Consultation outcome

Reforming the national Clinical Excellence Awards scheme: equality impact assessment

Updated 9 March 2022

Introduction

National Clinical Excellence Awards (NCEAs) are financial incentives, awarded via an annual open competition, to consultant doctors, consultant dentists and clinical academics. Their purpose is to recognise senior clinicians’ achievements of national or international significance, beyond what is expected as part of their job plan. Separate schemes operate in England and Wales using the same broad principles and a shared platform. This scheme is part of the consultant reward package and helps to retain talent in the NHS and encourage clinical excellence.

The scheme has seen a number of iterations since its inception in 1948, the most recent being the replacement of discretionary points and distinction awards in 2004 with the more graduated Clinical Excellence Awards scheme. The current reforms aim to broaden access to the scheme, make the application process fairer and more inclusive, and ensure the scheme rewards and incentivises excellence across a broader range of activity and behaviours.

Key to the reforms are the recommendations made by the Review Body on Doctors and Dentists Remuneration (DDRB) in 2012 in its Review of compensation levels, incentives and the Clinical Excellence and Distinction Award schemes for NHS consultants.

The Department of Health and Social Care (DHSC) and the Welsh Government undertook a consultation on proposals to reform national CEAs from 24 March 2021 to 16 June 2021, in accordance with the Cabinet Office consultation principles.

The reforms also reflect the changing demography of the medical workforce and take into account the views of stakeholders and wider evidence including Mend the gap: the independent review into gender pay gaps in medicine in England (GPG review).

The department received a total of 439 responses (England and Wales), 40 of which came from organisations. The government’s response to the consultation sets out more detail.

The public sector equality duty (PSED) is an ongoing obligation and considers the impact across all the protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

The PSED requires a public authority (which includes NHS organisations and the Secretary of State) to have due regard in relation to each of the protected characteristics set out in s149 Equality Act 2010 (EQA). It remains that trusts are responsible under employment law for their employees and for meeting their own responsibilities under the PSED.

In UK discrimination legislation, there is a fundamental distinction between direct and indirect discrimination. Direct discrimination is where an individual receives less favourable treatment because of a protected characteristic. Indirect discrimination concerns a provision, criterion or practice (PCP) that puts someone with a protected characteristic at a disadvantage, compare with people who do not share the protected characteristic. A PCP that causes disadvantage is lawful if it is justified (that is, is a proportionate means of achieving a legitimate aim). Respondents to claims for age discrimination are entitled to seek to establish the defence of justification in cases of both direct age and indirect discrimination. Direct, as well as indirect, age discrimination is also uniquely justifiable where the discrimination is the result of a proportionate means of achieving a legitimate aim.

This equality analysis has paid consideration to all statutory objectives under s149 EQA. These are as follows:

• the need to avoid unlawful direct discrimination, indirect discrimination or harassment; the need to advance equality of opportunity
• the need to promote good relations with different groups

The available data relating to protected characteristics and the current scheme are found in Annex A and B below.

This paper provides an analysis of the expected equalities impact on the reforms to the NCEA scheme. The available data relating to protected characteristics and the current scheme are found at Annex A below.

This paper covers England only. The NCEA scheme runs in both England and Wales. The Welsh Government will be providing its own equalities impact assessment.

The assessment is not static. DHSC will continue to undertake equality analysis to ensure that the objectives of the reformed scheme are being met. DHSC agrees with feedback received from the consultation concerning improvements to the collection and monitoring of equality and diversity data and improvements to associated reporting mechanisms. Diversity data will continue to be reported and will be expanded to cover all protected characteristics and provide greater transparency by region and specialty where possible.

Aims and objectives of the reforms

Rationale for change

NCEA applicants are currently not representative of the eligible communities, particularly with regards to women, consultants from ethnic minority backgrounds, part-time consultants and those from under-represented specialties. This presents a strong case to modernise the current NCEA scheme in a way that will reward eligible candidates more fairly and equitably.

