Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T20:28:55.677Z Has data issue: false hasContentIssue false
  • English
  • Français

Knights and Knaves in the English Medical Profession: the Case of Clinical Excellence Awards

Published online by Cambridge University Press:  02 October 2015

MARK EXWORTHY ,
PAULA HYDE  and
PAMELA MCDONALD-KUHNE
MARK EXWORTHY
Affiliation:
Health Services Management Centre, University of Birmingham, UK email: [email protected]
PAULA HYDE
Affiliation:
Manchester Business School, University of Manchester, UKM15 6PB email: [email protected]
PAMELA MCDONALD-KUHNE
Affiliation:
Kingston Business School, Kingston University, UK email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

We elaborate Le Grand's thesis of ‘knights and knaves’ in terms of clinical excellence awards (CEAs), the ‘financial bonuses’ which are paid to over half of all English hospital specialists and which can be as much as £75,000 (€92,000) per year in addition to an NHS (National Health Service) salary. Knights are ‘individuals who are motivated to help others for no private reward’ while knaves are ‘self-interested individuals who are motivated to help others only if by doing so they will serve their private interests.’ Doctors (individually and collectively) exhibit both traits but the work of explanation of the inter-relationship between them has remained neglected. Through a textual analysis of written responses to a recent review of CEAs, we examine the ‘knightly’ and ‘knavish’ arguments used by medical professional stakeholders in defending these CEAs. While doctors promote their knightly claims, they are also knavish in shaping the preferences of, and options for, policy-makers. Policy-makers continue to support CEAs but have introduced revised criteria for CEAs, putting pressure on the medical profession to accept reforms. CEAs illustrate the enduring and flexible power of the medical profession in the UK in colonising reforms to their pay, and also the subtle inter-relationship between knights and knaves in health policy.

