July 2018 - Dr John Crichton, RCPsych in Scotland Chair

This month's guest blog is written by RCPsych in Scotland Chair, Dr John Crichton. Dr Crichton will be updating you on the College in Scotland's activities quarterly via the guest blog.

On my work noticeboard is a letter from the Health Board Chief Executive. It warns all staff of financial constraints ahead and the imperative to work efficiently. It could have been written last week but dates from my first NHS employment as a psychiatry nursing auxiliary in 1985. It seems fitting to reflect on this the 70th anniversary of the NHS that some challenges have always been there. A fascinating insight into the creation of the NHS was conveyed in Archive on 4 UK Confidential: the Birth of the NHS (BBC R4, 30th June). There was an argument between localism in health administration and regional structures. Most hospitals were run by local authorities prior to 1948 and wouldn’t it be wise to maintain that local connection. Ultimately that approach was rejected because of the degree of variability in services and standards that were already apparent in local authority run hospitals. Many of the arguments for the retention of local authority control have parallels in the arguments which have resulted in our current health and social care partnerships. There remains the same tension between organisations prioritising local needs against providing an assured scope and quality of services. Part of the solution might be mental health service commissioning guidelines, but the voice of practitioners is also key.

Psychiatrists have a vital role in assuring the success of these arrangements and protecting against a mental health ‘post-code lottery’. As we face an inquiry into mental health services in Tayside, I am reminded that struggling services often appear to have disempowered clinicians from raising concerns and have disengaged them from planning. Partly, this is because old mechanisms of influence which are uni-professional and do not include lived experience appear anachronistic. It is surely time to reinvent local structures to ensure the scope and quality of local mental health services, and monitor the implementation of new initiatives arising from the mental health and suicide prevention strategies.

Another way we can exert influence is in responding to the numerous consultations which are sent to the College. We particularly look to our faculty representatives and to the larger faculty and committees for help. If there is a specific consultation you would like to contribute to through the College please let us know. We have all been invited to give our views in a Government survey of staff regarding investigations following the death of a patient following, for example, suicide. This is an opportunity for us to comment both in regard to internal incident reviews and external reviews – for example, by the Mental Welfare Commission. I would encourage everyone to participate and highlight the survey to multidisciplinary colleagues.

Recently, Vice Chair of the Royal College of Psychiatrists in Scotland (RCPsychiS), Linda Findlay, spoke at the Scottish Parliament’s Cross-Party Group (CPG) on Mental Health about primary care mental health. In that context you see MSPs from all parties working together. I am looking forward to working with our new Cabinet Secretary for Health and Sport, Jeane Freeman, and the new Minister for Mental Health and recent Chair of the CPG on Mental Health, Clare Haughey. Clare brings a wealth of experience as a mental health nurse and has been a faithful supporter of promoting mental health issues in the Scottish Parliament. I have written to acknowledge both the contributions of Shona Robison, who championed the parity between physical and mental health, and Maureen Watt who was always approachable and engaging.

An early challenge to the new Ministers will be the provision of CAMHS services as highlighted in the recent report on rejected referrals to CAMHS. Elaine Lockhart, Chair of the Child and Adolescent Faculty continues to influence the Government response and will be addressing issues of recruitment, retention and workforce expansion. I have been working closely with Government and will be following up my letter regarding retention to Health Boards with feedback from Dr Tom Brown, new chair of our Working Retired Psychiatrists Group. We will continue to seek funding for recruitment activities and I look forward to giving an update to you soon about this.

It was great to see so many Scottish Psychiatrists making their way to Birmingham for the RCPsych UK’s International Congress and supporting the vote at the Annual General Meeting to create Devolved Councils in Scotland, Wales and Northern Ireland. The creation of Devolved Councils will be the most important structural change to the College in Scotland for a generation. We owe an enormous debt of gratitude to RCPsych UK’s Chief Executive, Paul Rees. Paul identified that the old constitutional arrangements were inequitable and failed to meet the realities of devolution. Paul used his experience of introducing Devolved Councils at the Royal College of General Practitioners to push through this change. This step affirms the College in Scotland in its devolved role – engaging with NHS Scotland, NHS Education for Scotland, Scottish Government, Scottish Parliament and the Scottish media. There are further steps to be taken before the Devolved Councils can be formally put in place, but we look forward to these next steps.

To mark the creation of RCPsychiS Devolved Council we have been donated a gavel created by craftsman Matthew Toleman with wood from a 70-year-old ash tree taken from the Royal Edinburgh rebuild. A natural split in the wood during drying is secured by a set of butterflies – in the spirit of Kintsugi. It is on permanent display at the office in Queen Street. All members are welcome to drop in and use the facilities of the member’s room. I wish everyone a great summer and safe travelling for those going on holiday.

Dr John Crichton, RCPsych in Scotland Chair