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The Royal College of Psychiatrists Improving the lives of people with mental illness

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03/02/2017 14:32:59

Busy times, a royal riddle and dinner with a prince

It’s all happening at the moment, folks. I used to moan that we never got enough publicity. Suddenly I am nostalgic for those good old (quiet) days.

We have been talking on prison suicides (a predictable and self-inflicted disaster for which someone, and we all know who, should be held accountable). There has been the regular drum beat that antidepressants spell the end of civilisation (no they don’t).

There is a Panorama running on Monday night about problems in mental health care. I haven’t seen it, but am confident about two things. First, that my long interview will be reduced to ten seconds, missing out all the important bits and second, yet another Chief Executive will be heading for the tumbrils.

Their life expectancy is not much better than a first world war Flying Officer.

On the other hand, if you want something funny (funny peculiar I am afraid, not funny ha ha) listen in to the Life Scientific (BBC R4, Tuesday 14 February).

 

On the move

And I have been using my new bus pass. How long I will have it remains to be seen, since 30 minutes after it dropped on the mat, Simon Stevens was on the radio announcing that stopping perks like free bus passes was the only way to save the NHS.

But before he removes the only good thing about turning 60 I have been on the move. Health Education England to talk about the mental health workforce – yesterday the new data on career destinations of Foundation Year was slipped into the public domain.

It’s bad news for the profession – numbers of those going into higher training has declined for the fifth year running – but actually a little glimmer of light for us – psychiatry has shown a small but definite upturn.

Then back on the bus for multiple trips to the Department of Health and NHS-England– IAPTS, Out of Area Placements, CAMHS leads, addiction services and the lack of them, and so on.

Then the Ministry of Justice, followed by a stroll round the corner to talk sex with the Bishops, and then back to Home Office, and more Prevent.

We continue to work with them, DH, GMC, the police services and Uncle Tom Cobley about this.

Come to the Presidential Lecture on 14 March for a real bean fight about this, as we let Derek Summerfield off the leash.

But in the meantime we continue to steer the difficult path between our legal duties to prevent terrorism (a duty on every citizen), our duty to try and help those with mental disorders who might also pose some risks to themselves or others (familiar territory) and our duty not to cross ethical lines.

 

Knowing our history

One of the reasons I like psychiatry is that we as a profession are aware of past and present misdemeanours - political abuse of psychiatry in the old Soviet Union, or more recent dubious practices by psychologists in Guantanamo Bay. We know, and need to know, our history.

Which brings me by a tortuous and twisting path to history, which is what I want to write about today. I and probably you need a break from NHS politics and the constant game of “Cherchez l’argent”.

So I want to talk about America and a despotic ruler who many think is mentally ill. No, no, no, not him – I said this was history. We are talking George III.

Most of us only know two things about George. He lost us America and he went mad, although those with a degree in Advanced King George Studies might have heard that he wasn’t actually mad, but suffering from porphyria.

You may have caught last Monday (31 January) a BBC 2 documentary called “George III: The Genius of the Mad King”, which challenges all the above, as well as including a cameo from the Queen, standing next to a historian in full flight, whilst her expression says “I have no idea who you are, but you are clearly deranged”.

I shall leave the “Losing America wasn’t George’s fault” to others, and stick to psychiatry. Now making retrospective psychiatric diagnoses of historical figures is fraught with difficulty. There usually aren’t medical notes, and even if there are, the meaning of the words used have usually changed over time. The disorders themselves may also have changed.

However, one advantage of being a monarch is that there is plenty of material to study, especially as now we can read the letters he wrote whilst ill and when well. Even then, caution is needed. The illness of a King was a delicate matter – one of his doctors resorted to hiding the unpalatable truth behind Latin even in his private diary, writing that “Rex noster insanit” - Our King is mad.

 

The most likely diagnosis

The most likely diagnosis is that he was suffering episodes of mania, a severe version of what we now label “bipolar disorder”.

The over excitement, pressure of speech, sexual disinhibition, excessive disorganised activity, sleep problems and so on are characteristic. We are taught to look out for grandiose delusions - such as believing one is, or is related to royalty, as another feature of mania.

This doesn’t work so well when the patient is a genuine King, but the records give plenty of other evidence of delusional thinking common in mania.

Watch the programme also if you want to know why 5 December 1788 is the birth of our speciality and indeed ourselves.

But what about the porphyria? Everyone who has seen “The Madness of George III”, with the King so brilliantly played on stage and screen by Nigel Hawthorne, will remember that the film concludes by informing the audience that the King wasn’t mad at all, but had a rare metabolic disorder that only looked like madness.

The script suggests that the pompous doctors, played as comic turns, overlooked this, and it was only his servants who noted that the King’s urine returned to its normal colour as his mind returned - a classic sign of an episode of porphyria.

It was two psychiatrists, the mother and son team of Ida MacAlpine and Richard Hunter, who first proposed this diagnosis in 1968.

True, there were symptoms that might have suggested porphyria, a genetic disorder which has been found in some members of the Royal Houses of Europe. But later critics highlighted serious mistakes and inconsistencies in the sources, and that mania was more likely.

The question resurfaced ten years ago when scientists analysed a lock of the King’s hair, hoping this would prove that he had genetic evidence of porphyria, but they failed to extract any DNA, so it is as you were.

Why did the theory of porphyria gain such traction over the years? MacAlpine and Hunter were disillusioned. They were fed up with psycho analysis, and instead believed that most mental disorders were caused by either known (such as porphyria) or as yet unknown organic physical conditions.

Diagnosing an organic metabolic disorder in one of the most famous “madmen” in history would be a wake up call to modern psychiatry, and also remove the stigma or taint of mental illness from the Royal Family.

 

What can we learn?

Are there any lessons here for us? MacAlpine and Hunter’s wish to remove the stigma associated with mental illness remains a noble cause.

But instead of directly combating that stigma, their preferred method was to say that he wasn’t really mad at all, but had an organic and hence legitimate disorder.

They were probably mistaken in their preferred diagnosis, but that misses the point. It is wrong to go looking into the urine, even if Royal, solely to prove that this is a real disorder, as opposed to unreal mental illness, which was MacAlpine and Hunter’s position.

We do research to better understand bipolar disorder, and to develop better treatments, but not to prove it exists.

Now let’s fast forward to King George’s descendants to see how much times have changed. And a quick warning that the noise you are about to hear is the sound of a name being dropped.

Last week I hosted a private dinner at the Royal College of Psychiatrists attended by HRH Prince Harry on how we can improve the mental health of our current serving and ex serving personnel.

These things are off record, but I can say (and I swear I am not grovelling) that he was bloody good, and impressed even the old lags like me around the table.

The Heads Together campaign which the younger Royals lead is directly challenging the Hunter/MacAlpine assumptions that there is a hierarchy of illness, in which physical illness is placed above mental illness. King George would have approved.

Professor Sir Simon Wessely

 

23/01/2017 10:32:04

It's official - society does exist

When Napoleon was asked what he wanted in his Marshalls he answered “to be lucky”.

