Conflict of Interest in Health Procurement – Trouble at’t Trust in Yorkshire

The complex process for commissioning health services in the UK saw "clinical commissioning groups" (CCGs) set up to award contracts for health services to hospitals, mental and community health groups and occasionally private providers.  When the system was first devised, we expressed concern about the potential for conflicts of interest, with GPs (family doctors) and other health professionals involved in the procurement decisions - and sometimes also having interests on the supply side. It seemed to us that potential conflicts would need to be very carefully managed if trouble was to be avoided.

A current case in Yorkshire is highlighting that issue. The Vale of York Clinical Commissioning Group (CCG), has awarded a contract for mental health services to the Tees, Esk and Wear Valleys NHS Trust (TEWV), which has upset the incumbent supplier, Leeds and York Partnership NHS Foundation Trust (LYPFT). That organisation has complained to Monitor, the health regulator. Their allegation is that Dr Louise Barker played a key role in the CCG decision process, as an evaluator of the tenders. But her partner just happens to work for TEWV, the successful bidder! And she apparently gave her partner's organisation higher marks for their bid than her evaluator colleagues did.

That came out after the award decision and when LYPFT got hold of the evaluation documentation. No doubt more will come out on this matter but this comment is pertinent if somewhat confusing - from the Yorkshire Post article:

The personal relationship is acknowledged on Dr Barker’s formal register of interests with CCG, but the letter claims the CCG failed “to ensure that Dr Barker’s conflict of interest was registered in every meeting where the Procurement was discussed, and in failing to ensure that Dr Barker was not in a position to influence the outcome of the Procurement, it is the Trust’s contention that the CCG has failed to comply with both its statutory, and organisational, obligations in relation to the management of conflicts of interest.”

It seems very clear to us that the obvious conflict means she should not have been in that position, holding a key role in the selection process. But that extract suggests the CCG was aware of the conflict, yet thought it OK for her to be an evaluator - if true, that is stupid beyond belief. When there are likely to be just two serious bidders, and someone has a partner working for one of them, surely you would keep that individual miles away from the sharp end of the decision process. Someone needs to be sacked if they cannot see that.

However, it would be interesting to know how many organisations and how many procurement exercises do handle potential conflicts of interest properly. I remember working as an interim Procurement Director in government and my colleagues being somewhat shocked when I said I wanted a conflict of interest declaration from a whole range of people, up to and including the CEO, as we went into a very large and sensitive procurement. But that is what is needed - the scope should be proportionate to the procurement, but certainly anyone involved in the evaluation process needs to be checked in every case.

It is also important to define what is meant by "conflict" - and that it relates not just to the individual, but to family, even close friends. In these days of "partners" rather than husbands and wives, that is a particularly sensitive area. You might not want to lay it out in these precise words -  "and anyone you have had sex with in the last 12 months" - but actually, a conflict of interest could easily be driven by a non-marital partner of some sort, as well as a spouse, sister, father, etc.

We will keep an eye on what happens in Yorkshire anyway. But from what we've read so far, I suspect the CCG is in trouble.

 

Voices (2)

  1. Stephen Heard:

    This is just the tip of the iceberg I’m afraid. The future of the NHS has clearly been laid out in the Five Year Forward View which Peter has mentioned here before. The main drive of this plan, a strategy it is not, is partnership working through federations, strategic partnerships and other commercial vehicles set up to deliver the new care models promoted in this plan. A large number of these new delivery vehicles will have complex and intertwined relationships that will make the management of conflicting interests a full time job.

  2. DrGordy:

    In my past life a conflict of interest also meant exclusion from any part of the discussion on a procurement decision. COI with CCGS where a disaster just waiting to happen and it amazes me that DOH didn’t put in place a more robust risk management system to protect against them – will they now?

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