The consultant workforce has grown from around 31,000 in England in 2004 to around 52,000 in 2019. As the number of NCEAs available each year remains at 300, the scheme is becoming increasingly inaccessible to a growing consultant workforce.

NCEAs are currently pensionable – this does not align with the concept of a modern, non-consolidated reward and recognition scheme.

The working patterns of consultants have evolved over time and clinicians, in many cases, have more varied, portfolio careers. Further details on the case for change can be found in the consultation document.

Aims

DHSC intends the reforms to broaden access to the scheme, make the application process fairer and more inclusive and ensure that the scheme rewards and incentivises excellence across a broader range of work and behaviours. The scheme reforms will also reflect the changing demography of the consultant workforce.

DHSC proposes these reforms having examined the consultation responses and engaged with key stakeholders and the ACCEA Main Committee. Our agreed proposals are to:

• increase the number of available awards: once the transition process has completed, there will be up to 600 awards granted annually in England

• re-brand the scheme: the awards will be re-branded as the ‘National Clinical Impact Awards’ (NCIAs)

• re-structure the award levels: in England, the new scheme will operate as a 3-level award system:
  • National 1 (lowest)
  • National 2
  • National 3 (highest)

• refresh the assessment domains: the current assessment domains will be developed, combining both Domains 1 and 2 and introducing a new fifth domain

• simplify the application process: a single-level application process will be introduced with self-nomination being retained

• remove pro-rated awards: those working less than full time (LTFT) will no longer have their award payments pro-rated

• remove the renewals process: the renewals process will not continue in the new scheme; awards will be held for a total of 5 years, at which point applicants will need to re-apply

• remove the pensionability of awards: awards will no longer be pensionable or consolidated

• simplify the process for employers: employers will need to indicate their support for an application and will be required to provide a citation for each applicant. Employer scoring and ranking will no longer be required

An improved IT system will also be introduced in readiness for the 2022 awards round. The new system will ensure more applicants are confident in applying for awards by providing a more user-friendly interface to complete their applications. There will be additional training, guides and prompts within the online application form to ensure greater clarity and transparency. Users will be able to complete the whole process within the system.

We will also continue to work with the medical royal colleges, specialist societies (SSs) and NHS Employers to encourage greater gender and ethnic diversity and ensure our regional sub-committees, who score applications, are more representative of the NHS and wider population.

Who will be affected

The proposed reforms to the current national Clinical Excellence Awards scheme will affect:

• consultants employed under the terms of the 2003 national contract for consultant-graded doctors in the NHS

• consultants employed on other employment contracts who meet the eligibility criteria – they can apply for an award subject to agreement with the employer running the award round

• consultants, dentists and clinical academics who hold NHS honorary contracts

Addressing the impact of new reforms to the national Clinical Excellence Award scheme – by each protected characteristic

This section outlines the legally protected characteristics and how they are affected by the existing NCEA process and mitigation on the introduction of reforms to the scheme.  

Age

Data from the ACCEA annual report 2020 indicates that the number of consultants in receipt of a successful bronze awards in 2019 is 50.6 years. We acknowledge that this is in part due to the time it takes to build-up enough high-quality evidence to make a first successful NCEA.

Table 1: average age of successful 2019 applicants for a new award at August 2020 by award level

Level	Mean age (years)
Bronze	50.6
Silver	53.6
Gold	54.8
Platinum	60.2

Mitigation and justification

The reformed scheme will broaden access to the NCIA scheme and will move towards removing the apparent link between long service and higher level of award by moving to a non-stratified application process. Currently older consultants are more likely to hold a higher level of award (see Annex A below). This may not be the result of discriminatory practice but reflects the length of time it takes to climb the awards scale and to have developed the experience to demonstrate excellence in the application process.

