Anton Joseph

We should learn the lessons from Clinical Excellence Awards not scrap them

The fate of the Clinical excellence Award (CEA) scheme may have been decided. A brief history of the award scheme (which I was privileged to contribute to) may be found in: The Review of compensation levels, incentives and the Clinical Excellence and Distinction Award schemes for consultants, presented by the DDRB in December 2012.

The dissatisfaction with the CEA the scheme may be entirely attributed to the incompetence at the highest levels of administration in the Department of Health and NHS and their failure to address the imbalance between the academic and NHS service consultants holding higher awards. This despite a Department for Policy for Clinical Excellence Awards with a departmental head within the DOH.

Several assurances have been made to the NHS service consultants to give greater recognition of their contribution to the NHS even as far as to state, “A majority of awards will go to those who make the biggest contribution to delivering and improving local and health services”. (Why do academics dominate the CEAs? 20 September 2013.)

The inconsistency of this assurance within a system based purely on merit was never challenged.

It is however clear from the figures published in the DDRB report that the discrepancy persists  with “38% of clinical academics holding national awards and 26% of clinical academics holding local awards; and 10% of NHS consultants holding national awards and 40% of NHS consultants holding local awards”.

This strongly suggests that efforts taken by the DOH and the ACCEA, if any, were fruitless. I suggest that the assurances were made purely to placate the incessant demands by the profession and the politicians. Deceitful is an apt description. Not only is there no evidence of an attempted solution but there is evidence of contemptuous disregard of this issue. The ACCEA categorically informed the DDRB that they do not gather statistics for academic consultants since they could not categorise them as a distinct group – and yet they claimed to be addressing the problem.

It is clear there wasn’t even a consensus on the identity of the two groups. How could such divergence of opinion between the DOH and the body determining the awards have been tolerated? The Triennial review of the ACCEA with a specific mandate to review the governance of the scheme even failed to comment on this vital inconsistency in the scheme.

The Triennial review body on the other hand recommends changes explicitly shifting the distribution of awards even more in favour of the academics, recognising even more work of national or international significance ignoring the previous ruling by the CRE that this would be indirectly discriminatory to the ethnic minorities who working in larger numbers in the smaller DGHs have little opportunities to satisfy this requirement.

Assisting the review body and sitting in judgment was a Project body in which the chairman and medical director of the ACCEA, together with the policy head were members, while themselves being under scrutiny. Are we surprised that they came out squeaky clean?

Is there a possible explanation for the dominance of the academics? Pardon me if I stray into the land of political incorrectness. The academic consultants probably started with top A level grades, entered the more sought after universities and obtained the more sought after jobs with support for research and innovation. Their talents and achievements must be recognised not curtailed.

The fundamental error seems to the obsessive adherence to the belief that there should be proportional distribution of awards among all sub groups distinguished by ethnicity, gender, specialty and others. This has also been applied to academic and service consultants. Consultants of different ethnicity and gender are more likely to be exposed to comparable working conditions. However, the academic consultants are in a far better position to fulfil the domains designated in the criteria for awards.

I reliably understand that attempts to provide a more level playing field by the chairman of ACCEA was resisted by the department of policy in the DOH responsible for CEA policy.

This situation should be rectified and the concept of awards based on merit, achievements and rewards should be saved for the benefit of all consultants. Watch this space for a possible solution.

Will the head of policy for CEA in the DOH be held responsible for the incompetence that might well see the end of a fundamentally sound scheme that has survived since the beginning of the NHS and indeed survived several searching reviews? Will the hierarchy of the DOH and the NHS be prepared to indict themselves? It’s doubtful. Instead we’re likely to witness the demise of a scheme that has incentivised generations of doctors to go the extra mile and deliver great innovations.

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One Response to “We should learn the lessons from Clinical Excellence Awards not scrap them”

  1. mct.morrison says:

    It sounds a bit like “write your own Job Description” so that your CV will tick all the right boxes!

    I believe many consultants ‘at the coal face’ (though not in a coal mine!) are somewhat sceptical about being ‘judged’ by lay managers in regard to their ‘cilincal excellence’! Could they be influenced by how well the consultant ‘toes the (managemnt) line’?

    It is also quite interesting to contemoplate about where the ‘major advances’ in medicine originated. Certainly in orthopaedics, nearly ALL the major advances (joint replacement and arthroscopic surgery) were developed in ‘provincial’ DGHs!

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