'50% increase in doctors needed'

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The leading surgeon in England has said there needs to be a 50% increase in the number of hospital consultants by 2010.

Bernard Ribeiro, President of the Royal College of Surgeons of England, said the increase was necessary for a "safe service" in the NHS.

The Department of Health said last year that 2,700 more consultants would be needed in England and Wales by 2010.

But Mr Ribeiro said that since then a freeze on consultant posts has been introduced to help tackle debts.

A&E reconfigurations are not cost-cutting exercises - they are about providing the most appropriate care in the right setting and location. Department of Health spokesman

Speaking at the RCS, he said the increase from the current 5,462 that was needed "to guarantee the safety of patients."

"When I come into the A&E department having had a major road accident or because my aneurysm has ruptured I frankly want to be treated by a consultant straight away, who will say: 'you need x, y and z.'

"What I don't want to do is to come in to be seen by various tiers of staff who then do a series of investigations and then finally, the penny drops."

He added: "If you want a safe service and if you want that service delivered by a consultant, you have to train them and train enough of them."

'National plan'

Mr Ribeiro warned that, as a consequence of the freeze some senior doctors who do not have the opportunity to become consultants may decide to emigrate.

He said the impact of the freeze, along with the introduction of the European Working Time Directive (which will reduce doctors' working week by 14% to 48 hours) and less experienced trainees coming through the system, will make 2009 - when current government funding will have run out - "the crunch point".

He said the pressure on the emergency surgical service will mean the ability to maintain safe rotors to cover the emergencies in every district general hospital will be "severely challenged".

And he called for a national plan for emergency services, consisting of a network of hospitals providing three levels of care.

The top tier would have all major surgical specialities, 24 hour resuscitation and back up and a helicopter trauma service. The second tier would provide a 24-hour service but not all major surgical specialities, and the third would serve less than 200,000 people in a remote area and be able to treat and transfer patients to other hospitals.

Priorities

He said: "We are not talking about closure of emergency services, we are talking about redefining how those services are used.

"You might lose your A&E department but it doesn't mean that you lose your hospital, it doesn't mean that the surgeon won't be there to do out-patient clinics."

He added: "The focus should be on the critically ill patients.

"I am not saying we should ignore the elected patients but I think the pendulum has swung too far the other way."

But a Department of Health spokesperson said: "We have more consultants than ever before - 10,519 more than 1997."

He added: "Patient safety is always top priority for the NHS.

"A&E reconfigurations are not cost-cutting exercises - they are about providing the most appropriate care in the right setting and location.

"Decisions have to be clinically led, to ensure the best care for patients, but of course they have to take account of the budget.

"There are many examples of changed services providing both better quality care for patients and better value for money too."