NHS Scotland: Standards of Business Conduct

3. Identifying, Declaring, Publishing, and Managing Your Interests

3.1 Definitions of ‘Interests’ and ‘Conflicts of Interests’

In this guidance these terms mean:

‘Interest’

An interest is where a member of the public with knowledge of the relevant facts would regard an individual’s connection to a particular matter as being so significant that it would be considered as being likely to influence the discussion or decision-making. A connection is any link between a matter that is being considered and an individual, or a person or body associated with that individual.

‘Conflict of Interests’

A set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring health and care services is, or could be, impaired or influenced by another interest they hold.

A conflict of interest may be:

• Actual – there is a conflict between one or more interests.
• Potential – there is a possibility of a conflict between one or more interests in the future.

People may hold interests for which they cannot see a potential conflict, however, others may see it differently. Perceived conflicts of interest can be damaging and undermine trust in decision-making. As such, all interests must be declared where there is a risk of a perceived conflict of interest.

What are NHS Scotland bodies required to do?

All NHS Scotland bodies are required to have a system to collect information on the declared interests of all their staff.

It is not current practice for health bodies to publish information on declared interests of their staff, as is the case for Board members. There are several practical issues which need to be worked through (e.g. information governance issues, IT systems) before a standardised approach can be progressed across NHS Scotland.

In future, individuals listed in Box 1 on page 6, their employer or the organisation contracting their services will also be required to publish information on those declared interests. Sole practitioners who are within scope of Box 1 are responsible for ensuring information on their interests is published at a local level and accessible for the public.

Box 1

Individuals whose interests will be published in future:

• Registered health and care professionals.
• Individuals on the senior manager and executive pay grades.
• Individuals who are employed under the Agenda for Change terms & conditions, grade 8D and 9.

Board members must always observe the requirements of the Board’s Code of Conduct issued under the Ethical Standards in Public Life (Scotland) Act 2000 and maintain their entry on the Board Members Register of Interests. These requirements may be different from what is expected of staff generally.

New staff should declare their interests to their employer/healthcare provider, or confirm they have no interests, within one month of taking up their position. To facilitate this, the recruiting manager should include within the recruitment pack for the post information on the Principles of Conduct within the NHS in Scotland, and what the successful candidate will be expected to do:

• Carry out the NHS Scotland Employment Checks Policy before making a final decision to appoint any candidate. This includes considering whether the candidate has any secondary employment, and if this presents a conflict of interest.
• Plan within the first month of appointment for the new start to be briefed on the Principles of Conduct (as part of an induction programme), and for the individual to explicitly confirm that they understand the requirement to declare interests, and.
• Ensure that the new start signs their first declaration within one month of starting.

Implementing this Guidance to Health Bodies on establishing systems to capture information on interests

Health bodies may already have some system for capturing information on interests. However, there is variation on how these systems work in practice.

It is a significant project to have a system for all staff to declare interests. It is recommended that when health bodies are implementing this guidance, they should prioritise the individuals identified above.

In future, when an individual, listed in Box 1, declares any interests then this information should be published. For all other staff, health bodies should have a system to collect information on their interests, but the information will not be routinely published.

3.2 Key Actions for NHS Scotland Staff

Everyone must declare interests when they are relevant to the activities they are carrying out, or the matter being discussed (See Section 4).

When making their declarations, staff should:

• Provide enough information for anyone to understand the interests without having to undertake any further research.
• Declare any activity which creates a financial benefit. There are exceptions to this within Category 4 interests (gifts & hospitality). It is not necessary to disclose the amount of financial benefit (income earned or expenditure avoided) that you may receive from an interest.
• Always protect the confidentiality of another person’s business or financial interests when declaring interests. You are only required to provide enough information to make it clear why you consider you need to declare the interest.

All staff should take steps to ensure that their declared interests are up to date. This includes:

• Advising of any updates to declared interests within one month of a change in circumstances (e.g. whenever they have any new interests, or whenever a declared interest has come to an end), and
• Reviewing their entries in any system that holds their declared interests at least once a year to confirm that the information is correct and up to date.

