We analysed all 1213 negligence claims made against contributing psychiatric services since the inception of the National Health Service Litigation Authority (NHSLA) in 1995 and until 1 June 2009. More than half (55%) were settled, at a cost of £47.2 million, 26% were closed without penalty and 19% were still in progress at the time of review. Five individual claims exceeded £1 million.

By allocating 43 NHSLA-assigned causes for a claim to the 11 stages of a generalised patient journey, we noted that assessment of patient risks was the single largest cause of claims (32%) and the single largest cost of settlements (£16.2 million, 34%).

At the individual level it is difficult to see patterns of errors, whereas increased volumes reveal systemic trends. This analysis presents a new perspective from which to improve patient safety.

To audit the quality of medical recommendations for detention under the Mental Health Act 1983, Section 2 and 3. The recommendations were tested against a gold standard based on the statutory criteria. Two cycles were completed, the first containing 214 recommendations, the second 202. Relevant education took place after the first cycle.

The percentage of medical recommendations containing clear statements of why each of the statutory criteria was met increased in the second cycle. It reached 87% for mental disorder; 87% for nature and/or degree; 75% for why community treatment was not possible; 64% for why detention was in the interests of health; 60% for safety; 55% for protection of others; and 70% why informal admission was not possible.

Doctors, scrutineers and approved mental health practitioners welcomed clear guidance about what is expected in a medical recommendation for detention and endorsed the gold standard described. Armed with a better understanding of what is expected and a template to follow, there was an improvement in the reasons given for detention.

To explore attitudes and perceptions towards workplace-based assessment (WPBA) among psychiatric trainers in Wales and to compare them with those of trainees. To identify current problems and report recommendations made by survey respondents to streamline and successfully implement WPBA. An anonymous questionnaire-based cross-sectional online survey was conducted involving consultant psychiatrists in Wales and the results compared with a previous survey of specialty registrars.

In total, 104 of 164 consultants participated (63%), compared with 81 of 88 trainees (92%). Both surveys highlighted numerous problems and negative attitudes towards WPBA. Compared with widespread dissatisfaction among trainees, trainers appear more diverse in their opinions, although considerable numbers are dissatisfied with the new competency-based system.

Negative attitudes harboured by many trainees and trainers constitute a significant hurdle to the effective implementation of WPBA and undermine its efficacy as a tool intended to improve training. Specific measures with the potential to address various shortcomings are discussed, with a view to improving WPBA and rendering it more acceptable to both trainees and trainers – and thus facilitate improvement of training.

Service access is currently determined primarily by age and intellectual function and, unwittingly, is discriminatory. Our aim is to develop a novel, person-centred, non-discriminatory model of mental healthcare delivery. We sought the views of people who use services, carers, commissioners and local politicians.

The model represents a major change programme that commenced in September 2011.

By integrating specialist mental health services, with a single access point, and mapping of care to the person's needs, rather than their circumstances we hope to have developed a greatly improved and fairer service. A similar model could be adopted in other locations nationally.

To carry out a survey to ascertain the role of academic clinical fellowship posts within the integrated academic training programme for academic training in child and adolescent psychiatry. Questionnaires were sent to UK academic child psychiatric units.

A total of 18 units returned questionnaires; this identified eight university lecturers and two academic clinical fellows in post.

Integrated academic training pathways seem unlikely to contribute substantially to academic training and to maintaining the pool of academic clinicians in child and adolescent psychiatry. It may need reappraising with regard to psychiatric specialties.