Pharmaceutical companies have paid an estimated £156 million to NHS trusts in England between 2015 and 2022 without the public being told what the payments are for, reveals an investigation by The BMJ today.
The findings raise important questions about unrecognised conflicts of interest and have led to calls for a shake-up of current transparency rules.
The BMJ tracked all disclosed non-research payments to NHS trusts in England from 2015 to 2022 reported in Disclosure UK, a database run by the Association of the British Pharmaceutical Industry (ABPI), which requires participating companies to disclose cash payments and other benefits in kind to healthcare professionals and organisations.
In total, there were 58,302 payments worth £156,882,790 made to 217 NHS trusts, which make up a fifth of the value of all payments to healthcare organisations listed in the database, such as general practices, commissioning bodies, professional societies and medical schools.
The top 10 largest recipients accumulated £49,820,043 and included Guy's and St Thomas', University College London Hospitals, Manchester University, Imperial College Healthcare, University Hospitals Birmingham, University Hospitals of Leicester, Oxford University Hospitals, King's College Hospital, Barts Health and Royal Free London NHS Trusts.
The top 10 largest payments were worth £6,237,936. Most of the payments were relatively small, with 94% of payments below £10,000.
Of the 220 trusts operating in England between 2015 and 2022 only three received no payments, including two ambulance trusts.
The BMJ approached trusts for more detail but few were able to explain the purpose behind these payments. Some trusts said they found mistakes in the data, but would not provide more detail. Guy's and St Thomas' NHS Foundation Trust in London said it did not "recognise these figures as accurate."
Margaret McCartney, a general practitioner and transparency campaigner, questions whether it is "in the patient and public interest that such massive transfers of value are occurring between the pharmaceutical industry and the NHS?"
"When companies dole out over £156 million, they are not doing it out of the goodness of their heart, they are doing it because they expect some kind of return on their investment. The unanswered question, so far, is what do they want?" comments Joel Lexchin at York University, Toronto, Canada.
International experts slammed the Disclosure UK data quality and the lack of transparency of the NHS trusts.
"Legislation like the Sunshine Act in the United States that mandates disclosure by drug and device companies of transfers of value greater than US $10 to teaching hospitals is what is required," says Joel Lexchin.
Quinn Grundy at the University of Toronto adds: "For true transparency to exist, data on pharmaceutical company payments to publicly-funded hospitals needs to be not just available, but easily accessible, accurate, complete, and provide enough detail that members of the public understand why the company made the payment and what the hospital does with the money."
"Disclosure UK is widely regarded as a European leader in transparency", said Amit Aggarwal, ABPI executive director of Medical Affairs and Strategic Partnerships. Since its launch, the database has evolved, he said. "However, we recognise there is always room for improvement, and we welcome constructive recommendations", he added.
A spokesperson for the Department of Health and Social Care (DHSC) said it had been working with healthcare providers on updated guidance regarding doctors' potential conflicts of interest and has sought views on proposed mandatory payment reporting following recommendations of the Cumberlege review.