He would have been pleased with Theresa May. A year ago David Cameron gave a good speech on mental health - I know, I was there. But hardly anyone else does, because he chose the morning that David Bowie died. There was zero coverage.

Theresa May chose a day in which for some reason Donald Trump said nothing and the only other news was the London tube strike and so she dominated the airwaves. Even the strike worked in her favour - more people at home twiddling their thumbs with nothing better to do than follow the news.

A Prime Ministerial speech is important. It sets a tone. The political and civil service bandwidth for AOTB (Anything Other Than Brexit) is going to be narrow for years to come, so knowing what Downing Street is keen on really matters.

And there is no going back from this - Theresa May meant what she said on her first day in office – she wants to see a transformation in how we approach mental health. So we must applaud the fact that the speech happened at all.

But what about the content? Again, there was much to like. There was a spirited defence of the importance of social networks and social cohesion for mental wellbeing. Nothing that we would not agree with and perhaps a little dig at the first woman Prime Minister, who famously or infamously claimed there was no such thing as society. In our world there most definitely is.

We heard a lot about the early years - again, little we have not been saying ourselves, but still very welcome.

There was a commitment to ending using police cells as a place of “safety” for mentally ill adolescents. We have been pushing for this for some time. There will be more mental health education for teachers - Mental Health First Aid will be rolled out across the sector.

My alter ego, The Boring Boffin, might point out that the best trial of this showed that it did improve teachers’ knowledge of mental health, but had little impact on the children. However, this is probably the occasion to keep Boring Boffin in the kennel.

And to be fair, the pre-speech briefings (I will riff on the subject of what really goes on before, during and after a political speech in a later blog) did include the word “trials”. Boring Boffin worked hard to get that - not “pilots”, still less “evaluations”, but “trials”. Well meaning interventions, especially with children, can do harm as well as good.

It is our role as a calm but authoritative voice, to point this out. Where we have evidence - as in parenting programmes to reduce behavioural difficulties in children - we will shout this from the rooftops. But the only way we can find out what works and build our evidence-base, is through trials. There is no other way of assessing the balance between benefit and harm.

But we don’t need more trials to know that Prime Ministerial support for putting mental health services into A & E is a good thing. A & E services will always be seeing those with drug, alcohol, deliberate self-harm, comorbidity and so on. And they will also always have to see those with serious mental health problems who have developed acute physical health care issues. And so they will always need us.

Digital is all the rage, so not surprising that a lot was made of this. From our perspective it was good to see that six mental health trusts will be designated as “Digital Exemplars”, which comes with £5 million in extra funding, after competition.

I say good, because that would not have happened without our strenuous interventions when it became clear from the first announcement that mental health trusts were not originally included in the scheme.

As ever, what was not said was as important as what was said. We tried to get more in about the workforce - this wasn’t successful, but back chat indicated that our hope that the commitment to provide up to 1,500 extra places for medical students will include measures to ensure that they don’t all want to be surgeons (of which we need fewer, not more, in the future), but GPs and psychiatrists (of which we definitely need more) will be heeded soon. 1,700 new therapists were promised for CAMHS services - but not the 350 CAMHS psychiatrists that both ourselves and HEE have indicated are needed.

Nor did we get the PM backing to end out of area placements for adults. We created the Crisp Commission soon after I took office and were pleased when NHSE accepted its findings and recommendations, but not the deadline we had proposed to this practice finally outlawed. We had hoped the PM might advance this, but she remained silent.

But we return, as we almost must, to the money. The PM promised some – as far as I can gather, the only truly new money was £15 million allocated for out of hospital crisis care, such as mental health cafes.

Some previous commitments were repeated - liaison and court diversion schemes to keep people out of the criminal justice system being extended across the country. I actually thought that was already happening, but having the PM repeat it does no harm. Ditto the extra investment for A & E liaison psychiatry services.

But overall the picture is gloomy. Between 2010 and 2015 funding to the mental health trusts went down by over 8%. Not up, down. Since 2010 we have lost more than 2000 beds in England alone. But demand has risen - referrals to community mental health teams have gone up by 20%. So has there been a concomitant increase in staff?

Don’t hold your breath - that went down by 5%. Meanwhile, you probably have seen the coverage of the 50% rise in mental health attendances at A & E over the same period - with a particularly worrying increase in children. Some, but not all, of this is due to better coding, but clearly the underlying trend is not good.

And looming over it all remains the fact that sightings of the large sums (now we are talking not a few million, but over a billion) promised by George Osborne before he was defenestrated, remains as elusive as sightings of the Loch Ness Monster or the Beast of Dartmoor.

Confirmed sightings of the money continue to be of small kittens rather than the Sabre Toothed Tiger sized felines that we were promised. Certainly eating disorder and perinatal services are benefiting, which is great, but the radical transformation that the speech promises remain to be delivered.

We are responding, helped it must be said by the new NHSE “dashboards” - which give at least some evidence of what CCGs are actually spending on mental health. Before Christmas we had a blitz on CCGs that made Scrooge look like the Bill Gates Foundation when it came to funding CAMHS services.

Armed with the data, we targeted local MPs and media, in a bid to name and shame errant performers, this being almost the only weapon we have in the post Lansley/Health and Social Care Act era. Expect a lot more of the same as we get down to looking at numbers of Out of Area Transfers (OATS), or who is honouring the expected 1.5% mental health uplift.

But I am afraid talking to Medical and Finance Directors up and down the land, we know that the famine continues and the broad sunlit uplands remain a distant prospect. We are not alone in this – as I write you cannot help but notice the tension between Number 10 and Simon Stevens about the overall level of NHS spending - who promised what and where is it?

Simon seems to have the facts on his side, but this is now about politics and where this will end we can’t say. I hope that it will settle, because Simon Stevens has been a good friend to mental health (it is where he started his career) and it is also hard to see anyone who would want to do his job, let alone do it better than he does.

So where does that leave us? I don’t think I can improve on this week’s (Jan 14) Economist – “The Prime Minister makes a big speech but signs a small cheque”. Big speeches are good, cheques would be even better.

Professor Sir Simon Wessely

06/12/2016 14:29:11

All I want for Christmas is some good data

It’s not been a great year, has it? If there was an award for “Worst Year Ever”, 2016 would be up there in the Top Ten. OK, 1914 and 1939 are above it – 2016 hasn’t heralded the start of a World War. In 1347 the Black Death reduced Europe’s population by a third - so things could be worse.

But for my lifetime at least, 2016 is going to get the Oscar. It has been rubbish, hasn’t it? We had the referendum which doesn’t seem to have magically released millions a week for the NHS.

Then there is that man with the terrible haircut. Yes, our American friends have elected a bull and placed him in the china shop. Perhaps it will all be all right on the night. And perhaps it won’t.

We had the junior doctors dispute, from which no one emerged a winner. A Secretary of State who finds it difficult to visit front line medical services because of the welcome he might receive. Junior doctors demoralised and still angry. A host of issues around the workforce that are nothing to do with the contract unresolved.

