WHISe was initially set up to tackle the health inequalities faced by those with severe mental illness. It provides an annual physical health check to all service users under the Care Programme approach. This service has had a massive impact on the physical health of our service users and enabled us to identify health issues such as metabolic syndrome and hypertension through to more sinister/chronic illness like cancers, COPD and type 2 diabetes.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
WHISe was initially set up to tackle the health inequalities faced by those with severe mental illness. It provides an annual physical health check to all service users under the Care Programme approach. This service has had a massive impact on the physical health of our service users and enabled us to identify health issues such as metabolic syndrome and hypertension through to more sinister/chronic illness like cancers, COPD and type 2 diabetes. The workers involved with WHISe have been able to consolidate their learning through practice and fulfill their job role through satisfaction and knowledge that they have and continue to make a real difference to the lives of our service users and bring back the meaning of holistic care to our health delivery service.
As WHISe has developed it has targeted the modifiable factors faced by this population and has developed WHISe Choices; a weight management education programme which provides education and choice around healthy eating and challenges sedentary lifestyles. It is based on solution focus and compassion therapy with a motivational approach. The aim is to provide a more ethically sustainable weight management intervention, something which is not offered to our service users (SU) at this time. The only option is mainstream weight management options provided by bigger organisations whose understanding of Severe mental illness (SMI) is limited or non-existent, thus excluding them from a sustainable weight management option. The course runs over 12 weeks, including topics on medication and diet, why wholegrains are good, how to reduce glucose and cholesterol levels and how to make ‘WHISe Choices’ with diet and activity. The aim of this course is to provide education and understanding about lifestyle and tackle modifiable factors within their life including, activity, diet, alcohol and smoking.
WHISe has also developed walking groups as a 3 tier level. Starting with our ‘WHISe walk and talk’ which covers the local parks and area over flat terrain allowing those who are less mobile (including wheelchair users and limited mobility) to be involved. It usually covers around 2-3 miles in distance making sure to use local cafes and amenities encouraging social inclusion and confidence. This also encourages SU’s to meet in their own time in a place they are familiar with: our WHISe ramble covers around 5-8 miles in the local country side and encourages SU’s to use public transport to meet at a designated site. This walk is for those who are more physically able or who feel their fitness is at a stage where they want to do more. ‘WHISe hike’ is for those who are more in to walking and nature. This walk covers 10-15 miles and can be within the local area or further out including the Lake District or the Yorkshire dales.
WHISe also provide a local badminton group providing a service for all abilities whether just come for the social side or to take part in a game. This has been arranged with the local sports center who also offers a discount 12 week membership for SU’s to sample other facilities without committing to a contracted gym membership. Other socially inclusive groups which aim to the reduce stigma and increase confidence of service users and family/carers include the ‘WHISe voices support group’. This is for those experiencing (or have experienced) voices, thoughts or other symptoms of psychosis. The SU’s meet in a local café which provides an atmosphere of ‘normality’ and removes the ‘medical’ stigma of their experiences. Staff at the café has received some training around SMI and have a great rapport with the SU’s. The group was set up with SU’s and utilises an unstructured approach with no expectations of the attendees. This has proven very successful with many SU’s creating new friendships and meeting outside of the group for meals and socialising. Due to the success of this group WHISe have recently set up an ‘Everyone Welcome’ coffee morning. This emulates the Supporting voices group but is non diagnosis specific meaning any SU can attend. Its aims are simple, to reduce stigma and loneliness and increase social inclusion and reduce health inequalities as at these groups there is always a member of the WHISe team who can provide support, guidance or signpost/refer to other services and support the SU’s if they need it. All these groups are aimed to become SU lead and have a simple aim of encouraging social inclusion, reduce stigma and tackle the health inequalities faced by our SU’s and reduce the mortality rate expected by this population.
What makes your service stand out from others? Please provide an example of this.
