2014-19 Business Planning Template (QIPP, Cost Pressures, Integration
Transformation Fund)
cost avoidance / Recurring cash releasing / cost avoidance / total
cost reduction / Patient / User / Medical / Professional,
Commissioner
Name of
Initiative
Rapid Assessment, Interface and Discharge - RAID/Liaison
Benefit type
High level
description of
Initiative
Provide a comprehensive Liaison Service for Adult Mental Health
Services (AMHS) and Older Peoples Services (MHOPS) based on
the RAID model (Rapid Assessment, Interface and Discharge).
CCG priorities
Long Term Conditions / Ill-Health Prevention
Mental Health and Dementia Care
To enhance self-care and early diagnosis with effective
signposting into services with minimal delays.
Reduction in the need for non-elective admission
Collaborative working to improve the health of the local
population.
Enable early discharge and reduce length of stay
Easier access to services and information
Confirmation of
how addresses
ITF Priorities
Protecting social care services
7 day services to support discharge
Joint assessments and accountable lead professional
Description of
how meets CCG
Strategic
Priorities
Lead GP
Member
George Campbell
Integrated
Commissioning
Board priorities
Lead Manager (+
email)
Sarah Ferguson
sarah.ferguson5@nhs.net
Size of net
financial benefit
Releasing resources / Improving quality of care / Improving patient
experience / Working more effectively across services boundaries
/ Improving health and wellbeing
£200-499K;
Overall description/scope
Timescales and Milestones
Provision of liaison services 7 days per week, 8am-8pm, ensuring a liaison
approach rather than current consultation only approach (these hours would need
to be assessed against demand/need).
Agreement with provider to develop
Raid/Liaison model – March 2014
This approach would enhance the quality of care for patients by ensuring the
appropriate patients are referred into the service, assessments are undertaken on
admission therefore reducing the number of bed days and there are no delays in
identifying the appropriate pathway of care.
New model of service would ensure appropriate detection of mental illness,
signposting of specialist mental health services, working to avoid re-admissions
and up skilling ward staff. Development of Liaison would support other work
streams on S136 and telemedicine. Overtime scope would be extended to include
Service Design co-produced with providers
and commissioners – April 2014
Devise service specification and KPI’s – May
2014
Contract Variation – May/June 2014
Additional staff recruitment (provider) - April
2014
Time to project
delivery (contract
award)
6 – 12 months
Time to steady
state (from
contract award)
3 months to
implement
service and
recruitment.
outreach support to Nursing Homes and GP Liaison.
Service go live – April 2014
This service model will be delivered by increasing the number of existing liaison
nurses working into the Acute wards and A&E, increasing the specialist roles
including medical (consultant Psychiatrist) and psychology to enable rapid
intensive support which includes multidisciplinary assessments, which essential to
support appropriate and safe discharge.
Option 1: Implement Liaison Services for MHOPS (Older People only)
Resource: 1 x B7 , 1 x B6, 0.5 WTE Consultant Psychiatrist, 0.5 WTE B8b
Psychologist, 1 x B4 Admin Support. Total Cost: £281,874
Option 2: Implement Liaison Services for AMHS (Adults only)
Resource:1 B6, Consultant Psychiatrist, B8b Psychologist, B4 Admin. Total Cost:
£268,566
Option 3: Implement Liaison Services for MHOPS and AMHS (Older People and
Adults). Total Cost: £472,880
Patient
Acceptability &
Experience
The model will ensure patients mental health needs are
addressed when they are in an acute hospital for treatment
for their physical health needs. It would also enable earlier
discharge and reduce readmission rates.
Complexity of
stakeholder
engagement /
providers working
together
It would increase the number of people receiving appropriate
care and support and reduce the number of people
developing mental illness within an acute hospital setting.
Liaison services can reduce the risk of self-harm and suicide
while also addressing the long-term conditions and medically
unexplained symptoms with which many patients present.
The Provider and Acute Trust would be required to liaise in order
to establish a fully supported liaison service. As such we have
established Service Improvement Group to ensure local delivery
of key programmes of mental health related work and this has
representation for public health, NYCC, TEWV, South Tees NHS
Foundation Trust and local clinicians and is chaired by Dr
Campbell, CCG Deputy Chair and GP Lead. This working group
has already developed a detailed business case.
We will also look further incentivise progress through embedding
this as part of CQUINs for 2013/14 and 2014/15.
Recent Rethink and mental health service user events have
shown significant support for Liaison services, this model
would address many of the emerging themes from service
user events.
