Jeremy Hunt says total of 32 hospitals are now under investigation over links to claims of sexual abuse by presenter
A further 19 hospitals are to be investigated over their links to allegations of sexual abuse by Jimmy Savile, the health secretary, Jeremy Hunt, has said.
The move takes the number of hospitals under investigation to 32. Savile, who died in 2011 aged 84, is believed to have abused hundreds of children. He had a bedroom at Stoke Mandeville hospital, an office and living quarters at Broadmoor, and widespread access to Leeds General Infirmary. All three of those hospitals were among the 13 previously announced to be under investigation.
The wave of allegations made against Savile sparked the launch of the Operation Yewtree police investigation, which is also looking into claims about others linked to him, as well as separate allegations about a number of high-profile figures.
Hunt said last month that new inquiries could be launched after the Metropolitan police found "further relevant information" about Savile.
He said he had asked the Met to review its evidence to see whether any of the information it held "related to health and care settings".Haroon Siddique
A legislation gap has left prospective funders concerned about what would happen if an foundation trust couldn't pay its debts
So much has been mooted about the Nicholson Challenge that you would be forgiven for thinking all the answers have already been thought up, written about and tested. If only life were that simple.
Yes, it's true that the task of removing 20% of costs from the NHS has been met head on. Budgets available to the acute sector have, after all, slowly eroded to the point where the national tariff – the pricing mechanism used by NHS hospitals to charge commissioners – will be reduced by almost a quarter, at least in real terms – by 2014-15.
The net result, especially when combined with measures to cap paid-for activity, is that hospitals are increasingly doing more clinical work with less funding. Easy wins, such as delivering smarter procurement processes, are harder to find and providers are being forced to look to increasingly innovative models to deliver quality health outcomes.
The search for a new way of delivering healthcare means hospitals are re-organising how and where services are delivered on a grand scale. In some cases, this means operating more efficient urgent care centres and minor injuries units to take pressure off A&E; in others, it's about the delivery of more complex services in social, community and GP settings.
It is our belief that providers have been doing their best within existing infrastructure, but their task is not made easy by the poor standard and unsuitable configuration of much of the community estate, not to mention existing acute infrastructure which, in some areas, is certainly in need of replacement. It's a situation that cannot be allowed to continue indefinitely; funding will have to be found to reconfigure and improve some existing estate. Better yet, budget will need to be found to construct new facilities which are more fit for purpose – and recognise the needs of today's patients.
Asking whether this is realistic is a fair question. NHS capital budgets are shrinking, not expanding, and have seen 17% over the past three years. The fact is that unless land and buildings are about to get dramatically cheaper (housing prices suggest otherwise), the NHS is going to have to look outside the system and appeal to the private sector for funding.
Again, if only life were so simple … In the wake of the credit crunch, funders are understandably more cautious and the Health and Social Care Act 2012 contains some loopholes which make convincing those funders much harder than it needs to be.
All this begs a question about what, exactly is scaring the funders. Why are they loathe to invest in the NHS, when doing so will ensure we have a health system better able to deliver what clinicians need to perform and what patients need to recover?
Firstly, a key question for any lender always revolves around whether they can rely on being paid if the borrower fails. In their position, debate in the news about whether foundation trusts could become insolvent must be unsettling. No wonder potential funders fear they won't see a return on investment and find themselves out of pocket.
That is why initial consultation on the new Unsustainable Provider Regime was promising. Buried deep into the consultation document (paragraph 34 of "Securing continued access to NHS services" to be exact) was the notion that creditors would be entitled to be repaid in full either by the unsustainable Foundation Trust (FT) or its successor. The proposed terms were also fair – allowing FTs negotiation space to restructure any repayments to more viable terms.
Sadly, nothing so definitive has found its way into the Health and Social Care Act. Little wonder that with a lack of central government support, prospective funders are concerned about to what would happen if an FT couldn't pay its debts. It's easy to say that this would not be allowed to happen, but lenders and their credit committees are not easy to pacify with general statements of what a future government might "allow" to happen. After all, the US has just finished a monumental game of "political chicken" with its own lenders. And they do say that when America sneezes, the UK catches a cold.
Regrettably, this is a gloomy scenario – one which seems to be nothing less than Catch 22. But that doesn't mean the sensible option is to give up.
