DECLARATIONS OF INTEREST AND HOSPITALITY POLICY

Transcription

1 DECLARATIONS OF INTEREST AND HOSPITALITY POLICY 1. INTRODUCTION This policy applies to all staff within the Doncaster and South Humber Healthcare NHS Trust (hereto referred to as the Trust) and brings together the existing guidance from: The Standards of Business Conduct for NHS Staff (HSG (93/5) (Appendix 1) The NHS Executive guidance issued in November 2000 on Commercial Sponsorship- Ethical Standards for the NHS (Appendix 2). To comply with the above guidance the Trust needs to be clear about how it deals with offers of gifts, hospitality, commercial sponsorship and declarations of interest. It is in the interest of each member of staff, as well as the Trust, that they ensure they are not open to undue influence as a result of offers, interests or commercial sponsorship. 2. PURPOSE OF THE POLICY The main focus of the policy is on the receipt or offers of gifts, hospitality and commercial sponsorship by members of staff. Guidance is given on the parameters to apply when considering offering hospitality to others in section (4.4). This policy applies to all staff, and each individual is responsible for ensuring that they comply with the relevant legislation. The policy refers to: The broad principles of business conduct within the Trust. The Trust s policy with regard to the offer or receipt of gifts and hospitality, related party transactions, interests and commercial sponsorship. (Guidance on the definitions of related party transactions are included as appendix 3). The following extract from the Standards of Business Conduct for NHS Staff (HSG (93/5) highlights this responsibility: It is a long established principle that public sector bodies, which include the NHS, must be impartial and honest in the conduct of their business, and that their employees should remain beyond suspicion. It is also an offence under the Prevention of Corruption Acts 1906 and 1916 for an employee corruptly to accept any inducement or reward for doing, or refraining from doing anything, in his or her official capacity, or corruptly showing favour, or disfavour, in the handling of contracts.

2 2.1 Commercial Sponsorship Commercial Sponsorship is defined in the guidance as: Covering NHS funding from an external source, including funding of all or part of the costs of a member of staff, NHS research, staff, training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs (including trips abroad), provision of free services (including speakers) and buildings or premises. Where collaborative partnerships involve a pharmaceutical company, then the proposed arrangements must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 'Inducements and hospitality' attached at Annex B of Appendix 2), otherwise a criminal offence will have been committed. To meet these requirements the Trust must ensure that: Hospitality must only be at a reasonable level and be subordinate to the main purpose of the meeting or event. All offers of commercial sponsorship above 50 in value are accepted in line with the enclosed guidance, are declared, accurately recorded in a timely manner and are subject to approval by a Director of the Trust. 2.2 Gifts, Inducements and Hospitality Rules relating to offers of gifts and hospitality apply to all staff. With the exception of modest tokens of appreciation, all gifts, vouchers, fees, special discounts, rewards or preferential treatment must be refused. In situations where refusal is impossible or might offend, employees must only accept on behalf of the department or service which they represent and inform their manager or departmental head of the situation. Any monetary donation below the de-minimus limits referred to later, can only be accepted for inclusion in an established Trust fund and in all cases a receipt jointly signed by both parties must be issued. Offers of gifts and hospitality must be declared and accurately recorded in a timely manner before they are considered against the enclosed guidance. The guidance in relation to the acceptance of gifts and hospitality is contained in Commercial Sponsorship-Ethical Standards for the NHS, and the existing guidance on Standards of Business Conduct for NHS Staff (HSG (93/5). 2.3 Declaration of Interests and Related Party Transactions All NHS employees must declare to their manager all interests in organisations that could potentially result in personal gain for the member of staff, their family or friends, as a consequence of their position. Interests that appear to be in conflict should also be declared. Declarations of interests or related party transactions need to be made by all staff members on a timely basis so that they can be considered by senior management and accurately recorded in the appropriate Directorate Register. 2

