Managing conflicts of interest

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To deliver high-quality services, the organisations that make up the collective NHS need to work collaboratively, sharing examples of best practice and innovative delivery of care. However, to protect taxpayers’ money, a consistent approach to managing conflicts of interest must be adopted when organisations work in partnership with one another.

Following a consultation by NHS England in summer 2017, it became apparent that significant variation exists in current practice surrounding management of conflicts of interest across the NHS. 

NHS England guidance

To protect patients, taxpayers and staff employed in organisations in which there is a direct state interest, new guidance, developed by NHS England, came into force on 1 June 2017. 

The guidance is applicable to both NHS trusts and foundation trusts, which must have regard to it through its incorporation into the NHS Standard Contract. Clinical Commissioning Groups (CCGs), and NHS England are also in scope. While the guidance does not specifically apply to general practices, GP partners and other individuals in a practice directly involved with the business should note the requirements in the guidance for CCGs.

The guidance covers a number of key themes and:

  •          introduces consistent principles and rules for managing conflicts of interest
  •          provides advice to staff and organisations about what to do in common situations
  •        supports good judgment about how interests should be approached and managed.

When considering conflicts of interest, it is important to note that these may fall into a number of categories and, in addition to those concerning financial interests, there are those that touch upon professional, personal and indirect interests, the latter of which may arise through relationships with relatives, close friends and associates. 

A standard definition for what constitutes ‘a conflict of interest’, and information on how to interpret each of these categories, is contained within NHS England’s guidance. Read our common situations web page for examples of the most commonly found examples of conflicts of interest.

 

What action is required?

Organisations must support staff to understand that having interests is not in itself negative but not declaring them and managing them is. 

Polices

As a minimum, organisations should ensure their policies meet the standards set out in the NHS England guidance.  A model policy is included as a supporting document to the guidance, which you may wish to either adopt or adapt. Template declaration of interest and register of interest forms are also available on the NHS England website.

Processes

It is essential that you, as an employer, have clear and well-communicated processes in place to help staff understand what they need to do. Identifying a team or individual with responsibility for reviewing policies, training and supporting staff, and maintaining a register of interests is also important.

An interest should remain on a register of interest for a minimum of 6 months after it has expired, and organisations should retain a private record of historic interested for a minimum of 6 years after the date on which it expired.   

Decision-making staff

Some staff because of the requirements of their role are more likely than others to have a decision-making influence on the use of taxpayers’ money.  Examples of such staff include executive and non-executive directors, those who have the power to enter into contracts on behalf of their organisation, and those at Agenda for Change bands 8d and above.  As a minimum, organisations should publish the interests of these staff annually in a prominent place on their website. 

Boards and advisory groups

When considering the governance of boards, advisory panels and other strategic decision-making groups, it is essential that the interests of members is known, and meetings chaired appropriately, to avoid conflicts of interest. In instances, this may mean that a member is excluded from all or part of a meeting, although this should not always be the default position, as it may have a detrimental effect on the quality of the decision being made.

Procurement

In terms of procurement decisions, NHS Improvement and NHS England have detailed guidance on processes which organisations should consult. Procurement should be managed in a way that is compliant with procurement and other relevant law, and a clear audit trail should be maintained to show how conflicts of interest have been identified and managed.

Disclosure UK scheme

Disclosure UK is a searchable database, published on the Association of the British Pharmaceutical Industry (ABPI) website, detailing transfers of value – payments and benefits in kind – made to UK healthcare professionals and healthcare organisations by pharmaceutical companies. The database contains details of payments and other benefits in kind made to individual, named healthcare professionals annually, starting with 2015, unless there is a legal reason why an individual cannot be named.

The types of activities noted on the database include:

  • speaking at and chairing meetings
  • training services
  • advisory board meetings
  • fees and expenses paid to healthcare professionals
  • sponsorship of attendance at meetings, including registration fees and the costs of accommodation and travel, both inside and outside the UK
  • donations, grants and benefits in kind provided to healthcare organisations.​

To learn more about Disclosure UK, you can find links on the ABPI website to further sources of information which you may find helpful.

Breaches

Organisations should identify a team or individual to be notified of breaches, and be clear as to how staff can raise concerns about these. In compliance with your whistleblowing policy, staff should be encouraged to speak up about suspected breaches. You can find out more about creating the right conditions for staff to feel comfortable raising concerns on the whistleblowing section of our website.

When dealing with instances of breaches, you may wish to take legal advice prior to imposing sanctions, which could have serious consequences for those involved. Further information on the consequences of breaches and the range of potential sanctions can be found in the NHS England guidance.

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