Under plans being drawn up for the NHS, cash reward schemes could be extended to reflect performance against a number of quality indicators.

Imperial College Healthcare Trust in London, the largest hospital trust in the country, is currently discussing the proposal with a view to introducing a pilot scheme in the next few months. In the scheme, doctors would be rewarded financially for operations that are particularly successful.

"We are looking at a pilot scheme for a particular operation which will measure the improved functionality of the patient and we are looking at linking certain performance-related bonuses to that," a spokesman for the trust said.

The spokesman would not say which operation the scheme would apply to, but said it was chosen because it had "very clearly defined" indicators that made it suitable for testing the approach.

Similar schemes were used in other countries, the spokesman said, and the trust was keen to test the approach as a means of raising standards: "It's about rewarding excellence."

But Katherine Murphy, from the Patients Association, said: "Patients will be horrified. There is a real risk that the most complicated cases, and the patients in real need, will be forgotten because they don't get the best outcomes.

"Doctors already have a duty to provide high-quality care. I think a good doctor would be insulted by the idea that they will only do their best on the operating table if there is extra money in it."

The Government paved the way for linking cash incentives to measures such as post-operative mobility in the recently-published NHS Next Stage Review.

It stated that the current Clinical Excellence Awards Scheme, which gives consultants financial rewards for excellence, will be strengthened to reinforce quality improvement.



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