hospitalA pilot scheme in 4 mental health trusts almost doubled the number of people getting 5 key physical health checks, a final evaluation has shown. 

Hundreds of patients with serious mental illness (SMI) were part of the 2-year improvement programme to improve physical care in mental health inpatient units. This saw 86% get 5 recommended cardiovascular screens compared to 46% at the start.

It used the ‘Lester tool’, a poster and electronic clinical prompt system to support clinical teams to screen and intervene for cardiovascular conditions such as diabetes and high blood pressure, as well as smoking, lifestyle and weight. The programme was independently evaluated by the Royal College of Psychiatrists Clinical Care Quality Improvement Unit.

2gether NHS Foundation Trust, Northumberland Tyne and Wear NHS Foundation Trust, Mersey Care NHS Foundation Trust and Tees, Esk and Wear Valleys NHS Foundation Trust implemented the Lester tool (2014), which was updated for use in the UK by the Royal College of Psychiatrists and the Royal College of GPs and supported by the National CQUIN programme and National Audit of Schizophrenia in collaboration with NHS England and Public Health England.

The trusts took different approaches to the problem, and the final evaluation across the 4 sites showed that interventions delivered to those who needed them as a result of appropriate screening increased from 79% to 94%. Meanwhile, 89% of service users reported wanting one or more tests when in mental health hospital.

The main themes for bringing about change that are highlighted and addressed in the toolkit are:

Motivating and engaging staff

Clarity of roles and responsibilities

Skills and confidence


Recording, monitoring and communicating information

Communicating with service users to inspire action

Interfaces with other services

Equality and health inequalities.

The new toolkit shares practical materials such as health policies, job descriptions and lists of equipment to help others. Other trusts will now be able to use these as the basis for their own materials without needing to start from scratch.

The Lester tool has also been aligned as part of this project with the Bradford tool, an IT template system which supports physical health screening.

Professor Huon Grey, national clinical director (NCD) for cardiovascular disorders at NHS England, Professor Jonathan Valabhji, NCD for diabetes, and Dr Geraldine Strathdee, while NCD for mental health, directed the programme. 

Dr Strathdee said: “It is a major cause for concern that people with a serious mental illness have a life expectancy of the 20 years less, the same as for the rest of the population in the 1950s, because they so often suffer from lack of treatment of these physical illnesses. 

“We have been very pleased by the results from this pilot which have shown that physical health care in mental health in-patient settings can be improved, as well as treating their mental health. 

“We recommend that trusts and primary care teams, mental health trusts and commissioners use the Lester tool. This is now available as a poster for all clinical areas, as a clinician decision support template (the Bradford tool) for primary care, with roll commenced in leading specialist mental health electronic care records systems. 

“We can no longer see patients with serious mental illness only through the prism of their mental health; we must ensure an integrated physical and mental health, as well as social care, approach to monitoring and treating equally.”