RAID
trials, tribulations and evaluations
Dr George Georgiou
RAID Clinical Director
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The Overview
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Project initiated in 2008 in Birmingham
Commenced December 2008
Internal evaluation programme
Independent economic evaluation – Mike Parsonage and Matt
Fossey, Centre for Mental Health
• Prof Martin Knapp – LSE
• Rolled-out across 5 acute hospital sites, Dec 2011 – Apr 2012
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Older adult mental health
• Up to 70% of hospital beds are occupied by older people
Audit commission, 2006, Living Well in Later Life
• 2000-2010, hospital stay for 60-74 increased by 50%,
over 75 by 66%
Hospital Episode Statistics, 09-10
• Dementia, Depression and Delirium
Case for change- Mental Health liaison Service for Dementia Care in Hospitals:
Strategic Commissioning Development Unit (SCDU), 21st July 2011.
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Older adult mental health
• Concerns from Nursing staff :
• managing challenging or difficult behaviour
• communication difficulties
• not having enough patient time
• Concerns from Families:
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nurses not recognising or understanding dementia
lack of opportunity for social interaction
lack of personal care
patients not being helped to eat and drink
the person with dementia not being treated with due
dignity and respect
Alzheimer’s society report: Counting the cost (2009)
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Alcohol use disorders
• 88% of adults in the UK drink alcohol
– 38% of men: alcohol use disorder
– 16% of women: alcohol use disorder
(Alcohol Needs Assessment Research Project, 2005)
• Annual healthcare cost of £1.7 billion
(National Indicators for Local Authorities and Local Authority Partnerships, 2009)
• Alcohol related admissions and presentations
• Alcohol specific admissions and presentations
• Tri-morbidity
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Adults of working age
• Deliberate self-harm:
– In the top five reasons for admission in the UK
– 170,000 admissions per annum
• Inadequate training leads to negative attitudes and poor care
• Patient non-engagement and repeated self-harm behaviour
– Suicide completion
• Resource intense with little positive outcome.
Kripalani et al, (2010) Integrated care pathway for self-harm: our way forward. British Medical journal, 27:544-546
Kapur, N (2006) Self Harm in the general hospital. Psychiatry, 5 (3) 76-80
National Institute for Clinical Excellence (2010) Guidelines for Self harm.
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Physical and mental health
• 25%: Patients with a physical illness also have a mental health condition
• 60%: Rate in the over 60s
• Depression and anxiety: 2-3 times more common in those with physical
long-term illness
• Neuropsychiatry; postnatal psychiatry; eating disorders
• MUPS:
– long term disability and dissatisfaction
– most hospital specialities
– care costs estimated at £3.1 billion per annum
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Key principles
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Single point of contact
24/7
Rapid response
Acute hospital based- Integrated
Broad spectrum of mental health disorders
Integrated
• all age groups
• physical and mental health staff working together
• case load and staff training
• part of the hospital system and machinery
• Part of the community pathway and service delivery
• Flexible to local need.
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Expected outcome with RAID
• EARLY DETECTION: a proactive mental health RAID team are aware of the
case at an early stage
• COMPREHENSIVE ASSESSMENT AND REVIEWS: complex multi disciplinary
assessment with regular reviews as appropriate
• EFFECTIVE CARE PLANNING: confidence that a patient can be managed
away from the hospital, e.g. at home with appropriate package of support
• REDUCED LOS AND IMPROVED OUTCOME: facilitates earlier discharge and
better outcome for patient.
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RAID: An established speciality
RAID
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Mental Health Network: NHS Confederation
Briefing: November 2011 (228)
Liaison services can:
- Save money
- Improve health and well-being
Liaison services are:
- An essential component of effective acute hospital care.