The value of the awards will be reduced to enable more awards to be made available to a wider proportion of consultants, with the aim of making 600 awards available annually at the end of the transition period. This is in comparison to the current scheme where 300 awards are available annually. The provision of more awards will increase accessibility to the scheme and improve access for women and those from minority ethnic groups. Although the awards are reduced in monetary value, they remain prestigious and attractive to potential new applicants. 

The scheme will operate on a 3-level basis in future, with more awards at a lower level being made available (around 330). The scheme will continue to operate by self-nomination but there will no longer be the requirement to identify which award level the applicant aspires to. This will allow individuals to secure awards in line with their impact, and potentially be in receipt of a top-level award earlier in their career. This will contribute to the removal of any indirect age discrimination.

Nevertheless, older consultants are more likely, in general, to possess greater experience of working in the NHS and, therefore, may continue to be more highly represented by clinical awards, particularly for those that provide greater monetary value post-reforms.

The introduction of new guidance will provide more information on the responsibilities of employers to proactively encourage and support applications from a greater proportion of those demonstrating excellence at any point in their career. This will seek to ensure that employers are actively encouraging applications from previously under-represented groups and specialties. 

With the development and introduction of a new IT user system, additional mandatory training for scorers will be introduced with an emphasis on unconscious bias. The new system has been designed to include reporting mechanisms which will capture data on all the protected characteristics under the EQA for monitoring purposes.

In summary, the initiatives above which include broadening access to the scheme and easing the streamlining of the application process will make the system fairer. This will benefit the younger consultant workforce enabling them to achieve higher level awards as excellent performers as opposed to higher award being linked to time served at the consultant grade.

Making NCEAs non-pensionable

The DDRB, in its 2012 review, stated that it was no longer appropriate for the awards to be pensionable. They saw this as a legacy from a time when they were treated as permanent salary increases.

The consultation set out proposals that agreed with the DDRB recommendation that awards should be non-consolidated and non-pensionable – it supported the view that the pensionable status of NCEAs no longer fits with the idea of a modern, non-consolidated reward scheme. The current pensionable status of NCEAs has tax implications for some higher-level national award holders of long standing. This has resulted in some award holders surrendering their NCEAs for financial reasons or reducing their hours or retiring early. It may also have dissuaded applications and reduced the ability of the scheme to promote the retention of high- performing senior clinicians within the NHS.

We recognise that making NCEAs non-pensionable and non-consolidated may affect consultants at the earlier stages of their careers. However, making the awards non-pensionable will also allow the government to increase the number of awards available, meaning that more of our most senior NHS leaders will be in receipt of NCEAs throughout their career. Furthermore, it brings the scheme into line with modern remuneration practices, where bonuses and awards are non-consolidated.

This is consistent with practice across the public and private sectors and is aligned to local awards which have not been pensionable since 2018. Also, given that many consultants are affected by pensions tax policy, it makes sense to offer non pensionable reward with the employer pension contributions being made available to enable more awards.

It is open to those consultants who wish to increase their pension savings to buy additional pension with the value of their awards.

Non-consolidated CIAs will be counted as taxable income and as such may still have annual allowance implications for some award holders. However, as a result of the government increasing the annual allowance taper thresholds from 6 April 2020, award holders can earn £200,000 in taxable income before having their annual allowance limit reduced.

It is important to recognise that from April 2022, all members will be in the 2015 career average pension scheme and the impact of final pensionable pay on overall pension benefits will reduce as the proportion of overall pension savings made up by legacy final salary benefits reduces.

The protection set out in Schedule 30 of the consultant contract will mean that doctors in receipt of pension protection will have full pensionability for up to 10 years (as existing awards will continue for the remaining term) and CPI-linked protection after that until taking their pension.

Disability: attitudinal, physical and social barriers for both visible and hidden disability 

A small proportion of consultants declare having a disability (1.24%), compared with 4% for all hospital and community health services staff. ACCEA does not collect data on how many NCEA holders are recorded as having a disability and there is no other source of data to capture this. We cannot therefore confirm what proportion of disabled individuals hold an NCEA.

