{"id":333,"date":"2021-12-22T14:56:39","date_gmt":"2021-12-22T14:56:39","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=333"},"modified":"2022-01-17T15:49:18","modified_gmt":"2022-01-17T15:49:18","slug":"dont-just-screen-intervene-by-liam-loftus","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2021\/12\/22\/dont-just-screen-intervene-by-liam-loftus\/","title":{"rendered":"“Don\u2019t just screen, intervene” by Liam Loftus"},"content":{"rendered":"

The COVID-19 pandemic has shone a bright light on the seriousness of health inequalities within England, exacerbating the significant discrepancy between healthy life expectancy that is known to exist between the least and most deprived areas of England.\u00a0 A national approach to reduce health inequalities and narrow the life expectancy inequality gap, has been developed by Dr Bola Owolabi and the Healthcare Inequalities Improvement Team at NHS England. This approach, known as \u2018Core20PLUS5<\/a>\u2019, is to be implemented at both a national and system level. It defines target population cohorts \u2013 the \u2018Core20PLUS\u2019 and identifies \u20185\u2019 focus clinical areas that require accelerated improvement as a priority due to their contribution to the life expectancy inequality gap.\u00a0<\/em><\/p>\n

This is the second in a series of five blogs, written by clinical fellows on secondment at NHS England and NHS Improvement and Healthcare Quality Improvement Partnership (HQIP), explore the \u20185\u2019 focus areas, the links between health inequalities and the invaluable contribution of leadership to narrowing the life expectancy inequality gap. The \u20185\u2019 focus areas are cardiovascular disease<\/a>, cancer<\/a>, chronic respiratory disease, maternity<\/a> and mental health.<\/em><\/p>\n

In my personal life, I have seen first-hand the impact that severe mental illness (SMI) can have upon an individual. I have embraced the periods of stability and fulfilment that people with SMI experience, and I have comforted them during the times of anguish and distress. I\u2019ve seen in my professional life too, how the challenges of living with SMI extend far beyond the impact upon mental health. Most notably, I\u2019ve experienced how physical health issues are not only common, but are often overlooked; by patient, by clinician, and by the wider system.<\/span><\/p>\n

There\u2019s one fact in particular that continues to cause deep, personal sadness:<\/span><\/p>\n

On average, <\/span><\/i>a person with a diagnosis of SMI dies 15 to 20 years earlier than the general population.<\/span><\/i><\/a>\u00a0<\/span><\/i><\/p>\n

This sadness quickly becomes discomfort when I remember that this stark life expectancy gap is driven by physical conditions <\/span>which are largely preventable<\/span><\/i>; these include cardiovascular disease, respiratory disease, and infections. As leaders in healthcare, the responsibility for ensuring that this health injustice is tackled swiftly and directly sits on all of our shoulders.<\/span><\/p>\n

Where should we start?<\/strong><\/p>\n

One key mechanism to confront this life expectancy gap is through the early detection of physical health conditions. The annual physical health check for people with SMI (which includes people diagnosed with schizophrenia, bipolar affective disorder, and other psychoses) aims to do just this. This check involves assessing and recording key physiological measurements (see <\/span>below<\/span>) to identify current and future health challenges, and is followed by a structured, supported discussion on how a person\u2019s physical (and often mental) health may be improved.<\/span><\/p>\n

The six key indicators measured during the SMI physical health check:<\/span><\/p>\n