IMPROVING THE PHYSICAL HEALTH OF PEOPLE WITH A SERIOUS MENTAL ILLNESS IN COVENTRY AND WARWICKSHIRE

Area of focus: Prioritising prevention & improving future health outcomes through tackling health inequalities

Why change was needed

On average, people with Severe Mental Illness (SMI) experience worse health outcomes than the rest of the population. This includes a significant difference in life expectancy for people with SMI, known as the mortality gap, which currently stands at 15-20 years.

Annual physical health checks are a vital tool in reducing the mortality gap as they allow health professionals to identify potential health issues early, meaning treatment can be started sooner and conditions prevented from becoming more serious. Those with a SMI are entitled to a free annual physical health check but uptake has traditionally been low across the country, leading to a high proportion of undiagnosed health conditions amongst this group.

The uptake of annual health checks in Coventry and Warwickshire followed this national trend, with just 25.9% of those on the SMI register having a recorded health check in the previous year by March of 2020.

 

What we did

In order to understand why the rate of uptake was so low and what could be done to increase it, we engaged with people with SMI and their families. This revealed a lack of awareness of the entitlement to a free annual health check, with 74% of those spoken to not aware they were eligible.

This engagement with individuals with SMI and their families was crucial in shaping the ICS’s approach, and in shifting the focus from numbers or targets to seeing people who access the services as people with real lives and real experiences. In addition, there was significant input to the approach from clinicians and staff who deliver the service, meaning that everyone involved had the opportunity to shape what it looks like.

We introduced an approach that involved offering personalised support to individuals with SMI, including making them aware they are eligible for a free annual physical health check. There were also two new services developed, a ‘virtual hub’ and a mobile unit, to make vital information and support as accessible as possible.

The creation of the virtual hub saw the creation of an email and direct phoneline that allowed people with SMI to contact someone who understands their experiences and can help to alleviate any anxiety they feel. Sometimes elements of the health check can be delivered over the phone, offering a more flexible service for the individual.

The mobile unit allowed us to improve access to annual health checks by bringing them to communities and it was staffed by Primary and Secondary Care physical health check specialists. Patients were also able to access support with COVID-19 and flu vaccinations, sexual health services, and targeted support for the unhoused.

Partnership working across the health and care system in Coventry and Warwickshire was vital to the success of the approach, with primary and secondary care, mental health teams, VCSE organisations, the Integrated Care Board, local authorities and NHS England all being involved in its delivery.

 

Outcomes

Following the introduction of the approach and the awareness drive by the ICS, the percentage of those who had received a physical health check had increased to 67.8% in March of 2023 - an increase of over 450% in two years and above the target of 66% set out in the NHS Long-Term Plan.

The innovative approach was recognised by winning the ‘Performance Recovery Award’ in the 2023 Health Service Journal (HSJ) Awards. You can read more about that here.

Some feedback from those who have used the service showing the impact has been:

“I really appreciate having this check as it has been a while that I’ve seen someone face to face regarding my mental and physical health”

“I have never had this check before, but I definitely wouldn’t mind having this check again next year”

“I was surprised that I received a call to come in for this check, especially during COVID, but I’m glad that I did come in”

“Thank you for everything you have done. I appreciate all your staff and will always thank the NHS”

“You make me feel motivated in getting my life back on track”

“I feel like you care about me and making me a better person”

 

What’s Next

Coventry and Warwickshire ICS is now planning to build on this success with annual physical health checks to ensure onward referral and intervention to healthy lifestyle support, with the additional support of a community connector approach.

The programme will involve Community Connectors, people with a unique insight into the barriers people living in their communities’ face, supporting individuals to access local community health services and, where appropriate, help them to maintain engagement. Additionally, the Connectors will also be able to help provide support to people who become dis-engaged from services. It will strengthen the system’s local approach to “don’t just screen- intervene” to ensure this vulnerable cohort are supported to access relevant follow-up interventions