The winter pressures that NHS A&E departments experience every year are well documented. The increased complexity and severity of cases during the winter means that patients are more likely to spend longer waiting for triage and treatment, and struggle to secure a bed in over-capacity wards. This squeeze on human and physical resources means that, despite lower attendance rates than in the summer months (Health Committee, Winter pressure in accident and emergency departments) many hospitals struggle to hit their maximum four-hour wait target in the winter.
In the past, this has been balanced by acute services moving back towards their target waiting times during the summer. However, as the Commons’ Health Committee points outs in its recent report, this pattern no longer necessarily applies. As demand for each bed increases hospitals are falling short of the four-hour target year round.
We believe that mental health services have a major role to play in helping the acute sector to manage inpatient demand, not only during the winter but all year round.
The underlying reason behind many patients’ physical ill-health is often rooted in mental illness. Such ‘co-existing’ health problems cost the NHS around £13.5bn a year in extra spending on physical health services, and over 80% of all hospital bed-days are occupied by people with both mental and physical health problems (Dr Steven Reid, The London Mental Health Fact Book, February 2016). There are therefore very clear gains to be made by providing mental health support to patients in A&E and working alongside acute sector staff to: reduce repeat attendances, reduce patients’ length of stay, and free up capacity.
Liaison psychiatry services do just that. By providing mental health assessments to individuals receiving care at A&E, liaison psychiatry bridges the arbitrary gap between physical and mental healthcare, making the services offered more efficient, improving the patients’ experience and reducing the likelihood of patients returning to the A&E.
Our experience in London demonstrates this. At member Trust, the Central and North West London NHS Foundation Trust, when new liaison psychiatry services were developed, patients with a mental health diagnosis spent on average 1.3 fewer days in hospital and fewer people returned to the emergency department. When rolled out system wide, this has the potential to really help alleviate the pressures on A&E.
Liaison psychiatry is just one example of how partnerships between acute trusts and mental health services can bring genuine, tangible benefits to both patients and the NHS as a whole.
NHS England recommends that all hospitals are to have effective mental health services in place across all acute settings by 2020. While the NHS is some way from that figure - in 2015, only 7% of acute hospitals had a liaison psychiatry service operating 24/7 (National Audit Office, Mental health services: preparations for improving access) - what London’s Trusts have achieved shows how valuable liaison psychiatry can be.
The majority of acute hospitals in London have mental health services in place, however the figure across the country remains worryingly low and we are aware that the ‘vast majority’ is not the same as ‘all’.
The Cavendish Square Group is committed to making the case for greater investment in mental health liaison services - available 24/7, in every hospital. The NHS cannot afford not to.