Paul Jenkins makes a case for appointing a psychiatrist as the next NHS England medical director

Paul jenkins 3x2

Paul jenkins 3x2

Sir Bruce Keogh leaves a big set of shoes to fill as NHS England medical director and as the clinical leader for the transformation in care required by the Five Year Forward View. I am sure the books are already open on who his successor might be, but I want to make a strong case for appointing a psychiatrist.

This isn’t a glorified pitch for “Buggins turn”, although there would be some very powerful symbolism in using the appointment to counter the institutional prejudices which the medical profession has, at times, displayed towards its colleagues in mental health.

Work hard, as the story goes that young medical students are told, or you’ll end up a psychiatrist. No, the arguments are a lot more practical.  

Why a psychiatrist?

First, mental health is one of NHS England’s key priorities and one where it has committed itself to a major programme of change and service improvement.

Working alongside Claire Murdoch, the national mental health director, a medical director with a psychiatric background would give further credibility to Simon Steven’s promise to deliver the forward view for mental health together with genuine parity of esteem for mental health.

Most psychiatrists know intimately the challenges of delivering out of hospital care, of how risk is best managed in the community and how medical interventions sit alongside the contributions of other practitioners.

Second, much is made, at times, of the lessons which can be drawn, in implementing the forward view, from the experience of closing long stay hospitals. Most senior psychiatrists have lived through that transition and understand both the practical, but just as importantly, the cultural issues involved in that transition.

Linked to this, most psychiatrists know intimately the challenges of delivering out of hospital care, of how risk is best managed in the community and how medical interventions sit alongside the contributions of other practitioners. The best psychiatrists have a broad understanding of the bio- and psychosocial model of illness which sits at the centre of population approaches to health and the impact of the social determinants of health on individual outcomes.

Third, if we are serious about integrating mental and physical health and recognising and responding to the massive impact that mental health comorbidities have on the burden of physical health, in particular for long term conditions, what better than putting psychiatric expertise at the heart of decision making in NHS England.

Partnering with patients

Fourth, good psychiatrists are experienced in working with patients as partners. They operate in a system, which has a strong track record of involving service users and carers in codesign and they may have first hand experience of being a part of teams with peer workers where individuals with lived experience play a key role as paid practitioners in the delivery of mental health services.

There’s a strong case that the experience and insights of a career in mental health will bring ingenuity to this role in the current times

Fifth, at a time of great pressure and change in the NHS, it would be good to have a senior clinical leader who understands the psychological dynamics of providing care and who can bring these insights into the quality agenda and into the strategy for supporting staff wellbeing. Psychiatrists will also be familiar with the issues of scarcity of resources and the challenges of managing within limited cash resources. 

Finally, the best psychiatrists I know have a huge passion for improvement and change. Psychiatric leaders such as Geraldine Strathdee, Sue Bailey and Simon Wessely, to name a few, have been some of the most inspiring clinicians I have worked with in my career. 

For all of us who work in mental health, there is a real sense that however difficult the current circumstances are, this might be our hour to deliver a once in a generation transformation in the shape of services. That passion can extend, not just to improving mental healthcare, but more widely to the delivery of the forward view.

I know that we don’t condone positive discrimination and only the best person for the job needs to be appointed. However, there’s a strong case that the experience and insights of a career in mental health will bring ingenuity to this role in the current times. To deliver change, symbols matter.

So, here’s another ball, it’s high time Cinderella was invited too.

Paul Jenkins is chief executive officer at The Tavistock and Portman Foundation Trust