CONFLICTS OF INTEREST

Management

The NHS is wounded by internal market and inspection culture (The Guardian: 20th February 2017)

Here is an alternative to our chronic impasse over the NHS (Report, 17 February): abolish the internal market, together with its draconian micromanagement and inspection culture. These are flawed and failed ideologies. In attempting to replace vocational motivation with commercial incentives we have all but destroyed the best of healthcare’s professional art, heart, spirit and intellect. Our profession’s impoverishment of morale is widespread and increasingly hazardous. The internal market is inviably complex and divisive. It has undone collegial trust and therapeutic networking, and has replaced these with dense, rigid institutional procedures and documents that are often known to be senseless, often corrupting. Increasingly I have witnessed just-legal feints and “creative accountancy” to deceive yet formally comply: redesignations to double-count, cherry-picking referrals for financial or statistical advantage, for example...Read More 

 Turnaround consultants heading to more struggling trusts (The HSJ: 20th February 2017) 

NHS Improvement said the first wave of its financial improvement programme, in which consultancy firms were paid £25m to work with 16 providers last year, had identified £100m of efficiency savings.

Another group of trusts will now be sought to work with the firms, which could include PwC, EY, McKinsey, SSG Health, Grant Thornton, Deloitte and KPMG.

When asked what the budget would be, NHS Improvement said there is no specific budget as trusts will contract with the firms themselves.

On Friday, HSJ asked the regulator to provide its analysis of the return on investment for the first wave of the programme, but nothing has been received so far...Read More

NHS chief admits trusts will miss financial target (Irvine Times: 16 February 2017)

An NHS chief has admitted for the first time hospital trusts will miss their financial target this year as forecasts predict they are on course for a combined deficit of nearly £1 billion.

Jim Mackey, head of NHS Improvement, said efforts are now focused on "containing this to as manageable a number as we can" as trusts struggle with ballooning deficits.

Figures obtained from trusts by the Heath Service Journal (HSJ) show they are heading for a year-end deficit of around £970 million.

This is far higher than the £690m deficit predicted in November and would significantly breach the £580m maximum deficit "control target" set by national leaders.

The numbers, which have been collected from all but five of England's 237 NHS trusts, come ahead of the official figures next week and suggest their financial positions have deteriorated as the year has progressed.

However, it is understood the regulator, NHS Improvement, has managed to bring some of the forecasted deficits down following discussions with trust boards...Read More

Big pharma now helping to run King’s College Hospital? (Our NHS: 20 January 2016)

 Maybe it was the hangover from Christmas or the focus on the impending junior doctors’ strike, but few people seemed to pick up on a quiet press release from King's College Hospital NHS Trust on January 4th, announcing that the managing director of big pharma company, Pfizer UK, had joined their board.

Erik Nordkamp will spend “up to three days a month” as a non-executive director advising on the strategic direction of one the most respected and high-profile NHS Trusts in the country, alongside his day job running the UK operations of one of the world’s most profitable and controversial drug companies.

The appointment will raise questions about potential conflict of interest issues at King's, and increasing pharmaceutical and private sector influence over the NHS.

Dr Jacky Davis from Keep our NHS Public criticised the appointment:

"It is not appropriate for the head of Pfizer UK to be appointed as a non-exec director at one of the country’s most prestigious trusts. Clearly his presence on the board is likely to influence its attitude to the relationship between the private sector and the NHS, and increase the influence of the pharmaceutical industry within the trust and the broader NHS.”...(read more)

 

General practice commissioning: in whose interests? (BMJ: 11 November 2015)

An investigation into England’s clinical commissioning groups shows that many are commissioning from organisations in which board members are involved, Gareth Iacobucci reports in the BMJ.

Clinical commissioning groups (CCGs) in England have awarded hundreds of contracts worth at least £2.4bn (€3.4bn; $3.7bn) to organisations in which their board members have a financial interest, a joint investigation by The BMJ and The Times has found.

This new analysis shows the extent to which CCG boards have become conflicted under the health reforms introduced in 2012, which handed general practitioners control of around two thirds of the NHS’s total budget.

The data have reignited calls to ban GPs who are directors of provider organisations from holding board positions on CCGs that could commission them. NHS England has ordered an audit of how CCGs are managing conflicts of interest. Patient representatives, MPs, and doctors’ leaders are also concerned that governance standards are too lax in some areas. NHS England’s current rules allow CCGs the freedom to determine whether conflicted CCG board members should be excluded from relevant parts of meetings or join in discussions but not participate in decision making when commissioning services.1

This guidance was described by the head of the BMA’s GP committee as “too permissive.”The BMJ and The Times examined contracts awarded by a sample of 151 of England’s 209 CCGs between April 2013, when CCGs went live, and July 2015. These were cross referenced with the registered interests of board members that CCGs are required to maintain and keep up to date.

