The financial vulnerability estimate has decreased due to a reduction in the financial vulnerability rate. The expenditure figure has increased due to an increase in funding within this area.
Emerging trends and prevalent threats
Misreporting around ward utilisation is a realistic possibility. Likely impacting on medical wards with an absence of available beds resulting in care being provided to patients in the corridor, leading to patient and staff safety concerns.
£57.36m
vulnerable from an expenditure of £77.5 bn
Inaccurate coding processes, including upcoding to meet targets and potentially increase revenue is highly likely. Leading to the potential for inaccurate reflections of clinical information from a department. The approach of coding through robotics into the Patient Administration System could be utilised in a trust to meet deadlines, instead of manual coding.
Falsifying or altering data to meet a target was highly likely, with the potential for the discharge times of patients in a trust department to be altered with the intent of ensuring four hour waiting times are met.
Departments where data manipulation was reported to have occurred
Data could also realistically be changed prior to submission to NHSE at a regional level. Possibly with the intent of gaining a promotion based on the falsely reported performance figures. Additionally, falsifying data to gain a higher assurance audit score.
Funding could potentially not be used for the purpose for which it was allocated. There is the potential that staff could be kept at a lower banding once qualified, even though funding has been allocated to support their promotion pathway.
It is a possibility that a hospital pharmacy could retain refunds for medication returned by wards and/or clinical areas. The ward or clinical area would pay the pharmacy for the medication upon initial issue, and if returned would usually receive a refund. However, funds could be retained by the hospital pharmacy. Additionally, if the ward requested the same medication again at later point, they would likely be charged again.
PESTLE analysis
Political: The NHS Neighbourhood Healthcare Framework includes percentage-based targets, which can be vulnerable to data manipulation.
Economic: As part of the NHS Elective Care Capital Incentive Scheme, providers are incentivised to improve performance for rewards, for example significant progress in reducing waiting list times. Although this may drive progress, it could also performance figure manipulation.
Technological: Health information management professionals reportedly have concerns around the use of artificial intelligence and machine learning for coding within healthcare, specifically around accuracy, bias and nuance.
Environmental: Investments have already been made to roll out AI within trusts; however, data centres contribute to greenhouse gas emissions, threaten local water supplies and consume electricity.
Legal: The Health and Care Act 2022 introduced 42 ICBs, however ICB footprints are changing with mergers, abolitions and new establishments planned.
Organisational: The NHSCFA is looking to further harness AI capabilities to improve our knowledge and understanding within the area of data manipulation.
Media Factors: Patients being treated in corridors has been reported online, however, in April 2025 the Secretary of State for Health and Social Care was reported to be looking to combat this ongoing issue with tailored support being developed for trusts to address the issue.
Reporting
During this reporting period, the NHSCFA received 14 reports compared to last year’s total of 25.
| Thematic area | 2020-21 | 2021-22 | 2022-23 | 2023-24 | 2024-25 | 2025-26 |
|---|---|---|---|---|---|---|
| Data manipulation | 14 | 17 | 13 | 8 | 25 | 14 |