And England lost to Iceland [i].

OK, I feel I am about to succumb to what the poet Horace called “laudatory temporis acti”, loosely translated as “it was better in my day”. And in some ways, it was. But it’s not all been bad. Yes we lost to Iceland - but I was spared watching the ignominy because I was at a dinner celebrating our Pathfinders - 50 of the best and brightest medical students being supported by a generous donor to help them kick start a career in psychiatry. And that dinner took place on the first day of our International Congress at the Excel - our biggest and best yet. Yes, John Sweeney made me demonstrate my inner dancing Ed Balls on stage, a ghastly sight. But apart from that, it was plain marvellous. We had the serious - I don’t think anyone who saw the exhibition bringing back to memory those murdered by the National Socialists for the sole “crime” of being mentally ill or learning disabled, would not have emerged moved to the point of tears by the experience. We had the playful - interviewing the magnificent Jo Brand being my favourite. We had the spectacular - dinner in the Painted Hall at Greenwich Naval College as part of our send off for the longest serving Admiral in our fleet - Vanessa Cameron. And throughout it all a steady stream of exciting, challenging, thought provoking, entertaining and informative symposia, lectures, debates and more.

Congress is but once a year, but the work of the College goes on. And there is much to cheer us up. Now I am not going to give you all the Xmas presents at once, as I think we will all need a bit more cheering up in the months to come. So instead I will wrap a couple of successes in Christmas tinsel and keep back some others for later, perhaps when TIDS really starts to bite (Trump Induced Depression Syndrome).

So let’s talk data. The boring boffin that lurks in me gnaws at my conscience over the issue of data in all shapes and forms. We need reliable and transparent data so that we can make the right decisions about how to shape our services and so that the public and their representatives can hold those who make the decisions to account. That’s why we have worked collaboratively to get a system in which everyone can see how much and on what their local CCG is spending our money on mental health services in particular. In NHS Speak, this means a “dashboard”. And last month we finally got one. We immediately started analysing the mental health spends, current and projected, and naming and shaming those CCGs not pulling their weight. We used what the military would call a “combined arms” operation - using policy to get and analyse the figures, our parliamentary liaison to let local MPs know who was being naughty, and then our media and digital teams to get in touch with local media. In CAMHS for example, the spend per person varied from a low of £2 to a high of £144 - a massive variation. The squeals from those at the bottom of the class was a joy to hear and it turns out that some of them hadn’t supplied NHSE the correct numbers, and omitted to check their entries for accuracy either pre or post publication. This transparency lark is clearly a bit new to some of them, but hopefully they are on a steep learning curve because we’ll be checking, analysing and publishing our findings every quarter.

Over the lifetime of my career, it has become harder and harder to get good data for research. Nearly 30 years ago I needed to obtain the criminal records of over 1,000 patients known to have had schizophrenia in Camberwell over the previous 50 years. I wrote to the Home Office with the request, and a few months later the data arrived, all hand written by some poor junior civil servant. I think I had to sign a form, but frankly it wasn’t much more onerous than that. Looking back, I can see that system was probably too slack, but in the intervening years more and more barriers have been erected to the sharing of clinical data for bona fide purposes. But the good news is that over the summer we managed to prevent the erection of yet another barrier that would have had a very serious impact on mental health research and much else besides. NHS-Digital decided with the best of intentions that special safeguards were necessary to protect mental health data flows within the NHS, because these were seen as particularly sensitive and vulnerable to re-identification or hack attacks. We disagreed, arguing that it would hinder vital research and further disadvantage the already disadvantaged and marginalised. I made the case at the Board that if parity meant anything, it meant that we should treat mental and physical data the same. And I am pleased to say that NHS Digital did not dig in their heels, rather the opposite, and our suggestion is now policy.

Yes, I am indeed a boring boffin when it comes to data. But boring boffins are important, because data is important. Access to good quality data is fundamental to understanding our health care system. I would go further and say that it is a pre-requisite for a functioning democracy and civilised society. If you don’t believe me, check out Andrew Dilnot’s “A History of Britain in Numbers” or follow the marvellous “More or Less” Radio 4 series.

OK those are your Xmas presents for the moment. But if you were struggling to curb your excitement as they were unwrapped, I promise I have a few more bits of good news to see you through to the Spring.

But for the now, best wishes to one and all. Have a good break if you can. Notwithstanding some pieces of good news for us, there is no point in hiding the fact that overall it’s tough at the moment in the Health Service, and it’s going to get tougher. So as Sgt Esterhaus said at the start of every episode of the best cop show of all times, Hill Street Blues, “let’s be careful out there”.

[i] Pedanticus writes “not everyone reading this blog supports England, Simon. And the Welsh really did well."

Professor Sir Simon Wessely

03/11/2016 14:15:42

STP or not TP - that is the question

Let’s start with a little warm up exercise. I give you some initials, you tell me what they stand for. For example, I say NHS, and you say “outmoded concept that we cling to only out of nostalgia for the past and the sooner we get into a proper market driven system the better”, because you have been reading that Oliver Letwin again. OK, not the best example. Let’s try again. BMA. ECG. USA. Easy.

How about STP?

I am betting that caused some problems. But it might be something that you really need to know about.

STP stands for Sustainability and Transformation Plans (STPs). Some of you will be none the wiser, which is exactly the point of most initials that emerge from the NHS bureaucracy.

STPs are the brain child of Simon Stevens. I’ve mentioned him before because he is a Very Important Person. He also has a Very Big Brain (no, really he does) and for unknown reasons also now a rather fetching beard. Simon is the boss of NHS-England, high on the list of “Impossible Jobs that no-one in their Right Mind would Contemplate”. Simon wrote the NHS Five Year Forward View which I have said nice things about because it is indeed sensible, short and rather well written.

In the plan, Simon outlined the future of the NHS. He talked about how the NHS would survive in times of financial hardship, the importance of transferring care from expensive secondary care hospitals to primary and community care, why social care mattered, and why we needed to integrate physical and mental health care. All stuff we agree with.

But it was a bit light on how these things might happen. And after Lansley’s Monster, otherwise known as the Health and Social Care Act, getting things done in the NHS has not proven easy.

So he came up with the STPs. Every health and care system is now required to produce an STP, showing how local services will evolve and become sustainable over the next five years. These plans cover all CCG and NHS commissioned activity meaning commissioners and providers must come together to jointly plan services for a larger population. That’s an exercise in itself - since it becomes a bit like a version of the Prisoner’s Dilemma - everyone needs to co-operate to try and maximise the resources they can get, but equally need to compete to make sure that their own organisation gets the biggest slice of whatever cake there is.

In short, STPs are about trying to improve health and getting more care where it is needed. Nothing wrong there. But there is a sting in the tail in the words “sustainable finances”. We all know what that means, just like we know what cost improvements are. Don’t be fooled, part of the agenda is saving money. And as the NHS finances get worse this part of the agenda gets larger and larger.

So what about mental health? Well we know that NHSE is serious about making sure that CCGs spend more money on mental health, and we know that STPs are supposed to reflect it, with nine “must do” priorities, one of which is implementing the 5YFV for mental health.

