The term "deteriorating relationship" is too narrow. Other people in the scenario can shift their weight in the boat. The context is an increasingly financially constrained, centralised and authoritarian society, where only the more exploitative aspects of individualism are fostered. The NHS is not composed solely of consultants and administrators. It may be fruitful to cast other staff in the role of dependent or individuated children. Sibling rivalry between other professions for power, status, hegemony, etc., is being contained and acted out in the consultant versus administrator battle. Perhaps we shall see disputes in the 'lower ranks' involving clinical and administrative issues, which may then help the consultants and administrators either to pull together within the NHS, or finally separate (private practice). The wider context will also inevitably change. While financial constraints look set to tighten, it is by no means certain that the current emphasis on the economics of service delivery will continue to take precedence indefinitely over a medical notion which seeks to maximise the relief of individual suffering regardless of cost. To add to Ian's prescription, I would suggest that consultants and administrators could fruitfully get together to compare notes on the differences between the various pressures and constraints under which they respectively operate, and hope also that other staff will see fit to helpfully 'rock the boat'. Old case notes: A patient's file was destroyed after the age of 25, which is unwise as many children with psychiatric problems grow up to have psychiatric problems as adults. It is of immense help to adult psychiatrists if they are able to consult the files of their patients when they were children. Furthermore, it vitiates any possibility of longitudinal research being done on these patients. Although the present staff of the clinic may not wish to do research, I think consideration should be given to enable those who come after to undertake this work. The policy to destroy files is an extremely unwise one. The Department of Health and Social Security recommended a minimum retention period of the records for children and young people until the patient’s 25th birthday or eight years after the last entry if longer. However, alternatives such as micro-filming can be extremely expensive, and we must wonder if, in a time of expenditure cuts, a better use could not be found for the required amount of money. The dilemma of adolescent psychiatrists: The point of the paper was to emphasise the dilemma faced by all adolescent psychiatrists—if it is accepted that it is unreasonable to treat all categories in one unit, who should be excluded and what are the alternatives? In the past, most of us were taught that the treatment of conduct disorders, particularly those exhibiting personality disorder, is not really a medical responsibility, and that as a group they are not sufficiently responsive to treatment.The term "deteriorating relationship" is too narrow. Other people in the scenario can shift their weight in the boat. The context is an increasingly financially constrained, centralised and authoritarian society, where only the more exploitative aspects of individualism are fostered. The NHS is not composed solely of consultants and administrators. It may be fruitful to cast other staff in the role of dependent or individuated children. Sibling rivalry between other professions for power, status, hegemony, etc., is being contained and acted out in the consultant versus administrator battle. Perhaps we shall see disputes in the 'lower ranks' involving clinical and administrative issues, which may then help the consultants and administrators either to pull together within the NHS, or finally separate (private practice). The wider context will also inevitably change. While financial constraints look set to tighten, it is by no means certain that the current emphasis on the economics of service delivery will continue to take precedence indefinitely over a medical notion which seeks to maximise the relief of individual suffering regardless of cost. To add to Ian's prescription, I would suggest that consultants and administrators could fruitfully get together to compare notes on the differences between the various pressures and constraints under which they respectively operate, and hope also that other staff will see fit to helpfully 'rock the boat'. Old case notes: A patient's file was destroyed after the age of 25, which is unwise as many children with psychiatric problems grow up to have psychiatric problems as adults. It is of immense help to adult psychiatrists if they are able to consult the files of their patients when they were children. Furthermore, it vitiates any possibility of longitudinal research being done on these patients. Although the present staff of the clinic may not wish to do research, I think consideration should be given to enable those who come after to undertake this work. The policy to destroy files is an extremely unwise one. The Department of Health and Social Security recommended a minimum retention period of the records for children and young people until the patient’s 25th birthday or eight years after the last entry if longer. However, alternatives such as micro-filming can be extremely expensive, and we must wonder if, in a time of expenditure cuts, a better use could not be found for the required amount of money. The dilemma of adolescent psychiatrists: The point of the paper was to emphasise the dilemma faced by all adolescent psychiatrists—if it is accepted that it is unreasonable to treat all categories in one unit, who should be excluded and what are the alternatives? In the past, most of us were taught that the treatment of conduct disorders, particularly those exhibiting personality disorder, is not really a medical responsibility, and that as a group they are not sufficiently responsive to treatment.