Leading Article: The NHS is in need of a little surgery

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imagine getting a bonus this year. Try and imagine that it's a five-figure sum. And imagine that, irrespective of your subsequent performance, you would still be entitled to that bonus every single year until your retirement. A workers' paradise? The docks in the 1960s? Fleet Street in the 1970s? No, much more white-collar, white coat even. Until the Government yesterday decided that the party's over, it was seemingly the routine procedure for our hospital consultants to have something called the Committee on Distinction Awards, which is dominated by the consultants, look after their interests. And yet we should not be surprised about what is, after all, just the latest distortion in the way we reward those in the tellingly named caring professions.

One of the more dangerous traps when looking at pay in the health service is to view all those who work there as "angels". Many are, of course, dedicated and unmaterialistic. But despite their first duty to relieve suffering and save lives, they also have bills to pay and aspirations. Our persistent failure to recognise this, combined with the strength of some professional bodies and unions, and perennial cash crises, has led to some bizarre Spanish practices, like the consultants' scam, side-by- side with very low pay, poor morale and staff shortages. The pay review boards are often ignored.

Paying those in the health service should be unencumbered by false sentimentality. There is a market rate. The best should be paid whatever it takes to retain them. The Government has begun to recognise the force of this principle for teachers' pay and the same should apply in health care. The abolition of consultants' automatic merit awards (costing pounds 100m per year) should create the scope to offer perhaps larger incentives to those who are truly outstanding. The same, of course, goes for the best of our GPs, nurses, paramedics, auxiliary staff, and, yes, even the NHS administrators.

We have given little thought to how we manage the NHS's vast human resources. The Government is to be praised for indicating that it wants to.