The BBC's James Westhead at the BMA conference

In his final speech before standing down as chairman of the British Medical Association's council, Sir Alexander Macara said consultant expansion was desperately needed to boost the quality of patient care.

Without it, the hospital service was worthless and young doctors - better trained than ever before - were consigned to "uncertainties about their future".

Empty rhetoric

"Without consultant expansion, all the worthy aspirations about reducing our costs and engaging the profession in the management and development of services are by empty rhetoric because the workload on our existing consultants is increasing remorselessly," Sir Alexander said.

"The time and opportunity to teach, to research, to develop, to advise, to manage, is simply not there."

Sir Alexander said the jury was still out on the new government which had to deliver on its promises to renew the health service.

Private finance

He rounded on ministers for retaining the Conservatives' policy of using private finance to fund the NHS' development.

Sir Alexander Macara accuses Labour of 'about-turn' on PFI

"We see this government's convincing arguments against the Private Finance Initiative while in opposition now translated into enthusiastic implementation when in power: an about-turn which would be a comic turn were it not tragic," he said.

He stated that PFI would inevitably lead to commercial investors reaping a return "at the expense of higher public expenditure on healthcare and reduced patient services".

The government also had to admit rationing in services was a reality and accept a national debate was required on the choices which had to be made.

Provision of care must be based on patient need and effectiveness of outcome, said Sir Alexander.

Arrogance

Dr Fay Wilson from Birmingham is to put a motion to the conference, criticising the government for being arrogant.

Dr Fay Wilson accuses the government of arrogance

She said: "Doctors feel the government may be basking in the feeling that, as doctors welcome their new style and reforms of the internal market, they will lie down and say yes to everything."

She said many of the government's policies sounded good, but that doctors were worried that they were being implemented too fast.

And, although they welcomed the promise of extra money, but were anxious about where it would go.

"The government is steamrollering through policy in a very short time without the adequate tools being there to do the job," said Dr Wilson. "We must ensure that partnership is not just a one-way relationship."