They identified 50 CCGs that have awarded contracts where a conflict was present, with a total of 437 out of 5671 contracts awarded to healthcare providers in which one or more CCG board members had declared an interest. Most of the money went to NHS trusts or other similar organisations providing a range of acute, community, and mental health services (£2.2bn gained from a total of 116 contracts awarded with a conflict present).

Social enterprises were the next highest earners from contracts awarded with a conflict of interest present (£64.6m from 13 contracts), followed by limited companies, (£16.6m from 36 contracts), large commercial companies (£16.6m from four contracts), and confederations or cooperatives (£10.4m from 15 contracts). These contracts ranged from large deals to run general practice out of hours services to small contracts for community based service.

The remaining money earned from contracts awarded with a conflict present went to general practices (£7.4m from 232 contracts awarded to provide services such as screening, anticoagulation clinics, and minor surgery), hospices (£4.6m from nine contracts), councils (£4.1m from four contracts), nursing homes (£440 000 from two contracts), and charities (£260 000 from five contracts).

The findings follow a previous investigation by The BMJ in April 2013 which found that more than a third of GPs on the boards of CCGs had a conflict of interest resulting from directorships or shares held in private companies. For more information see: BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6000

 

Investigation launched over drug company payments to senior NHS staff (The Independent: 24 July 2015)

The Government is to investigate “extremely serious allegations” that senior health officials who help decide which drugs are bought by the NHS have been paid to work as consultants for pharmaceutical companies.

Following an undercover investigation, The Daily Telegraphreported that some staff charge as much as £15,000 to arrange “advisory board” meetings for private firms.

The allegations raised concerns that health service officials may have had a conflict of interest when deciding how to spend multi-million budgets for drugs.

A Department of Health spokesman said: “If these allegations are true, this is completely outrageous and amounts to an abuse of the trust that patients place in NHS staff.

 
Emergency GP takeover by hospital foundation trust could become permanent (Pulse: 15 May 2015)
 
North Derbyshire CCG said on Wednesday it had commissioned Chesterfield Royal Hospital, in the form of Royal Primary Care, to provide an 'emergency caretaker' service for around 24,000 patients registered with Holywell Medical Group in Chesterfield and Staveley.

Partners at the group, which operated across five sites, handed back their contract after recruitment problems and the costs of employing locum GPs made the practice unsustainable.

A spokesman for the CCG confirmed it was now reviewing its conflicts of interest processes and policies after the FT gained member practice status.

Derbyshire LMC secretary Dr John Grenville told GPonline the practice group had faced 'huge difficulties recruiting and retaining GPs, racking up huge locum costs and looking at rapidly decreasing profits to the extent they didn't think it was sustainable.'

 

NHS tests and drugs do 'more harm than good' (Telegraph: 12 May 2015)

NHS patients are being given drugs and tests they may not need because GPs and hospitals are paid for the quantity not quality of their treatment, senior doctors have warned.
 
The Academy of Medical Royal Colleges said patients should be encouraged to ask if their medical procedures were really necessary, in a bid to halt over-diagnosis and needless treatment of swathes of the population.
 
In an unprecedented intervention, the medics - who represent all 21 medical royal colleges in the UK - said too many patients were being forced to endure tests and treatments which could do more harm than good.

 

Fears grow over ‘land grab’ of NHS by private suppliers (The Guardian: 2 May 2015)

A new list of approved suppliers to the NHS has heightened fears of a multi-billion pound land grab by a handful of corporations.

Competition for contracts to supply support services to the GP-led commissioning groups will be dominated by management consultancies, outsourcing giant Capita, and the US health insurer UnitedHealth. NHS England insists that the companies bidding for the support contracts will supply a range of back office functions, cutting procurement times and allowing doctors to focus on how best to spend their £70bn share of the NHS budget.

David Cameron has said the plan “is to put the power in the hands of local doctors so that they make decisions on behalf of patients based on what is good for health care in their local area”.

But groups opposed to the further privatisation of the NHS claim the reality is that the scope of the private firms is being dramatically expanded so that they will be allowed to provide services that, until now, have been undertaken by the NHS. They say that the move will end up costing taxpayers more and result in conflicts of interest as a number of the private firms are also advising the GPs’ commissioning groups. NHS England has rejected these claims....read more

 

NHS shakeup created widespread conflicts of interest, says union (The Guardian: 9 March 2015)

More than one in four governing members of NHS clinical commissioning groups have links to companies involved in healthcare, according to research by Unite.

The trade union claims its findings provide evidence of conflicts of interest on a massive scale, facilitated by the Health and Social Care Act, which gave CCGs responsibility for commissioning services.

The groups comprising GP representatives, managers and laypersons have responsibility for budgets totalling £65bn a year.

[...]

