Advisory Committee on Clinical Excellence Awards: annual report for the 2021 awards round
Published 2 February 2023
Applies to England and Wales
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The Advisory Committee on Clinical Excellence Awards was replaced by the Advisory Committee on Clinical Impact Awards. Since 2022, the awards are known as national Clinical Impact Awards (NCIA).
Foreword
We are pleased to present our annual report for the Advisory Committee on Clinical Excellence Awards (ACCEA) for the final award round in this format. Although the focus of this report is on the output of the national Clinical Excellence Awards (NCEA) round in 2021, much time and effort during the reporting period was spent on consultation activities, review of stakeholder feedback and careful consideration of proposals for reform based on these helpful responses.
After 2021, the awards have been reformed to improve the breadth and access of consultants to national awards, with a renewed focus on diversity and impact, rather than just a description of activity undertaken as part of the evidence submitted. As such, from 2022, the awards will be known as national Clinical Impact Awards (NCIA).
We are most grateful to all those who took time to respond and provide thoughtful input to the shaping of the new scheme to help us achieve these strategic objectives. See details of the reform, its consultation and the government response.
In implementing the 2021 national Clinical Excellence Award round, we worked closely with multiple stakeholders to mitigate the effects of the suspended 2020 round due to the coronavirus (COVID-19) pandemic. An increased number of awards and applications in 2021, together with simultaneously managing the consultation and reform processes and the commissioning and implementation of a new IT system, led to an unprecedented degree of complexity.
In addition, 2021 saw a greater number of applicants due to the missed opportunities in 2020 together with many applicants who seemed to be applying for awards earlier than expected. This was most likely due to an awareness that the scheme was changing.
Although the details of the numbers of applicants and awards are described in the body of the report, we must recognise the exceptional efforts of our secretariat and sub-committees and scorers for their flexibility and adaptability in managing the increased workload these factors created. A substantial drive to recruit extra scorers by the secretariat mitigated some of the workload, as did the flexibility of scorers in being reallocated across regions to offset conflicts of interest, workload and scorer diversity.
The behind-the-scenes work undertaken by the secretariat is essential to ensure the scheme runs effectively and delivers on these objectives. While not always widely visible to those involved in different aspects of the scheme, this work is fundamental to the success of our operations and is much appreciated at every level.
With our ongoing focus on diversity, in reviewing the outputs of the 2021 award round, we see continued progress in both applications and success in attaining awards, in both numbers of awards and in success rates.
Similarly, the diversity of our scorers and sub-committees has shown some progress, with the reallocation of scorers across regions improving the balance of diversity and reducing the variances across the country.
Although improved, there is still more we have to deliver on multiple aspects of diversity and in ensuring it is representative across all award levels. This remains a focus and a strategic objective of the new NCIA scheme as we seek to retain, recognise and reward a wider cadre of senior clinicians who deliver national impact for the NHS.
These clinicians act as role models for their colleagues and peers, providing important innovation, research, training and teaching as well as the vital services upon which the NHS depends. All of them deserve our recognition and we are grateful and proud to be able to play a part in this.
Chair: Stuart Dollow
Medical director: Kevin Davies
ACCEA in 2021
The Advisory Committee for Clinical Excellence Awards (ACCEA) is an independent, non-departmental public body. ACCEA advises ministers in the Department for Health and Social Care and the Welsh Government on the provision of financial awards, granted via an annual competition to NHS consultant doctors, dentists and academic general practitioners.
The purpose of the awards scheme is to recognise senior clinicians’ achievements of national or international significance, beyond what is expected as part of their job plan. Separate schemes operate in England and Wales using the same broad principles and a shared application platform. Eligibility for the scheme is part of the NHS consultant reward package, and helps to retain talent and encourage clinical excellence in the NHS.
The committee is responsible for the operation of the scheme and is led by a publicly appointed chair and medical director. Secretariat support throughout the process is provided by a small team of civil servants within the Department for Health and Social Care.
The 2021 awards round was the final iteration of the national Clinical Excellence Awards (NCEA). From 2022 onwards, the scheme will be known as the national Clinical Impact Awards (NCIA) and governance will be provided by the Advisory Committee on Clinical Impact Awards (ACCIA). Further information on this transition can be found throughout this report.
More information on ACCEA, including our role and purpose, our governance and terms of reference, is available on the ACCEA organisation page.
Main committee
The decision-making body is our main committee. It meets to:
- discuss and agree changes to ACCIA policy and procedure
- agree the final recommendations to ministers for new and renewed awards
A list of members is also available on the ACCEA organisation page.
In advance of the 2022 awards round, we undertook an exercise to review main committee membership to increase diversity among committee members.
We advertised vacancies through a wide range of platforms and networks with the key aim of attracting applications from all under-represented groups. This included an approach to the General Medical Council and British Medical Association racial equality networks and other representative groups.
After a successful recruitment round in March 2022, we appointed 5 new members, bringing the total membership to 22 including the chair, medical vice-chair and ex-officio members.
Assuring the diversity across all our committees will be something we continue to monitor and to which we give priority under the new national Clinical Impact Awards scheme.
Our regional sub-committees
All applications for awards are scored by voluntary assessors. Our assessors are recruited regionally and, in most cases, only score applications from within their own region in a sub-committee structure. In 2021, for the first time, to maximise scorer numbers where a conflict of interest arose, or to balance workload or diversity of scorers, some assessors were re-assigned to another region to score applications.
Each sub-committee is led by a lay chair and a medical vice-chair who are responsible for the good governance of their committee. Regional sub-committee chairs and medical vice-chairs are also members of the platinum scoring committee (scored nationally) and score applications that are sent to the national reserve sub-committee for additional scrutiny.
The remainder of each regional sub-committee consists of a mixture of:
- professional members (practising clinicians from across a range of specialties, including public health and academia)
- employer members (from NHS organisations, including senior managers and other leaders)
- non-medical professional or lay members (from a variety of backgrounds, including higher education, law, human resources, research, management, business, or retired healthcare professionals)
In total,there are 14 regional sub-committees in England, with one additional sub-committee assessing applications in Wales. More information on our regional sub-committees can be found in our awards application guidance.
Note: the 14 regional sub-committees are: Cheshire and Mersey, East of England, East Midlands, London North East, London North West, London South, North-East, North West, South, South East, South West, West Midlands, and Yorkshire and the Humber
Sub-committee recruitment and training
ACCEA regularly refreshes the membership of our regional sub-committees to balance experience with fresh perspectives. Our aim is for the membership of each sub-committee to fully reflect the diverse make-up of the NHS consultant population they assess.
In 2021, we recruited a total of 142 new assessors, including one new chair and one medical vice-chair. ACCEA would like to thank all new and continuing assessors for their commitment and dedication to the scheme.
All new scorers are required to attend scorer training run by the ACCEA medical director and chair. The training equips all scorers with the skills to impartially assess each application in an equitable way. Assessor training is not reserved solely for new scorers. ACCEA actively encourages experienced scorers to refresh their knowledge by attending sessions as frequently as possible. In 2021, a total of 171 assessors attended scorer training, delivered online.
Sub-committee diversity
Gender
According to NHS Digital data, as of March 2021 (when the 2021 awards round closed for applications), 38% of the NHS consultant workforce in England was female. Our aim therefore was for each regional sub-committee to be constituted of at least 38% female members.
As of March 2021, according to ACCEA’s records, only 4 out of the 15 regional sub-committees had female membership of at least 38%. Table 1 shows the 2021 regional sub-committee membership by gender, and highlights that the DHSC and arm-s length body (ALB) (57.89%), London South (51.52%) and South East (39.39%) committees were the only regions with a representative number of female members when compared against the wider NHS consultant population.
