St John-Smith et al ^{Reference St John-Smith, McQueen, Michael, Ikkos, Denman and Maier1} provide a useful overview of the political imperatives which have shaped British psychiatry in the past 5 years, but as with other overviews ^{Reference Craddock, Antebi, Attenburrow, Bailey, Carson and Cowen2} it is difficult for the reader to come away with any constructive message.

The authors rightly recognise the original New Ways of Working project as a practical response to a shortage of psychiatrists, but believe this has become a shorthand for cutting the number of medical staff and reducing the psychiatric orientation of the service. The national workforce figures suggest otherwise: between 1999 and 2007, the number of psychiatrists in England rose ³ by 46% and few can argue that recruitment is not vastly improved compared with 10 years ago.

The reality is that new services have grown even faster, with an estimated £2 billion of additional investment since 1999, ³ mainly in specialist teams. The recruitment of medical staff and the establishment of suitable training placements have lagged behind, as outlined by the Audit Commission finding that almost a third of crisis resolution teams had no dedicated consultant sessions. ⁴

It is inevitable, and many would argue desirable, that non-medical staff will be involved in front-line assessment, as they are now in most other branches of medicine. The solution is not to decry ‘proforma tools and guidelines’, but to argue for these to be used by suitably trained and supervised staff working in teams with ready access to psychiatrists, as originally envisaged in New Ways of Working. ⁵ The College should lead on an overview of the medical staffing of specialist teams, and trusts and commissioners should be obliged to fund dedicated consultant sessions in order to meet their quality targets.

Although specialist teams provide some benefits, they have undoubtedly led to greater fragmentation of care and may not all survive beyond New Horizons. ³ Our battle should be to ensure that the additional money which came with these teams is not clawed back in times of greater austerity.