Counter Fraud Strategy and Anti Bribery Statement

Contents

1. Introduction
2. NHS Counter Fraud Framework
3. The Fraud Problem
4. National context
5. The EEAST response
6. Vision
7. Context
8. A Structure for delivery
9. EEAST Fraud Management Objectives
10. Objective 1 – Getting the basics right
11. Objective 2 – Building capability
12. Objective 3 – Insight
13. Objective 4 – Working together
14. Objective 5 – Minimising loss
15. Anti-Bribery Statement

 

Introduction

At the East of England Ambulance Service NHS Trust (EEAST), our overarching aim is to place our patients and staff at the heart of everything we do while delivering our vision of ‘outstanding care, exceptional people, every hour of every day’. We provide safe, high-quality services across the six counties we serve, and work closely with our partners to ensure that all our patients receive the right care, in the right place, at the right time. We are committed to applying the highest standards of ethical conduct and integrity and to delivering the highest standards of patient care, this means being focused on safeguarding the funds needed for this.

Fraud is an act of deception that it intended to make a financial gain or to cause loss to another party. Bribery is generally defined as the giving or receiving of a financial or other advantage in exchange for improperly performing a relevant function or activity.

EEAST is a publicly funded organisation and is committed to applying the highest standards of ethical conduct and behaviour, which includes having robust controls in place to prevent fraud, bribery and corruption. EEAST also expects its suppliers and those working on its behalf to adhere to these standards and may seek to terminate contracts with any suppliers found by a court of law to have been guilty of corruption.

EEAST has a zero-tolerance approach to fraud, bribery and corruption and will seek the highest levels of redress against those who commit fraud. Under no circumstances is the giving, offering, receiving or soliciting of a bribe acceptable. This strategy contains EEAST’s Anti bribery statement.

The success of the organisation’s counter fraud, bribery and corruption measures depends on all employees and those acting for the organisation playing their part in helping to prevent, detect and deter fraud, bribery and corruption.

 

We have developed this strategy to help us achieve those aims. It sets out the Trust’s vision and key objectives over the coming four years that focus on the implementation of risk-based systems and organisation wide approaches to tackling fraud, designed to cover all staff, departments, and locations.

 

The vision is supported by 5 key objectives:

• Getting the basics right – maximising fraud prevention
• Building capability – for a high performing counter fraud function
• Insight – intelligence sharing to identify threats
• Working together – collaboration and coordination of responses to fraud
• Minimising loss – embedding a culture of fraud prevention

 

NHS Counter Fraud Framework

From April 2021 it is a mandated national requirement that the Government Counter Fraud Functional Standard is applied to all NHS organisations. This standard contains twelve separate components and one of these relates to a requirement to develop and implement a 3 to 5 year counter fraud strategy.  This requirement is covered specifically under Component 2 of the standard which states:

“The organisation aligns counter fraud, bribery and corruption work to the NHS Counter Fraud Authority (NHS CFA) counter fraud, bribery and corruption strategy. This is documented in the organisational over-arching strategy or counter fraud, bribery and corruption policy, and is submitted upon request. The counter fraud work plan and resource allocation are aligned to the objectives of the strategy and locally identified risks.”

The following constitutes ‘The East of England Ambulance Service NHS Trust Counter Fraud Strategy 2021-2024’ and it is based on:

1. The Department of Health and Social Care (DHSC) Counter Fraud Strategy 2021-2024 published on the 31 March 2021;
2. The mandated requirements of the NHS Counter Fraud Authority (NHS CFA) Counter Fraud Functional Returns that was mandated for the NHS from April 2021; and,
3. The East of England Ambulance Service NHS Trust Local Fraud Risk Assessment (EEAST FRA) and the wider risk management requirements of the Trust.

The EEAST FRA is a restricted access document as it contains potential fraud risk exposures to the Trust. Fraud risk is considered regularly by the Trust’s Director of Finance and Commissioning, Fraud Champion, and the Trust’s Audit Committee in response to intelligence received from time to time from the NHS CFA, the police, other government agencies and internal and external whistle-blowers.

The underlying principle adopted by EEAST is an organisational and systems wide approach to tackling fraud that mirrors the approach taken by the DHSC in its 2021 counter fraud strategy.

 

The Fraud Problem

National context

The NHS Counter Fraud Authority (NHSCFA) have assessed, that, in the context of a 2019 to 2020 NHS budget in England of almost £140 billion, fraud, bribery and corruption against the NHS costs the public purse an estimated £1.21 billion.

This loss directly affects the services that the NHS provide, negatively impacting on the availability of resources, reducing the money able to be spent on key services and damaging the reputation of NHS bodies with their patients. The scarcity of Trust resources within the current economic and public health climate creates a further urgency to respond robustly to the fraud threat and is a key element when ensuring the proper administration of public money.

The risk of fraud potentially extends to every transaction, contract and payment made across the NHS. It is acknowledged that the overwhelming majority of activity and individuals working within the NHS are correct and honest, but this strategy acknowledges that there is a small minority of staff and external individuals and organisations that operate without a high degree of integrity and that they seek to exploit their own position or NHS systems and processes for their personal and illegal gain. 

The strategy recognises there is no one solution. Addressing fraud needs a holistic response incorporating detection, prevention, sanction and redress, underpinned by a strong understanding of risk. It also requires cooperation and a spirit of collaborative working between those working in the counter fraud arena and management and staff working throughout the Trust.

