NHS Consultants' bonuses - Are they justified?

When our new coalition government looks for ways to save money in the NHS, perhaps we should be looking closely at the way the NHS Consultants' Merit Awards system works, and ask whether it is time for a review?

The following is taken from an article in the Sunday Times in 2008 :

"Figures obtained by The Sunday Times under the Freedom of Information Act suggest hundreds of NHS consultants earned more than £190,000 in the financial year ending in March – more than Gordon Brown – putting them in the top 1% of earners.

By contrast with highly paid workers in the private sector, who now face widespread unemployment, they also enjoy full job security.

Previously NHS consultants turned to private work for extra income. The figures show they can now more than double their basic salaries by sticking with the health service, thanks to bonuses inflated by incentives to meet government targets to cut waiting lists.

The generosity of the NHS towards its senior staff may anger patients who have recently been deprived of modern cancer or osteoporosis treatments because they have been deemed too expensive."

Here's the views of "Old Sawbones", our Consultant in the know :

"The prioritisation of resources available from the tax payer to fund health care in a world of increasing financial restraint becomes ever more important, and the contentious issue of consultants' distinction awards should be open to public scrutiny.

The present system appears to be more equitable and transparent than when I was appointed to a consultant post in 1975, at which time it had many features of an "old-boy network". Committees were dominated by previous recipients, and the whole procedure was shrouded in such secrecy that one often did not know who had an award, and often quite why .

Indeed, I can recall the dilemma of a newly appointed consultant who was threatened with not being considered for one, if he did not toe a particular medico-political line.

Of course, this would not and indeed could not happen today. However, whether these awards are justified is a subject that now requires an open debate. When I left the NHS, the committees set up to award the discretionary points, given as a preliminary to the more major awards, were more democratic and a real attempt was made to ensure that the process was as fair and objective as possible. I am sure this has evolved further.

It would be helpful however, if the public and the profession could be reassured that the procedure for awarding the major B, A and A+ awards was transparent, and that the magnitude of these awards is justified.

Clinical excellence may not always be easy to assess, and it can be invidious to compare one medical speciality with another, when the pressures and challenges may differ widely. Service redevelopment, administrative duties and medical audit appear to be popular themes, but how easy can it be to quantify dedication, compassion and exceptional commitment to patient care, without true 360 degree appraisal, including nursing staff input and patient feedback?

It may be that the public and the profession can be reassured that the assessment of merit is now a fair and objective process, without political patronage or sycophancy. Perhaps however, one is left with the feeling that it is a privilege to be a doctor, and the professional rewards of a well remunerated job should be sufficient to prevent a consultant from being attracted to what may be a more lucrative elsewhere."

I think it is clear that the system needs to be looked at again and that there is a clear understanding why these payments are made and how they are justified. Employing armies of managers to create and monitor arbitrary targets just to support a bonus system, simply doesn't cut it.

Performance related pay structures for doctors would seem to me to be contrary to the welfare of patients and wholly inappropriate...