Our groups have been designed with SU’s being included in all decisions made around any group set up. We have involved them in the design and expectation of needs and wants in a collaborative way. The service is becoming an integral part of the community mental health teams. WHISe is the only service that provides a full holistic approach not only providing peer support but also provides a safe place for SU’s to talk about their experiences, speak freely about any issues and be given professional advice or sign posting/referrals to other agencies which could include health problems, housing issues and benefit advice. When initially looking at creating the WHISe service, it was identified that a holistic and person centred approach should be used, this allows for individuals experiences, cultural needs and specific barriers that that have faced previously to be identified and ensures that individuals are not assumed to have the same needs as any other individuals needing WHISe services. This has allowed the team to continually learn from the individuals we support, resulting in the team gaining a WHISe Peer Support Volunteer who has been within services for some time and can identify and empathise with individuals in a way in which the rest of the team cannot as easily. We work in a service user centred way and through feedback forms and discussions we develop our services and groups to meet their needs and not the needs of the service.
How do you ensure an effective, safe, compassionate and sustainable workforce?
Here at NAViGO we pride ourselves on being pro-active towards the health and well-being of our staff – we like to be responsive to need yet innovative/proactive towards improving our employee’s health in any way we can. A healthy workforce is a happier one and whatever we can do to reinforce this we will go the extra mile. The WHISe team is a small team which allows for a greater understanding of staff needs, wants and desires. Working collaboratively with service users has identified gaps in our training needs and has helped us to work towards providing a better skilled team building on the strengths of the work force which also helps to promote job satisfaction, respect and sustainability. Training provided so far has included ECG awareness via the University of Leeds, Venepuncture training via the National association of phlebotomist, Weight management training via the weight management centre, Blood interpretation training via Bishop Grosseteste Universtiy and diabetes awareness at level 2. Clinical and managerial supervision is provided every month with ad hoc supervisions taking place as and when required. With PDR offered annually and training requirements discussed as and when they are identified.
Who is in your team?
1 x Nurse Specialist band 7 Full time 1 x Assistant Practitioner band 4 full time 2 x Support worker band 3 1 one full time & 1 part time (3 days) 1 x Peer support volunteer 4 hours per week to cover groups and shadow clinics
How do you work with the wider system?
Working closely with public health, WHISe has negotiated ‘fast track’ referrals to oral health, smoking cessation, weight management and exercise trainers. WHISe have finalised their ‘WHISe Choices’ programme in partnership with public health. It will provide education and choice around healthy eating and challenge sedentary lifestyles. It is based on solution focus and compassion therapy with a motivational approach. The aim is to provide a more ethically sustainable weight management intervention. The course will run over 12 weeks, including topics on medication and diet, why wholegrain are good, how to reduce glucose and cholesterol levels and how to make ‘WHISe Choices’ with diet and activity. We have worked closely with a local café who have provided free space for us to deliver the group making it a more ‘real’ environment taking it away from health centers. WHISe continues to work closely with the local stop smoking service.
We have access to their electronic referral system which allows us to refer directly to their system meaning a more timely service with contact being made within 36 hours form referral. They have also provided cessation training for staff so as to enable us to deliver interventions more timely. We have also worked with them to explore the options of harm reduction; being involved in a pilot to explore the effectiveness of e-cigarettes as an aid to reducing or stopping tobacco use. From the pilot study 50% of those involved either stopped or reduced their tobacco use. Finally we are now working towards all our employees being provided with smoking cessation intervention training ranging from brief interventions to full cessation. We also have a good working relationships with primary care and are able to refer to our colleagues for more interventions/tests should there be a need identified. As we are based in the primary care centers we are able to literally walk down the corridor and seek further advice should we need it.
Do you use co-production approaches?
