White consultants get more merit awards

The NHS will spend nearly pounds 1bn over the next five years on distinction awards for hospital consultants which can double their salaries to pounds 110,000 a year. Jeremy Laurance, Health Editor, says ministers are to re-examine the system which has been criticised for being unfair, inequitable and poor value for money.

White consultants are three times more likely to get a distinction award than non-white ones, says a study.

The racial bias, revealed in an analysis of the 2,500 awards currently held by doctors worth between pounds 22,590 and pounds 53,645 on top of basic NHS salaries, is the latest charge to be made against the scheme which has been plagued by controversy since its inception.

Ministers are believed to be unhappy with the arrangements for rewarding consultants and want to see the scheme reworked to reflect not only the national and international recognition they have received, but also the contribution they make to the NHS. Many top consultants with awards have thriving private practices and other commitments which take them away from the NHS.

A spokesman for the Health Department said yesterday: "Large sums of money are paid out every year in distinction awards and ministers want to make sure it is in line with departmental policy. They have no plans to change it but they are looking at it as part of the comprehensive spending review."

Basic salaries for full time hospital consultants range between pounds 43,750 and pounds 53,645. With a B, A or A+ award they can almost double their salaries to a maximum of pounds 110,000. A+ awards are currently held by 213 consultants and the total cost of the scheme to the NHS is estimated at pounds 185m a year.

The awards were established in 1948, at the start of the NHS, to recognise "more than ordinary ability and effort" and to ensure that the financial rewards at the top were sufficient to attract the most able practitioners into specialist areas. They are made by a national committee, mainly of doctors, which considers names put forward locally.

The latest study of the scheme, published in the British Medical Journal, found 14 per cent of consultants are non-white but only 5 per cent hold a distinction award.

Dr Sam Everington, an author of the study and a former Labour Party adviser on health, said the findings illustrated the system's failings. "It is ludicrous that this money is not used to reward consultants who do more for the NHS."

Previous studies have shown men are more likely to receive an award than women, the specialties of cardiology and surgery are favoured over psychiatry and geriatrics, and academics in teaching hospitals get more awards than ordinary working doctors in district hospitals.

The awards are given "solely on grounds of merit but ... they are not intended - nor should they be seen - as a measure of the quality of treatment afforded to individual patients." This curious caution is intended to prevent their being used to construct league tables of the best doctors.

In an editorial in the BMJ, Dr Peter Rubin, dean of medicine at Nottingham University, says the mystery surrounding the awards should be dispelled. "A more explicit statement of the minimum requirements for each level of award could be helpful as would an indication of the relative importance of different professional achievements," he says.