Table 1: 2021 regional sub-committee membership by gender
| Sub-committee | Male (%) | Female (%) |
|---|---|---|
| DHSC and ALB | 42.11% | 57.89% |
| Cheshire and Mersey | 67.86% | 32.14% |
| East of England | 77.14% | 22.86% |
| East Midlands | 71.43% | 28.57% |
| London North East | 73.91% | 26.09% |
| London North West | 74.07% | 25.93% |
| London South | 48.48% | 51.52% |
| North East | 76.67% | 23.33% |
| North West | 84.44% | 15.56% |
| South | 62.96% | 37.04% |
| South East | 60.61% | 39.39% |
| South West | 64.52% | 35.48% |
| West Midlands | 72.41% | 27.59% |
| Wales | 77.27% | 22.73% |
| Yorkshire and Humber | 70.97% | 29.03% |
Female representation on ACCEA’s regional sub-committees decreased overall in 2021, with the percentage sitting at just over 30% compared with over 32% in 2018.
While there has been a decrease in the percentage of females overall, this can, in part, be explained by the significant recruitment drive that took place between 2018 and 2021, during which more male members applied to join these committees. A total of 126 new members joined ACCEA in this time and, in 11 of the 15 regional sub-committees, female membership either increased or remained at the same level as 2018.
ACCEA remains committed to increasing the gender representation among our regional sub-committees and, while female representation is moving in the right direction, we believe there is still much more to be done. We will report on progress on gender balance in our 2022 (ACCIA) report.
Ethnicity
According to the same NHS Digital data, in March 2021, the make-up of the NHS consultant population by ethnic group was 28% ‘Asian or Asian British’, 3% ‘black or black British’, 2% ‘Chinese’, 2% ‘mixed’, 55% ‘white’, 4% ‘any other ethnic group’ and 5% ‘unknown’.
Therefore, to mirror the wider consultant population, ACCEA would aim to have representation of around 55% from white ethnic groups and at least 39% from all other ethnic groups combined.
In 2021, the split of ACCEA’s regional sub-committee membership by ethnic group was 60.33% from white ethnic groups (including white minorities) and 39.67% from all other ethnic groups combined. This shows that there has been positive progress for ACCEA since 2018, where representation from all other ethnic groups combined sat at just over 32%. We are pleased to see that the ongoing refresh of regional sub-committee membership is seeing positive results for representation across regional sub-committees
Table 2 shows the ethnicity split of sub-committee membership by region. The table shows that, while there has been positive progress in representation of ethnic minority assessors overall across the regional sub-committees, there is still more work to be done within individual sub-committees to ensure that they reflect the wider consultant population.
Table 2: 2021 regional sub-committee membership by ethnicity
| Sub-committee | White ethnic backgrounds (%) | All other ethnic backgrounds combined (%) | Ethnic background not stated (%) |
|---|---|---|---|
| DHSC and ALB | 45% | 30% | 25% |
| Cheshire and Mersey | 47.37% | 36.84% | 15.79% |
| East of England | 72.97% | 18.92% | 8.11% |
| East Midlands | 41.67% | 45.83% | 12.50% |
| London North East | 31.82% | 50% | 18.18% |
| London North West | 65.52% | 17.24% | 17.24% |
| London South | 41.18% | 32.35% | 26.47% |
| North East | 58.06% | 29.03% | 12.90% |
| North West | 46.81% | 23.4% | 29.79% |
| South | 58.62% | 20.69% | 20.69% |
| South East | 56.76% | 24.32% | 18.92% |
| South West | 68.75% | 15.63% | 15.63% |
| West Midlands | 29.03% | 61.29% | 9.68% |
| Wales | 48.39% | 35.48% | 16.13% |
| Yorkshire and Humber | 78.26% | 17.39% | 4.35% |
| Total | 47.37% | 36.84% | 15.79% |
ACCEA undertook a re-balancing exercise for scoring in 2021 to ensure that each scoring group was representative in terms of gender and ethnicity. This saw some members moved from their home regions to other sub-committees to score. Table 3 shows the gender and ethnicity make-up of each region after re-balancing.
Table 3: regional sub-committee membership by gender and ethnicity after re-balancing
| Sub-committee | Male (%) | Female (%) | All other ethnic groups combined (%) | White ethnic groups (%) |
|---|---|---|---|---|
| DHSC and ALB | 50% | 50% | 30% | 70% |
| Cheshire and Mersey | 64.3% | 35.7% | 32.1% | 67.9% |
| East of England | 71.4% | 28.6% | 34.3% | 65.7% |
| East Midlands | 65.4% | 34.6% | 34.6% | 65.4% |
| London North East | 73.5% | 26.5% | 44.1% | 55.9% |
| London North West | 69% | 31% | 34.5% | 65.5% |
| London South | 71.8% | 28.2% | 30.8% | 69.2% |
| North East | 66.7% | 33.3% | 33.3% | 66.7% |
| North West | 73.2% | 26.8% | 36.6% | 63.4% |
| South | 72.4% | 27.6% | 37.9% | 62.1% |
| South East | 70.3% | 29.7% | 35.1% | 64.9% |
| South West | 75.8% | 24.2% | 30.3% | 69.7% |
| West Midlands | 61.3% | 38.7% | 45.2% | 54.8% |
| Wales | 78.26% | 22.73% | 17.39% | 82.61% |
| Yorkshire and Humber | 61.8% | 38.2% | 47.1% | 52.9% |
Note: no changes were proposed to the balance for the DHSC and ALB sub-committee or the Wales sub-committee.
Overall, the re-balancing ensured that there was more of a representative spread of scorers across all ACCEA’s sub-committees, and that the gender and ethnic diversity of each committee was closer to ACCEA’s targets.
The re-balancing exercise worked well, particularly as the regional sub-committee meetings were held virtually, ensuring that re-located scorers were not required to travel. ACCEA also received positive feedback of the impact ‘imported’ scorers had on their chosen regions, including bringing fresh perspectives to the committee.
As the Welsh committee and the Welsh scheme operates separately, no re-balancing was implemented between Wales and England.
We will continue to monitor and refresh our membership and report on progress in 2022. We will also continue to reallocate assessors between regions to optimise the gender and ethnicity distribution, and minimise sub-committee variability. We are grateful for the flexibility shown by our scorers in this regard.
A full list of the 2021 regional sub-committee members can be found on the Our governance page.
Our finances
The ACCEA chair and medical director are remunerated at a rate of £52,240 a year. Further information on remuneration of public appointees can be found on the HM Government Public Appointments website.
The ACCEA chair and medical director may claim expenses for travel and other associated costs. In 2020 to 2021, no expenses were claimed by the chair and medical director as all meetings – except main committee – were held virtually, these also having virtual capability for those unable to travel to London.
Lay regional sub-committee members and chairs can claim expenses for travel, meeting attendance and other costs such as scoring and appeal reviews. In 2020 to 2021, claims for such costs totalled £81,551.10.
The ACCEA secretariat consists of 5 civil servants employed by the Department for Health and Social Care. The team includes one grade 7, one senior executive officer, one higher executive officer and 2 executive officers.
Our operations – 2021 awards round
Following the suspension of the 2020 awards round due to the COVID-19 pandemic, the 2021 award round was permitted to consider allocating a higher number of awards to compensate for those who would have otherwise applied in 2020.
There were up to 600 awards available – double the amount available in a standard year – and this resulted in a significant number of applications for ACCEA to process, meaning increased administrative and governance work for the committees and secretariat.
While ACCEA strived to avoid any undue delays to the process, certain elements such as appeals took longer than anticipated to progress. ACCEA will endeavour to ensure that lessons are learned from this and that the process will run more efficiently in the 2022 awards round.
Timetable:
- 2021 awards opened for applications in December 2020 (earlier than normal) and closed in March 2021, extending the opportunity for applications
- regional sub-committee meetings were held between April and June 2021
- governance took place between July and September 2021
- main committee meeting was held in November 2021
- our recommendations were sent to ministers for approval in December 2021
- outcomes were communicated to applicants in January 2022
- appeals were processed between January 2022 and April 2022
Regional sub-committee meetings
Regional sub-committee meetings were held between April and June 2021. The meetings were held virtually. The virtual meetings were mostly well received as this provided greater flexibility for assessors, particularly professional members who were able to fit meetings more easily around work schedules.