3 Declare to your manager any relevant interests. If in doubt, ask yourself: Am I, or might I be in a position where I (or my family/friends) could gain from the connection between my/their private interests and my employment? Do I have access to information that could influence purchasing decisions? Could my outside interests be in any way detrimental to the NHS or to patients? Do I have any other reason to think I may be risking a conflict of interests? 3. ORGANISATIONAL PROCEDURES 3.1 Two separate registers should be maintained for each Directorate: For staff to declare any OFFERS of gifts, hospitality or commercial sponsorship. For staff to declare any INTEREST they (or their close family or friends) may have in organisations that interact with their employment. (See Section 4 for more information on operation of these registers). 3.2 A note with payslips will be sent out to all staff to remind them about the required disclosure twice a year. 3.3 In addition, the same statement will be included in the hospital Trust News Letter twice a year. 3.4 For new starters a reference to this policy will be included within all induction packs and included in the induction programme. 3.5 All staff will be expected to comply with the requirements of this guidance. For certain groups of staff it is essential that the requirements of this guidance be complied with because of their close involvement with critical purchasing decisions. a) Purchasing, Estates and Information Technology The professional codes in Purchasing and Estates and Information Technology demand the highest standard of conduct in the area of declaring interests and gifts and hospitality because of the closeness to key purchasing decisions of considerable magnitude. It is essential that staff in these areas make comprehensive declarations. b) Directors and Senior Managers Under the requirements of the Cadbury Report and the subsequent Greenbury Report, Directors and Senior Managers are expected to exercise the highest standards of probity and conduct in the areas of declaring interests. Because of their critical role in controlling and approving the procurement process it is essential that full and comprehensive declarations are made by staff in these areas. 3

4 4. OPERATION OF REGISTERS Registers are required to be maintained within each Directorate and for each Director of Care s geographical locality. The Director of Corporate Affairs will maintain similar registers for the Trust Board and other Directors of the Trust, and will monitor all other registers on a regular basis. All offers of hospitality and gifts or declaration of interests or commercial sponsorship must be declared by staff prior to acceptance, and within one week of the offer to the relevant Line Manager or Director. 4.1 Gifts and Hospitality All offers of gifts and hospitality should be reported to the relevant Line Manager and recorded in a Directorate register maintained by the Director s Personal Assistant. Only those offers above the de-minimus limits (which for gifts and hospitality are 50 or 100 in total from the same party within 12 months) need to be recorded in the Directorate Register. If there is any doubt as to the need to declare then a declaration should be made in the interest of guarding the individual s position. Each Director will maintain a register of all significant offers ( 50 or over) and detail the acceptance or rejection of such offers of gifts/hospitality within his/her directorate. The Personal Assistant to the Director of Corporate Affairs will maintain a register on behalf of the Chairman for Executive and Non-Executive Directors and other Directors of the Trust. Examples of acceptable offers (once approval is given by Line Manager) of gifts, hospitality are included within Appendix Declaration of Commercial Sponsorship Any forms of Commercial Sponsorship must be declared prior to acceptance to the relevant Line Manager who should inform the relevant Director. If the sponsorship offered involves the provision of supplies or services then details should be forwarded to the Supplies Department to ensure that they are aware of any issues. They may make recommendations to the relevant Director concerning the acceptance or otherwise of the offer. Each Director should always detail of all offers of commercial sponsorship in the appropriate register including all commercial sponsorship being undertaken by their staff. The Personal Assistant to the Director of Corporate Affairs shall maintain a register on behalf of the Chairman for Executive and Non-Executive Directors. 4

5 4.3 Declaration of Business or Commercial Interests Any Business or Commercial Interests or related party transactions must be declared. These should be reported to the relevant Line Manager who should pass them on to the relevant Director. Each Director shall therefore maintain a register that should always detail all such interests of their staff. The Director of Corporate Affairs will maintain a register on behalf of the Chief Executive for Executive and Non-Executive Directors and other Directors of the Trust. 4.4 Guidance covering The Provision of Hospitality The following guidance relates to all staff within the Trust: Hospitality provided by the Trust The Trust will provide hospitality for a number of reasons to its staff, working partners and others. Hospitality will be commensurate with the occasion in question. Hospitality is not the norm when conducting business, and should only be provided when it is necessary and fully justifiable in pursuing the work of the Trust. Hospitality should not be provided simply to reciprocate hospitality received on some previous occasion, nor should it be extended to spouses of staff or guests unless the circumstances justify this. Drinks may be provided, taking into account the likely length of the meeting, and the distance travelled by staff attending. Drinks provided should be non-alcoholic. Buffet style working lunches should normally be considered when lunchtime meetings include some attendances from off-site. In the provision of hospitality, the attention of staff is drawn to HGS (96) 10 on expenditure on staff benefits, and in particular to the importance of ensuring that those responsible for public money do not derive private benefit from it. In the majority of cases the catering department will provide hospitality internally. However it may be appropriate for the Trust to provide hospitality at an external venue. In all cases the offer of hospitality will be subject to prior authorisation. 5