Mitigation and justification

It is reasonable to assume that those with a disability are more likely to be absent from the workplace due to sickness, potentially long term, and as a result may find it problematic to produce evidence displaying excellence. Academic evidence finds that performance-based pay can negatively impact people with disabilities if administered without due regard (see Annex A below). We would expect modifications to the consultant role to be accounted for by the employer and detailed in the job description section of our application form.

We have proposed to simplify the application process which will ease the burden on applicants, assessors and employers. The introduction of a new IT user system will enable us to improve accessibility to the application process for those who require it. Additional guidance and prompts to ease the process for applying. Our new IT system has built-in facilities that will provide clarity on technical language and abbreviations with technical support through phone and webchats for applicants 24/7 and will be compatible with assistive technologies and reduce any potential barriers in accessing the system. We will also be conducting tests of the new IT user system in advance of its implementation, and will be inviting test users to assess the accessibility of the system in order to inform our final system design.

The new IT user system has been designed to include reporting mechanisms which will capture data on all the protected characteristics under the EQA for monitoring purposes. Regular assessment of the data that emerges will enable us to adapt the scheme accordingly should we become aware of discriminatory processes during the application and scoring processes.

With the development and introduction of a new IT user system, additional mandatory training for scorers will be introduced with an emphasis on unconscious bias.

DHSC will consider extending the requirement to provide evidence over a modified period in particular circumstances, which could include sickness and paternal leave, to ensure there is no indirect discrimination during the application scoring process. Advice for both applicants and scorers will be developed and introduced. It will remain a requirement to ensure excellence is evidenced over a sustained period for all applicants. However, where there is an absence due to maternity or ill-health, discretion will be used to extend the 5-year period over which we ask applicants to provide evidence of the impact of their work. Applicants will be encouraged to provide the necessary information in their applications, particularly around dates and time periods involved, to allow for an appropriate pro-rata extension.

Gender reassignment

There is no data available on this protected characteristic collected by ACCEA. However, there may be difficulties faced by applicants relating to gender reassignment in terms of potential discrimination and their ability to meet the criteria for an award if, for example, they need to take time away from the workplace and need a period of extended leave.

Mitigation and justification

ACCEA’s new IT user system has been designed to include reporting mechanisms which will capture data on all the protected characteristics under the EQA for monitoring purposes. Regular assessment of the data that emerges will enable us to adapt the scheme accordingly should we become aware of discriminatory processes during the application and scoring processes.

With the development and introduction of a new IT user system, additional mandatory training for scorers will be introduced with an emphasis on unconscious bias.

It is reasonable to assume that those on extended leave may find it problematic to produce evidence displaying excellence. We would expect modifications to the consultant role to be accounted for by the employer and detailed in the job description section of our application form.

Any concerns around potential discrimination would be addressed through our plans to put robust and mandatory training in place for scorers.

DHSC will consider extending the requirement to provide evidence over a modified period in particular circumstances, which could include sickness and paternal leave, to ensure there is no indirect discrimination during the application scoring process. It will remain a requirement to ensure excellence is evidenced over a sustained period for all applicants. However, where there is an absence due to maternity or ill-health, discretion will be used to extend the 5-year period over which we ask applicants to provide evidence of the impact of their work. Applicants will be encouraged to provide the necessary information in their applications, particularly around dates and time periods involved, to allow for an appropriate pro-rata extension.

Marriage and civil partnership  

ACCEA does not currently capture data on marriage and civil partnership. We do not envisage any significant impact on this protected characteristic.

Mitigation and justification

A new IT system is being procured. It will include reporting mechanisms which will capture data on all protected characteristics for monitoring purposes. Regular assessment of the data that emerges will enable us to adapt the scheme accordingly. The new IT system will also feature updated mandatory training, including on unconscious bias, and engaging guidance that ensures greater clarity.

