a QOF register

– 61% of the overall 2013 consultation workload

– 53% of GP surgery consultations, and 92% of GP home visits in 2013

• Patients with high consultation activity is not only accounted for by those on the QOF registers and 80+ population

• 20 patients not on any QOF, HRPP or Housebound register yet they are in the Top 200 Consultees between 2009 – 2013

– 2.1% of the overall 2013 consultation workload

cluster5

cluster1

cluster9

CMG Workload Clusters

Clusters 1, 5 and 9 include 377 patients (6% of the registered practice population)

accounting for 24% of the total consultations in 2013.

Nu

mb

er o

f co

nsu

ltat

ion

s (2

01

3)

Age

6.6

32.7

5.4

9.6

7.2

33.6

6.3

3.1

10.3

20.4

0

5

10

15

20

25

30

35

cluster0 cluster1 cluster2 cluster3 cluster4 cluster5 cluster6 cluster7 cluster8 cluster9

Nu

mb

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ver

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of

Pat

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ee

n

Cluster Name

Average number of Consultations per Patient in each Cluster (2013)

Clustering Analysis

Practice A Workload Clusters

Clusters 0, 2 and 7 include 393 patients (7% of the registered practice population)

accounting for 28% of the total consultations in 2013.

Practice B Workload Clusters

Clusters 3, 5 and 7 include 314 patients (4% of the registered practice population)

accounting for 19% of the total consultations in 2013.

0 5000 10000 15000 20000 25000

GP/Surgery

GP/Telephone

GP/Home Visit

Nurse/Surgery

Nurse/Telephone

HCA/Surgery

Number of Consultations

Act

ivit

y Ty

pe

Activity Type Consultation Comparison between HPCA Practices (2013)

Corbridge Medical Group Practice A Practice B

• On average High Users account for 6% of population and 22% of the overall workload

Practice Registered Patients

CMG 6592

A 5650

B 7131

55

Extremely High Users

20+ cons

Very High Users

15 - 20 cons

Moderate High Users

10 - 14 cons

341 patients4986 GP surgery and

home visit consultations43.1% workload in 2013

39 patients1108 cons9.6% of workload in 2013

122 patients1388 cons12% of workload in 2013

219 patients2490 cons21.5% of workload in 2013

Traffic Light Thresholds

High Users Consultation Alert – EMIS Web

• Limitations with EMIS Web Protocols & Concepts to identify difference in consultation types (surgery, telephone, home, admin etc.)

• Feasibility to alert user based on certain read codes only

• How does this or could change consultations with patients?

• Across HPCA: Could different approaches/services be offered to high user patients?

High user alert – GP views/actions• Surprise when a patient who they did not

expect to be a high user comes into the surgery

• Patients often see different GP’s and the alert has supported identification of these patients

• For some patients the GPs are arranging telephone reviews in order to move workload from face to face appointments into telephone work

• GP suggesting review periods to patients

• GPs have decided to take a closer look at their top 10 surgery consultees and top 10 home visit consultees to investigate if there are interventions that may have an impact on consultations whilst enhancing quality care

Why do patients seek consultations Analysis of presenting problem titles

GP Surgery & Home Visit consultations (Aug 2014 – July 2015)Common Presenting Problem Title Patients Occurrence Ratio

Musculoskeletal problems 183 592 3.23

Acute Respiratory 158 370 2.34

Digestive System 155 366 2.36

Dermatology 159 342 2.15

Depression and Anxiety 92 300 3.26

Ear / Nose / Throat 103 190 1.84

Cardiovascular Disease and Stroke 62 188 3.03

Neurological and Nervous System 85 171 2.01

Symptoms / signs and ill-defined conditions 75 132 1.76

Chronic Obstructive Respiratory Disease 36 132 3.67

Urinary Tract Infection - Suspected and Actual 66 108 1.64

Genitourinary 59 104 1.76

Women's Health / Gynaecological / Pregnancy 51 96 1.88

Hypertension 41 88 2.15

Infectious and parasitic diseases 51 87 1.71

Neoplasms 32 86 2.69

Operations / procedures / sites 51 83 1.63

Circulatory system diseases 40 82 2.05

Mental disorders 28 71 2.54

Eye and Sight problems 50 66 1.32

Respiratory system diseases 31 65 2.1

Medication Review and Advice 43 55 1.28

Alcohol 3 25 8.33

10+ Consultations

Can future consultation activity be forecasted?

