3. The new healthcare landscape
DoH
Monitor CQC
NHS CB
Clinical P
Networks
A
FT’s
T
Clinical CCG’s
Senates I
E GP Provider
Groups
N
GP Practices
T
S Third Sector
Health and Primary Care
Wellbeing
Boards Private Sector
4. Conflicts of interest
• the Bill
• Towards Authorisation
• the Governance Framework
• Towards Establishment
• other guidance
• commentary on conflicts
5. Conflicts of interest
• The Bill:
• Clause 24 of the Bill introduces a new Section 14 to the
National Health Service Act 2006 which deals with CCG’s
• Clause 14B refers to provisions about the constitution of a
CCG contained Part 1 of Schedule 1, which include that the
constitution must:
• specify the procedure to be followed in making decisions
• make provision for dealing with conflicts of interest of
members
• Secure that there is transparency about decisions and
the manner in which they are made
6. Conflicts of interest
• Towards Authorisation:
• One of the six domains in the Towards Authorisation
Guidance is that a CCG must have “proper constitutional
and governance arrangements” in place
• In describing this domain, the guidance states that CCG’s
“must be properly constituted with all the right governance
arrangements” but, again, is short on detail
• However, two technical appendices to the guidance provide
further clarification
7. Conflicts of interest
• Technical Appendix 3 contains principal corporate
governance arrangements, which include:
• Robust systems and processes in place for effective
decision-making and to manage conflicts of interest
• Decision-making structures clearly set out in the
constitution, to include an independently chaired audit
committee
• A scheme of delegation with underpinning processes to
delegate decision-making to an appropriate level
8. Conflicts of interest
• Technical Appendix 4 refers to the publication of a
Governance Framework for CCGs which will consider:
• Why good governance is critical
• Developing a model constitution
• The Accountable Officer and other lead roles
• Managing conflicts of interest
9. Conflicts of interest
• The Governance Framework:
• was scheduled for publication in autumn 2011 but has not
yet been produced (as such)
• however, the Towards Establishment guidance focuses
heavily on creating responsive and accountable CCGs and
deals with a number of governance issues
• whilst this is not made explicit, it will probably form the basis
of the Governance Framework
10. Conflicts of interest
• Towards Establishment:
• CCGs “will need to demonstrate probity and governance
commensurate with their considerable responsibilities for
their patients’ healthcare and tax payers’ money”
• to do this, CCGs will have to be “effective and safe public
bodies that embody Nolan principles.”
• However, within these parameters, CCGs are to have
flexibility to determine the arrangements that they judge will
enable them to be effective organisations
11. Conflicts of interest
• Towards Establishment:
• There is a lot of detail in this guidance but, in summary,
CCGs will be expected to:
• act transparently
• manage conflicts of interest
• have proper checks and balances in place to provide
assurance that decisions are taken in a way that protects
patients’ best interests
• promote continuous improvements in quality
• provide assurance that public money is well managed
12. Conflicts of interest
• Other guidance:
• The Nolan Principles:
• Selflessness
• Honesty
• Objectivity
• Openness
• Leadership
• Accountability
• Integrity
13. Conflicts of interest
• The Good Governance Standard for Public Services:
• performing effectively in clearly defined functions and
roles
• promoting values for the whole organisation and
demonstrating the values of good governance through
behaviour
• taking informed, transparent decisions and managing risk
14. Conflicts of interest
• Commentary on conflicts:
• RCGP / NHS Confederation publication “Managing
Conflicts of Interest in Clinical Commissioning Groups”
• BMA Publication “Ensuring Transparency and Probity”
15. Case Studies
• Out of Hours Procurement
• A CCG is going to tender the local GP OOH Service.
• The CCG asks two GPs who work for the current provider
to help it draft the service specification.
• Is there anything wrong with this?
• What if those two GP’s are also members of the Governing
Body of the CCG and will participate in the tender
assessment process?
16. Case Studies
• Drug and Alcohol Procurement
• A CCG is going to tender for Drug and Alcohol services.
• A GP who has been nominated to sit on the assessment
panel declares a conflict of interest on the basis that he
holds one share in a potential bidder.
• How should the CCG deal with this?
• What if he held no shares but his wife (also a GP) held one
share in a potential bidder?
17. Case Studies
• Request from unsuccessful tender participant
• An unsuccessful tender participant writes to the CCG
shortly after the announcement of the award of the tender.
• The participant requests details of:
• the basis upon which the decision was made;
• who participated in the decision making process; and
• what other interests (if any) they declared.
• How does the CCG respond and what are the key issues
here?