3.3 Categories of Interests

There are four categories of interests, and each has sub-categories:

• Direct Financial Interests
• Non-Financial Interests
• Indirect Interests
• Gifts & Hospitality

If staff have no interests to declare, it is best practice for them to provide a ‘Nil Declaration.’

Nil Declaration

Declaration: “I have no interests that may, or could be perceived to, impact on my decision-making or judgement. I acknowledge that to provide a false statement is an offence, which, if found, may result in internal, professional, regulatory, civil, or criminal proceedings.”

Category 1: Direct Financial Interests

Description: Where an individual may get a direct financial benefit from the consequences of a decision, they are involved in making. A financial benefit can include making a gain, avoiding a loss, or incurring expenditure.

Sub-Category 1A: Shareholdings and Ownership Interests

What should be declared:

Individuals should declare, as a minimum, any shareholdings and other ownership interests in any publicly listed, private or not-for-profit company, business, partnership, or consultancy which is doing, or might be reasonably expected to do, business with their organisation.

There is no need to declare any shares or securities held in collective investments (a trust where investments by many individuals are pooled, and the portfolio is held and managed by a financial institution), pension funds, or units of authorised unit trusts.

Individuals should also declare when any of the identified businesses have made a contract with their employer:

1. under which goods or services are to be provided, or works are to be executed; and

2. which have not been fully discharged.

Sub-Category 1B: Outside Employment

What should be declared:

‘Outside Employment’ is any work for which you receive, or expect to receive, payment. This excludes:

• any work that you undertake on behalf of your main employer or healthcare provider.
• any work that is clinical private practice. This is declared under a separate sub-category so that this information is explicit to patients.

You do not need to register the level of financial benefit, or the exact title of the role that you may carry out.

‘Outside Employment’ comes in many forms, such as:

1. employed

2. self-employed

3. the holder of an office

4. a director of an undertaking

5. a partner in a firm

6. a Board member of a public body

7. a trustee of a charity or a trust

8. paid advisory roles

9. paid honorariums

10. being appointed or nominated by his or her main employer or practice to another body; or

11. being engaged in a trade, profession or vocation or any other work.

Sub-Category 1C: Patents

What should be declared:

This only applies to patents or intellectual property rights to which are, or might reasonably be expected to be, related to items to be procured or used by your organisation:

• Details of any relevant patents or other intellectual property rights that you hold, or have started, or are currently applying for those rights to be registered.

Sub-Category 1D: Donations

What should be declared:

Health bodies govern and manage their charitable funds discretely from their core activities (see Governance of NHS endowment funds: review report). Donations should be given directly to the registered charity rather than individuals.

Health bodies should have processes in place to deal with charitable donations. OSCR publishes guidance on a wide range of activities, which can be found here: OSCR | Managing a charity guidance.

While an individual cannot personally accept a charitable donation, he or she may be involved in charitable fundraising, or be responsible for a specific charitable fund. Donations to causes which the individual is closely involved or interested in, or his or her service or work could benefit from, could be regarded as a personal interest. Where this is the case, the individual should declare this interest.

Individuals should declare any charitable donations which could be regarded as an interest.

Sub-Category 1E: Sponsored Events

What should be declared:

Commercial organisations may be involved in sponsoring or paying for events, such as offering to meet some or part of the cost of the health body hosting those events. Such sponsorship can create more opportunities for learning, networking, and partnership working.

Any sponsorship should be underpinned by a formal agreement which sets out the terms and conditions of the sponsorship. The agreement should observe the following principles:

The benefits to consumers and/or the public should outweigh the costs of commercial sponsorship.

1. Commercial sponsorship must not undermine health promotion.

2. Extra care should be taken where consumers are children or young people.

3. Commercial sponsorship cannot promote tobacco products or any other health-harming products.

4. Marketing activity should be proportionate.

5. Commercial sponsorship should be used for additions or improvements, and not for funding core functions and services.

The UK Department of Health & Social Care published Guidance for Engagement with the tobacco industry in June 2023. On a similar principle, sponsorship should not be accepted if doing so presents a conflict with public health policy.