The requirements on decision justification, and for consideration of evidence, will be strengthened. The University of Exeter was recently commissioned to undertake a review into the ACCEA scoring processes. Its review findings will feed into the new scoring system and will align with the non-stratified application process.

Once the transition process has completed, there will be up to 600 awards granted annually in England. The increased number of awards will increase coverage across the board.

Pregnancy and maternity  

Data on this protected characteristic is not collected by ACCEA but acknowledge that maternity leave and part-time working can reduce NCEA reward income in the current scheme. This is due to the requirement for individuals to escalate through incremental award levels to attain an award and also as a result of award payments being pro-rated for those working LTFT.

Please see the below section ‘Sex: men and women’ for an analysis on the specific equality issues that pertain to a candidate or potential candidate’s sex.

Mitigation and justification

DHSC will consider extending the requirement to provide evidence over a modified period in particular circumstances, which could include sickness and paternal leave, to ensure there is no indirect discrimination during the application scoring process. It will remain a requirement to ensure excellence is evidenced over a sustained period for all applicants. However, where there is an absence due to maternity or ill-health, discretion will be used to extend the 5-year period over which we ask applicants to provide evidence of the impact of their work. Applicants will be encouraged to provide the necessary information in their applications, particularly around dates and time periods involved, to allow for an appropriate pro-rata extension.

The simplification of the application process and clearer guidance and additional resources will ease the process for completion of applications and impact positively in those with caring responsibilities.

With the development and introduction of a new IT user system, additional mandatory training for scorers will be introduced with an emphasis on unconscious bias.

Race: ethnic groups, nationalities, Gypsy, Roma, Travellers, language barriers 

Consultants from ethnic minority backgrounds are currently under-represented as a proportion of applicants and this issue was raised throughout the responses to our consultation. Essex and others (2021) found that, while the percentage of awards given to those of an ethnic minority had increased, that substantial ethnic variations have persisted and that this difference becomes greater as the level of award increases – they identified a system that is complex, rewards English as a first language and produces non-replicable results. Data on ethnic groups is published in ACCEA’s annual report (see Annex B below).

Mitigation and justification

A new IT system will improve the collection and monitoring of equality and diversity data, providing more feedback to employers and regions. This will allow for a comparison of applicant’s diversity data against NHS Digital diversity benchmarks. Concerns were raised in the consultation responses that the current system could disadvantage those who do not have English as a first language. Our new IT user systems has built in systems for clarification of jargon and technical language and abbreviations used. Support for candidates will be available throughout the application process.

The reforms will remove the requirement for consultants to make their way up through the award levels over time – more consultants (including younger consultants) will be eligible for the highest level of award from their first application, which will see increased eligibility across the board. This will reward excellence rather than progression and will benefit those who have taken time out of their career or worked overseas.

With the development and introduction of a new IT user system, additional mandatory training for scorers will be introduced with an emphasis on unconscious bias.

The requirements on decision justification, and for consideration of evidence, will be strengthened. The University of Exeter was recently commissioned to undertake a review into the ACCEA scoring processes. Its review findings will feed into the new scoring system and will align with the non-stratified application process.

The awards will be re-branded as the National Clinical Impact Awards (NCIA) from 2022 – this move forms part of an effort to refresh perceptions of the award; the name change highlights the new criteria and that the scheme will be more accessible to those currently under-represented. This should encourage those who did not previously believe the scheme was aimed at them to engage.

DHSC will be working closely with employers to ensure there is wide coverage of the new scheme and that they encourage all those consultants displaying excellence to apply for the scheme.

Work with our sub-committees who are responsible for the assessment of applications to the awards scheme will continue. We are continually improving the representation of women and those from ethnic minority backgrounds on our sub-committees with diversity increasing year on year, albeit slowly. Ethnic minority membership of our sub-committees has risen from 20% in 2018 to over 25% in 2019. Work with Medical Royal Colleges, specialist societies and NHS Employers will continue to help us encourage consultants from ethnic minority backgrounds to join the sub-committees, ACCEA will be ensuring that their composition, with regards to the protected characteristics, more closely resembles the consultants they assess.

