FOI: Liaison Psychiatry Referral Policy

George Gillett made this Freedom of Information request to West London NHS Trust

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Dear West London NHS Trust,

We are a group of clinicians & researchers carrying out a national evaluation of liaison psychiatry service provision in NHS hospitals across England. As part of this project, we are submitting FOI requests to all NHS Mental Health Trusts to ask about local policy and practice. We kindly request the following information as per the FOI Act 2000.

Our enquiries relate to the provision of liaison psychiatry services in adult general hospitals, including patients in inpatient wards or A&E departments. This research is conducted as part of an Academic Foundation Programme research post. No specific grant was awarded for this project. All findings will be de-identified from Hospitals or Trusts before publication.

1. At which general hospital(s) does your Trust provide liaison psychiatry services?

For each of the above hospitals, please answer the questions below:

2. Is there a written policy about prioritising patients who have been referred to liaison psychiatry, or determining which referrals to accept? (If No, please move to Question 6).

3. If so, is this policy made available to all (psychiatry and non-psychiatry) clinicians working within the general hospital? If so, please specify where (e.g. Trust intranet)?

4. Please attach the policy document if possible. We aim to extract only certain information from the policy document, so if the complete policy document cannot be sent, please send the following information:

a. Details on which locations this policy covers and which patients (i.e. inpatient ward/A&E/referrals) the policy covers.

b. Details on any guidelines to prioritise or determine which referrals to accept. Specifically:
i. Patients should be medically fit for discharge prior to review
ii. Patients should be medically fit for assessment prior to review
iii. No restriction applied; all patients are reviewed
iv. Any other methods used to prioritise patient referrals (please specify)

c. Whether the policy states which professional group (e.g. psychiatrist, psychologist, nurse) should review the referral and/or assess the patient? If so, please specify.

d. When was the policy last reviewed or updated?

5. When (if at all) was local practice last audited against this policy and what were the findings?

6. At your Trust, how do doctors refer patients to liaison psychiatry for review (e.g. by telephone, by electronic referral system, by email, by fax)?

Many thanks for your time. Please do not hesitate to get in touch by email if you have any questions or clarifications. We look forward to your reply.

Yours faithfully,

Dr George Gillett, 
Academic Foundation Programme Doctor
Department of Psychiatry, University of Oxford 

Dr William Lee, 
Honorary Clinical Senior Lecturer, University of Exeter Medical School.
Consultant Liaison Psychiatrist, Devon Partnership NHS Trust.

Femi Ajibola, West London NHS Trust

1 Attachment

Dear Dr. George Gillett,

 

Ref No (332)

 

Thank you for your email. Your request is being dealt with under the terms
of the Freedom of Information Act 2000 and will be answered within twenty
working days. 

 

If you have any queries about this request do not hesitate to contact us.
Please remember to quote the reference number above in any future
communications.

 

Kind regards,

 

Freedom of Information Officer

Information Governance Team

West London Mental Health NHS Trust

Trust Headquarters

1 Armstrong Way | Southall | UB2 4SD

[1]Promoting hope Patua

 

 

 

 

 

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foi foi, West London NHS Trust

6 Attachments

Dear George,

 

Thank you for your request.

 

Please find below our response.

 

1.                At which general hospital(s) does your Trust provide
liaison psychiatry services?

·        Charing Cross and Hammersmith Hospitals (part of Imperial College
Healthcare NHS Trust) - as one team, the Hammersmith and Fulham Liaison
Psychiatry Service (HFLPS)

·        Ealing Hospital (part of London North West University Healthcare
NHS Trust) - Ealing Liaison Psychiatry Service (ELPS)

·        West Middlesex University Hospital (part of Chelsea and
Westminster NHS Foundation Trust) - Hounslow Liaison Psychiatry Service
(HLPS)

For each of the above hospitals, please answer the questions below:

2.                Is there a written policy about prioritising patients
who have been referred to liaison psychiatry, or determining which
referrals to accept? (If No, please move to Question 6).

Yes, each of our liaison psychiatry services have an operational policy
with this included. General liaison services have been operating 24/7
since July 2018, and although not yet at full Core24 staffing levels, we
are working towards that, including with a recent successful bid in NHSE
Wave 2b for HLPS. Despite not yet being at Core24 staffing numbers, all 3
sites consistently respond to around 85% Emergency Department (ED)
referrals within an hour (in September 2019 this response rate ranged from
87%-94% across our 3 ED sites). We also aim to respond to urgent ward
referrals within 4 hours and routine ward referrals within 24 hours, and
achieved this in 85% and 89% referrals respectively on average across our
teams in Sept 2019) - these targets exceed NHSE Core24 standards which
suggest an urgent ward referral is seen within 24 hours, and RCPsych PLAN
standards which suggest routine ward referrals are seen within 2 working
days.

3.                If so, is this policy made available to all (psychiatry
and non-psychiatry) clinicians working within the general hospital? If so,
please specify where (e.g. Trust intranet)?

