Working for Patients and the subsequent Working Papers mention psychiatric services explicitly only twice. The proposals have been formulated for patients requiring tests and treatment for elective surgical conditions. They are the conditions which are believed to be predictable and therefore the most receptive to contractual specification and pricing. The health care contract is to be central to the new NHS. It is the device by which the Department of Health hopes to produce a fundamental change in attitude by both doctors and managers. Kenneth Clarke seems much more concerned with this attitudinal shift than with the detail of what the NHS might resemble a decade from now. This omission of overt consideration of psychiatric services does not allow us to ignore the White Paper. I intend to focus on the potential implications of the proposed themes for psychiatric services, particularly in the context of what they might indicate about the Government response to Community Care: Agenda for Action.
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