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Psychiatric services are mired in managerial treacle

The Jobbing Doctor is trying to get one of his patients moved from a hospital 100 miles away, where he is sectioned, to a local ward. The psychiatrist there is happy to have him. But it's not his decision to make. Why? Because there a 'crisis team' of jobsworths in the way.

The Jobbing Doctor is trying to get one of his patients moved from a hospital 100 miles away, where he is sectioned, to a local ward. The psychiatrist there is happy to have him. But it's not his decision to make. Why? Because there a 'crisis team' of jobsworths in the way.

Sometimes, the role of the GP is to be an interested but powerless observer of what happens to our patients. We are often the main port of call for people wanting to talk about their experiences in the NHS. Sometimes this is a very positive description. Unfortunately, this is not always so.

The Jobbing Doctor is increasingly worried about what is happening in psychiatric services. Some of the developments are helpful, such as efforts to improve the numbers of counsellors, but unfortunately many are not.

One of my patients has a chequered psychiatric history. He had one episode of severe psychiatric problems a few years ago, but this was precipitated by events, and he has done well since. Things have spiralled downhill in the last few months, again due to events, and he now languishes in a psychiatric hospital over 100 miles away from his home and family. He fell ill when staying with his extended family. He rang me on his mobile, desperate to get nearer home.



He is not happy and the reason why is that (in the hospital he is in) every single member of the clinical staff he has interacted with is a foreign graduate and most do not have English as a first language. He says he cannot make himself understood. This is alarming in a specialty where nuances of history and expression are so very important. So he remains, languishing in hospital, on no treatment - his freedom denied to him by a Section 2 (which he does not dispute).

I have rung the local hospital and asked to speak to the psychiatrist who dealt with him a number of years ago. Can he arrange for my man to come into a bed in our local hospital? I had a lovely chat with him: he would be happy to have my patient back in his ward, but.....it was not up to him. It has to go through a ‘crisis' team, and the final decision is not his.

This is a pretty poor show, in Jobbing Doctor's experience. A consultant has to be in charge of his own patients' care. People go into hospital so that they can see doctors. I do not decry the important role of other professionals but in clinical terms it is and should be the doctor who makes the decision, informed by other professional opinions.

My experience of these ‘teams' is rather baleful, I'm afraid. They seem to be large meetings of a group of disparate people with their own professional prejudices and rivalries, and many meetings seem to be about protecting their own turf or scoring points about others' roles. The seem largely intent on avoiding work and quite often the reaction is to say that their clinical workload is full so that they cannot possibly take on any other work.

So. My patient is 100 miles away, not being treated and unable to communicate. He cannot get nearer home because no-one is doing anything where he is. Meanwhile, the local hospital is paralysed in administrative and managerial treacle and the consultant psychiatrist remains powerless to do anything to expedite this problem.

I have made phone calls. Of course I have. But my current role is currently a frustrated bystander.

You might wonder if my patient is being somewhat racist in his criticisms of the racial mix-up of the team at his current hospital. This certainly has been suggested if anyone dares to criticise a doctor's performance on the grounds of language or culture.

But I don't believe that my patient is racist. You see, he is Asian himself.

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