Strengthening Counter Fraud Provision across the NHS in England

AIM

To identify where approaches to counter fraud across the NHS in England can be improved and to generate evidence and resources that will (re)shape the focus, organisation and activities of counter fraud. The ultimate aim is to reduce the reputational and financial loss and negative impacts on quality and safety of healthcare from fraudulently obtained employment, property or funds depriving the NHS of budgetary resources.

BACKGROUND

Official estimates indicate fraud costs the NHS approximately £1.2bn per year, nearly 1% of the entire NHS budget (NHS CFA, 2020). Fraud within the NHS can also have substantial impact on public trust and the on quality and safety of health care. Frauds are committed by people within and outside the NHS, and can include procurement fraud (fraudulent contracts, or non-delivery of goods), patient fraud (treatment/exemptions fraud), and employee fraud (qualification/recruitment fraud, expenses/timesheet fraud).

NHS organisations are required to prevent and respond to fraud (NHS England and NHS Improvement, 2020), but what this involves in practice– in organisational, personnel/activity terms - varies considerably. Responses to fraud are provided by a confused patchwork of public and private bodies, including NHS staff and agencies outside the NHS (Griffiths et al, 2023) We will work with national, regional and local organisations across the NHS in England to gain a greater understanding of fraud responses and identify areas where counter fraud approaches can be improved.

METHODS Mixed methods design with four interrelated work packages:

• Describe national policy: Map the existing national policy and strategy frameworks and the consequential organisational setup(s) for implementation - through analysis of policy documents and interviews with policymakers.

• Understand regional work: Identify the role of regional forums and organisations in NHS counter fraud knowledge exchange through a rapid review of web-based resources and interviews with professionals involved in forums, and regional external auditing providers.

• Explain local practices: Explore daily practices from training through to roles of local counter fraud service providers through a national survey, focus groups and interviews.

• Develop and evaluate recommendations and resources: Work with public, NHS and counter fraud stakeholders to undertake co-design workshops to develop, prototype and test recommendations and resources addressing competency, skills and joined up working to strengthen counter fraud responses. Formally evaluate co-developed resources using mixed-method, longitudinal, data collection.

PATIENT AND PUBLIC INVOLVEMENT

The project has been designed with extensive input from the Research Support Service public panel. A Public Stakeholder Advisory Group (PSAG) will play an active role through the project by providing important perspectives on matters of public and experiential importance, and will play a key role in the project’s dissemination plan and overall governance.

DISSEMINATION

Evidence, recommendations and resources, such as policy briefing papers, physical and digital outputs to support training and intelligence exchange, accessible and engaging summaries for patients and the public, clinicians and non-clinical staff working in the NHS will be disseminated. We will develop a tailored knowledge mobilisation strategy, with our PSAG, NHS Staff, and Counter Fraud Policy and Professionals Stakeholder Groups.