CZAR TURNS

Juggling without success

The National Institute for Mental Health has commissioned a study of the workload of doctors working in the field, in a bid to tackle workforce problems.

The study, by the Royal College of Psychiatrists, will be conducted in parallel with a similar piece of work on psychiatric social workers, national director for mental health Professor Louis Appleby said.He said psychiatric consultant vacancies were running at 12 per cent, many would-be consultants were dropping out during training and many were retiring early.

Psychiatry needed to be seen as an attractive field to work in, and 'non-clinical pressures', including the amount of bureaucracy, were major deterrents.

'What makes some people feel overworked and some feel that they are coping?'he asked.'Only one issue is actually workload, there are lots of other things that determine how pressured people feel.'

Despite extra ringfenced funding and implementation of the national service framework, it was proving difficult to energise people to feel positive about the future.

'We have to be able to be honest about how people view Department of Health initiatives in the field, 'he said.'People feel there is not enough money, not enough staff and too many top-level priorities from the centre that people in the field are having to juggle.There is not enough local ownership to decide what to do - which is what people need to be motivated and to ensure high morale.'

Professor Appleby said every mental health service had been told to establish a local implementation team to address service development.

'Address neglect of the young'

The serious 'hidden'waits for children in the NHS must be urgently addressed, according to Professor Al Aynsley-Green, national clinical director for children.

'National performance indicators focus on things like trolley waits and on intermediate care - where are the children in that? , 'he said.'Children do not feature in the high-level performance indicators or delivery of contracts.'

Professor Aynsley-Green said children were waiting more than a year for an assessment for mental health problems that were interfering with their lives, and waiting for physiotherapy while symptoms worsened.Disabled children waited months for moulds to be made to allow them to sit up.By the time they got them, they no longer fitted.

Because children have not been seen as a problem or valued and have not had effective advocacy, the UK has seen the 'cataclysmic' experience of Bristol and 'disasters' like the Victoria Climbié case, he added.

'Nothing much has changed since the Court report in 1976 [Fit for the Future] and in fact some things have got worse - in terms of inequalities, for example, 'Professor AynsleyGreen said.

Despite evidence that child health and wellbeing is a determinant of adult health, children's needs have been neglected until now, he insisted, 'but these are people now, and they have human rights'.

For the first time, an explicit commitment has been made to develop fair and highquality children's services through a national service framework and taskforce, he pointed out.

Seven working groups are operating 'at a furious pace'.The creation of local strategic partnerships bringing together staff from primary and secondary care, education and local government was crucial to their success, Professor Aynsley-Green added.