But are they? When we look at what those who are drawing up the plans think it’s all about, mental health doesn’t seem to get a look in. Although NHS England has published an aide-mémoire for mental health and dementia to try and concentrate minds but this is only guidance. Which means that local areas don’t have to articulate how they will meet all of the targets of the Taskforce Implementation Plan.

And that is a bad thing. The things that the CCGs will be measured on - access standards for Improving Access to Psychological Therapies (IAPT), Early Intervention in Psychosis (EIP) and eating disorders are limited in their scope. Other priority areas - like child and adolescent mental health services - will continue to be variable across the country. And that’s certainly what we have been hearing from some of our members.

Now NHSE is not oblivious to these concerns. There is an impressive team now working on getting some results. Tim Kendall of this parish has taken on the mantel of national Clinical Lead, Karen Turner is the senior civil servant, the person who knows how the system works, and Claire Murdoch, the CEO of Central and North West London, is tasked with knocking heads together on the delivery of the 5YFV (please tell me you now know what this is).

We know that the party line is now that no STPs should be approved by NHS England that do not include a clear articulation of how they will achieve the priorities of the mental health taskforce, including the access and waiting time standards, as well as a clear demonstration of how local areas will increase their spending on mental health.

The problem - as ever - is that money is tight. History tells us that’s not good for us. We know that lurking in your local A and E or cancer centre are a host of Dick Turpins - ready to spring out, draw their pistols and shout “Your money or your life”, and for once I don’t mean that metaphorically. It will be phrased in exactly those terms. And whose money are we talking about? Ours. Unless we are careful, and perhaps even if we are, Dick Turpin and his fellow highwaymen may be able to shift money allocated for mental health improvements to supplant existing spend or balance reductions elsewhere in the system. And this is not far fetched. A recent survey found 61% of CCG leaders cite “organisational priorities” (ie balancing the books) trumping “whole system plans” (ie improving the way we deliver care) as a significant barrier to success.

And we are not talking about a few gold sovereigns. The Sustainability and Transformation Fund (STF) currently has a pot of £1.8bn for 2017/18 and 2018/19 respectively. Gosh, that’s a lot. Surely no one can steal all of that? Well, it may have been stolen already. The plan is for £1.5bn of this to go into a general fund allocated on the basis of emergency care; a £0.1bn general fund allocated to non-acute providers; and a £0.2bn targeted fund. I am losing you, I can sense it. OK, back to plain English. The providers - ie the acute trusts - have to balance their books by 2017/18. So if it all goes to them to do just that, there won’t be much left for real changes in services.

So our Three Musketeers (Claire, Karen and Tim) have a job on their hands to stand up to Dick Turpin and ensure that the mental health money allocated through the STF must is protected appropriately and local areas held accountable for delivering what they promised. We will be cheering them on.

Professor Sir Simon Wessely

28/09/2016 18:09:35

Satisfaction Guaranteed?

Not many of us go to work to do a bad job.  Most of us hope that we do the opposite – but how do we know if we are?  How can we tell if the service we provide is a good one and whether the work we do makes a difference?  Working out whether the services we and our teams deliver is up to scratch is not an easy task.  As a clinical academic I can point to papers published, or the results of the torment visited on us every few years known as the Research Excellence Framework, but even there a paper published can vanish into thin air, leaving no trace behind, and the judgement of our peers (which is basically what these assessment exercises are for) can be flawed.

And the situation is just as complex for clinicians.  We could and frequently do measure whether or not our patients are satisfied with us and our services. That’s no bad thing, and it is better to have a satisfied patient or relative than an unsatisfied one.  But measuring satisfaction alone is, well, unsatisfactory.  Some doctors get high satisfaction scores because they are polite, charming and give you just what you want – but they may simply be promoting snake oil. Studies show that patient satisfaction with their local hospital is significantly influenced by the availability of parking – important yes, but no reflection of the standard of care.

The RCPsych has been working quietly for years to help answer exactly these questions – how do we provide a good service?  The College Centre for Quality Improvement (CCQI) is the part of RCPsych that aims to help members assess and improve the quality of care they provide.

When I took over as President I have to confess that I knew very little about the CCQI.  That’s all changed now, and the more I learn about it, the more impressed I have become.  But talking to others I find that my lack of awareness of one of the most important parts of the College was by no means unique.  So for the rest of this blog I have teamed up with Professor Mike Crawford, who has been Director of the CCQI since 2011  to fly the flag for CCQI.  If you don’t know what it does, then please read on and you might be pleasantly surprised.

Let’s take two areas in which standards matter - good prescribing practice, and improving the physical health of our patients.  We know that prescribing drugs for too long and at too high a dose can be dangerous.  We also know that we have as a profession neglected the physical health of our patients for too long, with serious consequences.  Frankly, we have to accept responsibility for this. It’s not the fault of Andrew Lansley, the GMC, local councils or any other person or organisation that we often tend to blame (sometimes with good reason).

The ‘CCQI’ has been running audits like the Prescribing Observatory and National Audit of Schizophrenia for over 10 years.  There is good evidence that their focus on things like high dose prescribing and physical health are making a difference. Fewer patients are now prescribed antipsychotic medication above BNF limits and more patients are starting to have regular assessments of their physical health. However, access to psychological treatments remains poor and the speed with which services respond to mental health crises is still very patchy. A recent audit of Early Intervention in Psychosis services showed how long some people still have to wait before being taken on by a specialist team.

Finding out that services are not delivering high quality care is one thing; doing something about it is another. This is where our quality improvement networks come in. These programmes support services to conduct a self-review against national standards. This is then followed up by a visit from colleagues working in a similar type of service, along with service user reps and staff from CCQI.  The team discusses what they find compared to the results of the self-review with the local service and highlight strengths and weaknesses. Most of the CCQI’s quality improvement networks offer services the option of applying to be formally accredited by the RCPsych.

Now I know what you thinking, that is just a voluntary version of the CQC.  And we know the CQC is, well, not the most popular institution in the country.  When a service is informed that the inspectors are calling, the reaction is rarely  “jolly good, what fun - this is something that I am really looking forward to”.  We can put to one side the question as to whether or not they do a good job - that’s for others to answer - but we can say with some confidence that the job of a regulator is not to be popular.  Just ask the GMC.

But our quality improvement networks operate differently.  For a start, they are voluntary. They work with individual clinical teams rather than descending en masse in an attempt to assess a whole trust. But most importantly of all they provide structured feedback about specific strengths and weaknesses in a service as well as tailored support and advice about what other teams have done to improve when they have faced similar types of problems. Services that take part also have access to discussion groups and learning events where members identify areas they are struggling with and share good practice.

No one fails, which could very well leave them open to be named and shamed in the Daily Mail.  All that happens is that CCQI work with you to improve your game until you pass, and as a result  a get a coveted kite mark.  It’s a bottom up system of quality improvement, rather than top down.  And as the literature confirms, top down inspections can detect egregious examples of the unacceptable and they are much less effective in raising general standards.

