Shaping a service

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Shaping a service

• Colin Hughes
• Consultant Nurse - Older People (Mental Health)
• Chesterfield Primary Care Trust

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Chesterfield Royal Hospital NHS Foundation
Trust 570 acute beds
Walton Hospital Chesterfield PCT 104 general
intermediate care beds
Total beds 674
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• Do the
• Who Cares Wins
• calculation
• 129 will have depression
• 89 will have delerium
• 138 will have dementia

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• Consultant Nurse-Older People
• (Mental Health)
• Chesterfield Primary Care Trust
• 1st December 2004
• Clinical and developmental role
• to develop a mental health liaison service for
  older people with mental health problems in
  Chesterfield

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NSF for Older People (2001) Standard
Four Develop clear guidelines for involving
specialist mental health services in the care of
older people in hospital Staff should be trained
to recognise and manage behavioural problems
appropriately
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Health and Social Care Change Agent Team
(2004) Early identification of the mental
health problems Check if already known to the
specialist mental health services Responsive
multi-disciplinary liaison services that do not
solely rely on consultant-to-consultant referral
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• Benefits of providing mental health
• services into the general hospital setting
• shortened hospital stays and reduced costs
• improved physical functioning
• fewer nursing home transfers
• increased recognition of depression
• increased use of community services after
  discharge
• positive effects on outcomes for the treatment of
• depression and delirium,
• and for the prevention of delirium

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Consultation
Liaison
General hospital staff refer a patient to the
mental health service a member of the service
(usually a doctor) provides an assessment and
advice, then leaves. Patients may be reviewed.
Direct patient work involves more intensive
involvement. The liaison service is more
accessible, can respond quickly and review
patients more often. Liaison is more proactive
involving awareness raising of the profile of
mental health issues, collaborating in shared
care through joint meetings, developing education
and training programmes.
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• Advantages for the liaison model over the
  traditional consultation models
• referrals being more appropriate
• more accurate diagnosis by referrers
• increased referrals
• more referrals for depression
• reduced waiting time for assessment leading to
• increased satisfaction for the referrer
• more patient contact
• better adherence to recommendations
• better outcomes in some circumstances

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• Benefits in providing mental health services
  along the lines of a liaison model
• to referrers (e.g. increased satisfaction)
• to patients (e.g. treatment of depression)
• to hospitals (e.g. shortened hospital stays
• and reduced costs)

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• Who does mental health
• consultation-liaison in Chesterfield?
• psychiatrists
• clinical psychologists
• mental health nurses
• occupational therapists
• community mental health teams

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• Some ideas to start with
• build on current provision
• add something
• dont disrupt current processes
• current activity should continue

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• Option 1
• Develop a nursing liaison service
• Consultant Nurse expertise
• dedicated time, rapid response
• demonstrate nurse led services
• BUT
• replacing like with like
• need medical support
• isolation

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• Option 2
• Start to develop the idea of a multidisciplinary
  mental health liaison service
• partnership with Mental Health Trust
• enhanced sector model but Consultant Nurse is
  different
• change from the current consultation model to a
  liaison model

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• But where to start?
• work in partnership as a team with the medical
  psychiatric staff of Derbyshire Mental Health
  Services NHS Trust
• single point of entry for referrals to enhanced
  service
• same telephone numbers as previously
• Consultant Nurse leads change
• consultation to
  liaison

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Referral and allocation

• Referral from general ward phoned through to
  Barwise
• Administration staff at Barwise take referral
  information and complete referral form
• Consultant Nurse (or consultant psychiatrist in
  his/her absence) triages referrals daily
• For urgent referrals administration staff will
  contact most appropriate and available member of
  service for action
• Consultant Nurse allocates referrals to members
  of the service following discussion with the
  consultant psychiatrist as needed

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Liaison activities

• awareness raising of the profile of mental health
  issues
• undertaking training needs analysis
• developing education and training programmes
• collaborating in shared care through joint
  development meetings or participation in ward
  rounds
• development of protocols for detection,
  management and referral of mental health problems
  in older people
• follow up and tracking of particular patients as
  indicated

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Evaluation

• the development of a case register database
• audit of referrals before and after Consultant
  Nurse clinical involvement by number, source and
  reason for referral
• tracking of a sample of patients to record where
  discharged to re-admissions and reason for
  re-admissions physical and mental state
• examination of the views of nursing, therapy and
  medical staff
• development of patient and relative satisfaction
  measures
• examination of the operationalisation of the
  structure and processes of the service