Business ethics in NHS 'confused'

(First Edition)

SENIOR NHS executives and members of its boards and trusts are surrounded by 'moral confusion and uncertainty' over NHS business ethics, it was said yesterday.

A survey published in The Health Service Journal of 2,600 health authority chairmen and members of authority and NHS Trust boards, showed more than half believed it was permissible to pay-off professionals who would otherwise face disciplinary action for incompetence, lack of probity or pursuit of personal gain.

Almost half would be ready to sign contracts allowing expenditure before seeking authorisation; 46 per cent would bend NHS rules if they judged it in the organisation's interest; and 45 per cent would award redundancy pay to those they knew were moving to another NHS post. Almost 30 per cent felt it was permissible to use NHS staff and/or equipment for private work, 19percent felt in exceptional circumstances that it was permissible to undertake personal consultancy for firms they had contact with through NHS work, and around one in five felt it acceptable in some circumstances to become a director of an NHS supplier while still an NHS director. Twenty-nine per cent considered it permissible in at least some circumstances to work as a consultant of a possible purchaser of NHS assets.

The study, undertaken by staff at Sheffield and Manchester universities, showed wide variations in attitudes to probity among NHS board members, with health authority chairmen and chairwomen the most ethically conservative, followed by non-executive board members, with the most permissive attitudes held by NHS executives.

'Those whose experience had predominantly been in the NHS had more permissive attitudes than all other groups. A substantial minority were prepared to bypass rules and regulations within their work when it was expedient.'

The study found 'much disagreement about which sort of behaviour was permissible' and in some circumstances 'a substantial minority would permit behaviour which was regarded as ethically unacceptable by their colleagues'.

The findings come as the Public Accounts Committee has expressed mounting concern about ethical standards in public services, including notably the NHS after scandals in the West Midlands and Wessex regions. The research was carried out before draft codes of conduct and accountability were issued by the Department of Health. But the journal in a leading article says the findings are 'not an enouraging picture'.