Unite looked at the registered interests of 3,392 CCG board members, in what is says is the most extensive research undertaken into their interests. It found that 932 (27%) had a link to a private company involved in healthcare.

They included 513 company directors, 140 business owners, 105 external workers, 17 partners, 15 chairs, 10 company secretaries, five chief executive officers, one trustee, a financial officer and 125 others, including consultants.

The study also found that 409 board members (12%) were shareholders in such companies – a combination of businesses they own and external private companies, including providers of out-of-hours services.

 

Addenbrooke's gets planning permission for controversial private hospital on Cambridge site - plus hotel and conference centr(Cambridge News: 30 April 2014)

Planning permission has been granted for the £120 million Forum development at Addenbrooke’s – including a controversial private hospital.

Bosses say the 90-bedroom hospital, which will be run by Ramsay Healthcare, will generate income which will be ploughed back into NHS care – but critics fear it is the first step in a private sector takeover of the leading health centre.

Plans which were approved by Cambridge City Council’s planning committee today also include a 198-bedroom hotel to be operated by Crowne Plaza, a 900-delegate conference centre, and a postgraduate medical education centre

 

Norfolk and Suffolk NHS Trust spends £1.2m at consultant's hospital (BBC News: 17 March 2014)

A mental health trust planning to close beds has spent more than £1m sending patients to a private hospital linked to one of its senior consultants.

Norfolk and Suffolk NHS Foundation Trust spent almost £1.2m in 2013 with Milestones at Salhouse, near Norwich.

Milestones' medical director Dr Julian Beezhold is a consultant psychiatrist at the trust and has played a role in its bed-closure programme.

The trust said all its placements were audited externally and internally

The Campaign to Save Mental Health Services in Norfolk and Suffolk voiced concerns about the possible perception of a conflict of interests between Dr Beezhold's roles and called for an investigation.

However, there is no evidence that his role with Milestones has had any impact on the trust's decisions on bed closures or that he has acted inappropriately.
 

Scandal of experts who rule on NHS statins but get paid by drugs firms (The Express: 9 March 2014)

MOST of the experts who are set to recommend the widespread use of statins next month are in the pay of the drug ­companies that manufacture them. The specialists sit on the Government health watchdog, the National Institute for Health and Care Excellence (Nice).

Nice is expected to issue new national advice saying statins, now prescribed to about seven million people a year, should be offered to at least one in four adults.

The move has been criticised by many doctors who say that for many low-risk patients the benefits of statins do not outweigh poss­ible side effects including diabetes, impotence, cataracts, muscle pains, mental impairment, fatigue and liver dysfunction.

 

Firm linked to drug makers sought pact on access to 'care.data' patient records database (The Guardian: 24 February 2014)

A company working to access NHS prescription data on behalf of pharmaceutical firms attempted to sign a gentlemen's agreement last year for access to the new central database of medical information on every patient in England, the Guardian has discovered. The firm, i4Health, lobbied the new Health and Social Care Information Centre (HSCIC) in July 2013 for a memorandum of understanding to "ensure that requests [for patient data] from life sciences receive prompt attention", an examination of the stakeholder forums of HSCIC shows.

The pharmaceutical industry has championed the proposed "care.data" scheme, claiming that medical surveillance is key to making sure firms are getting the right drug to the right patients. Critics say the database's real worth is as an intrusive marketing tool. Drugs firms deny there is a risk of patients' personal medical files being rifled through. Lawrence Berry, i4Health's chief executive, said: "Companies such as ours use anonymised data, not identifiable confidential data, to look for where improvements can be made to improve treatments and outcomes for patients."

However, campaigners claim that i4Health looks like a front for the drugs industry. Phil Booth, of the patient privacy campaign group medConfidential, said: "First NHS England officials flat out deny they are selling our data, even though money changes hands. Then they deny they sell data to insurers, but they've just been caught doing that. Now we find pharmaceutical companies are queuing up behind so-called not-for-profit front companies to spy on what pills we take to get better. The whole care.data scheme is starting to look like nothing more than a giant medical data-laundering machine."
 

Revealed: Independent experts overseeing care.data have approved 31 releases of identifiable patient data since April (Pulse: 17 January 2014)

Requests for identifiable patient data have been approved more than 30 times since April by the group of independent experts which will oversee access to confidential records uploaded to the controversial care.data scheme. A Pulse analysis of applications to the Confidentiality Advisory Group (CAG) reveals there have been 31 releases of confidential patient information since April 2013 - 12 of which were to bodies outside the NHS. The frequent releases of data under the little-known Section 251 exemption are significant because a similar process will govern the release of identifiable patient data once GP records are extracted via the care.data programme. NHS England announced last year that it plans to sell care.data access to private companies and researchers for a nominal £1 - and private companies will be able to make applications to access identifiable data via the Section 251 process.

