Bottomley backs pay by results in NHS

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THE Secretary of State for Health, Virginia Bottomley, yesterday reaffirmed the Government's determination to introduce performance-related pay into the National Health Service in spite of strengthening opposition from doctors and nurses.

Consultants, academic and public health service doctors have all rejected outright the 'doctrinaire' imposition of performance-related pay on the NHS.

In a speech in Brighton to the British Association of Medical Managers Mrs Bottomley said: 'The freedom of NHS trusts increasingly to determine the pay and conditions of their staff is an important part of making services more responsive to local needs.'

She said she was encouraging the trusts to explore more flexible ways of rewarding their staff. 'We are not going to move from national to devolved pay arrangements in one dramatic leap. There must be a transition which commands the confidence of staff and supports the delivery of high-quality patient care . . . In my book, local pay arrangements should be linked to the success of the organisation. That success is determined by the organisation meeting its objectives to improve the quality and quantity of patient care. Properly handled, local pay will encourage and promote good clinical practice, not distort it.'

But the British Medical Association said performance-related pay would be a disaster for the NHS. All the evidence pointed to it being a 'complete failure in the public and private sectors'.

'Few trusts will be able to introduce local pay bargaining by next April. Mrs Bottomley seems strangely out of touch with what is going on in the health service on this issue,' it said.

The conventional wisdom that demand for NHS services is infinite and that rationing of health care is inevitable is challenged

today by the Royal College of Nursing. In evidence to the Commons health committee, the college says a big increase in resources might not be necessary if treatments that are not cost-effective are abandoned if favour of those that are.