Risk Stratification: GP Consultations

High Risk Patient

Pathway

DepressionAtrial

Fibrillation

Group 1 (AIC 746)

10**

Depression 7

Stroke/TIA 5

PAD 5

CHD 3

Heart Failure 3

Female 3

Housebound -3

Rheumatoid Arth. -5

No No

Yes

Yes

Group 2 (AIC 1707)

5**

Diabetes 6

CKD 4

Female 1

Meds*** 0

Group 3(AIC 360)

6**

Dementia 13

Atrial Fibrillation 8

PAD 7

Asthma 6

Age 70-80 yrs.* 5

Group 4(AIC 938)

5**

Housebound 6

CKD 3

Stroke/TIA 3

Group 5(AIC 9138)

5**

Palliative Care 4

Rheumatoid Arth. 2

Dementia 1

Female 1

Stroke/TIA 1

PAD 1

COPD 1

Meds*** 0

Age 60-70 yrs.* -1

Age 50-60 yrs.* -1

Below 50 yrs.* -1109275

56

137

1603

*Age coefficients relative to 50-60 age group; **Numbers roughly equate to extra number of visits and title number in each table is roughly baseline number of visits; *** Meds is per medication; Consultations are GP Surgery and Home Visits, totalling 11579 in 2013.

Hypertension

Yes

Patients

Consultations

5% (616)11% (1218)

3% (392)

7% (868)

73% (8485)

Key:

Presentation suggestive of UTI in adult

Consider face to face assessment if: Systemically unwell eg fever Frail / elderly Sx of upper urinary tract infection eg flank

pain Recurrent UTI ?clinical examination - ?Need

for further investigation

If >1+ haematuria repeat urine dip 2w post treatment (refer if ongoing sterile microscopic haematuria on 3 x urine dips over 1 month period)

MSU should be sent when possible

Treatment of UTI :3 days of trimethoprim or nitrofurantoin [If GFR >45] - (guided by previous MSU sensitivities) - for Simple UTI

7 days if: Upper UTI (use coamoxiclav) Complicated (constipation associated, structurally abnormal urinary tract, urinary retention) Male Catheter UTI Pregnancy (use cephalexin)

Clinical assessment – face to face or telephone

Urinalysis • HCA/Nurse dips urine and creates

externally entered consultation to record result.

• Pass slip to doctor with result• Retain sample for MSU

• Reception to ascertain from patient whether suspected UTI (not cystitis)

• Ask patient to bring urine sample• pass to HCA/nurse (or duty

doctor if not available) using protocol with slip

Notes: Consider self management plan if recurrent Consider further investigation in repeat sterile MSU eg ?overactive bladder ?malignancy Consider sexually transmitted pathogens in patients with sterile MSU eg chlamydia / gonorrhea

One-Stop-Shop Pilot

Patient

Disease review

Medication review/med

issue

Current problems/issues

Managing acute illness

Skill sharing and planning more

powerful with 2 clinicians in room

Patient felt cared for and able to talk about

things that were important to them but not normally

discussed

Joint consulting very helpful

Summary document about patient is useful.

Patient: A reminder of the care plan and

life plan.

Care Plan in some cases has also had a real impact

Questionnaire may have had a

influence on how patients feel about

their condition and/or state of

health

‘GPs are amazed at the impact the One Stop Shop chronic disease

review clinic seems to have had on the timelines – genuine changes

seem to have been achieved even though we are uncertain what has

made the difference.’

Overall Key Issues• High service users are not necessarily those with

multimorbidity and older• There are high services users not included on any registers • GP consultation thresholds of 10+; 15+;21+ can be used to

identify clusters of intense service users• Clinical predictors can be used to identify risk for increased

consultation levels• Increasing consultation levels is not sustainable within

existing service delivery models• Transformation of service delivery could involve

development of workforce roles; redesign of clinical pathways for common presenting problems (UTI); consideration of the workforce skill mix or economies of scale achieved across practices for intense service users

• Practice data can be used to inform transformation of service delivery

How “Nudge” is Being Used in the Telehealth

Programme North East and Cumbria

Paul Marriott

Independent TECS Consultant (Paul Marriott TECS Ltd)AHSN NENC Telehealth Programme Lead

