My Lords, in February the NHS Commissioning Board Authority published Towards Establishment which set out general safeguards that clinical commissioning groups (CCGs) should have in place to manage conflicts of interest. More specific guidance outlining safeguards for when CCGs are commissioning services that could be provided by GPs will be published shortly. We expect that both of these will inform the guidance the NHS Commissioning Board must provide for CCGs once it is established.
My Lords, I am grateful to the noble Earl for his response. He will be aware of research published at the end of March which showed 22 clinical commissioning groups where the majority of GPs on the board of those groups actually had a financial interest in companies that are in receipt of NHS funding. Given that decisions on future contracts will fall to clinical commissioning groups, can the noble Earl assure me that those GPs will not take part in any discussions or decisions about future contracts? Will he also acknowledge that the problem arises from the weakness of the corporate governance arrangements, because in some CCGs there will be no one left to make the decision?
My Lords, I do not accept that. CCGs will be subject to rigorous safeguards that prevent conflicts of interest affecting their commissioning decisions. Each CCG has to maintain registers of interest. They must have a governing body with lay members on it and other non-GP clinicians who will oversee the arrangements for governance. Each CCG must make arrangements set out in their constitution to manage conflicts and potential conflicts of interest. And the NHS Commissioning Board, as part of its overseeing role, will be responsible for making sure that every CCG has arrangements to manage potential conflicts of interest. So we do not see these problems arising in practice.
I should like to probe the Minister a little further in response to that. While he says that CCGs have to have a register of interest, how are they going to be monitored to make sure that actually happens? How will the register be kept up to date so that conflicts of interest cannot arise in the future? And what actions might be taken when a conflict of interest is proved?
My Lords, the watchword in this context is transparency in that the governing body of a clinical commissioning group will usually meet in public. There will be provision for the health and well-being board of a local authority to challenge decisions made by the clinical commissioning group in its annual commissioning plans. In general, if anyone has a concern about a conflict of interest, or indeed a perceived one, it is open to them to refer the matter, first to the CCG and, secondly, to the NHS Commissioning Board itself.
My Lords, have the BMA and the royal colleges been involved in drawing up the guidance? And if a member of a CCG believes that there is no conflict of interest but a member of the public believes that there is, what mechanisms are available to resolve such a dispute?
My Lords, we are involving all relevant stakeholders in drawing up the precise rules that we expect the NHS Commissioning Board to follow. As I mentioned in my initial Answer, part of that has resulted in guidance that has already been issued and the rest will follow shortly. As regards the second part of my noble friend’s question, the key is for CCGs to make arrangements to make sure that actual and potential conflicts of interest do not affect the integrity of the group’s decision-making process and do not appear to do so. Therefore, the CCG must not only be fair and open and honest, it must also be seen to be all those things, because a perceived conflict of interest which is not managed appropriately would be as damaging to the reputation of a CCG as an actual conflict.
As my noble friend may remember from our debates on the Health and Social Care Bill, we have undertaken to ensure that no member of a commissioning support organisation may also be a member of the governing body of a CCG. Having said which, it is important that CCGs have the freedom to take advice on back-office functions and other matters that will assist them in their clinical decisions.
My Lords, I have spent a great deal of time working in governance with professionals from many different groupings and, however experienced professionals are in their own trade, they are not always very clear about governance issues. This is often true of trustees in voluntary organisations as well as in clinical governance in the health service. What plans does the Minister have for training and advice to the new bodies in order to ensure that people who often believe that they know the answers really do know them?
The noble Baroness makes an extremely important point, which is why we have laid great stress on training and ensuring that the NHS Commissioning Board will develop appropriate guidance on procurement, avoiding conflicts of interests and avoiding unfair competition entering the arena.