Co-production is essential to any service and this is something NAViGO as a whole focus greatly on. Whether this is having community members- service users, carers on the NAViGO Board, as community representatives, within surveys and questionnaires, we have a service user forum ‘your voice’ where they are able to find out more information and give ideas, service users support on interview panels and we also have a number of staff members within the services who have been (or are) service users within the services themselves NAViGO have numerous ways to get the involvement of those most important. Service users and carers are included within the make-up of NAViGO- it’s something that has been incredibly important too is and thus incorporated at every level since day 1, the thought being why develop a service FOR someone when you can develop a service WITH someone– the service is for them after all. Having said that the WHISe service is run by professionals and a peer support volunteer to provide physical and lifestyle assessments valuing service user involvement. Additionally our other groups (WHISe Voices Support Group, badminton and walk & Talk) have been developed with service users and are facilitated by our peer support worker. The supporting voices group was developed directly with service users who stated what they would like form a group. Following this we were able to develop a peer support group that empowered and enabled those to discuss and talk about their experiences in a safe and relaxed environment with the knowledge that co-facilitators could empathise through their own experiences.
Do you share your work with others? If so, please tell us how.
We are committed to improving the quality and life expectancy of our service users and that of service users across the country. As such we have shared our ideas with many trusts and presented to many different organisations both regionally, nationally and internationally. We have presented at the ‘mind the gap’ conference in London and at the World Congress for Psychiatric Nursing in Canada. We have also presented to other NHS trusts including, Warrington, Hull, Barnsley, Derbyshire, South West Yorkshire and Wakefield. We have also presented to the Academic Health science Network and the regional Commissioning Network. We have also been invited to present at the international RCPSYCH conference this July. We have been involved in a research project with the York Health Economic Consortium along with Bradford District Foundation Trust who produced a long term economic outlook which suggested considerable savings across the NHS. This will be over a longer term period but for example if we considering diabetes cost the NHS nearly £200,000,000 per week, by preventing or early detection we could save the NHS millions of pounds. We have also been involved in supporting a chapter in a national book ‘the essentials of mental health nursing (2018)’ in which we provide evidence of our work to show how important addressing the co-morbid factors are for our client base. We are also working closely with the University of Hull to write a paper on our WHISe Choices which should be ready by the back end of this year.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The team can see that outcomes are being met by the physical health improvements of service users alongside their mental well-being by using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) alongside service user feedback forms, this reduces the dependency the service user has on Crisis support and Community Mental Health Teams (CMHT) as support is available within the groups or though friendships that they have made within the groups. The Supporting Voices has seen five individuals discharged from CCO within the last six months of the group running. The individuals also know that they can continue attending all groups WHISe facilitates and know that if they do need additional support staff are available at the group and a ‘Fast-Track’ referral back into CMHT can be completed if appropriate. For our WHISe service we complete a well-being questionnaire at the start of the course and at the end to evaluate their well-being as well as collecting health information (BP, weight, BMI, Lipid levels and HbA1c). The information is being collated and used for the paper in conjunction with the University of Hull. We work in a service user centered way and through feedback forms and discussions we develop our services and groups to meet their needs and not the needs of the service.
Has your service been evaluated (by peer or academic review)?
We have been involved in a research project with the York Health Economic Consortium along with Bradford District Foundation Trust who produced a long term economic outlook which suggested considerable savings across the NHS. This will be over a longer term period but for example if we considering diabetes cost the NHS nearly £200,000,000 per week, by preventing or early detection we could save the NHS millions of pounds. We have also been involved in supporting a chapter in a national book ‘the essentials of mental health nursing (2018)’ in which we provide evidence of our work to show how important addressing the co-morbid factors are for our client base. We are also working closely with the University of Hull to write a paper on our WHISe Choices which should be ready by the end of the year.
How will you ensure that your service continues to deliver good mental health care?
