Not the time to be complacent
There is much talk of legacy in the news. We want to memorialise the pandemic, place it in the past and look for something good to come from it. It is an enthusiasm of the moment as we come out of restrictions and not the reality of many parts of the world. The letter from BMA Council Chair Chaand Nagpaul on 29th April reminds us of our international links and interests. Remember colleagues who have families in countries struggling at this time and ask how they are doing.
The Disasters Emergency Committee is an excellent choice for those wanting to donate, as I write I see a staggering 386.000 new cases in the last 24 hours in India and I am sure that is an underestimate. Here in Scotland, we may not have turned the final corner in this pandemic but there is reason to be optimistic that the next wave of infections will be flattened by the vaccination programme and far fewer hospital admissions. The time to celebrate will be when all parts of the world can talk of legacy with optimism.
Legacy is also in the air for us as a College as many of us demit office and take on new roles and for me personally as I prepare to shortly ‘retire and return’ from my full time NHS Consultant post of 21 years. The origin of the term has nothing to do with celebrating achievement of who has gone before. ‘Legacy’ originally referred to the task passed on to another – it has the same word origin as to ‘delegate’ and ‘legate’ – a form of ambassador.
Going through all the various activities of the College in Scotland at the Officers handover meeting this week, I was pleased with how many of our campaigns have reached a satisfactory conclusion; as a result of the Personality Disorder campaign a Managed Care Network is to be formed; the Scottish Government are now going to take forward our ‘What Good Looks Like’ proposals; a specialist health and social care health service is being set up following a decade-long College campaign; we have secured promises of CT and FY expansion; following lobbying with our mental health partners, there is a substantial increase in mental health funding; our Holyrood election manifesto - No Wrong Door - was used extensively by all the major political parties in setting their own priorities.
Of the tasks I will be handing on, The Scot review of legislation, the Barron Forensic service response, and the ‘remobilisation’ of mental health and health generally, are all priorities. Having secured additional spending on mental health it will be important to follow the money and ensure those with serious and enduring mental illness do not miss out. What of the Covid Legacy? As a College we shall see a more blended approach to our meetings, working and committee work. When we meet in person, we must concentrate on those human things that are hard to accomplish over a video call.
Linda Findlay (Chair) supported by Jane Morris (Vice Chair) and Pradeep Pasupuleti (Finance officer) take up their new roles at the College AGM on June 25th. I would like to thank everyone who has supported my role as Chair over the last 4 years – especially the Queen Street team lead by Laura Hudson and my immediate Clinical colleagues at the Orchard Clinic, without whose encouragement and practical support the role would have been impossible. I would also like to thank everyone who volunteers time to contribute to College work.
Meeting the challenges of the here and now
To celebrate our 180th year as an organisation, there will be a series of free historical webinars exploring the development of psychiatry in the devolved nations. I am delighted that Alan Beverage will be contributing to that series of events. We are also supporting a free conference ran through the College’s Transcultural Forum, which will consider the impact of the last year on members from our ethnically diverse communities and other equality groups.
In the few weeks remaining as Chair, I am presenting a proposal to the Scottish Academy of Royal Colleges and Faculties to enhance the role of External Advisors in consultant appointments with the possibility of kitemarking those job descriptions which include wellbeing clauses and realistic DCC:SPA splits. I am also pleased to see an initiative from the medical managers and trainees in Lothian to capture our experience of Covid in inpatient settings and I would encourage you to participate in that work.
As for our Health Service, the challenge is immense. If Covid has taught us anything it is that groups of clinicians can work creatively and speedily to accomplish impressive results. No rigid ‘Command and Control’ model brought about the successes we have had in responding to Covid. If anything, Covid exposed how disconnected and out of touch some of our structures are. I regret the move away from local ‘Lead clinicians’ whose primary role was to shape and develop services rather than manage a group of colleagues. I regret efforts to conform to an anonymous corporate image rather than celebrate the local team. I regret that some parts of the Health Service are suffocated by an ever changing, self-serving bureaucracy where satisfying a process trumps appreciation for the essence of a task. I regret the cycle of service redesigns where the root of the problem is not efficiency but resourcing.
Whatever these regrets may be, they pale into insignificance compared to the immense pride I have in colleagues: the retired psychiatrists returning to undertake vaccinations or shopping trips for locked down patients; the enthusiastic trainees determined to find new and better ways of working; the managers struggling with shortages yet still keeping the show on the road; the academics with extraordinary insights into the cause and treatments or major mental illness. Then there is the privilege of working in a multidisciplinary team and particularly the contribution of peer support working. Greatest of all is my gratitude to patients who are our most important guides and teachers. At times over the last year I wondered if it was I keeping folk going at the end of a phone or the other way around. Patient after patient would be concerned about my wellbeing and what we were doing together to come through the pandemic.
Finally I am reminded of the Roman legal maxim, delegata potestas non potest delegari - to paraphrase ‘ you cannot pass on what’s delegated to you’. So for the next four years it will be Linda’s tasks and priorities which will shape the College in Scotland. I am looking forward to seeing how Linda’s team brings forward their ideas and wish them all every success.
Professor John Crichton