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This response to the report by lawyer Robert Francis into the failure of National Health Service (NHS) care in Mid-Staffordshire is fairly positive about its conclusions but points out that without consideration of personal, psychosocial factors in care, on the ward, in the institution things are unlikely to improve, the report leaves much unconsidered. Francis emphasises that patient care is at the very centre of the NHS, this is obvious but so often forgotten. He comments that the unhelpful blame culture still exists. Missing from Francis’ analysis is a psychological perspective – the systemic factors he mentions are administrative not relational. This response is an attempt to redress the balance in thinking about the improvement of care for patients and of the working lives of staff. [ABSTRACT FROM AUTHOR]

At first sight, a psychoanalytic perspective on clinical work may seem to some to have nothing to offer the old age psychiatrist and his team. However, psychiatrists' daily work involves unconscious as well as conscious phenomena. In this paper the present value and future possibilities of a psychoanalytic understanding are emphasised, both in terms of therapy for individual patients and also to inform other work within the department. Clinical material is introduced to illustrate these ideas. It is suggested that psychoanalytic psychotherapy is used not to replace other treatments, but as an adjunct to biological, social and other psychological approaches, to the benefit of individual patients, staff, and the service itself. [ABSTRACT FROM PUBLISHER]