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
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
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.
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.
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
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.
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
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:
at and chairing meetings
and expenses paid to healthcare professionals
of attendance at meetings, including registration fees and the costs of
accommodation and travel, both inside and outside the UK
grants and benefits in kind provided to healthcare organisations.
To learn more about Disclosure UK, you can find links on the
website to further sources of information which you may find helpful.
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
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.