"Service users not being given opportunities to improve their physical health"

About: NHS London South London And Maudsley NHS Foundation Trust / Inpatient mental health care

(as a volunteer/advocate),

NHS London has an Inequality Lead who raises awareness of the problem of poor physical health and reduced life expectancy of people with severe mental health problems, so to help combat this glaring healthcare inequality I lodged a complaint with NHS London because as far as I am aware the South London and Maudsley NHS MH Trust (SLaM) isn't keeping records of how its using it's gym services to help it's service users combat physical health problems.

The Trust claims to have no records on user usage numbers, induction, throughput or outcomes - and NHS London suggest that insistence on good record keeping to demonstrate most effective and efficient patient focussed use of resources isn't part of its strategic remit.

SLaM claims on its website to be driven by 21st Century Science and the needs of its service users. The Trust is however documenting, advertising and signposting staff usage of its gyms and claims that Health and Safety in workplace regulations compel it to do that and it has obligations to look after its staff.

As far as my experiences as a volunteer are concerned, I have not been aware of service users being made aware of the gyms and even if they stumble across them I do not know of them being offered inductions or encouraged to use the facilities. A search of SLaM's website only turned up one mention of a gym and that was in connection with it being used for Choir practice.

SLaM provides mental health services across a huge swathe of South East London and that's a lot of service users with physical health problems who I feel are being failed by this Trust and NHS London.

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Responses

Response from Bill Berry, Patient Experience Manager, Patient Public Involvement Team Organisation and Community Directorate, South London and Maudsley NHS Foundation Trust

Dear Andrei,

Thank you very much for your posting on Patient Opinion. It is very clear that you place great importance of the physical health care inequalities prevalent in those who suffer from mental illness and I thank you for your vigilance.

In the first quarter of this year, The Clinical Exercise Department, who are charged with providing physical activity, and rehab programmes for clients of SLaM conducted an activity review on both the Maudsley and Bethlem sites.

This review provided a more detailed analysis then the routine monthly attendance information and electronic patient journey data collected and kept by the trust. The review looked at social interaction, mood pre and post exercise, satisfaction and engagement levels and likelihood of return. In all these areas measured the department scored highly. Additionally, we collate monthly attendance figures which are kept within the department and were reviewed as part of this study. A copy of this study can be provided if requested.

With regards to patient access, all sessions are governed by sessional timetables where we provide ward specific and open groups that ensure maximum opportunity for most patients to participate in physical activity. We also provide exercise sessions on wards for those who find it difficult to access the gymnasium.

Timetables and other information about access to exercise are typically sent via e-mail to all wards, and the exercise instructors work with ward staff to ensure that the exercise programmes meet their individual ward needs as far as possible. We do not as a rule use the staff web pages to promote patient services.

If you wish to discuss this any further, please do not hesitate to get in contact with me.

Regards

Geoff Ravalier

Clinical Exercise & Physical Activity Manager

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Update posted by Andrei (a volunteer/advocate)

With respect it isnt very clear to me that SLaM has placed any great importance of the physical health care inequalities prevalent in those who suffer from mental illness if the research has only been undertaken in the last quarter.

SLaM stated under oath at the Bromley County Court in a gym service related disability discrimination hearing that there were no records for it's Ladywell gym over its entire first 10 years at all and said as much in response to patient FOIA requests as well. Implying the Trust is exemplary on record keeping in this area rather defeats the object of this website - open and honest communication to improve services, particularly what I believe to be a long neglected service like the Trust's gym's and physical exercise regimes that in my opinion have been poorly managed, documented and advertised.

I am now going to be requesting the detailed gym records you've mentioned here as an FOIA request and will raise the discrepancy with the Information Commissioner because it is important that the Trust are clear about what information they collect and retain when dealing with patients or their carers and advocates.

I know of patients that were told there was no information available on gym funding as well by SLaM executives who claimed that information was held by internal but separate Trust charity that was not required to be accountable in any way, even though the same executives who ran the Trust fronted that charity too and I think this system needs to end.

No one should withhold this kind of information requested by service users and those acting on their behalf. Trust's have to expect that the people they serve will be vigilant over patient treatment, care and support and Patient Opinion is part of that change.

Similarly , with regards to patient access, you state that ' all sessions are governed by sessional timetables where we provide ward specific and open groups that ensure maximum opportunity for most patients to participate in physical activity' . I don't believe that is true. At the time of this story being posted I could not find any information about structured patient access to the Trust's gyms or physical exercise regimes on the SLaM website at all, beyond a reference to the Maudsley gym being used for staff led choir practice - That's hardly targetting information about the gym and benefits of exercise at 'most patients' is it? Moreover this is in spite of SLaM informing the Bromley County Court that the gym services were open for use by ward and community patients equally so again I feel your response is unhelpfully misleading, I know of no timetables that patients outside of the wards are aware of - most community patients are not even aware the gym services are there and SLaM admitted to the court that it had no legal obligation to provide access to the gyms or physical exercise at all to community side patients and service users even though preventatively, this is exactly where poor physical ill health associated with enduring mental health problems predictably takes its toll .

Could we have some openess please Geoff? The SLaM Foundation Trust operates on top of a mental instution that has been around for hundreds of years and I feel your response is evasive in that it implies things have miraculously changed at SLaM regarding institutional policies, practices and attitudes ref openly and consistently offering patients and service users access to gym services and exercise equipment and routines in last quarter as part of what SLaM does - I believe it just doesnt bear up to scrutiny, even as NHS London's Inequality Team posts YouTube videos highlighting the disproportionate incidence of poor physical health and related deaths of people with severe mental health problems. It's my understand that most of these people are community side patients on psychiatric drugs which very often undermine health and/or make issues like obesity, heart problems and diabetes so much more likely.

I would prefer you not to commend patients, carers and advocates on their vigilance here, the problem as I see it has been and largely still is a lack of institutional vigilance from mental health Trusts like SLaM that offered and readily advertised gym and exercise regimes to its own staff but kept the same facilities a secret from most patients.

People need that information. Where is it?

One way SLaM could make amends here and demonstrate it's committment to physical health would be to install one of the popular adult playground exercise suites that boroughs like Camden and Greenwich are now placing in public parks in a highly visible and accessible place out front at the Maudsley and where possible on other large sites too so the link between mental and physical health is reinforced in a completely open and non stigmatising way. NHS London should seriously think about doing this too. Make physical exercise a more up front and integral part of the NHS brand.