Should we pay NHS directors £1m bonuses?

On the 1st of April the HSJ published an exclusive report.  “Performance Bonuses for NHS board directors which could be worth up to £1m, are the flagship recommendation of the report prepared for the government by former Marks & Spencer boss Sir Stuart Rose.”  The proposal is to adopt an approach modelled on those used by the FTSE100 companies, attracting and retaining the very best and motivating them to achieve success.

The idea is bound to divide opinion.  “An April Fool prank?” you may think, shuddering as you recall the scandalous impact of bonuses on the global financial crisis.  Alternatively you may take the view that the NHS is in effect a huge service provider business – one which we all pay for indirectly – and so it should learn from big business.

Doctors are expected to practise Evidence Based Medicine.  The question is does the NHS practise Evidence Based Business?



Before reaching your conclusion it is worth watching this thought provoking talk on motivation by Daniel Pink.  It’s one of the top 10 most watched videos on the TED website.  Over the 18 minute presentation  he eloquently and entertainingly explores the impact of incentivising performance.  He argues that there is “A mismatch between what science knows and what business does.”  He refers to information from studies by the Federal Reserve Bank in America and London School which conclude that bonuses work as long as the task involved has a simple set of rules and a clear destination.  However they are detrimental to performance when there is a need for creative conceptualisation, when the rules are not defined or when the solutions may be surprising, the destination unobvious.

Though you may not be in the position to decide whether or not NHS board directors will receive £1m bonuses, it is worth thinking about how you personally try to influence your colleagues and teams for performance at work.  Bonuses and incentives take on many forms: the ‘thankyou’ box of chocolates; letting someone finish their shift early; “I’ll do this for you if you do that for me” and so on.

There is an analogy of bonus and incentives as an addictive drug:  the first hit is fantastic; the next few times are good; you then start to expect or even rely upon it; then when you don’t get it ………….

Daniel Pink presents Autonomy, Mastery and Purpose as the three building blocks of performance, focusing on autonomy, with self-direction as the key to engagement.  There’s a key link here with the current Challenge Top Down Change Campaign for the NHS which reflects the spirit of the 5YFV.

So where is your personal emphasis on influencing others at work: incentives and bonus to get your will, or engagement through autonomy?


Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication interview and teaching skills in the medical environment.  Influence and achieving performance is a topic regularly explored in a variety of our courses.