This report provides an independent economic evaluation of the Rapid Assessment Interface and
Discharge (RAID) psychiatric liaison service operating in City Hospital, Birmingham. It is based
mainly on a critical scrutiny and re-analysis of data collected as part of a wider internal review.
We conclude that the service generates significant cost savings and is excellent value for money.
Psychiatric liaison services provide mental health care to people being treated for physical health
conditions in general hospitals. The co-occurrence of mental and physical health problems is very
common among these patients, often leading to poorer health outcomes and increased health
care costs. An effective liaison psychiatry service offers the prospect of saving money as well as
improving health.
RAID is an award-winning service which offers comprehensive mental health support, available
24/7, to all people aged over 16 within the hospital.
The analysis of cost savings in the internal review of RAID focused on the ability of the service to
promote quicker discharge from hospital and fewer re-admissions, resulting in reduced numbers of
in-patient bed-days.
Based on a comparison of lengths of stay and rates of re-admission in similar groups of patients
before and after RAID was introduced in December 2009, in place of a previous, smaller liaison
service, the internal review estimated that cost savings are in the range of £3.4 – £9.5 million a year.
Most of these savings come from reduced bed use among elderly patients.
To allow for uncertainty in these estimates, we undertook a cost-benefit analysis of RAID based
on very conservative assumptions, seeking to address the question of whether the service is
demonstrably good value for money even if its claimed benefits are put at the bottom end of a
plausible range.
This should provide decision makers with a sound starting point for future planning, including the
review of possible options for service re-design.
Our analysis indicates that the incremental cost of RAID (i.e. the additional cost of the service
compared with its predecessor) is around £0.8 million a year. In comparison, we estimate on
conservative assumptions that RAID generates incremental benefits in terms of reduced bed use
valued at £3.55 million a year, implying a benefit:cost ratio of more than 4:1.
The service also offers some potential savings in addition to reductions in bed use, such as fewer
discharges of elderly patients to institutional care rather than their own homes.
We conclude 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. Unlike most health care interventions, RAID actually
saves money as well as improving the health and well-being of its patients.
We identify possible areas for further work at the end of the report.