Dr. Tom Ryan:

There is a problem in that if a doctor is appointed as a consultant, one is appointing an independent medical practitioner and there is no possibility of mentoring an independent medical practitioner. If I ask a consultant colleague for his opinion, I expect an opinion from him that is valid, appropriate and discerning, not an opinion from somebody else who is mentoring him. The whole point of appointing a consultant is to appoint a substantial person who can practise independently. The whole notion of bringing them up to scratch is really a nonsense because they are either an independent medical practitioner or they are not. If they are not up to scratch, they should not be doing the job.

This is a confusion of risk and quality. In any other industry, like the aeroplane or transport industries, the industry does not act to mitigate risk, it acts to improve quality. It does not wait until the train or the aeroplane crashes and a person ends up in the courts or in front of the Medical Council; it ensures that the pilots are appropriately trained, the aeroplanes are appropriately maintained and good quality processes are in place. A basic quality process is to ensure that the staff who are supposed to practise independently are appropriately trained and qualified. It should never come to the fact that someone detects there is a problem only when a doctor ends up in front of the Medical Council or the High Court for malpractice. There should be quality programmes, and a basic part of a quality programme is to stick with basic professional standards and to ensure that all consultant staff who can practise independently are up to scratch and appropriately qualified. This is just the most basic standard that we would use to base any quality programme on. The whole notion that one would wait until somebody had caused a problem with the Medical Council and then flag up a risk is a problem. It is not prioritising quality of care, excellence of standards and an aspiration for either academic or clinical excellence. I believe the dialogue is misguided.