The meetings followed the same format introduced in 2019, where each meeting was split into 2 sessions – one led by the regional chair and medical vice-chair, and one led by the ACCEA chair and medical director. This format allows plenary discussions to take place among committee members before the national chair and medical director join to lead the second part of the meeting. A review of the utility of this split meeting was held at the end of the award round.
Main committee meeting
The 2021 main committee meeting took place on 22 November 2021. The main committee reviewed the outcome of the national reserve committee’s scoring before discussing and agreeing the recommendations for the 2021 new and renewal awards.
Renewals in 2021 were granted for either 4 or 5 years depending on whether the applicant had benefitted from a one-year extension in 2020 due to the pandemic suspension.
IT options appraisal
Following the discovery report produced by Lagom Strategy in 2020, a follow-up IT options appraisal was carried out to assess the available solutions on the market and how they could best meet the needs of ACCEA.
The contract was awarded to SSN Consultants who worked with the secretariat and other stakeholders to produce a comprehensive list of user requirements before systematically reviewing products available to cross-reference against needs and budget.
The appraisal identified a series of ‘Software as a Service’ products that could provide a flexible solution to ACCEA’s need to handle applications, assessment and finance within a single system.
IT procurement
Using the options appraisal findings, a procurement exercise was run through the government G-Cloud framework.
This identified SmartSimple Software as sole contractor able to meet the identified needs and, following negotiations, the contract was awarded in September 2021.
SmartSimple Software allocated the ACCEA contract to Re-Solved, a Canadian firm who act as delivery partner for SmartSimple, and who worked through the remainder of 2021 on scoping the development of a replacement IT system and building a timeline for the project through to the completion of the 2022 award round.
Scoring research
In April 2021, an NIHR award was made for a research project, Informing the national Clinical Excellence Awards (NCEA), run by the University of Exeter in collaboration with RAND-Europe.
The aim of the project was to inform the methodology for scoring in the new scheme and how it took into account how different stakeholders – including doctors, people who assess applications and members of the public – define excellence in relation to clinical practice. Also, the research investigated how the scheme could differentiate between doctors demonstrating different levels of excellence and be fair and non-discriminatory.
The research proposal set out to:
- undertake a brief review of literature relating to scoring of applications in other similar public sector senior performance bonus schemes (for example, in the police or education), and other key recent relevant literature
- inform the development of a new assessment schedule, taking account of revised areas of performance as advised by ACCEA, providing clear descriptions and scoring for different levels of excellence. This included 25 interviews with people who might apply for the scheme, people who currently assess applications and a range of stakeholders
Volunteers were recruited directly by the research team from current and past ACCEA regional sub-committee members and other stakeholders. ACCEA provided historic scoring and outcome data as well as a series of pseudonymised applications to be scored as part of the research.
The outcomes of the project are still in the process of publication. However, the initial and final reports were used, along with discussions between ACCEA and the research team, to inform decisions on the scoring scale, and the development of areas of the 2022 guidance and other areas of policy relating to the national award scheme.
Public consultation on reform
The DHSC, Welsh Government and ACCEA were keen to progress the overdue reform agenda for the scheme and, in March 2021, published a joint consultation Reforming the national Clinical Excellence Awards scheme.
The consultation set out the case for change, including the fact that the scheme had not seen any major changes since distinction awards were replaced in 2004, and the need to ensure the scheme was fit for purpose to serve a more diverse and evolving consultant workforce and their working patterns. The overall aim of the reforms proposed within the consultation were to:
- broaden access to the scheme
- make the application process fairer and more inclusive
- ensure the scheme rewards and incentivises excellence across a broader range of activity and behaviours
The proposals built on recommendations made in the review of the gender pay gap in medicine and by a review of compensation levels, incentives and the Clinical Excellence and Distinction Award schemes.
The consultation closed on 16 June 2021 and, building on the responses, the ACCEA secretariat developed a final design for the reformed scheme to include within the consultation response.
Read more information on what the consultation proposed.
Main committee reform meeting
An additional main committee meeting was held on 3 September 2021. The purpose of this meeting was to discuss and evaluate the responses gathered from the public consultation. Main committee was also invited to comment on and agree the proposed design of the reformed scheme.
2021 awards round
Funding flows
DHSC holds the budget for the small number of awards paid to those working within the department and for NHS Blood and Transplant, as well as awards paid to consultants working within any of DHSC’s arm’s length bodies.
Most awards in England are funded via NHS England. NHS trusts and foundation trusts receive their budgets from NHS England, which include the relevant provision for any renewed and new national Clinical Excellence Awards. Where an award holder is employed by a university or other academic institution, their academic employer recovers the costs for awards from NHS England.
In Wales, most awards are funded by the Welsh Government. Health boards in Wales receive their budgets from the Welsh Government and these incorporate costs associated with new and renewed Clinical Excellence Awards.
Note: in 2021, Public Health England was incorporated into DHSC and became the Office for Health Improvement and Disparities.
Award values
The Review Body for Doctors’ and Dentists’ Remuneration did not make a recommendation for uplifts to national Clinical Excellence Award values in their 2021 report, citing the lack of a reformed scheme for their rationale. The full value of awards in 2021 are shown in Table 4.
Table 4: 2021 award values
| Level | Wales | England |
|---|---|---|
| Bronze | £36,924 | £36,192 |
| Silver | £48,533 | £47,582 |
| Gold | £60,666 | £59,477 |
| Platinum | £78,866 | £77,320 |
It also remained the case that the value of a national Clinical Excellence Award was dependent on the number of programmed activities (PAs) undertaken by the respective award holder. For national Clinical Excellence Award holders working less than full-time, awards are paid pro-rata based on number of PAs worked. ACCIA defines 10 PAs or more as a full-time contract. As award outcomes are decided, ACCEA calculates the correct value of an award per holder and passes this information onto the relevant employer.
ACCEA also accounts for on-costs such as pension and National Insurance contributions in our calculations to relevant budget holders. In 2021, these on-costs were calculated at 28.18% for award holders on the NHS Pension Scheme and 34.9% for award holders on the University Superannuation Scheme.
Note: for consultants employed full-time on an NHS consultant contract, a minimum of 10 PAs is required for a full-value award. For clinical academics (holding honorary NHS contracts), the minimum number of PAs required for a full value award is 5 – these PAs must be clinically relevant and of direct benefit to the NHS.
Total value of awards in payment
In the 2020 to 2021 financial year, there were a total of 2,235 awards in payment, accruing a total value of £135,171,684. This total cost includes on-cost calculations and is the total value spread across 5 instalments.
More information on the numbers of awards in payment by award level and specialism can be found using our 2021 nominal roll.
2021 renewal applications
Renewal success rates
In the 2021 awards round, there were a total of 644 renewal applications submitted across both England (615) and Wales (29).
Table 5 shows that, of these 644 applications, 348 were successfully renewed at the existing level (326 in England and 22 in Wales) and 87 were unsuccessful renewals, of which 79 in England reverted to a local CEA and 7 in Wales reverted to a commitment award.
One English applicant was not eligible for local CEA reversion, being an academic GP, as this specialty group has different contractual terms.
A total of 71 applicants successfully renewed at a lower level (all in England): 5 moved from platinum to gold; 4 moved from platinum to silver; 10 moved from gold to silver; 8 moved from gold to bronze and 43 moved from silver to bronze. One applicant successfully renewed at a lower level from A to silver in England.
