It sounds like a good idea to have consultant presence on the wards 7 days a week, and it reflects a reality of modern day health care: consultants are the means through which investigation and treatment plans are currently achieved. Another solution might be to have teams that function effectively even in the absence of the consultant, but this does not seem to be a solution on the wider agenda. Consultants are the de facto clinical leaders, and they should be the experts. More junior doctors may be expert as well, and in many cases they offer leadership - but there is too much variation. The difference in expertise between a first year registrar and a final year registrar can be huge. The best way for the system to guarantee the best expertise is to focus on the provision of those people who have successfully navigated the training, and demonstrated the ability deliver the level of care required to be a consultant.
How well our training system does this is the topic of another conversation. But I can see why the currency of expertise in the current health service is measured in terms of consultant numbers.
Consultants are useful tools around which a health service can be shaped. But they are also the most expensive tools. We have to ensure that consultant time is used to the greatest possible utility.
If we look at how we might offer greater presence of consultants on the wards at weekends, there are a number of solutions that we might choose.
- Employ more consultants - costs more money, and requires more consultants to be trained.
- Pay current consultants more money to work more hours - costs more money, risks burn out, risks deterring young doctors from entering specialties that require 7 day working
- Focus 7 day provision on acute services, and cut elective services to create the capacity for more acute work - this will lengthen waiting times, and perhaps create a perverse incentive for more people to use acute services for chronic problems: we might arrive at a situation where the best way for patients to receive timely, expert care is through the acute services.