December 2016 - Dr Alastair Cook, Chair of the Royal College of Psychiatrists in Scotland

The mince pies are starting to appear at meetings and turkey is on the menu for team lunches and ward night outs. The Christmas hysteria seems to start a little earlier each year and all the old favourite festive songs start to dominate the airwaves.

It’s a time for reflecting back on the previous year and hopefully looking forward to fresh starts, new commitments and new plans.

It is hard to be positive about the year that has just passed. Big events such as Brexit, the US election, political uncertainty in the rest of Europe and the awful situations in Syria, Yemen and Iraq make the world feel a very uneasy and uncertain place.

Closer to home the junior doctor’s dispute in England, ongoing recruitment and retention problems and the emerging crisis in General Practice reflect a sense of unhappiness in our profession as a whole. We have lived with “austerity” for 9 years now and the impact is really beginning to bite. Efficiency savings have trimmed any fat that could be found and we are all facing the reality of real cuts to front line services, even in the supposedly “protected” NHS.

Austerity has had bigger effects on our new colleagues in the integrated world. The pressures on social services are making headlines as I write and there is a real sense of inevitability about rising demand for social care as our population lives longer with more long term conditions. People with greater complexity of need are spending shorter periods in hospital and our society demands that discharge is supported by higher levels of input by both paid staff and the huge army of unpaid carers that we need to support to continue doing what they do.

For our patients the real stresses of an unsympathetic benefits system, cuts to social services and third sector supports and difficulties in Primary Care make it more difficult to see where the light at the end of the tunnel can come from.

So where can we find glimmers of hope for 2017?

We will have a new mental health strategy for Scotland in early 2017. There will be a focus on prevention, early intervention, an improved range of options available to manage mental health difficulties in primary care settings and hopefully a commitment to begin to address the scandal of premature mortality amongst those with severe and enduring mental illnesses. The politicians 'get' the need for more parity between mental and physical health and we have to hope that the review of targets by Sir Harry Burns will result in a shift away from the obsession with access to unscheduled care and more emphasis on good holistic outcomes.

For all the potential risks in Health and Social Care Integration there are real potential benefits if we can use this as an opportunity get closer to our GP colleagues as well as those in Social Work and other services. The potential to shift the balance of care from acute to community will only be realised if those of us with experience of delivering this successfully in mental health and learning disability services can influence the wider health and social care system and help them learn from our mistakes and our successes.

As for the big picture... we can only hope that common sense prevails over some of the rhetoric and that 2017 brings a new sense of hope and optimism in the word.

To quote a festive favourite: 'A very Merry Christmas, and a Happy New Year, Let’s hope it’s a good one, without any fear'

Alastair

Dr Alastair Cook, Chair of the Royal College of Psychiatrists in Scotland