The clockwork behind an amazing machine

 ...except it's not like a machine at all, and very friendly and human when you get through the door. But it is run inside a steely and well-oiled modernist structure called the 'Royal College of Psychiatrists Centre for Quality Improvement'. When I was first involved, in 2000, the machine did have a slightly less managerial name ('College Research Unit'), and interface (no corporate websites in those days), and worked in a friendly but slightly ramshackle old office block near Victoria, where everybody knew each other and we could hang out for a chat with the people running the new 'quality networks', and sit on teach other's desks. I don't even know where the desk are nowadays - they are probably hot.

That was the year we started the work on what was to become the 'Community of Communities'. It all came about when I was serving my time as chair of ATC - the 'Association of Therapeutic Communities'. A few years later, in 2007, ATC merged with the 'Charterhouse Trust' children's TC organisation to become 'TCTC' - 'The Consortium of  Therapeutic Communities', which is still the only professional organisation for British TCs. At the time, the mighty firm grip of 'New Public Management' (an offshoot of marketisation and quest for econmic efficiency set to bear down on those of us in the soft and cuddly public services) was starting to be felt...

Specifically, NICE was founded and had a welcoming message about helping clinicians to make decisions when it was uncertain what course of action was best. Well, that was then. But as chair of ATC, I thought we should not be left out - and wrote to NICE asking if we could be included. I received a rather formal, but prompt, reply saying that I was out of scope and should approach my relevant professiuonal body. As a psychiatrist, this was obviously the Royal College. 

And I had a very friendly and helpful response, expalining how they were just starting to develop these 'quality networks', and were we interested? Well, I was certainly interested, as it sounded like 'the good old days' (of which which I only experienced the tail end) when ATC member communities used to take it in turns to hold open days - about four times each year - to gather  together in the different TCs and swop ideas about their successes, troubles and ideas. And have a lot of argy-bargy, as rumour has it.

The hitch was that it needed money - unlike the 'good old days' ATC version, when everybody did it for free. So, as ATC had already been successful in getting a National Lottery grant for a multicente research project (in 1998), when the lottery was a fairly new thing, we thought we shoud try again - with RCPsych as the applicant and ATC as the professional organisation backing it. The rest, as they say, is history. 

The first community meeting of the Community of Communities, 25 October 2001

So we were the third of the college's quality networks, with QNIC (for children's inpatient services) and CGQN (for the emerging process of clinical governance) already established. CGQN didn't survive long - and I'm not surprised as I went on one of it's early peer review visits and was bored out of my skull. So now, in 2023, we are the second oldest amongst a whole multitude of quality networks that have been set up since 2002, in the name of healthcare quality improvement. But I still like to think that we remain the most cross-sector,colourful, and (gently) subversive of the whole lot. With a high priority to service user involvement (despite the bureaucratic hassle) and co-production (which it has taken the rest of the college 20 years to catch up with). My colleague Nick Benefield and I reckon that quiet revolutions take about 50 years, so maybe we're on track.

Today, having not been since before covid, I went to the 2023 Annual Forum (perhaps better called Jamboree - though the college public relations committee would never allow such frivolity). It was a joy. It reminded me of why I have loved this work for the whole of my NHS consultant career, and have been so lucky to be part of it. There was everything here that you could hope for in a therapeutic environment - belonging, emotional safety, fun, playfulness, growth, spirituality, 'fire in the belly', new ideas, good food, boundaries, and something that none of us have ever found a word for - except 'tc-ness'.

The team at the college who run it has included dozens of amazing people over the years (who are young project workers who often spend a year or two with us before going on to higher things, with some great tools under their belts) - and our current gang are as marlvellous as they have ever been. So many thanks are due to Bethan, Katy, Leyla and Niamh for keeping the good ship CofC on course through some wild and choppy seas!

The 2023 team - plus a few extras - winding down after this year's Annual Jamboree (Forum)

(The extras in the photo are Jane, myself, Mike and Neels - who are all involved in varous ways with the mischief we get up to)