Table 5: 2021 renewal outcomes
| Outcome | Number of renewal outcomes – England | Number of renewal outcomes –Wales | Total renewal outcomes | Percentage of renewal applications (%) |
|---|---|---|---|---|
| Successful at existing level | 326 | 22 | 348 | 54% |
| Successful at a lower level: total | 71 | 0 | 71 | 11% |
| Successful at a lower level: platinum to gold | 5 | 0 | 5 | 0.8% |
| Successful at a lower level: platinum to silver | 4 | 0 | 4 | 0.6% |
| Successful at a lower level: platinum to bronze | 0 | 0 | 0 | 0% |
| Successful at a lower level: gold to silver | 10 | 0 | 10 | 1.6% |
| Successful at a lower level: gold to bronze | 8 | 0 | 8 | 1.2% |
| Successful at a lower level: silver to bronze | 43 | 0 | 43 | 6.7% |
| Successful at a lower level: A to silver | 1 | 0 | 1 | 0.2% |
| Unsuccessful | 80 | 7 | 87 | 13.5% |
Renewal success over time
Unlike new awards, there was no limit in the number of renewals, with success being determined by achieving the minimum standard as reflected in the scores of the lowest successful new applicant at that level.
Table 6 shows numbers and percentages of successful and unsuccessful renewals over time across England and Wales. The figures show that, overall, the percentage of successful renewal applications has increased between 2016 and 2021.
Table 6: renewal success over time in England and Wales
| Year | Number of renewal applications | Number of successful renewals (including renewal at a lower level) | Number of unsuccessful renewals | Percentage of successful renewals |
|---|---|---|---|---|
| 2021 | 644 | 409 | 87 | 63.5% |
| 2019 | 291 | 175 | 48 | 60.1% |
| 2018 | 454 | 264 | 94 | 58.1% |
| 2017 | 418 | 235 | 93 | 56.2% |
| 2016 | 416 | 242 | 82 | 58.2% |
2021 renewal success by gender
ACCEA is committed to improving the gender balance among our award holders. We continue to monitor and report on the success rates of applications by gender, and work actively with employers and nominating organisations to encourage them to advocate for more female consultants to apply.
According to our data, in 2021, there were 534 renewal applications from male applicants compared with 110 from female applicants. Of these, 330 male applicants successfully renewed (61.87%) and 63 (57.3%) female applicants successfully renewed (see Table 7).
Table 7: renewal success by gender
| Gender | Number of renewal applications | Number of successful renewals | Number of unsuccessful renewals | Percentage of successful renewals |
|---|---|---|---|---|
| Male | 534 | 330 | 71 | 61.87% |
| Female | 110 | 63 | 16 | 57.3% |
The proportion of female applicants who successfully renewed their awards during the 2021 awards round is therefore comparable to the proportion of male applicants. However, there remains a gap between the number of male and female renewal applicants, particularly when compared against the wider consultant population.
Females account for 17% of renewal applications, compared against 37% of females making up the NHS consultant population (as of September 2022). As renewals reflect award holders that have successfully gained an award historically, this reflects the traditionally higher proportion of male award holders when compared against the consultant population.
One of the proposals made within the consultation on reforms was the removal of renewals from the application process. The rationale for this proposal is to place all applicants in equal competition with each other, rather than allowing existing award holders to apply for their award through the alternative renewals route. As a result, ACCEA expects the inertia inherent in the renewals process to be removed to see a more representative number of female applicants compared with the wider consultant population.
2021 renewal success by ethnicity
ACCEA is equally committed to ensuring that the scheme is representative of the wider consultant population based on ethnicity. As with gender, we continue to monitor and report on the success rates of applications by ethnicity, and work actively with employers and nominating organisations, encouraging them to advocate for more consultants from ethnic minorities to apply.
Table 8: renewal success by ethnicity
| Ethnic group | Number of renewal applications | Number of successful renewals | Number of unsuccessful renewals | Percentage of successful renewal applications |
|---|---|---|---|---|
| White ethnic groups combined (including white minority groups) | 487 | 310 | 70 | 63.7% |
| All other ethnic groups combined | 151 | 94 | 15 | 62.3% |
| Ethnicity not stated | 6 | 5 | 0 | 1.3% |
Table 8 shows the numbers of renewal applications in 2021 by ethnic groups combined according to our data (Table 1, Annex A provides a full breakdown of data by ethnicity). The table also shows the numbers and percentages of those who were successful in their renewal application only (including those who entered a both type application) by ethnic group.
The data within the table (excluding not stated) highlights that:
- applicants from all white ethnic groups combined (including white minorities) had 487 renewal applications in 2021, 310 (63.7%) of which were successful
- applicants from all other ethnic groups combined (including mixed ethnic groups, any other ethnic group and other specified) had 151 renewal applications in 2021, 94 (62.3%) of which were successful
Therefore, while the numbers of successful renewals between the two combined categories is broadly comparable, a gap still persists in the number of applications submitted – particularly when compared against the wider consultant population, where all other ethnic groups combined make up roughly 36%.
As with gender representation, ACCEA expects that the proposal to remove renewals from the scheme will be one mitigating factor in helping to close the gap between the representative numbers of award holders from ethnic minority groups and white ethnic groups in the same way as expressed above for gender.
2021 renewals by regional sub-committee
Table 9 shows the number of successful renewals in 2021 by regional sub-committee.
The success of applications to renew awards is dependent on the scores of applications for new awards at the same level scored by the same sub-committee. As such, the quality and volume of applications for those new awards in the current and previous 2 years (as we also apply a 3-year rolling average score to smooth out year-on-year variation) are important factors in assuring the quality of successful renewal applications is maintained.
The table shows that there was a wide-ranging number of applications successfully renewed at either existing or lower level across the regional sub-committees, with the percentages of successful applications renewed at the existing level by region ranging from 41.3% up to 71.6%. As each region scores independently, it is difficult to draw comparisons between sub-committees. However, the table shows that the North West was the only region where no renewal applications were unsuccessful at any level.
As the consultation on reform proposed the removal of the renewals process and a move to a non-stratified application process, we look forward to seeing data on the numbers of existing award holders who successfully gain new awards under the new scheme rules and how this compares against previous renewal outcomes.
Table 9: renewals by regional sub-committee
| Regional sub-committee | Number of renewal applications | Number of successful renewals at the existing award level | Number of unsuccessful renewal at any national level | Percentage of applications successfully renewed |
|---|---|---|---|---|
| Arm’s length body committee | 26 | 16 | 3 | 61.5% |
| Cheshire and Mersey | 25 | 15 | 4 | 60% |
| East Midlands | 31 | 18 | 5 | 58% |
| East of England | 42 | 28 | 2 | 66.7% |
| London North East | 80 | 53 | 6 | 66.2% |
| London North West | 44 | 31 | 6 | 70.5% |
| London South | 58 | 24 | 17 | 41.3% |
| North East | 26 | 12 | 7 | 46.2% |
| North West | 53 | 38 | 0 | 71.6% |
| South East | 30 | 19 | 5 | 63.3% |
| South | 60 | 40 | 2 | 66.7% |
| South West | 34 | 21 | 7 | 61.8% |
| West Midlands | 45 | 23 | 7 | 51.1% |
| Yorkshire and Humber | 62 | 40 | 9 | 64.6% |
| Wales | 29 | 15 | 7 | 51.8% |
2021 new awards
In 2021, there were a total of 1,727 applications for new awards in England and 77 in Wales. A total of 529 new awards were granted overall – 502 in England and 27 in Wales (see Table 10), resulting in an overall success rate of 29.1% in England and 35.1% in Wales.
Table 10: applications for new awards
| Level | England | Wales |
|---|---|---|
| Bronze | 1091 | 41 |
| Silver | 390 | 13 |
| Gold | 206 | 6 |
| Platinum | 39 | 1 |
Success rates for new awards by level
Table 11 shows the number of applications, awards granted and success rate per award level in England and Wales.
Table 11: 2021 new awards granted by application level in England and Wales
| Level | Number of applications | Number of awards granted | Success rate |
|---|---|---|---|
| Bronze | 1152 | 334 | 28.8% |
| Silver | 400 | 124 | 30.8% |
| Gold | 212 | 64 | 30.2% |
| Platinum | 40 | 10 | 25% |
Table 11 shows that, in total, there were 1,152 applications for a new bronze award, 400 applications for a new silver award, 212 applications for a new gold award and 40 applications for a new platinum award.
