NHS Forth Valley – Register of Interests

NHS Forth Valley was the first of Scotland’s 22 NHS Boards that I approached about Register of Interests for all staff employed by NHS Forth Valley – as per HDL (2003) 62.

I first wrote to NHS Forth Valley on the 17th May 2011. This is now two-and-a-half years ago. There was no reply so I wrote again. But still no reply. I then contacted appropriate Line managers. I include the bulk of this communication below.

As of 10th November 2013, NHS Forth Valley do not have a register of interests for their employees. The Registers that exist are for Board members only. they can be accessed here: http://www.nhsforthvalley.com/about-us/board-matters/code-of-conduct

The 2013 NHS Forth Valley Board members Register (as of 10 Nov 2013):

CropperCapture[1]

You will see from the communication below that NHS Forth Valley are currently reviewing their policy in this area. I have asked to be kept updated but have had no further information supplied to me as yet.

Alex Neil, Cabinet Secretary for Health and Wellbeing on this matter:

Alex-Neil-on-Reg-of-Interes

————-
Sent: 17 May 2011 14:00 T
o: King Florence (NHS FORTH VALLEY – FK8 1DX)
Cc: O’Neill Kathy (NHS Forth Valley)
Subject: Hospitality et al Pharma Hospitality and funding of courses:

17th May 2011.

Dear Florence,
I take it all these declarations are published annually and open for all to see?

What about doctors who go out every week, or indeed twice-a-week, for lunch with drug-reps? Those £25 would add up, but not as much, dare I suggest, as the prescribing influence.

It is necessary for us all that continuing medical education is not driven by industry. Psychiatry here, as per the very latest article in the British Medical Journal, has been most vulnerable. Medicalisation: A new deal on disease definition by Ray Moynihan. BMJ 2011;342:doi:10.1136/bmj.d2548 (Published 3 May 2011)

I look forward to hearing your answer to my open question.

Kind wishes,
Peter Gordon

————-
From: Peter J Gordon
8 May 2013

Dear Forth Valley NHS Board,
Recently under FOI Request, you kindly provided  documents/spreadsheets regarding the FOI enquiry about: Register of payments from pharmaceutical companies to staff.

To seek absolute consistency of request – to all 13 Scottish NHS  Boards – I am using this online-process and so wanted to forward  the FOI request that I have sent to other 12 Scottish NHS Boards for you to review.

This is NOT a further FOI request, it is simply to ask if you could  upload all the NHS Forth Valley Hospitality Register spreadsheets that you provided to me for open public access through this page.

I shall also attach correspondence between myself and NHS Forth  valley on this matter by a separate post.

I am sorry for the inconvenience,

Yours faithfully
Peter Gordon

————

The updated letter is this
:

8 May 2013

Dear Forth Valley NHS Board,
Hospital Boards are reportedly meant to keep a register of payments from pharmaceutical companies (and other relevant companies) to  staff, in case of conflicts of interest [1]. I am requesting a copy  of the register for this Board – which I would hope includes  details of all relevant payments to staff and any related potential  conflicts of interest. If it would be possible to have this  information in an appropriate structured data format – for example,  a CSV file – this would be helpful. If this Board does not have a  complete register, I would request: the release of the information  on this topic that the Board does hold; and an explanation of why  the Board does not hold a complete register.

I am aware that some would view data on pharmaceutical funding as  personal data for those staff receiving the funding. Even if some  of the information on this register may be classed as personal data  (although this is contestable – for example, in some sectors of  academia information re funding sources is made public as a matter  of course) it would be covered by paragraph 6 of Schedule 2 of the  Data Protection Act. The release of these data is “necessary for  the purposes of legitimate interests pursued by the data controller  or by the third party or parties to whom the data are disclosed”  [2]. Spurling et al’s systematic review of how information from  pharmaceutical companies impacts physicians’ prescribing reported  that, of the studies included which looked at total promotional  investment, three “found that total promotional investment was  positively associated with prescribing frequency…Two…found both  positive results and no association…One study did not detect an  association” [3]. There is thus a legitimate interest in releasing  this register: the available research suggests that it is plausible  that payments received influence how public money is spent and the  type of care provided to members of the public.

For the reasons given above, there is a strong public interest in  releasing this information. While “requests for the personal data  of a third party are exempt under section 40(2) of the Freedom of  Information Act…if disclosure would contravene section 10 of the  Data Protection Act, the right to prevent processing likely to  cause damage or distress” [2], I would argue that, even if some of  those named in these documents feel that their release would cause  them damage or distress, this is outweighed by the significant  public interest served by releasing these data.

