Defining the scope for conflicts of interest in CCGs

It was only on the 15 March, discussing the potential Clinical Commissioning Groups' conflicts of interest, I said "what we don't know is how big a scandal some of those involved in CCGs could be walking into out of ignorance". Today's Sunday Times, 'naming and shaming' provides some indication that it will be a big scandal.

While "NHS England is creating guidance which outlines how conflicts of interest can be avoided and mitigated in the reformed health service" media attention and public scepticism just won't wait and have already jumped to conclusions.

I suspect a level of naivety in the NHS and CCG on procurement decision making and when those with a potential conflict of interest should absent themselves from the decision making process.

In commissioning the potential to exercise 'undue influence' is long before the decision of who should be awarded the contract and indeed long after. For example, the opportunity to influence for personal gain can be exerted:

1. In completing a strategic needs analysis and identifying which services would help match the needs of the area;
2. In prioritisation of the identified needs;
3. In determining the budget allocated to specific needs;
4. In determining the make/buy decision;
5. In determining the level of competition required;
6. In determining the potential for collaborative commissioning partners;
7. In determining whether the identified needs should be expressed as outcomes or narrowly defined inputs/outputs;
8. In agreeing the risk allocation;
9. In agreeing exit clauses;
10. In agreeing the bundling of contracts;
11. In determining when any contracts should be placed on the market;
12. In agreeing contract durations;
13. In determining the level of assets provided to potential providers;
14. In determining the level of assets and resources required by potential providers;
15. In determining the minimum selection criteria potential providers must match, included previous history of providing the service;
16. In determining the evaluation criteria;
17. In determining the evaluation weighting;
18. In determining who should be involved in any evaluation panels;
19. In determining delivery KPIs;
20. In agreeing the approach to performance management.

That's just a few examples that technically could be considered outside the 'decision making process' which most potential providers could welcome the opportunity to influence. It will be interesting how narrowly the NHS define the scope of conflicts of interest - I suspect a lot more narrowly. Of course contracts are already being shaped and, if the guidance takes much longer, the whole process may be irredeemably compromised and public confidence lost.

Should you want to pick up my other related blogs on this just follow this link.