The success rates for new awards were as follows:
- bronze – 28.8%
- silver – 30.8%
- gold – 30.2%
- platinum – 25%
Success rates are broadly aligned at each level, calculated as an indicative number of awards per region based on the number of applications in those regions. This allows a balance of success rates and regional equity of opportunity for applicants.
At higher levels of awards where there are fewer applicants and awards, the percentage rates may be skewed by small numbers so should be interpreted with caution.
Success rates for new awards by regional sub-committee
Table 12 sets out the number of applications, awards granted and success rates by regional sub-committee (RSC) according to ACCEA data.
Table 12: new awards by regional sub-committee
| RSC | Level | Number of applicants | Number of successful applications | Percentage of successful applications (%) |
|---|---|---|---|---|
| ACCEA platinum committee | Platinum | 40 | 10 | 25% |
| ALB committee | Bronze | 31 | 8 | 25.8% |
| ALB committee | Silver | 14 | 4 | 28.6% |
| ALB committee | Gold | 7 | 2 | 28.6% |
| Cheshire and Mersey | Bronze | 44 | 10 | 22.7% |
| Cheshire and Mersey | Silver | 23 | 7 | 30.4% |
| Cheshire and Mersey | Gold | 9 | 3 | 33.3% |
| East Midlands | Bronze | 68 | 18 | 26.5% |
| East Midlands | Silver | 24 | 9 | 37.5% |
| East Midlands | Gold | 12 | 3 | 25% |
| East of England | Bronze | 74 | 23 | 31.1% |
| East of England | Silver | 21 | 7 | 33.3% |
| East of England | Gold | 14 | 5 | 25% |
| London North East | Bronze | 136 | 40 | 29.4% |
| London North East | Silver | 43 | 12 | 27.9% |
| London North East | Gold | 23 | 7 | 30.4% |
| London North West | Bronze | 61 | 16 | 26.2% |
| London North West | Silver | 28 | 8 | 28.6% |
| London North West | Gold | 13 | 4 | 30.8% |
| London South | Bronze | 109 | 34 | 31.2% |
| London South | Silver | 39 | 12 | 30.8% |
| London South | Gold | 16 | 5 | 31.3% |
| North East | Bronze | 67 | 22 | 32.8% |
| North East | Silver | 28 | 6 | 26.1% |
| North East | Gold | 15 | 5 | 33.3% |
| North West | Bronze | 111 | 31 | 27.9% |
| North West | Silver | 38 | 11 | 28.9% |
| North West | Gold | 15 | 5 | 33.3% |
| South East | Bronze | 57 | 14 | 24.6% |
| South East | Silver | 11 | 4 | 36.4% |
| South East | Gold | 10 | 3 | 30% |
| South | Bronze | 80 | 23 | 28.8% |
| South | Silver | 34 | 11 | 32.4% |
| South | Gold | 19 | 5 | 26.3% |
| South West | Bronze | 86 | 25 | 29.1% |
| South West | Silver | 25 | 7 | 28% |
| South West | Gold | 17 | 3 | 17.6% |
| West Midlands | Bronze | 91 | 26 | 28.6% |
| West Midlands | Silver | 28 | 8 | 28.6% |
| West Midlands | Gold | 15 | 5 | 33.3% |
| Yorkshire and Humber | Bronze | 80 | 25 | 31.3% |
| Yorkshire and Humber | Silver | 37 | 12 | 32.4% |
| Yorkshire and Humber | Gold | 23 | 7 | 30.4% |
| Wales | Bronze | 57 | 19 | 33.3% |
| Wales | Silver | 13 | 6 | 46.2% |
| Wales | Gold | 6 | 2 | 33.3% |
The table shows that the successful percentage of new applications per region were broadly comparable at bronze, ranging from 22.7% to 31.3% across RSCs in England and a rate of 33.3% in the Wales RSC where the processes differ based on a pre-screening sift of applications.
The successful application percentages for silver varied more significantly between regions, with the ranges in England between 26.1% and 37.5% in the North East and East Midlands respectively. The different scheme in Wales RSC resulted in a success rate of 46.2%.
The number of successful gold applications is also broadly comparable, with the exception of the South West RSC’s rate of 17.6%, noting that, with relatively small numbers at higher award levels, any percentage differences are amplified.
As each region scores independently, it is difficult to draw conclusions from the RSC data, with governance processes for quality assurance being applied to all applications that are ranked within the indicative number for each region. ACCIA continues to monitor data annually in order to identify any particular patterns and feedback any discrepancies to the sub-committees as required.
Platinum awards are assessed separately by platinum committee. In 2021, the success rate for applications assessed by platinum committee was 25%.
ACCEA is committed to ensuring that opportunity for success is equitable across all regions in the design and operation of the scheme. We are pleased to see that average success rate across all regions and award levels is broadly comparable at the end of scoring following governance processes.
Success rates for new awards by specialty
We want to ensure that excellence across the breadth of specialties within the NHS is recognised by the scheme. We work closely with nominating organisations and employers to encourage more applications from any under-represented specialties, and closely monitor application and success rates by specialty.
Data on numbers of consultants by specialty in Wales is held separately and can be found on StatsWales.
Tables 13 and 14 refer to both England and Wales, while charts 1 and 2 show the separate data by each country. The labels used in both the tables and charts correspond with the labels on the respective data sets (note: not all specialties may be accurately reflected due to limitations within the data).
According to NHS Digital and StatsWales data, in March 2021, there were 51,701 consultants in the NHS in England (this does not include data on academic GPs) and 2,730 in Wales. Of these, the number of consultants per specialty is shown in table 13. The table shows that general medicine makes up the highest proportion of the consultant workforce in both England (24.5%) and Wales (21.3%), with public health medicine constituting the least in England (0.2%) and pathology representing the least in Wales (0.4%).
Note: there are limitations to NHS Digital data due to the way in which certain specialties are registered by their employer. Therefore, the number of eligible consultants by specialty may be greater than as reported for certain groups.
Table 13: number of consultants per specialty in the NHS as of March 2021 (England)
| Specialty | Number of consultants – England | Percentage of consultant workforce – England | Number of consultants – Wales | Percentage of consultant workforce – Wales |
|---|---|---|---|---|
| Anaesthetics | 7,694 | 14.9% | 433 | 15.9% |
| Clinical oncology | 815 | 1.6% | 44 | 1.6% |
| Dental | 891 | 1.7% | 193 | 7.1% |
| Emergency medicine | 2,167 | 4.2% | 427 | 15.6% |
| General medicine | 12,657 | 24.5% | 581 | 21.3% |
| Obstetrics and gynaecology | 2,651 | 5.1% | 362 | 13.2% |
| Paediatrics | 3,887 | 7.5% | 570 | 20.9% |
| Pathology | 2,831 | 5.5% | 12 | 0.4% |
| Public health medicine | 51 | 0.2% | 48 | 1.8% |
| Psychiatry | 4,469 | 8.6% | 275 | 10.1% |
| Radiology | 3,438 | 6.6% | 231 | 8.5% |
| Surgery (including ophthalmology) | 10,149 | 19.6% | 469 | 17.2% |
Table 14 shows the number of new applications in 2021 by level and specialty in England and Wales. The table shows that the specialty with the highest number of applications per level across both England and Wales was general medicine, except for platinum applications in England where surgery (including ophthalmology) had the highest number.
It is, however, difficult to draw conclusions as to what this indicates as some specialties have particularly low application rates at certain levels and this can skew data significantly. This is particularly challenging in Wales where numbers are smaller.
