We need a debate on New Ways of Working (Psychiatric Bulletin, February 2008, 32, ): good principles are being distorted by a range of conflicting influences - the most powerful is money (Sainsbury Centre for Mental Health, 2003). Doctors are expensive. Financial pressures encourage use of a cheaper member of staff whenever possible: replacing expensive staff with cheaper staff puts us at the cutting edge of New Ways of Working! This distorts team structure and working at all levels. Sometimes it might be appropriate, allowing highly trained staff to focus skills where needed. Alternatively it might deprive patients and families of access to expertise, and lead organisations to push staff to shoulder responsibilities which they feel are beyond their competencies or for which they are not adequately trained or remunerated.

Other pressures involve power and responsibility (General Medical Council, 2006). Undoubtedly there are people/organisations who see New Ways of Working as diminishing doctors’ ‘power’. Some fear that New Ways of Working diminishes medical responsibility, and leaves other staff carrying levels of responsibility that they are uncomfortable with, or worse, no-one has responsibility. But is power a finite package that gets cut up and doled out? Or can we become, by joining together, a more powerful force to work in the interests of patients and families?

Paradoxically, New Ways of Working stereotypes professionals. Organisations describe what different professionals do and how they should be working and, instead of introducing flexibility, enforce rigidity. They lose person-centred holistic care by replacing skilled clinicians with tick-box policies and procedures (Reference DrifeDrife, 2006) for people working beyond their competencies.