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Shaping a new mental health liaison service for older

people

Colin HughesColin HughesConsultant Nurse - Older Consultant Nurse - Older People (Mental Health)People (Mental Health)

2

Chesterfield Royal Hospital NHS

Foundation Trust:549 acute beds

Walton Hospital Derbyshire County

PCT:94 rehabilitation and

acute admission avoidance beds

3

4

5

Do the Do the

‘‘Who Cares Wins’Who Cares Wins’ calculation:calculation:

120 will have depression120 will have depression

84 will have delirium 84 will have delirium 130 will have dementia 130 will have dementia

6

No. ward referrals per year

162 171187 194

183

110 103 97 87 8465

76 81 90

66

0

50

100

150

200

250

1.11.00-31.10.01

1.11.01-31.10.02

1.11.02-31.10.03

1.11.03-31.10.04

1.11.04-31.10.05

CRHFT

Walton

Other

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The set upThe set up CN works in partnership as a team with the CN works in partnership as a team with the

medical psychiatric staff (Dr Sykes, Dr medical psychiatric staff (Dr Sykes, Dr Whittingham and Dr George) of Derbyshire Whittingham and Dr George) of Derbyshire Mental Health Services NHS TrustMental Health Services NHS Trust

single point of entry for liaison referrals to single point of entry for liaison referrals to an enhanced service (the psychiatrists’ an enhanced service (the psychiatrists’ office)office)

CN leads change:CN leads change: consultation to liaisonconsultation to liaison

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No. ward referrals to old and new service

173

70

243

273

95

368

0

50

100

150

200

250

300

350

400

CRHFT Walton CRHFT/Walton

1.6.04-31.5.05

1.7.05-31.6.06

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Number of ward referrals from CRH/Walton per monthJune 2004-December 2006

0

5

10

15

20

25

30

35

40

45

50

Jun-

04

Jul-0

4

Aug

-04

Sep

-04

Oct

-04

Nov

-04

Dec

-04

Jan-

05

Feb

-05

Mar

-05

Apr

-05

May

-05

Jun-

05

Jul-0

5

Aug

-05

Sep

-05

Oct

-05

Nov

-05

Dec

-05

Jan-

06

Feb

-06

Mar

-06

Apr

-06

May

-06

Jun-

06

Jul-0

6

Aug

-06

Sep

-06

Oct

-06

Nov

-06

Dec

-06

CPH started 20 June 2005

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No. of referrals seen by the CN between 20 June 2005 and

30 June 2006 380 referred to mental health 380 referred to mental health

service from CRHFT and Waltonservice from CRHFT and Walton 190 assigned to the CN (50% of 190 assigned to the CN (50% of

CRHFT and Walton referrals)CRHFT and Walton referrals)

167 assessed by the CN167 assessed by the CN 66 follow up contacts66 follow up contacts 23 Not seen for various reasons23 Not seen for various reasons

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12

Response time for referrals(Including 11 urgent referrals)

21 2330

40

28

15

3 41 2

0

10

20

30

40

50

0 1 2 3 4 5 6 7 8 9

No. of Working Days

No

. o

f R

efer

rals

Mean average = 2.8 working days66% of the routine referrals were seen within 3 working days84% within 4 working days.

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Placement outcomes by diagnosis

Outcome of 97 patients with dementia:Outcome of 97 patients with dementia:HomeHome 5252 (52.6%)(52.6%)TransferredTransferred 1919 (19.6%)(19.6%)

Residential/nursing home 10Residential/nursing home 10HomeHome 6 6DiedDied 3 3

DiedDied 1212 (12.4%)(12.4%)Residential/nursing homeResidential/nursing home 1414 (14.4%)(14.4%)

Outcome of 70 patients, not dementia:Outcome of 70 patients, not dementia:HomeHome 4040 (57.1%)(57.1%)TransferredTransferred 1515 (21.4%)(21.4%)

Still inpatient at 30/9/06 1Still inpatient at 30/9/06 1Residential/nursing home 4Residential/nursing home 4HomeHome 6 6DiedDied 4 4

DiedDied 77 (10.0%)(10.0%)Residential/nursing homeResidential/nursing home 88 (11.4%)(11.4%)

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Attitude of Consultant Attitude of Consultant PhysiciansPhysicians

How satisfied are you with the speed of response of the service?

0%

10%

20%

30%

40%

50%

Before (n=16) 6.7% 13.3% 46.7% 33.3%

After (n=18) 22.2% 38.9% 33.3% 5.6%

very satisfiedsomewhat satisfied

somewhat dissatisfied

very dissatisfied

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Attitude of Consultant Attitude of Consultant PhysiciansPhysicians

How satisfied are you with the current service overall?

0%

10%

20%

30%

40%

50%

60%

Before (n=16) 0.0% 50.0% 37.5% 12.5%

After (n=18) 22.2% 55.6% 16.7% 5.6%

very satisfiedsomewhat satisfied

somewhat dissatisfied

very dissatisfied

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