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Dr Stella Morris, Consultant in Liaison Psychiatry, Hull Royal infirmary


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Developing and delivering a Liaison Psychiatry service.

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Dr Stella Morris, Consultant in Liaison Psychiatry, Hull Royal infirmary

  1. 1. Developing and Delivering a Liaison Psychiatry Service Stella Morris Consultant Liaison Psychiatrist Department of Psychological Medicine Hull Royal Infirmary
  2. 2. Outline • Hull service development 1997 – 2015 • Current clinical model • Priorities for the Hull Service in 2015 • How liaison services can help with crisis care
  3. 3. Acute Hospitals (1997) Royal Hull Hospitals Trust Beds Hull Royal Infirmary (A&E) 721 Hull Maternity Hospital 163 Kingston General Hospital 120 Princess Royal Hospital 166 East Yorkshire Acute Trust Castle Hill Hospital 529 Regional Services to 1.2m for renal, oncology and neurosciences Mental Health input via sector teams and 1 nurse in A&E (on secondment) plus 2 social workers (funded by social services)
  4. 4. Initial Team and Service Provision (1997) Consultant - part-time Mental health nurse - full-time Secretary - part-time Referrals - Hull Royal Infirmary only No GP referrals 16 - 65 years A&E - clinical input via mental health nurse
  5. 5. Developments - 1 2001 - Cognitive Behavioural Therapist (Funding Acute Trust - waiting list initiative money) 2003/4 - Resources withdrawn from A&E / Self Harm Service (Social Services reorganisation) - Directly targeted PCT commissioners - A&E / Self Harm Service re-established Monday – Friday 9am to 8pm (Funding Hull and East Riding PCTs) 2004 - Development of Chronic Fatigue Syndrome Service (Centrally Funded)
  6. 6. Developments - 2 2007 - Business case for Specialist Community Perinatal Mental Health Service (Stimulated by NICE guidelines and recognition of clinical need locally) 2007/8 - A&E / Self-Harm Service 7 days a week, 9am – 8pm Ageless (Funding from Hull and East Riding PCTs)
  7. 7. Developments - 3 2010 – Investment of 1.2M from Hull PCT To establish: Older Peoples Liaison Service Learning Disability Service Specialist Community Perinatal Mental Health Service To extend: Existing Liaison Services
  8. 8. Acute Hospitals (2015) Hull and East Yorkshire Hospitals Trust Beds Hull Royal Infirmary (A&E) 739 (plus 93 Maternity Beds, 40 Dialysis Stations >120,000 attendances/ year in A&E) Castle Hill Hospital 658 Regional Services to 1.5 m for renal, oncology, neurosciences and trauma Commissioners – Hull and East Riding CCGs
  9. 9. Clinical Model for the Department of Psychological Medicine 2015 Outpatient Work (referrals from acute services) Medically Unexplained Symptoms Neuropsychiatry Physical illness with co-morbid mental illness (diabetes / renal /cystic fibrosis) Bariatric surgery Hospital Mental Health Team (HMHT) via SPOC Operates 7/7- 8 to 10pm All urgent referrals from A&E and wards at HRI & CHH 16+ (except self-harm - ageless ) HMHT includes older peoples team and LD Outpatient work (referrals from primary care) Chronic Fatigue Syndrome Service Perinatal Service Huntington’s Disease Service
  10. 10. Liaison Service in Hull 2015 • Total staff of 50 (clinical and admin staff) • Annual budget ~ £ 2M • 4317 referrals in 2014 (5% increase from 2013) (3236 seen by HMHT)
  11. 11. Success Factors for the Service • Growth period mainly 1997 – 2010 Labour government, Initiatives, NICE Guidelines, National drivers • Developed good relationships with commissioners • Consistency and persistence • Clinical champions • The Hull Factor • A little bit of luck!
  12. 12. Lengths of in patient stay before and after introduction of Older Peoples Liaison Service-OPLS 26.3 11.9 17.6 11.8 0 5 10 15 20 25 30 2009/10 2011/12 Referred to OPLS Not referred Meanlengthofstay(days •Patients referred to OPLS have more complex needs (older and longer admissions) •OPLS reduces length of stay significantly compared to non-referrals •No change in readmission rates
  13. 13. The Future • ‘5 year Forward View’ - prevention, partnership working, breaking down barriers so that care is delivered locally, multi-specialty community provision • Liaison services have a unique opportunity to support commissioners in helping address the complex physical and mental health needs of its communities. Our challenge is to be part of the discussion that shapes the future
  14. 14. Hull Service Priorities for 2015/6 • 24 hour service to A&E • Diabetes – proposing an integrated model of care based on the 3DFD model • Developing a model for the management of medically unexplained symptoms in primary care
  15. 15. Liaison Services, Crisis Care and 5 year forward • Rapid response for mental health patients within the acute hospital – reduce waits in A&E, reduce lengths of stay for in-patients • Training – management of delirium, acute behavioural disturbance, mental capacity assessments • Reduce admissions and improve clinical care – primary care liaison for chronic disease management/medically unexplained symptoms