Ministers should reform pay awards for clinical excellence – currently reserved for consultants – and open them up to nurses and other healthcare staff, according to a report.
The right-leaning think-tank the Centre for Policy Studies said that Clinical Excellence Awards (CEA) discriminated against non-consultant healthcare staff and damage team work.
“Its discriminatory if only consultants are eligible for a bonus”
In its report – titled An NHS Bonus – the centre criticised the current “broken” pay structured in the health service, including those for doctors and Agenda for Change.
For examples, it said that it was “particularly difficult for nurses, clerical staff or others to move upwards” since Agenda for Change was brought in to decide workforce pay.
It argued that opening up the consultant pay awards to all would allow for individual performance to be better recognised.
“Every member of staff would be eligible for the bonus. And the level would be based on objectives set at an annual employee review, aligned to core departmental objectives,” it said.
“The goals would reflect the need for team co-operation to drive through efficiencies”
Centre for Policy Studies
At the moment CEA awards are open to consultants who choose to nominate themselves for past work. Instead, a new system should reflect how individuals work as a team, the report argued.
It stated: “The goals would reflect the need for team co-operation to drive through efficiencies and quality patient outcomes, based on stretch team goals (eg a team of a consultant, secretary, specialist nurse and their outpatient staff could be charged with seeing X patients over the year, with Y positive outcomes).”
The report called on ministers to begin the process of reforming the CEA by “extending bonuses beyond the consultant class” and “tying them far more to performance according to the goals set by senior leadership”.
The report also highlighted that a lack of geographical flexibility in the NHS meant that hospitals in areas where house prices are high, such as Cambridge, struggled to attract enough nurses.
In contrast, hospitals in poorer areas tended to attract consultants, the report noted.
In addition, it controversially argued that “talk of pay freezes and 1% pay caps for the NHS” was misleading.
The think-tank claimed that the real annual pay rise between 2012 and 2017 had been between 2.5% and 3% due to increment rises gained by those moving through pay bands.
The report’s author Dr Paul Goldsmith, a consultant neurologist at Newcastle’s Royal Victoria Infirmary, said that replacing the CEA system was long overdue.
“To really maximise the quality of care you need a well functioning team,” he said. “Its discriminatory if only consultants are eligible for a bonus. You’re trying to properly reward staff and make the system fair and equitable.”
The current “retrospective” system where consultants applied for an award based on past performance should be scrapped, he said.
“I would make it prospective. It’s saying these are our priorities for improving patient care. These nurses, doctors and secretaries – it could be a diverse group of people – if they meet our goals then they should be rewarded for that,” he added.
Performance goals would need to be set collaboratively between staff members and managers, he added.