NHS England takes next step on tackling conflicts of interest
NHS England is launching a major consultation on proposals to strengthen the management of conflicts of interest, clamp down on inappropriate behaviour and ensure that the NHS is one of the leading healthcare organisations in the world in tackling these issues.
The six-week consultation is an opportunity for all interested parties to make their voices heard about these proposals which cover gifts, hospitality, employment, sponsorship and other interests.
In March this year, NHS England set up a group to look into developing a stronger approach to managing conflicts of interest, both real and perceived. Drawing on expertise from a wide range of organisations, the group is led by Sir Malcolm Grant, Chair of NHS England and includes representatives from the British Medical Journal, NICE, the Care Quality Commission, the Local Government Association and the Association of the British Pharmaceutical Industry.
The group has investigated best practice in health, other sectors and internationally and is now proposing measures to strengthen conflict of interest identification and management. These proposals include:
- setting out what is and is not acceptable in relation to individual types of interest such as the need to seek prior approval from the employing NHS organisation for any outside employment
- the processes by which interests should be identified and conflicts of interest managed appropriately, for example ensuring all senior staff complete an annual declaration of interest
- information which NHS organisations must publish in relation to the interests of their staff
- ensuring that staff and others understand what constitutes both interests and conflicts of interest as well as the circumstances in which they can occur
- the processes which organisations should have in place to ensure they appropriately manage any breaches of conflicts of interest policy.
Following the consultation, NHS bodies will work together to finalise the guidance and ensure effective implementation of the plans.
Sir Malcolm Grant said: “The public expect the highest standards of behaviour in the NHS, but we know there are times when the NHS has failed to meet this expectation.
“We have a responsibility to use the £110bn healthcare budget provided by the taxpayer to the best effect possible for patients, with integrity, and free from undue influence. Spending decisions in healthcare should never be influenced by thoughts of private gain.
“We want to hear from as wide a range of people and organisations as possible so they can help us bring greater transparency, and clearer guidelines for staff in a way that will benefit taxpayers, patients and the health service.”
Miss Clare Marx, President of the Royal College of Surgeons, said: “Clear guidance for NHS staff on managing any potential conflicts of interest is long overdue. The NHS is a complex organisation in which conflicts of interest may arise, and they must be handled with openness, transparency and consistency to ensure all staff work in the best interests of patients.
“For surgeons, our own guidance – Good Surgical Practice – is explicit that surgeons must demonstrate probity in all aspects of their professional practice, which includes declaring any commercial involvement, or work outside of the NHS. Patients rightly have a huge amount of trust in the medical profession and this guidance will help doctors to think about any potential conflicts of interest and help them to act appropriately at all times.”
10 comments
Many thanks for all of the comments given regarding this work, the consultation on which closed on 31 October 2016.
We are analysing the responses and will publish further information about next steps shortly. You can keep up to date with developments on our Conflict of Interest Task and Finish Group page.
Kind Regards
NHS England
I have no problem with the need to resolve conflicts of interest. I can see why stating the private earnings made on an NHS site would be logical in the context of working their agreed job plan but I cannot see why consultants should declare their earnings outside of this. If I choose to work in my free time seeing private patients I do not see how the requirement to declare my earnings in this activity addresses conflict of interest issues. If a private hospital was required to release this information without my agreement then it is probably a breach of data protection. What earnings from non medical activities have to be declared as well? This proposal aims to de-professionalise medicine and it may lead to some consultants ceasing all NHS activity altogether, which would affect both the clinical service and junior doctor training also. Will all NHS staff, including non-medical, be required to publicly declare their earnings or is this only to be targeted at senior clinicians?
In NHS we got to tackle conflict of interest. So far all regulation is focused on clinical staff (Trust disciplinary action, GMC, NMC and so on) and Organisational (CQC, Monitor, College visits and so on) but no accountability for NHS Trust Board leaders and managers. Until today, as far as I am aware no Trust Board leaders have been held to account. They move from one Trust to another.
With 110 Billion public money available it is important to make sure there is proper accountability for everyone. The culture of bullying, racism, discrimination, victimisation are all common in our NHS and it puts patients and staff at risk and lots of cover up goes on in our NHS
Hope this document holds everyone to account. Sad reality in our NHS is BME staff are more severely disciplined and disproportionately disciplined due to subconscious bias and in some cases blatant racism. No leader has been held to account for bullying. Hope this document goes long way to make NHS safer and better for all
As a consultant with a small private practice in addition to a full time NHS job I would make it clear that the time spent on ‘private’ work (which includes a lot of work on NHS patients treated by private providers) is clearly documented in my job plan kept by my employing NHS trust. There is no conflict of interest as a result of the transparency entailed. I have no difficulty in my job plan being available for public inspection. It is immaterial to the transparency in this process to require me to make reference to the financial sums involved.
Sir Malcolm Grant,
It is most welcome to have an “independent Chair”. The public could not wish for more.
Where can we find who you are, and the way your career has progressed till now? This is necessary to understand your independence.
My personal view is that the proposals of the group that you Chair seem weaker than weak.
Dr Peter J Gordon
NHS Scotland
I am not sure if this response, of two days ago, was received:
Response by Dr Peter J Gordon, 20 Sept 2016:
May I comment from NHS Scotland where a public consultation has recently taken place and the majority of those consulted were of the view that it should be MANDATORY for financial conflicts of interest to be declared.
In NHS Scotland, GUIDANCE produced by the Scottish Government, has been widely ignored by all NHS Boards.
I have to say I find the proposals of the Group chaired by Sir Malcolm Grant as extremely disappointing.
If you wish to look at the evidence why this matters, and the potential for patient harm, please look here: https://holeousia.com/tag/sunshine-act/
Given that that NHS is a high profile public entity, first and foremost is the public’s perception of its operations. For conflict of interest to work effectively there needs to three separate but distinct elements:
1. Legal implications for compliance with all the relevant statutes, policies and other related laws.
2. Standard Code of Ethics of which the profession must abide by.
3. Agreed and accepted good practice on how to handle conflicts of interest when then arise that are linked to points 1 and 2.
” …NHS England set up a group to look into… managing conflicts of interest,… expertise from a wide range of organisations…led by Sir Malcolm Grant,… includes representatives from:
* the British Medical Journal,
* NICE,
* the Care Quality Commission,
* the Local Government Association and
* the Association of the British Pharmaceutical Industry.”
BUT
NOT
Patients and the Public.
Not your choice of those you consider to be Patient Leaders (Self declared).
OUR choice, selected and elected by, and answerable to, US.
After all, it is OUR nhs, not yours.
Whatever happened to:
” we’re all in this together”, and
“no decision about me without me”?
Absolutely – patients should be given the opportunity to be involved within this initiative from the outset
The initiative should be expected to, and provide evidence that it is, complying with co-production model which was recently published? http://coalitionforcollaborativecare.org.uk/catherine-wilton/a-co-production-model-five-values-and-seven-steps-to-make-this-happen-in-reality/
Sir Malcolm needs to allow doctors to declare zero or less than zero earnings from private practice to give the public transparency. The lowest earnings bracket of “less than £50,000 quoted in the media” will be a travesty.