Download Emotional Wellbeing and Physical Healthcare in acute hospital

SECTION B PART 1 - OUTCOME SPECIFICATIONS
Mandatory headings 1 – 5. Mandatory but detail for local determination and agreement.
Optional heading 6. Optional to use, detail for local determination and agreement.
All subheadings for local determination and agreement.
Outcome Specification No.
Service
Commissioner Lead
Emotional Wellbeing and Physical Healthcare in acute hospital
settings
Acute service commissioner
Provider Lead
1. Population Needs
1.1 Local context and evidence base
Local
Locally defined
2. Key Outcomes
No Health Without Mental Health sets out a clear and compelling vision, centred around six
objectives:
(i)
More people have better mental health
(ii)
More people will recover
(iii)
Better physical health
(iv)
Positive experience of care and support
(v)
Fewer people suffer avoidable harm
(vi)
Fewer people experience stigma and discrimination
Each objective in the Implementation Framework (see Appendix) is relevant to acute services
although some will be held jointly with primary and mental health services and public health
especially physiologically explainable symptoms (‘medically unexplained symptoms’), emotional
wellbeing of people with physical health problems especially long-term conditions, physical health
care of people with mental health problems, early intervention, destigmatisation and suicide
prevention.
2.1 Strategic Outcomes
Commissioners, providers and other stakeholders should work together to develop the following
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strategies:
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Improve self-reported wellbeing through development of strategy to measure emotional
wellbeing (e.g. in association with ONS initiative)
Reduce excess under 75 mortality rates in adults with severe mental illness by implementing
strategy to measure Serious Mental Illness and improve outcomes.
Improve experience of those admitted with self harm and reduce subsequent hospital
admissions (coordinated strategy to measure and manage with secondary mental health
services)
Reduce suicide rates (through comprehensive local suicide prevention strategy)
2.2 Specification Outcomes
Please note these outcomes are a list of examples (including the percentages) and are not
proposed as mandatory. Local Commissioners will need to prioritise according to local need.
Percentages or numbers need to be decided locally and where current measures do not exist,
baseline data should be collected and increase or decrease negotiated within the timeframe of the
contract. The percentages stated are “educated guesses” and will vary locally.
Optimise health and well-being by supporting individual goals
Collaboration with informed service users and carers
 90% of all service users are effectively involved and engaged, and their views made explicit
within individual care planning processes
 Increase by 10%, self-management of co-morbid long term condition/s
 Increase by 10% the return to independent living for older people
Strengths based assessments and intervention
 98% of service users in settled accommodation are recorded on assessment
 98% of service users in employment are recorded on assessment
 98% or services users offered Patient Reported Outcome Measures (such as INSPIRE)
Timely, safe and effective interventions
 Decrease by 20% the use of poly-pharmacy and medication above BNF recommended levels.
Optimise physical health and Prevent people from dying prematurely
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90% of service users are screened for alcohol misuse, and AUDIT tool completed if concerns
identified and are referred on for follow up and management where appropriate.
Reduce by 10% subsequent healthcare utilisation, including emergency care and clinic visits
Reduce by 20% readmission at 6 months for older people
Reduce by 10% repeat admissions, length of stay or repeat outpatient appointments of
people with physiologically explainable symptoms
Improve emotional wellbeing of people with LTCs by 20% (e.g. measured using WarwickEdinburgh Scale)
90% of service users are screened for tobacco use and referred on for follow up and
management where appropriate
90% of service users are screened for obesity and are referred on for management where
appropriate
Implementation of the Preventing Suicide Toolkit in Emergency departments.
http://www.nhsconfed.org/Documents/Preventing-suicide-toolkit-for-emergency-
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departments.pdf
Provide least restrictive interventions in safe environments
 100% of service users offered access and information regarding advocacy services for those
detained under the Mental Health Act 1983 (amended 2007).
 Reduce by 10% those readmitted to inpatient care within 7 days and 30 days
 Provide an annual audit of Mental Health Act Assessment and Mental Capacity Act
Assessments with a focus on appropriateness.
 Reduce by 10% emergency admissions
 Reduce Length of Stay by 10% for people with comorbidity of physical and psychological
health problems.