Yours Faithfully,
Dr Peter J. Gordon

[1] http://www.guardian.co.uk/society/2013/a
[2] http://www.justice.gov.uk/downloads/info
[3] http://www.plosmedicine.org/article/info

———-

From: Peter J Gordon
8 May 2013

This is the previous correspondence between myself and NHS Forth  Valley on Hospitality Registers:

To Chief Executive, NHS Forth Valley;
From: Gordon Peter (NHS FORTH VALLEY)  S
ent: 13 February 2013 18:05  To: Mackenzie Fiona (NHS FORTH VALLEY)
Subject: NHS Forth Valley Hospitality Register

13th February 2013

Dear Professor Mackenzie,
Would it be possible for us to discuss NHS Forth Valley’s  Hospitality Register? I understand from our General Manager for NHS Forth Valley that it has never been functional. It has taken me two  years of polite enquiry to establish this.

I am most grateful.

Yours sincerely,
Peter Gordon

——————-

From: NHS FORTH VALLEY
Sent: 18 February 2013 14:52
To: Gordon Peter (NHS FORTH VALLEY)
Subject: FW: NHS Forth Valley Hospitality Register

Dear Dr Gordon,
Professor Mackenzie has asked me to reply to your query below.  There is in fact a functioning Hospitality Register that can be found at the below link. We are in the process of updating the  Business Conduct Policy and aim to re-launch this throughout the  organisation and through our General Manager structure which will  draw further attention to individuals responsibilities around the  Register. In addition there is also a Register held at Board level  for senior staff to document any hospitality. The Board members  declarations of interest are on the website and also note any gifts  or hospitality.

I hope this is helpful and if your require any more information  please do not hesitate to contact me.

Kind Regards
Head of Performance

———-

From: Gordon Peter (NHS FORTH VALLEY)
Sent: 21 February 2013 07:56
To: NHS FORTH VALLEY
Subject: NHS Forth Valley Hospitality Register

Dear NHS Forth Valley
I am sorry to trouble you again but I think I am confused about the  NHS Forth Valley Register.

After looking at the page you sent http://www.nhsforthvalley.com/about-us/b…  and opening up the link to the 2011 to the “Hospitality Register  2010/2011′ I am left wondering if this Register only applies to the NHS Board? Certainly it is listed under the overall framework for “Board Matters” and the only clinician (who is also a Manager) that is listed is Dr Allan Bridges.

I attach screenshot to make sure we are on the same page.

NHS Forth Valley General manager, Mrs Kathy O’Neill, wrote to me on the 27th December 2012 (see e-mail below) stating “there is no central hospitality register” for NHS Forth Valley.

I have perhaps not been clear enough, and if so I apologise: what I  am interested in, under FOI request if necessary is: if there is a  functioning central register for all NHS Forth Valley employees  (not just Board Members). My interest, as said, is actually nationwide and is based on the repeated assertions by the  Pharmaceutical Industry (I can provide the International Journal  references if you wish) that state that “collaboration” between the  NHS and the Pharmaceutical Industry on matters of “education” and  financial support are “transparent”.

In Forth Valley over many years, and continuing to this day, I have  been aware of

  • Pharmaceutical sponsored educational events for NHS Forth Valley  healthcare professionals;
  • Professionals talking of significant “honoraria” payments given  in return for “educational talks” at meetings set-up and sponsored  by the Pharmaceutical Industry
  • and on an on-going basis the payment and hospitality provided to  NHS Forth Valley Healthcare practitioners by the Pharmaceutical  Industry to attend International Conferences.

I am writing then to ask if your statement of the 18th February:  “There is in fact a functioning Hospitality Register that can be found at the above link” is correct and that it is open to all staff employed in NHS Forth Valley as per extant NHS Forth Valley  Business Conduct Policy?

I am very grateful for your help and apologise for my confusion.

Yours sincerely,
Dr Peter J. Gordon

————-

From: NHS FORTH VALLEY
Sent: 22 February 2013 11:05
To: Gordon Peter (NHS FORTH VALLEY)
Subject: RE: NHS Forth Valley Hospitality Register

Dear Dr Gordon,
I have put your queries into the FOI system to ensure we respond to  your actual issues. I hope this will be helpful in getting to the  bottom of this.

