As the shadow NHS Commissioning Board begins work and the Health Bill continues its passage through Parliament, the changing architecture of the NHS continues to dominate the headlines. Alongside this process, however, we need to keep our eyes on bigger prizes, in particular to find ways of simultaneously improving services and becoming ever more efficient in the use of resources.
Nowhere is this more evident than in the interface between physical and mental health: a link that health services too often fail to make, at a high cost both to the NHS and to the people it serves. As a new report shows, if this interface is well managed, it is possible to improve the quality of care the NHS offers while also making substantial cost savings.
Psychiatric liaison services provide mental health care to people being treated for physical health conditions in general hospitals. One of the most well-regarded such teams is the Rapid Assessment Interface and Discharge (RAID) team at City Hospital, a large acute hospital in Birmingham which forms part of the Sandwell and West Birmingham Hospitals NHS Trust. The RAID service is provided by Birmingham and Solihull Mental Health NHS Foundation Trust and commissioned jointly by Heart of Birmingham and Sandwell PCTs. It offers comprehensive mental health support, available 24/7, to all people aged over 16 within the hospital.
RAID was launched in December 2009 as a pilot project, in succession to an already established but much smaller service. It offers a comprehensive range of mental health specialities within one multi-disciplinary team, so that all patients over the age of 16 can be assessed, treated, signposted or referred appropriately regardless of age, address, presenting complaint, time of presentation or severity. It operates 24 hours a day, 7 days week.
The Centre carried out an economic evaluation of an internal review of RAID with the NHS Confederation’s Mental Health Network and the London School of Economics and Political Science (LSE), and funded by the Strategic Health Authority Mental Health Leads.
Our report found that the service generates significant cost savings because it is able to promote quicker discharge from hospital and fewer re-admissions, resulting in reduced numbers of in-patient bed-days. These cost savings amount to at least £3.5m a year. Most of these savings come from reduced bed use among elderly patients.
By contrast, the incremental cost of RAID (i.e. the additional cost of the service compared with its predecessor) is around £800,000 a year. This means that the benefits of RAID are four times higher than its costs: even without considering other possible savings such as reductions in the use of institutional care for older patients when they leave the hospital. In other words, unlike most healthcare interventions, RAID actually saves money to the NHS as well as improving the health and well-being of its patients.
On a more fundamental level, though, what RAID demonstrates once again is that 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.
Amid the structural changes that can too easily distract us from the real purposes of the NHS, investing in good quality liaison psychiatry represents an opportunity not to be missed both to improve the care we offer to patients and to make the service more efficient.