In recent years, the health and social care system in England has undergone substantial change. The Health and Social Care Act 2012 and the Care Act 2014 have devolved functions and powers away from the Department of Health to local and Arm’s Length Bodies.
In this new system, the Department has the key stewardship and assurance function designed to ensure that the new system and the multiple new and reformed bodies within it, have the appropriate functions and are performing to a high standard.
To perform this stewardship function, the Department is putting in place Triennial Reviews of all its Arm’s Length Bodies. This includes all Executive Non-Departmental Public Bodies (ENDPBs), Advisory Non-Departmental Bodies (ANDPBs), Executive Agencies (EA) and Special Health Authorities (SpHA). As an ANDPB, the Advisory Committee on Clinical Excellence Awards (ACCEA) is subject to review in 2014-15.
The programme of reviews builds on the approach developed by the Cabinet Office as part of their work on Public Bodies Reform.
This review is part of a wider programme the Department of Health has developed in support of its stewardship and assurance function. The review has two main aims which will be undertaken simultaneously:
- The first is to provide a robust challenge of the continuing need for the ACCEA, both in terms of the functions it performs and the model and approach in which these are delivered.
- The second will be consideration of the ACCEA's governance, performance and capability as well as exploring opportunities for efficiencies.
This Call for Evidence seeks views from respondents to assist its consideration of both of the above stages.
Why We Are Consulting
In order to conduct the review in an open and transparent manner and ensure that the findings are rigorous and evidence-based, the review team is seeking the views of a wide range of stakeholders. We are interested in the views of individuals and organisations that engage with the Advisory Committee on Clinical Excellence Awards (ACCEA) or have a wider interest in its work. The key areas of enquiry, based on the five standard areas that apply to all Triennial Reviews are set out below.
Advisory Committee on Clinical Excellence Awards (ACCEA) – triennial review – call for evidence
Please respond to one or more of the following 12 questions, in particular the Review is looking for evidence to inform considerations.
1. Is there an ongoing need for advice to Ministers on national level clinical excellence awards?
Yes
Please give reasons for your answer:
There is inevitable tension between the need to recognise and reward excellence on the one hand, and the need to be financially prudent on the other. Ongoing advice is required to ensure that an appropriate balance is achieved.
There is an undoubted range of commitment and abilities within the medical profession in the NHS serving the population. Advice to Ministers can highlight the occasions when it is appropriate that outstanding contributions and advances in quality of care, research and teaching should be recognised by the awards system.
2. Is the Advisory Committee on Clinical Excellence Awards the best way to award and administer national level clinical excellence awards?
Yes
Please give reasons for your answer:
The Advisory Committee structure delivers a synthesis of lay and professional advice, operates to a clear protocol and has an effective review process. This helps to promote transparency.
3. Think about the current structure for the administration of the awards, are there alternative methods for delivery? For example, other organisations for award applications from particular professional disciplines? What are the relative merits of current and alternative methods of delivery in terms of efficiency and effectiveness?
Please give reasons for your answer:
In comparison to the legal and teaching professions, the ACCEA structure neither operates on a purely commercial model nor is it linked to a single outcome set. Barristers are able to set fees which are in part determined by reputation and demand. Teachers can receive additional pay reward if certain outcomes and standards are achieved. Neither of these models are appropriate for hospital medical consultants, the best of whom deliver to a very high standard across a number of domains – patient safety and care; clinical innovation; academic research; teaching and standards; audit; public body policy and planning advice.
The current structure ensures equity, transparency and efficiency from start to finish of an important national process. A non-governmental body could administer the whole process for all specialities; however the only reason to change would be a significant financial saving.
4. Does the national Committee have the right level of independence to ensure its advice is robust and impartial?
Yes
Please give reasons for your answer:
The lay chairmanship and representation from professional, employer and lay members, along with input from Academy of Medical Royal Colleges, Universities and Department of Health results in a wide but balanced overview along with sufficient in depth detail to ensure that decisions are both fair and evidence-based.
5. Does the current composition of the national Committee's membership best support its functions?
Yes
Please give reasons for your answer:
As for question 4, wide representation is important and ensures impartiality.
6. Do you have any comments on the balance of the ACCEA structure that currently comprises a national committee and 13 regional sub-committees?
Yes
Please give reasons for your answer:
A national committee with regional review remains the best model, but there needs to be greater confidence in the structure of the regional sub-committees and greater scrutiny of the applications. Three of the regional sub-committees are London based and although this may be on the basis of population, it may lend a perception of central bias to the process.
There is also a need to have representation from all trusts and organisations in a screening group to avoid sensitivity that some trusts are over-represented on the local committee.
7. Do you have any comments on the split of responsibilities between the national Committee and the 13 regional sub-committees?
No
Please give reasons for your answer:
8. Are there other committees or organisations which could be used as a benchmark for the performance of the national ACCEA?
No
Please give reasons for your answer:
9. Are all aspects of the application process for national level awards, including applicant guidance, application forms and associated timelines, accessible and transparent for candidates?
Yes
Please give reasons for your answer:
The process is explicit and clear.
10. Are there any barriers to applications that should be removed?
No
Please give reasons for your answer:
11. Could the management of the applications process for national level awards, including associated communications activity, be improved?
Yes
Please give reasons for your answer:
The ability of the individual to track the application (for example online), and its progress through the process, would be helpful. The year end report should also be available within a month of the final results, allowing time for appeals.
There have also been suggestions that reviewing the scoring system would be beneficial. Currently the total score across several domains is evaluated; however a move to also assess the highest scoring domain would recognise some individuals who make an outstanding contribution to one area.
Increased recognition of education and training would also be positive.
12. Is there an appropriate level of transparency in the national Committee’s end to end processes and decision making?
Yes
Please give reasons for your answer:
Scoring criteria are available publicly on the website to see how the decisions are made.
13. Any other comments?
Suggestions for future development include the review of all citations within the scoring system and encouraging the use of letters of support for applicants from senior Clinicians who are not part of the committee structure.