Liaison psychiatry

I would like to echo the view of liaison psychiatry expressed by Dr Bolton (Psychiatric Bulletin, April 2004, 28, 149). When I moved to Wolverhampton nearly 6 years ago, there was a very well thought of nurse-led liaison psychiatry service which as well as providing an excellent response to the local accident and emergency department also was developing links with particular specialties. The service had been based at the general hospital along with the psychiatric beds, but when the latter were relocated to a purpose-built facility on a different site in December 2002, the liaison service lost its accommodation on site. Foreseeing this, we had provided a detailed service specification well in advance of the move; we were later told this had been ‘lost’, so resupplied it. At around the same time, there was a change in management as we were absorbed into the primary care trust and senior management became very interested at the point where it became clear that there had never been a service level agreement with the acute trust. The service was entirely funded from mental health, apart from one seven session psychology post that continues to be funded by the acute trust.

A number of meetings have taken place between senior management and clinicians between the primary care trust and the acute trust but these have proved frustratingly inconclusive. Despite the fact that my one or two sessions of input to the service remain significantly below the recommended norm of about two full-time equivalents for the size of the hospital, the team has continued to provide a well-thought of service which is valued by clinicians in the acute trust. Goodwill has not translated into funding however, and because the primary care trust has entered the new financial year short of cash, it is proposing to cut two nursing posts and redeploy the third into another needy area of mental health. The thinking behind this is presumably along the lines; ‘If it ain't broke… let's tinker with it until it is, and then we can abolish it….’