News 28th Sep 2021

UK Sunshine Act: The sun is still behind the clouds

Natalie Rhodes

Policy Officer, Health Initiative

Natalie joined TI-HI in October 2019 after gaining an MSc in Global Health from Maastricht University where she conducted a research project into buyer’s clubs and access to medicines. Natalie leads TI HI’s work on research and development with a focus on transparency and integrity in medical research. Outside of TI HI she works with grass-roots health movements including Universities Allied for Essential Medicines and People’s Health Movement alongside teaching on the Global Health MSc programme at Maastricht University.

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Related Publication

Declare interests. Manage conflicts. Protect the NHS.


This report looks at how changes to the NHS in England over the past decade have created greater risks of abuses of power, and how reforms to local commissioning are exacerbating them. Since 2012, membership organisations made up of General Practitioners (GPs), called Clinical Commissioning Groups (CCGs), have managed most of the NHS’ budget in England. They are responsible for purchasing £78 billion of healthcare services on behalf of the NHS. At the same time, these same GPs are independent contractors to the NHS and are in receipt of around £8.5 billion of NHS funding each year.

Because CCG governing boards comprise commissioners and contractors of health services, obvious conflicts of interest can arise. If not managed properly, this can result in the misuse of public money for private benefit at the expense of patients and taxpayers. As with any public body, these organisations should have measures in place to protect against the risks of impropriety. Specifically, they should have:

  • transparent and effective management of any potential conflicts of interest held by senior officials
  • clear governance arrangements

These core protective measures aim to prevent abuses of power for private gain and to ensure that decisions about healthcare services are taken in the best interests of patients and taxpayers.

This report looks at the potential scale of conflicts of interest within local NHS commissioning organisations in England, and how these organisations protect against their abuse. It covers CCGs and their emerging successor bodies that are taking over the co-ordination of local NHS services – Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs).

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The UK is falling behind as countries around the world introduce legislation to increase the transparency of payments made from the pharmaceutical industry to healthcare professionals.

The ability of the pharmaceutical industry to influence healthcare policy and decision making through gifts and payments is well established in the UK and around the world. Allowing these channels of influence to continue without sufficient scrutiny undermines the integrity of the UK health system and risks private interests to be put above patients.


What is the problem?

Relationships between the pharmaceutical and medical device industry and the healthcare community frequently go unchecked and unnoticed despite the well-established influence such relationships have on research outcomes and clinical decisions. This influence allows the introduction of bias into our health services at every level, granting huge benefits to private actors at the cost of the sustainability of the NHS and risks the health of its patients.

Scientific research funded by pharmaceutical companies is more likely to produce results that are favourable to the drug manufacturer. Patient organisations often contribute to government assessments to decide whether a treatment should be offered through the NHS, yet 2/3 groups receive funding from the manufacturers of the treatment they are asked to appraise. Medical experts sought for guidance by governments or sitting on drug reimbursement panels often can receive payments from pharmaceutical companies, which can then influence their recommendations as to whether a certain treatment should be offered to patients.  Doctors who receive gifts from pharmaceutical companies prescribe fewer generic drugs in favour of more expensive original products. It even can lead to prescribing drugs with more adverse side effects.

Whilst healthcare professionals in the UK are encouraged to disclose payments or gifts received from industry, nearly half fail to do so. This is not unique to the UK as it has been proven that such voluntary guidelines are ineffective in promoting transparency in other countries. As a result, countries such as Belgium, Denmark, France, Romania and the US have introduced mandatory reporting of payments legislation, often referred to as Sunshine Acts. Under such legislation healthcare professionals and pharmaceutical manufacturers have to publicly declare any financial relationship such as payments given to doctors to speak at conferences or research funding.


What progress has there been in the UK?

The issues of conflicts of interest in the NHS and the need for potential conflicts to be better mitigated is well recognised in the UK. In 2016 the NHS opened the consultation entitled Managing Conflicts of Interest in the NHS to which Transparency International Global Health (formerly known as the TI UK Pharmaceuticals & Healthcare Programme) submitted a response and stressed the need for greater transparency of gifts and hospitality received by NHS staff.

Yet insufficient action has been taken and concerns around conflicts of interest and the policy gap around better transparency in the UK was highlighted again in a government review into medicine and medical devices safety published July 2020. The review followed several high-profile cases of harm to patient safety, such as the use of pelvic mesh. It aimed to understand how these cases arose and form recommendations as to how such instances can be handled and avoided in the future.

Conflicts of interest arising in clinicians, expert committees and researchers were discussed with a key recommendation from the review being “mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians”. This recommendation was discussed in depth by the newly formed All Party Parliamentary Group (APPG), Do No Harm and the review was debated in the House of Commons one year after its launch in July 2021. Yet still no substantial progress has been made on introducing legislation required to introduce mandatory reporting.

Since this review, further research has found evidence of poor management of conflicts of interest in UK health policymaking and NHS governance. A study by researchers at the University of Bath found that nearly one-third of all funding received by health-focused APPGs constituted as conflicts of interest as the funding came from the pharmaceutical industry (either from companies directly or from industry-funded patient groups). Whilst public disclosure of funding is required it is done so in a way that is not readily accessible and requires further data processing which hinders public access to the information, despite the funding potentially influencing APPG positions on key health-decision making. Research by Transparency International UK found that uncovered that some £1.5 billion of public funds was paid to companies in which board members of NHS Clinical Commissioning Groups (CCGs), the bodies responsible for 60% of the NHS budget in England, had an interest in 2018/19 alone.


What needs to happen now?

To ensure transparency in our healthcare sector, the UK should:

  • Follow the lead of its international counterparts and legally mandate the public disclosure of all payments and gifts made from pharmaceutical and medical device companies to teaching hospitals, research institutions and individual clinicians.
  • Extend any payments disclosure legislation to cover funding of research and development and both patient organisations and APPGs. Transparency of APPGs should also be improved with data on APPGs published in machine-readable formats to enable proper scrutiny and reduce the risk that they are used as a means of buying influence over parliamentarians.
  • Remove opportunities for corporate influence in NHS and health decision-making processes by prohibiting NHS Clinical Commissioning Groups from contracting businesses where their board members have a financial interest and better defining governance structures of new NHS institutions (see here for expanded recommendations).

The failure to address conflicts of interest in our health system is allowing corporate interests to be put above the integrity of the NHS and putting its patients in harm's way. If sunlight is said to be the best disinfectant, then a UK Sunshine Act can offer patients the best protection.