Flexibility, delegation, and changing roles may improve value for money

Anaesthesia is the largest single hospital specialty. There are over 5500 anaesthetists in England and Wales alone, just under half of whom are consultants. Yet, as the introduction to Anaesthesia under Examination,1 published last month by the Audit Commission, points out, few mainstream medical specialties are as poorly understood. Many patients do not realise that anaesthetists are doctors or that they have responsibilities outside the operating theatre.2 Anaesthetists now provide clinical skills in acute and chronic pain management, intensive care, obstetrics, interhospital transfer, trauma, and resuscitation. This new found diversity may be partly to blame for current difficulties in service provision, for consultants' job plans have often not changed to reflect their increased activities.

Anaesthesia under Examination is based on a substantial amount of data. Most British hospitals replied to postal surveys on consultant shortages, maternity services, and services for pain after surgery; 39 randomly selected acute trusts underwent more extensive data collection, and in seven interviews were held with anaesthetists, managers, and patients. By highlighting anaesthetists' …