Our ability to meet CQUIN targets set by NHS England and NHS Improvement is one of many factors commissioners consider when deciding to use our services. CQUIN is short for Commissioning for Quality and Innovation and is a measure used to encourage evidence-based good practice and innovation. The 2019 CQUIN target is ‘Managing a Healthy Weight in Adult Medium and Low Secure Services’.
Lack of knowledge of physical health concerns and resources to address them, as well as challenges to accessing health promotion and physical health services are widely recognised as key factors in health inequalities for people with learning difficulties and mental health issues, notably in inpatient services.
Given that the above description encompasses our entire patient population, the need to ensure this is a focus for us is clear. Whilst managing a healthy weight is only one element of the care we provide, its link with co-morbidity indicators emphasise the need for this to be an area worthy of greater scrutiny and focus.
Cedar House Hospital already has in place both a Sports Development Leader and a Health Promotion Nurse but the CQUIN target has given us renewed impetus to focus on this area. Patients already have individual health plans, menu choices, food suggestions and enhanced physical activity choices but we realise that there is always more that we can do.
The CQUIN targets break down what is required into four distinct areas:
- Food and Nutrition
- Physical Activity
- Treatment Interventions (including medication)
- Workforce (skills, knowledge and confidence)
Food and Nutrition
All of our food is prepared and cooked on-site by our catering team and our Executive Chef and Food Safety Manager works closely with our patient-inclusive catering committee. The catering committee is made up of patient representatives, ward staff, one of the ward managers and the catering team to collect and provide feedback from our patients about the food on offer. The committee also taste test and approve new food types and meals that the catering team are considering.
The team are supported by a community dietitian who visits regularly to provide advice to individual patients and their supporting staff team. Patients at Cedar House are always encouraged to make healthy menu choices and to make this easier, healthy options on the menus are highlighted. Additionally, patients with a known weight condition receive extra support and advice from our team when making menu choices.
With the CQUIN target in mind, the catering team suggested switching to wholemeal rice and pasta so the catering committee organised a tasting session for patients, who all agreed that it was just as good as white versions. We now serve only wholemeal rice and pasta and plans are underway to see what other areas of the menu can be entirely switched to only include healthy choices. Changes will be made only with full approval by our patients and gradually over the course of the year.
Our full-time Sports Development Practitioner offers a range of group and individual sports and exercise sessions that are available to all of our patients. Patients can take part in weekly sessions for football, basketball, dance, gym or exercise classes. Where patients have a particular interest in a specific area of sport, our Sports Development Practitioner works with them to obtain ASDAN sports qualifications.
In addition to the sporting activities on offer Cedar House patients are able to take part in groups that also encourage physical activity including walking, fishing and gardening. Should patients prefer not to commit to planned activities they have use of both an outdoor gym and trampoline and are encouraged to offer up suggestions for other physical activities.
One such suggestion was to walk the almost 10-miles from Dover Castle to Deal Castle along the coastal path. One of our senior managers told a patient that they thought this was a fabulous idea – which lead the patient to ‘challenge’ the entire Senior Management Team to join them on the walk. The walk took place on the 9th October and proved a really great day for all. 11 patients, 17 of the Cedar House team, 3 dogs and our Senior Management Team braved somewhat challenging conditions to complete the walk in just over 8 hours.
We are constantly reviewing the range of physical activities on offer and looking to increase participation by patients. A new initiative this year was a Sports Day in which pretty much all of our patients participated with great enthusiasm. The day proved such a big success that it will now be an annual event.
We regularly monitor patient’s weight and BMI and where patients have a specific weight issue individual care plans are in place to support them. All patients undergo an annual physical health check by our GP service.
Every quarter our health promotion nurse organises an event linked to healthy weight and physical activity such as the Diabetes Awareness Day. Patients are encouraged to not only attend these events but to get involved in organising them.
Our quarterly drugs and therapeutics committee, made up of the three responsible clinicians, senior nursing team and a specialist mental health pharmacist, review current prescribing for all patients with an unhealthy BMI. This review considers not only any impact on the patient’s BMI but also any pharmacological innovations that may offer a preferable medication to facilitate maintaining a healthier BMI.
From induction onwards, all team members are encouraged to be involved in health promotion events and to take care of their own health. The Health Promotion Nurse delivers various training sessions and has recently trained all ward-based team members on the Malnutrition Universal Screening Tool (MUST).
Huntercombe offer a Cycle to Work scheme to encourage physical activity and of course our team are catered for by the same catering team as patients so can also access healthy menu choices.
Team members can access an occupational health service to seek advice and support on reasonable adjustments they may need as a result of an underlying condition or purely because they would like advice on treatment, diet or exercise.
Measuring how well we do.
All of our patients were weighed and BMI measured at the beginning of the year so that we can assess the impact of our focus on maintaining a healthy weight and we look forward to reporting back on our progress.