First days at work

We all remember our first day at work - the uncertainty, curiosity and fear. But some first days are a lot worse than others. In 1986 my contract with the Medical Research Council was due to come to an end, and I accepted an invitation to apply for a new post of Director of Planning and Information at what was then the Mental Health Unit of Central Birmingham Health Authority. Since I was the only candidate for the post, the job was mine. The Unit had been under the temporary management of a psychiatrist (Dr Patsy Goodyear) until the first of the new NHS general managers could take post. My appointment was intended to promote the very innovative ideas for mental health services developed by Dr Goodyear, and her colleague Dr Michael Radford. We were later joined by a superb psychogeriatrician Dr Hilary Nissenbaum.

On my first day, I arrived at the John Connolly Hospital. This was a rather battered building, dating from the 1960s,, which had originally developed a reputation as a rather non-conformist therapeutic community. By 1986, it had become a more standard inpatient unit, admitting patients from designated city wards in Birmingham, divided into ‘adult’ and ‘elderly’. Nevertheless, the Hospital was in a pleasant open space, patients could come and go easily, and patients and nurses would kick a ball around in front of the hospital at lunchtimes.

After arriving at reception, I was met by an efficient personnel officer and shown to my ‘office’. This was actually a partly-enclosed space in a corridor next to the toilets. There was a very old desk and chair, and a broken telephone. I gathered that my arrival was not welcomed by all the senior staff in the Unit. There was no induction training, or any indication of what I should do, so I wandered round making appointments to see whoever I could. Later that day, a cheery bricklayer arrived and began to wall me in to create a room. In the next few days, better office equipment arrived, I met the Unit General Manager, and began to be useful.

Over the four years I was in the post, the Unit planned and opened a phenomenal range of innovative services: inter-disciplinary mental health resource centres, the first team in the UK to treat people with acute and severe mental disorders in their own home, an intermediate treatment unit in an old people’s home, and community psychiatric nursing teams that recruited from all languages in the City, while we also planned (with Professor Ian Brockington) a new specialist academic psychiatric inpatient unit at the Queen Elizabeth site. We were therefore in process of developing something quite different from the model of psychiatric services which had been government policy from the mid 1970s. I also helped develop a low-cost computer system which generated rather better data than the expensive Patient Administration System (PAS) promoted by the computer companies and their satraps in different parts of NHS management.

Unfortunately, the satraps won. Central Birmingham Health Authority was merged with its equivalent in South Birmingham, and the combined mental health unit fell under the control of managers and senior nurses who had learnt their trade in big old-fashioned psychiatric hospitals. They were suspicious of academic clinical units, and naturally committed themselves to PAS. The new inpatient psychiatric unit opened in 1991, but became over-crowded. It was demolished 15 years later to make room for a new general hospital, and its replacement is a typically-plush product of a PFI deal. But as you pass it on the railway line, you can see the tiny exercise spaces and the high fences round the inpatient wards. This is to some degree the consequence of the very reforms we promoted. As more and more patients with acute mental illness were treated at home, only the most dangerous and disturbed were still admitted to inpatient care. Psychiatric hospitals became progressively more restrictive.   

Our dynamic staff team was also demolished. People retired or moved to new posts. The general management team fell into disarray, and the general manager developed an interest in setting up his own private nursing home. One day, without warning, his office had been cleared and he was never seen at the hospital again. I left in 1990, and, to my great surprise, became an academic. However, I still look back on my four years in the NHS as the time in my working life when I was most useful.