Furthermore, DHSC will ensure that mandatory training is in place to support all those who will be involved in the new scheme – assessors, employers, applicants and nominating bodies – to successfully navigate the new scheme and IT user system. The introduction of new guidance will provide more information on the responsibilities of employers to proactively encourage and support applications from a greater proportion of those demonstrating excellence at any point in their career.

Religion or belief 

ACCEA does not currently capture data on religion or belief. We do not envisage any significant impact on this protected characteristic.

Mitigation and justification

A new IT system is being procured. It will include reporting mechanisms which will capture data on all protected characteristics for monitoring purposes. Regular assessment of the data that emerges will enable us to adapt the scheme accordingly. The new IT system will also feature updated mandatory training, including on unconscious bias, and engaging guidance that ensures greater clarity.

The requirements on decision justification, and for consideration of evidence, will be strengthened. The University of Exeter was recently commissioned to undertake a review into the ACCEA scoring processes. Its review findings will feed into the new scoring system and will align with the non-stratified application process.

Once the transition process has completed, there will be up to 600 awards granted annually in England. The increased number of awards will increase coverage across the board.

Sex: men and women  

Around 38% of hospital and community health service consultants were women in March 2020, according to official figures from NHS Digital. This year’s award round data produced by ACCEA indicates that 476 women were in receipt of an NCEA compared to 1,701 men. The inequity is likely to be larger than this as progression through the awards is sequential in order of their value. The report found that, when women do apply, their chances of achieving the awards is comparable to men – 35.9% for men against 35.1% for women in 2021.

Maternity leave and part-time working can reduce NCEA income due to the requirement to attain awards sequentially in order of value and because in the current schemes awards are pro-rata (the GPG found that women are more likely to work part time then men).

The GPG review infers that differences in specialities comment to women may be a reason for some discrepancies – only 12% of NCEAs in surgical specialities went to women as per 2018 while 66.7% of awards in occupational health went to female doctors. For instance, women are not well represented in ranks of surgical specialties, but they are better represented in public health medicine and occupational health. The GPG asserted that:

it is well known that one of the issues that reinforces the gender pay gap is the differential evaluation of types of advanced job skill and performance that are worthy of bonuses

The GPG asserted that ensuring additional activity undertaken more frequently by women, such as mentoring, is awarded equally to that undertaken more frequently by men, such as additional clinical, managerial or research activity, would improve the gender balance of NCEAs.

Mitigation and justification

Working with stakeholders and using evidence from the GPG review we have reflected stakeholder views, consultation responses and recommendations to introduce reforms to make the new NCIA scheme more inclusive for women.

The pro-rata element of the awards for those that work full time, and who are predominantly women, will be removed. Careful consideration will be given to ensure that this change does not have any unintended consequences of treating those working LFTF more favourably than those working full time.

The introduction of a new domain which seeks evidence in other areas or work not necessarily related to clinical outcomes should benefit women applicants, particularly those in under-represented specialties. The new domain will capture evidence that may have more of a patient of public focus or evidence of how health and workplace inequalities are being tackled. Evidence of fostering inter-professional team building and new ways of working that benefit the NHS can be included in this domain.

The reforms will remove the requirement for consultants to make their way up through the award levels over time. This will reward consultants for the impact they have on the NHS, rather than their career progression and will benefit those who have taken time out of their career.

The move to the National Clinical Impact Awards (NCIA) from 2022 forms part of an effort to refresh perceptions of the award. The name change highlights the new criteria and that the scheme will be more accessible to those currently under-represented. This should encourage those who did not previously believe the scheme was aimed at them to engage.

A new IT system is being procured and will feature updated mandatory training, including on unconscious bias, and that ensures greater clarity.