6 Official attendance at events held with working partners On occasion members of staff are required to attend events organised by its working partners. To claim expenses for such occasions members of staff must complete an expenses claim form in the normal way. Expenses must be commensurate with the occasion and must relate to expenses incurred by the individual members of staff only. 5. FAILURE TO RECORD OFFERS OF GIFTS AND HOSPITALITY, COMMERCIAL SPONSORSHIP OR DECLARE INTERESTS Should an offer of gifts or hospitality or details of commercial sponsorship or details of business interests not be recorded in the appropriate register, or declared to a Line Manager, within the time period required prior to acceptance, then the Trust s disciplinary procedures will apply. The Head of Department or Executive Director will normally take the decision as to whether an offer could or should be accepted. This decision should be based upon their review of the appropriate guidance, attached in the appendices. Further clarification can be sought from the Executive Director of Finance or the Director of Corporate Affairs. All offers should be either given line management approval or formally rejected. This should be indicated on the form with the reason for approval/rejection documented. They should then be forwarded to the appropriate Director with financial responsibility for that area and placed in the register they maintain. 6. REVIEW OF REGISTER The Director of Corporate Affairs and the Chairman of Audit Committee will review the register of Offers of Gifts and Hospitality, Commercial Sponsorship and Interests held by each Director on an annual basis and report to the Audit Committee meeting the number and value of offers received. Full details of the registers should be available on request in each area to support this process. The Director of Corporate Affairs analysis should include a review by Finance staff in conjunction with the Supplies Department of any significant changes to contracts or suppliers which may have resulted from a gift or hospitality. A report should be made by the Supplies Department and provided to the Director of Finance on an annual basis. The Chief Executive will be responsible for monitoring the conduct of the Director of Corporate Affairs in terms of their management of this process. 7. PERSONAL INTERESTS AND RECHARGES TO THE TRUST As a general rule there should be no transactions or recharges for personal matters made through the Trust (except in specified cases such as the use of Crown cars and the personal use of Trust owned mobile telephones). If in any exceptional circumstances where such an arrangement has to be made this should be done with the agreement and approval of the line manager who will notify the Director of Finance who will register any such transactions. BP/JDC - January

7 8. REGISTER FORM (FOR COMPLETION AS APPROPRIATE) This form is in two parts. The appropriate section should be completed and forwarded to your relevant Line Manager within one week of the offer of gift/hospitality or commercial sponsorship or acquisition of business or commercial interest. Your Line Manager will approve the acceptance, not approve the acceptance or possibly discuss this further with their Line Manager prior to a decision being made 1.REGISTER OF OFFERS AND RECEIPTS OF GIFTS AND HOSPITALITY AND COMMERCIAL SPONSORSHIP Name: Position: Details of item offered including the offeree: Reason for accepting/declining: Value: Date of offer: Approved YES/ NO Date Reported to line manager: Authorised by: Date: Information should also be disclosed for a partner/relative of a Trust employee. For the purposes of the Register only offers of 50 or above need to be declared and the approval of the appropriate Line Manager/Director must be given before proceeding. For events organised by an individual or department on behalf of a wide range of attendees (such as an education or training event) the organiser may declare the whole event on one declaration. 7

8 2. DECLARATION OF BUSINESS OR COMMERCIAL INTERESTS AND RELATED PARTY TRANSACTIONS Name: Department: Contractor/Supplier: Financial interest declared: Declaration of interest: I have read the Trust s instruction note in respect of the Declaration of Financial Interest and certify to the best of my knowledge and belief that: 1. The above is a complete list of my interests, direct or indirect, in respect of organisations currently providing, or seeking to provide, goods or services to Doncaster and South Humber Healthcare NHS Trust. 2. I understand that I am required to inform the Director of Finance of any circumstance during the calendar year, which may change my declaration. SIGNED: DATED: Please return this form to your relevant Line Manager, who should then forward to the relevant Executive Director. 8

