We carried out this unannounced focused inspection of adult liaison psychiatry services as part of a system wide inspection of Urgent and Emergency Care provision in the Leicester, Leicestershire and Rutland Integrated Care System. Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, the Care Quality Commission undertook a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care.
Adult liaison psychiatry services are provided by Leicestershire Partnerships NHS Trust (LPT), the mental health trust in the Leicester, Leicestershire and Rutland Integrated Care System. Adult liaison psychiatry services are delivered by the mental health trust across three acute hospital sites at Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. We looked at how the adult liaison psychiatry service affected patient flow, admissions to hospital and discharges from the Leicester Royal Infirmary hospital as part of the system wide healthcare.
The adult psychiatric liaison service provides assessment and treatment for adults between the ages of 16 to 65, who experience mental health problems in the context of physical illness. Adult liaison psychiatry is categorised under Mental Health Core service of Mental Health Crisis and Health Based Places of Safety (HBPoS), as it is provided by the mental health trust, Leicestershire Partnership NHS Trust.
This was a focused inspection. We did not rate this inspection. We looked at the domains of safe, effective and responsive and we did not inspect all of the key lines of enquiry. We did not inspect the whole core service.
We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. We did not inspect the following areas of this core service:
- Crisis Resolution and Home Treatment teams (CRHT)
- Health Based Places of Safety.
We did not rate this service at this inspection. The previous rating of requires improvement remains. We found:
- Staff working for the adult psychiatric liaison team developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients.
- Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
- The service did not exclude patients who would have benefitted from care. The team engaged with patients who found it difficult or were reluctant to engage with mental health services.
- There was a full complement of staff with no vacancies.
- All areas were very clean, fresh smelling and fit for purpose. All assessment rooms had good visibility.
- Staff we spoke with were proud to work within the adult psychiatric liaison team and proud to show us the work they did and the service they provided. They were constantly looking at ways to improve their work and the patient experience of the service.
However, we noted one issue that could be improved:
- We found the average wait times for patients presenting with a mental health crisis or specific mental health needs were between 1.5 hours and 1.9 hours. This was because the EDU ‘batch’ refer sending four or five referrals at a time rather than when they arrive. We were aware the local commissioning groups had not set targets for wait times.
How we carried out the inspection
We spoke with six members of staff including matrons, team leaders and mental health practitioners and reviewed all the assessment areas the adult psychiatric liaison team uses. We reviewed data and documentation including three patients’ care records and risk assessments.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
What people who use the service say
We did not speak to any patients using the service at the time of the inspection.