The bonus culture, NHS consultants and the rest of us

Were we the only ones who didn’t know that NHS consultants are on bonuses?

There must have been others who also had their eyes opened when news broke of Deputy First Minister, Nicola Sturgeon’s letter to Gordon Brown.

Ms Sturgeon was suggesting that the UK-wide system of ‘Distinction Awards’ for NHS consultants should be dropped and replaced by a fairer scheme including a wider spectrum of NHS staff.

This move was attacked as a ‘meaningless gesture’ by the blunt instrument that is Tavish Scott, Leader of the Liberal Democrat group in Scotland, castigating Ms Sturgeon for not simply cutting the consultants’ bonuses on Scotland – as the Scottish Government has the power to do.

In something of a D’oh moment worthy of Homer Simpson – whom, come to think of it, he rather resembles, Mr Scott had failed to see the key point that was Ms Sturgeon’s concern.

If Scotland unilaterailly abolished this bonus, jobs as consultants in our hospitals would be much less attractive to the best candidates in the health service  job market than would competing opportunties elsewhere in the UK.

Slow-thinking politicians apart, we’re getting to the point where so many jobs in our society carry bonuses that we are  going to have to decide either to abolish them or make them universal.

A culture is no culture if it is divided into those who are ‘incentivised’ to work well, honourably and inventively and others who are exploited if they behave in the same way in other jobs where they are paid a flat rate.

There is no job that does not benefit from being done with skill, thought, interest and an eye to development.

Those who want to work and either cannot get jobs or have lost them in the current recession must find it particularly obscene that there are those who cannot be satisfied with having a job, often a very interesting job; are paid to do that job; and can only be motivated to do it by ‘bonuses’.

It’s not as if these ‘bonuses’ actually relate to individual or even to corporate achievement. Who could understand senior bankers in the spectacularly failed banks nevertheless receiving bonuses for ‘performance’ in the teeth of the collapse?

The bonus culture does not reward individual performance excellence. It is simply another – richer – version of every workplace where the real performers carry the jobsworths. The difference is that in the world of bonuses, they are all so well rewarded that the worker bees don’t care and the drones swagger.

But imagine if we did have a system where every job was paid on a basic wage, with bonuses for individual excellence added – and evidence to support such awards needing to be collected…

There you are, lying in the post-operative recovery ward, drifting in and out of consciousness with the anaesthetic just starting to wear off. The pain starts to break through, You groan. Some blurred shape in scrubs holding a needle appears. ‘Some pain relief?’

You feel a crude puncture in your arm but then a sense of ease. Before you slip into sleep a pen is forced into your limp fingers and a voice says: ‘Where would you say that pain relief came on a sliding scale of 1 – 5, where 1 is lowest and 5 is highest?’

You blink uncomprehendingly, wanting only to rest. A hand grasps yours. ‘You feel so much better now, don’t you’, the voice intones. You nod – honestly. You do. The alien hand guides your hand with the pen onto something hard, board-like thing and the voice says: ‘Just sort of mark it here. Shall we say a 5?’ And the hand makes a little ‘tick’ with your hand.

Just as everything has gone quiet again and you’re slipping into oblivion, a sharp professional voice wakes you up, saying your name. You open your eyes vaguely. The light hurts. You close them again but you’re left with the sense of the shape of a dark suit and the smell of gentle antiseptic.

The voice says: ‘Mr CutandRun, your surgeon. Of course you’re tired but I wanted to see you to tell you how very well it has all gone’.

Nice man, you think. How considerate. How caring. How good to know it’s all OK.

The voice interrupts the easing of your tension. ‘Let’s just tidy up the loose ends, shall we?’, it says crisply, ‘get the old admin straight?. You were out like a light. We whipped it out, stitched you up like the neatest hedgetear darn your granny never saw and got you out again in a flash. You can have a kip here for a couple of hours and then we’re letting your lovely friend take you home for some tlc. There’ll be a few painkillers to take home,  dissolving stitches… no need to come back. One of my assistants will see you in a couple of months just to make sure it’s all tickety-boo. How’s that for service?’

You nod faintly, gratefully, eyes closed again. A very firm hand grasps your wrist. Another pen is rammed into your hand. No chat this time. No nonsense about 1 is the lowest and 5 is the highest. The hand makes a firm ‘tick’ with yours, replaces your hand, penless, on the bed and a fast retreating voice says: ‘Five. How very perceptive.’

Then there’s the cleaner… the novice nurse who takes you for a bath… the ward assistant who helps you dress…  the receptionist who rings for your friend to come and take you away…

So many clipboards. So many ticks. So many Fives. And nobody ever said anything about that C Diff thing you’d picked up, that took you months to get over and left you permanently weak.

But that was nothing to do with them. That was just bad luck.

‘O brave new world that has such people in’t’.