Individuals must declare any involvement in sponsored events, and any details of the event, name of the sponsor, and any benefits that the sponsor derived from sponsoring the event. A simple way to achieve this is to cross-refer to the sponsorship agreement that the health body has put in place.

Sub-Category 1F: Sponsored Research

What should be declared:

Individuals must declare when they have an involvement in sponsored research and any relevant information about the research, such as:

• The name and/or the reference number of the project.
• A description of their role in the project.
• The relevant dates for each project. There should at least be an approximate start date. If it has ended, provide an end date. If ongoing, record it as ongoing.

Sub-Category 1G: Sponsored Posts

What should be declared:

Any sponsorship agreements should be in line with the requirements set out Category 1 E). With respect to Principle 6, a health body may not accept commercial sponsorship to fund its core functions and services, which includes staffing costs.

If a health body did wish to establish a post that is not concerned with its core functions and services, it may enter into a commercial sponsorship agreement to do so. However, the health body must have controls in place to ensure that this agreement has no influence on decision-making relating to core functions and services or create additional financial risks.

If an individual is aware that his or her post is supported by such sponsorship arrangement, then he or she should declare the details of this.

Sub-Category 1H: Clinical Private Practice

What should be declared:

If individuals carry out work in clinical private practice, then they should declare the following information:

• Where they practise.
• What they practise (specialties, types of procedures).
• When they practise (time commitments).

Category 2: Non-Financial Interests

Description: Where an individual may personally obtain a non-financial benefit from the consequences of a decision, they are involved in making.

An example may be where a NHS Board has entered into a joint-working agreement with a pharmaceutical company under the terms of A Common Understanding 2012: Working Together for Patients.

It is difficult to set out a definitive list of interests, and the table below offers some examples.

Sub-Category 2A: Research Role

What should be declared:

For any research & development projects that individuals are involved in on a voluntary or unpaid basis, they should declare:

• The name and/or the reference number of the project.
• A description of their role in the project.
• The relevant dates for each project. There should at least be an approximate start date. If it has ended, provide an end date. If ongoing, record it as ongoing.

Sub-Category 2B: Advisory Role

What should be declared:

These are unremunerated roles. Examples of this type of role are:

• Being a member of a lobby or pressure group with an interest in health or care.
• Being an advocate for a specific group of patients.
• Being an advisor to an external body, such as a regulator, a branch of Government, or a private organisation.
• Being a member of an advisory group or other decision-making forum which may influence decision-making in health and care.

Sub-Category 2C: Voluntary Role

What should be declared:

If you hold an unremunerated position on a board or another position of authority in another organisation, you should register:

• The name of the organisation.
• A description of the role you have.
• An indication of the time period of the interest. There should at least be an approximate start date. If it has ended, provide an end date. If ongoing, record it as ongoing.

These organisations could be other public bodies, charities, etc.

Sub-Category 2D: Other

What should be declared:

Individuals should only use this option if it is not possible to use one of the above sub-categories.

Category 3: Indirect Interests

Description: Where a person has a close associate who or which has an interest in a decision that the person is making, and the close associate could stand to benefit from it.

A close associate can be an individual or an organisation. Close associates can fall into three broad groups:

1. Close family members.

2. Close friends and associates.

3. Business partners and associates.

If a close associate is an employee of your employer, then this does not need to be recorded as an interest. However, individuals may need to declare this association in the conduct of business, e.g. if an individual is on an interview panel and the close associate is an applicant.

Staff should apply a common-sense approach to identify a ‘close associate,’ as this will depend on individual circumstances.

Sub-Category 3A: Indirect Interests

What should be declared:

Identify the relationship with the close associate and the nature of their potential interest in decisions. You do not need to disclose any unnecessary personal data.