In our view, the legislative framework should provide adequate protection for lenders without separate need for central government support mechanisms, such as deeds of safeguard. Trusts are already closely monitored and already need layers of approvals from their own boards, commissioners and the Trust Development Authority or Monitor to enter into major transactions. So closing this legislative gap doesn't really create a great deal of additional risk for central government. It would also reflect the commitment made in the consultation documents on the Unsustainable Provider Regime.
Without this, funders will need to revisit their credit analysis of foundation trusts in the light of the existing legislation and take something of a leap of faith in relation to the protection offered by untested laws. Given that trust in and around the economy is still lukewarm at best, this could well be a difficult call.
Until the issue is met head on, reconfiguration will be harder to achieve, infrastructure improvements will be delayed and those that do occur will be more costly, both in terms of credit and advisory costs. It's a fairly stark choice, but as things stand it is difficult to see how improved infrastructure will be delivered.
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers
Finding comes in a government report showing wide variations in dementia care in England
Less than half of people suffering from dementia in England are being formally diagnosed with the condition, leaving hundreds of thousands struggling without support, the health secretary, Jeremy Hunt, has revealed.
The finding comes in a government report that shows wide variations in standards of dementia care with three quarters of patients receiving a formal diagnosis in the best areas but only a third in the worst.
The figures are also being published in an interactive online map, which Hunt said would help raise standards by allowing patients to see which parts of the country were guilty of "poor performance".
He added that stigma was a serious hurdle in tackling the disease with patients either too fearful or too complacent to seek a diagnosis.
He is launching a strategy to encourage people to discuss diseases such as Alzheimer's more openly. "We must come together as a society to get better at fighting dementia," he said.
The online dementia map will show diagnosis rates, referral rates and the frequency of anti-psychotic drug prescription for the 670,000 people with dementia.
Although there has been a slight improvement in the national diagnosis rate, up from 46% to 48% since 2011, the gap between the best and worst performing areas is stark. The best is Corby in Northamptonshire on 75%; the worst are Herefordshire and Harrow, in north-west London, on 33%.
"In too many parts of the country, people think there is no point in getting it diagnosed because they think nothing is going to happen," Hunt told the Daily Mail.
"And sadly, in some parts of the country, that is true. We need to ensure that when someone is diagnosed, the system swings into action and gets people the support they need. There is a demographic timebomb but we are not giving people the care we should be giving them."
The national dementia survey assesses how well the condition is being dealt ahead of a G8 summit next month called by David Cameron to discuss how to tackle the growing issue.
The World Health Organisation estimates the number of people worldwide living with dementia could more than treble to 115.4 million by 2050 due to ageing populations. The number in the UK alone is expected to pass the 1 million mark by the end of 2020.
The report pointed to an almost doubling in government-funded research, a fourfold increase in the numbers being assessed by memory clinics, and training for 108,000 NHS staff in spotting early symptoms.
But the shadow minister for care and older people, Liz Kendall, said dementia care was getting worse. She said: "If David Cameron was serious about improving the quality of dementia care, he would not have cut council budgets for older people's social care to the bone.
"And if Jeremy Hunt was serious about improving transparency, he would be publishing how many 15-minute home visits there are in each area, and people with dementia have unnecessarily ended up in hospital or having to go into a care home because they can't get the help they need to stay living in their own homes."
MPs also called on the government to set out a long-term strategy for tackling dementia, before its presidency of the G8 summit in December.
Conservative MP Tracey Crouch warned that the current dementia strategy is due to expire in 2014.David Batty
Online 'customer' comments could allow us to indulge in our latest national pastime: leaving silly reviews
As part of the creeping privatisation of our National Health Service, a "Tripadvisor-style" reviews site for hospitals will be rolled out over the coming year.
On the one hand, it's reasonable that patients' views about their treatment are heard. On the other, it seems a trifle unwise to judge neurosurgeons in the same way that we appraise B&Bs in the Cotswolds. On this third hand that a clearly under-qualified sawbones has accidentally stitched to my elbow, what we're looking at here is a new outlet for the thing we do best: leaving playful and/or wilfully silly reviews for things. It's practically a national pastime.
To mark the beginning of this glorious new strand to our shared culture, let's warm up with a few practice swings …
• "Dreadful service. Uncomfortable beds. And to make matters worse I dozed off one afternoon and when I woke up someone had removed a mole I was particularly attached to." – Now-unemployed Marilyn Monroe lookalike, Cheshunt.
