Authors' response

It is always good to hear from an old friend and Dr Moliver does well to emphasise Dr Tyrer's point ¹ that a considered evaluation of any new service is essential to its development. We are already engaged in commissioning this process.

The need for a leap of faith is an unfortunate reality of services adapting to fast-changing business environments. Organisations that succeed place their trust in the analysis of experts to place them into a strong position to face new challenges. The pace of change is rarely sympathetic to the needs of more cautious individuals whose grasp of the issues and need to change may be equally acute but whose ability to make rapid intuitive shifts is limited by their need for security. The principles of Fair Horizons are unarguable, its service model addresses these, and we suggest that any service model demonstrating equal adherence to such principles will be sustainable in the future.

Dr Moliver is concerned about the fate of older people within age-blind services. Fair Horizons retains highly specialist services for those with dementia and other specialist needs. Many with less severe illness will be managed in primary care as proposed by the National Dementia Strategy. For those with functional illness, it is increasingly difficult to identify at what age people move to older people's services, given the advancing age and increasing health of the population. This has been an issue for many years and we would draw Dr Moliver's attention to the significant number of patients whose care continues in adult generic services into their seventh and eighth decades. Colleagues in older people's mental health recognise that such individuals continue to receive appropriate care within services for younger adults: Fair Horizons provides for joint working with older people's specialists if required.

Dr Tyrer makes the point that any service model works only if local clinicians commit to it. We have commitment from the majority of local colleagues from across professional groups. Nevertheless, there is work to do to ensure that all colleagues are fully supportive of the principles underpinning Fair Horizons.