Psychiatric hospital services

Description

The service required is an out of hours liaison psychiatry service (5 p.m.-9 a.m. Monday – Thursday and 5 p.m. Friday to 9 a.m. on Monday) for the Royal Marsden NHS Foundation Trust, both the Chelsea and Sutton sites of the hospital. [On the Sutton site the hospital has 101 beds for adult patients being treated for cancer and no emergency department. On the Chelsea site the hospital has 105 beds and 16 critical care beds]. This service is required to support the medical teams who are managing inpatients with mental health problems who either present for the first time or become acute outside of normal working hours (9 a.m.-5 p.m. Mon-Fri). Issues which may arise include delirium, steroid induced psychosis or behaviour that puts either the patient or others at risk with a potential need for detention under the mental health act. The out of hours service (5 p.m.-9 a.m. Monday–Thursday and 5 p.m. Friday to 9 a.m. Monday plus UK Bank Holidays) will have three on-call components: 1) provision of out-of-hours on-call telephone psychiatric clinical advice/consultation/assessment from a consultant psychiatrist for medical teams managing inpatients; 2) provision of face to face psychiatric assessment by a consultant psychiatrist if onsite intervention is required following initial telephone assessment; 3) provision of the responsible clinician function out-of-hours is required which will include very occasionally the assessment for detention under section 2 of the mental health act for patients detained under section 5(2) out of hours by the nominated deputy of the responsible clinician (i.e. by one of the oncology ST/Clinical Fellows). In addition, this service is required during work hours to cover for any periods of annual leave/sickness of the consultant psychiatrist. Out-of-hours response times 1) On-call telephone advice will be provided by a consultant psychiatrist within sixty minutes of the initial call by clinical staff at The Royal Marsden Hospital. 2) If a face to face assessment is required, this will take place within 4 hours of the initial call. 3) An assessment for detention under the mental health act will take place within the required 72 hours from the initial assessment following discussion with the onsite clinical team. All the doctors providing the on-call service will be consultants psychiatrists. The provider will be responsible for ensuring that: • they have completed the relevant statutory and mandatory training as defined by the NHS core skills framework; • they have completed all the necessary NHS employment check standards; including relevant professional registration, references, right to work etc.; • have a current valid DBS- enhanced with barred list information; • have annual appraisal; • are familiar with the details of the service requirements of this contract; • valid section 12 certification; • organising a back-up service if the individual on call is not available; • current liability insurance is in place. Securing out of hours liaison psychiatry cover for both sites of the Royal Marsden has been difficult for a number of years (since 2011). Various solutions have been sought including negotiating with local NHS Trusts, establishing a consortia of local psychiatrists to provide cover and most recently going out to tender for liaison psychiatry services that included out of hours cover. A tendering process took place in 2018. Three potential vendors submitted an initial application (all NHS Trusts) but none of them were able to provide the level of out of hours cover required because of the geographical distance between the Chelsea and Sutton site and the challenges each faced in staffing the internal out of hours rota. Cognacity the current supplier is an independent provider of out of hours psychiatry services to other specialist hospitals locally including The Royal Brompton and Mount Vernon so they were approached to determine their interest. A contract was established with them in August 2018 driven by clinical need as no other solution was found. As they met the KPI set, this contact was then renewed for an additional year and ends 31 July 2020.