WHO CARES? (true stories of the NHS reforms)
by Peter Bruggen (1997) Jon Carpenter">
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BOOK REVIEWS
WHO CARES? (true stories of the NHS reforms)
by Peter Bruggen (1997) Jon Carpenter, pp.314, £12.
This revelatory book arose
from disillusion experienced by Peter Bruggen as a distinguished retired consultant
psychiatrist and respected author in the field of adolescent psychiatry. He became one of
the first medical directors of an NHS Trust and had embraced that commitment with
enthusiasm, believing then in the need for tougher management and control of doctors. But
by the age of 58 he was suffering insomnia and various psychosomatic stress complaints,
and felt unsure whether he could survive within "a National Health Service writhing
in agony".until his planned retirement at 60.
Whilst contemplating writing up his own
experiences, colleagues encouraged him to broaden the subject, because they felt so firmly
gagged from disclosing the realities. Organisations, including Unions and the BMA, were
equally reticent. The BMJ, in which doctors’ disclosures are common, was silent on
what it felt like to be suspended, moved out of one’s office, told to rewrite a
business plan or to shed staff.
This is a compelling and uniquely disturbing account of the
lack of care and concern for themselves experienced by caring professionals. Their
confused administrators are characterised as both hatchet men and potential victims of the
far reaching recent reforms of the NHS. Stress arising from fears of redundancy, awareness
of sudden suspensions and moving goalposts is rife throughout the new Trusts, which impose
gagging clauses into contracts, so that most of the author’s testimonies are perforce
anonymous. Their probity is not undermined by that necessity; Bruggen’s credentials
are impeccable and his handling of 100 ‘true stories’ sensitive and free from
gratuitous dramatisation. The collective picture is persuasive and echoes feelings within
the service which are constantly discussed in privacy.
Peter Bruggen clarifies the complicated relationships
between ‘purchasers’ and ‘providers’ and the managerial intricacies of
Trust mergers, but retains deliberately the confusion felt by his subjects, together with
the atmosphere of insecurity and fear within which many of them tried to comprehend what
was going on, changing as it did from day to day. His net is cast widely, including
accounts from hospital and ‘the community’, patients as well as nurses, doctors
and dentists, and administrators at various levels in the hierarchy. He describes most
informants as submerged under paperwork and unable to trust colleagues.
Psychological interventions are mentioned
only in passing, and such counselling as was provided could not meet the devastating
situations to be confronted. Whilst many of these NHS horror stories could, no doubt, be
matched by personal experiences in other large organisations, they take on a special
colour from the paradox that the central role of the NHS is to provide good care for its
clients, in a spirit of openness to complaints. The present revelations indicate an
important role for psychiatrists in helping staff members, and also in considering how the
NHS and its Trusts might further develop without inflicting such damage upon its
workforce. This substantial and inexpensive book is meticulously edited and handsomely
published, with comprehensive bibliography and index.
P Grahame Woolf
CLIFTON HOSPITAL, An Era
by M T Haslam (1995) Golden Flower Press,
Belper, Derby, pp.194 (£7. 50 from Haslam, Box 129, Harrogate HG1 1JR).
This book provides an
overview of the history of Clifton which first opened in 1847 and, nearly a century and a
half later, closed its doors. In its heyday, Clifton Hospital in York was a centre for
excellence, introducing modern methods of treatment and practising humane care, which had
been carefully nurtured in the mid-nineteenth century by Tuke and others. With the
development of the Retreat in York, and the founding of the York Medical Society and York
Medical School in 1834, it becomes clear that public officials were very conscious of the
fact that clinical teaching, public dispensary and psychological medicine were equally
important. Although the Medical School closed 25 years later, it provided a course in
psychological medicine. Patients were examined in the Retreat, and the County Hospital was
used as a teaching centre.
The second chapter outlines the development
of Clifton Hospital, with the processes of design, purchase of land (initially 40 acres)
and construction. The next two chapters provide the background on the early years and
consulidation. There is a fascinating account of the impact of the 1914-18 war on the
staff, and also upon patients who came from the armed fores. During the period when Dr
Ivison Russell was in charge the development of occupational therapy provides an
interesting insight into the emergence of multi-disciplinary functioning. The use of
insulin, camphor, malarial treatment for syphilis, and prolonged narcosis is described.
Subsequent chapters deal with the development of modern treatments, the impact of repeated
re-organisations and the difficulties of keeping services going. The author also covers
the development of psychology and child and adolescent services during the same period.
The League of Friends of the hospital gets an honourable mention.
Haslam’s well researched volume is
packed with fascinating information, and contains enough for the student of psychiatry to
learn about the antecedents of the profession and how far psychiatry has come in the last
150 years. It should be read by all trainees, most of whom will have no direct experience
of the old mental hospitals, and it should be in the libraries of other mental health
professionals, so that we all learn its lessons to prevent the next generation from making
the same mistakes.
Dinesh Bhugra
Institute of Psychiatry,
London
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