Published: 17/11/2005 Volume 115 No. 5982 Page 31
Is it a sign of my advancing conservatism that I find myself reading the Daily Mail? No. It is because Mrs Taylor is a regular subscriber and it gets recycled as lining for the daughter's new puppy's dog-toilet. Hence my regular scanning of the great blacktop tabloid, as I wait in pointless expectation for the dog to do something party-political over the Mail's front page.
I was awaiting the inevitable outcome of the dog's recycling of Kibbles, tree bark, carpet and leaves when my eye was drawn to the harbinger of doom's splash headline 'Third of NHS hospitals are in the red'. Only a third? The dog cocked a quizzical eyebrow at me and we both silently agreed that CP Snow's aphorism 'The first victim of war is truth' was particularly apposite.
'No, ' said the dog. 'It was CP Scott, editor of the Manchester Guardian in the 1920s, not CP Snow the novelist. Ah yes, of course. 'Good dog!' I made a mental note to try to reduce the stress in my normal working week.
As we continued our scanning neither of us could spot a mental health trust being cited. I am sure the usual suspects were there. But was that 'Surrey and Sussex' or a small patch of canine urine? Mid Yorkshire or a smudge of poo? It was hard to tell. At last, the dog - I am convinced on spotting the mighty University College London Hospitals trust - found it within herself to do the dirty deed, and that fine organisation was literally in the brown and steamy.
We both reflected with quiet satisfaction that while it may be an absurdly partisan newspaper, the Mail is as accurately prophetic as any Old Testament soothsayer.
Sparing a moment's empathy for the good men and women of the NHS's acute hospitals, I offered these colleagues the comfort of the Marxist encomium: what doesn't kill you makes you stronger.
'Nietzsche, ' replied the dog. I really must get myself on beta blockers, I thought.
The whole episode left me wondering why it was that, even for all the wrong reasons, mental health trusts are unable to get into the headlines and provoke some furore over massive overspends and underfunding. We can't even muster a half decent market mechanism between us. Is that the answer? To ape our acute service brethren and harness the forces of demand and supply to articulate our case? But how? We do not have any easily measurable outcomes.
Well I have a suggestion: what we could do is to have competition between community and hospital psychiatric treatment. If we topsliced, say,£1m each year from our health communities into a paymentby-results pool we could have crisis resolution and early intervention services team-up together against in-patient acute psychiatry and assertive outreach.
The hospital-based and outreach services would of course 'win' if they were able to grab a patient in the community for compulsory admission under the Mental Health Act - say a£1,000 win bonus per section, and the crisis resolution/ early intervention services would fight to prevent the admission.
Whatever was left in the pot at the end of the year would go to the community-based services. Genius!
I gazed at the dog and couldn't help but think of that Adam Smith quote: 'The more the state plans the more difficult planning becomes for the individual.' 'Hayek, ' the dog replied. After you with the Risperidone!
Jeremy Taylor is chief executive of Nottinghamshire Healthcare trust. He writes in a personal capacity.