The Manpower Sub-Committee of the Education Committee has been concerned about the future medical staffing structure in psychiatry, particularly with the future of the non-consultant medical grades, and whether there should be a place for a Medical Assistant or similar non-consultant career grade. A questionnaire was sent to all psychiatric consultants, and another questionnaire to all other grades of psychiatrists in order to obtain their views on this question. These questionnaires have now been analysed, and the detailed findings are presented.

(i) The powers available to the Courts for the disposal of offenders requiring psychiatric treatment should be flexible, offering the widest range of options. To this end, the facts having been established, the Courts should have the power to impose a ‘Court Treatment Order’ which would allow a possibility of treatment in a variety of settings according to need. With suitable upgrading of facilities (referred to later) a Court Treatment Order would allow treatment of a disturbed offender in designated prison hospitals (if a high degree of security was required), in hospital, Special Hospital, medium-secure or special treatment unit, and with supervision and after-care mandatory on release. This implies the power to impose a period of care for a fixed period or for an unlimited period of time. The existing parole system and appeals system could operate appropriately.

Recent disputes in the N.H.S. are highlighting a number of problems which have been swept under various carpets of indifference, denial or muddle for a long time. One of these is the number and quality of recruits coming into psychiatry and completing their training. Like almost everything else in Britain, it gets worse as you go further from the London and the South-East area—at least until Hadrian’s Wall is reached. And in this, as in many other respects, psychiatry seems to illustrate the inherent difficulties of the N.H.S. in a particularly striking way.