The requirements on decision justification, and for consideration of evidence, will be strengthened. The University of Exeter was recently commissioned by the National Institute of Heath Research to undertake a review into the ACCEA scoring mechanisms. Its findings will help ensure that our scoring processes are fair and non-discriminatory and reflects the right balance between breadth and depth of achievement. The outputs from the review will help to inform our assessment and validation of any revised scoring processes in our new scheme.

The GPG review found that the level of female representation differs by specialty. To ensure that no specialty or sub-specialty is represented by multiple bodies, and therefore potentially able to over-leverage their influence, a review is being undertaken. A survey has been conducted and a working group has been established, which together will determine an appropriate list of accredited NNBs and SSs.

As the consultant workforce has grown, from around 31,000 in England in 2004 to around 52,000 in 2019, the current level has become more inaccessible. An increased number of awards will help correct this.

Sexual orientation: straight (heterosexual), gay or lesbian, bisexual or other sexual orientation

ACCEA does not currently capture sexual orientation data. We do not envisage any significant impact on this protected characteristic. 

Mitigation and justification

A new IT system is being procured. It will include reporting mechanisms which will capture data on all protected characteristics for monitoring purposes. Regular assessment of the data that emerges will enable us to adapt the scheme accordingly. The new IT system will also feature updated mandatory training, including on unconscious bias, and engaging guidance that ensures greater clarity.

The requirements on decision justification, and for consideration of evidence, will be strengthened. The University of Exeter was recently commissioned to undertake a review into the ACCEA scoring processes. Its review findings will feed into the new scoring system and will align with the non-stratified application process.

Once the transition process has completed, there will be up to 600 awards granted annually in England. The increased number of awards will increase coverage across the board.

Engagement and involvement

In developing our proposal, we have also consulted widely with employers from across the NHS, gender medical practices, specialist associations and colleges, and the British Medical Association (BMA). This included a series of focus group discussions held through Summer 2020. Our stakeholders, including the Royal Colleges and the BMA, also had early sight of the proposed reforms and have provided comments on the proposals directly.

Transitional arrangements

In 2018, the government approved Schedule 30 of the 2003 consultant contract, negotiated, and agreed between NHS Employers and the BMA. The schedule provides transitional pay protection where a new national scheme is introduced that has lower award values. This protection is costly and the NCIA scheme must remain affordable within the annual budget available and so pay protection will have consequences for the money available new awards in the short and medium term.  Our reformed scheme proposed the introduction of lower award values to enable more awards to be made available to a wider section of the consultant population – those who are currently under-represented in the current scheme include younger consultants. However, as an outcome of lowering the award values the pay protection arrangements which come in will benefit existing awards holders by enabling them to effectively ‘top up’ their award value to the current award level values.

The contractual arrangements for pay protection can only be altered by collective agreement with the recognised trade unions. To date the BMA has not been willing to enter discussions to renegotiate the terms. However, we remain open to reconsidering the pay protection arrangements in partnership should the BMA’s position change. However, we consider that the benefits of the new awards, including their broader scope, outweigh these issues.

The cost of the pay protection arrangements has been factored into plans for the reformed scheme. However, there is uncertainty around these costs and, as such, the actual costs will be reviewed periodically and the numbers of awards available may be adjusted as a result.

Our aim is to award up to 600 awards per year. The pay protection provisions described above mean we may not be able to award the full 600 awards in the first few years of the scheme or may have to adjust the number of awards at each level each year. The number of awards at each level will be adjusted annually if needed, taking into consideration the actual costs of pay protection as they become clear each year.

Conclusion

The key aims of the reforms to the NCEA scheme are:

• to ensure that access to the scheme is broadened, particularly to those currently under-represented in the scheme
• that the process for application is fairer and more inclusive
• to remove the renewals process

We expect these reforms, and the introduction of new NCIAs moreover, to have very positive equality outcomes.

Annex A

Age data

The ages for successful applicants are as follows.

