Conflicts of interest in the NHS is a hot topic at the moment. New statutory guidance was issued by NHS England for CCGs in June followed in September by the launch of a consultation on a standard approach, across the whole of the NHS, to managing conflicts of interest. Organisations that don’t pay attention to this will likely find themselves in the spotlight. So what do boards need to think about?
First we must ask the question “what is it for?”
One quickly comes to the view that the fundamental concern is to create an environment in which the best decisions can be taken and in which all of our stakeholders have confidence. Anything that has potential to get in the way of this needs managing.
There are a few deliberately chosen words in those couple of sentences.
First, note that I talk about stakeholder confidence. Nothing would undermine confidence more than if it was believed an option was chosen because someone was swayed by their own gain. The importance of the actual decision will be lost if our public or staff believe that we had ulterior motives for our decisions and it risks distracting us from the important business of getting on with implementation.
Second, notice that I say managed and not removed. There are few hard and fast rules; little black and white and LOADS of grey. The important bit is talking about and developing a shared understanding of the grey areas. It’s all a matter of judgement. For example, CCGs need to carefully balance the massive benefits of having the specific insight and expertise of local GPs with them being involved in taking decisions about primary care services that they will deliver. When designing a new care pathway, who would think it appropriate to suggest that the consultants from the local provider should not be involved?
Also, note that I say potential rather than actual. We all have interests and its usually because of our interests that we have been selected for the role we undertake. Some of these interests will conflict with other loyalties and some won’t. Be mindful that because perception is of such importance here, then it should not be up to me to make the judgement about whether my interest presents an actual conflict or not.
I have three simple pieces of advice for boards:
1. Understand that this is about taking good decisions. Strip back all the anxiety and technical language and ask yourself “what do we need to have, know, and do?” in order to make good decisions.
2. Recognise that there is a difference between having an interest and there being a conflict of interest. All conflicts and potential conflicts of interest should be managed in a pro-active way but not all interests present a conflict. Be proportionate.
3. Draw a distinction between the making and taking of decisions. Decision making: The process through which information is gathered on which to make judgements- this includes developing principles, criteria, consultation, debate, option appraisal etc. Decision taking: The formal point at which a course of action is agreed by the individual/ group who have authority and accountability. This concept was first proposed by the Good Governance Institute and provides a helpful framework to enable the necessary expertise to be included at each stage, without undermining the decision taken. Conflicts occur in both phases but the mechanisms for managing conflicts can be different.
thiNKnow can provide bespoke training for your board to help you get beneath these issues. Visit our website for more information or contact Nicola King nicola@thinknowltd.com for a no obligation chat about your needs.