9 Extract from HSG (93) 5 Appendix 1 Standards of Business Conduct for NHS Staff (January 1993) HSG (93) 5 Part A: Prevention of Corruption Acts 1906 and summary of main provisions Acceptance of gifts by way of Inducements or Rewards 1. Under the Prevention of Corruption Acts, 1906 and 1916, it is an offence for employees corruptly to accept any gifts or consideration as an inducement or reward for: Doing, or refraining from doing, anything in their official capacity; or Showing favour or disfavour to any person in their official capacity. 2. Under the Prevention of Corruption Act 1916, any money, gift or consideration received by an employee in public service from a person or organisation holding or seeking to obtain a contract will be deemed by the courts to have been received corruptly unless the employee proves the contrary. Part B: NHS Management Executive (NHSME) - general guidelines Introduction 1. These guidelines, which are intended by the NHSME to be helpful to all NHS employers (I) and their employees, re-state and reinforce the guiding principles previously set out in Circular HM (62) 21 (now cancelled), relating to the conduct of business in the NHS. Responsibility of NHS employers 2. NHS employers are responsible for ensuring that these guidelines are brought to the attention of all employees; also that machinery is put in place for ensuring that they are effectively implemented. 9

10 Responsibility of NHS staff 3. It is the responsibility of staff to ensure that they are not placed in a position which risks, or appears to risk, conflict between their private interests and their NHS duties. This primary responsibility applies to all NHS Staff, i.e. those who commit NHS resources directly (e.g by the ordering of goods) or those who do so indirectly (e.g by the prescribing of medicines). A further example would be staff who may have an interest in a private nursing home and who are involved with the discharge of patients to residential facilities. Guiding principle in conduct of public business 4. It is a long established principle that public sector bodies, which include the NHS, must be impartial and honest in the conduct of their business, and that their employees should remain beyond suspicion. It is also an offence under the Prevention of Corruption Acts 1906 and 1916 for an employee corruptly to accept any inducement or reward for doing, or refraining from doing anything, in his or her official capacity, or corruptly showing favour, or disfavour, in the handling of contracts (see PART A). Staff will need to be aware that a breach of the provisions of these Acts renders them liable to prosecution and may also lead to loss of their employment and superannuation rights in the NHS Principles of conduct in the NHS 5. NHS staff are expected to: Ensure that the interest of patients remains paramount at all times; Be impartial and honest in the conduct of their official business; Use the public funds entrusted to them to the best advantage of the service, always ensuring value for money. (i) In these guidelines "NHS employer" means all "for action' addressees listed on the Title page of HSG(93)5. 6. It is also the responsibility of staff to ensure that they do not: abuse their official position for personal gain or to benefit their family or friends; seek to advantage or further private business or other interests, in the course of their official duties. Implementing the guiding principles Casual gifts 7. Casual gifts offered by contractors or others, e.g. at Christmas time, may not be in any way connected with the performance of duties so as to constitute an offence under the Prevention of Corruption Acts. Such gifts should nevertheless be politely but firmly declined. Articles of low intrinsic value such as diaries or calendars, or small tokens of gratitude from patients or their relatives, need not necessarily be refused. In cases of doubt staff should either consult their line manager or politely decline acceptance. 10

11 Hospitality 8. Modest hospitality provided it is normal and reasonable in the circumstances, e.g. lunches in the course of working visits, may be acceptable, though it should be similar to the scale of hospitality which the NHS as an employer would be likely to offer. 9. Staff should decline all other offers of gifts, hospitality or entertainment. If in doubt they should seek advice from their line manager. Declaration of interests 10. NHS employers need to be aware of all cases where an employee, or his or her close relative or associate, has a controlling and/or significant financial interest in a business (including a private company, public sector organisation, other NHS employer and/or voluntary organisation), or in any other activity or pursuit, which may compete for an NHS contract to supply either goods or services to the employing authority. 11. All NHS staff should therefore declare such interests to their employer, either on starting employment or on acquisition of the interest, in order that it may be known to and in no way promoted to the detriment of either the employing authority or the patients whom it serves. 12. One particular area of potential conflict of interest, which may directly affect patients, is when NHS staff holds a self-beneficial interest in private care homes or hostels. While it is for staff to declare such interests to their employing authority, the employing authority has a responsibility to introduce whatever measures it considers necessary to ensure that its interests and those of patients are adequately safeguarded. This may for example take the form of a contractual obligation on staff to declare any such interests. Advice on professional conduct issued by the General Medical Council recommends that when a doctor refers a patient to a private care home or hostel in which he or she has an interest, the patient must be informed of that interest before referral is made. 13. In determining what needs to be declared, employers and employees will wish to be guided by the principles set out in paragraph 5 above; also the more detailed guidance to staff contained in Part D. 14. NHS employers should: ensure that staff are aware of their responsibility to declare relevant interests (perhaps by including a clause to this effect in staff contracts) consider keeping registers of all such interests and making them available for inspection by the public. 11

