1. Letter from Professor Sheila Hollins,
President
Dear members
This month there are two important issues which have been of
enormous concern and I would like to comment on both.
The first is MTAS and I am sure there is not a single member of
the College who has not been involved in some way in this
fiasco. We are continuing to collect data about members who
have been unsuccessful in obtaining posts at ST4 level where there
has been a particular shortage. This is partly because a
number of doctors previously in SAS posts have been successful at
this level.
The overall fill rate has been higher than expected, but there will
be a round 2 at most levels in most Deaneries throughout the
UK. Later this week, with the Dean and Associate Dean, I am
meeting the senior responsible DoH official to explore the latest
situation with respect to recruitment into psychiatry, and to
explore any possible adjustments to the numbers at each
level. The DoH in each country will be offering transition
arrangements to try to ensure that every doctor who was in training
has continuing employment.
The College Officers remain very concerned about individual
doctors caught up in this situation for whom additional worry may
have caused intolerable, but understandable stress. We would
like to encourage you to continue to provide support, mentoring,
and friendship to anyone who is still unsure where they will be
working from August, who is still trying to get a training post, or
who is facing a move to somewhere distant from family and
friends.
I am sure you will be equally welcoming to new doctors who are
due to arrive in your Trust on 1st August. These are
stressful times but with your help we can ensure that a whole
generation of trainees does not feel disenfranchised. We in
the College will continue to do our utmost behind the scenes in
addressing the cause of the problems.
The second issue is the completion of
the passage of the Mental Health Bill (England and Wales) through
Parliament. Dr Tony Zigmond has given an immense amount of
time, energy and expertise to his role as Honorary Vice-President
responsible for mental health legislation. Tony has summarised the
changes which have been agreed in Parliament and you can read about
these on the parliamentary pages of the College website. (To view, click here).
We issued a press release on Monday to
coincide with the final debate in the House of Lords. Our
main point was that we are disappointed that the government has
failed to recognise that most people who suffer from a mental
illness are capable of making decisions for themselves, and present
no threat to anyone. Yet, under the Mental Health Bill, they could
still have their choice of treatment overruled. However, we
welcomed a number of significant amendments which are beneficial to
the care and treatment of mental health patients including:
- no patients will be able to be detained in
hospital for a purpose other than to improve, or prevent, a
deterioration in their health;
- all detained patients will have access to an
advocate;
- children will be treated in services which
are appropriate to their age.
It is of course essential that sufficient
resources are now provided for mental health services to ensure
that the legislative changes can be made to work properly. We are
determined to play a key role in the development of the Code of
Practice.
I am sure you will join me in thanking Tony
Zigmond for his hard work on behalf of our patients and
ourselves.
2. Results available
from first online survey of College members
The first online survey of College members
focused on the assessment of risk to others. The rationale
for the survey was to inform a multi-disciplinary review of risk
assessment and management practice chaired by Baroness Kennedy
(this group will report in September).
The survey ran over 19 days and was completed
by 1937 members including 91% from the UK and the Republic of
Ireland. One of the central messages was that although
psychiatrists continue to play an important role in managing the
risk that a small number of people with mental health problems pose
to others, the bureaucracy related to risk assessment may be making
mental healthcare less safe.
91% of the psychiatrists reported working in
mental health services which require them to routinely complete a
form recording the risk that patients pose to other people.
However, 56% of psychiatrists reported that they were expected to
complete forms for all their patients, regardless of whether these
patients were part of a high risk group or not. 84% reported
that such forms had been developed within local services for
internal purposes.
Critically, few of these locally developed
forms would have been tested for their ability to identify patients
who pose high levels of risk.
Although psychiatrists perceived risk
assessment as an important clinical skill - with 83% believing that
a well-designed risk assessment form could aid the application of
clinical skills - respondents reported that the forms and
procedures accompanying risk assessment need to be reviewed.
86% of the psychiatrists think that existing risk assessment forms
could instill a false sense of security that risk has been
assessed, with such forms often using a 'tick box' approach to
assessment. 58% of psychiatrists also reported that their
organisation had introduced such forms as a 'defensive measure' in
response to a wider cultural context in which mental health
services are blamed for adverse events involving mentally ill
people.
Meanwhile, 82% of respondents believe that the
requirement to use risk assessment forms indicates that concern for
public safety has taken political precedence over the welfare of
those suffering from mental disorders. This is a problem
because the best way to reduce risk is to provide the highest
possible standard of care.