Kind Regards
Head of Performance
NHS Forth Valley
Carseview House

———–
From: Gordon Peter (NHS FORTH VALLEY)
Sent: 22 February 2013 11:15
To: NHS FORTH VALLEY
Subject: RE: NHS Forth Valley Hospitality Register

Dear NHS Forth Valley,
Many thanks. I am grateful for your help and kind assistance.

Peter Gordon

———-

Medical Directorate
Information Governance Department,
CSD,
Colquhoun Street
Stirling,
FK7 7PX

NHS Forth Valley  Date: 22 April 2013
Our Ref: 0001095 Review

Dear Dr Gordon,
Re : Request for Review Under the Freedom of Information [Scotland] Act 2002
I would initially say that while you have asked for a review under  the Freedom of information (Scotland) Act 2002, technically this is  not a review but rather additional questions in relation to your  primary request.

The other clarification I would like to make is that there is more than one process that you refer to within your correspondence and  this may be a cause for confusion.

The Register of Interests is a process that the Board members go through and rests within the Code of Conduct for Board members  (2003). There is a process relating to the organisation and  pharmaceutical companies, both are currently separate from the  Hospitality Register process which is part of the Policy on Standards of Personal Business Conduct (2007) and relates to all staff.

1. To see the hospitality register, extant as you confirm under FOI  0001095, for all the years it has functioned, {assume this goes  back to a time before I enquired in May 2011.

Response:
The only hospitality registers we have available are for the  following years 20l0-2011, 2011-2012 & 2012-2013 with the current  ersion on the website being 20l1-20l2: http://www.nhsforthvalley.com/_documents

I have enclosed a copy of these registers for ease.

This is the only information we have received from staff through the Policy on Standards of Personal Business Conduct 2007. This  policy is for all staff.

The Policy on Standards of Personal Business Conduct 2007 is available via the staff intranet under Financial Operating  Procedure 20 —I have enclosed a copy of this for your information.

2. Can NHS Forth Valley confirm they have followed the Scottish  Government Guidance to Boards (Working together for patients) which  “expects al Scottish NHS Boards to have publically-open and functioning Hospitality Registers to include hospitality from industry honoraria paid to staff and sponsorship of continuing medical education.”

Response:
I can confirm The Policy on Standards of Personal Business Conduct 2007, as stated in our initial response is currently undergoing extensive review and will be reissued to staff. This review will  take on board changes in legislation e.g. Bribery Act 2010,  Pharmacy procedures, the guidance contained in Work Together for  Patients — A Common Understanding which you reference and was  published in November 2012 and any other appropriate changes.

NHS Forth Valley has published the hospitality register for the  year 201l-2012 on the public website and will continue to do so.

I hope this information can be of assistance to you.

Please do not hesitate to get in touch if you require any further assistance.

———–
From: Gordon Peter (NHS FORTH VALLEY)
Sent: 24 April 2013 11:31
Subject: advice  24th April 2013.

To Kinburn Castle,
St Andrews,
Fife.

Dear Scottish Information Commissioner,
I enclose the reply I had from the Head of Clinical Governance for NHS Forth Valley after seeking clarification under FOI law about  Forth Valley NHS staff and any collaboration with  industry/commerce. I wanted to establish if such was declared and  openly registered: including any financial, hospitality or gift  transactions.

I also attach the extant NHS Forth Valley ‘Hospitality Registers’ as open to public: http://www.nhsforthvalley.com/_documents

NHS Forth Valley’s ‘Policy on Standards of Personal Business  Conduct 2007’ can be sourced as per letter from Deidre Coyle  (copied below).  It has taken me two years to get this far. It has not been easy.

You will note that NHS Forth Valley ‘Hospitality Register’ is for NHS BOARD members only.  There is NO record of ANY collaboration between NHS FV healthcare  workers and outside Industry/commerce. None. Not one record of  sponsored meetings, sponsored attendance to courses, honoraria  received or any other ‘collaboration’.

I am very concerned about this lack of transparency.

I am writing to ask your advice. I would like to put all this information together with all letters and databases supplied on  open access on the Intranet: to create a coherent, open and  balanced record of where we are now on this important matter. I  write to ask if there are any reasons why I should not do this?  I have copied our Health Minister into this as the Scottish  Government Guidance to Boards (Working together for patients)  “expects al Scottish NHS Boards to have publically-open and functioning Hospitality Registers to include hospitality from industry honoraria paid to staff and sponsorship of continuing medical education.”

I would also recommend you read NHS Forth Valley’s ‘Policy on Standards of Personal Business Conduct’ a policy that has existed  since 2007 (6 years ago). It is clear that this policy has not been followed.

