With ever increasing budget restraints and firm emphasis on community treatment, South Essex Partnership NHS Foundation Trust introduced the Assessment Unit in April 2005. It serves a dual purpose of gatekeeping and deciding appropriate care setting for patients.

Patients deemed likely to require admission, either by the on-call junior doctor or the community teams, are first admitted in this unit. Alternatives to in-patient treatments are explored and a comprehensive assessment of needs is conducted within a maximum of 72 hours. This ensures adequate utilisation of in-patient beds and also prioritises community treatment.

Tangible benefits in the past 2 years include a 36% reduction in admissions through accident and emergency units with an overall reduction of in-patient admissions of 42%. The average wait for allocation of beds has halved and use of out-of-area beds has been reduced to zero. The downside has been an increase in average length of stay as an in-patient. This is understandable with a greater proportion of severely unwell patients on the wards now. A recent staff survey shows a high level of satisfaction with the unit and some of the main reasons highlighted are early input from senior medical staff and an alternative to in-patient care. Junior doctors particularly found this unit extremely helpful especially in complementing their out-of-hours work.

The trust also has had substantial financial benefit including closure of a 23 bed acute in-patient ward.

We feel this model of working has been successful in our trust and can possibly benefit others in similar situations.