• "After a torrid beginning to my stay, in which I was given the most undignified bathrobe I've ever worn and was kept awake all night by another guest constantly yelling 'they've taken my leg', I was all set to check out early. But then one of the staff gave me a frankly rather intimate wash while I was still in bed and I'm now planning to book for next Easter." – Ukip voter, Macclesfield.
• "A distinctly unmemorable holiday. I was only discharged yesterday and I honestly can't recollect a single thing about the place. Bland and forgettable." – Amnesia sufferer, North Shields.
• "For a spa, the therapies were distinctly thin on the ground. There were no massages on offer and the only treatments we were offered consisted of a daily injection that made my hands swell up like two balloons." – Medical guinea pig, Oxford.
• "After a restful start to my holiday, in which I'm told I slept for four months, I was rudely awoken by David Soul singing by my bedside. I don't even like David Soul. I think he was booked for the next patient along." – Coma survivor, Abingdon.
• "I don't even know what my spleen is and I am now told that someone's removed it. I'm immensely bitter about this turn of events. And a chap in a white coat blathering on about Howell-Jolly bodies isn't helping. There's nothing remotely jolly about it. Insulting." – Charles Baudelaire, Hull.
• "A lovely stay. Friendly staff. A chocolate on my pillow every night. Well, I think it was a chocolate. The only negative was when I was presented with the bill. Quite a shock, I can tell you." – Health tourist, abroad.
• "Had a perfectly lovely time. Friendly staff in lovely starchy uniforms. Other guests very friendly and always pulling hilarious pranks. A substantial matron who bore a close resemblance to the late Hattie Jacques gave me an extra glass for my Lucozade so I could share it with the charming malingerer in the next bed. The only negative was that someone else ate my grapes." – Time traveller, Bromley.
Leave your own candid patient reviews below.Michael Moran
Competition has motivated trusts to provide better care – but it can also serve to protect services that should be closed
The government's doctrinal obsession with competition in the NHS is damaging care, holding back improvement and undermining integration. But ditching competition is not the solution.
Numerous studies on the impact of competition on the quality of healthcare (John Appleby of the King's Fund has written an excellent summary) broadly demonstrate that when used appropriately it can bring benefits, but it is by no means a universal tool for improvement.
There are powerful examples of its successful use. Under Labour, employing independent sector treatment centres to help clear the backlog of operations jolted many hospitals into finding improvements and efficiencies in the way they managed elective surgery.
Under the new regime, clinical commissioners have found that putting services out to tender has pushed trusts who thought they would automatically keep the business into reassessing their care from the patients' perspective and promising better integration with primary and community services. Medical directors and consultants suddenly become motivated to lead reforms.
But the difficulty is in defining when competition should be deployed and when it would be counterproductive, such as by undermining other services in a trust, inhibiting integration or sacrificing quality.
During the passage of the Health and Social Care Bill, the government offered an elegant solution: commissioners would decide when to put services out to tender. But that is not the way the legislation is working.
Competition law is having five detrimental effects. It is railroading commissioners into tendering services, interfering with service integration, inhibiting providers from collaborating and merging, protecting services that should be shut (under the guise of preserving competition), and exposing commissioners to protracted legal disputes with both public and private sector providers.
The accusations by Spire Healthcare Limited against Blackpool, Fylde and Wyre clinical commissioning groups are a particularly unedifying example of how competition law is being used to undermine the freedom of commissioners to do what they think is best for patients. Spire has complained to competition regulator Monitor that the CCGs are directing patients away from its hospital, a claim the commissioners refute. The GPs are now caught up in an investigation, leaving them even less time to focus on the things that matter.
Elsewhere, competition law has led to GP practices being blocked from coming together, and plans to centralise specialist acute services have been delayed.
Most shocking of all, NHS England has encountered a trust trying to protect a substandard cancer service in the name of competition.
But there is no consensus for change. This month NHS England chief executive Sir David Nicholson told the health select committee the service was "bogged down in a morass of competition law". But in an interview with the HSJ this week, Clive Maxwell, chief executive of the Office of Fair Trading, dismissed the idea of reforming his organisation's oversight of trust mergers.
He extolled the virtues of a uniform approach to competition across the economy. While this might appeal to a tidy mind, it exposes the OFT's failure to understand the unique characteristics of a free at the point of need, state-funded healthcare system that cannot be regulated in the same way as other industries.
