The Physical Health Portfolio for Physical Care in the Medium Secure Unit

ContactDr. Nangai Azhahan, Specialty Doctor
AddressMarston House, Corporation Street, Stafford, ST16 3AG

The Physical Health Portfolio for Physical Care in the Medium Secure UnitStaff at South Staffordshire and Shropshire Healthcare NHS Foundation Trust have developed a Physical Health Portfolio to ensure best practice in meeting the physical health needs of forensic service users.

The Portfolio provides a comprehensive and holistic picture of the service user’s physical health and ensures that investigations and referrals for specialist opinions are undertaken in an efficient and timely way


This folder was developed in responses to problems faced staff at the Trust in managing physical health needs of patients at the medium secure unit.

Dr. Nangai Azhahan, Specialty Doctor at the Trust, noticed that due to the frequent rotation of junior doctors and nursing staff, the poor understanding of their physical health problems by service users when mentally ill and the poor documentation and storage of appropriate investigations and correspondences; some investigations and referrals for specialist opinions were repeated unnecessarily. This meant that appropriate care for the patients was sometimes delayed and there was a waste of clinical time and money.

Dr. Azhahan developed a separate Physical Health Portfolio folder, which is used to store all basic information about allergies and past medical history from patient’s GP/previous service provider, initial physical health assessments, all physical examinations including annual physical health check for the forensic patients (CQUIN requirement), investigation results including bloods and ECG, daily/weekly/monthly physical health monitoring including height, weight and BMI apart from BP, pulse, respiratory rate, oxygen saturations and correspondence with specialist services at the general hospital.

An Annual Physical form was developed as part of the folder, which takes a holistic and comprehensive picture of the patient including vision, hearing and metabolic syndrome identification in addition to the usual system examinations.


  • Cost to design and print 100 folders, index cards, assessment questionnaires – £1631
  • Both medical and nursing staffs are sharing responsibilities to document sections of the folder. Regular ward clerk time would be appreciated, but due to absenteeism and cross covering, this service is not readily available currently and this has been compensated by the nursing and medical secretaries currently.


This folder was rolled out for all patients within the forensic services in Stafford and Shropshire between April and June 2013. This has greatly assisted delivery of the directorate’s Physical Health CQUIN for 2013/2014 because most of the required data could easily be collated from the physical health portfolio folder.

The nursing and medical specialties have noticed the benefits of keeping all the physical health information collated in one folder in terms of ease of access, documentation, filing correspondences and retrieving information when needed. This has helped staff to work efficiently and ensure the service users receive the appropriate care at the right time.

The folder also provides an excellent opportunity for nursing staff to educate and support service users in 1:1 sessions regarding their physical health problems and management plans, thus encouraging and enabling service users to take ownership of their physical health needs.


The trust had a policy of having a single medical folder and it took some convincing to emphasis how this single medical folder was not working for the special client group in medium secure unit, who depended on us for primary care unlike the other general psychiatric patients, who had access to their GPs.

Future plans

A regular GP session would make this setting akin to the primary service available in the community. However, we currently do not have this service provision and the Trust is looking at employing a GP and Primary care nurse for 1 to 2 regular sessions per week.

This folder should be regularly reviewed and constantly updated if clinically indicated.
This folder could be rolled out to other services where the average period of patient stay exceeds a year.

Key learning points

This system would only work if the appropriate information is constantly updated in the physical health portfolio folder, which requires repeated encouragement and reminders to nursing and medical colleagues.

Further information

Dr Azhahan was awarded the Chris Hollen Award for Innovation in the SSSFT annual awards 2013