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Racial discrimination in the allocation of distinction awards? Analysis of list of award holders by type of award, specialty and region

^a Harvard Medical School, Boston, MA 02115-5818, USA, ^b Medical Practitioners Union, London SE1 1UN, ^c Department of General Practice, University of Manchester, Rusholme Health Centre, Manchester M14 5NP

Correspondence to: Dr Esmail aesmail@warren.med.harvard.edu

	Introduction

Top Introduction Methods and results Comment References

There has been much concern about the possibility of discrimination in the allocation of distinction awards to consultants. The aim of this study was to assess whether there is any disparity between white and non-white consultants in the receipt of distinction awards.

	Methods and results

Top Introduction Methods and results Comment References

We used the list of all consultants in England and Wales who are currently in receipt of a distinction award published by the Advisory Committee on Distinction Awards¹ to determine the ethnicity of award holders using the surname of the award holder as a proxy for ethnicity. We classified consultants with Asian, Chinese, and African names as non-white and consultants with Anglo-Saxon, East European, and South European names as white. All consultants are eligible for distinction awards, so for denominator data we obtained the number of consultants by region and specialty from the 1996 census of the NHS workforce carried out by the Department of Health.² This census categorises consultants as white, black, Asian, other ethnic, and not known. We classified black, Asian, and other ethnic as non-white. We excluded the not known category in our calculations.

We tabulated results of award holders by type of award, specialty (only those with more than 50 award holders), and NHS region. The ratios of the proportion of white and non-white consultants with awards were calculated together with their confidence intervals (see 1.

	Comment

Top Introduction Methods and results Comment References

Distinction awards are "granted to individuals solely on the grounds of merit. Consultants from all backgrounds, regardless of gender and race, are judged equally."¹ The systematic differences that we have tabulated between white and non-white consultants therefore need some explanation.

The use of surnames as a proxy for ethnicity is open to criticism because of the problems of misclassification. This method cannot identify people with European sounding names who may be Asian or Afro-Caribbean and who would therefore have been classified as white. Nevertheless, this misclassification would probably not have altered the very large differences that we observed. We did not have ethnicity information on 12% of the consultants eligible for awards. The ethnic distribution of this group is unlikely to different from the group as a whole, and the omission of these consultants from the denominator ratio would not produce any serious bias.

If discrimination is an explanation, then it can arise at two stages: at nomination and at awarding. We have no information on the ethnic composition of those who are nominated or on those who are turned down by the regional committees. However, the fact that the end result is the under-representation of consultants from ethnic minorities, particularly in certain specialties and regions, suggests that something other than sheer excellence is operating at these stages. We have no information on the composition of regional award committees, and there is only one consultant from an ethnic minority who sits on the national advisory committee. If these committees are predominantly white and male they could be open to accusations of bias against women and ethnic minorities.

Distinction awards are an important source of income for consultants: an A+ award is worth £52 925 a year, an A award £38 995, and a B award £22 285. A system which appears systematically to exclude a section of the consultant workforce from recognition and reward cannot be defended. We have previously shown that racial discrimination is widespread in the NHS.^{3 4 5} In the absence of more information on the workings of the distinction award system—at present it is cloaked in secrecy—charges of racial discrimination in the allocation of distinction awards can be also brought against the system.

	Acknowledgements

AE carried out this study while a Harkness Fellow of the Commonwealth Fund of New York. We thank the Department of Health for providing us with the data on the NHS workforce. Contributors: AE planned the study, carried out the analysis, and wrote the paper and acts as guarantor. HD collected the data from the various reports and prepared them for analysis. SE initiated the idea and participated in writing the paper.

Funding: None.

Conflict of interest: AE and SE are vice presidents of the Medical Practitioners Union, which is opposed to the present system of distinction awards for NHS consultants.

	Notes

Contributors: AE planned the study, carried out the analysis, and wrote the paper and acts as guarantor. HD collected the data from the various reports and prepared them for analysis. SE initiated the idea and participated in writing the paper.

	References

Top Introduction Methods and results Comment References

1. Advisory Committee on Distinction Awards. Report on the 1996 awards round. London: Department of Health, 1997.
2. Hospital Medical Staff: England and Wales. National and regional tables. Leeds: Statistics (Workforce) Branch, National Health Service Executive, 1996.
3. Esmail A, Everington S. Racial discrimination against doctors from ethnic minorities. BMJ 1993;306:691-2.
4. Esmail A, Everington S. Asian doctors still being discriminated against. BMJ 1997;314:1619. [Free Full Text]
5. Esmail A, Everington S. Complaints may reflect racism. BMJ 1994;308:1374.