NHS Requirement 6

The organisation identifies and reports on annual outcome-based metrics with objectives to evidence improvement in performance. This should be informed by national and local risk assessment, national benchmarking and other comparable data. Proactive and reactive outcomes and progress are recorded on the approved NHS fraud case management system.

Metrics should include all reported incidents of fraud, bribery and corruption, the value of identified fraud losses, the value of fraud recoveries, the value of fraud prevented, criminal sanctions and disciplinary sanctions.

Organisation meets the requirement

The organisation has agreed targets / outcomes and has metrics in place to monitor progress - these are regularly reviewed by the Audit Committee and revised where necessary. New metrics are appropriately implemented.

Successful metric outcomes are demonstrated through full reporting by the organisation via the approved NHS fraud case management system.

Counter fraud costs and organisational data benchmarking are reported to the organisation’s audit committee on a regular basis.

Organisation partially meets the requirement

The organisation has agreed targets / outcomes but no evidence of tracking or monitoring to measure progress.

The organisation has risk-based objectives, outcomes and metrics in place to monitor progress but there is no evidence of evaluation undertaken to ascertain effectiveness.

Organisation does not meet the requirement

No metrics are in place (or defined outcomes against counter fraud initiatives or investments).

Metrics are in place at the organisation but the outcomes from these are not recorded fully on the approved NHS fraud case management system.

Counter fraud costs and organisational data benchmarking are not reported to the organisation’s audit committee on a regular basis.

Guidance, supporting documentation and evidence

Organisations should consider the following (the list is not exhaustive):

  • The NHSCFA strategy
  • NHS Counter Fraud Manual
  • The NHSCFA instructions and guidance on the use of the NHSCFA case management system.
  • Approved NHS fraud case management system records
  • Approved NHS fraud case management system weakness records
  • Investigation files
  • Evidence of proactive prevention and detection exercises
  • NHSCFA Benchmarking data
  • Counter fraud, bribery and corruption work plan
  • Audit committee minutes
  • A measured reduction in risk or expenditure
  • NHSCFA circulars
  • NHSCFA’s Intelligence Alerts, Bulletins and Local Warnings Guidance
  • Results of thematic engagements
  • Evidence derived from participation in the National Fraud Initiative (if appropriate)