Key Findings and Case Studies 6

Contents

Summary 4

Key Findings and Case Studies 6

Owners 6

Directors 6

Shares 6

External work 6

Lay members 6

Clean CCGs 7

Case Studies of GP conflicts of interest 7

Individual CCGS 9

A-E……………………………………………………………………………………………………………………………………………..9

F-M 14

N-S 19

S-Z 23

Summary

·  Following the introduction of the Health and Social Care Act 2012, and the Transatlantic Trade & Investment Partnership, which threatens the irreversible privatisation of the NHS, Unite researched the board members’ interests of the newly formed CCGs to find out how many have a registered interest in private companies involved in healthcare.

·  The legislation handed CCGs responsibility for the £63.4 billion NHS budget for commissioning services and in doing so, opened the door to conflicts of interest on a massive scale.

·  This first comprehensive study of the new NHS commissioners’ external interests in private healthcare reveals the extent of the conflicts of interest held by CCG Board Members.

·  Unite looked at the registered interests of 3,392 CCG board members, which are made up of managers, lay members and GPs, the most extensive research of these interests undertaken. The search revealed directorships, chairmanships, partnerships, ownerships, shareholdings, consultancy services and external employment in companies involved in private healthcare.

·  The Health and Social Care Act forced GPs into a business model in which, the vast majority did not want to participate. [1] The design of the Act was such that it created opportunities for exploitation and at the same time made other GPs to take radical action to protect the NHS. GPs have sat on the board of some CCGs to ensure that to the best of their ability services are protected. Other GPs have set up federations in an attempt to prevent services going into the hands of private companies. [2] [3]

·  Of the 3,392 Board Members, 932 (27%) of CCG board members were found to have a link to a private involved in healthcare including:

§  513 Company Directors;

§  140 business owners

§  105 external work

§  17 Partners;

§  15 Chairs;

§  10 Company Secretaries;

§  5 CEOs;

§  1 Trustee and

§  1 Financial Officer and

§  125 others including consultants, advisory, associates, speaker, OOH.

·  We also found 409 (12%) board members are shareholders in such companies; a combination of businesses they own and external private companies, including providers of ‘Out of Hours Services’.

“If conflicts of interest are not managed effectively by CCGs, confidence in the probity of commissioning decisions and the integrity of clinicians involved could be seriously undermined. However, with good planning and governance, CCGs should be able to avoid these risks.”- RCGP and NHS Confederation’s briefing paper on managing conflicts of interest September 2011 [4]

The findings show the devastating extent to which the new financial gatekeepers of our NHS have conflicts of interest which threatens to destroy the trust currently held between patient and GP.

The British Medical Journal produced a report in December 2014, which revealed of 3,494 contracts awarded by 182 Clinical Commissioning Groups in England between April 2013 and August 2014, 33% went to the private sector providers’. [5]

The report highlighted that many of these contracts being won are [6] in areas that are typical of the financial links held by CCG Board Members.

When the CCGs were created, responsibility for dealing with conflicts of interest was left to each individual CCG, with guidance set by NHS England that includes a register of interests. [7]

It is expected Board Members with a conflict of interest will register that interest and then leave CCG meetings when that conflict of interest arises. However there is no sanction for breaking the code of conduct and the fact remains that the conflicts of interests that were not there before are now prevalent amongst NHS commissioners.

Deputy Medical Director at NHS England Dr Mike Berwick said one idea to counter these conflicts of interests, was to introduce more lay people onto CCG boards in order to challenge decisions. [8] However, Unite research reveals that 110 lay members also have financial interests in companies, many of which are involved in healthcare.

Clinical Commissioning Groups are about to be given more powers with their role expanding to include commissioning of Primary Care. NHS England admits this will ‘increase the range and frequency of real and perceived conflicts of interest’. [9]

A GP survey carried out by GP magazine found 73% of GPs surveyed said co-commissioning would make avoiding conflicts harder and 63% said lay-led committees would undermine clinical leadership of CCGs. [10]

A King’s Fund report published in January 2015, titled ‘Risk or Reward? The changing role of CCGs in general practice’, it said, Our research suggests that ‘the benefits provided by the shift towards CCGs co-commissioning primary care could be compromised by potential conflicts of interest.’ [11]

‘The forthcoming introduction of co-commissioning combined with the ongoing ambition to increase the amount of community-based care (as reiterated in the Five Year Forward View: NHS England and others, 2014), means that CCGs will face an increasing number of decisions that may raise conflicts of interest.’ [12]

Key Findings and Case Studies

Owners

·  There are 140 Governing Board Members who own or co-own a business involved in healthcare.

