In this month's issue...
College news
1. Have you
booked to attend the Annual Meeting 2009 in Liverpool, Tuesday
2 _ Friday 5 June?
2. Update
from Professor Dinesh Bhugra, President
3. New Ways of
Working: Dr Sally Pidd, Associate Dean - Workforce
4. Community Treatment Orders (CTOs):
Dr Tony Zigmond, College Lead on Mental Health Legislation
5. New Horizons and
mental health policy - What the College is doing: Katie Gray,
Policy Analyst
6. Consultation on extension of
direct payments for those who lack capacity: Dr Rowena Daw, Head of
Policy Unit
7. Update from the Scottish
Division Scottish Party Conferences: Karen Addie, Scottish Division
Policy Manager
8. Update from the Northern
Ireland Division: Liz Main, Public Affairs Consultant
9. Volunteer Sub-Committee: Invitation
to trainees to learn about volunteer programmes in Ghana, Iraq
and Malawi
10. Forthcoming literary events
at the College
Consultations
11. Tier 4 Personality Disorder
Consultation, West Kent PCT
12. GMC consultation on End of
Life Care
In the news
13. Tough powers for new health
and adult social care watchdog
14. Law comes into force to strengthen
protection of vulnerable people
15. Website to help professionals
working with carers
16. Patients to help put quality
at the heart of NHS and social care
17. PMETB trainees' survey closes with
record 42,000 returns
18. NHS better care better value:
quarter 2 indicators
19. British Indian Psychiatric
Association (BIPA) Trainee Award
20. What’s new online?
College News
1. Have you booked to attend the Annual Meeting 2009
in Liverpool, Tuesday 2 - Friday 5 June?
Book now
online.
2. Update from Professor
Dinesh Bhugra, President
Members continue to raise concerns about New Ways of
Working (NWW). It is helpful, therefore, that
Dr Sally Pidd, Associate Dean - Workforce, has put
its development into context in her account below. For the
profession there remain a number of issues of concern in terms
of workforce development and relationships with
employers. This is particularly important now in view
of the credit crunch, and its likely impact on funding and
services in the future.
The College is looking at two possible ways forward.
First, the College is assessing the impact of the
economic slow-down on people and services, and to this end will
produce a report with advice to commissioners and providers in
the early autumn. Second, we have set up a multi-disciplinary group
to look at the way other disciplines should be working
with psychiatrists.
There is no doubt that NWW did good things for recruitment,
morale and the way we look at services. It affected not only our
self-image, but also our relationships with other disciplines. I
believe the time is right to move forward, but to remain vigilant
to ensure that service cuts don’t happen under the guise of NWW.
Any changes should be discussed and raised with the providers of
services, including consultants and their teams.
I would like to take this opportunity to thank Sally for all the
work she has done with great charm and style over the years.
3. New Ways of Working: Dr Sally
Pidd, Associate Dean - Workforce
The work stream that came to
be known as New Ways of Working (NWW) was initiated at the request
of Mike Shooter, then President of the College. This was in
response to longstanding concerns about Consultant recruitment and
retention, linked partly to issues of burnout and excessive
caseloads, particularly among General Adult Psychiatrists. The
NIMHE National Workforce
Programme took this on and a huge amount of work has been done
in terms of the piloting of new roles for Consultants, as well as
the introduction of a variety of new roles for other mental health
professionals over the last six years. The National Steering
Group on NWW, co-chaired by the last two College Presidents,
in turn oversaw this.
Concerns have been raised
about the implementation of NWW in some Trusts and for the past two
years the College has had a Steering Group on NWW. One of its
aims has been to identify and resolve any conflicts or problems
that may arise in the course of the implementation of NWW, and to
help the College and its partners facilitate smooth transitions in
whole systems change. It has also sought to act as a
consultation group where information about successes, as well as
difficulties in implementation, are considered with a view to
promoting good practice.
To address specific concerns
to do with implementation, we have explored in detail the idea of
carrying out a survey of the membership on NWW. However, to do
so in a valid way has proved challenging. A more ambitious
plan involving not only our members, but Trusts, other professions,
and users and carers replaced the idea of a College only survey.
