Conflicts of interest
A conflict of interest is a set of circumstances by which a reasonable person would consider that an individual's ability to apply judgment or act, in the context of delivering, commissioning, or assuring taxpayer-funded health and care services is, or could be, impaired by another interest they hold.
A conflict of interest may be:
- Actual - there is a material conflict between one or more interests.
- Potential - there is the possibility of a material conflict between one or more interests in the future.
Staff may hold interests for which they cannot see potential conflict. However, caution is always advisable because others may see it differently. It will be important to exercise judgment and to declare such interests where there is otherwise a risk of the imputation of improper conduct. The perception of interest can be as damaging as an actual conflict of interest.
NHS North Yorkshire Clinical Commissioning Group (CCG) is responsible for commissioning healthcare services to improve the health and wellbeing of people in North Yorkshire. It decides which services the people of North Yorkshire most need and pays local hospitals and other healthcare providers to provide these services. In addition, it holds the healthcare providers to account to ensure that they provide the services paid for.
Conflicts of interest are inevitable in commissioning and it is how we manage them that matters. As a membership organisation management of conflicts of interest is part of our day-to-day activities. By bringing more clinical leadership into commissioning and enabling more local decision making, CCGs are empowered and enabled to improve services locally for the benefit of patients and local communities
Therefore, it is important to manage conflicts of interest to:
- Protect the integrity of the CCG's decision making processes and decisions;
- Avoid improper influence and prevent fraud
- Ensure decisions are legal and can be defended in the case of a legal challenge
- Fulfill its duty to look after public money
- Ensure honesty, fairness, transparency, and equality in the way we spend money
- Ensure our patients receive the best possible care
The CCG takes its responsibility to manage conflicts of interest seriously and has a Conflict of Interest Policy. This policy is in line with the updated Conflict of Interest Guidance published by NHS England in June 2017.
The Policy sets out how NHS North Yorkshire CCG Governing Body members, staff, members and clinical leads should behave in their role at the CCG. It also sets out the steps and measures that the CCG takes to manage conflicts of interest. An example of this is that the Policy requires those people referred to above to declare any and all interests which may be, or may lead to, a conflict of interest.
The Lay Member of Audit and Governance, who is also the Audit Chair of the Governing Body, has been appointed as the 'Conflict of Interest Guardian' with specific responsibilities set out in the Conflict of Interest policy. The Conflict of Interest Guardian is responsible for providing impartial and unconflicted advice and judgement to the CCG and Governing Body in cases where it is not obvious whether a material conflict exists or how best to manage it. In such cases they define a reasonable balance so as to avoid conflicts whilst enabling the CCG to harness the knowledge of clinicians and other staff for commissioning so as to improve care to patients and value for money to the taxpayer. Day-to-day management of Conflicts of Interest is managed by the Board Secretary / Senior Governance Manager.
The most common types of conflicts of interest include:
- Financial interests
- Non-financial professional interests
- Non-financial personal interests
- Indirect interests
When a conflict of interest is identified it should always be disclosed, as openness and transparency allows for conflicts and potential conflicts of interest to be assessed and managed. This includes publishing all conflicts of interest of 'decision making' individuals (Agenda for Change 8b and above) on a Register of Interest (Updated December 2020).
In most instances the individual with a conflict of interest will be removed from decision making on that particular issue. In the rare instance that this is not possible, the CCG manages the risk of improper or undue influence carefully. This includes documenting how the conflict of interest has been assessed, controlled and managed.
To find out how the CCG manages conflicts of interest, please refer to the Conflicts of Interest Policy.
All suspected or known breaches should be reported to the Conflicts of Interest Guardian, Accountable Officer or the Director of Corporate Services, Governance and Performance in the first instance. All such notifications will be treated with appropriate confidentiality at all times in accordance with the CCG's policies and applicable laws.
It is the duty of every CCG employee, governing body member, committee or sub-committee member and GP practice member to speak up about genuine concerns in relation to the administration of the CCG's policy on conflicts of interest management, and to report these concerns. The CCG has an obligation to publish any breaches on a yearly basis. The breach log will next be published in March 2021.
Gifts, hospitality and sponsorship
CG staff should not accept gifts that may affect, or be seen to affect, their professional judgement. This overarching principle should apply in all circumstances;
Any personal gift of cash or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) must always be declined, whatever their value and whatever their source, and the offer which has been declined must be declared to the team or individual who has designated responsibility for maintaining the Register of Gifts, Hospitality and Sponsored Events (updated December 2020) and recorded on the register.
