4/ Editorial introductions

In chapter twenty one Hugh McKenna and Jim Brown review the prevailing ideology of the marketplace as it influences psychiatric nursing care. They examine the intrusion of the business ethos with its unsophisticated ideas of financial accountability and audit. They consider the implications of this on the running of the NHS and provision of health services. In particular, Hugh and Jim look at the effect of measuring clinical outcome using primitive methods. They consider its dehumanising effect on staff and the resulting deterioration of quality in their relationships (and therefore also their clinical work) with clients. Hugh and Jim highlight the morally dubious ways that data from such quality audits can be used and the interests its use can serve. They look particularly at how ethical standards, confidentiality for example, as well as standards of care, can, paradoxically, be compromised. They then look at ethical problems in research generally with those who are mentally ill. Finally, they highlight various ethical difficulties in artificially soliciting and using clients' opinions on care provision. In conclusion Hugh and Jim stress the importance of developing ways of assessing clinical standards which are genuine, rather then ideological manoevres, and which also protect both clients and staff from abuse.