Adults - Achievements and actions by the CCG

A&E Liaison Pilot – Commenced in April 2016

The overall aim of the pilot is to provide an enhanced Mental Health Liaison clinic package to both Emergency Departments complimenting the existing team and provide improved patient experience, this pilot is to improve and reduce the following:

  • Reduction in emergency attendances for the identified cohort of frequent attenders for self-harm or other mental health issues
  • Reduction in identified frequent attenders
  • Improved staff awareness of Mental Health issues within acute / A&E
  • Reduction in number of adverse events taking place for individuals presenting with self-harm
  • Facilitate early discharge from the acute trust of patients who have presented with self-harm
  • Reduction of mental health breaches due the team’s involvement. 
  • Improved communication with GP practices in relation to high attenders 
  • Improved patient experience due to follow up clinics, improved support to service users. Patients presenting with mental health issues in the A&E Liaison will be able to be seen much quicker
  • Reduction in the use of NWAS                                                                                                                  
  • In some cases prevention of admission to mental health inpatient beds

In order to achieve the above the team will provide:

  • Enhanced response times to referrals received from general wards as this is a 7 day service, supporting the acute trust in timely assessments enabling patients to be discharged to the most appropriate environment at the earliest opportunity.
  • Provides sessional clinics to high intensity users of the Emergency Departments which offers time limited psychological interventions and sign posting and support to access other services where appropriate.
  • The practitioners will also take lead on working with and enhancing communications and liaison between multiple agencies, developing links with the Liaison service to enable a smoother transition to other agencies in a timely manner.
  • The practitioners also link in with the established frequent attender forums with the acute trust and provide appropriate feedback to other agencies that will promote shared care within services.
  • Assess in-patients on the acute wards who may present as MUS (Medically Unexplained Symptoms) and other mental health symptoms and provide a formulation/report  to assist care planning and sign-posting to other services. 
  • Provide a link and support to GP practices particularly when they may have patients who present as problematic with regards to attending A&E, frequent calls to 111 and if they are not known to mental services.
  • Collaborative working arrangements with other mental health services.  This would also include CAMHS.

Out of Areas Reviews

The CCG has funded a specific post for the above function.  The post holder is a mental health nurse and provides scrutiny on all the high cost out of area placements. The post has been in place for approximately 2 years.  The rationale for commissioning the post is that there was a lack of scrutiny in the funding and monitoring of out of area placements. This often led to lengthy delays in individuals stepping down  from high cost placements to a less restrictive environment and delay in returning back to their local area near to family/friends.  As well as clinical benefits it was also noted that cost efficiencies could be made by ensuring there was more scrutiny around timely discharge  from these placements.    

Since the post has been in place, the following has been achieved:

  • Improved patient experience by avoiding delays in repatriation
  • Reduction of the number of patients in out of area placements and transition to less restrictive environments in a timely manner in response to clinical needs
  • Enhanced recovery rates and less reliance on out of area placements in the future by developing a range of accommodation options in partnership with other agencies
  • Increased clinical knowledge of the patients and their progress against measurable outcomes. Strong links have already been established with care coordinators which creates partnership working