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Sir Malcolm Grant, Chairman of NHS England, discusses developing a set of principles to protect the integrity of decision making in public duty.
To ensure that no individual should find themselves in a position where there is the possibility of conflict between their NHS duties and other interests, we have set up a special ‘task and finish’ improvement group to look at managing conflicts of interest.
The group has focussed on developing a unified set of principles and rules that protect the integrity of decision making in the discharge of public duties.
There is no problem in principle in holding of such interests; the NHS benefits from knowledge, skills and expertise that has been gained by employees, non-executives and advisers in different yet often closely related contexts. An example of this would be clinically-led commissioning by GPs through CCGs, for which we have recently issued specific advice. Our concern is to ensure that these other interests do not come into conflict with public duty. This calls for transparency and scrupulous behaviour in identifying potential conflicts of interest and avoiding their crystallisation into actual conflicts of interest.
The group discussed the relative merits of a principles based versus a rules based approach. We felt that aligning guidance to a key set of principles would support good judgement by individual staff making decisions. However, we believe it is important that we go further by providing clear rules on what is and what is not acceptable where we are able to do so. For example, when discussing gifts we felt the key principle is that:
- Staff should not ask for or accept gifts, rewards or hospitality that may affect, or be seen to affect, their professional judgement
In addition, we clarified a distinction between gifts from patients, which we saw as legitimate expressions of gratitude and therefore important not to curtail, and gifts from suppliers, which the group felt there was no legitimate reason to accept with the exception of very minor promotional items which could not be seen to affect judgement – for example, a bag given out at a conference. For these reasons we added several supplementary rules to the above principle:
- Gifts from patients up to the value of £25 may be accepted and need not be declared
- Gifts from patients over the value of £25 may be accepted and must be declared
- Gifts from suppliers or potential suppliers should be declined with the exception of promotional items of minor value i.e. under £5 which can be accepted and need not be declared.
We also considered the principles and rules appropriate to a range of other interests including hospitality, other employment, private practice, commercial sponsorship, shares, patents and loyalty interests. We are engaging with a range of stakeholders over the summer and our intention is to formally consult on our proposals early in the autumn.
We heard from Mike Thompson of the Association of British Pharmaceutical Industry about their recent initiative Disclosure UK, which publishes payments from pharmaceutical companies to UK clinicians and organisations. In 2015 there were over £340m worth of payments and 70% of recipients consented to their data published representing around 48% of the total value paid. Mike was clear that this percentage is likely to increase as it becomes a cultural norm for information to be available. The group welcomed the initiative as an important first step in bringing about greater transparency however there was broad support for going further in order to capture all payments from industry and other players to health care professionals.
At our next meeting we will consider the importance of transparency in managing conflicts of interest and therefore appropriate publication regimes for registers of interests. Transparency requires that the external interests of those taking decisions or offering advice or exercising other relevant functions are properly declared, both on a register that is publicly available, and specifically in relation to any item of business that may be arising, for example on an agenda. This is not a static process. People’s circumstances are constantly changing. The register needs to be continually reviewed and updated.