Gifts from suppliers or contractors doing business (or likely to do business) with the CCG may be accepted where they are under the value of a common industry standard of £6 (these gifts do not need to be declared but staff should notify their line managers when a gift is accepted). All gifts over the value of £6 should be declined and declared by completing a Gifts and Hospitality Declaration Form and recorded on the Gifts, Hospitality and Sponsorship Register.
- CCG staff should not ask for any gifts;
- Modest gifts under a value of £50 may be accepted and do not need to be declared;
- Gifts valued at over £50 should be treated with caution and only be accepted on behalf of an organisation (i.e. to an organisation's charitable funds), not in a personal capacity. These should be declared by staff;
- A common-sense approach should be applied to the valuing of gifts (using an actual amount, if known, or an estimate that a reasonable person would make as to its value);
- Multiple gifts from the same source over a 12 month period should be treated in the same way as single gifts over £50 where the cumulative value exceeds £50.
Hospitality means offers of meals, refreshments, travel, accommodation, and other expenses in relation to attendance at meetings, conferences, education and training events etc.
- CCG staff should not ask for or accept hospitality that may affect, or be seen to affect their professional judgement;
- Hospitality must only be accepted when there is a legitimate business reason and it is proportionate to the nature and purpose of the event;
- Particular caution should be exercised when hospitality is offered by actual or potential suppliers or contractors, these can be accepted if modest and reasonable, but individuals should always obtain senior approval and declare these.
- Under a value of £25 may be accepted and need not be declared;
- Of a value between £25 and £75 may be accepted and must be declared;
- Over a value of £75 should be refused unless (in exceptional circumstances) senior approval is given. A clear reason should be recorded on an organisation's register(s) of interest as to why it was permissible to accept;
- A common-sense approach should be applied to the valuing of meals and refreshments (using an actual amount, if known, or an estimate that a reasonable person would make as to its value).
- Modest offers to pay some or all of the travel and accommodation costs related to attendance at events may be accepted and must be declared;
- Offers which go beyond modest, or are of a type that the CCG itself might not usually offer, need approval by senior staff (e.g. the CCG governance lead or equivalent), should only be accepted in exceptional circumstances, and must be declared. A clear reason should be recorded on an organisation's register(s) of interest as to why it was permissible to accept travel and accommodation of this type;
A non-exhaustive list of examples includes:
- Offers of business class or first-class travel and accommodation (including domestic travel); and
- Offers of foreign travel and accommodation
Sponsorship of NHS events by external parties is valued. Offers to meet some or part of the costs of running an event secures their ability to take place, benefiting NHS staff and patients. Without this funding, there may be fewer opportunities for learning, development, and partnership working. However, there is potential for conflicts of interest between the organiser and the sponsor, particularly regarding the ability to market commercial products or services. As a result, there should be proper safeguards in place to prevent conflicts from occurring.
When sponsorships are offered, the following principles must be adhered to:
- Sponsorship of CCG events by appropriate external bodies should only be approved if a reasonable person would conclude that the event will result in clear benefit for the CCG and the NHS;
- During dealings with sponsors there must be no breach of patient or individual confidentiality or data protection rules and legislation;
- No information should be supplied to the sponsor from which they could gain a commercial advantage, and information which is not in the public domain should not normally be supplied;
- At the CCG's discretion, sponsors or their representatives may attend or take part in the event but they should not have a dominant influence over the content or the main purpose of the event;
- The involvement of a sponsor in an event should always be clearly identified in the interest of transparency;
- CCGs should make it clear that sponsorship does not equate to endorsement of a company or its products and this should be made visibly clear on any promotional or other materials relating to the event;
- Staff should declare involvement with arranging sponsored events to their CCG.
Other forms of sponsorship
Organisations external to the CCG or NHS may also sponsor posts or research.
However, there is potential for conflicts of interest to occur, particularly when research funding by external bodies does or could lead to a real or perceived commercial advantage, or if sponsored posts cause a conflict of interest between the aims of the sponsor and the aims of the organisation, particularly in relation to procurement and competition. There needs to be transparency and any conflicts of interest should be well managed. For further information, please see Managing Conflicts of Interest in the NHS: Guidance for staff and organisations.
Procurement and tendering procedures
It's important that the services which the CCG commissions are underpinned by robust, fair and transparent procurement exercises to ensure that the quality of those services are achieved and maintained in order to facilitate greater choice for our patient population and to secure best value for money with public resources.
Conflicts of interest can arise in many situations, environments and forms of commissioning, with an increased risk in primary care commissioning, out-of-hours commissioning and involvement with integrated care organisations. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring.
A register of procurement decisions is available here (Updated December 2020).