12 develop a local policy, in consultation with staff and local staff interests, for implementing this guidance. This may include the disciplinary action to be taken if an employee fails to declare a relevant interest, or is found to have abused his or her official position, or knowledge, for the purpose of self-benefit, or that of family or friends. Preferential treatment in private transactions 15. Individual staff must not seek or accept preferential rates or benefits in kind for private transactions carried out with companies with which they have had, or may have, official dealings on behalf of their NHS employer. (This does not apply to concessionary agreements negotiated with companies by NHS management, or by recognised staff interests, on behalf of all staff - for example, NHS staff benefits schemes.) Contracts 16. All staff who are in contact with suppliers and contractors (including external consultants), and in particular those who are authorised to sign Purchase Orders, or place contracts for goods, materials or services, are expected to adhere to professional standards of the kind set out in the Ethical Code of the Institute of Purchasing and Supply (IPS), reproduced at PART E. Favouritism in awarding contracts 17. Fair and open competition between prospective contractors or suppliers for NHS contracts is a requirement of NHS Standing Orders and of EC Directives on Public Purchasing for Works and Supplies. This means that: no private, public or voluntary organisation or company which may bid for NHS business should be given any advantage over its competitors, such as advance notice of NHS requirements. This applies to all potential contractors, whether or not there is a relationship between them and the NHS employer, such as a longrunning series of previous contracts. each new contract should be awarded solely on merit, taking into account the requirements of the NHS and the ability of the contractors to fulfil them. 18. NHS employers should ensure that no special favour is shown to current or former employees or their close relatives or associates in awarding contracts to private or other businesses run by them or employing them in a senior or relevant managerial capacity. Contracts may be awarded to such businesses where they are won in fair competition against other tenders, but scrupulous care must be taken to ensure that the selection process is conducted impartially, and that staff that are known to have a relevant interest play no part in the selection. 12

13 Warnings to potential contractors 19. NHS employers will wish to ensure that all invitations to potential contractors to tender for NHS business include a notice warning tenderers of the consequences of engaging in any corrupt practices involving employees of public bodies. Outside employment 20. NHS employees are advised not to engage in outside employment, which may conflict with their NHS work, or be detrimental to it. They are advised to tell their NHS employing authority if they think they may be risking a conflict of interest in this area: the NHS employer will be responsible for judging whether the interests of patients could be harmed, in line with the principles in paragraph 5 above. NHS employers may wish to consider the preparation of local guidelines on this subject. Private practice 21. Consultants (and associate specialists) employed under the Terms and Conditions of Service of Hospital Medical and Dental Staff are permitted to carry out private practice in NHS hospitals subject to the conditions outlined in the handbook "A Guide to the Management of Private Practice in the NHS". (See also PM(79)11). Consultants who have signed new contracts with Trusts will be subject to the terms applying to private practice in those contracts. 22. Other grades may undertake private practice or work for outside agencies, providing they do not do so within the time they are contracted to the NHS, and they observe the conditions in paragraph 20 above. All hospital doctors are entitled to fees for other work outside their NHS contractual duties under "Category 2" (paragraph 37 of the TCS of Hospital Medical and Dental staff), e.g. examinations and reports for life insurance purposes. Hospital doctors and dentists in training should not undertake locum work outside their contracts where such work would be in breach of their contracted hours. Career grade medical and dental staff employed by NHS Trusts may agree terms and conditions different from the National Terms and Conditions of Service. Rewards for Initiative 23. NHS employers should ensure that they are in a position to identify potential intellectual property rights (IPR), as and when they arise, so that they can protect and exploit them properly, and thereby ensure that they receive any rewards or benefits (such as royalties) in respect of work commissioned from third parties, or work carried out by their employees in the course of their NHS duties. Most IPR are protected by statute; e.g. patents are protected under the Patents Act 1977 and copyright (which includes software programmes) under the Copyright Designs and Patents Act To achieve this NHS employers should build appropriate specifications and provisions into the contractual arrangements, which they enter into before the work is commissioned, or begins. They should always seek legal advice if in any doubt in specific cases. 13

