We often think of alcohol misuse in terms of dependence and the conditions associated with heavy drinking like liver disease and pancreatitis. But, as last year’s Chief Medical Officers’ new guidance indicated, lower levels of alcohol misuse can contribute to a wide range of conditions not so readily associated with alcohol. Is it therefore worth considering how alcohol could be affecting the health of a wider range of patients and not just heavy drinkers?

The guidance indicates that regular consumption of more than 14 units of alcohol a week significantly raises the risk of ill health for adults. In fact, the risk of some cancers, including breast cancer, starts to increase with regular consumption of any alcohol.

Obviously, most people don’t knowingly want to take risks with their long-term health. The majority of patients who regularly drink over 14 units are probably unaware of the level of risk from their alcohol consumption. But, there are quick, effective screening tools available to health professionals to assess a patients risk from alcohol use and strong evidence that spending less than five minutes making people aware of that risk can persuade them to drink less.

Identifying those at risk and alerting them to the risk, known as alcohol identification and brief advice (IBA), has been researched extensively over the last 35 years. The overwhelming conclusion is that the practice can reduce weekly drinking across the patient cohort by up to 34% (between 3 to 9 units per week). This will reduce relative risk of alcohol-related conditions by c14%, and absolute risk of lifetime alcohol-related death by c20%.”. IBA can take less than 5 minutes and surveys have found that patients expect and are accepting of health practitioners asking about their alcohol use. NICE guidance recommends that all health professionals carry out IBA as an integral part of routine practice.

NICE guidance also recommends alcohol screening and advice for hypertensive patients – 35% of hypertension cases among men and 15% among women are alcohol-related[i]. Reducing alcohol consumption reduces the blood pressure of hypertensive people and alcohol-induced hypertension resolves within two to four weeks of abstinence (or substantial reduction)^[ii].

IBA might be done at key opportunities with all patients, or targeted at particular at-risk groups. There are numerous opportunities to address alcohol consumption, such as when patients register with a GP or when reviewing medication. The NHS Health Check also includes an alcohol risk assessment and advice to those at risk and, in 2017-19, a CQUIN scheme will incentivise alcohol IBA and very brief advice on smoking for all inpatients in secondary care.

Health Education England elearning for healthcare (HEE elfh) has therefore worked with Public Health England to produce elearning sessions to support delivery of IBA. Courses take less than an hour to complete and give health staff understanding of the tools and techniques for delivering effective IBA.

For more information about elfh visit www.e-lfh.org.uk.

Professor Sir Ian Gilmore MD, DL, FRCP

Chairman, Alcohol Health Alliance UK

University of Liverpool.

Camden and Islington NHS Foundation Trust empowering teams through training and transforming physical health checks for people with mental health needs

People with serious mental illness (SMI) are at greatest risk of poor overall health and premature mortality. Figures show that people with SMI on average die 15 to 20 years earlier than the general population due to preventable physical health problems. Premature and avoidable deaths in people with SMI could be significantly reduced if their physical health needs were identified much earlier and effectively managed.

People with SMI often do not access healthcare in the same way as the general population.  For a long time this group of people have struggled to get appropriate, timely information, advice and support for their physical health needs on subjects including diabetes, chronic obstructive pulmonary disease (COPD), and how to quit smoking. Effective communication and collaboration across primary and secondary healthcare settings in closing the care and quality gaps in physical health and the management of care in people with severe mental health illness needs to be number one priority across the NHS.

Addressing the problem

Camden and Islington NHS Foundation Trust’s (C&I) innovative approach focuses on the coordination and treatment of physical and mental health needs of people with psychosis and bipolar disorders, providing particular health treatment for COPD and diabetes. This is through physical health tests undertaken at special health and wellbeing clinics, use of a specially-designed physical health screening tool for tighter assessment and a programme of physical health training options for mental health staff.

