‘Designed for Life - Creating World Class Health and Social Care for Wales in the 21st Century’ is a Welsh Assembly Government (WAG) document that outlines the future of health and social care in Wales. This document describes principles that underpin the transformation from the national illness service into a truly national health service. With recent developments in other parts of the UK and changing times in the NHS this seems like a good time to review the current situation with a liaison perspective. Services: In Wales Local Health Boards (LHB) are equivalent of PCTs. Twenty two LHBs are commissioners of primary, secondary, tertiary and community care. There are 12 regional Trusts that cover groups of local authority areas. There is a separate Welsh Ambulance Trust and a Velindre Trust for cancer services. The Health Commission of Wales of the Welsh Assembly of Wales (WAG) provides advice and guidance about specialist services to the NHS Wales. A significant difference from our colleagues across the Severn Bridge is that the mental health is part of a bigger trust rather being a separate trust. This has number of benefits for psychiatrists overall and Liaison Psychiatrists in particular. Not only that it helps in dealing with stigma associated with mental illness it also breaks down the barriers that come as a package when the two trusts are independent. A recent survey of eleven acute NHS trusts in Wales showed that the three Trusts did not have a dedicated liaison service and had crisis resolution home treatment team covering emergency liaison work. Out of the eight trusts with a liaison service only one team had a full-time Consultant Liaison Psychiatrist but even that did not meet the Royal College of Psychiatrists recommendations of at least two full-time Consultant Liaison Psychiatrists in a teaching hospital. Three trusts had a nurse led liaison service but none of them had five or more full-time equivalent nursing staff. The rest of the five teams were multi disciplinary with nursing and medical input including dedicated consultant sessions and input from other medical colleagues like SHO, staff grade and F1. Only two teams had a full-time junior doctor. None of the teams had a clinical psychologist and only one team had two full-time counsellors.

The Cardiff and Vale NHS Trusts has approved a Consultant in Old Age Liaison Psychiatry to enhance service provided by two Old Age Liaison Nurses. These nurses have so far provided service to two big teaching hospitals and a number of smaller units. Funding: While in England the NHS must compete at Westminster with other public services such as education and defence for its share of the monies raised. The situation in Wales is rather different. Wales spends over four billion every year on its health services and this figure is set to continue to rise. NHS Wales receives its allocation as part of the process of negotiation between Westminster and Wales, Scotland and Northern Ireland offices. The sum available for health and health services in Wales forms part of what is called the „block grant‟ which is the total amount of money for all the areas for which the National Assembly For Wales (NAfW) has responsibility for and is devolved to the NAfW. Increases over and above the overall share of the NHS are subject to the Barnett formula which seeks to ensure that all increases are based on actual population. Significantly, Payment by Results (PbR) does not apply to Wales but referrals outside of Wales will be subject to PbR. This experience in England would be useful to monitor for its impact on liaison services elsewhere.

Dr Tayyeb Tahir, Consultant Liaison Psychiatrist, University Hospital of Wales, Cardiff, CF14 4XN tayyeb.tahir@cardiffandvale.wales.nhs.uk

Dr Divya Sakhuja, Specialist Registrar, Department of Liaison Psychiatry, Morriston Hospital, Swansea.