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...

READ MORE » NHS Consultants' bonuses - Are they justified?

Bullshit bingo!

Don't know about you, but I'm getting to the point where listening to all the parties droning on is beginning to get to me!


So come on guys, let's bring some colour into the campaign! Spice up your rhetoric! You know you can do better!

Here's a list of just a few of the useful phrases I have already spotted some of you using (you know who you are!)....

• Let me just pop something into your mental microwave and see if it defrosts
• The wheel's spinning but the hamster's dead
• We’re not cutting back, we’re just shortening the waste chain
• We've got to downsize our sloppiness
• We need to ensure we're all singing from the same hymn sheet before we push forward
• Scatter the ideas across the floor and let's see where the chickens scratch
• We will introduce a radical cost reduction action plan (C.R.A.P.)
• Unemployment is higher than it was in 1994, but not as high as it would have been if the others had been in power
• We will cut the deficit by ensuring that the increase in our rate of overspending is not as high as it otherwise would have been
• I'll do whatever I can to make sure that the future of this country becomes entrenched
• Frontline services will be protected but it may be necessary for some frontline services to be reclassified into the backoffice
• Government waste is running out of control and it is essential that we ensure that any future waste will not be unnecessarily wasted (sorry?...)
• Management is essential but we must ensure that these managers are effectively managed
• We need to increase National Insurance so that it is not necessary to increase taxes

And my own particular favourite :

• We need to deliver simplified contract management, effective service evolution and responsive scaling to requirement bringing cost savings by flexible services, control and balanced service levels

I will leave it up to you to work out who used that particular little gem...

READ MORE » Bullshit bingo!

Who disconnected my MP !?!?

A recent survey in the newspapers this week revealed that MPs feel disconnected from the public, powerless and frustrated. Equally, the electorate feel that politicians are out of touch with their needs and that there is no point in voting in an election.

So what is it that has caused this rift between the government and the people?

To get to the root of this problem we need to look at the way policies are set at the highest levels of government and how they are implemented at the lowest levels. Everyone knows that unemployment is a bad thing. Unfortunately, in recent years the politicians at the top of the tree have decided to implement huge quantities of unnecessary and politically correct legislation in order to create jobs for civil servants and local government officials to implement.

People's lives are affected by it every day minutiae. If you have a problem with your environment, there are huge potholes in your roads, the guy in the house next door is running an illegal and noisy business or even a street light needs to be repaired then it is likely that you will have to deal with some form of local government clerk.

Regrettably, the chances are that the clerk you will be dealing with will be an otherwise unemployable youngster who has been given the job purely for the purposes of removing him from the unemployment statistics. He or she (note the careful observation of equalities legislation here) is probably ill educated and badly trained. It is further quite likely that the legislation and procedures they are being asked to implement are completely beyond their comprehension. Of course, you could argue that this is due to the shortcomings in educational and training policies in the first place.

So, you make your phone call or write your letter. You will probably receive standard response number 22 from the manual of how to deal with 'customers'. This makes you immensely frustrated so eventually you contact your MP. Unfortunately, your MP is locked away in the great white ivory tower known as the Houses of Parliament and is so busy deciding on high-level policies that they frankly do not have time to deal with your problem even if they actually want to.

The fact of the matter is that your MP answers to somewhere around 70,000 constituents -- most of whom must be remembered could not be bothered to vote for them in the first place -- and if every one of those constituents pulled his problem to his MP, he or she would simply be swamped.

So we need to inject some enthusiasm into the lower levels of government. The fact of the matter is that the quality of staff employed is inadequate, and they are demotivated, demoralised and disinterested. The greatest malaise of recent years is this government's obsession with targets. No one is interested in collecting meaningless statistics to be massaged by their manager so that it looks like central government is achieving a target.

To make things worse, the people at the top are obsessed with these targets because the figures that are then produced make it look as if they have actually achieved something. The fact of the matter is we have achieved absolutely nothing. What we have done is to create work at the top thinking up new targets and work at the bottom collecting statistics to prove that we have met these targets.

The answer then is quite simple -- we need to set a target for how many targets we can abolish. The money that we save by doing this can be spent on proper education, training and recruitment so that we have the right people in the right places to solve our everyday problems in the first place.

This will make our electorate much more contented, will demonstrate to them that the people we are paying taxes to employ actually have some effect, and will make them feel more inclined to go out and vote.

Alternatively, we could simply set a target to get more voters into the booths....

READ MORE » Who disconnected my MP !?!?