Yet again, managers and clinicians are left feeling powerless as Whitehall figures fight it out.
The problem is not competition itself, but its reckless use on the back of inept legislation. Commissioners need to have the freedom to do what is best for their patients, and often that will mean using competition to find the best service and push existing providers to improve quality and drive down costs.
But the misuse of competition is undermining care and preventing the NHS from making the transformative changes required to make it a sustainable, high quality service in a tough economic climate. The law should be there to enable NHS staff to do the right thing, not act as a legal straitjacket.
Competition has an important role to play, but it is out of control. There is now an unassailable case for urgent action.
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offersRichard Vize
Following a three month trial involving 20 hospital trusts, the scheme is to be rolled out nationally next year
The NHS is to establish a patient feedback website, styled after the popular travel site TripAdvisor, to allow patients to post complaints online – including those containing potentially derogatory comments about medical staff – and show hospitals' responses to them in real time.
In an interview with the Guardian, Tim Kelsey, the NHS director in charge of patients and information, said a low-key three-month trial involving 2o hospital trusts on the Care Connect website had seen complaints and reviews logged, mapped and dealt with, night and day, in London and the north-east. The scheme will be rolled out nationally next year.
Kelsey pointed out that serious issues had already been tackled using the system – highlighting one instance when an elderly patient recovering from a cancer operation had been "left without morphine for a few hours – something she needed every four to five minutes".
Her daughter posted on the website that "the surgeon came into the room and not only berated the staff again but said 'this unit is really going downhill'. The whole experience is surely unacceptable in this day and age."
Kelsey said that this was not about "naming and shaming" but instead allowed the NHS trust in question – St Helier in south London – to contact the patient within hours of the complaint, before escalating it to the patient liaison service within 48 hours.
"It's what any consumer of health services would expect," he said.
The news of the system's planned roll-out came as the Patients Association charity published its annual study highlighting stories from patients and their families. The report said too many parts of the NHS had "lost their way", with a lack of basic care in hospitals, and the NHS often forgetting that "care and compassion should be at the heart of what staff do".
Kelsey said that by embracing "openness" the NHS would improve. He said the idea came from the United States, where cities such as Boston, New York and Miami have pioneered a system of public feedback to reshape public services. "Local authorities have invited the public to tell them about services. People can tweet, send in pictures. In the US 90,000 citizens do this every day about their trash not being delivered and the state of roads.
"This allows local authorities to hold providers of services to account and it's transforming services. The last mayor of New York, Michael Bloomberg, said that he thought it was a more legitimate form of citizen engagement than democracy itself".
The system allows the NHS to deal "intelligently" with patients, often in surprising ways, Kelsey said. "This has gone really quite well. So we have taken the decision to roll it out nationally next year"
He said this was "creating a 24/7 modern consumer health service". The NHS had to innovate in terms of patient safety, especially since the Francis inquiry into the appalling care at Mid Staffs hospital concluded that the health service must become more open and transparent and "embody a duty of candour".
While the public can access Care Connect online, by text, phone, Twitter and Facebook, their complaints and reviews are first assessed by case handlers who moderate the posts for privacy and, if out of hours, they contact the hospital to ensure the issue is taken up immediately.
However, posts on social media cannot be moderated – possibly exposing NHS staff to libel and threatening to breach patient confidentiality. "You cannot screen this stuff out on Twitter or even on Facebook which can see people repost stuff," said Phil Booth of privacy campaigners medConfidential. "I am not sure they have thought this through."
Comments on the site last night showed that at a London hospital vulnerable patients were being "smeared and laughed at" by staff; that a routine blood test left a patient with a lump the size of a tennis ball at Guy's hospital; in Essex a woman complained that she waited two months for contraception; and in Surrey an alleged failure to spot an ecotopic pregnancy left a woman infertile.
The British Medical Association had concerns that comments would be patrolled effectively.
A spokesman said: "It's important that comments that are defamatory, or which threaten the confidentiality of other patients, are screened out and consideration is given to how patients might interact with the service using social media."
Jane Barnacle, Kelsey's deputy, admitted that it was difficult to police complaints made on Twitter and Facebook. "The law does apply to social media so people would have to be careful."
The system was designed to "allow the public to choose the privacy level that suits them. If they wish to remain anonymous they can, or they can choose to have the details of their problem made public, as long as it passes the moderation process, either with or without their name published."
