Planning for winter

As we get closer to Winter, I want to acknowledge that mental healthcare continues to be under significant pressure.

Our community services are not yet sufficiently developed to make up for the significant reduction in mental health beds over the past twenty years. Too many Trusts have bed occupancies of over 95%, with a number functioning with bed occupancy regularly over 100%.

This means thresholds for admission increase whilst thresholds for discharge decrease, with only the most ill or those in crisis being admitted. More people are likely to be compulsorily detained and therefore to have longer stays in hospital.

In response to these pressures, myself and others at the College have been working closely with our NHS senior leaders providing recommendations for the immediate to short term to support hospital avoidance; ensure adequate bed provision where needed and support appropriate and timely discharge, the aim being to secure better outcomes for our patients.

The value and future of our workforce

There has been a lot of engagement and discussion this month with the Academy of Medical Royal Colleges as we prepare for the challenges to and opportunities for our healthcare systems.

I joined the Academy Council Policy Day on Wednesday 13 September where I spoke with my fellow Medical Royal College Presidents about a number of topics including the role of Physician Associates (PAs).

PAs are not medical doctors. They have not undergone the same medical training or specialist education as a psychiatrist. As healthcare workers, however, PAs can play a valuable role supporting the mental health multidisciplinary team in healthcare delivery, in the same way as Occupational Therapists and Pharmacists.

I have listened and understand the concerns that have been rightly flagged about the impact of the role of PAs on trainees and other doctors and I want to reassure you that the College will be undertaking comprehensive work to create clear guidance on how PAs can best support the multidisciplinary team in the delivery of good quality mental healthcare to patients.

All of us were shocked and dismayed at the reports of sexual harassment and violence towards female surgeons. In psychiatry, we cannot be complacent and this must not be tolerated. Our Presidential Leads for Women and Mental Health are working on a strategy which will include recommendations about tackling sexual harassment in mental healthcare settings.  

At the Academy Council, we also spoke more broadly about workforce, in particular workforce retention and the role that the Medical Royal Colleges will play going forwards in working with and influencing decision makers to support doctors and improve and adapt the healthcare system in the face of changing challenges.

I had the pleasure of joining the Northern and Yorkshire Division at their fantastic Autumn Conference earlier this month and it was great to meet many of you in person for the first time. I was impressed with the achievements of the Division and also had the opportunity to discuss the priorities for my tenure and how local members and affiliates can get involved with the College.

At the UCL Institute of Mental Health International Conference, I took part in a mini-symposium where I discussed how to fund a National (mental) Health Service, a fascinating discussion that highlighted that while there are many challenges, there are also opportunities which we must be ambitious and courageous in seizing.

Industrial action

Last week, both consultants and trainee doctors took part in planned industrial action, a first. More industrial action is planned for next week.

The NHS medical workforce, including the psychiatry workforce, has been under immense pressure for years. Psychiatrists in common with other doctors have worked tirelessly before, during and since the pandemic, to keep NHS services running with inadequate resources.

We are the professional medical body responsible for supporting psychiatrists at all stages of their careers. It is not our role to advise members on whether they should take part in industrial action. This is a personal decision for each doctor.

While this will be a difficult decision for some, I know that colleagues who decide to take industrial action will do so after careful consideration and after balancing the various risks to patient care and service provision.

In order to deliver the best possible care to our patients, we need a workforce that is motivated, supported, and happy in their jobs, and I will continue to campaign for the changes necessary to make this a reality.

Fairness for all

I was privileged to be asked to speak about inequality and mental illness at the Royal Society of Medicine’s conference about delivering collaborative whole pathways of care, and also the National Association of Psychiatric Intensive Care Units (NAPICU) Annual Conference.

At both, I spoke about the systems and organisations that are supposed to support and improve our health, and how our policies sometimes exacerbate the disadvantage already experienced by certain groups. I highlighted the evidence demonstrating the impact of inequality on mental health, and how we can use the evidence to reduce mental health inequality.

And finally, I was incredibly proud to hear that the College was named 'Campaigning Team of the Year' at the 2023 Charity Times Awards for its work on equality, diversity and inclusion.

My congratulations and thanks go to our members, affiliates, Experts by Experience and College staff who have worked tirelessly to progress our pioneering EDI work.

While the ‘Campaigning Team of the Year’ award is a welcome and well-earned reminder of our successes, I look forward to seeing how we can continue to innovate and lead in our ongoing efforts to secure fairness for all. 

Wishing you all the best for your work and homelife,

Lade