The College has become increasingly concerned about the failure to achieve what has for many years been a reasonable policy for the chronic mentally ill. This paper will outline the significant effect that the blight in provision of services for this group of patients has had on mental health services as a whole, the extent of the shortfall and the effect on the patients themselves.

During the last decade there have been a number of legislative changes establishing and extending the rights of patients to have access to their own medical and social service records. The Data Protection Act 1984, as modified by the Subject Access Modification Order 1987, gave patients access to computerised medical records with certain restrictions, in particular for information thought to be harmful to patients. The Access to Personal Files Act of 1987 granted access to Social Services Records. Again there were restrictions, e.g. to protect clients from serious harm or to protect confidential staff judgements. Finally, the Access to Health Records Act of 1990, which took effect on 1 November 1991 gives patients access to their own medical records and enables them to correct inaccuracies which they may find. Information likely to cause serious harm to the physical or mental health of the patient or of any other individual who could be identified can be withheld.

Most previously published opinion has indicated that the medical profession is predominantly opposed to the package of NHS reforms outlined in the Government's white paper Working for Patients and especially opposed to the administration of hospitals by self-governing trusts (Lister, 1990). Yet only Whitfield et al (1989) can claim to have independently and directly polled the opinions of a representative sample of a defined population of doctors on this subject, and their survey was published two years before NHS reform began to impinge on hospital practice.

It is over a year since the Government introduced its reforms of the NHS and, despite surveys of consultant attitudes to these changes (Whitfield et al, 1989; Delamothe, 1990) and numerous letters to journals from those working in Trusts, there has been no attempt to systematically investigate the experiences of consultant psychiatrists working in NHS trusts. This information would be of use to those contemplating whether to countenance trust status for their own hospitals and those yet to make up their mind about their attitudes to the reforms.

The increasing awareness that serious mental disorder is common among men residing in homeless hostels has acted as a fillip towards providing new services for this disadvantaged group. Conventional psychiatry frequently fails to meet their needs, not least because of the formality and inaccessibility of the contact. Detailed psychiatric history taking, for example, is often perceived as a barrier to communication with no intrinsic benefit for the homeless. Indeed psychiatrists often appear distant to hostel staff. The Salvation Army have gone so far as to suggest to the House of Commons Social Services Committee that community psychiatric nurses are effective because of their ability to mediate with consultant psychiatrists.

Descriptions of psychiatric morbidity among the homeless have generally been carried out in community settings (Marshall, 1990) or among those who have come into contact with psychiatric services.

As long-stay patients move into the community, the relationship with the psychiatrist gets diluted. One reason is the logistical problem of visiting widely spaced residences, but another is that patients are primarily under the care of general practitioners (GPs) who provide physical care in the majority of cases. The way in which psychiatric care is delivered is variable (Horder, 1991). For the system to function a modus vivendi has to develop between GPs, psychiatrists and care staff. This study looks at current practice in Gloucester.

I previously reported (O'Shea, 1989) on the experiences of national Huntington's disease (HD) organisations in Britain, Holland, Ireland, New Zealand, and the USA. The Australian experience was discussed later (Kapp, 1990; O'Shea, 1990). The earlier paper supported the contention (Black, 1988) that the medical profession in general was not supportive of HD voluntary groups. I also expressed concern that the lobbying of voluntary groups representing far more common disorders was “bound to dilute the impact that Huntington societies may have.”

The aim of audit is to monitor and evaluate clinical practice with the intention of refining and improving practice. Once implemented the changes can in turn be monitored, creating the audit cycle. This paper illustrates one way to capitalise on the changes generated by an auditing process in an in-patient adolescent unit.

During their period of training, trainee psychiatrists are usually involved in multiple educational activities. Clinical activities include case demonstrations at the bedside, ward rounds, and other multidisciplinary team meetings. Another group of activities, not directly clinical, include didactic teaching in the form of lectures, case presentations at conferences, seminars, audit and journal clubs.

Medical students at University College Hospital are attached to medical firms during their first clinical year, where they receive one hour of liaison psychiatric teaching every week. The teaching usually takes the form of a presentation to the group of a patient seen by one of the medical students on the medical ward, followed by a discussion with particular emphasis on the doctor-patient relationship.

During 1991–2, the Department of Health is spending £3 million on an experiment. Consultants with an interest in management are being sent to Business School to rub shoulders with middle managers from outside the NHS. Without setting any specific individual objectives, the Department hopes that the acquired learning will be beneficial in the new market-orientated NHS. Together with a community paediatrician, an anaesthetist and a microbiologist, I was selected for a place on the G-course at Ashridge Management College, an intense, four week residential immersion in the theory and practice of profit-driven business.

This article addresses Jadresic's quandary (1992) on management training. Learning about management requires the same process as learning about medicine; it is not just another topic or qualification to add to a CV. Doctors need to incorporate management skills into their everyday working lives to ensure the effective delivery of care to their patients. All trainees manage. They organise duty rotas by negotiating with colleagues, they prioritise their clinical workload etc., so they have a sound management base.

About a year after applying to come on the Overseas Doctors' Training Scheme (ODTS), I was offered a post. The letter arrived about two months before I was to start work in the UK; it contained pertinent information about my job, the training programme, and the community I would live in. The information and its early arrival enabled me to make adequate preparation for my trip.

Computers are essential tools for medical research, communication and management. Informed choices require a basic knowledge of computers. Many doctors have, however, been frustrated by unnecessary jargon.

The problem of geographical dispersion is common in clinical academic departments. Often there is a main departmental base in a teaching hospital with various smaller units either elsewhere on the same campus or based in other hospitals in the same city. In addition, staff may do their ward work, out-patient clinics and their associated clinical teaching scattered over a number of sites. Although these arrangements usually have some effects on departmental cohesion, problems can usually be overcome with a little effort and the traditional means of ensuring communication and developing common policies in teaching, research and service development has been to hold regular departmental meetings.

This is the third and last in my series on recent changes incorporating the introduction of Disability Living Allowance in the allowances for the mentally ill. The Invalid Care Allowance is unusual in that it is paid to the person who does the caring and not the person being cared for.

Recently several cases have drawn our attention to problems associated with professional driving and mental disorder. All drivers are responsible for informing the licensing authority of any disability likely to cause them to drive hazardously. Medical Aspects of Fitness to Drive (Raffle (ed.), 1985) gives detailed guidelines to help doctors advise their patients. Those relating to ordinary licence holders appear intuitively correct and most psychiatrists would give similar advice without reading them. However, the guidelines for vocational drivers, especially holders of Public Service Vehicle (PSV) and Heavy Goods Vehicle (HGV) licenses, are more stringent because of the serious consequences when accidents occur. The guidelines follow those of the Royal College of Psychiatrists, revised in 1983.

This article attempts to describe a senior manager's search for ‘the medical model’ in psychiatry in two large provincial teaching units. I was brought to a number of realisations and moved to write this article by watching the film ‘Awakenings’∗. This portrays with great sympathy and effectiveness the angst and real pain suffered by a neurologist watching his patients in relapse and being powerless to help them. This was reminiscent of many of my consultants describing their own feelings.