Abstract
In the modern anaesthetic directorate with expanding demand in terms of service delivery of surgical contracts, growing emergency demand and increasing demands for anaesthetists' services outside the operating theatre, there will always be conflicts. It is not possible to increase the services provided endlessly without further resources, whether in terms of staff, equipment, space, etc. Some sort of service level must be understood as fair and equitable, and a balance must be struck between quantity and quality which is a proxy for safety. It will be the role of the clinical director to negotiate with colleagues at board level to ensure that demands do not outstrip supply. An individual consultant anaesthetist cannot be committed to additional work or changes in practice by the clinical director. Only by careful and fair negotiation can agreements be concluded which respect the opinions of professionals involved and which ensure, as far as possible, the safety of patients and staff.
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