Although psychiatry's future looks less and less likely to be in large psychiatric hospitals, trainees at SHO/registrar level still spend nearly all their time in them. Although the White Paper looks set to dismember comprehensive provision as we know it, few psychiatrists have experienced self-employment, and most are untrained in practical management skills. Although our consumers – as we must now view them – are getting more discerning about what services we offer, psychiatrists only see them after they become ill, and less able to decide for themselves.