Here’s another example.  One of the first networks, ‘ECTAS’, has delivered big improvements to the quality of ECT services around the country - 10 years ago some of these were in a bad state. We know that ECT has a small, 'though well defined and sometimes life saving role to play.  But more than anything else when done badly it can give us a bad press that can take decades to overcome. It is just possible that people are starting to forget “One Flew Over the Cuckoo’s Nest”, but the reactions to the revival of Harold Pinter’s “The Caretaker”, whose emotional centre piece is Aston’s monologue remembering the ECT he had received, shows that this an area in which we have an absolute duty to maintain best practice if we are to maintain public confidence in something that we believe needs to remain available in extremis.

Other programmes like Accreditation of Inpatient Mental health Services (AIMS) and inpatient CAMHS services (QNIC) have done much to help improve the quality of hospital-based care that patients receive. The great thing about these programmes is that they support teams to learn from peers, share good practice and then solve problems based on the experiences of colleagues.

But there are problems. While hundreds of services are now taking part in these programmes, many choose not to.  Some don’t because they think they are already good, and others because they know they are poor. What struggling services need to know is that the College’s quality improvement networks support teams to improve through sharing the experiences of other teams that have already been through the process. Mental health services that are not quite ready for accreditation are supported by the CCQI to reach the standards required over time and with help, most services are able to achieve accreditation.

Another problem results from the very limited use of routine outcome measures in psychiatry. This means that, while accreditation programmes can help ensure that care is delivered in accordance with recommended standards, it may still not be clear that this results in better health for patients. In response to this, services aiming for CCQI accreditation are now being asked to collect and make use of clinical outcome measures. The more services that use outcome measures, the more confident we can be that our patients are benefiting from the care we provide.

Numbers matter; they help you counter criticism when something does go wrong. It is significantly easier to be able to say that this was an isolated incident and not part of a general pattern of poor care if you have the data to back that up.  And whilst it is not the point of measuring outcomes – it can also make a difference to clinicians when it comes to applying for ACCEA points and awards.  One reason that Psychiatrists don’t do as well as, for example, surgeons is because they can point to routinely collected outcome data as objective measures of service excellence, and all too often we cannot.

All Trusts in England and Health Boards in Wales now take part in the audit programmes and staff working in the quality improvement networks went on over 500 visits to hospitals across the country last year. Methods developed by psychiatrists and colleagues at the College have been taken up outside the UK to assess and improve the quality of care provided elsewhere in Europe and beyond. At a time when there seem to be continuous ‘cost improvements’ and morale is often “challengingly”  (as you can tell, we are rehearsing our entry for the annual NHS Cliché of the Year competition) low, the quality improvement networks are doing their best to give staff something to cheer about. Taking part in the network requires time, resources and commitment, but our members consistently tell us that the benefits of belonging to a peer-led network far outweigh the costs.

The CCQI plays a vital role in justifying why we continue to need institutions like the Royal College in the 21st century. The RCPsych does indeed represent our profession, and long may that continue.  But the public can lose sight of the fact that the purpose of the profession, and therefore the College, is ultimately to improve our understanding and treatment of mental illness. And part of that must be to improve the quality of care that patients receive.  This is not a peripheral objective, but a substantial part of why we exist.

So to go back to the beginning.  We know that no one reading this will go to work tomorrow determined to do a bad job.  We were attracted to psychiatry to do the opposite - to in some shape or form improve the lives of those with mental illness, both presently and for the future. The CCQI is here to help you achieve it.  Try it.

Professor Sir Simon Wessely

 

02/09/2016 07:47:08

Planned strikes by Junior Doctors

This morning’s papers are full of the news that the Academy of Medical Colleges has issued a statement saying that it is ”disappointed at the prospect of further industrial action by junior doctors”, and that RCPsych has signed up to this. As far as I know only one College did not.

Until now our position has been to be supportive of our juniors in terms of the goals they wish to achieve, but to refrain from taking a position on the tactics being employed; in other words industrial action.   In various fora I have made it clear that I strongly believe that the causes of the obvious dissatisfaction felt by so many juniors (and of course not just juniors) are wide ranging and have been a long time coming   On Wednesday of this week, before the crucial meeting of BMA Council, I had a piece in the Times,  again outlining what I saw as the many serious issues affecting morale and well-being which would not be addressed by industrial action.

Many seem condemned to spending years rootlessly shuffling from one place to another like lost luggage, buffeted about by a promotion system that seems to be little more than a lottery.

Whilst terms and conditions are not issues for medical Royal Colleges, training, standards, morale, safety, health, satisfaction and so on definitely are.   Royal Colleges are also concerned with not just the welfare of psychiatrists, but also the welfare of those who we treat – our patients.  Sometimes those words sound like empty slogans.  How many times I have I heard “we must put the patient at the heart of everything we do” used as a clichéd rhetorical device to justify something that has at best peripheral relevance to patient care.

But a five day strike must inevitably threaten patient safety.   And to be fair, those who have been advocating industrial action accept this.  After all, if such a prolonged withdrawal of labour did not affect patient safety, one might wonder what on earth are we all doing for a living anyway?

So patients may well be harmed.  Perhaps not in such obvious and eye catching ways as might happen in Accident and Emergency departments, intensive care units or operating theatres – but our patients may also suffer.  We can be sure there are members of the media keenly waiting for the first death in order to unleash a wave of synthetic outrage.  The stories are already written, all that is missing is a name and face.  Even if a year and one public inquiry later it is concluded that such an event was not related to the strike, the damage will be done.  Unlike journalists and politicians we are trusted – trusted not to harm our patients – but we should remember that trust is earned, not a right.  It can be lost swiftly, and then take a generation to recover.

I have seen some social media postings saying “there is no pain without gain”, or “you need short term pain for long term gain”.   That pain is going to be felt by patients.  I don’t think that doctors should be making those arguments.

I have also seen other messages saying “if you are not with us, you are against us”.  I reject that.  It is specious and false. One can be with you, share your aims and cause, but still disagree with the tactics employed.  We remain as committed as we ever were to the long term ambitions that we all share. We all want to improve the working lives of our members, knowing also that unhappy, demotivated doctors who no longer feel in control of their careers or lives, deliver poorer care to patients. 

We all know that the NHS is also facing the biggest crisis in its history.   We know that promises that have been made such as increased funding have yet to be honoured   We know that demand has increased, sometimes unavoidably, but sometimes by  eye catching initiatives that turn out to been based on quicksand – chief amongst these being the “7 day NHS” - uncosted, untested and understaffed.    

None of that has changed.

So as before, you will make up your own minds.  I can only ask you to consider whether or not a prolonged industrial action is the best way to achieve our shared objectives. I can only ask that you consider the serious risks that such a path runs, to our patients, and our profession.  If you do decide after sober reflection that this is a risk that you are prepared to take, then so be it.  You will still be valued members of this College, and we will continue to do our best to support you.  In psychiatry we have a tradition of vigorous debate and dissent, whilst still remaining loyal to each other and proud of our profession.  Disagreement is not the same as division, and never more so than today.

