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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
Affiliation:
Health Services Management Centre, University of Birmingham, UK email: M.Exworthy@bham.ac.uk
PAULA HYDE
Affiliation:
Manchester Business School, University of Manchester, UKM15 6PB email: paula.hyde@durham.ac.uk
PAMELA MCDONALD-KUHNE
Affiliation:
Kingston Business School, Kingston University, UK email: p.mcdonald@kingston.ac.uk

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
Copyright
Copyright © Cambridge University Press 2015 

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