Anton Joseph

An opportunity to make CEAs more equitable

Repeated assurances on distinction awards and clinical excellence awards given to consultants is institutionalised historical deception. I apologise for the triple plagiarism.

In the past many discrepancies such as the gender and ethnic discrimination in the distribution of awards have been raised and addressed with some degree of success.

The one that seems to defy a solution is the discrepancy between the ‘clinical academics’ and the ‘NHS consultants’ (probably not the most appropriate terminology but I will stick to the use of these by the pay review body DDRB). The figures in the DDRB review reveal that the clinical academics hold 38% of the national awards and 26% of the local awards, while the NHS consultants hold 10% of the national awards and 40% of the local awards. The clinical academics predominate even more in the higher grades of national awards.

These figures do not bear out the historical assurances made to the NHS consultants.

From the time of the inception of the awards scheme it has been held that the basic purpose of a distinction award is to reward the individual consultants for outstanding work in the NHS. This has been further reinforced by assurances by past chairmen of the awards committees.

“…the essential prerequisite is the achievement of high standards in the consultant’s clinical or para-clinical work and if that is lacking he is unlikely to gain an award.” Again “Sheer clinical excellence and the direct benefit it brings to patients is in its own right is a major criterion of distinction.” (Sir Hector MacLennan, Health Trends. 1973, Vol. 5:24-26).

“Directly or indirectly, there must be good service to the NHS patients: without this a consultant however well-known he may otherwise be, will have little support for an award.” Sir Stanley Clayton went further: “Not only would this lead to rigidity in the service, with those holding appointment in the larger units and academic centres having benefits which their efforts would not entirely justify, but there would be little hope of recognition of peripheral excellence.” (Sir Stanley Clayton, Health Trends, 1973, Vol. 11:73-76).

(Reference to the gender by both Sir Hector and Sir Stanley is very revealing).

The dominance by the academic and larger DGHs however persisted. The adverse criticisms also mounted, recognised and expressed in the DDRB Twenty-Third Report 1994. “Wide spread dissatisfaction” as perceived among the consultants by the DDRB was flatly denied by the CCSC in their evidence to the Kendell Committee in 1994.

The BMA might be accused not just of misrepresentation but of contributing to the perpetration of the discrepancies. The DDRB reiterated their perception of dissatisfaction among the consultants again in their 1998 report.

The deceitful assurances by the DoH continued into more recent times. Given under the watchful eyes of the BMA and the politicians they were accepted in good faith by the consultants.

The 2001 consultation document: Rewarding commitment and Excellence in the NHS stated: “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 services including those who do so through their contribution to academic medicine.”

In establishing the Clinical Excellence Awards scheme in 2003 assurances were given that “A majority of awards will go to those who make the biggest contribution to delivering and improving local and health services”. How this could be justified within a merit based system defies belief.

Even in 2010 the assurance was: “The awards process has been repositioned to recognise the excellent work of the consultants for the NHS in non teaching centres.” (Guidelines 2010). The promise of a favoured status for the NHS consultant is clear. Did the BMA believe these assurances or did they turn a blind eye?

The ACCEA do not appear to have openly challenged this impractical assurance. How free was the chairman or medical director to question these assurances by the DOH when the Chief Medical Officer DOH, Chief Executive NHS and the Medical Director NHS were ex-officio members of the committee.

The figures in the DDRB report, however, provides no evidence of a successful outcome of these assurances for the NHS consultants, who through their loyalty and services delivered under difficult circumstances form the back bone of the NHS.

When will this deception end. Can the consultants rely on the  BMA to demand honesty and integrity? Is it not time to demand an apology from the DOH?

As a critical time for the CEA scheme approaches, with the BMA’s negotiations with NHS Employers over the consultant contract coming to a head, will consultants and the BMA now demand an explanation from the government’s policy lead for Clinical Excellence Awards?

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2 Responses to “An opportunity to make CEAs more equitable”

  1. Joe says:

    Correction with apologies to the DDRB
    I am most grateful to Mr. Clifford Wilkes, Secretary, Review Body on Doctors’ and Dentists’ Remuneration for bringing to my attention the error (para 3) in the percentage of the awards held by clinical academic and NHS consultants. It should read:
    “the report shows that 38% of clinical academics hold national awards and 26% of clinical academics hold local awards; and 10% of NHS consultants hold national awards and 40% of NHS consultants hold local awards”.
    I am most grateful to Mr. Wilkes for this.
    In addition to enabling the correction to be made it should give Mike Broad, the editor and readers of Hospital Doctor great satisfaction that detailed attention is being paid to the contents of the Journal. Well done Mike. I hope action will follow.
    At the same time it should also disturb the readers that in spite of the genuine efforts made by the DDRB to produce the report and repeatedly over the years to bring to the attention of the DOH and the profession matters of serious concerns in the awards scheme there is nevertheless a ‘Carry on Regardless’ attitude on the part of those who should institute a more equitable scheme. There is no mechanism to ensure that concerns expressed by DDRB are acted on and inquired into and not summarily dismissed or ignored. It is one thing for the government not accepting all the recommendations by the DDRB but it is another to ignore the concerns of dissatisfaction on the part of the profession perceived by the DDRB. This was a shocking betrayal of the consultants.
    The role of the DDRB is to highlight the deficiencies and concerns and justifiably may conclude that it is not their role to police the administration of the scheme. The truth is it is given into the hands of the DOH with little concern by anyone thereafter. Who is to be held responsible. Another opportunity has presented itself to make redress. Will those responsible act to ensure justice. The concept of awards is a great one but it has fallen into some disrepute by the way it has been managed by the DOH. Will deception and indifference be replaced by honesty and a genuine interest to reward those deserving consultants.

  2. Joe says:

    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”.
    But on the same web site 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”. Note not setting of policies.
    Under the caption ‘What we do’, the ACCEA’s responsibility is further downgraded to: approving the criteria for assessing the scheme and considering development of the scheme. Note progressive stripping of powers. Whose prerogative is it to do this and indeed who is responsible for this?
    Again in the Annual report 2012 and Code of Practice for the ACCEA, July 2013, the committee’s Terms of Reference are duties get even more mundane:
    To advise health ministers on the making of clinical excellence awards to consultants (and academic GPs) working in the NHS as defined in guidance. 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 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 the Department has indicated that it would accept recommendations on the reform of the current arrangements as part of a negotiated agreement”.
    Can the DOH explain these confusing roles of the ACCEA as contained on its own web site. ‘The answer my friend is blowing in the wind’: the Policy Lead in the DOH. The DOH and NHS hierarchy nodded in agreement

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