 

29/07/2016 12:29:06

The tasks of the Taskforce

Mental health seems to have had a political promotion in the past weeks. Notably, it was one of the key social injustices – alongside poverty, gender and racial discrimination - highlighted in Theresa May’s inaugural speech as Prime Minister. This prominence matters. You might not remember the last time that David Cameron spoke about mental health – but that wouldn’t be surprising because he did so on the morning of David Bowie’s death, so probably the only people who actually heard him were the 40 or so in the audience, including me. But his launching of the 2012 Dementia Challenge managed to avoid the demise of an international icon, and the cogs of government sprang into action.

Shortly after Theresa May’s speech, it was announced that mental health would now come within the purview of the unshuffled (and presumably unruffled) Secretary of State, rather than being the responsibility of one of his Ministers. Again, this is politically significant and a welcome move. The Ministers previously responsible for mental health made genuine improvements (which the College has recognised by awarding both Norman Lamb and Paul Burstow President’s Medals), and Alistair Burt, a thoroughly decent man, was an unflamboyant but steady voice as well. It’s exciting to think about what the added attention of the Secretary of State could mean.

So there’s some good news. The bad news is that the good news has come at a particularly critical time for mental health. The Care Quality Commission has just completed the first round of its inspections of mental health trusts under their new framework, and the results make fairly grim reading. No trusts are ‘outstanding’. One third are ‘good’ and the remaining two-thirds ‘require improvement’. OK, anyone who has been on the receiving end of a visit from the Inspectorate will need no reminding of the imperfections of the system, but it would be foolish to simply ignore these results. Things aren’t right. Likewise, the number of patients sent out-of-area - sometimes hundreds of miles away – has more than quadrupled between 2011/12 and 2015/16 – proving that our decision to launch the Crisp Commission was more than justified. And the hearty welcome that met the announcement of the first access and waiting times standards for mental health has sharply given way to anger that they won’t be fully funded.

Giving political prominence to mental health is important, but prominence is meaningless without a plan. And there is a plan. And a pretty good one at that. A few days ago NHS England published its implementation plan setting out the actions it is taking to fulfil the recommendations of the influential Five Year Forward View for Mental Health report of the Mental Health Task Force. Those sad people who follow this blog may remember this featured rather prominently in a number of blogs last year, partly because it seemed to be rivalling the Chilcot Inquiry when it came to ever elastic deadlines, but it did indeed deliver earlier this year. Simon Stevens (the CEO of the NHS), Paul Farmer (the chair of the Task Force) and myself did the press launch. The Curse of Cameron was avoided, no celebrities passed away on that day, and we got very good coverage. But the publication of the Implementation Plan is actually more newsworthy, because it outlines how new funding will be made available for CCGs year on year, as well as showing how the workforce requirements will be delivered in each priority area and the way in which data, payment and other system levers will support transparency. The latter may sound like a dull cliché, losing its tarnish through over use, but is actually essential if we are to “follow the money”.

So if Carlsberg made plans, they’d look like this – costed, practical, measured in tone and measurable in nature. And I am pleased to say that the RCPsych can take some credit for both: the original report and for this plan. The College identified twelve priority areas for inclusion within the Taskforce report, of which 100% were included. Of our 13 Faculties and the Public Mental Health Network, the Mental Health Taskforce’s report included recommendations specific to 12 of them (the exceptions were intellectual disability and neuropsychiatry, which unfortunately were beyond the remit of the Taskforce). Similarly, our comments have been taken on board with the implementation plan – thanks in no small part to the heroic efforts of Holly Taggart, our invaluable Policy Research Fellow, who kept me supplied with a regular stream of messages, post it notes and killer facts to cover up my many areas of ignorance.

But we can’t and won’t rest on our laurels. The College has a key (and somewhat meta) role in implementing the Taskforce’s implementation plan, and we’re not hanging around. Throughout the summer, the Liaison Faculty is working with NHS England to model and analyse different options for allocating transformation funding. The CCQI is developing a self-assessment tool for CCGs to measure whether Early Intervention in Psychosis services are actually delivering NICE-concordant care. The Policy Unit is advising NHS England and the HSCIC on the development of a better indicator for measuring Out of Area Treatments, and its work implementing the recommendations of the Crisp Commission (did I mention that was established by the College? Well, I’m mentioning it again) will facilitate the reduction of Out of Area Treatments (“OATs”) by showing services, CCGs and psychiatrists how they can review pathways and remove the bottlenecks which lead to them. NHS England has commissioned the College to run its ‘Building Capacity in Perinatal Services’ project, and the NCMH to develop its Achieving Better Access programme of work for acute adult care. Underpinning this, the College continues to make the case to Government that access and waiting times must be fully funded.

Theresa May lamented that ’if you suffer from mental health problems, there’s not enough help to hand.’ Hopefully with a plan, political prominence and the College promoting the discussion and pulling its weight, the next Prime Minister will list mental healthcare as a national asset rather than as an injustice.

Professor Sir Simon Wessely

22/07/2016 17:12:57

What Fresh Hell is This

My title comes from the words that Dorothy Parker used whenever she answered the phone. These last weeks I have felt the same, and suspect I am not alone. True, there have been the occasional pieces of good news. Wales lifted the spirits of anyone who likes football.  A Brit won Wimbledon and another one looks likely to take the most difficult prize in sport - the Tour De France. Having said that, as I write this in a café the TV screen on the wall is showing Chris Froome running up Mont Ventoux, lacking what one would have thought was essential for a cycle race - a bike. This is further proof that we have entered a space time continuum plunging us into a new world where the impossible has become the normal.

Such is the pace of events, that when I started to write this blog Jeremy Hunt was still Secretary of State. Half way through the first paragraph the BBC announced he was sacked, then going to another department, and as I now plod on he seems to be back where he started, still in charge of the Department of Health.  I have no idea if that will still be true when you read this. Perhaps Jamie Oliver will be in charge – or Katie Hopkins. In a world where Boris Johnson can lead us out of Europe on his personal journey to become Prime Minister, then be cast in the wilderness by a treacherous colleague only to end up as Foreign Secretary, and all in the space of a few days, anything is possible.

OK, back to the serious business. The results of the EU Referendum have precipitated a series of events that few, if anyone, could have foreseen and none can know the eventual outcome. When Zhou En Lai was asked by Richard Nixon in 1972 what he thought had been the impact of the French Revolution he replied “it’s too early to say” [i]. So no one can yet have the faintest idea of how our own turmoil will end.  Those who led the campaign to leave seem to have been following Napoleon’s maxim – “on s’éngage, et puit on voit” – loosely translated as “One gets into the battle, and then who knows?”

At the moment no one knows. Many, myself included, are worried about the future.  Here is what I wrote the day after the result and again today, concentrating on the impact on science and then psychiatry research.

