1. Message from the President: Professor Sheila
Hollins
I am delighted to announce that Prof Dinesh Bhugra is our
President-elect and will be inaugurated as President on 2nd July
2008 at the College AGM to be held at Imperial College in London.
Until then Dinesh will work closely with me on matters of national
and international importance in psychiatry, as well as listening to
the concerns of individual members. We will now start the election
process for a new Dean - a role Dinesh has held so ably for nearly
five years.
A matter of considerable importance was the publication last
week of Sir John Tooke's interim report on postgraduate education.
Sir John called his report 'Aspiring to Excellence' (http://www.mmcinquiry.org.uk/draft.htm).
He makes many recommendations which the College welcome. I will
highlight a couple. He suggests that the first foundation year
should revert to a pre-registration house year linked to the
completion of a medical degree. The next three years would form
core training in clusters of disciplines during which trainees will
have longer to choose their preferred specialty and longer to
demonstrate their competencies. If this is adopted run through
training will not survive. He also called for more flexibility and
easier transition between training grades and Trust grades.
At the AGM three years ago, a resolution about psychiatry in
China led to a commitment to find a way for the College to offer
some training in China. Last month, three College officers and our
International manager attended the first WPA conference held in
Shanghai. There was a College symposium on mental health
legislation around the world with contributions from England, Egypt
and Shanghai. We also had talks with the British Council, met
psychiatrists working in mainland China and visited the Shanghai
Mental Health Centre. Our report will be considered at the next
meeting of the Board of International affairs.
2. NICE guidance on the
treatment of Alzheimer’s: Judicial Review
In September NICE published an amended
version of its technology appraisal of drugs to treat Alzheimer's
disease to fully comply with the judge's ruling on the judicial
review. The guidance issued in November 2006 still stands and drugs
continue to be recommended only for people with moderate
Alzheimer's disease. In line with the judge's ruling NICE has
clarified how the guidance should be applied to certain groups
including people with learning difficulties and whose first
language is not English. The amended guidance is available at
http://www.nice.org.uk/guidance/TA111.
3. Johnson makes Commons Statement on Health and Social
Care – “More funds for talking therapies.”
Health Secretary Alan Johnson used a statement on Health and
Social Care to outline plans to spend millions more on "talking
treatments" for depression and anxiety in England. He said that by
2010, £170m a year would be spent - allowing 900,000 more people to
be treated using psychological therapies.
The new plan aims to reduce the current average 18 month wait
for treatment to just a fortnight, in line with improvements in
outpatient waiting times in other parts of the NHS.
The Department of Health said that all GP surgeries would have
access to the treatments as the programme "rolled out" across the
country. It is planned to recruit an extra 3,600 therapists.
The whole speech itself was an explanation of the measures
proposed in the PBR and CSR. As would be expected it focused on the
Darzi review’s four over-arching themes: fairness, personalisation,
innovation and safety. The announcements on “talking treatments”
came under the theme of ‘personalisation’.
To read more, click here: http://news.bbc.co.uk/1/hi/health/7037400.stm
Click here for our response:
http://www.rcpsych.ac.uk/pressparliament/pressreleases2006/pr955.aspx
4. Attending the Party
conferences
The College attended the Liberal
Democrat, Labour, and Conservative conferences this year in
Brighton, Bournemouth, and Blackpool respectively. The Royal
College of Psychiatrists' activity at the party conferences was led
by Dr Ian Hall, the Chair of the Westminster Parliamentary Liaison
Committee (WPLC), and organised by Neil Balmer, the College's
Public Affairs Officer (nbalmer@rcpsych.ac.uk).
The party conferences give the College
the opportunity to meet with key Parliamentarians and other mental
health organisations, attend and speak in debates on topical policy
issues, and, more generally, gain an insight into the direction in
which the political parties are developing their policy.
Through the College's policy process,
we decided on the key issues which we wanted to lobby on at the
conferences and produced a conference newsletter to take to the
conferences. The issues we focussed on primarily in one-to-one
meetings, fringe meeting debates, and round table discussions were
mental health and employment, mental health in the criminal justice
system, and military mental health. We also discussed legislative
work, including further work on the Mental Health Act Code of
Practice, and the proposed Health and Social Care Bill.