The website has cost £150,000 to set up. The plan is to bring in a private company eventually to run the service. The NHS deals with over 1 million patients every 36 hours, but officials are confident that it can handle the volumes of complaints.Randeep Ramesh
Yes, the NHS should help people quit – but depriving people of the relief of a cigarette in moments of stress isn't the way to go about it
Today the National Institute for Health and Care Excellence (Nice) has issued guidelines that propose banning NHS workers and patients from smoking on hospital grounds. To which I say: if they think that this is a good idea or even remotely enforceable, they must be smoking something.
I am not advocating smoking and nobody is arguing that if you're an emphysemic hacking up your lungs that reaching for a lighter is a great idea. But if you are a patient at a hospital or a psychiatric institution, by definition your life is not great at present. And if you are a smoker, in times of misery, stress and angst, a cigarette makes your situation that tiny bit more manageable. Why else would every photograph of the first world war show tommies in the trenches puffing away?
When I was an inpatient at a psychiatric hospital, admitted because I was fluctuating between suicidal ideation and mania, my mum piped up in my first meeting with the head psychiatrist and said with eager, optimistic eyes that she hoped that by the end of my stay I would have quit smoking.
My psych gravely replied that my quitting smoking was really not the priority at the moment. Because it really, really wasn't. And actually, I'm sure if my mum had been given the choice of me continuing to smoke 15 cigs a day and getting better or me choosing to live and engage with treatment, she'd be perfectly happy. Which she was.
In America, almost half of all cigarettes are sold to people with mental health difficulties, and trust me, I understand why.
Then there is the fact that one of the greatest impediments to quitting smoking is the social side. Now imagine how much more important that is when you are spending your days bored stiff, shuffling around in a paper dress, pissing into a cardboard container or having to queue up for meds. For a smoker in a hospital or psychiatric ward, chatting and having a fag with other patients is the one time you feel human again, like yourself in the outside world.
Another one of Nice's suggestions was preventing NHS workers from smoking "during work hours or when recognisable as an employee". Now, I can understand patients objecting to being treated by someone who smells like they've just hooked up with Philip Morris in the hospital canteen, but I am pretty certain that smoking members of NHS staff are careful to avoid this; you can't walk five metres in a hospital without getting to a soap dispenser and being reminded to wash your hands. If I'm in hospital all I want from my nurses and doctors is that they do their jobs well, which the overriding majority do. Patients should focus on their job, which is primarily, getting better, not moralising on the private lives of the people who are there to treat them.
And, to be perfectly honest, if I worked for, say, Barts Health NHS Trust, at a time when 1000 staff members are being asked to compete for their own jobs, and 600 nursing posts are being axed or downgraded, I'd be in need of a fag or five.
Not to mention how this ban would be almost impossible to enforce. Would hospitals have to install a mass of CCTV cameras, or hire fake smoking Gestapo types? The whole thing would just lead to people puffing out of toilet windows. And what about visitors smoking? Do you really want to be the person to have to go up to a distraught mother who has just found out their child has died, or a man who has just found out his wife has had a stroke, and ask them to politely stub out?
It's fine that the NHS is doing all it can to help smokers quit, disseminating information on how best to kick the habit, how smoking impacts on illness and mental health. But making life stuck in a hospital or institution even more depressing than it already is is not fine.
A few years ago the band Editors released a song with the lyrics: "Smokers outside the hospital doors / the saddest thing that I ever saw", which means they probably never watched Marley & Me, or the News at 10. Smokers outside hospital doors are not the saddest thing. The saddest thing is people being in hospital or institutions in the first place, and the way this government is systematically dismantling the NHS. Gimmicks like these are just a smokescreen.Hannah Jane Parkinson
New statistics show how many women are smokers when they give birth, which parts of the country have the most pregnant smokers and how that number is changingMona Chalabi
The government's response fits in with the wider political strategy of blaming individuals for shortcomings in the system
2013 has been quite a policy year for NHS care standards – there has been the Francis Report, the Keogh and Berwick reports, Cavendish on support staff, Clwyd on complaints, and the government's final response to the 290 Francis recommendations.
The latter runs to almost 400 pages over two volumes. What have we got to show for it? The answer is a raft of solutions largely modelled upon a marketised view of the NHS in which "consumers" are "empowered" and a failure regime is in place to deal with "imperfections".
