1. Dr Vishelle Kamath Consultant Psychiatrist SEPT
Providing an Accessible Mental Health Liaison Service to a General Hospital: Challenges and Solutions  
Dr Vishelle Kamath
Consultant Psychiatrist
SEPT

2. Background The L & D – a large district general hospital
A wide and diverse population from 3 different counties
£3.6 million - The total cost to the commissioning body, NHS Luton, for admissions to the L&D for psychiatric presentations including dementia, self-harm and substance misuse was approximately ( )

3. Background continued...
A high proportion of patients in general hospitals have co–morbid mental health problems, leading to poorer health outcomes and increased healthcare costs.
[Joint Commissioning panel for mental health]
Mental health service users2 have double the rate of hospital attendances compared to the general population3 – across A&E, inpatients and outpatient services
[ The Health and Social Care Information Centre (HSCIC)]

4. The Problem
The current level of psychiatric input into the L&D cannot meet demand.

5. Objective To develop a psychiatry service that : Will meet the demand
Is accessible to all patients
Will measurably improve outcomes with regards to health, finances, patient and carer experience
Be implemented by December 2013

6. Root cause Analysis
National Drivers
Media/
Expectation
L&D

7. Root cause Analysis
The current model of mental health service provision to the L &D is one of ad hoc psychiatric consultations with separate services for adults and older adults (those aged 65 and over).
The growing demand for psychiatric assessments and input cannot be met at the current levels of resource allocation
The result of this inequality between supply and demand is placing immense pressure on the hospital
- increased lengths of stay
- hospital acquired infections, poorer patient experience and poorer health outcomes.

8. Strategic Options Continue with the Existing Service
Augment the existing service
Commissioned Psychiatric Liaison Service

9. Comparison of Strategies
Strategy
Cost
Effectiveness
Quality
Accessibility
Risks
Stakeholder Support
Time to effect
Potential saving
Continue with existing service ↑
Augmented Service
Commissioned Psychiatric Liaison Service ↓

10. Key Milestones Implementation Modelling of Options
Trial of Augmented Service
Re-evaluation
Position statement
Idea generation
Consultation with Stakeholders
Business planning &Service Specification
The beginning

11. Implementation Steps Pathways & Operational Policies
Risks and risk management strategies
Outcome Measures and KPI’s
Financial management & Reporting arrangements
IT systems
Workforce recruitment
Governance Structures
Service Review

12. Evaluation Plan
Strategic Aim
Equitably accessible, high quality service that improves patient outcomes
To facilitate efficiency in the service with a resulting financial saving
Short Term
Improved patient experience
Improved quality of care
Long Term
Better patient satisfaction
Financial savings

13. Measurable Outcomes Improved patient and carer satisfaction
Reduced length of inpatient stay in the general hospital
Avoidance of admission to the general wards
Reduced frequency of readmission after discharge
The proposal costs approximately £300,000 per year
The cost savings are based on the analysis of data at Birmingham City Hospital RAID service between 1st December st July 2010*
Savings from reduced Length of Stay = £1.75 million
Improved patient and carer satisfaction
Improved patient choice
Reduced delays in accessing mental health input
*Economic Evaluation of Liaison Psychiatric Service Centre for Mental 2011

14. Agreed KPI’s KPI Comment/Query Notes
1.To reduce the number of emergency admissions.
This refers to emergency admissions via A/E to the L&D.
If L&D admissions, SEPT will be dependent on L&D to report.
2. To reduce the number of readmissions.
This refers to emergency readmissions via A/E to the L&D.
If L&D readmissions, SEPT will be dependent on L&D to report.
3. To reduce the number of delayed discharges from the L&D due to mental health causes.
Will need to define which delayed discharge codes will need to be monitored.
SEPT will be dependent on L&D to report.
4. EAU admission avoidance in L&D
This is to monitor those patients that are admitted to the Emergency Admissions Unit in the L&D from A&E.
Measure used in the economic evaluation of RAID by the LSE. The rationale is that the RAID model demonstrated a reduction in admissions to the equivalent unit within the general hospital
5. Monitoring of discharge destinations e.g. more people discharged home
Secondary measure suggested in the economic evaluation of RAID by the LSE.
6. Length of time from referral by L&D to;
Could compare to pre service implementation if baseline information gathered.
1 working day for assessment on base wards
CRHT response times to A&E to be reduced from 4 hours to 1 hour

15. Agreed KPI’s cont….
7. To reduce L&D delayed transfers of care due to MH causes.
Will need to define which codes will need to be monitored.
8. Increase in referrals to Psychiatry Liaison Team (PLT).
Would need a baseline, not available as a new service, could suggest a trajectory.
9. Total number of referrals.
10. Proportion of referrals assessed as appropriate.
11. Patient/carer satisfaction before and after implementation.
To be measured by Patient experience team, to work with L&D patient experience team.
12. L&D hospital clinical teams satisfaction before and after service implemented
To be measured by patient satisfaction team.
13. L&D Hospital staff awareness of liaison service. .

16. Lessons Learnt So a new service..... Why all the fuss?
The right proposal by
The right provider
The right time
Transformational Leadership
Influence and relationships
Achieving consensus – unfiying objectives

17. Lessons Learnt ..... The spending paradox Stakeholder management SEPT
Stellar reputation as a provider of excellent services
Track record of successful service transformation
The spending paradox
Spend Averse Climate
Investing to save

18. Lessons for me
Maintaining momentum...

19. Lessons for me
Time distortion!

20. Lessons for me
Sequential problem solving

21. Lessons for me
More than just numbers....

23. Thank you!