Just to give some more information, I've force installed the psa-qmail rpm overtop of the old one, but things still seem a little sluggish. While top is running I'm seeing things like (the huge number of spamd processes worries me, should I be?):
PID USER PR NI VIRT RES SHR S %CPU %MEM TIME+ COMMAND
4086 root 17 0 3216 976 1624 R 1.0 0.8 0:00.84 top
4136 qmaild 16 0 4836 800 3224 S 0.7 0.6 0:00.02 qmail-smtpd
2288 root 15 0 8216 1456 6844 S 0.3 1.2 0:01.84 sshd
2 root 34 19 0 0 0 S 0.0 0.0 0:00.00 ksoftirqd/0
3 root 5 -10 0 0 0 S 0.0 0.0 0:00.00 events/0
4 root 5 -10 0 0 0 S 0.0 0.0 0:00.00 kblockd/0
6 root 5 -10 0 0 0 S 0.0 0.0 0:00.01 khelper
5 root 15 0 0 0 0 S 0.0 0.0 0:00.00 khubd
7 root 15 0 0 0 0 S 0.0 0.0 0:00.02 pdflush
8 root 15 0 0 0 0 S 0.0 0.0 0:00.06 pdflush
10 root 15 -10 0 0 0 S 0.0 0.0 0:00.00 aio/0
9 root 16 0 0 0 0 S 0.0 0.0 0:01.15 kswapd0
113 root 22 0 0 0 0 S 0.0 0.0 0:00.00 kseriod
147 root 15 0 0 0 0 S 0.0 0.0 0:00.21 kjournald
944 root 18 0 0 0 0 S 0.0 0.0 0:00.00 kjournald
1598 root 15 0 3024 540 1300 S 0.0 0.4 0:00.31 syslogd
1602 root 16 0 2088 372 1248 S 0.0 0.3 0:00.03 klogd
1620 rpc 16 0 2156 440 1376 S 0.0 0.4 0:00.00 portmap
1639 rpcuser 17 0 2700 568 1472 S 0.0 0.5 0:00.00 rpc.statd
1665 root 16 0 2568 484 1300 S 0.0 0.4 0:00.00 rpc.idmapd
1751 root 18 0 2040 352 1240 S 0.0 0.3 0:00.00 acpid
2233 named 18 0 38252 2768 4780 S 0.0 2.2 0:00.00 named
2266 root 16 0 4440 856 3444 S 0.0 0.7 0:00.00 sshd
2279 root 15 0 2844 724 1688 S 0.0 0.6 0:00.03 xinetd
2304 root 19 0 6992 996 5028 S 0.0 0.8 0:00.02 safe_mysqld
2328 mysql 16 0 119m 3948 5608 S 0.0 3.1 0:00.19 mysqld
2394 root 21 0 3844 724 3300 S 0.0 0.6 0:00.00 couriertcpd
2397 root 18 0 3556 328 3192 S 0.0 0.3 0:00.00 courierlogger
2406 root 24 0 4836 724 3300 S 0.0 0.6 0:00.00 couriertcpd
2409 root 24 0 4532 328 3192 S 0.0 0.3 0:00.00 courierlogger
2416 root 15 0 4188 792 3300 S 0.0 0.6 0:00.02 couriertcpd
2418 root 15 0 4256 508 3192 S 0.0 0.4 0:00.01 courierlogger
2427 root 23 0 4600 724 3300 S 0.0 0.6 0:00.00 couriertcpd
2429 root 25 0 4008 328 3192 S 0.0 0.3 0:00.00 courierlogger
2438 qmails 15 0 2160 348 1260 S 0.0 0.3 0:00.22 qmail-send
2440 qmaill 16 0 2320 408 1232 S 0.0 0.3 0:00.03 splogger
2441 root 16 0 2396 328 1240 S 0.0 0.3 0:00.00 qmail-lspawn
2442 qmailr 15 0 2244 248 1236 S 0.0 0.2 0:00.00 qmail-rspawn
2443 qmailq 16 0 1972 272 1232 S 0.0 0.2 0:00.01 qmail-clean
2470 qmailr 15 0 4392 688 3248 S 0.0 0.5 0:00.00 qmail-remote
2504 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:01.78 spamd
2506 popuser 22 0 28556 1940 7412 S 0.0 1.5 0:01.81 spamd
2517 root 16 0 2896 360 1448 S 0.0 0.3 0:00.00 gpm
2520 popuser 18 0 29832 4868 7412 S 0.0 3.9 0:00.77 spamd
2521 popuser 18 0 29828 6792 7412 S 0.0 5.4 0:01.09 spamd
2522 popuser 18 0 29820 6524 7412 S 0.0 5.2 0:01.09 spamd
2524 popuser 18 0 29888 9224 7412 S 0.0 7.4 0:01.18 spamd
2529 popuser 18 0 30152 6544 7412 S 0.0 5.2 0:00.89 spamd
2530 popuser 18 0 29888 7252 7412 S 0.0 5.8 0:01.27 spamd
2531 popuser 18 0 29900 8456 7412 S 0.0 6.7 0:00.72 spamd
2532 popuser 18 0 30000 10m 7412 S 0.0 8.8 0:01.07 spamd
2533 popuser 18 0 29748 10m 7412 S 0.0 8.8 0:00.58 spamd
2534 popuser 18 0 29936 10m 7412 S 0.0 8.7 0:01.45 spamd
2537 popuser 18 0 29952 13m 7412 S 0.0 11.3 0:01.26 spamd
2538 popuser 18 0 29584 14m 7412 S 0.0 12.1 0:00.50 spamd
2539 popuser 18 0 29656 16m 7412 S 0.0 13.8 0:00.67 spamd
2540 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2541 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2542 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2543 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2544 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2545 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2546 popuser 25 0 29040 2996 7412 S 0.0 2.4 0:00.00 spamd
2547 popuser 18 0 28556 1932 7412 S 0.0 1.5 0:00.00 spamd
2548 popuser 18 0 28556 1932 7412 S 0.0 1.5 0:00.00 spamd
...