Table 2: average age of successful 2019 applicants for a new award at August 2020 by award level

Level	Mean age (years)
Bronze	50.6
Silver	53.6
Gold	54.8
Platinum	60.2

Note: table 2 is the same as table 1 above and is reproduced here for ease.

Table 3: 2019 applications and success rate for new awards by age group at August 2020

Age group	Details	Bronze	Silver	Gold	Platinum	Total
<35	Applications	5	1	1	1	8
<35	Awards	0	0	0	0	0
<35	Success rate	0%	0%	0%	0%	0%
36 to 40	Applications	18	-	-	-	18
36 to 40	Awards	4	-	-	-	4
36 to 40	Success rate	22%	-	-	-	22%
41 to 45	Applications	95	6	-	-	101
41 to 45	Awards	26	3	-	-	29
41 to 45	Success rate	27%	50%	-	-	29
46 to 50	Applications	187	32	6	-	225
46 to 50	Awards	70	18	2	-	90
46 to 50	Success rate	37%	56%	33%	-	40%
51 to 55	Applications	169	99	45	1	314
51 to 55	Awards	53	33	20	1	107
51 to 55	Success rate	31%	33%	44%	100%	34%
56 to 60	Applications	104	96	46	11	257
56 to 60	Awards	27	25	10	4	66
56 to 60	Success rate	26%	26%	22%	36%	26%
61 to 65	Applications	24	25	20	14	83
61 to 65	Awards	5	5	2	5	17
61 to 65	Success rate	21%	21%	10%	36%	20%
>66	Applications	4	5	2	5	16
>66	Awards	2	0	0	1	3
>66	Success rate	50%	0%	0%	20%	19%

There is an identifiable pattern when it comes to age and applicant success with the highest success rates for applicants between the ages of 46 to 50. 

Disability

Hoque and others (2018), making assessments from the nationally representative British Workplace Employment Relations Study 2011, find a negative relationship between ’high-performance work practices’, including pay that is partly determined by performance evaluation, and the number of disabled employees in a workplace. However, the authors further find that such a negative relationship is not present if workplaces utilise disability equality practices. They find that such discrimination is not necessarily direct, but as a result of universal practices unsuited to the disabled, and that unfair assessments of disabled people also affects the recruitment and retention of people with disabilities. This is supported by Rubery (1995) who finds that appraisals can be disadvantageous if they focus on an ability to fit in with organisational standards and norms.  

Stone and Colella (1996) find that performance-based pay can be fairer for disabled people, however, as it can ensure they are measured against objective criteria. Furthermore, they find that individual criteria allows for impairments to be taken into account. However, Stone and Williams find that such tests must accommodate impairment-related restrictions. Furthermore, Colella and others (1997) finds that equality training and transparency are important in appraisal criteria to prevent discrimination against disabled people. 

As per Hoque and others’ findings, payments based on performance may be a factor that worsens inequality for disabled persons at work. However, Hoque found that, for organisations with rigorous equality policies, such inequalities are not found. The NHS employs rigorous equality policies for legally protected characteristics, included for disabled persons.

Annex B

Ethnicity data

Table 4: 2019 applications and success rate for new awards by ethnicity at August 2020

Level and ethnicity	Applications	% applications at level	Awards	Success rate
Bronze: white	391	64.5	131	33.5%
Bronze: BAME	162	26.7	41	25.3%
Bronze: not stated	53	8.7	14	26.4%
Silver: white	177	67.3	63	35.6%
Silver: BAME	71	27.0	20	28.2%
Silver: not stated	15	5.7	2	13.3%
Gold: white	92	76.7	26	28.3%
Gold: BAME	25	20.8	8	32.0%
Gold: not stated	3	2.5	0	0.0%
Platinum: white	28	87.5	7	25.0%
Platinum: BAME	3	9.4	3	100.0%
Platinum: not stated	1	3.1	1	100.0%
All levels: white	688	67.4	227	33.0%
All levels: BAME	261	25.6	72	27.6%
All levels: not stated	72	7.1	17	23.6%