Table 14: number of applications per specialty and level in England
| Specialty | Level | Number of applications - England | Number of applications – Wales | Number of successful applications – England | Proportion of successful applications – England (%) | Number of successful applications – Wales | Proportion of successful applications – Wales (%) |
|---|---|---|---|---|---|---|---|
| Academic GP | Bronze | 13 | 0 | 7 | 53.8% | 0 | 0% |
| Academic GP | Silver | 7 | 0 | 1 | 14.3% | 0 | 0% |
| Academic GP | Gold | 5 | 1 | 3 | 60% | 0 | 0% |
| Academic GP | Platinum | 2 | 0 | 0 | 0% | 0 | 0% |
| Anaesthetics | Bronze | 65 | 4 | 23 | 35.4% | 2 | 50% |
| Anaesthetics | Silver | 19 | 0 | 4 | 21.1% | 0 | 0% |
| Anaesthetics | Gold | 14 | 2 | 5 | 35.7% | 1 | 50% |
| Anaesthetics | Platinum | 2 | 0 | 0 | 0% | 0 | 0% |
| Clinical oncology | Bronze | 20 | 2 | 7 | 35% | 1 | 50% |
| Clinical oncology | Silver | 6 | 0 | 4 | 66.7% | 0 | 0% |
| Clinical oncology | Gold | 2 | 0 | 1 | 50% | 0 | 0% |
| Clinical oncology | Platinum | 2 | 0 | 1 | 50% | 0 | 0% |
| Dental | Bronze | 18 | 3 | 3 | 16.7% | 0 | 0% |
| Dental | Silver | 7 | 1 | 0 | 0% | 1 | 100% |
| Dental | Gold | 2 | 0 | 0 | 0% | 0 | 0% |
| Dental | Platinum | 0 | 0 | 0 | 0% | 0 | 0% |
| Emergency medicine | Bronze | 30 | 0 | 5 | 16.7% | 0 | 0% |
| Emergency medicine | Silver | 3 | 0 | 0 | 0% | 0 | 0% |
| Emergency medicine | Gold | 2 | 0 | 1 | 50% | 0 | 0% |
| Emergency medicine | Platinum | 0 | 0 | 0 | 0% | 0 | 0% |
| General medicine | Bronze | 329 | 21 | 109 | 33.1% | 7 | 33.3% |
| General medicine | Silver | 124 | 3 | 39 | 31.5% | 2 | 66.6% |
| General medicine | Gold | 78 | 1 | 25 | 32.1% | 0 | 0% |
| General medicine | Platinum | 8 | 0 | 1 | 12.5% | 0 | 0% |
| Obstetrics and gynaecology | Bronze | 50 | 4 | 15 | 30% | 0 | 0% |
| Obstetrics and gynaecology | Silver | 15 | 1 | 4 | 26.7% | 0 | 0% |
| Obstetrics and gynaecology | Gold | 8 | 0 | 3 | 37.5% | 0 | 0% |
| Obstetrics and gynaecology | Platinum | 2 | 0 | 1 | 50% | 0 | 0% |
| Paediatrics | Bronze | 134 | 5 | 32 | 23.9% | 2 | 40% |
| Paediatrics | Silver | 48 | 1 | 18 | 37.5% | 0 | 0% |
| Paediatrics | Gold | 11 | 1 | 1 | 9.1% | 1 | 100% |
| Paediatrics | Platinum | 3 | 0 | 0 | 0% | 0 | 0% |
| Pathology | Bronze | 49 | 3 | 21 | 42.9% | 2 | 66.6% |
| Pathology | Silver | 20 | 0 | 9 | 45% | 0 | 0% |
| Pathology | Gold | 9 | 0 | 2 | 22.2% | 0 | 0% |
| Pathology | Platinum | 4 | 0 | 2 | 50% | 0 | 0% |
| Psychiatry | Bronze | 47 | 1 | 7 | 14.% | 1 | 100% |
| Psychiatry | Silver | 16 | 2 | 1 | 6.3% | 1 | 50% |
| Psychiatry | Gold | 6 | 1 | 1 | 16.7% | 0 | 0% |
| Psychiatry | Platinum | 2 | 0 | 0 | 0% | 0 | 0% |
| Public health medicine and dentistry | Bronze | 23 | 1 | 5 | 21.7% | 0 | 0% |
| Public health medicine and dentistry | Silver | 8 | 0 | 2 | 25% | 0 | 0% |
| Public health medicine and dentistry | Gold | 6 | 0 | 3 | 50% | 0 | 0% |
| Public health medicine and dentistry | Platinum | 1 | 0 | 0 | 0% | 0 | 0% |
| Radiology | Bronze | 47 | 0 | 16 | 34% | 0 | 0% |
| Radiology | Silver | 20 | 0 | 6 | 30% | 0 | 0% |
| Radiology | Gold | 9 | 0 | 0 | 0% | 0 | 0% |
| Radiology | Platinum | 2 | 0 | 0 | 0% | 0 | 0% |
| Surgery (Including ophthalmology) | Bronze | 265 | 13 | 66 | 24.9% | 4 | 31% |
| Surgery (Including ophthalmology) | Silver | 97 | 5 | 29 | 29.9% | 2 | 40% |
| Surgery (Including ophthalmology) | Gold | 53 | 1 | 17 | 32.1% | 0 | 0% |
| Surgery (Including ophthalmology) | Platinum | 12 | 0 | 5 | 41.7% | 0 | 0% |
Chart 1 shows the number of applications for new awards relative to the proportion of the workforce within each specialty in England (excluding academic GPs who are not included in NHS Digital data).
The graph serves to highlight that, while we do expect the larger specialties to make up a higher proportion of applications, certain specialties such as surgery, general medicine and paediatrics are over-represented while other specialties such as anaesthetics, psychiatry and emergency medicine are under-represented. The over-representation of larger specialties can make it more difficult for representation among smaller, less populated specialties due to the limited number of applications available.
Chart 1: graph showing proportion of applications relative to proportion of consultant workforce in England
Chart 2 shows the number of applications for new awards relative to the proportion of the workforce within each specialty in Wales. The specialty labels correspond with the available data on the StatsWales website.
The graph shows a similar picture to within England, where specialties such as general medicine and surgery remain over-represented in Wales, while anaesthetics, emergency medicine and radiology are under-represented in Wales. The graph shows that, in contrast to England, in 2021 applications from the paediatric specialty were under-represented in Wales.
Overall, the data shows that there is still more to be done to ensure that there is a representative and even spread of applications across the NHS’s breadth of specialties.
The consultation on reform proposed that the assessment domains be altered to ensure that consultants from all specialties felt able to provide evidence to demonstrate the impact of their work and to encourage more applications.
In addition, changes to the way in which national nominating organisations engage with award processes were proposed to better balance citations by specialty proportions.
Nevertheless, we recognise that workload pressures – particularly during and immediately after the pandemic – may have affected specialty groups differently, impacting the time available to apply and any evidence that may have otherwise been provided to support their application.
Age
As mentioned in the above analysis of renewals, ACCEA is committed to ensuring that the awards scheme does not contribute towards, or further entrench, pay disparities. We want the awards scheme to be representative of the entire consultant workforce.
Table 15 shows the number of successful new applications by age bracket. The table clearly shows that the number of successful applications is skewed towards the age ranges between 40 and 59, accounting for 88.3% of successful awards – with the highest success rate among those in the 50 to 54 age bracket (32.9%).
While this is not unexpected due to patterns in previous years and the hierarchical progressive nature of the NCEA scheme, we believe that more can be done to even out the spread of new awards granted across the age ranges, and to ensure that more consultants earlier on in their careers can apply and attain awards, while continuing to reward top-performing senior clinicians. Retention is one of the stated aims of the award scheme, and the numbers of older consultants retiring, or considering retirement, is increasing, something that could have a measurable impact on government priorities such as elective recovery.
