John Wattis

Use of guardianship under the 1983 Mental Health Act.

The powers of guardianship under the 1983 Mental Health Act confer on the guardian powers to require the patient to reside in a specified place, to require attendance for treatment and to require access to the patient for appropriate health and social services personnel. This paper presents a descriptive study and analysis of the use of guardianship over a 5-year period in four geographical areas. Cases were collected retrospectively from a variety of sources and scrutinized systematically. Three cases of guardianship for mental impairment were excluded from the analysis leaving 23 patients with mental illness. All but two of the patients were female. Older patients, mostly with dementia, accounted for three-quarters of the sample and the majority of orders in this group were to require residence in an old peoples home (usually with an apparently good outcome), though three were intended to facilitate home care. In most of the younger patients a functional psychiatric illness was diagnosed and powers were used to maintain the patient at home. The absence of a specific ‘power to convey’ needs to be resolved for elderly patients needing residential care. The use of guardianship orders to maintain older patients in the community needs further exploration.

Medicine and Society

Medicine and Society John Wattis C. Ham, D. J. Hunter and R. Robinson, Evidence based policymaking. British Medical Journal, 310 (1995), 71—72. This selection from the last ioo references I have scanned highlights three important political issues, continues the debate on psychiatry and religion and reports on one extraordinary old lady. The political issues start with the campaign for evidence-based medicine. In the light of the myth of the infinite demands for medical services predicated by some politicians, doctors are increasingly asked to justify their behaviour in treating patients according to medical evidence. An academic industry has been built on the need for systematic reviews of the evidence for and against medical procedures, and further work on developing clinical practice guidelines and care pathways led one senior physician to comment that consultants might soon be reduced to painting by numbers. Of course there is a need for value for money in medicine, as in any other sphere of life, but there is little evidence whether this will be best served by the industrialisation and deprofessionalisation of medicine. Many of the questions in the treatment contract with an individual can only be addressed in the context of a personal relationship between the physician and patient but the industrial model tends to de-personalise. Ham and his colleagues plead for evidence-based policymaking and for a Centre to analyse and co-ordinate the results of the work of the existing institutes, independent of political parties and credible to governments of any complexion. In this way perhaps the politicians may be hoist with their own petard. The Health Policy Network, Health Policy Networks in Practice: The NHS Market, National Health Service Consultants Association, Banbury, Oxfordshire, OX 17 iQH, 1995, 50 pence. This report, from the UK National Health Services Consultants Association, a group devoted to defending the values of the NHS as originally set up, analyses the problems of the NHS reforms. Enthovens initial analysis of the NHS failures is described as flawed. He assumed terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0144686X00002634 Downloaded from https://www.cambridge.org/core. IP address: 54.70.40.11, on 29 Apr 2018 at 18:36:13, subject to the Cambridge Core