Anton Joseph

CEAs are changing and they need clear principles

It now seems a certainty that there will be major changes to the Clinical Excellence Awards. Despite the objections raised, the award scheme should survive. Abandoning the scheme will be tantamount to rejecting the universally cherished concept of rewards.

Before any changes it is essential to identify those aspects which require change. Changes in the past addressed with some degree of success, secrecy, gender and ethnic discrepancies and the composition of the advisory committee to make it more relevant. The preponderance of  academic consultants however has largely defied attempts to correct the perceived anomaly.

Representations were made to the CRE (renamed Equality and Human Rights Commission) that the smaller DGH consultants and hence the ethnic minorities working there in larger numbers were at a disadvantage due in particular to the requirement of work of ‘national or international significance’ for the higher awards. The CRE recommended against this requirement. The outcome of these discussions were reported in the Fifth Annual report of the ACDA published in 3 March 1998. The DDRB,  unaware of this, has suggested the return of this criterion for the national awards.

The DOH in a consultation document (2001): Rewarding commitment and Excellence in the NHS – proposals for a new consultant reward scheme, stated that “Clinical excellence awards will reward those consultants who contribute most towards the delivery of safe and high quality care to patients and to the continuous improvement of the NHS service”. This was reiterated with the launch of the Clinical Excellence Awards launched in 2003 when it was even stated that the majority of awards would be to recognise these contributions.

It defies belief that such assurances could have been given. However it placated the politicians and consultants were lulled into a false sense of security.

Who was responsible for the scheme? The chairman of the ACDA wrote on 16 May 1996 to say, “They were not developed by us, but following a substantial formal negotiation between the Department of Health and the Profession”.

However as recently as 25 June 2013, the ACCEA web site, (contents being the responsibility of the DOH) states, the main committee sets the policies and establishes the criteria against which the candidates will be assessed. However in the Draft heads of terms on consultant contract reform issued jointly by the BMA and NHSE July 2013 it states that Clinical Excellence Awards are currently a matter for the Department of Health and the Department would accept recommendations as part of a negotiated agreement for a framework based on which the ACCEA’s successor organisation would perhaps formulate the policy. In spite of the declaration on the website, the advisory committee was never responsible for policy in the past and it is unlikely this time either.

The ACCEA, an important stakeholder, does not appear to have been invited to the discussions yet. Their experience would be invaluable. Their lack of involvement is inexplicable.

There is blatant duplicity in the presentation of the functions of the ACCEA and the practices adopted. As it stands could a chairman held responsible for setting the policy declare the policy to be flawed?

The inclusion of the Chief Medical Officer DOH, Chief Executive NHS and the Medical Director NHS in the ACCEA may carry with it some advantages but it could also give rise to conflicts of interest.

Most stakeholders are probably unaware of this duplicity. The current scheme based on the framework reached by the BMA and the NHSE is clearly flawed and is likely to be repeated. It is still not too late despite the DOH refusal to have greater  involvement of stakeholders and the recognition that the consultants are the most relevant stakeholders.

Heads of terms for agreement have been negotiated, but the principles underlying the scheme as in the past  have not been enunciated.

Here are my key principles for discussion:

– clearly defined premise

– total transparency

– awards aimed at rewarding consultants for the services delivered for the benefit of the patients, the wider NHS and those who bring reputation to British medicine

– the roles of the DOH and the ACCEA should be stated without ambiguity with independence of the granting body to develop policy and criteria within an agreed framework. The ex- officio membership should be revisited, since the present composition may result in conflict of interests

– a  common scheme for the academic and the non academic consultants, the fundamental cause for the failure of the current scheme, should be treated as untenable

– the scheme should be based entirely on rewarding merit and fairness. It does not make sense to emphasise balancing ratios between any two groups within a scheme declared to be fair and based purely on recognising merit. We can ignore political correctness.

What do you think?

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