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Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is to combine objective and subjective quality indicators to assess hospital-based CLP service utilisation, efficiency and effectiveness.

Service utilisation rate was calculated over the service's first four years. Patient characteristics and objective quality indicators relating to response timeliness in 2012 were examined. Totally, 41 staff and 52 consecutive patients completed evaluation surveys to subjectively evaluate effectiveness.

The utilisation rate increased initially and then slightly declined to 1.03 per cent of all hospital admissions. In 2012, 91.5 per cent were seen on the same referral day and 99.4 per cent by the next day. The benchmark for urgent referrals was not met (77.4 per cent). Patients rated involvement with the CLP service a positive experience (90 per cent), but were less clear about follow-up plans (68 per cent). Staff believed that the service improved the patients’ hospital course (98 per cent) and was communicated well (93-95 per cent). Only 63 per cent agreed that relevant CLP education was provided and 76 per cent rated follow-up plans as clear.

This CLP service was evaluated by measuring utilisation rates, referral response timeliness and consumer feedback. Referral to contact time is a useful objective quality indicator but should be combined with subjective yet standardised measures surveying service recipients (patients and referring staff) to be comprehensive and meaningful.

The Archers is a much-loved soap opera which relies entirely on audio outputs: on actors speaking and listeners listening. Despite this, many silent characters populate the drama. In fact, from Rosaline in Shakespeare’s Romeo and Juliet to Godot in Beckett’s Waiting for Godot, and not forgetting Tracey the barmaid in Eastenders, silent characters have long played a crucial role in dramatic productions, an influence all the more acutely felt if they are unseen as well as unheard. Therefore, using key examples of silent characters, and with reference to Freda Fry in particular, I discuss the expanding role and influence of the silent characters in The Archers. In addition, by invoking philosophies of language and silence, I will suggest they have an influence and potency in the storylines that speaking actors should envy, and that Freda Fry reigns supreme over all others.

In this chapter, we consider how the character of Rob Titchener has been developed in The Archers, moving him from hero of the hour to villain of the piece. We draw on a critical disability studies’ perspective to argue that ability and disability have been crucial in turning the character of Rob from the desirable and attractive man who first arrived in the village into a national hate figure, despised by all. We begin this analysis by introducing critical disability studies and studies of ableism as fields of academic inquiry. We then draw on these resources to offer an analysis of the ways in which ability and disability were used as a narrative device to develop Rob’s character. We question the ways in which ability and disability are used to denote ‘good’ and ‘evil’ in the development of characters in cultural texts like The Archers, and end with a plea to scriptwriters to engage differently with dis/ability and to consider the impact of the stories we tell on the everyday lives of disabled people.

This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.