And what about the wider NHS? The only people who still believe in the £350 million a week that will come to the NHS as a “Brexit Bonus” still believe in Tooth Fairies and Santa Claus. To their shame even those who promised this bonanza lost no time in admitting it was a mirage. The new boss of  NHS Improvement was closer to the truth when he said this week that the “NHS is in a mess” and one that is set to become even worse as we start to see - as we are already doing - signs of the economic down turn triggered by Brexit.

But it’s not just about the money. Immigration dominated the referendum debate, and what a nasty debate it was. The author Robert Harris tweeted at one point “How foul this referendum is. The most depressing, divisive, duplicitous political event of my lifetime. May there never be another”.

But I wouldn’t be here without immigration. My father would for certain have perished in the land of his birth, Czechoslovakia. And the NHS wouldn’t be here either, whilst British medical science would be infinitely poorer as well. Brexit or no Brexit, the NHS and science both can only flourish with immigration.

So we as Royal College of Psychiatrists celebrate the fact 25% of all NHS doctors were not born in this country – a figure that rises to 35% for psychiatry. We are delighted that 10% of all NHS doctors come from non UK EU.

Thus message is being echoed across the NHS, from the very top and throughout the organisation. But it is natural for those of you who are from the non UK EU to be directly concerned about your future, and I have received messages from several to this effect.  Frankly, I doubt very much that anyone already resident here has anything to fear.  The government has already acknowledged that anyone who has been resident for five years is protected by existing legislation, that this cannot change until we have actually left, and even the most ardent “leavers” made it clear that there was never any intention to interfere with EU nationals currently living and working here.

The problem will be whether or not we are permitted to recruit more of the doctors, nurses and scientists that we will continue to need for as long as we continue to fail to produce enough within this country – in other words for a very long time.  That we don’t know, and it may be a long time before we do.

But worse, even if they are permitted to come, will they want to?  And here is the most pernicious consequence of the campaign.  As the Lancet pointed out this week the increase in nationalistic sentiments “manipulated by some leaders of the leave campaign, is already reducing the attractiveness of working in the UK”.  The Lancet continued that “it is a bitter irony that the NHS was used so deceitfully as the very embodiment of a British institution in a struggle over sovereignty and control, and yet now the future of this great tradition is so under threat” [ii].  As Francis Urquhart, the anti-hero of the British “House of Cards” might have said, “you might very well think that; I couldn’t possibly comment”.

But what all of us in the Royal College of Psychiatrists can say loud and clear is that the reports of an increase in petty and not so petty intolerance and xenophobia directed against both EU and non EU migrants shame us all. I witnessed such an episode recently and it sickened me. Two young men started verbally abusing a man on a station platform opposite me who looked “foreign” (he was in fact a Mexican) - swearing, demanding to see his passport and saying it was time he “p***ed off home”. But what I also saw was that within a short space of time a far larger number of people had intervened to protect the man, prevented the abusers from leaving until the police arrived -  which they did - and made their abhorrence for the incident extremely plain. There is hope.

I openly campaigned for Remain (not wearing my Presidential hat I hasten to add in case the charity Commission is listening).  Along with most doctors and virtually all scientists I warned of the probable consequences for health, science and medicine should we vote to leave. Now we have left, all of us who supported Remain must work just as hard to prove ourselves wrong. This is a task for everyone, whichever way we voted.

I do not think we are doomed – and was cheered up by the wonderful science blogger Jenny Rohn only a few days ago.  As she says, there is a storm coming, but we can weather it. It will take hard work on our side and good will from the rest of Europe – something that might be in short supply at the moment – but perhaps as raw emotions settle will return. But most of all, I genuinely believe that after a campaign that spoke too much to division, fear and prejudice, we will again see the better angels of all our natures reasserting themselves and showing to the world that this is still a wonderful place in which to live and work.

So let me end with a French film. Made in 1966, it is called Le Roi De Coeur, the King of Hearts. Set in 1918, it takes place in an old mental asylum in the countryside, which then becomes engulfed by the Great War. As a result all the doctors and nurses flee, leaving the patients to their own devices. Cautiously they open the doors and gates and set off the first time in years to explore the countryside and town nearby. In a series of episodes they encounter the folly, stupidity, madness and absurdity of the world of the so-called sane. One by one they make their way back to the hospital. In the final scene a hand reaches out from inside the asylum to pull the door to the outside world shut again.

So may I wish you all a pleasant and happy holiday wherever you are going, and hope that you will have at least some respite from all the anxiety that so many of us are feeling, before we have to reopen that door and return to the chaos of the real world.


i] Pedanticus writes “it’s possible that Zhou En Lai’s most famous quote was not quite as wise as it sounds.  Some think he misunderstood Nixon’s question and thought he was being asked his views on the 1968 student riots and upheaval, not the 1789 revolution “  

ii] The lancet editorial also called on the government not to impose a contract on the junior doctors at this time, “rather than taking stock to re-evaluate the repercussions on a post-Brexit NHS.  I am afraid I very much doubt the government will heed this advice, but the world is so strange at the moment that one never knows. Anyway, I will return to the junior doctors’ dispute in my next blog.

Professor Sir Simon Wessely

25/05/2016 12:40:43

In Praise of Old Nick: In which our treasured Treasurer invites you to see the treasures of our Congress

In writing these blogs I rarely stray far from the subject of money and this is no exception.  For once I am not about to bang on again about ‘where is it’ – those promised millions, nay billions, set to transform mental health services. In case you are wondering, apparently they are coming.  But not today. Or next year.  Perhaps the year after that.  Who knows? No, I am talking about your money; about what we do with the money you pay the College.

The way the College works is that we have four officers, all of them elected by you.  There’s the Dean, who does the education side.  There’s the Registrar, who does the policy and most things.  Then the President, who takes the credit for everything done by everyone else.  And finally, the Treasurer. The Treasurer’s role is probably the least visible, dealing with the money, and only getting the limelight when we run out of it.

So when it goes well, the Treasurer is an unsung hero.  So I want to do a bit of singing for once.  Our current Treasurer, Nick Craddock, steps down next month after five years in office. We will also be saying goodbye to Wendy Burn, our Dean, but more of her anon.  For the moment let’s stick with the money.

Nick has been an astonishing success.  During his five years in office both our fixed assets and general reserves have increased.  So have our membership fees; but by a grand total of £7 over five years.  And the examination fees have dropped by 21%.  That’s an economic record that George Osborne would weep for.  Of course it’s not just Nick – there are many people responsible for this, especially our finance director, Paddy and CEO, Vanessa – but it’s worth celebrating.

But there is one more statistic.  Over the last five years the prices we charge for you to attend the annual Congress have reduced by 30%.  But the opposite is true of the quality. It is going up and up.  Improving quality but reducing cost is the Holy Grail of NHS England and every CCG – and we have managed it. Normally you can do one or the other, but not both.  And as a result, we already know that this Congress will be the best attended ever. And as Nick is a key part of the Organising Committee of the Congress, he can take a bow now.