A full conference report and analysis
will be available on the website at a later date. We are already
making plans for next year's activity and would welcome any
feedback or suggestions from Members.
5. College Policy Documents:
root and branch review: Dr Ola Junaid, Associate-Registrar
(Policy)
I was appointed Associate Registrar
for policy earlier this year. My first task was to undertake a
review of College reports.
My terms of reference are: ‘A root and
branch review of all Council reports to inform CEC how these
reports arose, what has triggered them, what purpose they have and
continue to serve, and how they are used by members of the College,
general mental health service professionals, and policy makers.
‘Re-examine all College Reports,
ascertain what had instigated the drafting of the reports,
determine how widely reports were open to consultation, and to
differentiate between College documents and Faculty documents.’
I identified 115 College reports, of
which 79 are currently available on line. Most fit into one of the
following four categories:
- clinical guidance
- advice on service provision
- formal College response to white papers and other reports
- advice to members, usually relating to training or professional
matters
My recommendations for the College
include:
- appoint lead authors rather than
chairs of working groups. The lead author should assemble a team
fit for purpose, with appropriate representation and use technology
to ensure wider participation. The lead author should also be more
accountable for the budget for the report
- write guidance on when the College should produce a report
- improve the process of reviewing reports
- abolish paper copies
- introduce a new system for naming and numbering reports
- have defined objectives for specific items of work with
explicit timeframes
My report is now out for
consultation and I would value any comments or feedback. Please
send to me at dhart@rcpsych.ac.uk.
6. Involving patients and
carers in the work of the College
Do you know of any patients and carers
who would be interested in joining the new College patient and
carer forums?
Earlier this year, the College
reviewed the patient (and carer) input into the work of the
College, not only centrally, but also at Faculty, Section and
Divisional level. The main recommendation which emerged from this
review, and which was agreed by the Central Executive Committee
after much discussion, was to replace the Patients and Carers
Committee with a user forum and a carer forum. Each forum will meet
individually and will then join up at the end of the day to discuss
their findings. We hope that this will contribute to developing
policy and support practice.
If you feel that you have a user or
carer who would be interested in getting involved and would be
interested in contributing to the work of the College, please
contact Deborah Hart. There will not be formal interviews, but we
will ask people to send a brief CV explaining why they would be
interested in joining either the patient or carer forum and what
they feel they can contribute. Email: dhart@rcpsych.ac.uk or tel:
020 7235 2351 ext.127.
7. Review of CR125 ‘Good
Psychiatric Practice: Dr. Elizabeth Fellow-Smith, Chair of the SCPG
and Dr. Laurence Mynors-Wallis, Associate Dean – Lead for
Revalidation
The Special Committee on Professional
Governance and Ethics is embarking on a review of CR125 ‘Good
Psychiatric Practice’. This new (3rd) edition will
update standards in line with current practice and provide the
basis to meet potential requirements for revalidation. The key
objectives for the revision are firstly to review the standards,
secondly to make the standards objective and measurable as far as
possible and thirdly to provide guidance as to what evidence can be
gathered to demonstrate that the practice meets the standards
set.
We are writing at this early stage to invite
your ideas and comments on changes required to the standards and
how to measure or evidence practice.It would be most helpful if you
can return any comments you have to Charlotte Cox at the College
(ccox@rcpsych.ac.uk) by
27th November 2007. The current version of ‘Good
Psychiatric Practice’ can be located on the College
website.
8. Sexual Boundary Issues in
Psychiatric Settings (Council Report 145, on College website since
22nd August 2007): Professor Sue Bailey, Registrar
CR145 highlights an important, but difficult issue.
I am asking for feedback as to how far the recommendations in this
report are playing out in your services. I hope to focus on this
topic at the 2008 Annual Meeting and am interested over the next
few months in taking up any of the themes you think should be
included in the Registrar's slot at the conference.
The recommendations are as follows:
- sufficient numbers of qualified staff must be on duty at all
times
- staff must be regularly supervised
- ward design should allow sufficient space for patients to be
cared for in safety and privacy
- Trusts should have evidence bases and protocols for
treatments
- clinical staff and managers must develop an understanding of
the causes, and recognition, of sexual abuse
- each psychiatric unit should have a policy and procedures to
cover the appropriate expression of sexuality among in-patients.