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Evaluation: In a nutshell
• Total savings:
• £3.55 million to NHS
• At least 44 beds/day
• £60,000/week to social care cost
Invest £1 in a RAID model and save £4
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Wider Potential Benefits
Potential Benefits of RAID
Complaints
Social care £
Staff satisfaction
Patient satisfaction
Outcomes
Considered in this Study
Inpatient LoS
Acute staff confidence in
dealing with MH conditions
Staff sickness
Readmission
rates
Demand for community MH services
Time in A&E
A&E reattendance rates
Admission rates
fro A&E
Discharge destination
MH outcomes
SUIs
Quality
Time to readmission
Acute staff training
Acute £
Prov / Comm
Security
Referring / Signposting to
community MH services
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Outcome of CSU evaluation
• Some savings made at front door:
-5.9% City Hospital:
-14.4% Heartlands Hospital: -9.8% Good Hope Hospital
-8.2% QEH
• £485,000 saving on saved admissions for commissioners
• £557,000 on avoided admissions for providers
• Most savings made on the wards:
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£1,635,863 saving on reduced length of stay for commissioners
£5.3M on reduced length of stay savings for provider
• Overall finding of for every pound spent, £4 saved
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Quality
•Discharge Outcome Form:
(DOF)
•Patient satisfaction:
semi-structured telephone interviews
•Staff satisfaction:
semi-structured face to face or telephone interviews
•Teaching and training:
feedback questionnaires
initial accreditation: September 2010
innovation in mental health:
November 2010
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Results from 184 completed Patient satisfaction
questionnaires
• 93% of patients agreed that they were seen in good time
• 99% of patients agreed that they were treated with dignity and
respect
• 98% said that the team listened carefully
• 98% said that the RAID staff gave them time to talk
• 92% said that seeing someone from the Mental Health Trust was
helpful to them
• 91% said that they felt involved in deciding what help they needed
• 96% said that they were satisfied with the support that was offered
to them
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Service user comment of service prior to RAID
“Basically I didn’t feel very good at all and I was being pushed out of the hospital that’s the way I felt”
Brian
Service user comment of RAID service
“She didn’t actually do off a tick box or whatever, I was able to have a conversation…yeah, I felt quite comfortable
telling them what my circumstances were and obviously my symptoms ,she was happy, well no, not happy with it, but
she was understanding with it… ”
Nadia
“It was only the RAID team that “got me” and it was what I needed at the time, I was in real
trouble”
David
“It was a life saver, I was very mentally ill at the time and I was very vulnerable, I do see that could have gone and
continued and just back to square one again…”
Brian
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Of 205 staff replying to the RAID evaluation questionnaires
• 97% of staff said that they were fully aware of the role and function
of RAID
• 97% believed that the RAID liaison service improves patient care
• 97% believed that the RAID liaison service supports acute hospital
clinical staff
• 92% said that they would be keen to receive teaching and training
on mental health issues by the RAID team
• 95% said that they were satisfied with the response time of RAID
during office hours
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Birmingham GP regarding patient seen by RAID at Queen Elizabeth Hospital Birmingham:
“Just a quick note to say how impressed I was by your very accurate and perceptive
assessment of our very complex patient. All too often in the NHS we get letters of
complaint! I would like to say that your last paragraph is one of the most concise and
impressive summing up of this quite difficult lady that I have ever seen. I do not know
whether you need feedback for your appraisal review process but would like to thank you
for your assessment. I think it will help us to help manage her health needs.”
Consultant, Heartlands Hospital:
“I saw the patient again today in clinic. She has fully accepted the fact that she has a
somatoform disorder and using the relaxation techniques that she was taught by my
colleague Dr Mary Oldham – RAID Clinical Psychologist, she has now regained control of her
life. Her quality of life has massively increased and she is no longer attending hospital.”
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“Thank
you for all the times you have been and helped us down on MAU. You’re a
valuable asset!”
City Hospital Nurse
“Brilliant service in A&E, fabulous staff. Patients able to see appropriate MH personnel
quickly, negating long delays and increasing frustration”
Heartlands Hospital Sister
“Don’t know what we would do without them!”
“RAID is needed strongly within this trust”
Queen Elizabeth Hospital Nurse
Good Hope Hospital
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Obstacles faced during this journey
• Clinician suspicion
• Management suspicion
• Several different Trusts debating the value/ benefits to
themselves
• Lack of integrated thinking
• Lack of whole pathway thinking
• Lack of whole person/ patient experience thinking
• Still awaiting CEO signoff
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RAID – Trials, Tribulations and Evaluations