However, we could not find funding and methodological problems
remained unsolved.
At the end of last
year, the NHS Confederation Mental Health Network indicated
they no longer wished to proceed with the survey, as in their view
the NWW Programme after six years was no longer new and things
had moved on. Indeed, that was the theme of the final
Conference held under the auspices of the NIMHE National Workforce
Programme before it was wound up at the end of March.
Entitled Moving on from
New Ways of Working to a Creative Capable Workforce, the
Conference was an opportunity to present much of the work carried
out across disciplines and specialties, again all available on the
website as above. At the Conference, the NHS Confederation
launched its own briefing on NWW, which is well worth reading to
understand the employers’ perspective on supporting and developing
a more effective workforce.
The only professional group
left wishing to carry out a survey on NWW is the College, and for
those of us who have been working on this, it remains unclear what
the focus of this should be and what it would achieve. There is no
identified funding for such a survey, and as yet no agreed workable
methodology.
The College’s Steering Group
on NWW ended at the same time as the National Programme. The
President is considering how to move forward to address the
concerns of members and at the same time to explore how the
College, perhaps through the CRTU, can better support Consultants
in new and challenging roles, to ensure they are equipped to
provide the medical leadership needed by the teams in which they
work.
Finally the work of the NSG
on NWW will continue in a new employer led multiprofessional forum
with a focus on all workforce issues and the College will play its
full part in this.
4. Community Treatment Orders
(CTOs): Dr Tony Zigmond, College Lead on Mental Health
Law
Colleagues in England and Wales may recall
some of the arguments over the years about CTOs. Should they be
available as an alternative to admission to hospital (as in
Scotland) or only on discharge from detention? Would they (should
they) be used primarily for so-called ‘revolving door’ patients?
Was there a danger professionals would feel obliged to put patients
on CTOs as a feature of defensive practice? Most importantly, would
they be of value to patients, their families and society?
It’s early days, so it’s not surprising we
have far more questions than answers. The CTO provisions of the
2007 Mental Health Act are certainly being used. The MHA Commission
has recently published figures indicating that there have been
1,200 requests for CTO Second Opinions in under six months.
This number appears high in comparison with the government’s
predicted 450 in the first year. A possible explanation is that
there was a ‘backlog’ with colleagues waiting for the availability
of the provision. On the other hand, the figure may be in line with
what should have been expected. It was suggested that eventually
approximately 10% of Section 3 detained patients would be placed on
a CTO. Given that there are around 22,000 such detentions each
year, 1,200 CTOs for six months is about right.
We have, as yet, no knowledge about outcomes.
We also have little or no information as to whether or not the
availability of CTOs has had an impact on the number or duration of
detentions (we know the number of SOAD requests for inpatients has
fallen slightly) or guardianship orders. We don’t know how long the
average CTO will last. This is particularly important in
determining how many patients will eventually be subject to
compulsion - it seems likely that they will exceed the average
length of a Section 3 (three to four months). Nor do we have a
picture of the number of, or reasons for, recalls or
revocations.
The College, working with the new Care Quality
Commission (which has absorbed the MHA Commission) in the best
interests of patients, wishes to be in a better position to guide
and inform all those involved in the implementation and monitoring
of CTOs. Colleagues’ day-to-day experiences would be of enormous
value. We ask, therefore, for members to help by providing further
information. Why are you recommending CTOs? Are the processes
working? How frequently are you having to recall patients and why?
Does recall work or is revocation commonly necessary? Do you have
information on the impact, if any, on readmission or re-detention
rates? Please email your thoughts and experiences to cto@rcpsych.ac.uk
5. New Horizons and
mental health policy - What the College is doing: Katie Gray,
Policy Analyst
New Horizons aims to “work
inclusively to achieve the active promotion of whole-population
mental health and well-being, and for those experiencing mental
health problems to recover a good quality of life, ensuring they
have equal access to high quality, personalised services”.