Directors

·  There are 513 directors of companies, including managing director positions and non-executive positions. This amounts to 15% of all CCG Board members. In addition, there are 5 CEOs, 1 Trustee, 17 partnerships, 10 Company Secretaries, 15 Chairs, 1 financial officer.

Shares

·  409 board members have shares, which are a combination of businesses they own, and external private companies involved in healthcare including Out of Hours Services. (12%)

External work

·  105 board members declared external work with private health companies including companies such as Circle, Spire, BMI and pharmaceutical companies that include Lily pharmaceuticals and Astrazeneca. The roles include consultancy, advisory and private practice.

Lay members

·  110 lay members have financial interests in companies, many of which are involved in healthcare.

Clean CCGs

·  A mere 11 CCGs have managed to avoid recruiting board members without outside interests in private companies involved in health. Brighton, Cumbria, Guildford and Waverley, Rotherham, Salford, Slough, Solihull, South East Staffs and Seisden peninsula, Trafford, Vale Royal and Warwickshire North.

·  In the worst cases, we found over 70% of Board Members at North Norfolk and South Norfolk CCGs have financial interests in private companies involved in health.

·  We did not look at or include the family interests of CCG board members in this research. However, a previous study by the British Medical Journal showed that 9% of Board Members had such interests. [13]

Case Studies of GP conflicts of interest

·  A CCG awarded all its existing enhanced services, worth £2.3 million, to a new single federation made up of all practices in the region. [14]

·  A GP group in Croydon paid more than half a million pounds to a healthcare company of which half a dozen of its board members and senior clinicians are shareholders. [15]

·  A report on ‘Out of Hours’ services by the Health Select Committee, highlighted that in Barnet, Enfield and Haringey, a ‘number of GPs who work for the CCGs also have shareholdings in the organisation that provides out-of-hours care. They also noted that some clinical commissioning groups have awarded out-of-hours contracts without a competitive procurement process. [16]

·  In November this year, the Lancashire Telegraph revealed that 30 doctors' surgeries bought shares in a company called Lancashire EU of GPs Ltd, which can bid for services. The GP practices are also members of the East Lancashire Clinical Commissioning Group (CCG), who are responsible for how NHS money is spent. [17]

·  Concerns were raised about the support being offered to the GP Company by the CCG, which held a meeting of invited doctors to 'finalise arrangements for setting up the Lancashire EU of GPs'. [18] Labour MP Mr Jones said: “These GPs have now set themselves up as a business and they will effectively be bidding for contracts and also determining who will receive them. This demonstrates how the legislation is a disaster and is unravelling by the day."

·  A GP practice wrote to patients to advertise private cardiovascular screening tests available on the NHS. The company had paid them a nominal fee for hosting the service. [19]

Individual CCGS

The list below contains the basic information of the research findings for each individual CCG. Some Members have more than one interest.
A-E
NHS Airedale, Wharfedale and Craven CCG

-  Six members have interests (33%)

-  One owner, five directors

NHS Ashford CCG

-  Three members have interests (21%)

-  One Member, director, independent sessions

NHS Aylesbury Vale CCG

-  Ten members have interests (52%)

-  Nine have shares, self-employed, mentor

NHS Barking & Dagenham CCG

-  Ten members have interests (66%)

-  Seven directors, two have shares, three outside work (consultant, speakers)

NHS Barnet CCG

-  Five have interests (38%)

-  One owner, one Chair, three have shares

NHS Barnsley CCG

-  Four members have interests (30%)

-  Two owners, three directors (one both)

NHS Basildon and Brentwood CCG

-  Eight have interests (34%)

-  Four directors, two have shares, one business interests, consultant

NHS Bassetlaw CCG

-  One member has interests (7%)

-  One has shares

NHS Bath and North East Somerset CCG

-  Three have interests (21%)