Patient Safety
Current limited liaison service provision provides a
consultation only approach to urgent patients presenting in
A&E, this service is only operational during office hours and
Resources
required to
Implementation of this model would require project management
support to recruit and establish a liaison team. The provider has
already identified a project manager and a business case has
Clinical
Effectiveness
there are no cover arrangements in place. The current model
provides a piecemeal service operating on a part time basis,
there is an unmet demand which cannot be quantified at the
present time, the quality of this model is therefore
compromised as it is not available to some individuals whom
may benefit. The new model of service would provide more
streamlined approach to care with appropriate medical input
from clinical teams.
implement project
The model is based upon the principles of Birmingham &
Solihull Mental Health NHS FT’s Rapid Assessment Interface
& Discharge (RAID) Project, which has received accreditation
from the Psychiatric Liaison Accreditation Network of the
Royal College of Psychiatrists and also won a Health Service
Journal Award for innovation in mental health in 2010.
Certainty of
service continuity
The liaison model would enhance current service provision and
ensure service continuity, rather than seek a new provider. Both
Trusts would be using the same staff members which would
ensure a reliable and responsive service.
been prepared outlining the service requirements.
To achieve the objectives it is also essential that links are
developed and maintained with Adult Social Care, Acute
Community Services, Mental Health Community Services, START
Team and HIT.
Engagement will be required with the Commissioning Support Unit
Business Intelligence Team and providers performance
management team to develop and implement performance
management measures
The economic evaluation study of RAID concluded that the
RAID service is good value for money, particularly as the
benefits included in the assessment are over and above any
improvements in health and quality of life which are the
fundamental justification for health spending.
The Government’s Mental Health Strategy No Health Without
Mental Health 2011, emphasises the importance of improved
services that interface between mental and physical health
where co-morbidities exist.
Equity of Access
The model would not present any negative impact on equity
of access. It would enhance the identification of suitable
patient pathways of care.
Confidence in
market
Variation to an existing contract and existing pathways
Sustainability /
Corporate Social
Responsibility
This would reduce repeat attendances to A&E through early
diagnosis and clinical intervention. It would also signpost to
appropriate primary care services therefore avoiding
unnecessary travel.
Information
Availability
An economic evaluation has been undertaken by LSE, this
evaluation has been reviewed internally in order to make
assumptions on cost and potential savings.
Risks
Risks identified (including unintended
consequences)
Mitigating actions
Timescale
1. Impact upon mental health community teams and
inpatient units
 Staff recruitment to new service may lead to a
loss of skills to existent services.
 Capacity issues with memory clinic services due
to increased demand
2. Unable to evidence benefits in a timely manner
 Predominant information available from RAID is
qualitative research and estimations with regards
to Quantitative research. This business case
includes a request to fund temporary project lead
post to ensure we are able to collate and evaluate
the enhancement of services.
3. Inability of community services to react in a timely
manner to support discharge
Provider to manage risk
April/May 2014
Monitor activity closely
June 2014 onwards
Liaise with BI and provider analysts to identify effective collection and
analysis of performance and quality data
May 2014
Engage community services as part of implementation plan with
expectations of discharge timescales
April 2014
Benefits/Outcomes
 Enhance quality of care for patients
 Ensure appropriate patients are referred into the
service
 Appropriate clinical input from medical staff
 Reduction in the number of bed days and readmissions
 No delays in identifying appropriate pathways of
care
 Support crisis services and Section 136 workstream
Stakeholder group and purpose
Method of Identifying (including KPIs)
 Reduction in admissions to medical wards
 Early diagnosis of dementia
 Reduced admission to residential care following discharge from
hospital
 Patient supported in the community for longer
 Reduced length of stay – where appropriate
 Reduced repeat attendance at A&E through early diagnosis and
intervention
 Improved patient satisfaction
Where are savings released?
Method of engagement and frequency
Exit plan
Service provider and relevant staff groups
Acute Trust and relevant staff groups
Community Teams and GPs
Feedback to be obtained on proposed new service specification
Redeployment of staff and / or
reduction in contract size if activity
levels or outcome targets are not
achieved.
Benefits/Outcomes
£’000
FY14/15
Expenditure
473
Saving
(520)
(47)
Total net
savings
FY15/16
FY16/17
N.B The gross saving reflects costs before non-elective threshold and re-admission adjustments.
FY17/18
National benchmarking statistics
provide evidence for a much higher
cost saving. However with other
schemes potentially impacting on nonelectives a more realistic saving of 5% 20% saving would generate a cost
saving of approx. £220k-£800k
FY18/19
Total