TECS Lead Consultant NHS England Strategic Clinical Networks

TECS Clinical Advocate NHS England

South of Tyne & Wear

Northumberland

Durham

The South of Tyne &

Wear PCT Telehealth

Project ran from May

2011 to March 2013

Population of around 644,000

3 - Foundation Trusts

3 - PCT’s / CCG

3 - Metropolitan Councils

Sunderland, Gateshead and South

Tyneside

The Origins of Telehealth In Tyne & Wear

“The headline findings of Telehealth were mixed. The good news was that

mortality of Telehealth patients over the year of the trial was 46% less

than the control group. Hospital admissions were 18% lower. To me,

these figures should be enough to justify an immediate rollout. I fancy the

idea of increasing my chances of staying alive. But it won't happen –

because the third big finding of the report was that Telehealth would not

save money.”

The Guardian 2nd July 2012

Headlines on the Whole System Demonstrator

Only 3 Conditions were Included in the Trial

1st Generation Telehealth

2nd Generation Telehealth

3rd and Now 4th Generation Telehealth

Annual Average Cost Per Patient by Generation of Equipment

Equipment

Type

1st Year

Capital

Purchase

Cost

Annual

Leasing

Cost

Annual

Maintenance

Cost

Total

1st Generation

Purchased System

£2000 £1000 £3000

2nd Generation

Leased System

£1150 £1150

3rd & 4th Generation

Rapid Deployment

Leased System

£365 £365

SMS Florence

System

NHS Owned

£45 £29 £74

Optimum Health

Good Health

Average Health

Signs of Illness

Chronic Illness

Irreversible Illness

Death

Wh

ole

Lif

e P

ers

pe

cti

ve

Conception

Death

The Multi Matrix Model Seeks to Cross “The Whole Life Perspective”

NHS Florence SMS Simple Telehealth System

SMS

Prompts and

adviceGP Practices

Specialist Clinicians

Community and

Specialist

Nursing

Public Health

And the 3rd Sector

Local Authority Control Room and Adult Social Care

Example of Flo Messages

A quick reminder that your Blood Glucose

Reading is due e.g. “BG 6”. Thanks Flo

Your blood glucose reading is fine. Take care

Flo

Your blood glucose reading is a little high

today. Please refer to your management

plan and follow the advice provided. Take

care Flo

Your reading indicates that you might need a

change to your treatment.

Please ring . . . immediately.

Take care Flo

RESEARCH ARTICLE

Randomised Trial of Text Messaging on

Adherence to Cardiovascular Preventive

Treatment (INTERACT Trial)

David S. Wald*, Jonathan P. Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J. Wald

Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ,

United Kingdom

*d.s.wald@qmul.ac.uk

Conclusions:

In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular

disease, text messaging significantly improved medication adherence compared with no text

messaging.

Trial Registration: Controlled-Trials.com ISRCTN74757601

Condition Clinical Lead

Heart Failure, Angina etc. FT, GP

COPD and Respiratory etc. FT, GP

Hypertension GP

Diabetes FT, GP

Gestational Diabetes FT

Type 1 Kids T1KZ FT, GP and 3rd Sector

Parkinson’s FT

Rapid Discharge FT

Carers Pathway GP, LA & PH and 3rd Sector

Acquired Head Injury and Stroke FT, GP

Primary Care Step Up Step Down GP

Care and Nursing Home GP, LA

Weight Management FT, GP, LA & PH

Smoking Cessation LA & PH

Remote Wound Dressing Monitoring FT

Community Matron Case Load FT

Alcohol Induced Morbidity FT, GP

FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health

Some of the Current Pathways within the North East and Cumbria (there are

now over 220)

Expand and Widen the Number of Telehealth Pathways and Clinicians

Florence Usage across the NHS in the UK and the DVA in the USA

Patient Outcomes

COPD Patient “I am much better now as I am

using 02 readings to prompt using oxygen I

feel my condition is more controlled now.”

COPD Patient “I like the reminder text as I would forget. Prompts me to think about doing my breathing exercises

when readings are low. I like the freedom of doing the reading more often.”

Heart Patient “Its easy to use and my son helps with the readings. Its

great we can now go to family members for

example at Christmas and continue to do

readings.”

Young Diabetic “I Don’t have to come in every

week now which is much better I have a busy life and that helps as I have a another child which I needed to get looked after. Costs me £8 on

bus to attend each appointment at clinic.”