14 24. With regard to patents and inventions, in certain defined circumstances the Patents Act gives employees a right to obtain some reward for their efforts, and employers should see that this is effected. Other rewards may be given voluntarily to employees who within the course of their employment have produced innovative work of outstanding benefit to the NHS. Similar rewards should be voluntarily applied to other activities such as giving lectures and publishing books and articles. 25. In the case of collaborative research and evaluative exercises with manufacturers, NHS employers should see that they obtain a fair reward for the input they provide. If such an exercise involves additional work for an NHS employee outside that paid for by the NHS employer under his or her contract of employment, arrangements should be made for some share of any rewards or benefits to be passed on to the employee(s) concerned from the collaborating parties. Care should however be taken that involvement in this type of arrangement with a manufacturer does not influence the purchase of other supplies from that manufacturer. Part E: Institute of Purchasing and Supply - Ethical Code (Reproduced by kind permission of IPS) Introduction 1. The code set out below was approved by the Institute's Council on 26 February 1977 and is binding on IPS members. Precepts 2. Members shall never use their authority or office for personal gain and shall seek to uphold and enhance the standing of the Purchasing and Supply profession and the Institute by: a. maintaining an unimpeachable standard of integrity in all their business relationships both inside and outside the organisations in which they are employed; b. fostering (the highest possible standards of professional competence amongst those for whom they are responsible; c. optimising the use of resources [or which they are responsible to provide the maximum benefit to their employing organisation; d. complying both with the letter and the spirit of; i. the law of the country in which they practice; ii. such guidance on professional practice as may be issued by the Institute from time to time; iii. contractual obligations; e. rejecting any business practice, which might reasonably be deemed improper. 14

15 Guidance 3. In applying these precepts, members should follow the guidance set out below: a. Declaration of interest. Any personal interest, which may impinge or might reasonably be deemed by others to impinge on a member's impartiality in any matter relevant to his or her duties, should be declared. b. Confidentiality and accuracy of information. The confidentiality of information received in the course of duty should be respected and should never be used for personal gain; information given in the course of duty should be true and fair and never designed to mislead. c. Competition. While bearing in mind the advantages to the member's employing organisation of maintaining a continuing relationship with a supplier, any relationship which might, in the long term, prevent the effective operation of fair competition, should be avoided. d. Business Gifts. Business gifts other than items of very small intrinsic value such as business diaries or calendars should not be accepted. e. Hospitality. Modest hospitality is an accepted courtesy of a business relationship. However, the recipient should not allow him or herself to reach a position whereby he or she might be deemed by others to have been influenced in making a business decision as a consequence of accepting such hospitality; the frequency and scale of hospitality accepted should not be significantly greater than the recipient's employer would be likely to provide in return. f. When it is not easy to decide between what is and is not acceptable in terms of gifts or hospitality, the offer should be declined or advice sought from the member's superior. BP/JDC 3 October

16 Appendix 2 COMMERCIAL SPONSORSHIP - ETHICAL STANDARDS FOR THE NHS 16

17 COMMERCIAL SPONSORSHIP: ETHICAL STANDARDS FOR THE NHS 1. The New NHS: Modern and Dependable places an obligation on Primary Care Groups, Health Authorities, NHS Trusts and Primary Care Trusts to work together and in collaboration with other agencies to improve the health of the population they serve and the health services provided for that population. 2. All health professionals including independent contractors, locum practitioners, working under NHS terms and conditions are intended to be covered by the document. The guidance contained in this document should apply equally to charitable sources of funding as well as GP Co-operatives and initiatives such as PMS, NHS Direct, Walk In Centres, Health Action Zones etc. 3. Collaborative partnerships with industry can have a number of benefits in the context of this obligation. An important part of that joint working will be a transparent approach to any sponsorship proposed to a Primary Care Trust, HA, NHS Trust or Primary Care Trust, or to independent contractors and their staff. If any such partnership is to work, there must be trust and reasonable contact between the sponsoring company and the NHS. Such relationships, if properly managed, are of mutual benefit to the organisations concerned. 4. A previous circular on Standards of Business Conduct for NHS Staff was issued in 1993 (HSG(93)5) regarding the general standards that should be maintained by staff working in the NHS. This guidance is still extant. The purpose of the current document is to emphasise that NHS bodies and primary care contractors and their staff are accountable for achieving the best possible health care within the resources available. It advises them to consider fully the implications of a proposed sponsorship deal before entering into any arrangement. In particular it is important to seek advice when necessary from the Health Authority on the effect on other aspects of healthcare. 5. For the purposes of this guidance commercial sponsorship is defined as including- NHS funding from an external source, including funding of all or part of the costs of a member of staff, NHS research, staff, training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs (including trips abroad), provision of free services (speakers), buildings or premises. In all these cases NHS bodies, members of NHS staff and independent contractors should use local arrangements to publicly declare sponsorship or any commercial relationship linked to the supply of goods or services and be prepared to be held to account for it. A simple ledger may suffice - to avoid any unnecessary paperwork. 6. Where such collaborative partnerships involve a pharmaceutical company then the proposed arrangements must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 'Inducements and hospitality' attached at annex B). Any person who contravenes regulation 21(1) is guilty of an offence, and liable, on summary conviction to a fine not exceeding 5000, and on conviction on indictment to a fine, or to imprisonment for a term not exceeding two years, or both. Anyone contravening regulation 21(5) is also guilty of an offence and liable, on summary conviction to a fine not exceeding 5000.' The MCA Guidelines on Promotion and Advertising set out the standards to be followed. 7. Whatever type of agreement is entered into, clinicians' judgement should always be based upon clinical evidence that the product is the best for their patients. 17