Supporting individuals to maintain independence and maximise opportunity
Quality and accessibility of information
 A annual audit of Information available for service users, family and carers using a variety of
media including leaflet and web based including reasonable adjustments allowing for
accessibility
 90% of records for service users have a recorded diagnosis or working diagnosis recorded
 Decrease by 10% un-validated notes on RIO (or other information systems)
 Decrease by 10% un-outcomes appointments notes on RIO (or other information systems
NB: Validated notes are those that are signed off by clinicians. Outcome within the information
system report on the pathway used and may also be used linked to payment systems.
Staff skills and supervision
 Reduce the levels of staff sickness absence by 10% (e.g. Mindful Employer schemes)
 95% of clinical and support staff receive evidence based supervision.
 95% of clinical and support staff receive training in Safeguarding Adults and Children
 95% of clinical staff receive training in clinical skills (risk assessment, care planning)
 95% of clinical and support staff receive appraisals
 30% of hospital staff have received training in identification of mental health problems
 95% staff receive training in identification of mental health problems at induction (e.g.
Mental Health First Aid)
 20% of condition specific specialist staff trained in delivering Low Intensity psychological
therapies.
Effective, recovery-oriented, risk assessment and management
 Conduct biannual reflective practice sessions in all teams, focussed on risk (including
positive risk taking)
 Conduct biannual reflective practice sessions in all teams, focussed on recovery approaches
 100% of risk assessments are up to date
 70% of risk assessment and management is done in collaboration with service user and carer
 90% of Critical Incident Reports completed within 45 days
 90% of Complaints dealt with within agreed timescales
 90% of Serious Incidents Reports dealt with within agreed timescales
Effective multi-agency partnerships
 100% of team has plans in place to support working relationships with CAMHS, OPMH, SMS,
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primary care, police, housing, third sector MH services, service user and carer support/
involvement groups
3. Scope
3.1 Population covered
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acute mental health presentations to the Emergency Department including self harm
acute mental health issues in outpatients and on wards (mainly anxiety or depression but
also psychosis, personality disorders impacting on treatment)
People with a long term condition and co-morbid mental health conditions
People with physiologically explainable symptoms (PES) without a demonstrable physical
illness
Training and up-skilling of condition specific specialist staff within the hospital to identify
and manage low intensity psychological intervention
At least 25 per cent of patients with a physical illness admitted to hospital also have a diagnosable
mental health condition; a further 41 per cent have sub-clinical symptoms of anxiety or depression.
Patients with a physical illness are three to four times more likely to develop a mental illness than
the rest of the population: poor concordance with care associated with mental health issues is
common and poorly recognised despite being associated with increased morbidity in a range of
Long-Term Conditions.
3.2 Service description/care pathway
In the acute sector, multidisciplinary liaison services have been shown to be highly cost-effective and
bring the following benefits:
 improved patient self-management of their care
 assessment, engagement, formulation and treatment with reduced healthcare costs, of
patients who may be reluctant to attend other mental health services and including those
with physiologically explainable symptoms PES (‘MUS’)
 improved physical and mental health outcomes, e.g. improvement of clinical outcomes of
depression which is an independent predictor of readmission at six months in older people.
 support with patients admitted to medical wards with severe anorexia nervosa who are at
high risk from combined physical, psychological and behavioural problems
 improved return to independent living for the elderly
 reduced stigma associated with mental health care
 advocacy directly for the physical care of those with mental health problems in acute
services
 reduction in readmissions and length of stay
 advice on, and where appropriate, management of complex issues to do with the Mental
Health Act and Mental Capacity Act
 reduction in subsequent healthcare utilisation, including emergency care and clinic visits
 improved mental health skills and wellbeing of staff in acute hospital settings
 assistance in relieving the stress that staff often feel when dealing with patients with
complex needs and this reducing levels of sickness absence
Liaison services aim to increase the detection, recognition and early treatment of impaired mental
wellbeing and mental disorder to:
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reduce excess morbidity and mortality associated with co-morbid mental and physical
disorder
reduce excess lengths of stay in acute settings associated with co-morbid mental and
physical disorder
reduce risk of harm to the individual and others in the acute hospital by adequate risk
assessment and management
reduce overall costs of care by reducing time spent in A&E departments and general hospital
beds, and minimising medical investigations and use of medical and surgical outpatient
facilities
ensure that care is delivered in the least restrictive and disruptive manner possible.
Priorities for development in all general hospitals are services for:
 acute mental health presentations to the Emergency Department including self-harm
 acute mental health issues on wards especially delaying discharge (mainly depression but
also organic psychosis, personality disorders impacting on treatment, advice on capacity,
complex diagnoses, and advice on the use of psychopharmacology).