The reforms proposed within the consultation included a move to a non-stratified application process. This would remove the requirement to progress up through award levels and mean that consultants earlier on in their careers would be able to reach the higher award levels sooner. There is also more proactive messaging and engagement to be done with stakeholders to ensure that younger consultants:
- are aware of the scheme
- feel empowered to apply
- are supported by their employers and nominating organisations
Table 15: successful applications by age
| Age | Number of successful new applications | Proportion of new awards granted (%) |
|---|---|---|
| Under 30 | 0 | 0% |
| 30 to 34 | 0 | 0% |
| 35 to 39 | 1 | 0.2% |
| 40 to 44 | 29 | 5.5% |
| 45 to 49 | 110 | 20.8% |
| 50 to 54 | 174 | 32.9% |
| 55 to 59 | 154 | 29.1% |
| 60 to 64 | 55 | 10.4% |
| 65 to 69 | 6 | 1.1% |
| 70 to 74 | 0 | 0% |
| 75 to 79 | 0 | 0% |
| Over 79 | 0 | 0% |
Gender
ACCEA is equally committed to improving gender representation among award holders. Table 16 shows the numbers of total applications for new awards by gender across England and Wales, according to our data.
Table 16: 2021 new applications by gender in England and Wales
| Gender | Number of applications | Percentage of applications (%) |
|---|---|---|
| Male | 1215 | 67.4% |
| Female | 494 | 27.4% |
| Not specified | 95 | 5.3% |
In 2021, there were a total of 1,215 applications for new awards (67.4%) from male consultants, while there were 494 applications (27.4%) from female consultants (an increase on 2019 from 26.3%), 95 applicants (5.3%) did not specify their gender.
This data shows that female applicants remain under-represented in both application and award rates when compared against the wider consultant population where female consultants make up roughly 38%. However, Table 17 goes on to show the number and percentage of new applications that successfully gained a new award in 2021, by gender.
While there is still much more to be done to encourage more applications from female consultants, we are pleased to see that success rates between male and female applicants remain broadly comparable with a relative gap of 1.2%.
Table 17: 2021 successful new applications by gender in England and Wales
| Gender | Number of successful applications | Number of unsuccessful applications | Success rate (%) |
|---|---|---|---|
| Male | 358 | 857 | 29.5% |
| Female | 140 | 354 | 28.3% |
| Not specified | 31 | 64 | 32.6% |
Table 18 shows success rates for new awards over time by gender. The success rate dropped slightly in 2021 among both male and female applicants, and there was also a change from 2019 where the success rate was higher among female applicants than their male counterparts.
ACCEA remains dedicated to its commitment to increasing gender diversity among award holders and, while we are pleased to see that the success rates have remained broadly comparable over time, the below table highlights that there is still much more to be done.
Table 18: success rate for new awards by gender over time
| Year | Male | Female |
|---|---|---|
| 2021 | 29.5% | 28.3% |
| 2019 | 30.5% | 31.6% |
| 2018 | 31.3% | 30.2% |
| 2017 | 30.2% | 26.7% |
| 2016 | 26.8% | 25.6% |
It is our sincere hope that the scheme reforms proposed within the consultation will encourage more applications from female consultants, and we will continue to report on these figures in future reports.
Ethnicity
As with age and gender, ACCEA is equally committed to ensuring that the awards scheme is representative of the wider consultant workforce in terms of ethnicity.
As raised in the analysis of 2021 renewals, in order to reflect the NHS consultant population, we would expect applicants from white ethnic groups to account for approximately 64% of applications and applicants from all other ethnic groups combined to account for around 36% of applications.
The data within table 19 shows that there were a total of 1,149 applications (63.7%) from white ethnic groups and a total of 626 applications (34.7% – increased from 25.6% in 2019) from all other ethnic groups combined (Table 2, Annex A provides a full breakdown by ethnic group). 29 (1.6%) did not state their ethnicity.
While these figures are not fully representative of the wider consultant workforce, we are pleased to see that the application numbers are closer to mirroring the balance in the wider consultant population. However, the table does highlight that there is still a gap in success rates between applicants from white ethnic groups and all other ethnic groups combined.
Table 19: number of applications and success rate by ethnicity
| Ethnic group combined | Number of new applications | Percentage of overall applications (%) | Number of successful new applications | Success rate (%) |
|---|---|---|---|---|
| White ethnic groups combined (including white minority ethnic groups) | 1149 | 63.7% | 369 | 32.4% |
| All other ethnic groups combined | 626 | 34.7% | 153 | 24.4% |
| Not stated | 29 | 1.6% | 7 | 24.1% |
Table 20 provides further information by showing success rates for new awards by ethnic groups combined over time. The table shows that the gap in success rates between all other ethnic groups combined and their white ethnic group counterparts had narrowed significantly between 2018 and 2019. However ,despite the highest ever proportion of successful applicants from other ethnic groups gaining awards (28.9%), we are disappointed to see that the success rate gap broadened again between 2019 to 2020 and 2021.
Table 20: application numbers and success rates for new awards over time by ethnic group
| Year | White ethnic groups (including white minority ethnic groups) – success rate (%) | All other ethnic groups combined – success rate (%) |
|---|---|---|
| 2021 | 32.4% | 24.4% |
| 2019 | 33% | 27.6% |
| 2018 | 31.8% | 23.3% |
| 2017 | 30.2% | 25.7% |
| 2016 | 26.8% | 26.1% |
Overall, while we were pleased that there was a greater number and proportion of ethnic minority awardees in 2021, the success rates were disproportionately lower.
We recognise that there is clearly more to be done to ensure greater equity in success rates between applicants from ethnic minority groups and applicants from white ethnic groups. ACCEA is continuing to work closely with stakeholders such as employers and nominating organisations to ensure that all consultants, including those from ethnic minority backgrounds, feel empowered and fully supported to apply for awards.
Furthermore, through the reforms proposed within the consultation, it is our sincere aim that more ethnic minority consultants will continue to apply and successfully be able to gain new awards.
We will continue to monitor and report on any progress within our 2023 report on the 2022 award round.
Appeals
In the 2021 awards round, ACCEA also received an increased number of appeal requests: a total of 63. Of these 63, each was carefully assessed to determine whether there was a basis for an appeal and to ensure that due processes had been followed.
Grounds for appeal can only be made based upon demonstration of either of the following criteria:
- failure of scorers or committees to follow established processes
- the presence of bias in scoring
Disagreement with the outcome of the scoring is not grounds for appeal. All requests were reviewed by the ACCEA chair and medical director, followed by an independent panel of at least 2 senior assessors, typically consisting of a regional sub-committee chair and medical vice-chair who had not scored the application previously. After review of each request, scoring patterns and the process flow for each applicant who requested consideration, it was concluded that none were deemed to have sufficient grounds for appeal.
Due to the additional time required to process the volume of requests at the same time as finalising the reforms for the 2022 award round, the responses were delayed for significantly longer than expected. We would like to thank any appellants who were impacted by the delay for their patience during this time.
To ensure that each appeal is fully scrutinised, it is important that this process remains robust. In future years, ACCIA will prioritise expediting this process for appellants in a timely manner.
Looking forwards
ACCIA and reform
As mentioned in the first section of this report, from the 2022 awards round and onwards the Advisory Committee for Clinical Excellence Awards will be known as the Advisory Committee for Clinical Impact Awards. This is to reflect the move from the national Clinical Excellence Awards to the national Clinical Impact Awards.
In January 2022, the joint consultation response from DHSC and the Welsh Government was published. The consultation response set out the final scheme design for the reformed scheme and signalled a move to a scheme that endeavours to be fully representative of the diverse nature of the NHS’s consultant population.