Which brings me to the subject of the Congress.  We start on a high note – with a neuroscience key note from our most recent Nobel Laureate, Sir John O’Keefe. But things don’t go downhill from there, just the opposite.  I doubt that John Sweeney will be covering much science later in the day – best to leave that to Sir John  - but he is covering the opposite; the Scientologists.  Sparks will fly – not literally we hope, but I have to warn you that when we say you will need your conference badges to gain admission, we mean it.

We will continue the recent tradition of attracting speakers from outside psychiatry – am particularly pleased that Sebastian Faulks is going to talk about psychiatry in his novels  (trust me, there’s a lot of it).  Carol Morley will be screening “The Falling”.  David Halpern will be nudging us along.  Of course we also have our own star turns, Jim Van Os, Vik Patel and Dilip Jeste as well as the very best of psychology, with Trevor Robbins, Sarah Jayne Blakemore, Essi Viding and others. From the charity sector comes Paul Farmer, CEO of Mind, the TaskForce, Mastermind and one of our latest Honorary Fellows.

Throughout the Congress the theme of recruitment and retention will be much in evidence.  Plenty of students and trainees will be around and lots of sessions focus on them – please try and attend at least one.   Indulge me when I mention one trainee social worker – a fellow called Ben Wessely -giving his first ever paper.  I cross my heart and swear that this was news to me; I choked on my porridge when I read the programme.

So many highlights.  Education and training will be prominent.  Try and listen to Wendy Burn and Nick Craddock introducing our new curriculum project and I am delighted to be able to announce today that although Wendy steps down as Dean, we won’t be seeing the back of her as she will be cochairing our Gatsby/Wellcome Neuroscience Commission, alongside Mike Travis, once of this parish but now a guru of psychiatric education in Pittsburgh.

Carson and Stone, our psychiatric Laurel and neurological Hardy will be doing their double act as usual – Science will always be on the agenda – if you haven’t yet take a look at our Making an Impact display; useful ammunition for the pub bore who tells you that “you psychiatrists are all very well, but you don’t ever change anything – you just aren’t proper scientists”.  Stuff and nonsense.  Meanwhile, modern psychopharmacology is one of the themes of the conference.

Our Congress, like psychiatry itself, never shies away from controversy – we embrace it. So we will have sessions on transgender, discrimination, parity, social justice, the politics of addiction and radicalisation.  We will be trendy (“Big Data”); topical (“Policy Lab”); practical (“How to Peer Review); complicated (lots of sessions starting with the word “complex”); tiring (“Sleep Disorders); sustainable (“Chris Ham”) and optimistic about the future (“Pathfinders”). And there will also be the incomprehensible “Tron Goes Gleek”.  Gleek?  Nope, no idea either.

Conferences should also be fun.  We will have our traditional Shakespearean Debate – this time Romeo and Juliet will be in the dock.  Comedy may be entirely absent though when I interview Jo Brand on “Comedy, showbiz and other mental disorders” in what may become a classic car crash moment.  Christopher Wren will look down on our gala dinner in the Painted Hall at Greenwich – a truly spectacular setting.

Psychiatrists always respect the past.  So many of our Past Presidents will be much in evidence. And one of our most crowded sessions,  “What I have learned in my career as a psychiatrist”, otherwise known as “Grumpy Old Men and Women”, Desert Island Discs without the music, will be back by popular demand.

And such is our generosity, we don’t want to keep this embarrassment of riches to ourselves.  Our new Director of Comms, Kim Catcheside, will be explaining the art of getting the message across and our Twitterati get their own session to help you do this.

But to end on a sober note. I hope you will all take a little time out from the fun, excitement and stimulation to spend a private and possibly, emotional, moment at the Exhibition.

I look forward to seeing as many of you as possible during the Congress.

Professor Sir Simon Wessely

18/05/2016 17:10:25

College responds to Junior Doctors' Contract Agreement

It’s not over. Not by a long way. There is much more to do. But we have definite progress. As you all know the most recent negotiations between the BMA Junior Doctors and the Department of Health have ended. We understand that a deal has been reached and that this is going to be put to a full vote of the membership. 

Just as the College didn’t advise our junior doctors whether they should or should not strike, we are not going to tell you how to vote. As before, you will make up your own minds. I can however make one or two observations that may assist.

No negotiated settlement ever gives anyone everything that they want. There is always compromise. Dr Malawana, who has clearly negotiated long and hard, has delivered more than most people can have expected.  Of course he won't be happy with everything and I suspect nor will you. I understand that , but I would remind you this is not the end.

I also know just how much effort you have all given to get this far. I know from talking to many of you that no one wanted to take industrial action, either partial or full, and those that did chose that path without enthusiasm and with a sober realisation of what that could mean for the public and our patients. That has not changed.

If this offer is accepted then most of you will, like myself, feel a sense of relief. This will be shared by the vast majority of the public and our patients and carers. The level of support for you has been extraordinary. Within the profession I have never known such solidarity, and it is clear that the public too was largely behind you. We cannot know what might happen should the action continue and I fervently hope we will never find out. But even if the offer is accepted and the industrial action comes to an end, this is not the end. 

From the start I have said this strike was never only about terms and conditions. It was about much more. At some stage, perhaps not immediately but soon, we need to look at all the issues that have brought us to this place. We need to look at the way in which your training has developed since the advent of Modernising Medical Careers which, not for nothing, was also known as Mangling Medical Careers. We need to see how this can be improved and how you can regain control of your careers and work/life balance. We need to look at how your efforts are rewarded, and I do not mean financially. All of this still needs to be done. I think that the industrial action has now paved the way for a fresh look and a new settlement in these areas. 
There is also a wider agenda.

We all know, because we work in the system, that the NHS is facing a critical financial crisis. We know that we are expecting too much for the funding that we have. We cannot deliver a service that is, as some say, the envy of the world on the resources that are deployed. We know that the NHS is the most cost effective health care system in the world, but it cannot continue in the face of rising demand and falling funding: 10.1% of GDP in 2010, 7.3% in 2014 and projected to be 6.6% in 2020.

We know also that we do not have enough staff to deliver what is now being asked. That is not an issue restricted to psychiatry, it is across the NHS. The Government’s manifesto commitment to create a “7 Day NHS” still requires a great deal of clarification about what that means, the evidence behind it, and how it is going to be to be resourced in the real world where, in my experience, you can only spend the same pound once. 

One of the things to emerge from this dispute is that these issues can no longer be ignored. The actions of our junior doctors have made that impossible. These are questions that cannot now be avoided. It is the role of the profession, united as I have never seen before, to ensure that they are not.  
 

 

 

 

 

 

 

 


 

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Professor Sir Simon Wessely

   

Professor Sir Simon Wessely

President


Sir Simon Wessely is Regius Professor of Psychiatry and Co-Director King’s Centre for Military Health Research and Academic Department of Military Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London.  He is a clinical liaison psychiatrist, with a particular interest in unexplained symptoms and syndromes. 

He has responsibility for undergraduate and postgraduate psychiatry training, and is particularly committed to sharing his enthusiasm for clinical psychiatry with medical students. He also remains research active, continuing to publish on many areas of psychiatry, psychological treatments, epidemiology and military health.

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