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Political and managerial attention has focused on the consequences of the failure of community services to provide effective care to a small number of people with severe mental illness. However, the nature and value of care in hospitals have received less scrutiny. This paper addresses deficiencies in our knowledge about nursing care in acute psychiatric wards. It reports the findings from a recently completed study for the United Kingdom Department of Health. Four key developments are identified which, together, pose significant problems for nursing in acute wards: the increasingly diverse patient mix in wards; the volume of administrative duties performed by nurses; the weakness of multidisciplinary team working; and inappropriate education. In conclusion, the challenges for managers and clinicians responsible for local policy and practice and, by extension, those at the centre responsible for such services, are examined.

This review highlights the non-clinical training needs of new consultants, identifying strategies for meeting these needs. Non-clinical activities are integral to the consultant's role and senior clinicians need training in these areas. Concerns over the quantity and quality of current provision are compounded by changes the European Working Time Directive and Modernising Medical Careers initiative will bring. Accelerated progression to senior level and reduction in time for training suggest a pressing need to respond to the needs of new consultants. Ad hoc initiatives in a range of healthcare contexts offer examples of how training needs may be met, including mentoring and continuing professional development schemes. A multiprofessional strategy, incorporating elements of higher professional education in general practice and other NHS initiatives (particularly management/leadership training), may offer an appropriate framework within which to capitalise on existing opportunities. There are, however, resource implications that need to be addressed.

Ray Higgins Nuffield Institute for Health 71-75 Clarendon Road Leeds LS2 9PL UKThe recent community care reforms have placed a high premium on interagency collaboration between health and social care agencies to ensure the delivery of high quality services to users. An examination of the historical record reveals the problematic nature of such activity. This paper provides a review of this record and then illustrates contemporary inter-agency issues through an analysis of a local experiment in joint service delivery in Leeds (LJK). The papeis examination of the literature on joint working provides same clues as to why the experiment's original aims and objectives remained largely unrealized. The difficulties encountered by the key actors were a mix of cultural, professional and organizational factors.