Listening to and supporting patients and helping them to exercise choice are all prominent themes. Much of this was already in train, such as the extended use of the Friends and Family Test, more prominence for the NHS Constitution and acting upon the Clwyd recommendations on strengthening the complaints system.
New proposals are for a hospital safety website – ambitiously aimed at "putting the truth about care at the fingertips of patients" – and the creation of an army of 5,000 patient safety tsars within five years. These are helpful, though not game-changing, measures.
The thrust of the new measures is towards regulation of activity and criminalisation of breaches of behaviour. There are a wave of proposals including a new duty of candour on provider organisations (but not individuals) to tell patients about medical errors – and a threat to remove indemnity cover if the rule is broken; more robust inspections by the Care Quality Commission; new barring regimes to determine if board directors of NHS provider organisations are "fit and proper persons"; and new criminal offences of wilful neglect and the provision of false or misleading information.
Spurred on by lurid headlines about "50,000 too many people" dying under Labour governments, this will doubtless strike a chord with the public. It also fits in with the wider political strategy of blaming individuals for shortcomings in the system – people without jobs failing to look for work, people with disabilities holding the wrong mindset, people with too many rooms who are selfish. Now we can add NHS staff who simply don't care enough.
The other problem here is not so much what is in the government's response; but what is left out. The key omissions are around participation and support. The Francis report had much to say about the miserable record of the NHS in its relationship with local people, observing that the high tide had been reached with Barbara Castle's Community Health Councils, which Labour abolished in 2003.
His proposals on strengthening the role of foundation trust governors, improving public and patient participation in Monitor and strengthening the role of Local Healthwatch have all been downplayed. Notwithstanding recent guidance from NHS England on improving public and patient engagement the reality is that local people – individually and collectively – have little or no say in how their healthcare is commissioned and provided.
The greatest omission, however, is an offer of support – as opposed to exposure and regulation – to NHS staff. The government seems to have largely turned its back on Don Berwick's advice to "abandon blame as a tool" and "make sure pride and joy in work, not fear, infuse the NHS". The registration of untrained Health Care Assistants, as recommended by both Francis and the Health Select Committee, is rejected along with legal protection for the whistleblowers who put their careers on the line.
More significantly and predictably, the government has sidestepped the need for adequate levels of staffing, both in terms of volume and skill-mix. Rather than set legal minimum requirements, hospitals will be told to use evidence-based tools to decide for themselves what staffing levels to use, and to publish twice-yearly figures to show they have met these standards.
Even the measures that are being proposed will have considerable cost implications.
Hospitals will be saddled with more targets and reporting requirements at a time when much of their administrative infrastructure has been abolished. Around 7,000 nursing posts have already disappeared since 2010 but somehow hospitals will be urged to meet new staffing levels. In the meantime, most trusts are being financially crucified by 4% per annum efficiency savings, PFI repayments and crippling tariff rules on delayed discharge, emergency readmissions and accident and emergency services.
What we are left with is an imbalanced response to the issue of harm-free care – one that prioritises blame and recrimination over learning and support, inspection over participation and the imparting of information over accountability to local people. Failure will be perpetually in the spotlight, successes rarely exposed and celebrated. But maybe – just maybe – this is exactly what Jeremy Hunt has in mind?
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offersBob Hudson
The first gay president of the World Psychiatric Association wants a radical rethink of mental illness and for the profession to apologise for the harm it has inflicted on gay people and women
What do we mean by mental illness and what do we want psychiatrists to do about it? These are just the opening questions posed by Professor Dinesh Bhugra, the incoming president of the World Psychiatric Association. The Indian-born Briton is calling for a radical rethink not only of services for the mentally ill but for the entire societal and medical approach to psychological illness.
"The question is whether we focus on symptom reduction or social functioning," he says.
Controversially, Bhugra, 61, suggests the latter – getting people back to work rather than eliminating symptoms.
"I have patients who, in spite of hearing voices, are still holding down perfectly responsible jobs. By my account they are a success – they have managed to contain their symptoms and function."
He wants all medical, psychiatric and nursing students to be trained first in sociology and anthropology so they understand the culture in which they will practice and for a return to the "menu of options" available for psychiatric patients before care in the community – more day centres, emergency clinics and rehabilitation centres. All of which he believes will help rectify two urgent crises: the shortage of beds and of "demoralised" psychiatrists. Furthermore, he says, two groups need statutory regulation: psychotherapists and NHS managers, so they can be struck off when failures occur.