The full results of the survey can be viewed
here
3. College Officers: Retirements and appointments:
with effect 21st June 2007
* retiring
! new appointment
Replacements:
*Sab Bhaumik (Chair, Trent Division)
(NB Dr Bhaumik remains Chair of Learning
Disabilities Faculty)
(New Chair not yet known)
*Jed Boardman (Chair, G&C
Faculty)
!New chair: Michelle Hampson
*Steve Choong (Management Special Interest
Group)
!New Chair RS Deo
* Joe Bouch (Director of CPD)
!New Director: JS Bamrah
*Kate Ganter (Chair, Irish
Division)
!New chair: Consilia Walsh
*Hamid Ghodse (Director of International
Affairs)
!New Director: Rachel Jenkins
*Mike McClure (Director of
Public Education)
!New Director: Peter Byrne, Associate
Registrar for Public Education
*Mike Nowers (Chair, South
West Division)
!New Chair: Adrian James
*David Roy (SC Professional Governance &
Ethics)
!New chair: Elizabeth Fellow-Smith
*Richard Williams (Director of
Conferences)
!New Director: Helen Miller
New appointments:
!additional Associate Dean: Laurence
Mynors-Wallis
!additional Registrar: Peter Byrne (special
responsibilities: Public Education, patients and carers)
!new post: Honorary College Archivist: Fiona
Subotsky
!Chair, Eating Disorders Section (formerly
SIG): Dr Ulrike Schmidt
4. The Launch of The Lancet Series on Global Mental
Health
On the 3rd September 2007, King's College London and the London
School of Hygiene and Tropical Medicine will be hosting an
international event organised by the International Mental Health
Centre. This event is The Launch of The Lancet Series on
Global Mental Health, which is a series of papers about
global mental health.
http://www.iop.kcl.ac.uk/international/
5. MTAS: Open
Forum for Trainees: 17th July 2007
Tuesday 17th July - 4pm at No 15 Belgrave
Square for a Question & Answer session with the Dean of the
college regarding any MTAS issues, followed by drinks and canapés
at the College (information
also on the College website).
6. College response to the Options for the Future
of Payment by Results
The promotion of high standards of
mental healthcare requires an adequate level of funding, used
effectively to deliver a high quality of service. Given the
inevitable financial constraints there is a need to determine how
NHS funding should be equitably distributed between areas and
across specialities. The Royal College of Psychiatrists is
mindful of the importance of this issue and agrees with the
Department of Health that there are difficulties that arise in
applying approaches for funding of acute care to mental health
services (as noted in Appendix B). The College has
established a working group so as to be able to support the
Department of Health in achieving these goals. This document
can be seen as a first contribution to that process – providing a
general reaction as well as detailed comment that may be carried
forward into subsequent stages.
We note with concern the lack of
progress that has been made in addressing the problems of applying
PBR to Mental Health Services, given that this is the only funding
mechanism being considered. It cannot be true that PbR is a
force for the good generally but that it is of no consequence that
such a major sector of the NHS is excluded for the foreseeable
future. The College believes that the benefits of an improved
funding mechanism will be different for mental health compared to
the acute sector, but no less significant.
Two recent mental health pilot
projects have begun to develop an appropriate mechanism, and have
again confirmed the need for an extensive, long term development
and implementation programme. The number of issues which must
be addressed, only some of which have been mentioned in this
document, is easily underestimated and suggests the need for a long
term, incremental approach.
Although the aim of PBR may not be to
achieve fair distribution between health sectors, we believe that
there is a secondary negative effect of partial adoption which must
be addressed.
Professor Louis Appleby, commenting on
Mental Health Reform on 11th May, noted that Mental
Health Services receive 14% of the NHS budget but account for one
third of all illness and 40% of all disability. There is a widely
held view that mental health services have been disadvantaged by
their inability to compete at local level with acute services,
whose case for funding increases is strongly made by activity data
that can be set against a tariff. The College is keen that
not only should there be a clear proposal for future funding but
that there should be a system in place in the meantime to ensure
that services not currently covered by Payment by Results are not
financially disadvantaged until that or an equivalent funding
mechanism is in place.
The College believes that the principles by
which a national mechanism for the distribution of funds should be
judged are that:
- It should provide the means to maintain the
overall funding of mental health services at a fair level in
relation to other care sectors.
- It should provide the means to maintain or
enhance the quality of services as a whole. This requires
integration with other information-based commissioning and
governance approaches.
- It should enhance the ability of mental
health services to provide equity of access for service users,
across geographical boundaries, between socio-economic and
sub-cultural groups, and between people with different types of
mental health problems.
The proposals in the Consultation document
have been assessed in terms of these principles. We have attached
our detailed response to both the general and specific issues
raised in the Consultation document. Because the document
addresses principally the issues facing acute services,
unfortunately our responses are often to the effect that the
proposals will not be feasible in our sector within the foreseeable
future. That should not be confused with a lack of
willingness to tackle the issues.
We therefore warmly welcome the opportunity to meet with staff
of the Department of Health not only to discuss future mental
health funding further but to determine how appropriate levels of
funding will be allocated in the meantime.