Influencing health and
wellbeing boards...
Conflict of Interest
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About this briefing:
In late 2013, Regional Voices conducted a survey of voluntary and community sector (VCS)
health and wellbeing board representatives, Healthwatch organisations and the wider VCS about
their experiences of engaging with health and wellbeing boards. In response to the comments,
we are developing resources to help the VCS to influence their local health and wellbeing
boards, sharing learning from around the country.
One of the issues which was brought up by the survey was that the voluntary sector is
sometimes excluded from involvement with health and wellbeing boards because of conflict of
interest. This briefing looks at some mechanisms the VCS can use to reduce perception of and
actual conflict of interests.
Jo Whaley, Regional Voices and David Simmons, FaithAction, February 2014
"Conflict of interest", real or perceived, may lead to the VCS being excluded from membership of
health and wellbeing boards, not being allowed voting rights or distanced more broadly from the
board and its sub-groups. In some locations, the VCS merely has an advisory or observation role
at their health and wellbeing board because of a perceived conflict of interest. One respondent to
our survey on health and wellbeing board engagement stated that a challenge for them had
been "perceived potential conflict of interest in terms of informing commissioning priorities". This
is backed up in other recent research:
"procurement decisions are sometimes challenged by unsuccessful bidders and the involvement
of a service provider in the commissioning process could be deemed to have influenced the final
decision. Another example is where an audit of local service need and provision debates the
decommissioning of a service. If that service is run by a VCS organisation, their involvement
could again be seen as a conflict of interest."
(From The Role of the Voluntary Sector in Providing Commissioning Support, The Nuffield Trust,
2013)
Provider organisations may have a conflict of interest in certain discussions; however, VCS
organisations are not the only providers in health and wellbeing boards. GPs and foundation
trusts (where included) also may have a conflict of interest around commissioning. Health and
wellbeing boards, like clinical commissioning groups (CCGs), should have procedures in place
for dealing with conflicts of interest. All involvement in health and well being boards (and their
sub-groups) should be open, transparent, and easily audited – (see Operating Principles for
health and wellbeing boards: NHS Confederation, 2011):
“Transparency, earned trust and co-production will be the essential underpinning for a locally
organised and delivered public health service in England” (CEO of Public Health England, 22
March, 2013).
Potential safeguards against possible conflicts of interest for the VCS maybe similar to those
suggested by NHS England for CCGs (which could have conflicted interest if its component GP
practices benefit from the commissioning themselves):
Safeguards that CCGs should have in place to manage conflicts of interest include:
 arrangements for declaring interests;
 maintaining a register of interests;
 excluding individuals from decision-making where a conflict arises; and
 engagement with a range of potential providers on service design.
From The NHS Commissioning Board Document on Managing CCG Conflicts of Interest,
NHS England
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It is however, important for health and wellbeing boards to work with provider organisationsbecause of the insight their experience brings. As one VCS representative on a health and
wellbeing board told us in the health and wellbeing board engagement survey:
“You need them [providers] in the room to develop strategic direction because often they have an
understanding of a lot of the level of detail commissioners may not have.” i
A local infrastructure organisation (such as a council for voluntary services – CVS) are often
selected to be representatives as they are not health and social care providers per se and thus
able to advocate for wider VCS interests.
e.g. CVS representing the sector(Oldham)
In Oldham, the health and wellbeing strategy has been produced in collaboration with the VCS
and Voluntary Action Oldham (VAO: which is a council for voluntary services), which is involved
in representing its members in particular sub-groups. The Director of VAO represents the
voluntary sector at the health and wellbeing board, and holds quarterly meetings together with
the Healthwatch representative to disseminate information to the wider VCS in Oldham. The use
of a non-provider organisation has facilitated the process and helped them to avoid conflicts of
interest.
However, a CVS can't have the expertise in all areas of health and wellbeing and it should be
noted that occasionally a CVS can be thought to have a conflict of interest, if perceived to be
more concerned about their own funding than the interests of the sector.
A VCS representative (on either the health and wellbeing board or its sub-groups) can reduce
any perception of a conflict of interest by working transparently with the wider VCS. Suggestions
to VCS reps from the wider VCS, in the first health and wellbeing board survey, that could help
transparency and perceived conflict of interest include:
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Create a transparent route for feeding back to the wider VCS sector about activity on the
board;
Think about how to engage with the wider VCS (those not already in your networks);
Regular briefings/update/feedback on board activity;
Be clear about what voices you represent and the networks you have access to, and
when you need to access other expertise and networks.
Where VCS reps are able to work transparently with a wider VCS network, be it a consortium or
forum, then views presented can be more representative, reducing the likelihood of being
perceived to have a conflict of interest. Individual organisations are not seen to be benefiting
directly and it also means the rep is better supported in their role. It can however, be resource
intensive to set up a wider network, if not already funded by local authority or CCG (see
examples below), but may be worth exploring options with your local CVS or Healthwatch to
develop a wider network.
Involvement in an expert sub-group (Hackney)
In Hackney and City there is a voluntary sector health and social care forum, a network of 230
VCS organisations, which underpins VCS engagement on the health and wellbeing board. It
enables the VCS voice to be heard, and encourages the public to be present at “open meetings”
where local health issues are discussed openly and transparently. A forum representative (from
St. Joseph’s Hospice) attends the health and wellbeing board and reports decisions back to the
forum. The VCS accountability is therefore a joint one: to the board on the one hand, and the
forum on the other.
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Independent Forum (Norfolk)
Norfolk Health and Wellbeing board has three VCS representatives (in addition to the
Healthwatch seat), nominated from Voluntary Norfolk: the Joint Health and Social Care Voluntary
Sector Forum (which is a forum made up of leaders from a range of voluntary sector networks). A
‘role description’ (which includes a section on conflict of interest) sets out that representatives
attend on behalf of, and are accountable to, this Forum. Their voice at the board is one of the
VCS as a whole and of service area specialisms (not one from their particular organisation) and
as such minimises any possible conflict of interest. The representatives are supported by the
Manager of the Voluntary Sector Engagement Project which is funded through Norfolk County
Council.
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Regional Voices and FaithAction are Strategic Partners to the Department of Health, NHS
England and Public Health England.
Regional Voices connects voluntary and community organisations with
government, through nine regional networks, to inform and influence
policy at local, regional and national levels. To find out more about
Regional Voices' work in health, wellbeing and care go to
http://www.regionalvoices.org/developments
FaithAction is a national network of faith-based and community organisations. FaithAction works
to provide support, advice and training for organisations as well as working with local and central
governments to highlight the work of organisations in their communities. To find out more about
FaithAction's work in wellbeing and pubic health go to http://www.faithaction.net
Follow us on twitter @regionalvoice
@FaithActionnet
If you require this information in an alternative format or further information email or
call: contact@regionalvoices.org 0113 394 2300
See also, NHS Confederation, Stronger Together- http://www.nhsconfed.org/Publications/reports/Pages/Strongertogether.aspx
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