• CQC asked for clinical excellence awards to be routinely withheld from medics at special measures trusts
  • Chief inspector of hospitals Ted Baker said the bonuses “may send the wrong message”
  • But DHSC advisory committee rejected the proposal

The Care Quality Commission said clinical excellence awards should be routinely withheld from senior medics at trusts in special measures, according to documents obtained by HSJ.

The quality inspectorate wrote to a Department of Health and Social Care advisory board to ask that awards only be made in “exceptional circumstances” if a consultant’s employer is in special measures, documents released under the Freedom of Information Act reveal.

Minutes of a meeting of the DHSC’s advisory committee on the awards said: “The CQC’s chief inspector of hospitals, Professor Ted Baker, has stated that he is concerned about awarding clinical excellence awards (CEAs) to trusts that are in special measures as it may send the wrong message.

“He recommends that awards are only made to consultants in those trusts in exceptional circumstances.”

The advisory committee, which sanctioned £143.5m of payments to consultants under the scheme in 2017-18, disagreed with Professor Baker’s view.

The document said: “This represents a change in the stance of the CQC. Acceptance of this would mean that the vast majority of individual applicants for a CEA from within any trust in special measures would be denied the opportunity to have their application for an award assessed objectively and fairly upon the evidence of personal achievements set out in their application.”

In a statement, Professor Baker stressed consultants working in special measures trusts should not be barred from receiving the awards, but said it should be given “careful consideration”.

The awards can add between £46,000 and £100,000 to a consultant’s yearly salary and are pensionable.

The committee document said Professor Baker’s predecessor, Sir Mike Richards, “did challenge one award in 2016 for a medical director at a trust in special measures” – but the committee granted it “based upon the fact that [the] individual had demonstrated significant achievements over and above contractual requirements and the fact that there was no direct link between the performance of the individual and the trust CQC rating”.

It added: “The application was therefore judged on merit and not on the basis of a CQC judgement on the overall performance of the trust in which the applicant worked.”

The committee minutes said it had “carefully considered” the recommendation from Professor Baker, but decided the awards should stand, partly because “the ‘perception’ of how an award will be received is not a sound basis for making decisions about CEAs”, and that blocking new awards would raise questions over whether existing CEAs should be honoured at these trusts.

However, it said it would look at awards for doctors who were also the medical director of their trusts to see whether the organisation being in special measures was in any way attributable to them.

The document said 16 applications made on behalf of medics at special measures trusts (Barts Health Trust, St George’s University Hospitals Foundation Trust and Brighton and Sussex University Hospitals Trust) had been signed off in the latest round.

The committee received 1,002 applications for awards in 2017, the most recent data showed, and 300 of these were successful.

In a statement, Professor Baker said: “Where… consultants are working in a trust in special measures, then we suggest this should be given careful consideration, as a number of the trusts’ services have been found to require significant improvement, but it is absolutely not our view that consultants working in special measures trusts should be barred from receiving an award for their achievements – particularly where that individual has demonstrated a positive impact in driving improvements in care.”