According to at least one interview yesterday, Jeremy Hunt is still keen to ensure that the pay of staff such as Nurses and Doctors needs to be linked to how well they care for their patients, and presumably how quickly these ill people recover from their conditions. The idea is not new, but in the context of this weeks news that some nursing staff will be disadvantaged by the timing and decisions taken over increases in public pay, Mr Hunt has once again raised this suggestion. Performance related pay is something that is very difficult to introduce in a meaningful way, particularly where the outcomes being assessed are the extent to which very ill people feel cared for. There are some patients who are so grateful for every action, that they may never be objective enough to know whose care is the strongest, and other patients who will rarely be satisfied and again for similar reasons have no objective judgement. The internal cost of introducing performance related pay can also be significant. There can be no value in asking more clinical staff to deal with the additional administrative burden, so the politics of introducing additional administrators into the NHS will inevitably come into play. One of the other challenges associated with this idea is the impact on the workplace. I have worked in settings where all of the pay was related to performance. It was clear that those who did much better than their colleagues, could only remain in these positions by exhibiting very different characteristics to the care and nurture that Jeremy Hunt is proposing will be rewarded. Those who care best and nurture most may find they are inspired to bring the team on with them, not seek to benefit personally at the expense of most of their colleagues. However before Jeremy gets a chance to introduce his pay reform into the NHS, what about something that is just as pressing?

The extent to which our MPs are effective is determined by our MPs as being based on the response at subsequent elections. This means they are only assessed for their competence and effectiveness once every 5 years. Extensive work has been carried out to show that over 550 of the 650 constituencies are safe seats. This means that less than 100 that are likely to change hands at the next election, although of course the Political Party they represent is able to deselect these men and women if it wishes, more or less at will. In other words only 15% of our MPs are impacted by a true performance assessment by the people they represent, yet they all have to retain the support of their party if they are going to stay in the safe space. Perhaps Mr Hunt could persuade his colleagues to adopt some form of truly objective assessment throughout the period of each government by people who they represent, not just those who are on the same team as them. If the representing quotient can be measured for the 650 MPs, we could then have a bit more confidence in the idea of measuring the caring quotient for the many Nurses in our NHS.