Category 4: Gifts and Hospitality

Description: The subject of gifts and hospitality is complex. This guidance uses two Sub-categories: Gifts (4A) and Hospitality (4B).

As a general principle, if it is easy to avoid or decline gifts or hospitality, then do so.

Staff should refuse all but the most trivial gifts or hospitality, if accepting them could be interpreted as an attempt to gain preferential treatment, or accepting would mean that the staff would contravene their professional code of practice.

Staff must refuse all gifts or hospitality where the person offering the gift or hospitality may be trying to retain or win business with the NHS, or influence decision-making. Decision-making includes decisions made as part of the treatment of individual patients, as well as decisions in business processes and meetings.

Health bodies can establish key controls to reduce the risks to individual staff in this area. This includes:

• Using the procurement system in advance of the event, to pay for any delegate fees, travel and accommodation for the individual attending the event.
• If a health body is hosting an event, and is willing to accept sponsorship from third parties, then the health body should enter a sponsorship agreement with that third party in advance, setting out the terms of that sponsorship and any associated hospitality at the event. When staff attend such events, they can declare this as an interest under ‘Category 1E: Sponsored Events’ but do not need to declare it under ‘Category 4B: Hospitality’.

What is an ‘Event’?

An event can be anything that an individual can attend in person or virtually. Examples of events can be meetings, a conference, a dinner, away-days, concerts, sports events, and other cultural/social activities. An event may include the travel and accommodation that an individual may need to attend the event.

If an event is entirely unrelated to the conduct of an individual’s duties or role, and/ or their professional or scientific knowledge and development, then the event should be treated as a ‘gift’ under Sub-Category 4A.

If the event is related to the conduct of an individual’s duties or role, and/or their professional or scientific knowledge and development, then it should be treated as ‘hospitality’ under Sub-Category 4B.

Advertising of Medicinal Products to ‘Persons Qualified to Prescribe or Supply’ Medicines (‘PQPS’)

There are regulations on the advertising of medicinal products which apply to PQPS. Examples of PQPS include doctors, dentists, nurses, pharmacists, pharmacy assistants, optometrists, chiropodists, midwifes, and other ancillary healthcare staff and retail staff who are entitled to supply medicinal products directly to the public. The Medicines & Healthcare Products Regulatory Agency is the regulatory body and has published guidance: The Blue Guide.

The regulations include a criminal offence for any PQPS to solicit or accept any gift, pecuniary advantage, benefit in kind, hospitality or sponsorship prohibited under the regulations. Care should therefore be taken when healthcare professionals are remunerated for services to ensure that there is no element of promotion.

Sub-Category 4A: Gifts

What is a Gift?

Gifts include cash, vouchers, or any goods, or services, which are provided for personal benefit, free of charge, or at less than its commercial value. So ‘gifts’ can include items like:

• Inexpensive items from organisations which are customary business practice for the maintenance of goodwill, such as pens, notepads, calculators, computer accessories, diaries, calendars, surgical gloves, tissues, and coffee mugs.
• An event which is entirely unrelated to the conduct of an individual staff member’s duties or role, and/or their professional or scientific knowledge and development.
• Free goods or services (such as holidays) or vouchers for the same.
• Membership schemes and cumulative points schemes which have the effect of conferring benefits in the form of free or reduced-price goods or services, which are not available to all NHS staff or the general public.
• Provision of services at a price below that are generally charged to the public, which are not discounts generally available to all NHS staff (see below).
• Incurring personal debts or obligations on behalf of a member of staff.
• Preferential rates or other benefits in kind for staff and/or to the benefit of their family and friends.

Cash returns to individuals and other personal benefits in lieu of discounts such as preferential loans, relief from debts, share options, shopping vouchers, gifts or special prices for travel, insurance, office equipment or computer software.

What is not a Gift?

An acceptable discount is not a gift.

