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	While we were sleeping Dr Dermot Ward The Society of Clinical Psychiatrists has been deeply concerned about profound changes inflicted by government-driven changes to so many aspects of medical profession function in NHS healthcare. Inevitably this impacts on patients and a long suffering public. As a profession we seem to have allowed a creeping paralysis of our former ability, as that body which is most informed about overall individual patient treatment and care, training our young doctors, researching our work and developing evidence based healthcare policy to shape NHS policy. Instead we appear to have allowed politicians to call the shots. They having long ago forced the BMA to become a union and when they deem it useful they dismiss pejoratively such mild opposition it offers as that of a mere self-interested ‘trade union’. The chaos associated with Modernising Medical Careers (MMC), Medical Training Application System (MTAS), the callous disregard for trainees current and future careers and their families: public alarm about the reconfiguration of primary and secondary medical services has brought about public demonstrations in numbers without precedent in post-war Britain. There is puzzlement, anger and opposition as chameleon ‘modernisation’ stealth plans emerge from strategic health authorities and trusts. Both represent a nadir of confidence not only in the competence and integrity of politicians in healthcare but also in the BMA’s inability or unwillingness to vigorously contest Postgraduate Training and Medical Education Board (PTMEB), plans. Of course that body is a creature of politicians ceded to them by the Academy of Royal Colleges. The MTAS debacle was predicted, and its postponement passionately pleaded for in the Journal of the Royal Society of Medicine more than a year earlier by Dr Jonathan Osborne (Osborne J. Modernising medical careers:an open letter to the royal college presidents.J R Soc Med 2006;99: 56-7). The case for the MTAS was made by Dr Alan Craft in the same journal issue in his capacity as president of the Academy of Royal Colleges (Craft A.Modernising medical careers: a response from the Academy of Royal Medical Colleges. J R Soc Med 2006; 99: 165-7). The SCP strongly supported Osborne in the journal (Ward D. Osboren and Craft Duologue: relative values. J R Soc Med 2007; 100: 164) The intense strength of his logical argument was matched by the feebleness of the Craft defence. That issue alone has proved such a disgrace that the viability of royal medical colleges has been called into questioned. That heads have rolled in the BMA and indeed outside is no comfort albeit an endorsement of abdication of proper responsibility and accountability for avoidable development in patently flawed politically (rather than professionally) developed policies; veritable hubris in ignoring the voice of its bedrock medical constituency. This is history but not the end of inevitable damaging sequelae for the corpus of the medical profession as a whole, individual doctor’s whose careers have been blighted and again harmful, albeit unintended, consequences on patient care. So much for analysis. Let us discuss some positive goals for both public and profession. 1. Restoration of Community Health Councils (CHCs) in England. These were created statutory bodies in England and Wales in 1974 and continued until abolished by government (in England) in December 2004. Oddly they continue to exist in Wales. Scotland continued unaffected with its own system. Local CHC branches in England were independent, had quite wide ranging powers including local hospital inspection (not necessarily with advance warning). They were not perfect but they did function as patients’ NHS watchdog demanding answers to awkward questions about patient services such as unduly lengthy patient accommodation on trolleys and actual hospital bed numbers. 2. We suggest that consideration be given to dropping the term “junior” hospital doctor. Our reason for this is that junior tends to diminish the professional medically onerous role, clinical skills, duties and responsibilities of such doctors. Although perhaps not long registered medical practitioners it is they who frequently are the first medical contact with a seriously and urgently ill patients. Just how seriously titles are contemporarily regarded is attested in the manner in which other disciplines allied to medicine have arrogated previously medically exclusive titles when styling themselves as ‘consultant’ nurse, nurse ‘practitioner’, consultant clinical psychologist etc. Politicians also, have helped themselves to holding ‘clinics’ and ‘surgeries’ doubtless hoping some of the high public regard regularly shown in opinion surveys for doctors generally will vicariously rub off on them (a triumph of hope over experience). I wonder do many doctors share my dislike for ‘medic’ which I think of as a military medical orderly with minimal first aid skills and primarily an USA poorly defined import. Perception, perception, perception. Some short time ago a study in industry showed that workers were prepared to accept a cut in salary in exchange for a more important-sounding job title. Before that study had someone suggested that outcome to me I would likely have dismissed it as nonsense. Interestingly, I have noticed that while being a consultant visiting wards in different hospitals senior nursing staff not infrequently introduce themselves as ‘ward manager’ (perhaps a wee bit tricky that for the day-to-day consultant). Female staff seem happier than males to be addressed as ward sister, staff nurse. Where I encounter equivocation I ask ‘are you a nurse?’ and when the reply is a yes I think it important to point about that for my particular brief and perception the important job description for medicolegal purposes is unequivocally ‘nurse’. An interesting observation is that a next door neighbourhood (Southern Ireland) more than twenty years ago twigged that ‘junior’ doctor was inappropriate. They were re-branded ‘non-consultant hospital doctors’ and nobody has had any more trouble using ‘NCHD’ than, say, SHO. Medical trainees in today’s NHS with its historically low morale because of, largely, politically-charged changes can do with all the respect they deserve. 3. Freedom of speech in the NHS. In recent times our political masters talk much about ‘transparency’ and ‘openness’. There is also regular reference to ‘whistleblowers’. The first two more aptly translate into opacity and threat in an NHS context. In 1994, news item in the BMJ, quoted paragraph 330 of the Terms and Conditions of Service for Hospital Medical Staff and I quote:- ‘A practitioner shall be free, without prior consent of the employing authority, to publish books, articles, etc, and to deliver any lecture or speak, whether on matters arising out of his or her hospital service or not’. It was observed that ‘a growing number of trust hospitals have contracts which have replaced this with a gagging clause’. Just how this gulag innovation and unilateral breach of contract by government was allowed to happen by any major medical representative body (the BMA and GMC for a start) is astonishing. What trade union body (apart from that mentioned) would have allowed that to happen to its members? The consequences of that political healthcare perfidy has inhibited the medical profession locally and nationally in its ability to push for relevant corrective measures to government health policies considered inimical to good medical practice and associated patient care. Its depression on the morale of the wider profession as a consequence of the most informed single body on healthcare matters, the sapiential leaders of healthcare services at local and national level being sidelined by bureaucrats ineluctably has led to the failing NHS in treatment efficacy. Today in healthcare statistical analysis the NHS is regularly headlined as lagging behind some of our far less affluent European neighbours. Is there any cogent reason why BMA’s Jonathan Fielding should not embrace a vigorous campaign to restore that Clause 330 in hospital doctor contracts as a major goal in his tenure of office? On succeeding he might not be rewarded with a politically delivered Honour at the end of his term in office but might not the respect and gratitude of all hospital doctors, the lasting confidence of his colleagues and the consequent benefit to patients of unfettered vigorous medical leadership prove to be something rather more honourable and precious. For psychiatrists, nothing so reveals the deliberate disempowerment of doctors as government’s 1999 National Framework for Mental Health which formalised and detailed in a surprisingly concrete way future services for the severely mentally ill. Psychiatrists were notable insofar as they were excluded from the process of that framework’s development. Disquieting, surely.