Although the recently updated policies have only gone through internal
approval processes and have not shared with the acute trust, we are
intended to go through a more meaningful discussion process on this by
creating a memorandum of understanding or joint op policy with the acute,
starting with our Ealing service.

4.                Please attach the policy document if possible. We aim to
extract only certain information from the policy document, so if the
complete policy document cannot be sent, please send the following
information:

a.                Details on which locations this policy covers and which
patients (i.e. inpatient ward/A&E/referrals) the policy covers.

Please see attached, the policies cover all referrals from inpatient wards
and EDs at the acute trusts we cover.

b.               Details on any guidelines to prioritise or determine
which referrals to accept. Specifically:

i.                 Patients should be medically fit for discharge prior to
review

No, we work to the concept of 'parallel assessment' where patients are
assessed by liaison psychiatry as soon as they are alert enough, in
parallel with any medical investigation and treatment that is required. If
a patient is for example in a state of lowered consciousness due to injury
or intentional overdose, or intoxicated with drugs and alcohol, a first
contact would still be carried out and an interim risk management plan put
in place.

ii.                Patients should be medically fit for assessment prior
to review

Please see response to i. above.

iii.               No restriction applied; all patients are reviewed

We do not see every patient referred. Some patients may not need to be
seen face to face: telephone discussion with the acute trust clinician may
be all that is required, for example for medication advice. Occasionally
referrals may be signposted to a more appropriate source of help, for
example hospital social work colleagues, or a separate acute trust
employed alcohol care team.

iv.              Any other methods used to prioritise patient referrals
(please specify)

Yes – all ED referrals are automatically allocated to a 1 hour (emergency)
response regardless of clinical urgency of presentation to support the 4
hour ED waiting time target; MAU/CDU referrals are allocated to a 1 hour
or 4 hour response (even if clinical presentation is less urgent) to
support their short stay (24 hour) turn around ; ward referrals are
prioritised to 1 hour, 4 hour or 24 hour response times based on clinical
urgency of presentation – most ward referrals get allocated for 24 hour
response though.

c.                Whether the policy states which professional group (e.g.
psychiatrist, psychologist, nurse) should review the referral and/or
assess the patient? If so, please specify.

Liaison psychiatry services at the trust are multidisciplinary teams and
we work to the principle that the most appropriate person sees the patient
dependent on circumstances. Most commonly a nurse or junior doctor will be
the initial assessor, and then cases are discussed at regular handovers
which occur multiple times a day with senior colleagues, who review where
necessary. Clearly for a Mental Health Act assessment a specialist
registrar or consultant psychiatrist is involved.

d.               When was the policy last reviewed or updated?

Hounslow op policy was signed off on  13/11/19, H&F and Ealing was signed
off on 23/08/19 (virtual).

5.                When (if at all) was local practice last audited against
this policy and what were the findings?

The Ealing and H&F services have recently undergone PLAN reaccreditation
process and the Hounslow team is submitting further evidence to complete
the process so the need for auditing against policy is less urgent.
However, aspects may have been reviewed when undertaking SI or complaint
investigations, .

6.                At your Trust, how do doctors refer patients to liaison
psychiatry for review (e.g. by telephone, by electronic referral system,
by email, by fax)?

All three teams accept referrals via team.

 

This completes our response to your request for information. If you are
unhappy with our response, please write to us giving your reasons and we
will address them.

 

If you remain dissatisfied you are entitled to appeal to the Information
Commissioner:

 

Customer Contact

Information Commissioner's Office

Wycliffe House

Water Lane

Wilmslow SK9 5AF

Tel: 0303 123 1113

[1]http://ico.org.uk/concerns/getting/repor...

 

Kindest Regards,

 

Deena Vora

Freedom of Information Officer
Trust Board Secretariat
West London NHS Trust
Trust Head Quarters, 1 Armstrong Way, Southall
UB2 4SD

 

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Hi Deena,

Thanks very much. Do you have a copy of the policies you could share please? Also please could you clarify the answer to question 6 - what do you mean that referrals are accepted "via team" - is that by telephone, by electronic referral system, by email, by fax)?

Many thanks.

Yours sincerely,

George Gillett

foi foi, West London NHS Trust

3 Attachments

Dear George,

Thank you for your email.

Apologies, I have attached. As for your clarification request, I will check this with the team and get back to you as soon as possible.

Kindest Regards,

Deena Vora
Freedom of Information Officer
Trust Board Secretariat
West London NHS Trust
Trust Head Quarters, 1 Armstrong Way, Southall
UB2 4SD

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foi foi, West London NHS Trust

3 Attachments

Dear George,

I can confirm for question 6, it would be via team bleep.

Kindest Regards,

Deena Vora
Freedom of Information Officer
Trust Board Secretariat
West London NHS Trust
Trust Head Quarters, 1 Armstrong Way, Southall
UB2 4SD

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