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It is good to hear of any new developments in liaison psychiatry or psychological medicine. I would just like to add some qualification to Dr Yousif's article, for those less familiar with the area.

The term "liaison" doesn't derive from the provision of outreach services by mental health Trusts; its origins go back to WW2 and it refers to a service that is based upon long-standing personal relationships between mental health and physical health clinicians, distinguished therefore from consultation-based services which work only on the basis of ad hoc referrals.

So, there is nothing unprecedented historically about general hospitals employing mental health staff - in the UK as elsewhere there are several services that do or have done so. The service in which I worked clinically in Leeds used to be managed in this way, an arrangement that was changed eventually because of the barriers it created to full integration with the other parts of the mental health service - in relation to staffing arrangements and not just clinical care.

What is relatively unusual about Oxford is the scale of investment in a uni-disciplinary (largely consultant-only) service. It remains to be seen if that is a good idea, but for the immediate present it's difficult to see whythis model more than others should be regarded as evidence of parity of esteem. Pretty much every other service in a big general hospital is multi-disciplinary, so rather than representing parity it seems to represent difference at least of expactation. Esteem for professionals accrues from the job they provide individually and as a team and most of the liaison psychiatrists I talk to feel themselves held in good esteem by their general hospital colleagues because the need they meet is well understood.

Dr Yousif provides a rather unbalanced picture of other UK liaison services. It isn't correct that many of the 168 such services in England have in recent times been "focused on deliberate self-harm". All certainly work on the acute care pathway, but much of that work relates to acute psychiatric problems other than self-harm. And 59 English liaison services work in non-acute aspects of liaison psychiatry, undertaking specialist liaison and outpatient work.

Dr Yousif is right to highlight the challenges of integration regardless of the model of service. In a surprising number of places services within the same hospital are provided by different bodies, and for example Emergency Department services in Oxford are not fully integrated with the ward-based service and are provided by the local mental health Trust. And pretty much everywhere liaison psychiatry and clinical psychology are less-than-fully integrated in general hospital work. Links between secondary care and primary care are tenuous and only slowly are new approaches emerging nationally. Oxford like all of us has a way to go before it can really say its services are fully joined up.

Evaluation of whole services is indeed challenging because of their diversity. I am leading an NIHR-funded project LP-Maestro, attempting to tackle exactly this challenge. It would be interesting to hear what evaluation Oxford UH planned as part of their investment.