Professor Matthew Sadlier:

Two issues are being conflated here. One is the requirement relating to an involuntary detention and the need to consult with another member of the multidisciplinary team which, in fairness, is a very small but very important part of every consultant psychiatrist's work. However, as previously said, only a very small fraction of the patients are admitted as involuntary patients. We would have serious concerns about having to consult with another member of the multidisciplinary team given that in the current structure only doctors are people who work on-call and who work on 24-7 basis. Obviously, nurses work in staffing the inpatient units on a 24-7 basis, but involuntary admissions occur at all times of the day and night. The other members of the multidisciplinary team invariably work a 39-hour week. There are variations and obviously I will let other specialties and professions speak for their own contractual entitlements. Historically and up to now they have not worked on a shift rota pattern; only doctors have done that. Will we be delaying involuntary admissions that occur at 4 o'clock in the morning waiting for somebody to be there?

To have that level of staffing, we would need to double, if not triple, the numbers of staff and I am not sure enough qualified people are available internationally to fill the number of posts this requirement could create. That relates specifically to the issue of approved centre admissions.

The other area relates to the general principle of multidisciplinary or interdisciplinary team working. The documents even show what the difficulties are, such as the confusion between multidisciplinary and interdisciplinary team working. Nobody is against the concept of multidisciplinary working with patients. As for how the health service structures that in a way that avoids issues such as postcode lotteries and allows complicated and specialist care to be given to complicated and specialist patients, which is a much longer discussion about how we structure mental health services, that is a different issue.