Integrated service improves care and saves at least £3.4 million in just one hospital

18 Nov 2011 01:47 PM

A study commissioned by the NHS Confederation Mental Health Network shows integrated services saved at least £3.4 million in one hospital alone.

An evaluation of the integration of mental and physical health services in one city centre hospital has improved care for patients while making estimated savings of between £3.4 and £9.5 million a year.

These are the findings from a report from the NHS Confederation's Mental Health Network with the Centre for Mental Health and the London School of Economics and Political Science (LSE).

The study looked at an award winning scheme at Birmingham City Hospital called Rapid Assessment Interface and Discharge (RAID) that integrates physical and mental health care. It is available to any adult patients in the hospital who self-harm, are alcohol dependent, have substance misuse issues or have mental health difficulties associated with old age.

The RAID service aims to make sure patients with mental health problems get treated in the most effective way. Often this means diverting people to alternative services. For example, A&E departments are unsuitable for many people with dementia and can be cared for more effectively on specialist wards.

The report also found that there was a significant increase in

Other benefits to patients of the RAID service included:

• Improved follow up support - 71.2 per cent of patients were referred on to GPs with a similar number formally referred to other services.
• Diversion from A&E - Over 40 per cent of referrals to the RAID service came from the A&E department. Particularly for patients with dementia, A&E departments are not always the most appropriate place for people with a mental illness.
• Discharge to patients' own homes - 67 per cent of all elderly patients were discharged to their own homes. Assuming that this was mainly to residential or nursing homes rather than local authority care homes, there is potential for RAID services to save money in social care too.

The RAID service was also shown to offer significant cost savings estimated at £3.4 to £9.5 million with £6.4 million as the mid point. Most of these savings came from reduced bed use among elderly patients.

The RAID service is just one example of many liaison psychiatry services across the NHS. Liaison psychiatry is a general term for services that bring together the diagnosis, treatment and management of patients with mental and physical health problems. They will include specialists from nursing, psychiatry, psychological therapy and social work.

Mental Health Network director Steve Shrubb said:

"The results of this evaluation are extremely encouraging. Patients get better care when mental health needs are assessed and treated at the same time as physical health.

"Patients are taken to the right place, problems can be identified earlier and follow-up is more effective.

"These services will almost certainly save money too. Integrated care such as this could help the NHS go a long way towards meeting its current unprecedented savings challenge.

Chair of the SHA Mental Health leads group Lawrence Moulin said:

"SHA leads across the country welcome the building evidence base that not only does mental health support for people in acute hospitals improve quality, but it also leads to real savings. We look forward to supporting its universal implementation."

Centre for Mental Health chief executive Sean Duggan said:

"Separating out physical and mental health needs is no longer sustainable in a health service facing rising cost pressures. It doesn’t make sense to patients and it doesn’t make business sense, either.

"Liaison psychiatry is an important way of bringing physical and mental health care closer together and when it is done well it provides excellent value for public money."

George Tadros, Consultant in Old Age Liaison Psychiatry and RAID lead clinician, said:

"RAID is an innovative service which has brought psychiatry back to the front doors of an acute hospital and managed to integrated mental health services within physical health provision. As a clinician, I hope similar schemes will develop across the country."

Notes to Editors