Clean-up for NHS bonus system

Action to clean up the merit award system which gives high- ranking NHS consultants bonuses of over pounds 50,000 a year will be announced today by the Health Minister, Alan Milburn, after evidence of racial discrimination against doctors from ethnic minorities. Ministers believe the system has become an "old-boys' network".

Those who receive the highest awards, of pounds 53,645, include Lord McColl, a Tory spokesman in the Lords on the NHS. Critics say the awards given by peer review among consultants are for academic merit but they should be reformed to reflect commitment to the NHS.

Consultants, especially surgeons, hold the key to cutting waiting lists and ministers are known to be unhappy with arrangements for rewarding them. The cross-government comprehensive spending review is understood to be focussing on consultant workload because of concern that some are doing too little.

Many top consultants with awards have thriving private practices and other commitments which take them away from the NHS.

The latest awards, to be announced today, show for the first time an ethnic breakdown of those receiving the bonuses. The figures reveal that 13.9 per cent of NHS consultants are from ethnic minorities but only 6.2 per cent hold an award. Mr Milburn will say this is "unacceptable" and will welcome action being taken by the Advisory Committee on Distinction Awards on three fronts: members of the ethnic minorities are to be appointed to the regional committees which make the recommendations for bonuses for consultants; there will be better ethnic monitoring of nominations for award-holders; and the ACDA is promising to work more closely with the Commission for Racial Equality. Earlier protests about sex discrimination led to a slight increase in the number of women consultants gaining awards, but the attack on the failure properly to reward members of ethnic minorities could be the lever for more reforms of a system many believe is discredited. Sam Everington, a former Labour adviser and a member of the BMA council, said the figures confirmed his own survey showing racial discrimination in the awards. "It is an old-boy network. You make friends with those on the committee and it is done by a nod and a wink. They say it is done by `taking soundings'."

Dr Everington, a GP, said the waiting list could be reduced by paying NHS consultants to carry out more operations, if the system was geared to those working in the NHS rather than private practice. The awards are given "solely on grounds of merit but