Vulnerable patients deserve, at minimum, clarity and openness about  any ‘collaboration’ otherwise we cannot even attempt to distinguish ‘medical education’ from ‘marketing’.

Kind wishes,
Peter Gordon

————

From: Gordon Peter
Sent: 25 April 2013 12:44
To: NHS FORTH VALLEY
Subject: FW: Enquiry: information request to NHS Forth Valley

Could you read this over and give guidance on NHS FV and copyright?

I would like to place all communication on-line.

My over-arching view is that the population of Forth Valley deserve  transparency about this matter, noting that NHS Forth Valley has NO  record of collaboration (be it financial or of any other form) with  Industry/commerce outside NHS.

Aye Peter Gordon

——–
From: [email address]
Sent: 25 April 2013 12:21
To: Gordon Peter (NHS FORTH VALLEY)
Subject: Enquiry: information request to NHS Forth Valley

Dear Dr Gordon
Enquiry: information request to NHS Forth Valley

Thank you for your enquiry dated 24 April 2013.

In your email you ask for advice on putting information relating to  your on-going communications with NHS Forth Valley (NHSFV)on the  internet and whether there are any reason why you should not do  this.

Generally speaking I do not see any issues with you deciding to  publish the correspondence between yourself and the authority that  has been created as a consequence of the request you made to NHSFV.  Indeed there is a website called WhatDoTheyKnow where details such  correspondence is available to the public to look at. You may find  this of interest to look at and as such please see the following  link for reference: https://www.whatdotheyknow.com/

The one thing I would draw to your attention in relation to making  available information you have gathered as a consequence of your requests, is that information released under FOI legislation is  still subject to copyright rules. With this in mind I would suggest  that you clarify NHSFV’s copyright arrangements, including what’s  called third party copyright, where the information supplied by in  this case NHSFV does not actually hold the copyright. This is a  specialist area and I would suggest that after clarifying the  authority’s position you might want to look at the fair dealing  provisions, which refer to this. For reference I have provided a  link to the UK Copyright Service http://www.copyrightservice.co.uk/copyri

With respect to FOI legislation itself please see the following  link to the Commissioner’s guidance booklet “Your right to know”, which provides an overview of the processes involved in FOI and how  to progress matters to the Commissioner if this becomes necessary

I hope the above is useful, however should you have any queries  please feel free to contact me.

Yours sincerely
Freedom of Information Officer
(Policy and Information)

The Office of the Scottish Information Commissioner
Kinburn Castle
Doubledykes Road
St Andrews
Fife  KY16 9DS

—————

Sent: 02 May 2013 08:23
To: Gordon Peter (NHS FORTH VALLEY)
Subject: RE: Enquiry: information request to NHS Forth Valley

Hi Peter,
Apologies for the delay in getting back to you but I have been out  of the office and like everyone else I have an e-mail backlog.

Thank you for your recent enquiry regarding NHS Forth Valley and copyright.

I have no issue with you publishing what we have provided to you so far through the Freedom of Information Act.

The Board does have copyright in the material it has published, but as it is publically available you can link to it.

We have not provided you with any information that is not the copyright of NHSFV.

It may be prudent in future to seek legal advice about the content of anything you choose to publish as this cannot be approved for you by the Board.

Hope this helps
Kind regards

Head of Information GovernanceLink to this

———–

From: NHS FORTH VALLEY  Sent: 10 May 2013 15:21
To: Gordon Peter (NHS FORTH VALLEY)
Subject: Hospitality Registers

Hi Peter,
I have arranged today for all three registers that we supplied to  be placed on the NHS Forth Valley public website.

They can be found at the link below – http://www.nhsforthvalley.com/about-us/b

I hope this is what you were looking for.

Kind regards
Head of Information Governance

(Please note: comment by Peter Gordon the link provided above is NOT to Central Hospitality Registers for all NHS staff employed by NHS Forth Valley. These are Registers of Interests of BOARD members only)

——–
Communication with NHS Forth Valley here: https://www.whatdotheyknow.com/request/register_of_payments_from_pharma_166#outgoing-273345

A summary database of all FOI returns from Scotland’s 22 NHS Boards: due to the heterogeneity of the returns this is a rough guide at best:  https://docs.google.com/spreadsheet/ccc?key=0ApF86-MCSbZzdGlVd2ZPYWhyN1ZUbkliNlFpTGxtMFE#gid=0

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