Middle Aged Diabetic “Really happy with the

service. It’s a combination of exercise

Programme and monitoring my health my control is far better now”

Community Nursing Patients

Feed Back

Telehealth with a human touch

Florence Patient Video

Contact Details

Paul Marriott Independent TECS Consultant (Paul Marriott TECS Ltd)AHSN NENC Telehealth Programme Lead

TECS Lead Consultant NHS England Strategic Clinical Networks

TECS Clinical Advocate NHS England

NHS England Northern Senate

Waterfront 4, Goldcrest Way

Newcastle upon Tyne, NE15 8NY

Mob: 07779816519

paul.marriott@nhs.net

marriott.p1@sky.com

www.england.nhs.uk

AHSN North East North Cumbria

Biomedical Research Building

Campus for Ageing and Vitality

Nuns’ Moor Road

Newcastle upon Tyne

NE4 5PL

www.ahsn-nenc.org.uk

A Nudge in the Right Direction for Physical

Healthcare within Mental Health and Learning

Disability Services

Alexia Hardy, Physical Healthcare Project Lead

Pauline Smith, Physical Healthcare Project Nurse

People with a

SMI die on

average 15-20

years sooner

than the general

population

Approximately 40% of these

service users are obese, compared

to 25% of the general population

(The NHS Information Centre 2014).

Type 2 diabetes – prevalence

2-3 times higher.

People with a SMI are twice as

likely to die from heart disease.

61% of people with schizophrenia

smoke (33% of general population).

(The Abandoned Illness,

Schizophrenia Commission 2012)

NOW DECREASED TO 20%

People with schizophrenia who

develop cancer are 3 times

more likely to die.

Context

Clinical Guidelines

NICE: Guidelines for Schizophrenia

(2009 & 2009)

NICE: Smoking cessation in

secondary care: acute, maternity and

mental health services (November

2013)

NICE: Psychosis & Schizophrenia in

Adults (February 2014)

NICE: Physical Health, Obesity, Lipid

Modification, Preventing Type 2

Diabetes, Hypertension (Various

dates)

Government Policy

National Service Framework

(DoH 1999) > SMI Registers

No Health without Mental

Health (DoH 2012)

NHS Outcomes Framework

(DoH 2012)

The Abandoned Illness

(Schizophrenia Commission

2012)

National Audit of

Schizophrenia (2012)

Cardiovascular Outcome

Strategy (2013)

The National Agenda

Physical Healthcare Project

2014-16Business Plan priority to develop

standards required for the

assessment and monitoring of

physical health.

Local CQUIN 2014/15Health promotion for people with

psychosis accessing community

services focussing on weight

management and smoking

cessation.

GP Engagement Project

2014-17

Aims to improve clinical

communication with GPs

using standardised

electronic referrals and

discharge letters.

National CQUIN 2014/15Improving physical healthcare to

reduce premature mortality in

people with SMI.

TEWV Physical Health Agenda

Smoke Free ProjectTEWV aims to go smoke free

on 9th March 2016 (National No

Smoking Day).

Physical

Healthcare

Project 2014-16

EWS

• Bespoke training offered to services

Trust-wide.

• Additional support post training.

EWS audit across all service areas to

monitoring compliance of new procedure

and identify where staff may need further

support.

• EWS Procedure

• Diabetes Management Guideline

• Cardiovascular Guideline

• Staff Engagement Events/Workshops

• Staff and Student Induction

• Patient workshops

• Patient and carer meetings/focus groups

Engagement and

communication

Development of

standards

Training

Audit

• Project Newsletter for staff

• Project update for patients and carers

• Social Media

• Page on Trust intranet

Diabetes Management

• E-learning in line with new guideline.

• Pilot of face to face training.

• Involved and engaged staff by asking ‘What

does physical healthcare mean to you?’

• Used staff thoughts and ideas to produce

project banner to emphasise the whole body

in mind.

• National ‘nudge’ and interpretation of NICE.

• Development of standards in a language

suitable for mental health and learning

disability settings.

• EWS Quick Reference Guide to support

recognition and response to the

deteriorating patient.

• Bespoke EWS training delivered within

service areas across the Trust.

Staff Nudge

Patient and Carer Nudge

Empowerment

Thought

provoking

Increased

awareness

Informative

Thank you