-  Two have shares, one director

NHS Bedfordshire CCG

-  Five have interests (27%)

-  Four directors, one Chairman, two shares

NHS Bexley CCG

-  Seven members have interests (50%)

-  Four directors, four have shares, one locum

NHS Birmingham CrossCity CCG

-  Ten members have interests (55%)

-  One part-owner, four have shares, OOH, five directors

NHS Blackburn with Darwen CCG

-  Four members have interests (26%)

-  Four directors

NHS Blackpool CCG

-  Eight have interests (47%)

-  Four have shares, outside NHS work, One owner, two directors

NHS Bolton CCG

-  Three have interests (18%)

-  Two have shares, two directors

NHS Bracknell and Ascot CCG

-  Two have interests (15%)

-  Two directors, one has shares

NHS Bradford City CCG

-  Five members have interests (33%)

-  Five directors

NHS Bradford Districts CCG

-  Three Members have interests (25%)

-  Two directors and one external private work

NHS Brent CCG

-  Seven have interests (30%

-  Two have shares, five directors

NHS Brighton & Hove CCG

-  No members have interests

NHS Bristol CCG

-  Four members have interests (25%)

-  Three have shares, one owner, two directors

NHS Bromley CCG

-  Two members have interests (13%)

-  Two work with private companies

NHS Bury CCG

-  Six members have interests (42%)

-  Four directors, one senior partner, one outside company

NHS Calderdale CCG

-  Five Members have interests (29%)

-  One owner, part-owner, four directors

NHS Cambridgeshire and Peterborough CCG

-  Twelve members have interests

-  One secretary, six directors, one senior partner, four have shares

NHS Camden CCG

-  Five members have interests (31%)

-  Four have shares, one Chair

NHS Cannock Chase CCG

-  Five members have interests (29%)

-  Five members are directors, two have shares, four owners

NHS Canterbury and Coastal CCG

-  Eight members have interests (44%)

-  Seven have shares, three directors, one company secretary

NHS Castle Point and Rochford CCG

-  Five members have interests (26%)

-  Three directors, one has shares, one outside private work

NHS Central London (Westminster) CCG

-  Six members have interests (27%)

-  Six directors, one has shares

NHS Central Manchester CCG

-  Nine members have interests (52%)

-  Three directors, five have shares

NHS Chiltern CCG

-  Six members have interests (42%)

-  Four has shares, one private work

NHS Chorley and South Ribble CCG

-  Six members have interests (46%)

-  Five have shares, one private work

NHS City and Hackney CCG

-  Two members have interests (8%)

-  One director, one private work

NHS Coastal West Sussex CCG

-  Seven members have interests (31%)

-  One adviser, six shares, one director, one part-owner

NHS Corby CCG

-  Six members have interests (50%)

-  Four have shares, two directors, one owner

NHS Coventry and Rugby CCG

-  Three members have interests

-  One part-owner, two directors

NHS Crawley CCG

-  Seven members have interests (63%)

-  Two have shares, two private work, three directors

NHS Croydon CCG

-  Twelve members have interests (52%)

-  Seven are directors, three private work, six have shares

NHS Cumbria CCG

-  No members have interests

NHS Darlington CCG

-  One member has an interest (5%)

-  One director

NHS Dartford, Gravesham and Swanley CCG

-  Four members have interests (25%)

-  Four directors, one owner, one Chairman, external OOH

NHS Doncaster CCG

-  Seven members have interests (33%)

-  Six have shares, one part-owner and two directors

NHS Dorset CCG

-  Five members have interest (18%)

-  One has shares, one owner, three directors

NHS Dudley CCG

-  Nine members have interests (40%)

-  Nine directors, two owners, three have shares

NHS Durham Dales, Easington and Sedgefield CCG

-  Three members have interests (15%)

-  One company secretary, two private company work

NHS Ealing CCG

-  Ten members have interests (45%)

-  Eight directors, Two owners, three part-owners, two have shares

NHS East and North Hertfordshire CCG

-  Five members have interests (22%)

-  One owner, three directors, one has shares, one outside private work

NHS East Lancashire CCG

-  Three members have interests (21%)

-  Three directors

NHS East Leicestershire and Rutland CCG