Conflicts of interest: Is the sun shining brighter a year on? | Nick Goodman

Nick Goodman

 The head of MES reflects on progress made a year on from the launch of NHS England’s guidance on managing conflicts of interest in the NHS.

Twelve months ago, following ‘task group’ work and a consultation exploring the idea of a Sunshine Rule, NHS England issued new guidance on managing conflicts of interest in the NHS. It was (and still is) a worthy aspiration, aiming to put in place more stringent governance requirements on NHS bodies while promoting a consistent approach in how potential conflicts are managed, reported and handled.

The guidance came into force on 1 June 2017.

I will show my cards in the interests of, appropriately enough, transparency. MES supplies engagement, governance and patient experience solutions to the sector. Before the June 2017 start date, we had a product ready to offer that we had been working on for some time – we then road-tested it with NHS organisations that were turning their minds to this programme of work, did some more development based on the findings and fine-tuned what would become our MES Declare solution.

We now have 20+ NHS clients and have been shortlisted for a HSJ Partnership Award for the solution.

Putting to one side our commercial ambitions, what I have observed in the last 12 to 18 months are a number of all-too-obvious bear traps on NHS England’s side. Following the launch of the new guidance in February 2017 and a (some might say) rather Draconian, ‘do this by June’ message (which by all accounts was then gently revised to October), there has been a deafening silence from NHS England. No next steps. As far as we can tell, no checking to see if anything has changed or is changing.

Most trusts and CCGs have undoubtedly looked at the guidance. Many may have thought ‘good idea’. Many more may have thought ‘a good idea dreamt up in Whitehall that is rather difficult to deliver on an ever-stretched budget and certainly not achievable in three months’.

Some though, dare I say, may even be trying to avoid the issue altogether, given the many other priorities higher up the list. There simply isn’t the bandwidth in many organisations to deal with this too. At least not right now.

As such, we are seeing a number of organisations taking one of three approaches:

  1. We will get to this when we can.
  2. We will wait and see if NHS England chastise us for not meeting the guidance (by inspecting our website and/or processes).
  3. We will deal with it if we ever face a problem…which we hope we never do.

The rest are implementing solutions to meet the guidance, though my sense is that a year on, this may still be a minority. A number may be struggling to deliver all parts of the guidance. This may be because there are some aspects open to interpretation that have not had a clear enough steer from above. Or it could be that there is not the resource to commit either time or money to what may be viewed as ultimately an administrative and bureaucratic function, albeit an important one.

That guidance was issued for good reasons: in the spirit of transparency and further embedding trust in the system and how it’s governed. It undoubtedly sends a strong and positive message about good governance, consistency and trust, not just to the health sector, but beyond too.

But it needs a push. Not a stick as such, but more of a focus from those who issued it in the first place, because we’re a year on and the mood seems to be ‘yes, will do, eventually’.

Regardless of whether our product is used or the trust works on their own solution, my observation is one that applies to several schemes: countless initiatives are launched by NHS England with a degree of fanfare or a pressing urgency (and a good degree of cost). Remember NHS Citizen anyone? Or the saga?

Too many initiatives, this one being a great example, are left to ‘hopefully happen’. Experience of working with the sector to date is that it needs more than that.

Hope is not a strategy. Gentle (or sometimes, eventually, perhaps more forceful) support, checking in, highlighting of good examples, spotlighting the topic… keeping the subject alive and letting the sector know it matters and was not a tick-box exercise.

The sector is more stretched than ever with the resource jam being spread thinner and thinner. In these times, a little more interest and proactivity from NHS England (which this time last year expected the guidance to be followed within three months) would ensure this agenda is far more likely to become firmly rooted into system-wide, organisational business-as-usual processes.

A final thought: maybe the answer as to why the agenda is getting such little push lies closer to home… looking on NHS England’s website it is difficult to track down where they are publishing their own declarations of interests by decision-making staff!

Nick Goodman is managing director of MES, an associate partner of the NHS Confederation. Follow him and the organisation on Twitter @Nick_MES @MESsocial

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