Health Warnings
Day 2 of an SR investigation

The bonus boys

Kenneth Roy

Last Friday, I emailed the Scottish Advisory Committee for Distinction Awards (SACDA) – the public body which recommends merit awards (commonly known as bonuses) for NHS consultants – and asked it to provide a link on its website to the current annual value of these awards. I was already aware of the figures, but only at second hand. By 9am yesterday, when I wrote a piece headed 'Scotland's NHS rich list', I had heard nothing back.
     At lunchtime, two hours after the publication of the Scottish Review, I did receive a reply – not from the committee, but from NHS National Services Scotland. This gave me the figures, but it failed to provide a link to SACDA's website, which is what I had specifically requested. My correspondent added that SACDA's website was being 'reviewed'. I replied that I no longer accepted what was claimed on the website – that the figures were there to be accessed. By mid-afternoon, NHS National Services had added the figures to the site, along with additional information of public interest.
    
Why is SACDA so shy about these figures that they are not published in its annual report, in its guide to applicants for the loot, or – until yesterday afternoon – anywhere on its website? No doubt the applicants are well aware of the colossal size of the annual bonuses – ranging from £32,000 to £76,000 – which, once awarded, may be held for the rest of a professional career; but not everyone can be assumed to be familiar with the top-up rates of NHS consultants. The public has a right to know. The public does now know.
     Is it conceivable that the hitherto extremely low profile of the amounts in question points to an insecurity about their very existence?
     Merit awards for consultants are as old as the NHS itself. In the early years they were shrouded in the most extraordinary secrecy, although perhaps not so extraordinary within the context of the deferential society which then existed. The public was not informed who got them, or why, or how, or how much. The awards were made in a closed world of peer review. It was only through the dogged work of a few MPs that a little knowledge began to emerge through persistent parliamentary questions.
     We no longer live in a deferential society. We live in a society in which the principle (if by no means the practice) of freedom of information is enshrined in law. We also live in a society experiencing acute suffering after a long period of unparallelled prosperity. For both these reasons, the idea of substantial sums of public money being doled out to some of our highest earners, by a committee whose rules and methods are only dimly comprehended, will inevitably encourage both scrutiny and scepticism.
     To some extent this was always so. In the British Medical Journal 15 years ago, a critic wrote of the scheme: 'No other profession would copy this system and consultants would gain respect by scrapping it – especially self-respect.' But it was not scrapped; instead, it was tinkered with. In 1994 an official review conducted in the UK as a whole – its chair was Dr Robert Kendell, then Scotland's chief medical officer – rejected the idea of replacing the scheme with a new system of performance-related pay. It concluded, however, that the existing system was too secretive, that NHS employers should have more say in the allocation of awards, and that the committee should have a lay chair rather than a medical one. The last proposal was implemented at once.
     Four years later, Scotland acquired its own advisory committee. Since devolution it has reported to the Scottish health secretary.
     The present health secretary, Nicola Sturgeon, has just made three appointments to SACDA. The new chairman will be Kenneth Thomson. The new lay appointee is Frederick Hall. As we reported yesterday, Dr Charles Swainson will be the new part-time medical director.

It is worth looking at the committee in more detail.
     The present part-time medical director of SACDA, who retires from the post at the end of this week, is Professor J L Reid, a physician at the Western Infirmary in Glasgow. He has been one of the beneficiaries of the merit awards – on the top grade, A+ – since 1996. Had the award been made at the present level of £75,889 a year for all of the last 13 years, Professor Reid would by now have received the grand total of £986,557. Presumably, since the present value of the award has not always been £75,889 a year, the actual total is somewhat less.
     Another member of the committee, Professor Donald Hadley, a consultant at the Southern General Hospital in Glasgow, has been an A+ award-holder since 2003. Had the award been at its present level for the last six years, Professor Hadley would have received the grand total of £531,223. Another A+ award-holder is Professor James McDonald, whose status since 2006 would have entitled him to awards totalling £303,556 at the current rate.
     Among the other members, Robert R Jeffrey, a surgeon at Aberdeen Royal Infirmary, has been an 'A' holder since 2006 – worth a total of £223,696 at the current rate; while Professor Ken Paterson, clinical director of medicine for North East Glasgow, has been an 'A' holder since 2005 – worth a total of £279,620 at the current rate.
     Professor Hilary Capell, who is described by SACDA as a retired consultant formerly at Glasgow Royal Infirmary, was an 'A' holder from 2001. Since she was still at work when she was appointed to the committee last year, we will assume that she retired at the end of that year; if that was the case, she would have received a total of £447,392 in merit awards; again, however, expressed at the current rate. The same is true of surgeon Peter Raine, who may have retired last year; he became an 'A' holder in 1998 and would have been granted £615,164 at the current rate.

What does all this mean? The seven medical members of the awards committee – the people doling out the awards to fellow consultants – have themselves received, at a conservative estimate, awards of around £3 million. There is nothing improper about this. Far from it: it is how the system works; it is how the system has always worked. It is essentially a system of peer review. But that does not necessarily make it satisfactory.
     Indeed there is a strong case for suggesting that the composition of the awards committee in Scotland fails to respect the spirit of Dr Robert Kendell's 1994 review and the changes which were subsequently introduced. It was accepted then that the committee should no longer have a chair from the medical profession, but a layperson who would bring a neutrality to the decision-making process. The new chair of SACDA, Kenneth Thomson, is not from the medical profession, but he is very much a health service insider, latterly chief executive of a large NHS trust. No doubt Mr Thomson is a man of great knowledge and experience, but is he truly a layperson? He is certainly not in the same wholly disinterested category as the present chair, Professor Colin Suckling, a chemist unconnected to the NHS or the medical profession.
     It was accepted 13 years ago, after the Kendall review, that the NHS employers should have more say in the allocation of the awards: it was said then that employers should account for a quarter of the places on the awards committee. Yet there is only one employer on SACDA – Charles Winstanley, the chair of NHS Lothian. This is the same health board which employs the committee's new part-time medical director, Dr Charles Swainson. There are 13 other boards, none represented.
     What of lay representation? There is Sandra Douglas, a retired civil servant, and – just appointed – Frederick Hall, a recently retired policeman in Oban.
     So there it is: a committee handing out bonuses worth £5 million a year to NHS consultants in Scotland consists of two lay representatives; one NHS employer; and seven doctors, all of whom are themselves beneficiaries of the scheme.
     And what is the scheme for? Officially, it is an incentive to encourage the most talented doctors to stay in this country. Here is a fact: the average age of the holder of one of these awards, at the time of receiving it, is 51. Exactly where is a doctor in his 50s going to go?

Tomorrow: Health Warnings Day 3

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