The project’s key targets are:

• reducing the suicide rate among psychosis patients by 20% by 2022
• cutting the percentage of those smoking by 2% per year by 2020
• widespread screening for diabetes to determine full prevalence up to 2020, before then reducing to stabilise at 18% or lower by 2022, reversing the national trend.

How is C&I transforming the way physical health checks are carried out amongst patients with SMI and related needs?

C&I set up a five-year programme known as the Integrated Practice Unit for Psychosis (IPU), working in partnership with Camden and Islington Clinical Commissioning Groups, local authorities, GPs, acute trusts and community health services. It is targeting 18 specific improvement outcomes addressing both mental and physical health, as well as wellbeing and quality of life.

Training

Breaking Down the Barriers (BDtB) programme, funded by Health Education England, North, Central and East London and supported by UCLPartners has facilitated the delivery of training sessions at the Trust on Physical Health Checks, who does what? including the National Audit of Schizophrenia health check, Lester tool and Health Improvement Profile (HIPs). The programme aims to raise awareness of the importance of and significant positive health outcomes that early and timely physical health checks could have on people with SMIs.

Refining the physical health checks approach

C&I has a comprehensive Physical Health Screening Tool (PHST) in place and flow chart which describes the process staff should follow. This is supported by staff training, in addition, C&I has recently audited its medical equipment to ensure that staff working in the service have the right equipment in place. The Trust’s approach to ensuring staff are skilled in physical health assessment and intervention is based on the use of physical health skills self-assessment and training passport. This builds on existing skills and learning is through formal training, use of a simulation suite and in-team training with the practice development team.

Anthony Jemmott, a Community Nurse Manager with the Trust’s Integrated Practice Unit (IPU) in Camden, attended one of the BDtB training sessions in 2016. He said: “The BDtB training supported the development of the IPU and the physical health and wellbeing clinics within C&I. It has raised staff awareness and gave them the confidence to address the physical health and wellbeing needs of our service users with SMI. The research shows that people with serious mental illness die younger than the normal population – not from the mental health problems, but from a preventable long-term physical health condition. By carrying out physical health screening on this client group we would detect early symptoms of preventable long term physical health conditions like diabetes and COPD, also make interventions in smoking cessation, and therefore reduce the prevalence of these diseases and mortality rates.”

Seeing results

Susan Cummins, Community Physical Health Matron, said: “The BDtB modules on COPD and diabetes are very informative and highly relevant to mental health staff working with service users who are more at risk of these conditions. The material is accessible to all staff, using plain and simple language. It is evidence- based and highlights the day to day challenges of treating and managing these long-term conditions. Participants are signposted to lots of other helpful resources for professionals. The sessions have been very well attended by a very broad range of disciplines and are highly engaging.”

Ronke Adejolu, Breaking Down the Barriers, UCLPartners, said: “NHS mental health professionals and the multidisciplinary workforce play a pivotal role and have exclusive opportunities to help people in their care to improve their physical health alongside mental health.”

Breaking Down the Barriers’ free physical health awareness training materials aim to increase awareness, skills and knowledge across the NHS workforce to help in the early identification of key risk factors that are known to adversely affect the physical health of people with mental health needs, including subsequent management of care and timely referrals to appropriate services.

Access Breaking Down the Barriers physical health checks training resources

Training resources can be accessed via elearning for Healthcare http://www.e-lfh.org.uk/programmes/breaking-down-the-barriers/

Further information

Please visit bit.ly/UCLPBreakingBarriers

Tweet us @UCLPartners #UCLPartnersBreakingBarriers

Call us direct +44 (0)20 3108 2319 or contact the Project Support Officer ellen.nelson@uclpartners.com

There is nothing more powerful than when the NHS health and social care workforce and community comes together to share ideas, stories and hope. UCLPartners makes this happen by bringing people and organisations together to transform the health and wellbeing of the population.

Get in Touch www.uclpartners.com or contact@uclpartners.com