Examples of Acceptable Discounts which are not ‘Gifts’

Discounts which are generally available to all staff either at a national-level or by the healthcare-provider are not considered as ‘Gifts.’ Examples include:

• NHS Staff Benefits
• Health Service Discounts
• Welcome to Blue Light Card

Where the business already has an established practice of offering discounts to NHS staff, and the business offers the discount unconditionally (other than asking staff to show that they work for the NHS). The discount must not be capable of being construed as a bribe.

Note: Staff must not accept a discount which is only offered to them personally, nor ask a business to give them a discount simply because they work for the NHS.

‘Hospitality’ is not a gift. Staff must consider what is being offered. If it is hospitality, follow the guidance in Sub-Category 4B.

Gifts: General Principles

Staff must not ask for or seek any gifts, and must politely, but firmly, decline any gifts of cash or vouchers.

A common-sense approach should be applied to the valuing of gifts. Staff should use the actual amount if known, otherwise a reasonable estimate.

Gifts made to or accepted on behalf of the organisation

Someone may wish to give a gift to a ward, department, or the wider organisation, rather than individual members of staff. Many health bodies have endowment funds which operate as a registered charity. Unless a gift is of a personal nature, it is better that gifts are received on behalf of the organisation or an endowment fund, rather than a member of staff personally accepting it.

Health bodies should have systems of control which set out how gifts accepted on behalf of the organisation are accepted and recorded. Those systems should also determine what happens to the gifts once they have been received. The measures should be proportionate to the nature and purpose of the gift. For example, gifts such as Easter eggs and Christmas presents for patients, can simply be shared with those on the ward.

Staff should advise anyone wishing to make a charitable donation of the local processes to follow.

Sometimes individuals are offered personal gifts that they cannot accept. In circumstances where it would be inappropriate to decline the gift, the member of staff can use the above systems to accept the gift on behalf of the organisation.

Where a gift is accepted on behalf of the organisation, then staff do not need to declare the gift within their interests, unless the gift could be considered as a personal interest, for example, see Section 1 d) – Donations.

When health bodies are developing their systems of control, they must consider relevant law. This includes:

1. Gambling Act 2005. A health body may consider running a raffle to raise funds from gifted property. However, a raffle is a form of ‘lottery’, and specific conditions need to be followed to avoid committing a criminal offence. Fundraising, raffles, and lotteries (gamblingcommission.gov.uk)

2. Charity Law. If the health body’s charity is involved in handling the gift, then the health board (as the charity trustee) needs to follow OSCR’s Fundraising Guidance for Charity Trustees.

Gifts offered to individual members of staff from patients, service-Users, their families, etc

Staff are often offered personal gifts as expressions of gratitude for the care they have given someone. Staff must carefully consider the circumstances in which these gifts are offered. For example, staff working in an area looking after vulnerable patients may conclude that it is inappropriate to accept any gifts from them. Another example is where staff are being repeatedly offered gifts from the same source.

Staff may accept gifts of a personal nature from patients, service-users, their families which are of a value no more than £25, and there are no concerns on the acceptability of the gift. Staff do not need to personally declare the acceptance of these gifts or make a personal declaration when such gifts have been offered but declined.

As a general principle, staff must politely decline all other gifts from patients, service-users, and their families. If staff consider that declining an offer of a gift would cause offence, then they should accept it and hand it over to their line manager at the earliest possible opportunity. The gift should then be handled as if it was a gift accepted on behalf of the organisation.

Gifts offered to individual members of staff from any other source

Staff must politely decline any other gifts offered to them personally from any other source.

The exception to this are low-cost promotional aids that are inexpensive and are relevant to business use or the practice of an individual’s role. Inexpensive items are those which do not cost the provider more than £6 (exc VAT) and represent a similar value to the recipient. A gift is ‘relevant’ when it has a clear business use and may include such items as pens, notepads, calculators, computer accessories, diaries, calendars, surgical gloves, tissues, and coffee mugs.

Staff must declare the details of all personal gifts that they do accept from any source, apart from gifts of gratitude from patients, service users, their families etc.

Staff must declare the details of any offered gifts that they have declined.

Sub-Category 4B: Hospitality

What is Hospitality?