The policy will address human rights, legality, capacity and
consent, contraception and cultural variance
- each unit should have a policy regarding sexual harassment,
sexual abuse and rape
- there should be regular audits of incidents, complaints and
allegations, patient attitudes to policies, and staff attitudes and
adherence to policies
- senior management must support training in the prevention,
recognition and management of abusive and potentially abusive
situations
- patient information should be readily available
9. Earlier Detection of Chronic Kidney Disease –
estimated GFR and lithium.
Professor Richard Morriss, Professor of Psychiatry and Community
Mental Health, University of Nottingham and Honorary Consultant
Psychiatrist, Nottinghamshire Healthcare NHS Trust.
In 2005, the Royal College of Physicians published guidelines on
the assessment and management of chronic kidney disease (CKD) in
the community1. CKD is graded in 5 stages (5 is endstage CKD).
Grade 3 CKD is associated with a 40% increase in cardiovascular
mortality in the community when all other cardiovascular risk
factors are controlled for 2.
These guidelines promoted the reporting of eGFR (estimated
glomerular filtration rate) on routine blood urea and electrolytes
because eGFR is a more sensitive indicator of grade 3 CKD than
elevated or rising urea and creatinine levels. The detection of
grade 3 CKD is important to psychiatrists in particular because we
prescribe and monitor a potentially nephrotoxic drug, lithium. We
are also increasingly concerned about reducing the risk of
cardiovascular mortality in serious mental illness in general.
Untreated grade 3 CKD may progress to endstage renal failure but
may be reversible by reducing exposure to lithium, and managing
hypertension and diabetes mellitus or other risk factors.
An eGFR of 30-59 indicates grade 3 CKD. On routine urea and
electrolyte tests, this estimate may be inaccurate in people over
70 years of age, who are black or are otherwise physically unwell.
If there are two abnormal eGFRs in 3 months, refer for a specialist
opinion if any of the following apply: the patient is less than 55
years old; a rising creatinine on serial tests (even if it is not
elevated); persistent proteinuria; any haematuria; signs of
anaemia, diabetes, hypertension or known structural urogenital
problems.
1. The Royal College of Physicians and Renal Association. The UK
Chronic
Kidney Disease Guidelines (2005). http://www.renal.org/CKDguide/ckd.html.
2. Di Angelantonio E, Danesh J, Eriksdottis G, Gudnason V. Renal
function and risk of coronary heart disease in general populations:
new prospective study and systematic review. PLos Med 2007 (Sept
9); 4 (9): e270.
10. Images of Psychiatry - £75,000 awarded to Divisional
projects
As part of the Images of Psychiatry campaign, bids for funding
of projects which support the campaign's objectives were invited
from all College Divisions. We received 33 bids with the funding
requested totalling almost £260,000. From a central fund of
£75,000, allocations were offered to 16 bids with at least one per
Division.
The College President, Professor Sheila Hollins, said “The
steering group's hopes that the campaign would be adopted locally
are being realised and I am looking forward to hearing about
progress in the diverse projects being presented at the annual
meeting in London next year.”
For a full list of successful bids, click
here.
11. Events
(i) Quality Improvement Network for Multi-Agency CAMHS
(QINMAC)
QINMAC aims to facilitate quality improvement and development in
'Tier 2 and 3' CAMHS, through a supportive peer review network.
This professionally-led network has completed its second annual
audit cycle and will be holding its Annual Forum on 8th November
2007. The forum is a key information-sharing event for existing and
potential QINMAC members, other CAMH professionals and
commissioners. For more details, please click here or e-mail
mcraig@cru.rcpsych.ac.uk
Now approaching its 3rd annual cycle, QINMAC is currently
accepting applications for membership. For further information
about the benefits of membership and how to join, please visit the
project's webpage: www.rcpsych.ac.uk/cru/qinmac.htm
QINMAC is part of the College Centre for Quality Improvement
(CCQI).
(ii) College
events
(iii) External
events