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NHS: Clinical Excellence Awards

Volume 728: debated on Monday 27 June 2011


Asked By

To ask Her Majesty’s Government why they have decided not to recommend any Clinical Excellence awards for NHS consultants this year.

My Lords, the 2011 round for clinical excellence awards is currently proceeding, with the rules unchanged. No decisions have been taken about the 2012 round. The Doctors’ and Dentists’ Review Body is taking views on the matter from other parties and in due course will make a recommendation, which the Government will consider.

My Lords, I thank the Minister for that Answer. Is he aware that there has been some ill informed comment in the public press suggesting that these awards are bonuses? They are not. They are a fundamental part of the salary structure of senior clinical academics and consultants. They were introduced as distinction awards by Aneurin Bevan at the inception of the National Health Service in order to persuade distinguished consultants and academics to give their services to it. If it were to be suggested that these awards would be abandoned, as has been thought in certain quarters, would the Minister agree that that would sound the death-knell for clinical academic medicine and high-quality clinical practice teaching and research in the NHS?

My Lords, in building the NHS that we all want for the future, we need to continue to recognise and reward those individuals who give outstanding patient care and who contribute in a notable way to clinical academic excellence. At the same time, we need to ensure that the system in place to do that is effective, affordable and in line with other public sector reform. It is those questions that the Doctors’ and Dentists’ Review Body is considering at the moment.

Does the Minister agree with the Academy of Medical Royal Colleges, the Academy of Medical Sciences and others that clinical excellence awards make an important contribution to the quality and excellence of care in the National Health Service? How will the replacement of these awards by one-off non-pensionable awards, like the proposed surgeon of the year prize, improve standards?

My Lords, as I have just said, we believe that financial rewards, in the form of clinical excellence awards, should remain. It is just a question of how that system is designed. We have not said that non-financial recognition should take the place of financial awards. They would operate alongside financial awards; they would not in any way supplant them. However, we think that there is a role for perhaps more imaginative thinking in areas like speciality-based awards or departmental or division-based awards, for example, or indeed ad hoc recognition for outstanding clinical leadership. The DDRB is looking at these questions too.

My Lords, I commend the noble Lords, Lord Walton and Lord Ribeiro, on doing a really admirable job as the shop stewards for distinguished clinicians—and quite right, too—but I would point out that innovation and excellence cuts across all NHS staff, including nurses, midwives and therapists, who often introduce wonderful innovation at their level. Could the Minister tell us what incentives are in place in the system that recognises that excellence as well?

The noble Baroness is absolutely right. We do need to incentivise all staff, both clinical and non-clinical in the NHS, to innovate. We can do that in a variety of ways. She will know that the noble Lord, Lord Darzi, proposed a number of ways of doing this, including innovation prizes and innovation funds, which are extremely popular. We also can incentivise through the tariff. As she will know, we have protected the research budget, which in the long term will serve us well in driving through innovation in the NHS.

My Lords, can I encourage my noble friend, when he considers the 2012 awards, to talk to his colleagues about introducing some more transparency into the awards? Part of the difficulty referred to by the noble Lord, Lord Walton, is that no one knows who, or why, or how much. Transparency would be a strengthening as well as a salutary experience for many in the health service.

I agree with my noble friend. We have identified a number of anomalous features in the current scheme which need to be looked at. He is absolutely right to point out that the current scheme is far from transparent. It enables rewards to continue that are based on historic performance rather than anything more up to date.

My Lords, clinical excellence is important at community level as well. Would the Minister tell the House whether any restrictions will be placed on the commissioning groups concerning the payment of rewards to their members?

My Lords, the pay structure for clinical commissioning groups is a separate issue from clinical excellence awards, which apply only to those holding a consultant’s contract in the NHS. To the extent that anyone holds a consultant’s contract in any of the clinical commissioning groups, they will be subject to whatever new scheme the DDRB recommends and the Government accept.

Would my noble friend accept that one of the real challenges is to make sure that people who are working in clinical practice have the opportunity to engage in research? Research salaries are significantly lower than clinicians’ salaries. What is the Minister doing to try to ensure that there is a seamless progression between research and clinical practice and between clinical practice and research?

My Lords, those who hold honorary contracts, who are in general clinical academics, are well represented among those who are awarded clinical excellence awards. We are absolutely clear that that should continue as long as possible. We must incentivise those who do not spend the bulk of their day engaged in treating patients so that we ensure that we have a bank of academic excellence driving forward innovation in the NHS.

My Lords, what role do Her Majesty’s Government see for the academic health science centres in promoting clinical excellence? In asking the question I remind the House of my interest as a director of the UCL Partners academic health science centre at University College London.

I believe that, on current showing, the academic health science centres have pointed the way to how clinical academic leadership can promote excellence both in patient care and in translational research. We are encouraged by everything that the AHSCs are doing. We will formally review them in due course, but I am absolutely onside with the noble Lord in wishing to see the progress that they have made rolled out more generally in the NHS.