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Shining a light into dark corners – Sir Malcolm Grant

The Chairman of NHS England explains what is being done to tackle conflicts of interest:

Earlier this month I chaired the first meeting of a task and finish group charged with improving the management of conflicts of interest across the NHS.

The group’s membership and terms of reference are now available.

The issue is a topical one; several recent stories in the press have highlighted examples where the conduct of NHS employees in receiving payments from pharmaceutical companies has been open to question, and has raised legitimate public concern.

This is a complex area.  Conflicts of interest can occur in a multiplicity of different situations within healthcare, however their management is fundamentally a question of good judgement supported by due process.

I am clear that we have a responsibility to use the £110bn healthcare budget provided by the taxpayer to the best effect possible for patients, with integrity and free from undue influence. If we do not, we have failed in our duty and will lose the public’s trust.

I’m very pleased that we have convened a group of capable individuals who are committed to addressing this issue.

Our group will meet four times over the summer in order to develop an approach that we hope will make it easier for individuals and organisations to understand and appropriately manage conflicts of interest.

At our first session there was a good discussion on the variation in the current system and the need to learn from the best to create greater consistency and a levelling up of practice. There are many local and national organisations that do this well. NICE, for instance, have a comprehensive policy and approach which addresses the specific conflicts that arise in the context of advisory groups.   There are also lessons we can learn from other countries – such as the physician payments or Sunshine Act in the USA.

There was a valuable consensus among the group about the need to have a common definition of conflicts of interest. We felt it important to stress the possibility for a person’s judgement in regard to a primary interest or duty to be affected by a secondary interest they hold. This could be a conflict between a public role and a private investment but could just as easily be a conflict between two public duties.

We recognised that conflicts can be actual i.e. real and present, potential ,i.e. likely to arise unless action is taken. We also agreed on the importance of avoiding perceived conflicts of interest even where no actual conflict is present, since we need to maintain public trust.

We will need to carefully consider how we will maximise the impact of our work; our worst fear is that we produce a report which gathers dust on a desk. Our ambition, therefore, is to engage with the system through our call to evidence and consultation to produce a set of usable tools which facilitate and reinforce the ethical culture of the NHS.

At the next meeting on 4 July we will focus on both the appropriate principles and rules needed to manage conflicts of interest and also the approach to identification and management of interests when they arise.

Professor Sir Malcolm Grant CBE is the Chairman of NHS England.

Sir Malcolm is also Chancellor of the University of York, and immediate past President and Provost of UCL (University College London) from 2003-2013. He is a barrister and a Bencher of Middle Temple.

As an academic lawyer he specialised in planning, property and environmental law, and was Professor and Head of Department of Land Economy (1991-2003) and pro-vice chancellor (2002-03) of Cambridge University, and professorial fellow of Clare College.

He has served as Chair of the Local Government Commission for England, of the Agriculture and Environmental Biotechnology Commission and the Russell Group. He is currently a trustee of Somerset House, a director of Genomics England Ltd and a UK Business Ambassador.

Channel website: https://www.england.nhs.uk/

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