Where there’s a will, now there’s a way

Following the launch of NHS England’s Acute Hospital Liaison Mental Health Fund, Tim Kendall, NHS England’s National Clinical Director for Mental Health, celebrates the ambition and opportunities driving a transformation in urgent and emergency mental health care in A&E and beyond.

In recent weeks, we’ve see a flurry of activity across every facet of mental health care, support and advocacy clearly demonstrating that good mental health care remains a priority for everyone. At NHS England, we’ve made a series of announcements about how we are continuing to progress with the commitments sets out in the Five Year Forward View for Mental Health including additional central funding from A&E liaison services, early adopters of integrated IAPT (psychological talking therapy) services and new sites delivering perinatal mental health care in community settings.

By focusing on enabling those services at the forefront to go further, faster whilst supporting those who have more work to do, we keep driving forward our ambition that mental health services will have equal status in terms of funding and access as physical health services. And, of course that wherever possible, physical and mental health services are delivered in an integrated way which makes sense for service users and promotes better outcomes.

One of the most effective ways to break down these barriers between mental and physical health care is good liaison mental health services.

Evidence tells us that people with mental ill health have three times more A&E attendances and five times more emergency inpatient admissions than people without mental ill health. Perhaps this is no surprise when we consider that people with severe mental illness, such as bipolar disorder and schizophrenia, die up to 20 years earlier as a result of unrecognised and untreated and often serious and enduring physical health problems.

Alongside the overwhelming argument for better patient care, there is clear evidence to demonstrate that effective liaison services can provide significant cost-savings which should help commissioners to make a comprehensive case for investment. We are supporting them to do that having just published implementation guidance for urgent and emergency liaison mental health services in acute hospitals for adults and older adults.

A step towards this is a CQUIN which comes into force from April 2017. This incentivises better care planning for people with mental ill health so there is greater understanding of people’s individual needs and so they have a more appropriate place to turn to other than the local A&E to access the care and support they need. This CQUIN will reward services that provide effective mental health or psychosocial interventions for people with primary or secondary mental health needs who present repeatedly at A&E and would benefit from such interventions, thereby reducing the number of avoidable attendances at A&E.

We’ve now taken a bigger step to put our money where our mouth is, launching the transformation fund for acute hospital urgent and emergency liaison mental health services for adults and older adults. The fund will provide £120m over four years out of central funding to support trusts to meet the “Core 24” standard of care. Core 24 is important. It is a service model which sets a minimum standard for 24/7 urgent and emergency care at a level which brings both clinical and financial benefits and includes access to a multidisciplinary mental health team including a consultant psychiatrist. Teams resourced to deliver Core 24 services are able to give more effective and compassionate care and provide skilled assessments, detection and treatment of mental ill health in general acute hospitals.

In each of years one and two, we will award £15m to services that can demonstrate they are ready and able to use the funding to reach this standard. We will also support other services to get them to that state of readiness, so that across years three to four, when the funding levels will increase to £90m, the number of sites receiving financial support will increase. Our longer-term aim is to make the Core 24 level of care, support and compassion the norm across England’s acute hospitals once the workforce has grown. By 2020/21, we have committed to ensuring that 50% of all acute hospitals will operate within this exemplar standard. Service improvement does not stop there.

There are already examples of innovative practice which we can learn from. Bradford’s liaison service, part of the West Yorkshire Urgent & Emergency Care Vanguard, has embedded housing and social care support. Hull Royal Infirmary’s liaison team is reducing the length of stay for people with complex needs, particularly older people.

I know that people using and working in A&E need all of us to make things much better, to invest to create better teams of mental health professionals able to address individuals’ problems when they present. I also know that liaison professionals want to step up and make this happen. Let’s work together and really make a difference!

Professor Tim Kendall

Professor Tim Kendall is NHS England’s National Clinical Director for Mental Health. He has been Director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists for 15 years and Visiting Professor at University College London for the last eight years.

Tim has also been Medical Director for 13 years and continues as Consultant Psychiatrist for the homeless at Sheffield Health and Social Care NHS Foundation Trust.

As Medical Director, Tim has set up a service user experience monitoring unit, led the reconfiguration of acute care and rehabilitation leading to the elimination of out of area treatments, the modernisation of the acute and crisis care pathways and initiated the development of NICE recommended personality disorder services within the community.

He chaired the first NICE guideline, launched in December 2002, on the management of schizophrenia and the first National Quality Standard (Dementia) for NICE.

Tim has published numerous articles and papers and often represents the NCCMH, NICE or the Royal College of Psychiatrists in the media. In 2004, he was awarded “Lancet Paper of the Year” for showing the impact of selective publishing by the drug industry about antidepressants in the treatment of childhood depression; and with others was awarded the Paper of the Year Award for the Health Economic Journal ‘Value in Health’ in 2012 for work on schizophrenia.