Professor Louis Appleby (National Director for
Mental Health) and the DH have established a New Horizons
Board to oversee the consultation process and steer the delivery of
this post-NSF mental health policy. The Government’s process of
consultation includes:
- A New Horizons consultation
paper
- A series of ‘listening
events’ in each of the Strategic Health Authorities
- A series of ‘regional and local stakeholder
engagement’ events which will explore ways in which stakeholders
can contribute to the development of New Horizons
The College is keen to contribute to the
development of the New Horizons work and is
coordinating four high level policy seminars which aim to
identify key priorities for mental health and wellbeing. The
seminars, organised in partnership with the DH, Royal College of
GPs, Royal College of Physicians, NHS Confederation, Faculty of
Public Health, National Mental Health Development
Unit, Association of Directors of Adult Social Services and
Foresight Programme Team, are being held between April
and June 2009. They will cover:
- Young People and Families
- Social Inclusion and the Adult Years: Social
and Emotional Capital
- Healthy Ageing
- Priority Setting and the New Horizons Mental
Health National Service Framework
The College has linked its New
Horizons work with the work of Sir Michael Marmot, who was
recently asked by the Government to chair an independent review to
propose the most effective strategies
for reducing health inequalities in England from 2010.
The College is also involved in the
Future Visions
Coalition which is led by the Mental Health Network as part of
the NHS Confederation. The Coalition includes mental health
organizations such as Mind, Rethink, the Sainsbury Centre for
Mental Health, Together and others. It was established in early
2008 with the intention of stimulating debate about future mental
health policy and practice. Following public consultation, a
final report will published this summer.
6. Consultation on extension of
direct payments for those who lack capacity: Dr Rowena Daw, Head of
Policy Unit
The
government response to the consultation on the extension of
direct payments to those who lack capacity is now available. The
College was cited for its view that detained patients should no
longer be denied direct payments for matters that are not covered
by the MHA.
7. Update from the Scottish
Division Scottish Party Conferences: Karen Addie, Scottish
Division Policy Manager
In February and March, the Scottish
Division organised fringe meetings at the Labour and the Liberal
Democrats Scottish Party Conferences.
At the Labour conference, we had presentations
on the importance of early years on the later development of
children and what can happen to their mental health if they don’t
have good attachment to their parents and positive early
experiences. We had contributions from a GP who is doing
research in this area and a child CAMHS psychiatrist. For the first
time we invited participation in the fringe event from Barnardos
Scotland.
At the Liberal Democrats conference, we had a
fringe meeting on self harm in children and adolescents, including
alcohol and drug misuse and children whose parents self-harm. We
had two speakers from the Division, one from Addictions and
one from CAMHS. The third speaker was from Aberlour Trust, a
children’s charity that offers support for vulnerable children and
young people.
Both these meetings were successful with good
audiences generating lots of questions and debate. Having a single
theme (CAMHS for 2009) for all our Party Conference activity is an
idea we may repeat in 2010.
The Scottish Parliament Health and Sport
Committee is also looking at certain aspects of CAMHS as part of an
enquiry and the College gave oral evidence to the Committee in
April.
The Scottish Government has plans to tackle
Scotland’s relationship with alcohol. The Division continues to
work with Scottish Health Action on Alcohol (an intercollegiate
body of which the College is a member) to raise awareness of this
issue. The Scottish Government wishes to introduce a minimum price
per unit of alcohol, a move that producers and retailers are
strongly resisting.
8. Update from the Northern Ireland Division: Liz
Main, Public Affairs Consultant
(a) Multidisciplinary Conference
Dr Roger Banks, the College
lead on primary care, visited Belfast to chair ‘Mental Health
and Primary Care' - this year’s Northern Ireland Multidisciplinary
Mental Health Conference. This annual meeting was organised by the
Northern Ireland Division, in conjunction with professional bodies
representing nurses, psychologists, occupational therapists and
social workers, supported by the Province’s DH.
