Case study: New psychological service, Liverpool University Hospitals NHS Foundation Trust

Statement 3.4

After diagnosis, all patients should have full assessment of their disease, nutritional status, bone health and mental health, with baseline infection screen, in order to develop a personalised care plan.

Statement 5.6

Patients and parents/carers should be provided with information about post-operative care before discharge, including wound and stoma care, and offered psychological support.

Statement 6.8

On admission, patients with IBD should have an assessment of nutritional status, mental health and pain management using validated tools and be referred to services and support as appropriate.

Who's doing it well?

The IBD service at the Royal Liverpool Hospital, part now of the newly merged Liverpool University Hospitals NHS Foundation Trust (LUHFT), in response to a number of patient incidents where struggles with psychological health and accessing support negatively impacted on IBD care, recognised the need for an integrated psychological service within their IBD team. After merging as a trust, a clinical psychologist has been appointed in 2021 to LUHFT, covering not just the Royal Liverpool Hospital but also Aintree Hospital in the north of Liverpool.

The idea

Clinicians within the IBD team developed the business case for the new psychological service for patients with IBD in Liverpool. This new service is now embedded and integrated within the IBD team with new processes currently being finalised for referrals and the overall scope of the service. It is expected that any member of the IBD team can refer patients to the psychological service, including doctors, specialist nurses, dieticians and pharmacists, with patients being prioritised on the basis of need and urgency.

As well as offering an inpatient and outpatient service, empowerment and training of other IBD team members to think more about the psychological aspects of IBD care is a specific goal of this new service. In addition, signposting to support services in the community is a key aim of the service so patients receive the right support from all available services.

The business case for a psychologist is not specific to IBD care, however it is felt that key IBD patient groups may benefit from this service (although not exclusive to these groups):

IBD patients in distress – particularly those undergoing surgery in the future or who have had negative psychological outcomes from surgery in the past.
IBD patients undergoing transition from paediatric to adult IBD care.
IBD patients who require nutritional support, such as those with short bowel syndrome and those on long term parenteral nutrition.

Results

Although this is a new service, several key performance indicators have been set to assess the success of the service into the future – in line with the UK IBD standards¹.

It is hoped that the new LUHFT psychological service will improve the psychological well being of patients in Liverpool and meet a clear unmet need within the region, hopefully becoming a flagship centre in the UK which other centres can benchmark against.

The aim of integrating psychology within the gastroenterology service is to enhance both clinicians’ and patients’ recognition of the psychological impact that having IBD can have, and how this can interplay with a person’s ability to manage the condition, adapt accordingly and maintain a good quality of life. There is increased awareness of mind-body links and emphasis towards a bio-psycho-social model where an understanding of physical, social and psychological factors are integrated to provide a more holistic and person centred approach. It is very much a valued opportunity to work with clinicians who have actively sought to create this post within their established medical team and who recognise the importance of developing both their own understanding and skills in supporting patients with their psychological adjustment and impact, and also want their patients to be able to access specific and direct IBD psychological therapy where needed. I am very pleased to be part of the team here at LUHFT and look forward to developing the provision of psychological therapy for IBD patients.

Dr Rachel McGowan, Clinical Psychologist, LUHFT

We are delighted to have Dr McGowan as part of our team as the psychological needs of IBD patients can often be overlooked when treating the patient’s inflammation. We hope this more holistic approach will enhance patient care and well being and ultimately improve overall outcomes for our patients.

Dr Philip Smith, Consultant Gastroenterologist, LUHFT

We are delighted to have the addition of Dr McGowan to the IBD team. She will help develop the understanding and skills of staff in supporting patients who have unmet psychological needs. For those patients who have specific psychological needs that are impacting on their clinical care, Dr McGowan will be providing evidence based psychological interventions designed to improve clinical outcomes and support patients. This is good news for IBD patients in Liverpool.

Dr Martyn Dibb, Consultant Gastroenterologist and Luminal Lead, LUHFT

^{1. Kapasi R, Glatter J, Lamb CA, et al Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK Frontline Gastroenterology 2020; 11: 178-187}

^{Date created: May 2021}