"Part of the characteristic of a profession is regulation. Managers at the moment may be answerable to somebody but there are no professional standards."
Another prime imperative for the government, he argues, is to tackle youth mental illness, as the onset of three-quarters of psychiatric disorders occurs between the ages of 15 and 24. "Every school should have a health professional knowing the basics about mental health. That would be a great step forward."
GPs' surgeries need a rethink too, he adds. Family doctors either need to undergo an extra six months of training in mental health or to have a psychiatrist attached to every surgery.
Part of the reason for the lack of resources – coalition spending on mental health has decreased two years in a row – is down to the psychiatric profession failing to convince successive governments of its value, argues Bhugra. This has led to mental illness being "at the bottom of the priority list – it's cancer and heart disease that's prioritised," says Bhugra. But he claims that for every £1 invested in childhood trying to prevent conduct disorders, it will save £6 of public funds in the long run.
Bhugra issues a stark warning – his "nightmarish vision" – regarding the impact of the Health and Social Care Act on psychiatric patients. "There will be a lot more fragmentation, which means bits of the service will be sold off," he states. This will work for those with mild to moderate conditions – anxiety and unipolar depression, he predicts. But, he says, people with schizophrenia and bipolar disorder "will probably languish somewhere. There isn't profit in schizophrenia. A third of patients with schizophrenia develop chronic illness, so nobody's going to look after them. This is a serious danger."
He also fears psychosexual problems will go untreated for those who cannot afford to go private, in what will become "more than a two-tier system" – private (the top tier), followed by NHS services of varying levels of quality; a second tier for mild conditions and a third or fourth tier for acute and chronic conditions.
A further area of concern, he says, is the mental wellbeing of gay people. Although Bhugra, professor of psychiatry and diversity at King's College London, and chair of the Mental Health Foundation, is "out" in his personal life, he has not spoken publicly about it before.
"Being gay is an important part of me, but a private part," explains Bhugra.
Growing up in Yumuna Nagar, a small city in northern India, he didn't have a word for his feelings. But after coming to the UK to train as a psychiatrist he realised he was gay, which he says "wasn't difficult – it gave meaning to how I felt". When Bhugra met Mike, his partner of over 30 years, he helped him to come out to friends and family.
"My father freaked out completely, my mother was really pragmatic and said, 'Who's going to look after you in your old age?'"
Bhugra will next year become the first gay president of the World Psychiatric Association, which represents and supports 200,000 psychiatrists worldwide. The significance of this appointment can scarcely be overstated in a profession whose history is tainted with the abuse of gay patients. For decades, in an attempt to "cure" homosexuality, electro-convulsive therapy (ECT) and chemical castration were administered.
"There are still countries where it's seen as an illness," he says. "We need to make a stand." He is still deciding how best to do that. In Britain, gay people are at greater risk of a range of mental health problems, and, it is believed, are more likely to take their own lives. But the law needs to be changed, Bhugra argues, to force coroners to record the sexual orientation of suicides.
Does he believe psychiatry should apologise for the harm inflicted on gay people? "There is no doubt psychiatry hasn't covered itself in glory. I think we ought to be apologising for all of the areas, not just one bit – like the treatment of women," he says. "I remember seeing a patient admitted to a psychiatric hospital when she was 16 because she got pregnant outside marriage. She died there in her 80s."
Yet, it is racism that Bhugra recalls more than homophobia. He says: "When I was dean of the Royal College of Psychiatrists, a fellow came up to me saying, 'What do we have to do to get you speaking proper English?'"Curriculum vitae
Family Long-term relationship.
Home Brixton, south London.
Education Mukand Lal secondary school; Armed Forces Medical College, Poona University; licentiate, medicine and surgery, Society of Apothecaries, London; PhD/MA social anthropology, University of London; MPhil psychiatry, University of Leicester; MSc sociology, South Bank University.
Career 1989-present: variety of positions from researcher to professor, mental health and diversity, Institute of Psychiatry, King's College, London; 1986-89: senior registrar, Bethlem Maudsley training scheme.
Public life 2014-17: president, World Psychiatric Association; chair, Mental Health Foundation; former president/dean, Royal College of Psychiatrists.
Interests Bollywood films, theatre, crime novels.Patrick Strudwick