As the health system becomes more complex and decentralised, there is a growing need for consistent fraud principles and standards, clearer visibility of fraud risk, stronger fraud response and improved governance and assurance across regional and local systems. In 2026–27, our focus will be on strengthening the foundations for improved governance and oversight, prompting leaders to recognise vulnerabilities earlier and respond more effectively. As services move to alternative settings, strong counter fraud controls, governance, clearer reporting and oversight are essential for identifying fraud risk early and taking robust action where fraud has occurred.
To deliver this, we will:
- work with selected ICBs and health bodies to improve counter fraud controls through commissioning activity ensuring proportionate governance and controls
- work with the DHSC and selected local systems to review the application of GOVS013 counter fraud standards in practice and develop improvement plans, piloting strengthened counter fraud governance and oversight arrangements
- develop and pilot improved counter fraud performance reporting, metrics and benchmarking to enable early action in response to emerging fraud risks and vulnerabilities
- work with local systems to improve digital literacy, enabling better understanding and interpretation of counter-fraud intelligence and metrics to drive meaningful fraud prevention and control activities
- take robust action when fraud is detected, sanctioning fraudsters and sharing learning with the sector to strengthen fraud controls
By March 2027, this work will have resulted in:
- counter fraud considerations featuring more consistently in commissioning decisions
- improved application of counter fraud standards, governance, assurance and control mechanisms for identified ICBs
- qualitative feedback from stakeholders on the value and impact of collaborative counter fraud support
- piloting of improved performance frameworks to allow benchmarking at local, regional and national levels
- feedback from selected health leaders showing that counter fraud reporting and assurance processes are more consistent and meaningful in pilot areas, enabling earlier and more proportionate intervention
- positive appropriate outcomes from fraud investigations