Where shall John go? Boston, USA.

MR KLEIN: The medical profession also has an important educative role in trying to persuade nurses and ancillary workers that, for example, the woman who stabbed her baby should not be in prison but in a mental hospital. The medical profession does not carry conviction in psychiatry because it has interpreted leadership in a terribly narrow sense of "We take the clinical decisions and that is what leadership means." Actually leading a team means fighting its battles. You do not just tell them what to do but also kick up a fuss on their behalf. To return to the main theme, isn't Dr Clare's paper saying that psychiatrists are very peripheral to psychiatry? For most of the patients most of the time it is the ancillary and nursing staff who are most important. To take the recent report on St Augustine's, what struck me was that here was a sort of closed community run by nurses: the doctors didn't really come into it. If that is the right way of organising things then the responsibility has to be put where the work is. If the nurses do 99", of the work in the chronic long-stay sector, providing the care, determining the environment, then shouldn't they be formally allowed responsibility ? Isn't that partly what the whole argument is about ? When you look at the various inquiries in the psychiatric and handicapped long-stay sector in recent years, how many of them were instigated by doctors ? Not many. Surely, a sense of responsibility implies a duty to do something when things go wrong. Appointments of speakers