Managing conflicts of interest in UK health commissioning

We’ve got a very interesting guest post from Dr Gordon Murray coming this week on the UK’s health sector. But before that, we wanted to return to a point we’ve made before and that seems to be coming back into the news again.

We wrote recently about the new health regulations and what they might mean for private sector involvement. But the issue of conflicts of interest amongst the Clinical Commissioning Groups (CCGs),  who are making contracting decisions and awarding business to various providers both public and private sector,  was picked up by the Sunday Times the other week.  A whole range of people, including  doctors, local councillors and others, are sitting on these decision making bodies, then seeing businesses in which they have a direct interest gain contracts, income and advantage from the CCG decisions.

THIS IS JUST NOT RIGHT.

There’s no halfway house or mitigation strategy here. It’s just wrong.  Can you imagine the outcry if back in the 1990s, when I was Procurement Director for the Department of Social Security, we’d awarded DSS contracts to my consulting firm?  (Not that I had one then, but you know what I mean).

And if I’d said, “It’s OK, I excused myself from the evaluation panel meeting for the key part of the contract award discussion”, I don’t think anyone would have been persuaded that such a step made it all OK.

Yet that is exactly the situation we see, with CCG members winning significant business from their own CCGs.

There is a simple answer. No-one on a CCG should have a business interest in a provider to the CCG. As simple as that.  If that means a few good people can’t sit on CCGs, well, that’s a shame, but it is for a greater good – the integrity of the whole system.

And why doesn’t the NHS Commissioning Board, which oversees the whole system, and is led by David Nicholson as CEO, have a single person with any procurement background on it? Given they are regulating what is essentially a procurement (or purchaser – provider) system, that seems an odd decision. Or is someone afraid that a procurement person might kick up to much of a fuss about the potential for corruption at the heart of the new system?

And the final point of this rant – shouldn’t CIPS take a stand on this? Anyone on a CCG should agree to be bound by a CIPS-type ethical code, and CIPS should campaign for good procurement practices, professional representation on the Commissioning Board, and a tough line on conflicts of interest.  If this isn’t addressed, then scandal will dog the new process from the start, I’m sure.

Voices (11)

  1. Dan:

    Preventing conflicts of interest is a little too close to regulation and red tape for this government.

  2. Trevor Black:

    Conflicts of interest are just for the little people. Apparently there is nothing wrong in being an MP advising the Government on energy policy while being a paid as a Non-Exec Director of a wind farm supplier. I sit on my local Parish Council and a colleague has to declare at each meeting that he also sits on the Village Hall committee to avoid any conflict of interest. Above Parish Council level apparently we must trust our elected representatives and quango cats that they are honorable and not vulnerable to any dishonest or corrupt practices. At least in Italy they are honestly corrupt!!

  3. life:

    Vis a vis the discussion here around G Cloud the other week, isn’t this also evidence of a general regression rather than move forward in procurement practice by the executive?

    It appears to be sloppy thinking, motivated to achieve narrow (more political) points, rather than an informed procurement savvy focus on the bigger picture.

    A bit like the localisation of planning laws, unless you build in strong integrated controls (or you just don’t do it!), you are putting people in harms way – once you let corruption into the system it can be very hard to shake it out. This is partly because even people who are blameless are tainted and quickly find themselves in a position of defence – like you say Peter, it isn’t right, but once you’ve worked with it, to an extent you’ve endorsed it and, to an extent at least, are complicit. How on earth did this one slip through?

  4. colin cram:

    Great minds think alike. I wrote on this last week. http://www.guardian.co.uk/public-leaders-network/2013/apr/05/nhs-conflict-of-interest-guidelines

    Let’s hope someone takes note

  5. Sam Unkim:

    Please dont expect to get much traction here.

    One of the few benefits to patients of this whole process could be doctors practice surgeries becoming “poly clinics” feed by self commisioned care.

    In effect a one stop shop for many minor treatments, rather than the present endless trudge around OPD clinics

    1. Dave Orr:

      Plain English please – what is an OPD clinic?

      1. Sam Unkim:

        Whoops sorry

        Out Patients Depts

    2. Dave Orr:

      OPD – Ta.