18 8. The arrangements in paragraph 5 do not apply to- personal gifts of less than 25 per gift e.g. gifts of post-it pads, pens etc. However gifts should be declared if several small gifts worth a total of over 100 are received from the same or closely related source in a 12 month period gifts from patients to GPs which are being addressed by changes to the terms of service of GPs income generation schemes which will be logged separately at local level discounts on particular pharmaceuticals. 9. A model code is attached at Annex A, for use by those who do not have an existing professional code of conduct. Where an Employer's code is used, this should be in addition to professional codes, or be for the benefit of those staff who are not regulated. Considerations 10. PCTs Health Authorities and primary care contractors will need to consider issues such as: industry often wishes to have close involvement with the NHS. Quite often this may be to mutual advantage, but both partners should assess and understand the costs and benefits of any such agreement; purchasing decisions, including those concerning pharmaceuticals and appliances, should always be taken on the basis of best clinical practice and value for money. Such decisions should take into account their impact on other parts of the health care system, for example, products dispensed in hospital which are likely to be required by patients regularly at home; Hospital trusts that are offered significant discounts on drugs may wish to consult the relevant PCGs/PCTs about possible implications for subsequent prescribing in primary care. when making purchasing decisions on products which originate from NHS intellectual property, ethical standards must ensure that the standard is based on best clinical practice and not on whether royalties will accrue to an NHS body; deals whereby sponsorship is linked to the purchase of particular products, or to supply from particular sources, are not allowed, unless as a result of a transparent tender for a defined package of goods and services, (see Annex C on research and development); patient information attracts a legal duty of confidence and is treated as particularly sensitive under Data Protection legislation. Professional codes of conduct also include clear confidentiality requirements. It is extremely important therefore that NHS bodies assure themselves, taking advice when necessary, that sponsorship arrangements are both lawful and meet appropriate ethical standards; 18

19 where a sponsorship arrangement permitting access to patient information appears to be legally and ethically sound (eg. where the sponsor is to carry out or support NHS functions, where patients have explicitly consented), a contract should be drawn up which draws attention to obligations of confidentiality, specifies security standards that should be applied, limits use of the information to purposes specified in the contract and makes it clear that the contract will be terminated if the conditions are not met; where the major incentive to entering into a sponsorship arrangement is the generation of income rather than other benefits, then the scheme should be properly governed by income generation principles rather than sponsorship arrangements. Such schemes should be managed in accordance with income generation requirements, i.e. they must not interfere with the duties or obligations of the trust. A memorandum trading account should be kept for all income generation schemes; as a general rule, sponsorship arrangements involving NHS Trusts, Primary Care Trusts, Health Authorities and Primary Care Trusts should be at a corporate, rather than individual level. Hospitality and meetings 11. Industry representatives organising meetings are permitted to provide appropriate hospitality and/or meet any reasonable, actual costs, which may have been incurred. If none is required, there is no obligation, or right, to provide any such hospitality, or indeed any benefit of equivalent value. 12. Hospitality must be secondary to the purpose of the meeting. The level of hospitality offered must be appropriate and not out of proportion to the occasion; and the costs involved must not exceed that level which the recipients would normally adopt when paying for themselves, or that which could be reciprocated by the NHS. It should not extend beyond those whose role makes it appropriate for them to attend the meeting. 13. Where meetings are sponsored by external sources, that fact must be disclosed in the papers relating to the meeting and in any published proceedings. Research and development 14. Guidance on research and development is contained in Annex C. Charitable funding 15. Trustees should take steps to remove any non-charitable items within charitable trust fund accounts. Examples include drug trials undertaken directly by a consultant and supported by funding from non-official sources (ie not part of the R&D programme managed by the provider). Not all consultant drug trials are non charitable (see "NHS Charitable Funds: A Guide", published by the Charity Commission), but, where they do not have charitable status, they should be removed from the charitable trust fund accounts. If the drug trial contract is made between industry and the NHS Trust or Primary Care Trust, then the transaction should be recorded as a normal income generation scheme. In other cases, the NHS Trust or Primary Care Trust should consider other options including the transfer of responsibility back to the consultant concerned. 19

