NHS Requirement 10
The organisation undertakes proactive work to detect fraud using relevant information and intelligence to identify anomalies that may be indicative of fraud, bribery and corruption and takes the appropriate action, including local exercises and participation or response to national exercises. Results of this work are evaluated and where appropriate feed into improvements to prevent and deter fraud, bribery and corruption.
Relevant information and intelligence may include (but is not limited to) internal and external audit reports, information on outliers, recommendations in investigation reports and NHSCFA led loss measurement exercises. The findings are acted upon promptly.
Organisation meets the requirement
Where anomalies are identified which may be indicative of fraud, bribery and corruption, the organisation carries out proactive exercises to address them. Resulting recommendations are actioned.
The results of these exercises are evaluated and, where appropriate, fed into improvements in the processes for detecting anomalies.
Organisation partially meets the requirement
The organisation can demonstrate that it uses relevant information and intelligence to identify anomalies that may be indicative of fraud, bribery and corruption.
There is evidence to indicate that, where anomalies are identified, proactive exercises are carried out to assist in the prevention and detection of fraud, bribery and corruption. Any fraud detected as a result of these exercises is investigated appropriately.
There is little or no evidence of the effectiveness of actions taken to reduce fraud, bribery and corruption as a result of anomalies being identified.
Organisation does not meet the requirement
There is no evidence that the organisation uses relevant information and intelligence to identify anomalies that may be indicative of fraud, bribery and corruption.
There is no evidence to indicate that where anomalies are identified, proactive exercises are conducted to assist in the mitigation of fraud, bribery and corruption risks.
Guidance, supporting documentation and evidence
Organisations should consider the following (the list is not exhaustive):
- The NHSCFA strategy
- Results from evaluation activities, for example a measured reduction in risk
- Evidence of liaison with internal audit
- Evidence of liaison with finance and payroll staff
- Minutes of relevant meetings, action points and records of their execution
- Information from the NHSCFA’s Information and Intelligence Unit
- Other records held by the NHSCFA (e.g. on the approved NHS case management system)
- Documents relating to the planning and preparation of proactive prevention and
- detection exercises, such as terms of reference
- Final reports from proactive exercises
- Final report findings from participation or response to national exercises.
- NHSCFA circulars
- NHSCFA’s ‘Intelligence Alerts, Bulletins and Local Warnings Guidance
- General Condition 5.8 of NHS Standard Contract 2017/18-2019/20
- Home Office guidance 'Right to work checks: an employer's guide'
- NHS Employers guidance, Employment Check Standards
- Care Quality Commission ‘Guidance for providers on meeting the regulations’
- Learning aims and outcomes of training on pre-employment checks
- Evidence that relevant staff have been trained and that training is kept up to date
- Evidence of the organisation checking external employment agencies’ compliance
- Evidence that the appropriate processes have been followed (e.g. records of sample checks made by the organisation)
- Evidence of review of contracts
- Evidence of supplier framework audits
- Evidence of proactive work conducted in this area
- Examples of reviews and/or audits of pre-employment checking
- Examples of where the results of evaluation and/or audits have led to improvements to pre-employment checking
- Relevant risk assessments
- Evidence of the review of policies and procedures relating to procurement fraud, bribery and corruption
- Additions to risk matrices
- Risk management group minutes
- Records of prevention and detection work carried out in compliance with the NHSCFA document ‘Pre-contract procurement fraud and corruption: Guidance for prevention and detection’
- Awareness materials for fraud, bribery and corruption risks in the area of procurement
- Evidence of the evaluation of counter fraud measures
- Evidence of gifts and hospitality declarations and conflict of interest declarations by procurement staff and evidence of any necessary subsequent actions taken
- Examples of where the results of evaluation and/or audits have led to improvements to procurement processes
- NHS England ”Managing Conflicts of Interest in the NHS” Guidance for staff and organisations.
- The NHSCFA document Invoice and mandate fraud: (guidance for prevention and detection)
- Evidence of the review of policies and procedures relating to invoice fraud
- Records of deterrence, prevention and detection work carried out in compliance with the NHSCFA guidance
- Awareness materials on fraud, bribery and corruption risks in the area of invoicing
- Examples of where the results of evaluation and/or audits have led to improvements to invoicing processes