01.04.16
Conflicts of interest ‘guardians’ amongst major CCG policy shake-up
Following a string of allegations against potential conflicts of interest in CCG contract awards, NHS England has announced a shake-up of its policy within the health service.
Incoming changes include new positions for ‘conflicts of interest guardians’, strengthened statutory guidance and a new cross-system task group chaired by NHS England chairman Sir Malcolm Grant.
These reforms are the result of months of discussions with senior leaders in CCGs, internal audit colleagues and NHS England’s legal team. The organisation will kick off a four-week consultation during April and will take final guidance to its board in May, with a view to publish it in early June.
CCGs will then be required to review and change their processes in line with updated guidance by the end of November.
Part of the core proposals will require the introduction of a conflicts of interest guardian in all CCGs, a role undertaken by CCG audit chairs and an “important point of contact for any conflicts of interest queries and issues”.
Justifying the new role, NHS England’s national director for commissioning strategy, Ian Dodge, said in a board paper: “We recognise that conflicts of interest come in different guises, and that responses to them need to be tailored.
“By introducing a conflicts of interest guardian, we will strengthen expertise in the CCG and ensure there is a clearer point of contact for any issues which should lead to firmer and more consistent decision-making.”
Simons Stevens, NHS England's chief executive, added: “In a tax funded health system, the public rightly demand high standards of probity from both NHS staff and health care suppliers. Recent cases in the UK and indeed worldwide have underscored the need for action. ‘Sunshine’ rules to bring greater transparency, tougher restrictions on conflicts of interest, and clearer guidelines on industry partnerships and influence will benefit patients and protect taxpayers.”
CCGs will also be required to include an annual audit of conflicts of interest management within their internal audit plans, and to publish findings within their annual governance statement at the end of each year.
They will eventually implement a robust process for managing breaches within their conflict of interest policy, publishing any breaches on their website, as per recommendations from the National Audit Office.
NHS England is also recommending a minimum of three lay members in CCG governing bodies, rather than two as statutorily required, in order to help manage these conflicts.
“These proposals represent a broad response to the concerns raised. In developing them we have been cognisant of the additional burden on CCGs, most obviously in relation to funding a third lay member. We have tested this with CCGs – firstly there has been strong support for this proposal, and secondly about 30% of CCGs already have 3 or more lay members,” Dodge said.
More CCGs will be forced to publish information on issues of gifts and hospitality, given that just 20% do so at present.
All CCG staff, and the staff of their member practices, must also complete mandatory conflicts of interest training, provided by NHS England. This will be supplemented by face-to-face training sessions for CCG leads.
To strengthen this “system-wide approach”, Sir Malcolm’s task group will help develop a set of rules to be adopted. According to NHS England, this approach has been agreed by chief executives of arms’-length bodies and the Department of Health, and has the support of NHS Confederation members.
“This cross system task and finish group will also consider guidance on collaborating with industry, and whether there is a case for aggregation of the information on conflicts which this work will lead to the publication of on a central web platform, akin to the provisions in place in the US following passing of the Sunshine Act,” added Dodge.
For more information on the upcoming changes, and for ‘illustrative examples’ of what some of the rules and mechanisms for compliance might be, access NHS England’s board papers.