Audit Wales finds specialist services conflicts of interest
CONFLICTS of interest exist within the branch of NHS Wales that co-ordinates specialist services for patients across the country, according to a new report from Audit Wales.
The Welsh Health Specialised Services Committee (WHSSC) has an overall annual budget of £680m, and commissions services in the specialisms of cancer, cardiac, neurosciences, major trauma, and renal dysfunction.
The report says conflicts of interest arise out of the fact that officials who sit on the committee find themselves in a position to commission services from the health boards they work for.
It states: “While membership of the joint committee is drawn from existing health boards, the members are supposed to be independent.
“However, decision making for some members poses a potential conflict of interest.
“This is because the larger Welsh health boards are substantial providers of specialised services, especially in south Wales.
“Those we spoke to reported that there can be some tensions around negotiations, citing the major trauma centre and thoracic surgery, and potential to draw attention on these specific issues at committee meetings at the expense of wider aspects of the agenda.”
The report says that because of previous challenges in decisionmaking, voting arrangements had been changed in the committee so that proposals could now be passed with a two-thirds majority rather than requiring 100% agreement.
However, it adds: “The governance arrangements mean that chief executives and independent members take part in votes on commissioning services from their own health board.
“As a result, the previous interim Chair of WHSSC reinforced the need to act on behalf of the all-Wales position when making decisions.
“Moving forward, the difficulties presented by the pandemic are likely to be challenging.
“When acting on behalf of ‘allWales’ and to minimise patient harm as a result of delays in receiving specialised care, shifts in investment may be necessary.
“This again may increase the risk of conflicts of interest if chief executive members are required to vote on diverting investments from their own health boards.”
The report says the overall costs of specialised services have increased above inflation since 2014.
It adds: “In the short to medium term, however, the impact of Covid-19 on finances presents a number of challenges, including the fact that payments to providers have continued in Wales and England although recent negotiations have resulted in rebates/ reductions where there is under-delivery by providers; a lack of service delivery during the pandemic has created a backlog of waits for some specialised services; and a lack of patients presenting to primary and secondary care with symptoms during the pandemic may mean that there is greater hidden demand, and that conditions may have exacerbated, requiring more costly intervention downstream.
“The WHSSC should seek to understand the short and medium term financial impacts of Covid-19 to determine what this means for service recovery plans.”
Auditor General Adrian Crompton said: “An immediate challenge for WHSSC is to develop a clear strategy to address the challenges associated with recovering specialised services following the Covid-19 pandemic.
“My report also shows that there is still a need to take a more fundamental look at the model for commissioning specialised services, in line with the commitment set out in the Welsh Government’s NHS Plan A Healthier Wales.
“It is important that this commitment is taken forward and I hope that the findings set out in this report can helpfully inform that debate.”