I’m very pleased that the public consultation on managing conflicts of interest in the NHS has been published; we hope to receive a wide range of responses which allow us to refine our proposals before commending them to the NHS and its partners. This blog provides some background to the consultation by describing key points of discussion from the last task and finish group.
The group discussed the need to strike the right balance by ensuring that our recommendations mitigate conflicts whilst not creating an undue burden, particularly for people with limited responsibility for decision making. We therefore drew a distinction between all staff, and those senior staff with identified decision making responsibility, where additional safeguards should apply; for example completing an annual declaration of interests. There was much discussion about which groups should fall under the category of senior staff and we concluded that individual organisations are best placed to identify this in their own context. However in the consultation document we do suggest the groups this would usually include.
In developing our proposals we engaged with a range of partners and one issue raised was that of private practice by clinical staff. The group discussed the potential for independent practice to conflict with NHS duties. This risk could arise not just in relation to doctors, but also for other classes of clinician too. Whilst recognising that many staff manage their practice appropriately, the group felt that greater transparency is required.
We therefore made proposals on the type of information which should be declared and published. An issue debated by the group was whether this should include private practice income, a suggestion received during stakeholder engagement. Some members of the group felt that private practice primarily created a potential conflict of time and therefore declaring sessions undertaken was sufficient, others felt that declaring income provided an additional safeguard to understand the degree of potential conflict. The group concluded that it was right to consult on this issue and recommended a specific question be asked in the consultation document. However this is not about declaring specific sums earned, just selecting one of three categories – under £50,000, under £100,000 and then over £100,000.
We also discussed the best means of publishing information in order to ensure transparency. The group considered whether a single database of the kind seen in the USA as a result of the Sunshine Act was desirable. We agreed that interests should be interpreted in context and therefore individual interests need to be linked to the NHS organisation concerned. Stakeholders with knowledge of the US database described the high costs of establishing and maintaining such a system. After some discussion the group concluded that it was preferable for registers of interests to be published on organisational websites and that as far as possible these should be accessible via central websites such as NHS choices. However we stopped short of proposing the creation of a central database for all interests.
Finally, the group recognised that whilst our consultation makes every effort to speak to all groups of staff sometimes it is difficult for individuals to identify the likely impact on them. To this end we have published some Frequently Asked Questions to help bring the proposals to life.
Our final proposals will reflect the feedback we receive during consultation and we look forward to receiving responses. We absolutely need the help of NHS organisations, staff, patients and the public to get these proposals right. Following this the task and finish group will meet for a final time to agree the final recommendations which will ultimately be issued as guidance to the NHS.
If you think that we have got elements of this wrong, or if you have suggestions about better approaches, then the consultation is your opportunity to tell us. We look forward to hearing from you.
Sir Malcolm is also Chancellor of the University of York, and immediate past President and Provost of UCL (University College London) from 2003-2013. He is a barrister and a Bencher of Middle Temple.
As an academic lawyer he specialised in planning, property and environmental law, and was Professor and Head of Department of Land Economy (1991-2003) and pro-vice chancellor (2002-03) of Cambridge University, and professorial fellow of Clare College.
He has served as Chair of the Local Government Commission for England, of the Agriculture and Environmental Biotechnology Commission and the Russell Group. He is currently a trustee of Somerset House, a director of Genomics England Ltd and a UK Business Ambassador.