This paper has been prompted by the decision to close a large psychiatric hospital in its entirety and reprovide its services within the community. This was announced in 1983 with the aim that it would be effected within a ten year period. The hospital at that time had approximately 1,000 patients and the decision, which came as a shock to the staff, was taken not by the local management or clinicians but by the more distant administrative structure.

Interest in all aspects of NHS management has increased recently, and senior registrar training schemes are becoming widespread.

Large psychiatric hospitals are notoriously resistant to change. Their size and organisational complexity inevitably hinder their capacity to keep pace with trends. The serious consequences of a system that has ceased to adapt have been documented many times. Stereotyped routines and practices combine with rigid and bureaucratic management structures to produce the phenomenon of staff ‘burn out’, the “I've seen it all before and it doesn't work” syndrome.

The final page of this manuscript was inadvertently omitted and the full Comment section is printed below. We regret this omission.