20 Examples of Potential Conflict 16. Some examples of potential conflict are set out at Annex D. Monitoring Arrangements 17. Employers should ensure that monitoring arrangements are established to ensure that staff register any sponsorship and are held accountable for it. This may be through scrutiny by an appropriate committee, eg. local audit or ethics committees, as part of their normal activity, as well as through publication in the Annual Report, where this is practicable. An official register of interests should be established as part of the monitoring arrangements. At corporate level, employers should ensure that contract negotiations are conducted according to high ethical standards. 18. Employers finding evidence of unapproved sponsorship should act swiftly to deal with the situation and bring it within their local arrangements. Action 19. Employers (eg NHS Trust, Primary Care Trust, HA, Primary Care Group) and independent contractors should: make all staff aware of NHS guidance, the legal position and appropriate professional codes of conduct, eg GDC, GMC, RCN, RPSGB, UKCC, and Prescription Medicines Code of Practice Authority (PMCPA) codes; take responsibility for ensuring that they and their staff adhere to their professional code, or for unregulated staff a code devised by the organisation. The code should contain clear guidance around offers of sponsorship; ensure all sponsorship deals are documented through use of a register or simple ledger, held by the employer e.g. the Health Authority, NHS Trust or Primary Care Trust, which can be audited as appropriate. In order to demonstrate openness, it is essential that the Register should be available on request to the public and be made available at all HA board meetings; make it a matter of policy that offers that could possibly breach the code must be reported to the relevant Board (NHS Trusts/Primary Care Trusts/HAs/Primary Care Groups) or Health Authority (independent contractors). Minimum standards for the reporting system should be determined locally, but ideally should include some time limit (eg. two weeks) for the reporting of any such offers; ensure that all staff record with their HA, in the interests of transparency, any financial interest in organisations (eg. company shares or research grant) which impact upon funding, whether through contracts, sales or other arrangements that they may make with non NHS organisations. 20. Before entering into any sponsorship agreement, HAs, NHS Trusts, Primary Care Trusts, PCT staff and independent contractors should: satisfy themselves, with reference to information available, that there are no potential irregularities that may affect a company's ability to meet the conditions of the agreement or impact on it in any way eg. checking financial standing by referring to company accounts; 20

21 assess the costs and benefits in relation to alternative options where applicable, and to ensure that the decision-making process is transparent and defensible; ensure that legal and ethical restrictions on the disclosure of confidential patient information, or data derived from such information, are complied with. Additionally, disclosure for research purposes should not take place without the approval of the appropriate research ethics committee; determine how clinical and financial outcomes will be monitored ensure that the sponsorship agreement has break clauses built in to enable the NHS Trust, Primary Care Trust, PCG, independent contractor to terminate the agreement if it becomes clear that it is not providing expected VFM/clinical outcomes. 21. Existing contracts, which include any element of sponsorship agreement, should be reviewed and any clauses that do not follow the recommendations set out above should, where possible, be renegotiated to ensure that real patient need is being met. 22. Existing corporate governance policies and disciplinary procedures should be reviewed to ensure that they cover the need for open declaration and to enable sanctions against those failing to comply. In the event that they do not do so, the policies should be strengthened or amended. Corporate and or clinical governance policies should address the ethical implications of commercial sponsorship. Summary 23. Employers should take action as set out in paragraphs having taken account of considerations in paragraph 10. Department of Health November