      Try listening on catch-up to Radio 4’s PolyOaks about a poly clinic – v funny.

      http://www.bbc.co.uk/programmes/b011sd1w

      Will they really be open 24/7 then? See Phone 111.

  6. Roger Conway:

    A bright boy, that Dave Orr – he so skilfully latches onto the key elements, does his research and then comes up with logical explanations.

    In a week when we have be discussing the legacy of Thatcher, this is yet more evidence of the moral corruption of government at all levels (probably with considerable criminal corruption as well, if there were any way of getting to the bottom of it) and in true Masonic code “scratching each others backs” whilst they stitch up the population.

    All this of course aided and abetted by the most inept and intellectually challenged set of elected people to District & County Councils I can ever recall (I’m 66 and have been politically aware and interested from my teenage years) And Parliament is no better, probably worse if truth be told.

    Every day another stone is turned over and another scandal exposed. What happens? Diddly squat, that’s what. We have either been so brain washed as to not notice or so exasperated as to not bother or so numbed and immured as to not care.

    Thatchers said “there is no such thing as society” and she made bloody sure that the prediction came true.

    Hurrah for campaigners like Dave Orr. I so glad that someone cares enough to do something about it.

  7. Dave Orr:

    Peter: Thank goodness you are highlighting this and taking a stance and stimulating debate. Has the horse bolted clean out of the stable though?

    This isn’t accident it is by design!

    I always saw the unexpected NHS reforms as an exercise to get large budgets accessible to privatisation and outsourcing (aka cuddly word “commissioning”). FOLLOW THE MONEY!

    How would people have reacted if they had been called Health Contract Letting Boards?

    Here in Somerset, BBC regional news reported that the CCG was still awaiting final statutory instruments to be drawn up, to definitively answer whether retaining a joined up clinical service (avoiding “fragmentation”) and stopping cherry-picking, would be legal defensible. Expect massive private providers to threaten and take legal action under EU & UK Competition rules.

    Their governance does allow Freedom of Information requests, so at least they are accessible to public enquiry as a public body. Hopefully, that is common to all CCGs? Will they have the resources & capacity to cope with FOIs though?

    Perhaps Peter you (and CIPS) could FOI every CCG (compile a distribution list) and ask how they will deal with conflicts of interest? Then compare answers!

    Will a CCG, when faced with optimistic service and savings claims by a private provider, as compared to a known NHS service, award the contract to the private provider due to glowing pre-sales claims? If those claims fall well short of pre-contract promises, there will be no NHS service to return to?! Then too costly & time-consuming to re-build original NHS service.

    http://www.harmoni.co.uk/nhs-111

    Sorry to harp back to IBM & Southwest One….but I was deeply impressed by all the promises made and even looked forward to some IT career-enhancing training, skilling and experience. None of that happened. The disastrous rest is almost history now. Of course, Somerset can never get back their in-house IT service, so for 2017 end of contract, can we look forward to Capita, G4S, ATOS etc?

    What if that scenario occurs in the NHS? Same outcome?

    I believe that it will result in another contract let to another private provider and the service will never be NHS-led or public again. GOES PRIVATE, STAYS PRIVATE.

    The market will, after some years & like the energey market, move to a cartel-like setup with a modest number of big providers carving up bigger & bigger contracts, chasing the elusive goal of scale savings (via a one-size-fits-all factory approach). See new Phone 111 service:

    http://www.pulsetoday.co.uk/commissioning/commissioning-topics/urgent-care/nhs-111-service-launch-delayed-for-more-than-half-the-country/20002420.article

    I hope you find time to cover risk transfer.

    On our local news last night they reported on Winterbourne View where Panorama uncovered shocking abuse of people with Learning Difficulties. The company in charge Castlebeck simply went inot receivership and now the recovery costs are back with taxpayers. No bond, no risk transfer, no culpability at Director level! Sound familiar (Banks)?

    http://www.bbc.co.uk/news/uk-england-bristol-22075816

    Anyone brave enough to make the sociological link back to “Thatcherism” right now?

  8. Robert Beveridge:

    The PM and ministers must realise what they have sanctioned here. Are they so wedded to the privatisation of the NHS that a blind eye has been deliberately turned? Well done for stating the case so strongly. Lets see what response is provoked.

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