Discrimination in the discretionary points award scheme: comparison of white with non-white consultants and men with women

The discretionary points award scheme is one of the main mechanisms for rewarding consultants beyond their basic salaries in England, Wales, and Scotland. Half of all consultants have received awards. Together, the discretionary points and distinction awards cost the NHS about £251m ($410m; €380m) each year. Each discretionary point is worth £2645, so a consultant with the maximum of eight discretionary points earns £87 280.

Department of Health guidance for awarding points instructs employers to ensure that consultants are treated equally regardless of colour, race, sex, religion, politics, marital status, sexual orientation, membership or non-membership of trade unions or associations, ethnic origin, age, or disability.¹ We assessed whether any disparity between the discretionary points awarded to consultants in England and Wales and in Scotland is associated with ethnic origin and sex.

Methods and results

We used data for 2000-1 from the Advisory Committee on Distinction Awards for England and Wales and the Scottish Advisory Committee on Distinction Awards. These disaggregated data included date of birth, sex, ethnic origin, specialty, level of award or number of discretionary points held, and the year the awards or points were granted.

We categorised the ethnic groups Bangladeshi, black African, black other, Chinese, Indian, and Pakistani as non-white and compared these groups with consultants who described themselves as white. Consultants classified as from any other ethnic group and those who did not give their ethnic origin were excluded. We divided the number of consultants with discretionary points by the total number of consultants who did not receive distinction awards, as consultants without awards are eligible for discretionary points. We compared the proportion of consultants with discretionary points between white and non-white consultants and between men and women (table).

In England and Wales, white consultants had 1.37 (95% confidence interval 1.31 to 1.44) times as many awards as non-white consultants, and men had 1.25 (1.21 to 1.30) times as many as women; in Scotland the ratios were 1.34 (1.08 to 1.66) and 1.36 (1.23 to 1.51). The ratios increased with increasing level of award (table).

Comment

Non-white and female consultants may be disadvantaged under the discretionary point award scheme. The non-response rate of 16% (3597/22389) in England and Wales may have affected the results. To negate the differences, all the consultants who did not give their ethnic group and received awards would, however, have to be non-white. Non-white consultants are older when appointed, and, therefore, their period of eligibility for discretionary awards is less than for white consultants. Non-white consultants may also be concentrated in specialties which are less likely to receive awards.²,³ The reason for differences in the number of points awarded to men and women is unclear, but differences could be due to discrimination.⁴

Points are awarded by local decision making groups which usually consist of three non-eligible consultants and three managers. The deliberations of these groups are not usually open to scrutiny. The lack of published data on the scheme locally and nationally is a continued source of concern. Employment tribunals have already found in favour of consultants who have alleged racial discrimination.⁵ Without effective monitoring, it is impossible to judge whether the scheme is operated fairly and without discrimination.

Table.

Distribution of discretionary point awards by ethnic group and sex for consultants in England and Wales and Scotland

	Race*					Sex†
	White	Non-white	Total	Ratio‡ (95% CI)		Male	Female	Total	Ratio§ (95% CI)
England and Wales
No eligible for award	16 411	2395	18 806	—		17 105	5284	22 389	—
No with award	9 261	983	10 244	—		9 540	2351	11 891	—
% with award	56.43	41.04	—	1.37 (1.31 to 1.44)		55.77	44.49	—	1.25 (1.21 to 1.30)
No with award beyond
D1	7 414	706	8 120	1.53 (1.44 to 1.63)		7 622	1732	9 354	1.36 (1.30 to 1.42)
D2	5 361	459	5 820	1.70 (1.57 to 1.86)		5 540	1124	6 664	1.52 (1.44 to 1.61)
D3	4 222	326	4 548	1.89 (1.70 to 2.10)		4 408	805	5 213	1.69 (1.58 to 1.81)
D4	3 488	245	3 733	2.08 (1.84 to 2.35)		3 643	627	4 270	1.79 (1.66 to 1.94)
D5	1 319	70	1 389	2.75 (2.17 to 3.48)		1 304	223	1 527	1.81 (1.57 to 2.08)
D6	594	23	617	3.77 (2.49 to 5.70)		577	96	673	1.86 (1.50 to 2.03)
D7	235	10	245	3.43 (1.82 to 6.45)		229	45	274	1.57 (1.14 to 2.16)
Mean age (years)	36.3	39.0	—	—		36.7	37.1	—	—
Scotland
No eligible for award	2 533	140	2 673	—		2 087	677	2 764	—
No with award	1 310	54	1 364	—		1 136	270	1 406	—
% with award	51.7	38.5	—	1.34 (1.08 to 1.66)		54.4	39.9	—	1.36 (1.23 to 1.51)
No with award beyond
D1	984	29	1 013	1.88 (1.35 to 2.60)		869	174	1 043	1.62 (1.41 to 1.86)
D2	707	19	726	2.06 (1.35 to 3.14)		635	103	738	2 (1.65 to 2.42)
D3	503	6	509	4.63 (2.11 to 10.18)		457	66	523	2.25 (1.76 to 2.86)
D4	394	4	398	5.44 (2.06 to 14.36)		359	50	409	2.33 (1.76 to 3.09)
Mean age (years)	35.4	40.4	—	—		35.7	35.5	—	—

^*In England and Wales, 2425 consultants, and in Scotland, 91 consultants did not give their ethnic group and we classified 1172 as “other ethnic group.” 

^†In England and Wales, 14 consultants did not provide information. 

^‡In England and Wales, χ² for the linear trend was 316 (P<0.0001); in Scotland χ² was 35 (P<0.0001). 

^§ In England and Wales, χ² for the linear trend was 347 (P<0.0001); in Scotland χ² was 79 (P<0.0001).