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        Insidious undermining of the liaison nursing role
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Kewley & Bolton's survey (Psychiatric Bulletin, July 2006, 30, 260–263) of London liaison psychiatric services raises concerns that government pressures to observe 4-hour targets in accident and emergency (A&E) departments may have compromised liaison input for other general hospital patients. Almost all teams surveyed fell short of College recommendations regarding service provision (Royal College of Physicians & Royal College of Psychiatrists, 2003) and the recent threats to liaison services in Oxford and London suggest that resources will not become available to meet these standards. Compounding this issue is the trend towards merger of crisis resolution teams and liaison psychiatric nursing teams to cut service costs. Community patients in crisis may tend to be prioritised over patients within the hospital, irrespective of the level of need. This undermines the skills specific to liaison nursing and their unique role in general hospitals.

Our recent survey at Chelsea and Westminster Hospital of the provision of psychosocial assessments to A&E patients presenting with suicidal thoughts or behaviours showed that 90% received full assessment by the liaison team or duty psychiatrist, with plans for further action communicated to their general practitioner (or community mental health team). This level of service was achieved with a liaison nursing team managing 85% of out-of-hours clients without medical input, with implications not only for 4-hour targets but also for the European Working Time Directive on junior doctors’ working hours. Any further threats to liaison services run counter to the government's efforts to tackle suicide targets, to address the psychological needs of patients with cancer, HIV, neurological disorders, cardiovascular disease and diabetes, and its obligation to uphold employment law.

Royal College of Physicians & Royal College of Psychiatrists (2003) The Psychological Care of Medical Patients. A Practice Guide (Council Report CR108). Royal College of Physicians & Royal College of Psychiatrists. http://www.rcpsych.ac.uk/files/pdfversion/cr108.pdf