The impact of fraud is a threat to NHS sustainability and patient care. Every pound lost to fraud is a pound diverted from frontline services. As the NHS evolves and changes, the national counter fraud response must also transform to align to the health sector’s needs and evidence a clear return on investment.
We aim to deliver enhanced capability to prevent, detect and recover losses from fraud, while embedding fraud risk assessment, deterrence, and awareness across the system. This new operating model will be affordable, deliverable within budget and focused on the areas where it can have the greatest impact.
We will achieve this by:
- designing and implementing a new counter fraud operating model that is sustainable, flexible, responsive and aligned with the NHS’s evolving structures
- exploring opportunities for revenue generation to strengthen resilience and re-invest income into health focused counter fraud activity
- resources are focused on the highest risk areas identified through fraud risk assessments, fraud loss measurement exercises and the SIA ensuring maximum return on investment and smarter use of specialist counter fraud expertise
- acting as the central point for collating, assuring and reporting the prevention, detection and recovery of £600 million in health-wide counter fraud savings
- advocating for reforms to counter fraud legislation and powers, including mechanisms to recover funds more quickly, impose financial penalties and consequences for non-compliance of counter fraud responsibilities
- evaluating the feasibility and benefits of alternative models for criminal investigations to ensure the highest level of case quality, value for money and improved outcomes
Outcomes by 2029
Our ambition is to strengthen the system and reduce the vulnerability of financial losses to fraud, maximising the return on counter fraud investment, strengthening financial stewardship and reinforcing public trust.
We will ensure that:
- at least £600 million in fraud savings is achieved by 2029 through proactive prevention, detection, recovery, and deterrence
- roles at national, regional, and local levels are clarified, coordination is strengthened and a unified framework is in place for managing counter fraud activity
- consistent standards are embedded, intelligence is shared, and agile responses to complex or multi-agency fraud risks are maintained so that resources are deployed where they deliver the greatest impact
The combined effect of a strengthened national operating model, consistent approaches and a risk-based approach to managing priorities will result in measurable reductions in fraud.