Anton Joseph

Can we salvage the concept of fair reward?

Following the announcement of the review of the clinical excellence awards scheme, I have attempted to analyse several aspects of the scheme in a series of blogs – from the lack of transparency in the negotiating process to restricting the participants to the BMA and NHS Employers.

What came as a total surprise during my research was the inconsistent roles and responsibilities of the ACCEA, ranging from setting policies and criteria for awards to just considering the need for developing the scheme. The only role identifiable with certainty is the nomination of candidates for awards. Even the terms of reference for the ACCEA are expressed variably in the annual reports.

The nearest one gets to an admission of responsibility for the scheme itself is to be found in a footnote in the Draft Heads of Terms Agreement on consultant Contract Reform. (31 July 2013). “Clinical Excellence Awards are currently a matter for the Department to determine. However Department has indicated that it would accept recommendations on the reform of the current arrangements as part of a negotiated agreement”. It may be implied that this applies to the policies and criteria.

The ACCEA website updated on 25 June 2013, in the ‘Document on ACCEA Information’ states, “The main committee sets the policies by which the scheme operates, based on the framework document of 2003 on which the scheme was established”.

What is there to be concerned about? However another document on ‘Background information for members of the national committee and the regional sub-committees’, states, “The ACCEA’s function is to establish the criteria against which candidates will be assessed and to set up and administer the process by which nominations will be judged”.

Could it be that the first document is aimed at enticing potential applicants to the committees and the latter at the elected members of the committees awakening them to a far more modest reality of their role.

But under the caption ‘What we do’, the ACCEA’s responsibility is further downgraded to:

· approving the criteria for assessing candidates

· considering the development of the scheme

Is this careless wording or does it reflect the true role of the ACCEA as decided by the DOH. Has the ACCEA requested clarification? They owe it to the consultants to expose the reality.

The ACCEA’s function “to establish the criteria against which the candidates would be assessed….” ,dates way back to the guidelines issued for the 2004 awards and the wording later repeated . It’s disappearance and replacement ‘to approving the criteria’ is inexplicable. Who stipulates the criteria?

There was further surprise in the annual reports. In the 2009 report,

The Committee’s Terms of Reference are:

“To advise health ministers on the making of clinical excellence awards to consultants working in the NHS as defined in guidance. Awards will reflect achievement over and above what is expected contractually at local levels. Decisions must reflect significant achievement and be judged against strict criteria to be set out in guidance and agreed with ministers.”

In the 2012 annual report and also in Code of Practice for the ACCEA, July 2013, the committee’s Terms of Reference are:

To advise health ministers on the making of clinical excellence awards to consultants (and academic GPs) working in the NHS as defined in guidance by:

– ensuring that the criteria against which candidates will be assessed reflect achievement over and above what is normally expected contractually;

– considering the need for development of the scheme; and

– considering other business relevant to the development and delivery of the scheme.

The ACCEA obviously admits to this limited role. What is its influence on the policies and criteria?

Throw into this confusion the role of the secretariat. “To lead in the Department of Health on development of operational policy for ACCEA” (contained in document: Information for members of the National Committee and Regional sub-committees).

It is highly significant that the policy lead for CEAs in the department is also the head of the secretariat.

How all these differing  roles and responsibilities of the ACCEA with its secretariat appear on the same website under the watchful eye of the high powered officials, including the CMO, head of NHS England and NHS medical director, as members of this committee is perplexing.

The news that female consultants are losing out under the current CEA system highlights one of the many discrepancies recognised within the scheme. It is time to question why in spite of the repeated assurances these discrepancies continue.

Could there be an underlying cause?

It is time to stop tinkering and ask fundamental questions about the policies – do they even exist – and the validity of the criteria?

The assumption is that the ACCEA is responsible for the scheme. The evidence is that the only role for the ACCEA  is to decide on the nominations for the awards – with no responsibility for policies or criteria.

The inconsistencies within the administration must be eliminated. The composition of the ACCEA needs revision. The policies that govern the scheme should be clearly stated. Means of addressing gender, ethnic, differences between academics and service based consultants and specialties should be outlined in the guide to the scheme rather than continuing to provide explanation for discrepancies in the annual reports.

The terms of reference should be based on the policies. The ACCEA should be released from the shackles and dictates of the DOH. Needless to say that the policies and criteria should be discussed and agreed with the DOH. They should not be imposed as it is now.

The concept of reward is a great one – I hope it can be salvaged.

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