Hospitality comes in different forms, including for example:

• An offer of food or drink.
• An offer that enables or supports an individual to attend an event that is relevant to an individual’s professional or scientific role or the conduct of their duties.

Hospitality does not include anything defined as a ‘gift’ in this guidance. Where this is the case then staff should follow the guidance in Sub-category 4A.

Staff must always exercise judgement. This guidance uses 4 types of hospitality. For both Types 1 and 2, staff cannot accept hospitality that meets any of the criteria set out in Type 3.

• Type 1: Staff may always accept this hospitality and are not required to declare it.
• Type 2: Staff may only accept this hospitality if it is modest, normal, and reasonable in the circumstances, it is approved by their line manager, and are required to declare it.
• Type 3: This is unacceptable hospitality which staff must always decline.
• Type 4: This is offers of hospitality of a value of at least £25 which staff have declined.

A key factor for hospitality is that an ‘event’ must be relevant to an individual’s professional or scientific role or the conduct of their duties. Such hospitality should be incidental to the main purpose of the event.

The nature of some roles may require the postholders to attend more events than others. Some events may be about the training, learning, and development of individuals, which is relevant to carrying out duties and responsibilities.

All hospitality should be modest, normal, and reasonable in the circumstances. It should be recognised that the nature of some hospitality and its location can make it more expensive, but still be acceptable. Similarly low-cost hospitality may still be unacceptable in certain circumstances. A key test is whether the hospitality creates a conflict of interest. So, this guidance offers a benchmark value for low-cost hospitality (£25), to help staff exercise judgement, and provide transparency on higher value offers.

Staff must notify their employer if they are repeatedly being offered hospitality from the same source or offers of significant value. An individual offer may be low value, and moderate, normal, and reasonable in the circumstances, however repeated offers could give the perception of inappropriate influence. Regardless of whether offers are accepted or declined, the individual should inform their employer of these offers to monitor the situation.

Type 1 Hospitality

Staff may accept the following hospitality if they are satisfied that the hospitality does not meet any of the criteria for unacceptable hospitality (see Type 3):

• Any hospitality that a public body (see National public bodies: directory) or the Scottish Government is directly providing itself
• Any hospitality that a public body or the Scottish Government is paying for, e.g. hospitality provided to attendees of a conference for which the public body is paying the delegate fee through its procurement system. Another example is where the public body organises and pays for the travel and accommodation arrangements for its staff through its procurement system, and/or the member of staff can claim any incidental costs through the staff expenses system.
• Any hospitality which is provided to all attendees at events which are open to anyone to attend, and of a value no more than £25.
• Any hospitality offered when attending an event in the normal course of carrying out their duties, which would be considered inappropriate to refuse, and of a value no more than £25.

Staff do not require their line manager’s approval before accepting Type 1 hospitality. Staff are not required to declare Type 1 hospitality but can do so if they wish.

Type 2 Hospitality

Staff may accept hospitality, which is not covered by Type 1, which meet all the following criteria:

• It is modest, normal, and reasonable in the circumstances.
• It does not meet any of the criteria of Type 3 hospitality;
• It is of a value of at least £25; and
• The staff member’s line manager has approved the acceptance of the hospitality before the hospitality is received.

Staff are required to declare and record Category 2 hospitality. All declarations must set out who offered it and provide a description of the hospitality and the context that it was offered.

Type 3 Hospitality

Staff must decline hospitality that meets any of the following criteria:

• The hospitality is not necessary for carrying out an individuals’ duties and is appropriate to refuse.
• The person offering the hospitality is waiting on a decision from the individual’s employing organisation or is seeking to carry out business with it.
• The hospitality provides the receiving staff member with a real and substantive personal gain. This is anything beyond what is normal and reasonable in the circumstances and should be easily refused in the conduct of duties.
• The hospitality creates a conflict of interest.

Type 4 Hospitality

Staff must declare any hospitality that they have declined if it is of an estimated value of £25 or more. The declarations should have the same level of detail as Type 2 declarations to provide transparency.