11th February 2019
Two years ago, on 9th February 2017, NHS England issued new guidance on managing conflicts of interest in the NHS. Initially known as the sunshine rule, this followed an investigation in 2015 that found cases and serious risks of corruption in the NHS with regard to the receipt of gifts, hospitality and sponsorship that could unduly influence decisions and awards of contracts.
A Task & Finish group was set up by NHS England in 2016 including a public consultation led by Sir Malcolm Grant leading to the launch in 2017. Two years on, it seems like a suitable anniversary to pause, observe and reflect on what has changed…
Our first observation is that this should not have been called guidance! It is mandatory for NHS organisations and all should be standardising their processes and approaches to meet the requirements set out. Introduce a word like guidance and people will take it as just that: ‘well I could be doing it like that but our current approach is probably good enough’! We should perhaps not be surprised that in February 2018 an interim review by NHS England on how things were going showed just 5% of acute trusts and 20% of community, care and mental health trusts were publishing the required registers and were fully compliant. A few months on, in October 2018 matters had improved with a sample test (of 17) showing 23% of acute trusts being fully compliant and further gains in being partially compliant. There remains however a long way to go. Saying that, it should be noted that CCGs, who have had policies in place for longer, are now 100% compliant (note the messaging in the CCG sector was much clearer about it being mandatory and not for guidance!).
Other things we have observed or heard:
Generally, all Trusts we have spoken to are well aware that they need to do this, but it is simply further down a very big priority list. It is making its way further to the top, but resource and time is scarce as we know, and there is a cost implication in doing this too of course (even if it is pretty low through our solution!).
More training and awareness is needed amongst workforces. The justification and rationale needs to be articulated better to staff. The absence of this creates a vacuum which then gets filled with resentment and misunderstanding. Here is an example of one such conversation I had with a midwife last year:
“So are you making your declarations?”.
“Why should I? I am squeezed enough as it is. If I get a bouquet of flowers or chocolates why should I have to report that?”.
NHS staff need to understand this is not about witch-hunting or accusing, it’s about openness and reassurance.
It takes time to embed new practices and install new behaviour and culture. NHS organisations do need to start now and commit, and not wait for a problem or exposure to then force them to act more urgently. Start now and commit to a programme of implementation, review and improvement. As NHS England continue their monitoring, they will start to get heavier on those organisations doing nothing at all with this work stream.
Our solution, Declare, is now used by 30+ NHS organisations and these customers are starting to see real efficiencies, more reporting and as such a healthier visibility of activity amongst staff bases. Where Trusts were once seeing just a handful of reported declarations, now we are helping them achieve hundreds and, as such, far greater compliance than ever before. We are also reducing the burden as Declare removes the dependency on paperwork, data entry, spreadsheets and so on.
If you would like to find out more or discuss conflicts of interest in the NHS, we’re here for a talk.