The change and decentralisation of services can amplify potential fraud vulnerabilities if counter fraud principles are not considered at the early design stage. Complexity arising from multiple providers, diverse workforce arrangements and fragmented oversight means that fraud controls must be continuously strengthened and engrained to protect system integrity, improve efficiency, enhance accountability and ensure that NHS resources are directed to frontline services. We will work with the health sector to strengthen responses to fraud ensuring that fraudsters are sanctioned appropriately. We will work with counter fraud specialists, providing leadership to bolster counter fraud resilience in healthcare systems.
We will achieve this by:
- investigating fraud and driving appropriate enforcement action where it is detected
- collaborating with leaders and the counter fraud community to embed counter fraud principles in commissioning activity and service design ensuring controls are proportionate, governance is clear, and accountability is maintained across diverse providers
- helping Integrated Care Systems and local leaders meaningfully adopt and embed GOVS013 standards, to strengthen resilience, local assurance and governance, and where needed pursue appropriate enforcement action
- taking proactive action where there is evidence of dereliction of counter fraud responsibilities
- strengthening awareness and deterrence across systems by partnering with organisations to drive fraud awareness and counter fraud ethical behaviour into everyday practice
- developing business intelligence to drive improved fraud reporting, standards adoption, transparency and early action
- driving digitalisation and improving digital literacy of counter fraud products and tools
Outcomes by 2029
These ambitions ensure that healthcare systems are supported to design services that are fraud resilient, spot and respond to fraud risks and have clear counter fraud accountabilities.
We will ensure that:
- counter fraud principles are adopted in the development and delivery of existing and new healthcare services, so that providers understand their responsibilities under the GOVS013 standards, taking proactive action where there is a lack of evidence of this
- commissioning is underpinned by strong governance and accountability
- local healthcare systems can evidence strong counter fraud assurance and a culture of integrity
As the NHS provision moves closer to patients and communities, it will do so with transparency and resilience, and with confidence that the NHS finances and resources are protected.