How we work

Our operating model.

Our operating model, developed under our Evolution and Change programme, has been a major force running through our previous strategy. As we enter our new strategic period, there will be a renewed focus on stakeholder engagement with the aim of delivering an enhanced counter fraud response across the NHS and wider health sector. This includes ensuring we deliver the right things in the best possible way and at the highest quality, whilst remaining within our existing budget. The business model below sets out how this works in practice.

Key features are as follows

  • Enhanced intelligence capability, strengthening how resources could be better utilised, key partners better engaged with and functions aligned.
  • The concept of a Fraud Hub focused on supporting, enabling, assisting, and guiding health bodies on fraud – bridging the gap between our national fraud response and the local counter fraud response. Harnessing existing resource and continuing our efforts to engage with our key counter fraud community partners to understand the barriers and challenges to fighting fraud in the sector.
  • A strengthened investigative team structure within the National Investigation Service (NIS), with the development of a quality management system for enforcement and enhancing the approach to financial investigation and use of financial intelligence.
  • A strengthened fraud prevention function, aligning to the Fraud Hub , incorporating elements of deterrence, and keeping up to date with policy and systemic changes in the NHS through horizon scanning.
  • Enhanced planning, strategic development, and support to the NHSCFA’s strategy. Centralisation of data analytical functions in relation to oversight of techniques, data, resilience, and skills and enhancing our capability to identify potential fraud using latest innovations.
  • Enhancing and strengthening business support functions to fully support organisational aims and objectives. Incorporating resilience and cover whilst aligning and embedding with the NHSCFA’s integrated planning approach. This includes the need for a longer-term estates and IT strategy alongside provision for HR, workforce development and communications.
diagram of the NHSCFA's operating model

Government Counter Fraud Functional Standards

Our advice, guidance and intelligence
  • Fraud Prevention
  • Intelligence
Our enforcement
  • National Investigation Service
  • Including Digital Forensic Service and Financial Investigators
  • Investigation Quality Management
Our continued change and transformation
  • The development of transformation and change activity
Our support
  • People and Workforce
  • Information Systems
  • Finance and Corporate Services
Our counter fraud analytical ability, governance & performance
  • Information Analytics
  • Performance & Governance
Our stakeholders and partnership working
  • Local counter fraud services
  • NHS bodies
  • PSFA

Objectives and areas of focus

Fraud Hub
  • Developing system-wide counter fraud networks of stakeholders
  • Maintaining and developing a counter fraud culture
  • Guidance and toolkits within the NHS network
  • Local fraud prevention activity
  • Provide direct support/advice/guidance in relation to the Fraud Investigation Model
  • Managing the case managment system and associated process e.g. nominations
  • Provision of evaluation and assurance of compliance against the Counter Fraud Functional Standard by NHS Bodies
  • Determining thematic counter fraud priorities
  • Intelligence and analytical capability
Investigative priorities
  • Investigations are considered, prioritised and allocated
  • Investigating allegations of fraud across national and local services
Identifying, assessing and informing
  • Collating information against fraud threats
  • Strategic Intelligence Assessment (SIA)

Working with the Department of Health & Social Care Anti Fraud Unit

The NHSCFA provides an essential function as part of the wider health family in the fight against fraud, ensuring tax-payer funds are used to deliver better patient care and not diverted into the pockets of fraudsters. This new three-year strategy will ensure that the NHSCFA understands and keeps pace with new and emerging threats and has the capability to deal with them.

Sean Byrne, Deputy Director, Head of Counter Fraud, Department of Health & Social Care

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