Book review

Date15 February 2019
Published date15 February 2019
AuthorShoumitro Deb
Subject MatterHealth & social care,Learning & intellectual disabilities
By Nick Bouras
Pavilion Publishing and Media Ltd
£14.95 (pbk)
ISBN 978-1911028413
Review DOI
When my daughter was in s chool she could
not wait for the Harry Potter instalments to
come out and she would start reading the
book on the moment the b ook was out and
would read non-stop until the whole tome
was finished by the lat e evening. Despite a lot
of encouragements from her, I have never
moved beyond the first page of the first
book. However, when I started reading
Professor Nick Bourasbook, I felt the same
urge like my daughter t o finish the whole
book in one go (and I am a slow reader!).
Such is the attracti on of this book for
someone like me who ha s travelled some of
Bouras as an excellent Clinician, Scientist,
Leader, Academic, Educator, Mentor,
Trainer, Policy Maker, Medical Manager,
International Networker (all these qualities
that made him the Renais sance man in the
master storyteller!
There is a hierarchy in science and at the top
is perhaps the rocket scienceand at the
bottom, medicine. Within medicine,
psychiatryperhaps comes at the bottom
and within psychiatrythe intellectual
disability (ID). Professor Bourasendeavour
to collect data meticulously and analyse them
using scientific methods as described in his
book, no doubt, helped to make ID psychiatry
respectable nationally and internationally. His
book is the proof of the disaster that can
happen if you go with the flow and do not ask
questions and gather the right evidence! In
that sense, Professor Bouras was ahead of
his time, perhaps because of his exposure to
community-based mental health services very
early on through the Mental Health Advice
Centre about which he writes passionately in
his book!
In his book, Professor Bouras through his
personal journey also takes us through the
journey of the NHS in the UK in the last four
decades as well as services for people with
ID. Many of us will remember the profound
changes that Griffiths report brought into the
NHS that advised the Government to run the
NHS like a supermarket only to realise that
unlike the supermarket the consumers of
health service do not have to pay for the
service. In order to rectify this mistake, a
pseudo market was created by developing
the commissioner-provider split. That was the
beginning of the manager culture in the NHS
and ring-fenced budget within small units, a
small amount of resources guarded dearly by
the managers of those units. Professor
Bouras talks in his book about the tension
that these changes brought for implementing
community care and how medical
establishment in the hospital was perhaps
understandably reluctant to give any of their
meagre share of resources to community
care. At a personal level, I felt the same as a
psychiatry registrar when I went to ask for
some syringes and bottles from an inpatient
unit as I was going to do a home visit and
needed to take some blood samples from a
patient. The ward manager told me that I
could not use their equipment for patients
who were not in their unit. This in a way
exemplifies the wider problem of loss of
flexibility within the NHS as a whole!
Professor Bourasbook reminds us of many
forgotten stories such the extra-contractual
referrals, many of which were necessary
because of expensive out of area placements
in private settings (£8.8m just from one
London area in 2017 quotes the book) that
created a false economy in the NHS (the
latest figures show in the UK, there are 2,500
psychiatric inpatient beds in the NHS and
2,800 beds in private sectors most of which
are in locked units). This book also resurrects
for me some of the anecdotes we used to
hear through the grapevine as psychiatry
SHOs such as Professor Elaine Murphys
sedan doing home visits in the not so affluent
parts of London. His book also reminds us
how in the old days our clinical psychologist
Reflections on the
Challenges of
Psychiatry in the UK
and Beyond: A
Chronicle from
to Community Care
VOL. 13 NO. 1 2019, pp.52-54, © Emerald Publishing Limited, ISSN 2044-1282
Book review

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