1. Innovations in Liaison. Lisa Howarth, Advanced Nurse Practitoner, Tracey Hilder, Advanced Nurse Practitioner Paula Atkinson, Nurse Consultant, Durham and Darlington Liaison Team January 2016

2. Background Developments Development of post discharge and Outcomes Challenges and successes Where next Questions What we plan to look at:

4. Pastures New In April 2012 the Durham and Darlington liaison team, based in TEWV NHS Foundation Trust received increased funding form local CCG’s of £2M per annum,.

5. Extended Liaison team: With the increase in funding the service was able to provide a 7 day service 8am to 10pm. Cover for the 2 acute hospitals including A&Es and MAU Extended into the 6 community hospitals Follow up service with brief interventions MUPs team Diagnostic service for older people. Development of a role specific OT service. We also developed a post discharge liaison team and frequent attenders service

6. Why post discharge development ? Known blocks and delays to discharge of mental health patients over 65 from the acute trust were based around concerns from the acute trust about management of risk in patients with cognitive impairment. The team was developed to overcome these blocks with the aims of: 1)discharging more patients back to their own home instead of 24 hour care 2)discharging patients within a shorter time frame. Previous experience

7. What we did….. The team covers the whole of Durham and Darlington and takes patients from all 8 hospitals. It consists of: - 4 band 6 nurses - 8 band 3 support nurses - input from Occupational Therapy - input from band 8 Nurse Consultant and band 7 Advanced Nurse practitioner when needed. The focus of the team is around short term management of risk at home – including assessment of risk at home and development of a risk management plan.

8. Outcomes During the first year we were able to establish: The majority of the patients have complex psychological and physical co-morbidities. On average patients have 4 and 7 diagnosed physical complaints and an average of 7 prescribed medications. 83.9% of patients admitted from home returned home

9. Outcomes (cont) The team saw approximately 240 patients delirium and dementia – as anticipated - accounts for the majority of these cases 20 – 25 % of discharge team patients are referred in to mental health services Less than 2% of these patients are readmitted to acute hospitals.

10. Why Frequent attenders ? Took steps to standardise, collaborate and improve the efforts made in managing a cohort of patients who are regular attenders to Emergency Departments (ED) at DMH and UHND, with a view to reducing unnecessary attendances and signpost this, at times, vulnerable patient group to the most appropriate care and treatment for their needs. The cohort of 25 patients from Durham and Darlington included in this CQUIN had 773 attendances to the Emergency Department 2014/15.

11. Purpose The purpose of the psychiatry MDT group is to provide a forum to discuss ‘regular attenders’ at both the DMH and UHND sites. The group will support and lead on the development of actions that can be applied to real time management plans in order to support the ED and FOH agenda and thus in turn reduce the effect of this patient population on the hospital, ensuring that the patient is directed to the appropriate care and treatment for their needs

12. Key objectives of the Project To develop a standardised approach to regular attends to the ED To increase collaborative working with multidisciplinary agencies and NEAS to ensure regular attender patients get the most appropriate care and treatment for their needs To empower medical and nursing teams to coordinate care across whole system approaches in both primary and secondary care

13. Outcomes 2014/2015 Dec/ Jan 773 presentations 2015/2016 Dec/Jan 474 reduction of 289 We found majority of frequent attenders in this cohort attend around 20 times a year. There is a fairly even spread of presentations across mental health (predominantly self harm), alcohol services, respiratory, pain, suspected dementia (who often present with falls), medically unexplained physical symptoms (mostly functional neurology or health anxiety), and a minority of patient who present with multiple comorbidities not easily defined by one particular group. In Nov The Project was shortlisted for NHS Leadership Recognition Award for outstanding collaborative leadership

14. Challenges for post discharge Training Education of acute hospital staff Lack of access to physiotherapy Disparity in hours of working Risk taking.

15. Challenges for Frequent attenders DNA rates Training for acute and liaison staff Consent

16. Patient benefits CMHT /Crisis benefits Acute hospital benefits Carer benefits Cost benefits Benefits agency !

17. Where Next ? Continuing evaluation and development of current enhanced service Service currently under review ? 24 hour ? Increase in consultants ? How to reduce inappropriate admission to acute trust ? Introduction of physio and social work

18. Questions ??????????

19. Contacts Paula.atkinson2@nhs.net Lisa.howarth4@nhs.net tracey.thompson6@nhs.net Paula.atkinson2@nhs.net

20. References: Parsonage, M., Fossey, M. & Tutty, C. (2012) Liaison Psychiatric Services in the Modern NHS Department of Health. (2009) Living well with dementia: a national dementia Strategy. London: Department of Health Royal College of Psychiatrists, (2005), ‘Who Cares Wins’ CSIP, (2005), ‘Everybody’s business’ Aitkin, Robens, Emmens, (Feb 2014), Developing Models for Liaison Psychiatry – Guidance Centre for Mental Health, Department of Health, Mind, NHS Confederation Mental Health Network, Rethink Mental Illness,Turning Point, (2012), No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of all ages.