We are continuingly working with our commissioners and have secured some recurrent monies to be able to extend our team by 1.5 band 3 support workers to aid with shared care and ongoing facilitation of groups and WHISe assessments. As part of the national and local CQUIN we have to provide evidence that we are committed to ensuring our service users receive an annual health check which we have achieved and exceeded year on year. As we are a very small service with little funding we are innovative in our approach and use local cafes and venues for our groups and use the local areas for social inclusion activities. By providing the service we do it alleviates the work load of our care coordinators and allows them to focus on their more troubled service users. It also allows the service users to seek alternative peer support during difficult times. In our groups we have been able to identify several service users that could be discharged form our service and remain involved in the groups they attend which allows for a faster referral back in to service should they need this. Because the groups are becoming service user lead any change in management will not affect the current situation. With regards to the WHISe service, our evidence shows this is a successful service and is now and integral part of our policy thus meaning any change in management will not affect the service or running of it.
What aspects of your service would you share with people who want to learn from you?
We found some GP’s opposed to WHISe as they thought we were ‘doing their job’ and duplicating work. Education around WHISe and explanation that we do not diagnose but monitor, test and signpost if results indicate has been challenging at times. Responsibility does not lie solely with one branch of health care but all providers and working together ensures a better experience for patients. Time was a challenge due to the number of patients to be seen. We appointed two part time HCA’s to run mobile clinics with clinical staff supporting them. Attendance was an issue at 50% but working with care coordinators and by offering home visits this has improved to over 85%. Equipment and training needed to be addressed, this has been a good investment and training provided on a reciprocal basis with our primary care colleagues reducing costs and increasing knowledge for all parties. As far as group work goes the biggest advice shared is to involve service users and ask what they would like. I have worked in different areas and noted that most groups do not last, we believe this is because the groups have been set up by ‘professionals’ with no consultation as to what the service users would like. We believe this why our service continues to grow and is becoming truly holistic rather than generic being bespoke to the needs of the service user.
Additional Questions
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How many people do you see?
Currently the WHISe service is offered to all service users under care coordination (CCO) which equates to approximately 450 service users. We also provide monitoring under shared care estimated to be 30-60 service users per year (300 appointments per year) giving a total of 510 appointments per year. Our groups are open to anyone under CCO (with the exception of the WHISe supporting voices group which will be open to anyone with these types of experiences in the near future) and we currently have around 40 in attendance giving us a total of a minimum of 560 service users
How do people access the service?
WHISe is offered to all those under CCO information provided by our performance team using the case load management tool which pulls through all those requiring and assessment as well as letting us know when they are due and last had one. Group referral is obtained either at the WHISe assessment or via the CCO who are aware of all groups currently being run. This information is provided at weekly meetings, staff hand books, acute units and at our service user forums (your voice). As stated previously WHISe annual health checks are offered in a variety of locations allowing access to all service users. The groups are held in the community near the bus station allowing easy access.
How long do people wait to start receiving care?
WHISe assessment is on an annual basis so there is no waiting list. If there is anything identified that requires follow up (e.g. repeat blood test in 3 months’ time) we will support and make sure this is not missed. Groups can be accessed immediately with the exception of WHISe Choices which is a 12 week programme so can only be accessed at the start of the course.
How do you ensure you provide timely access?
All WHISe information is shared with GP, consultant and CCO within 48 hours of the assessment. All staff are fully trained in ECG, venepuncture, basic observations and blood interpretations and dedicated to their role. With the new increase in staff we are now able to manage any staffing issues effectively.
What is your service doing to identify mental health inequalities that exist in your local area?
By using local businesses and local area we are helping to challenge stigma and inequalities. The reason WHISe was established was to tackle the mortality rates faced by those with SMI and over the past years we believe we have challenged this and changed the perspective of many of our general health colleagues. We have highlighted that just because you have a mental illness does not exempt you from and physical health problem.
How do you identify the needs of a person using the service?
We currently use the WHISe assessment tool which is based on the health improvement profile.
What support do you offer families and carers? (where family/carers are not the service users)
We involve carers, family and friends as much as the service user allows or wants. Particularly during home visits by including them with basic health and lifestyle advice and when permitted we invite them to attend groups to help them get a better understanding of the illness being experienced.