 
 
A Hastings Borough Councillor's view on conflicts of interest and the closure of dementia services  (Cllr Mike Turner Baird Ward report: 12 November 2013)
 
Several specialist dementia units which provide full time respite and EMI care in Hastings, are facing closure or privatization... As well as being one of the Councillors for Baird Ward, I represent Hastings Borough Council at the Health and Wellbeing Board. The Board has espoused initiatives to localise healthcare and bring it under the scrutiny and control of local people. One of it’s’ responsibilities is to advise where to direct funding in order to reduce health inequalities and improve services. On its’ board are the Lead Member for Social Services, the Chair and Director of Adult Social Care, the Director of Children’s’ services, County Councillors and some local Councillors. I consider it to be of profound concern that all these individuals have ostensibly signed up to health initiatives which in their capacity as members of Clinical Commissioning groups (CCGs), many then actively undermine. Members of the Health and Wellbeing Board, including the Director of Adult Social Care, signed up to an initiative to improve dementia care for example. The same people then go away and put on a different hat and initiated a consultation to be brought before East Sussex County Council’s cabinet, to privatise dementia services at the Isabel Blackman Centre and close dementia units such as Mount Denys and Pine Hill. Both of the two units facing closure have been commended for their high quality of service and are frequently used by the NHS and private care providers as well as informal carers. They are extremely important in providing respite for the latter…. I believe this affair not only calls into question the role and independence of the Health and Wellbeing Board, but a fundamental lack of democracy and transparency which characterises many of the changes occurring within Health and Social Care.
 

Private equity firms approached by NHS to run spending advisory organisations (BMJ: 5 November 2013)

Health campaigners have reacted angrily to reports that private equity companies have been approached to help run organisations that advise the NHS on purchasing billions of pounds of healthcare services in England. The Financial Times reported on 4 November that several companies had been approached by the NHS about the possibility of taking over or merging with 19 commissioning support units (CSUs), set up under the Health and Social Care Act 2012 to advise clinical commissioning groups (CCGs) on NHS spending. NHS England told the BMJ that it had held “exploratory” talks with potential providers and investors from the private and voluntary sectors to discuss how they may become involved in the organisations, which provide services such as contract management, procurement advice, and back office IT support.

Louise Irvine, executive member of the NHA party, a GP in Lewisham, southeast London, and member of BMA Council, said: “There will be huge conflicts of interest as they will give lucrative contracts to their friends in the private sector. Deals will be hidden behind commercial confidentiality. Money will be drained from the NHS into private pockets and there will be further cuts to frontline services as a result.” John Lister, member of the NHA party and director of campaign group London Health Emergency, added: “Putting private equity firms in de facto charge of commissioning—advising GPs and shaping local policy options for CCGs—is really like putting Dracula in charge of the blood bank.”
 

NHS guidance on conflicts of interest should be mandatory (The Guardian: 5 April 2013)

The disclosure that one in three GPs running the new CCGs also help run or hold shares in private healthcare firms has raised concerns about managing widespread conflicts of interest. The NHS Commissioning Board has issued guidance for CCGs, and it is clear that CCG board members should declare all relevant financial interests and exempt themselves from discussion of contracts from which they might benefit personally. However, the article notes that even when procedures are correctly followed, it can be easy to bias the outcome in favour of a particular healthcare supplier - this is a “huge risk” that the government is taking with its reforms. Any suspicion of bias, justified or not, that a private healthcare contract was awarded unfairly could quickly discredit the reforms, which have already raised questions about the quality and consistency of NHS procurement.

 

Private companies to access patient data for £1 (Pulse: 9 August 2013)

Private companies and researchers will be able to access data from GP records for £1, under plans revealed by NHS England to radically reduce the cost and boost the availability of information about patients available outside the NHS. The body’s chief data officer has revealed he wants to reduce the costs for companies to access NHS datasets, from around £20,000 to £30,000 currently, to just £1. NHS England said the data would be used to identify where improvements and efficiencies could be made in the NHS and that only approved companies would have access to the data. But the GPC has raised concerns that private companies would have access to NHS patient data ‘on the cheap’.

 

NHS guidance on conflicts of interest should be mandatory (The Guardian: 5 April 2013)

The disclosure that one in three GPs running the new CCGs also help run or hold shares in private healthcare firms has raised concerns about managing widespread conflicts of interest. The NHS Commissioning Board has issued guidance for CCGs, and it is clear that CCG board members should declare all relevant financial interests and exempt themselves from discussion of contracts from which they might benefit personally. However, the article notes that even when procedures are correctly followed, it can be easy to bias the outcome in favour of a particular healthcare supplier - this is a “huge risk” that the government is taking with its reforms. Any suspicion of bias, justified or not, that a private healthcare contract was awarded unfairly could quickly discredit the reforms, which have already raised questions about the quality and consistency of NHS procurement.

 

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