3.3 Location(s) of Service Delivery (locally defined)
3.4 Days/Hours of operation (locally defined)
3.5 Referral criteria & sources (locally defined)
3.6 Referral route
3.7 Access times
Urgent : 1 hour
Routine: 1 day
3.8 Any acceptance and exclusion criteria
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Assessment of or established mental disorder,
Exclusions include
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Crisis related solely to relationship issues (except when assessed as a predictor in
young people who self harm)
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Adults with a developmental disorder, where no co-morbidity exists.
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Anger control and violence without associated mental illness,
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Disorders of sexual preference (e.g. paedophilia, fetishism without associated
mental illness,
Services will not exclude people on the basis of age, gender, race or sexual orientation and will
explicitly address issues of staff safety including a statement of zero tolerance for racial or physical
abuse. This will ensure adequate assessment to ensure that treatment is not withdrawn
inappropriately e.g. when abusive behaviour is a manifestation of psychotic illness.
3.9 Interdependencies with other services (needs referral to local provision)
NB: Correspondence with community and primary care teams should be managed in a timely way
and include diagnosis or working diagnosis.
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clinical health psychology embedded in medical teams, such as oncology, diabetes, renal,
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rheumatology or respiratory teams and providing specialist talking therapies, assessment,
consultation, training and research
chronic pain management teams and chronic fatigue teams, operating over a wider area
than a single acute hospital
cancer network of psychosocial support professionals, organised to support sophisticated
training arrangements for medical and nursing oncology staff (and often including liaison
psychiatrists)
Cardiac and pulmonary rehabilitation teams.
Gastroenterology services
Acute and Community mental health services
Psychological therapy services (IAPT and/or others)
Primary care and community services
There is an expectation that key organisational arrangements will be in place which are consistent
and equitable across the population. These include:
 Single management and unambiguous lines of responsibility;
 Consistent gate-keeping procedures;
 Consistent care planning arrangements across the multiple and complex pathways;
 Single assessment at point of entry, including risk assessment, which is consistently revised;
 Discharge or transfer planning from the start;
 A clear purpose for each step along the pathway;
 Effective and consistent communication mechanisms between clinicians, teams, and
agencies to promote discharge with continued carer and support where necessary.
4. Applicable Service Standards
4.1 Applicable national standards e.g. NICE, Royal College
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No Health Without Mental Health (2011) & Implementation Guide (2012)
Joint Commissioning Panel for Mental Health. Guidance for commissioners of liaison mental
health services to general hospitals. London: The Royal College of Psychiatrists, 2012.
Joint Commissioning Panel for Mental Health. Practical Mental Health Commissioning: A
framework for local authority and NHS commissioners of mental health and wellbeing
services London: The Royal College of Psychiatrists, 2011.
National Institute for Health and Clinical Excellence (2009) Depression in Adults with a
Chronic Physical Health Problem: Treatment and Management (Clinical Guideline CG91).
NICE.
Naylor, C. & Bell, A. (2010) Mental Health and the Productivity Challenge: Improving Quality
and Value for Money. King’s Fund.
NHS Commissioning Support for London (2011) Medically Unexplained Symptoms (MUS):
Project Implementation Report. NHS Commissioning Support for London.
NHS Confederation (2009) Healthy Mind, Healthy Body: How Liaison Psychiatry Services can
Transform Quality and Productivity in Acute Settings. NHS Confederation.
NHS Institute for Innovation and Improvement (2006) Improving Care for People with LongTerm Conditions: A Review of UK and International Frameworks. NHS Institute for Innovation
and Improvement.
Royal College of Psychiatrists & Academy of Medical Royal Colleges (2009) No Health
without Mental Health: The ALERT Summary Report. AoMRC.
Parsonage M, Fossey M. Economic evaluation of a liaison psychiatry service. Centre for
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Mental Health, 20110. www.centreformentalhealth.org.uk
Emotional Wellbeing: Cases for change – physical health conditions
http://www.emotionalwellbeing.southcentral.nhs.uk/component/content/article/368
4.2 Applicable local standards
Locally Defined
5. Location of Provider Premises
The Provider’s Premises are located at:
[Name and address of the Provider’s Premises OR details of the Provider’s Premises OR state “Not
Applicable”]
6. Price
[Insert details including price where appropriate of Individual Service User Placement]
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