Dr. Tom Ryan:

There were some comments recently that this, to some extent, was about mitigating risk. However, that is not a culture of excellence. It is not a culture of providing the best possible care that the patient deserves. I have commented that risk could be mitigated by mentoring but many of the people who are appointed to consultant posts and who are not on the specialist register are appointed in smaller, more remote hospitals where the possibilities of mentoring would be minimal. An additional complication arises from the fact that sometimes - not infrequently - doctors who are not on the specialist register are appointed to act as consultants and then receive a contract of indefinite duration and are thereby incorporated into the system for good. The problem about all this is it does not prioritise excellence or quality. It actually may prevent a hospital developing. There are situations that might arise where there may be a number of consultants in a smaller, more peripheral hospital who are not on the specialist register. Then that hospital becomes uniquely unattractive for a well trained, broadly experienced consultant to come back and work in. This practice might stymie the development of some of the smaller feeder or peripheral hospitals.