Professor Louis Appleby’s keynote speech was a major draw
for the 170 delegates. He outlined developments in England,
while Dr Maura Briscoe from the DH outlined the Department’s plans
for mental health reform, including new mental health and capacity
legislation. Dr Clare Gerada, from the RCGP, brought her
perspective as the daughter of a GP who trained as a psychiatrist,
married a psychiatrist and then became a GP.
(b) Mental Health Legislation
The Province's DH is
considering responses on a consultation on plans to reform mental
health legislation and introduce capacity legislation. The Division
has presented a robust argument for a single piece of legislation
that would not only provide a seamless interface between mental
health and capacity legislation, but also reduce the stigma that
people who are detained under the existing Mental Health Order
experience.
The College is an active
member of the Mental Health and Learning Disability Alliance that
is lobbying for single legislation. The Alliance’s membership
includes service users and carers, voluntary sector organisations,
legal organisations, and organisations representing mental health
professionals.
(c) Northern Ireland Division Annual
Meeting
The Northern
Ireland Division Annual Meeting will be held at Clifton House,
Belfast on 20th May. Dr Tony Zigmond will be speaking on
mental health legislation reform, with other speakers looking at
forensic services and the NICE guidelines on
schizophrenia.
9. Volunteer Sub-Committee: Invitation
to trainees to learn about the volunteer programmes in Ghana, Iraq
and Malawi
The Volunteer sub-committee would like
to invite any interested trainees to attend a volunteers forum at
the College from 4.30-6.30pm on Wednesday 13th May 2009.
The provisional programme will deal with Ghana, Iraq
and Malawi, and will cover volunteer experiences from
members of the College. If you would like to attend, please email
yvettet@rcpsych.ac.uk,
or to discuss contact Dr Peter Hughes,
organiser and member of the VSC.
10. Forthcoming literary events
at the College
‘Is everyone mad?’ The
presentation of mental disturbance in the novels of
Dostoyevsky: Lecture by Dr Allan Beveridge
6.30pm on Wednesday 6 May 2009
This talk examines how madness is depicted in
the work of Dostoyevsky. It will give a brief account of
Dostoyevsky's life before looking at the many ways that he
portrayed insanity. It suggests that he provided a
sophisticated and complex picture of mental illness which has
relevance for how contemporary clinicians conceive
psychiatric illness.
Mad, Bad and Sad: A history of
women and the mind-doctors from 1800 to the present:
A talk by Ms Lisa Appignanesi
6.30 pm on Tuesday 16 June 2009
Lisa Appignanesi's book Mad, Bad and Sad:
A history of women and the mind-doctors from 1800 to the
present has been hailed as 'endlessly fascinating'
and 'a remarkable achievement'. Ms Appignanesi will talk about
the book and a few of its intriguing case histories.
“This history of the rise of the
mind-doctoring professions tells the story of how we have
understood mental disorder and extreme states of mind over two
centuries and how we conceive of them today when more and more of
our inner life has become a matter for medics and
therapists.” Lisa Appignanesi.
‘Mindreadings: Literature and
Psychiatry’: Lecture by Professor Femi Oyebode
6.30 pm on Tuesday 14 July
Professor Oyebode will discuss the themes
covered in his book “Mindreadings: Literature and
Psychiatry”.
These lectures are free. To reserve a place
email nboyce@rcpsych.ac.uk and give the
title of the lecture in the subject bar. Places are limited and
tickets will be issued on a first-come-first-served basis.
Consultations
11. Tier 4 Personality Disorder
Consultation, West Kent PCT
West Kent PCT has launched a consultation
on how to improve services for severe personality disorder
services across the South East Coast, East of England, South
Central and London regions, which together cover a population of
about 20 million. The aim is to make services as accessible and
high quality as possible for people with complex and severe
personality disorder.
12. GMC consultation on End of Life
Care
The GMC is asking doctors and patients for
their views on how to make difficult decisions on end of life care.
The draft guidance End of life treatment and care: good
practice in decision making seeks to help doctors provide good
care by responding to individual’s clinical, emotional and
psychological needs. This includes making decisions about when
treatments may become too burdensome in relation to the benefits
they bring.
