New Ways of Working: fences and cuckoos

There is a clue in the capital letters: New=old, Ways=one way, Working=work avoidance. It is Newspeak.

It did not occur to me when responding to the histrionic outpourings of oppressed general psychiatrists (Jolley, 2002) that their despair would spawn a quasi-religious management sect. I drew attention to practices within other specialties which maintained morale and positive service profiles and suggested that a more equable spread of manpower would reduce the difficulties.

In semi-retirement I have experience of general and old age psychiatry reconfigured to the model commended by Vize et al and Kennedy, and questioned by Lelliott (Vize et al, 2008; Kennedy, 2008; Lelliott, 2008). Every device is deployed to separate patients and families from consultants: to fragment patterns of care and to divert (‘signpost’) expectations and responsibilities elsewhere.

This is not the work of thoughtful, caring, clinical innovation which sparked and sustained my enthusiasm, confirming that we are available, with knowledge, skills and wisdom for people wherever they are in need (Jolley, 1976). Community psychiatry, including old age psychiatry, demonstrated professional humanity and superbly efficient use of resources. Let us return to the lessons of the recent past and set aside these ugly new clothes. Those who have been led astray are not to be blamed, but understood and thanked for the challenge they have given us. There is always something to be learned: we can do better. Taking down fences rather than sitting on them or jumping from them might be a good idea.