Dr. Lorcan Martin:

There are two issues to consider. The Deputy referred to matters such as out-of-hours services, admitting patients and so on. Consultant psychiatrists have a specific set of skills and very extensive training. They have a remit within their contracts as clinical team leaders. The difficulty will arise when another professional disagrees with the consultant psychiatrist about whether somebody needs to come in. How is that going to be resolved? If somebody needs to attend out of hours, we have an on-call system whereby we are available at any time to see somebody who is seriously ill. The same thing will have to be arranged from a logistical point of view.

More fundamentally and philosophically, we have a very specific set of skills and specific training. We are trained not only in mental health; we are also trained as doctors. Nobody presents purely with mental illness. They are going to present with other illnesses that may compound the mental illness. They are going to present on medications from their GPs that may interact with psychiatric medications or that may, in fact, be a part of the cause of the so-called mental illness presentation. That is why the consultant is uniquely placed to be clinical team leader.

I totally echo what our colleagues from the IASW are saying. It is entirely appropriate for individual professionals to have their own line manager and accountability. A well-functioning multidisciplinary team - and I feel blessed to work in one - is not simply a bunch of professionals working together. It is a bunch of professionals dovetailing together to provide the best possible outcome for a patient. There will be overlapping roles where people help each other out but also a clear delineation of individual roles and functions within that team. It also involves a common vision and moving forward to provide the best possible outcome for a patient. If governance is shared, that system begins to fracture. People need someone to whom they can turn for a focus. They need someone they know has the background and training for the overall maintenance of the welfare of the patient. That is where the consultant is uniquely placed.

No one is saying that other people should not have a voice; they absolutely should have. As Dr. Whyte said, everyone brings their own unique perspective and set of skills and that is what makes for a functional team. There are a number of issues around redefining the multidisciplinary team. Working as a multidisciplinary team as currently defined, if well resourced, well supported and working well, is a very good way of working. I have seen that to be the case. The whole issue of individual accountability within professions and supervision and training are important. I have, unfortunately, seen situations where people come in to jobs as, for example, managers of a particular allied health profession without a background in mental health. That causes real problems and it is very frustrating then for the people who work below such a manager because they turn to the manager for supervision and, in fact, the manager know nothing about it. It is not only important to have adequate supervision but adequate supervision by people who are in a position to supervise. I absolutely endorse what Mr. Barry and Mr. Geiran have said about having well-resourced teams with individual accountability for the professions and which pull together at a clinical level with a single vision under a clinical team leader, who I believe should be the consultant psychiatrist for the reasons I have outlined.