The draft guidance is clear that “decisions
concerning life-prolonging treatment must not be motivated by a
desire to bring about the patients’ death, and must start from a
presumption in favour of prolonging life.” The draft guidance is
not about assisted suicide or euthanasia but about ensuring that
all doctors know how to treat patients at the end of life and
within UK law. It aims to ensure that all doctors are aware of the
ethical and legal principles that should underpin practice in end
of life care and to let patients know what they can expect from
their doctor.
A short version of the
consultation is available online and has been designed to
assist the public and patients give their views on the draft
guidance.
In the news
13. Tough powers for new health
and adult social care watchdog
The Care Quality Commission (CQC), the new
regulator of health, mental health and adult social care, has
published details of the enforcement powers that will help it
protect the health, safety and welfare of people who use health and
adult social care services, and to improve the quality of these
services.
The CQC will be able to draw on a wider range of powers than its
predecessor regulators to help it achieve its aim of being a tough
but fair regulator. It has new powers to issue warning notices and
penalty notices and in extreme circumstances to suspend or cancel
the registration of organisations who do not meet essential
standards of quality.
14. Law comes into force to strengthen
protection of vulnerable people
Some of the most vulnerable people in society will be better
protected against abuse and poor care as a result of the
legislation which recently came into force in April in England and
Wales. People who lack capacity in hospitals and care homes are be
protected by the new law known as the
Mental Capacity Act Deprivation of Liberty Safeguards.
This law introduces new safeguards, so that if a care home
or hospital needs to deprive someone of their liberty for their own
safety or wellbeing they must apply for permission. It only applies
to people in care home and hospital settings who are unable to make
decisions on their care or treatment and who need to be deprived of
their liberty in their own best interests to protect them from
harm.
The safeguards make it lawful for a person to be deprived of
their liberty, based on a rigorous, standardised assessment and
authorisation process. The law also gives people the right to
challenge any decision to deprive them of their liberty, a
representative to act for them and protect their interests and the
right to have their status reviewed and monitored on a regular
basis.
15. Website to help
professionals working with carers
The Princess Royal trust for Carers has
launched a website to help
professionals who work with unpaid family carers. It contains
information, news and resources to help professionals identify and
support unpaid adult and young carers. The website also offers
specialist information for those who work with carers in the
health, education and social care sectors.
16. Patients to help put quality
at the heart of NHS and social care
The DH has announced a new package of
measures to put high quality patient care at the centre of NHS
work. The measures include:
- the Performance Framework to set minimum
standards of quality, safety and financial management
- patient feedback on operations
- the National Quality Board to provide
strategic oversight and leadership on quality in the NHS
- a new, simpler complaints system
- significant new powers for the Care Quality Commission to
assure people that services are fair, personal, effective and
safe
Health Minister Lord Ara Darzi described
the announcement as "a landmark day in the history of the
NHS".
17. Trainees’ survey closes with
record 42,000 returns
PMETB's annual survey of trainee doctors has
closed after receiving 42,000 responses - a response rate of over
82%. Results from the survey will be available to Deaneries at the
end of April, and to the public from 11 May. PMETB will
provide further information on how stakeholders can get the most
from the surveys’ online reporting tool in a series of Quality
Framework Outcomes workshops. These are being held across the UK
throughout May 2009. For more information, and for details of the
current Trainers' survey, visit the PMETB website.
18. NHS better care better value: quarter 2
indicators
Quarter 2 data for the NHS better care better value
indicators 2008/09 are now available. To ensure the indicators
continue to add value to local discussions, an online survey has
been launched to help establish how the information currently
produced is used and identify what future changes could be
valuable.
19. British Indian Psychiatric Association (BIPA)
Trainee Award
BIPA is inviting applications for
the 2009 BIPA
Trainee Award. An award of up to £500 is available for trainees
for the purpose of conducting research, or presenting a
paper/poster at a major international academic event. The
winner will make to give a presentation of their work at the
BIPA AGM. The closing date is 15 May 2009.
20. What’s new
online?