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Majority of A&E departments fail liaison psychiatry standards

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Almost three-quarters of England’s liaison psychiatry services in hospital emergency departments are rated substandard.

A national study carried out for NHS England reveals 133 out of 179 A&E departments – 74% – were found to be below the minimum core standard for 24/7 liaison psychiatry.

This service has been identified as necessary for trusts to improve outcomes and increase savings for the NHS.

“My biggest concern at the moment is that the expansion won’t be backed up by the staffing we need”

Alex Thomson

The poor state of liaison psychiatry services has emerged as NHS England has set out how it intends to make a £30m investment to “pump prime” development of mental health services in A&Es in 2015-16.

NHS England wrote to CCGs and providers last month describing how £25m would be shared among CCGs, with £4m additionally targeted at the eight urgent and emergency care vanguard sites that are piloting new ways of working set out in NHS England’s five-year plan, the Five-Year Forward View.

The remaining £1m will be divided up between the four regions to prepare for future liaison psychiatry access targets.

Half of the funds were released to CCGs in October. The remainder will be released in December once NHS England regional teams have signed off investment plans at the end of this month.

Experts told Nursing Times’ sister title Health Service Journal that this was not enough and would leave a burden on local commissioners, who will need to fund services beyond this year or risk service collapse.

“What commissioners might want to consider is the £3.5bn tied up in the wrong kind of care for people with medically unexplained symptoms”

Peter Aitken

Alex Thomson, consultant liaison psychiatrist at Northwick Park Hospital, said: “My biggest concern at the moment is that the expansion won’t be backed up by the staffing we need.

“The danger is we have a national rollout which isn’t fully resourced and we find we can’t meet expectations and the whole thing collapses,” he said.

Peter Aitken, chair of the Faculty of Liaison Psychiatry, helped advise NHS England on the models that should be adopted by trusts.

He said: “This £30m gives commissioners breathing space but in time commissioning will have to find a way to fund the mental health component of the emergency care pathway and it is bigger than liaison psychiatry, it impacts on crisis and home treatment, early intervention and street triage and how to support first responder organisations.”

He warned CCGs against withdrawing funding from other areas of mental health inpatient care, saying: “There are perversions in the commissioning system caused by silos and short-termism – that is clear.

“What commissioners might want to consider is the £3.5bn tied up in the wrong kind of care for people with medically unexplained symptoms who benefit from liaison psychiatry and the £10bn cost of unmanaged depression in long term conditions such as [chronic obstructive pulmonary disease],” he said.

“If they pull liaison psychiatry away from tackling long term conditions and concentrate only on A&E they will probably find themselves financially disadvantaged over the medium term,” he added.

In total, 169 A&E departments had a shortage of 1,270 trained nurses to support the delivery of liaison psychiatry, while 153 departments had a shortage of 230 trained consultants.

Eleven hospitals had no liaison psychiatry service, with only 35 departments delivering at or above the minimum standards.


Trusts with largest shortage of trained liaison psychiatry consultantsFTEs needed to fill gap
Sheffield Teaching Hospitals FT5.37
Central Manchester University Hospitals FT4.51
Nottingham University Hospitals Trust4.19
Newcastle upon Tyne Hospitals FT4.11
University Hospitals of North Midlands Trust3.63


Trusts with largest shortage of trained liaison psychiatry nursesFTEs needed to fill gap
University Hospitals of Leicester Trust35.3
Newcastle upon Tyne Hospitals FT31.9
Sheffield Teaching Hospitals FT29.7
University Hospital Southampton FT22.1
Norfolk and Norwich University Hospitals FT17.3


Research by the Centre for Mental Health suggests liaison psychiatry can deliver as much as £4 in savings for every £1 invested through improved patient outcomes and reduced lengths of stay.

Mental Health Network chair Stephen Dalton said the state of liaison psychiatry services was “symptomatic” of the bias in service investment by CCG.

He said: “All roads lead back to local decision making by CCGs. If we know liaison psychiatry works and is money well spent, why are we in a position where 133 of them are underinvested in?

“It is quite simply because there isn’t that much evidence of intelligent commissioning when it comes to mental health,” he added.

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