Introduction

The Strategic Intelligence Assessment is produced to establish fraud threats and estimate the amount of funding for the NHS in England vulnerable to fraud, bribery and corruption annually on behalf of the Department for Health and Social Care (DHSC). This informs the NHSCFA and its stakeholders of the priorities for the year ahead by capturing established, emerging, and potential future threats. The SIA has, and will continue to, ensure a coordinated response to fraud.

Since 2016–2017, the NHSCFA has continued to monitor and document the ongoing fraud threat facing the NHS in England. The SIA remains a consistent and reliable source for the fraud community to draw upon. Because fraudsters are quick to adapt to their current climate, the NHSCFA’s analysis is crucial to identifying the threats and intelligence gaps within an ever-evolving landscape. Allowing a coordinated response to fraud across the health sector and the maintenance of checks and balances that act as an effective deterrent.

The financial vulnerability is an estimate of how much NHS funding is exposed to the risk of loss from fraud. The current figure equates to 0.72% of the NHS budget for 2024 - 2025 and is a percentage decrease when compared with the previous budget. Although we have seen a financial vulnerability increase of £30.9 million (2.4%) when compared with the previous SIA, the allocated budget for the NHS in England has increased by over 9% to £186.838^e billion for 2024 – 2025. Therefore, it is likely that there is a correlation between the increase in budgets and an increase in the amount vulnerable to fraud. Although the overall financial vulnerability has increased, the decrease in the percentage of the budget vulnerable to fraud showcases an effective counter fraud approach across the health sector contrary to fraud increasing in England and Wales by 33% since 2017^f. The financial vulnerability data runs a year in arrears to reporting data therefore, this assessment will include 2023 – 2024 financial data and 2024 – 2025 reporting data.

Across 2024 – 2025 there have been increases within procurement in clinical expenditure, driven by inflation and changes in drugs and devices used. There has also been an increase in the number of prescription items dispensed, alongside a cost per item increase. Dentists are offered incentives with the aim of creating more than 2.5 million NHS appointments, with a minimum Unit of Dental Activity (UDA) rate being implemented. This reporting period also contains the second year of a £645 million investment for an expansion in primary care access in community pharmacy, including the Pharmacy First initiative. Additionally, member state claims issued against the UK, as well as the costs of an European Health Insurance Card (EHIC)/Global Health Insurance Card (GHIC) application increased. Furthermore, funding allocated to Integrated Care Boards (ICBs) has increased in comparison to the previous year, but inflation has reportedly still eroded the financial allocations received by trusts potentially incentivising fraudulent activity to plug the gap.

Reporting received by the NHSCFA has increased by 95 reports to 6,462 during 2024 – 2025. It is possible that with individuals reporting they are dissatisfied with the NHS, staff and patients may look to reporting fraud to improve circumstances. Furthermore, the cost-of-living crisis and global landscape can influence reporting patterns.

The NHS is exposed to increasing pressures and an ever-changing landscape both domestically and globally. Winter 2024 - 2025 A&E attendances were the highest on record, described as in line with a growing and aging population, although a disproportionate number of operational problems occurred. Bed occupancy has risen over the last 15 years and 11% of patients waited 12 hours before being admitted into hospital in January 2025. Although staff vacancies across the NHS were at 7.2% and overall sickness absence rates at 5.7%, a staff survey reported that one-third stated there were enough staff to perform their jobs properly.

In March 2025, the government announced that NHS England will merge with the DHSC, whilst Integrated Care Boards (ICBs) will be required to halve their costs, and the new NHS 10-Year Health Plan aims to result in transformation across healthcare. Additionally, the UK was impacted by the baseline tariff^g as part of the reciprocal tariffs introduced by the United States of America which could impact on healthcare costs. Change therefore continues to alter on the NHSCFA’s knowledge base, and we are continuously working to re-establish expertise and close intelligence gaps.

The NHSCFA’s 2025-2026 Business Plan details how we will protect the NHS from fraud, bribery and corruption through leading the NHS response, empowering others and being experts in our field, whilst also putting the interests of the NHS and its patients first. This is possible because the NHSCFA is an intelligence led authority which looks to the National Intelligence Model (NIM) for strategic direction, and with the support of our four strategic pillars^h we continue to improve our alignment to this model and support counter fraud activity against the backdrop of an ever-evolving landscape.

The NIM helps us to identify medium to long term priorities and prioritise the allocation of resources based on demand. The NHSCFA therefore follows the intelligence cycle to formulate these strategic plans, and the Strategic Intelligence Assessment is a key part of this. The DHSC-NHSCFA framework agreement and cycle require the production of a strategic assessment annually which identifies the threats and our understanding of them, as well as intelligence gaps and emerging trends to inform the NHSCFA and its stakeholders of the priorities for the year ahead. Therefore, the decision-making stage of the intelligence cycle determines what information will be collected based on intelligence from the previous cycle.

The collection stage involves gathering data through various methods to meet intelligence requirements. Once the raw data has been collected it can be processed / evaluated including assessing it against a criterion of threat, risk, harm and priorities to become information. The Home Office defines intelligence as ‘assessed information’, so analysis will then be performed on the processed information. This requires research and intelligence development, which results in intelligence assessments at both strategic and tactical levels, such as the SIA. This will then be disseminated to the correct recipients.

Integration then allows the NHSCFA and its stakeholders to determine how we are going to respond to fraudsters and disrupt criminal activity across the sector based on the intelligence provided within the assessments, whilst also feeding back into decision making on future priorities. As a result, the SIA has a designated place within an intelligence led organisation and can be used both internally and externally to drive overt activity to combat described threats and minimise the highlighted intelligence gaps. This ensures an intelligenceⁱ led response to fraud in the NHS to drive forward counter fraud activity and protect money for patient care.

Over the past year we have continued to expand and improve our working relationships within the counter- fraud community, collaborating with stakeholders internally and externally to further combat fraud against the NHS, including Project Athena data scientists and our newly embedded Fraud Risk team. We have also worked with multiple external stakeholders, including NHSE, to improve our knowledge around data manipulation and pharmaceutical contractor fraud, whilst maintaining relations with policy holders, including the Department for Health and Social Care (DHSC) regarding reciprocal healthcare fraud and fraudulent access to NHS care from overseas visitors. We continue to bring more accurate and informed intelligence to the health sector. Both newly established and continuous stakeholder relations have not only increased confidence in our analysis but maintained the reliability and accuracy.

5. Total NHS revenue department expenditure limit (RDEL) as per financial directions
6. Between year-end March 2017 December 2024 - ONS
7. Other than with automobiles
8. Understand, Prevent, Respond and Assure
9. This assessment is based on intelligence, data and information from various sources, therefore the hypothesis and inferences drawn are from the most appropriate and accessible / available information at the time of writing.