The reforms are wide-ranging but in summary they will:
- re-structure the award levels. In England, the new scheme will operate as a 3-level award system with awards remaining valid for 5 years: national 1 (£20,000), national 2 (£30,000) and national 3 (£40,000). Up to 600 awards will be available in England, subject to affordability of transitional arrangements between NCEA and NCIA schemes. In Wales, a national 0 award level will be introduced at a value of £10,000
- refresh the assessment domains. The current assessment domains will be developed, combining domains 1 and 2, and introducing a new fifth domain encouraging a wider scope of evidence to be submitted
- simplify the application process. A single level (unstratified) application process will be introduced with self-nomination being retained. Award levels will be determined based on unstratified ranking of scores against the indicative numbers of awards available in each region
- remove pro-rated awards. Those working less than full time will no longer have their award payments pro-rated
- remove the renewals process. The renewals process will not continue in the new scheme – awards will be held for a total of 5 years, at which point applicants will need to re-apply
- remove the pensionability of awards. Awards will no longer be pensionable or consolidated
Note: in Wales there will be an additional level, national 0 (£10,000).
Full details of the national Clinical Impact Award Scheme can be found in the consultation response.
Since the consultation response was published and in advance of the 2022 awards round, ACCIA has also been engaging closely with stakeholders – including NHS Employers, reward networks, nominating organisations and trade unions – to raise awareness of the reformed scheme and encourage more applications.
Until the new scheme is embedded, we will not be able to make a full assessment of the impacts of the reforms and some changes will take time to fully assess due to the 5-year transition period for those holding legacy national Clinical Excellence Awards. These are affected by the financial impacts of Schedule 30 (PDF, 236KB) provisions made by NHS England in the consultant contract during this period. However, in future reports, ACCIA will continue to monitor and report on progress, particularly on diversity data.
We also want to ensure that the work of award holders is publicised. ACCIA will continue to publish a data-focused annual report while separately highlighting the profiles and achievements of our award holders, celebrating their clinical impact with an aim to encourage other consultants to apply.
The role of key stakeholders will also evolve under the new scheme, as the process for employers is simplified. ACCIA is also continuing to evaluate the role that national nominating organisations play in the awards process, and this will remain under review into future years.
We look forward to continuously working with our delivery partners and informing all our stakeholders on progress throughout the implementation of the reformed scheme. Our objectives remain to operate and deliver a scheme that equitably retains, recognises and rewards senior NHS clinicians across England and Wales, making the most substantial national impact above the expectations of their roles, reflecting the diversity of the NHS population and incentivising those within it.
Annex A
Table 1: 2021 renewal success by ethnicity
| Ethnicity | Number of renewal applications | Number of successful renewals | Success rate (%) |
|---|---|---|---|
| Asian or Asian British – Pakistani | 6 | 5 | 83% |
| Asian British | 2 | 1 | 50% |
| White – Italian | 1 | 0 | 0% |
| Not stated | 6 | 5 | 83% |
| White – Scottish | 6 | 5 | 83% |
| Black or black British – Caribbean | 1 | 1 | 100% |
| Asian – unspecified | 1 | 1 | 100% |
| Asian mixed | 2 | 2 | 100% |
| Asian – Punjabi | 1 | 0 | 0% |
| Asian or Asian British – Bangladeshi | 2 | 2 | 100% |
| Mixed – Chinese and white | 1 | 0 | 0% |
| Other – specified | 4 | 4 | 100% |
| White – Greek | 1 | 0 | 0% |
| White – Greek Cypriot | 1 | 0 | 0% |
| White – Turkish | 1 | 0 | 0% |
| Asian or Asian British – Indian | 75 | 51 | 68% |
| White – English | 13 | 7 | 54% |
| White – any other white background | 38 | 26 | 68% |
| Asian or Asian British – any other Asian background | 11 | 8 | 73% |
| White – Welsh | 10 | 5 | 50% |
| Chinese | 16 | 9 | 56% |
| Mixed – white and Asian | 8 | 4 | 50% |
| White – British | 383 | 248 | 65% |
| White – Irish | 21 | 12 | 57% |
| Black or black British – African | 9 | 4 | 44% |
| White – other European | 4 | 3 | 75% |
| White – Northern Irish | 3 | 2 | 67% |
| Any other ethnic group | 9 | 3 | 33% |
| Mixed – any other mixed background | 2 | 0 | 0% |
| White – unspecified | 4 | 0 | 0% |
| White – mixed | 1 | 0 | 0% |
| Asian – Sri Lankan | 1 | 0 | 0% |
| Mixed – black and Asian | 0 | 0 | 0% |
| Asian – Tamil | 0 | 0 | 0% |
| Asian – Kashmiri | 0 | 0 | 0% |
| Japanese | 0 | 0 | 0% |
| Mixed – white and black African | 0 | 0 | 0% |
| Mixed – white and black Caribbean | 0 | 0 | 0% |
| Mixed – other or unspecified | 0 | 0 | 0% |
| Mixed – black and white | 0 | 0 | 0% |
| Mixed – Asian and Chinese | 0 | 0 | 0% |
| Malaysian | 0 | 0 | 0% |
| Asian – Sinhalese | 0 | 0 | 0% |
| Black – Nigerian | 0 | 0 | 0% |
| White – Turkish Cypriot | 0 | 0 | 0% |
| Black – British | 0 | 0 | 0% |
| White – Polish | 0 | 0 | 0% |
| Asian – Caribbean | 0 | 0 | 0% |
Table 2: 2021 new award success by ethnicity
| Ethnicity | Number of new applications | Number of successful applications | Success rate (%) |
|---|---|---|---|
| Asian or Asian British – Pakistani | 52 | 9 | 17% |
| Asian – British | 7 | 3 | 43% |
| White – Italian | 9 | 3 | 33% |
| Not stated | 29 | 7 | 24% |
| White – Scottish | 14 | 2 | 14% |
| Black or black British – Caribbean | 4 | 1 | 25% |
| Asian – unspecified | 2 | 0 | 0% |
| Asian – mixed | 3 | 0 | 0% |
| Asian – Punjabi | 3 | 2 | 67% |
| Asian or Asian British – Bangladeshi | 3 | 3 | 100% |
| Mixed – Chinese and white | 3 | 2 | 67% |
| Other – specified | 2 | 0 | 0% |
| White – Greek | 3 | 1 | 33% |
| White – Greek Cypriot | 4 | 2 | 50% |
| White – Turkish | 1 | 1 | 100% |
| Asian or Asian British – Indian | 341 | 80 | 23% |
| White – English | 40 | 11 | 28% |
| White – any other white background | 136 | 41 | 30% |
| Asian or Asian British – any other Asian background | 31 | 9 | 29% |
| White – Welsh | 19 | 10 | 53% |
| Chinese | 35 | 11 | 31% |
| Mixed – white and Asian | 23 | 10 | 43% |
| White – British | 833 | 273 | 33% |
| White – Irish | 36 | 10 | 28% |
| Black or black British – African | 24 | 6 | 25% |
| White – other European | 23 | 4 | 17% |
| White – Northern Irish | 8 | 4 | 50% |
| Any other ethnic group | 38 | 10 | 26% |
| Mixed – any other mixed background | 14 | 3 | 21% |
| White – unspecified | 10 | 4 | 40% |
| White – mixed | 11 | 2 | 18% |
| Asian – Sri Lankan | 9 | 1 | 11% |
| Mixed – black and Asian | 1 | 0 | 0% |
| Asian – Tamil | 6 | 1 | 17% |
| Asian – Kashmiri | 3 | 0 | 0% |
| Japanese | 2 | 0 | 0% |
| Mixed – white and black African | 2 | 0 | 0% |
| Mixed – white and black Caribbean | 3 | 0 | 0% |
| Mixed – other or unspecified | 2 | 1 | 50% |
| Mixed – black and white | 2 | 0 | 0% |
| Mixed – Asian and Chinese | 1 | 0 | 0% |
| Malaysian | 3 | 0 | 0% |
| Asian – Sinhalese | 1 | 0 | 0% |
| Black – Nigerian | 2 | 1 | 50% |
| White – Turkish Cypriot | 1 | 0 | 0% |
| Black – British | 3 | 0 | 0% |
| White – Polish | 1 | 1 | 100% |
| Asian – Caribbean | 1 | 0 | 0% |