NCCMH mental health care pathways
Have you implemented any of the mental health care pathways developed by the NCCMH (on behalf of NHS England)?
Other: Liester tool
If you have implemented any of the above, what were the benefits and challenges?
Helps guide and support the interventions to prevent cardio metabolic syndrome.
Further information
Is there anything else you want to share about what makes you an example of positive practice?
All our groups work and are regularly attended because there is no expectation or pressure placed on the service user. They are run and developed with the service user in mind and have a simple peer support therapy foundation. Staff are present as much as possible to allow any service users to discuss any issues that may be upsetting and/or distressing to them and/or to seek advice or guidance on any issues they may have from benefit forms to securing training or employment. Our groups have naturally evolved and with our peer support volunteer we now have a truly holistic service that is relatable for our service users.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): North East Lincolnshire Clinical Commissioning Group (NELCCG) and NHS England (Rharian Fields)
Provided by (e.g. name of NHS trust) or your organisation: NAViGO CICis a not for profit social enterprise formed in 2011 under the Right to Request Agenda. The whole of mental health services in N E Lincolnshire transferred out of the NHS yet is still the preferred provider to the NHS delivering both statutory and a range of innovative additional services in N E Lincolnshire. Becoming a social enterprise has allowed the organisation the autonomy to develop innovative projects. Any surplus made by working smarter is re-invested to improve services for local people.
Population details
Brief description of population (e.g. urban, age, socioeconomic status): North East Lincolnshire is a small unitary authority covering an area of 192km2 with a population of around 159,000. The majority of the resident population (around 94.2%) live in the urban towns of Grimsby and Cleethorpes with the remainder living in the smaller town of Immingham, or in surrounding rural villages. On the Northern border, the Humber estuary has been designated as a Site of Special Scientific Interest and to the south, the Lincolnshire Wolds are recognised as an Area of Outstanding Natural Beauty. Cleethorpes gained 4 national Seaside Awards in 2015. North East Lincolnshire has a distinctive economy, built on expertise in manufacturing, engineering, ports and logistics, and food processing. The local area has some significant advantages stemming from its location, labour force, and transport infrastructure that position it for growth in renewables, chemicals, advanced manufacturing and the food and drink sector. Taken together, Grimsby and Immingham constitute the UK’s largest port by tonnage shipped. Whilst the general direction of travel for the locality is around improving the environment and perception of the area, N E Lincolnshire does have pockets of high deprivation, ranking high on the IMDO (Index of Multiple Deprivation) which measures the following 7 deprivation indicators:- • Income • Barriers to housing and services • Employment • Living Environment • Health/Disability • Crime • Education/Training An example, East and West Marsh, two Wards within the North East Lincolnshire Council area, now rank in the top 1% deprived sub-areas nationally. As a result of the deprivation there are long standing health inequalities with those in the more deprived areas dying on average 8 – 10 years before those in the most affluent. According to the National Office of Statistics, around 18.46% of the population have some sort of emotional disorder. Other key points to note:- • The boundary of North East Lincolnshire is comprised of 106 Lower Super Output Areas (LSOAs); these LSOAs which contain a minimum population of 1,000 and a mean average of 1,500 are distributed amongst the fifteen electoral wards. • Overall, North East Lincolnshire is ranked as the 31st most deprived local authority in England, out of 326. (increased from 46th in the ID 2010.). • 32,567 residents, which is approximately 20% of the population are classed as income deprived with 25% of LSOAs being in the 10% most deprived for income nationally. • 15,140 residents are classed as employment deprived. • 20.1% of the working age (16 to 64) population of North East Lincolnshire have a known disability • 95.4% of the resident population of NEL are White British. • The January 2015 School Census shows 23,541 children on roll, 2981 ( 12.5%) of school pupils were identified as having Special education needs • Presently 28.5% (8,500) local children are thought to live below the poverty line
Size of population and localities covered: Population c159,000 – NAViGO covers the area of N E Lincolnshire