Type
Articles
Information
Journal of Social Policy , Volume 45 , Issue 1 , January 2016 , pp. 83 - 99
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bourdieu, P. (1990), The logic of practice. Cambridge: Polity Press.CrossRefGoogle Scholar
Bloor, K., Freemantle, N. and Maynard, A. (2008), ‘Gender and variation in activity rates of hospital consultants.’ Journal of the Royal Society of Medicine, 101, 1, pp.27–33.CrossRefGoogle ScholarPubMed
Calnan, M. and Gabe, J. (2009), ‘The restratification of primary care in England? A sociological analysis.’ Chapter 3 (pp.56–78) in Gabe, J. and Calnan, M. (eds) The new sociology of the health service. London: Routledge.Google Scholar
Capita (2011), Compensation levels and incentive systems for medical and dental consultants: international experience. Harrogate: Capita.Google Scholar
Cho, YK. and Parry, JL. (2012), ‘Intrinsic motivation and employee attitudes: role of managerial trustworthiness, goal directedness, and extrinsic reward expectancy.’ Review of Public Personnel Administration, 32, 4, pp.382–406.CrossRefGoogle Scholar
Courpasson, D. (2000), ‘Managerial strategies of domination: power in soft bureaucracies.’ Organization Studies, 21, 1, pp.141–161.CrossRefGoogle Scholar
Crilly, T. and Le Grand, J. (2004), ‘The motivation and behaviour of hospital Trusts.’ Social Science and Medicine, 58, pp.1809–1823.CrossRefGoogle ScholarPubMed
Deakin, A. (1993), ‘Richard Titmuss twenty years on.’ Journal of Social Policy, 22, 2, pp.235–242.Google Scholar
Deakin, A. and Mann, K. (1999), ‘Agency, modernity and social policy.’ Journal of Social Policy, 28, 3, pp.413–435.Google Scholar
Deci, EL. and Ryan, R. (2000), ‘The what and why of goal pursuits: human needs and the self-determination of human behaviour.’ Psychological Inquiry, 11, 4, pp.227–268.CrossRefGoogle Scholar
Disney, K., Le Grand, J. and Atkinson, G. (2013), ‘From irresponsible knaves to responsible knights for just 5p: behaviour public policy and the environment.’ Chapter 3 (pp.69–87) in Oliver, A. (ed) Behavioural public policy. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Dixon-Woods, M., Yeung, K. and Bosk, CL. (2011), ‘Why is UK medicine no longer a self-regulating profession? The role of scandals involving “bad apple” doctors.’ Social Science and Medicine, 73, 10, pp.1452–1459.CrossRefGoogle ScholarPubMed
Elston, M-A. (2009), ‘Re-making a trustworthy medical profession in twenty-first century Britain.’ Chapter 1 (pp.16–36) in Gabe, J. and Calnan, M. (eds) The new sociology of the health service. London: Routledge.Google Scholar
Esmail, A., Abel, P. and Everington, S. (2003), ‘Discrimination in the discretionary points award scheme: comparison of white with non-white consultants and men with women.’ British Medical Journal, 326, 7391, pp.687–688.CrossRefGoogle ScholarPubMed
Exworthy, M. 1998, ‘Clinical audit in the NHS internal market: from peer review to external monitoring.’ Public Policy and Administration, 13, 2, pp. 40–53.CrossRefGoogle Scholar
Exworthy, M. and Halford, S. (eds) (1999), Professionals and the new managerialism in the public sector. Buckingham: Open University Press.Google Scholar
Ferlie, E. and Geragthy, KJ. (2005), ‘Professionals in public services organisations: implications for public sector “reforming”’ Chapter 18 (pp.422–445) in Ferlie, E., Lynn, LE. and Pollitt, C. (eds) Oxford handbook of public management. Oxford: Oxford University Press.Google Scholar
Freidson, E. (1994),Professionalism: the third logic. Chicago: University of Chicago Press.Google Scholar
Frey, B. (1997), Not just for the money: an economic theory of personal motivation. Cheltenham, UK: Edward Elgar.Google Scholar
Frey, B. (2013), ‘How should people be rewarded for their work?’ Chapter 7 (pp.165–183) in Oliver, A. (ed) Behavioural public policy. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Frey, BS. and Jegen, R. (2001), ‘Motivation crowding theory.’ Journal of Economic Surveys, 15, 1, pp.589–611.CrossRefGoogle Scholar
Frey, BS. and Neckermann, S. (2009), ‘Awards: a view from economics.’ Chapter 5 (pp.73–88) in Brennan, G. and Eusepi, G. (eds) The economics of ethics and the ethics of economics. Cheltenham and Northampton: Edward Elgar.Google Scholar
Grant, S., Guthrie, B., Huby, G., Watkins, F., Checkland, K., McDonald, R. and Davies, HTO. (2009), ‘The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.’ Sociology off Health and Illness, 31, pp.229–245.CrossRefGoogle ScholarPubMed
Greener, I. (2002), ‘Agency, social theory and social policy.’ Critical Social Policy, 24, 2, pp.688–705.CrossRefGoogle Scholar
Harrison, S. (2002), ‘New Labour, modernisation and the medical labour process.’ Journal of Social Policy, 31, 3, pp.465–485.CrossRefGoogle Scholar
Harrison, S. and Checkland, K. (2009), ‘Evidence-based practice in UK health policy.’ Chapter 6 (pp.121–142) in Gabe, J. and Calnan, M. (eds) The new sociology of the health service. London: Routledge.Google Scholar
Harrison, S. and Pollitt, C. (1994), Controlling health professionals. Buckingham: Open University Press.Google Scholar
Health Select Committee (2013), Urgent and emergency services. Second report of session 2013–14. HC171. London: House of Commons.Google Scholar
Hsieh, H-F. and Shannon, SE. (2005), ‘Three approaches to qualitative content analysis.’ Qualitative Health Research, 15, 9, pp.1277–1288.CrossRefGoogle ScholarPubMed
Klein, R. (1990), ‘The state and the profession: politics of the double bed.’ British Medical Journal, 301, 6754, pp.700–702.CrossRefGoogle ScholarPubMed
Klein, R. (2012), ‘The great transformation.’ Chapter (pp.192–200) in Marmor, TR. and Klein, R. (eds) Politics, health and health care: selected essays. New Haven: Yale University Press.Google Scholar
Kuhlmann, E. (2006), Modernising healthcare: reinventing professions, the state and the public. Bristol: Policy Press.Google Scholar
Le Grand, J. (1997), ‘Knights, knaves or pawns? Human behaviour and social policy.’ Journal of Social Policy, 26, 2, pp.149–169.CrossRefGoogle Scholar
Le Grand, J. (2003), Motivation, agency and public policy: of knights and knaves, pawns and queens. Oxford: Oxford University Press.CrossRefGoogle Scholar
Marshall, MN. and Harrison, S. (2005), ‘It's about more than money: financial incentives and internal motivation.’ Quality and Safety in Health Care, 14, pp.4–5.CrossRefGoogle ScholarPubMed
National Audit Office (2010), Management of NHS hospital productivity. HC491. London: NAO.Google Scholar
National Audit Office (2013), Managing NHS hospital consultants. HC885. 6 February 2013. London: NAO.Google Scholar
Needham, C. (2006), ‘Customer care and the public service ethos.’ Public Administration, 84, 4, pp.845–860.CrossRefGoogle Scholar
OECD (2005), Performance-related pay policies for government employees. Paris: OECD. http://www.oecd-ilibrary.org/governance/performance-related-pay-policies-for-government-employees_9789264007550-en (accessed October 2013).Google Scholar
Suddaby, R. and Viale, T. (2011), ‘Professionals and field-level change: institutional work and the professional project.’ Current Sociology, 59, 4, pp.423–442.CrossRefGoogle Scholar
Taylor-Gooby, P., Sylvester, S., Calnan, M. and Manley, G. (2000), ‘Knights, knaves and gnashers: professional values and private dentistry.’ Journal of Social Policy, 29, 3, p.375–395.CrossRefGoogle Scholar
Timmins, N. (1995), The five giants: a biography of the welfare state. London: Fontana Press.Google Scholar