in 1997 the teleradiology facilities at princess margaret hospital swindon were upgraded to a modern dicom compliant system. we describe the practicalities rather than the technical issues of setting up and running a teleradiology system that can send images to the radiologists' homes on call obviating the need for them in many cases to attend the hospital. we list the initial doubts and concerns voiced by both radiologists and radiographers and describe the means of overcoming the problems that arose. from these reflections we have obtained a deeper insight into the use of teleradiology in a district general hospital (dgh) setting. our conclusions are described.

Objectives: To establish if the relocation of the acute adult psychiatric services of the Dartford area from a district general hospital (DGH) to a new unit in the grounds of Stone House Hospital, the large institution where they were formerly based, increased the stigma of receiving inpatient treatment.

Method: A brief survey of service users asked if this move near to, but not within, the old institution potentially increased the stigma of receiving inpatient treatment.

Results: Inpatients initially welcomed the move but expressed greater concern about stigma and on balance were substantially less enthused than outpatients about the move to a separate psychiatric hospital.

Conclusions: Moving an inpatient unit back to the vicinity of a large institution from a DGH setting is rare, however concerns about consequent stigma, particularly felt by inpatients merits early consideration at planning stages.

Objective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.