 

The EEAST response

Vision

The Trust will implement a risk-based system and organisation wide approach to tackling fraud which is designed to cover all staff, departments and locations for the purposes of:  

• Maximising fraud prevention.
• Proactively detecting where EEAST may be exposed to fraud and offer recommendations on improvement.
• Managing cases on a cost-effective basis.
• Embedding the risk methodology used to assess all other Trust risks.
• Linking the counter fraud strategy to EEAST’s overall risk strategy and the Trust’s overall risk appetite.
• Underpinning a zero tolerance to fraud.
• Providing a systematic methodology to tackle fraud that protects the taxpayer’s money and by doing so increase investment in patient care.

 

Context

There are 5 internationally recognised principles for public sector fraud and our counter fraud work is based on and predicated by these underlying principles:

1. There is always going to be fraud

It is a fact that some individuals will look to make gains where there is opportunity and organisations need robust processes in place to prevent, detect and respond to fraud and corruption.

2. Finding fraud is a good thing

If you don’t find fraud you can’t deal with it. This requires a change in perspective, so the identification of fraud is viewed as a positive and proactive achievement.

3. There is no one solution

Addressing fraud needs a holistic response incorporating detection, prevention, enforcement and redress, underpinned by a strong understanding of risk. It also requires cooperation between counter fraud providers and local Trust departments under a spirit of collaboration.

4. Fraud and corruption are ever changing

Fraud, and counter fraud practices, evolve very quickly and organisations must be agile and change their approach to deal with these evolutions.

5. Prevention is the most effective way to address fraud and corruption

Preventing fraud through effective counter fraud practices reduces the loss and reputational damage. It also requires less resources than an approach focused on detection and recovery.

Delivering the counter fraud principles in the NHS

We will deliver the 5 key principles in EEAST by ensuring our work:

• Is provided by individuals who are appropriately qualified and have experience of countering NHS fraud.
• Is reliant on a collaborative, trust based and mutually respectful approach between the counter fraud and departments within EEAST especially with regards to sharing information about identified and potential fraud risks and best practice.
• Recognises that reducing fraud and financial loss is the responsibility of all staff and therefore supports the development of a clear assurance framework that is underpinned by consistent guidance and clear escalation routes.
• Builds on previous successes and lessons learned at the Trust and by proactively seeking to introduce preventative ways of permanently eradicating whole categories of fraud and financial loss through new systems design and application and minimising the opportunity for new categories of fraud to arise.
• Acknowledging that work on fraud and other types of financial loss is critical to maintaining a sustainable and financially balanced NHS.

Our strategy will remain flexible and adapt to and anticipate the changing environment and emerging fraud risks to ensure we still deliver.

 

A Structure for delivery

The role of the NHS Counter Fraud Authority (NHSCFA)

The NHSCFA will be the single expert intelligence-led organisation providing centralised intelligence, investigation and solutions capacity for tackling fraud, bribery and corruption in the NHS in England. The NHSCFA will act as the repository for all information and intelligence related to fraud in the NHS and the wider health group and will have oversight of and monitor counter fraud work across the NHS. They will provide strategic and tactical solutions to identified fraud risks, counter fraud standards and assessment of performance through the provision of comparative data.

The NHSCFA will work collaboratively across the NHS, DHSC and other relevant organisations to obtain better information and intelligence on the types of fraud the health group is exposed to and assist in putting in place effective measures to better prevent, deter and investigate fraud.

The role of NHS England and NHS Improvement and NHS Commissioners

Within the framework of the overall anti-fraud work directed by DHSC, NHS England and NHS Improvement and NHS Commissioners will be responsible for implementing the required activities. Having due regard for the Cabinet Office Counter Fraud Functional Standards.

NHS England and NHS Improvement will investigate allegations of fraud against NHS England and NHS Improvement (NHSEI) and its constituent parts, NHS commissioners will investigate where they have suffered a loss, unless these fall within the remit of NHSCFA. Each commissioner will have an appropriate programme of proactive counter fraud work to address its own fraud risks. NHS commissioners will have appropriate anti-fraud measures in place when contracting with providers of NHS services.

The role of the NHS providers

NHS providers are required to comply with the requirements of the NHS standard contract and undertake counter fraud measures at the local level. They will assist NHSCFA in the implementation of actions arising from the centrally determined approach and action plans, including the provision of information and data to enable effective counter fraud work to be undertaken.

Additionally, they will undertake local prevention and deterrence activity, along with appropriate investigation and sanction activity, and demonstrate compliance with the Government Counter Fraud Functional Standards (GCFFS) from April 2021. 

 

EEAST Fraud Management Objectives

To achieve our vision, we have identified 5 key objectives that are fundamental to our success.

 Objective 1 – Getting the basics right

We will maximize our fraud prevention work by working with process and policy owners, consider, design and build in fraud mitigation measures from the outset

Actions to achieve our objective

To achieve our objective, we will undertake the following actions:

1. Facilitate collaborative working between counter fraud with Finance, HR, IT, Policy, Governance and Risk and Communications to ensure they have sufficient understanding of their capability/ ability to interrogate systems and data to monitor for evidence fraud / adequacy of fraud prevention measures.
2. Demonstrate value for money through counter fraud cost and benefit reporting.
3. Raise awareness of the Government Counter Fraud Functional Standards within EEAST.

Measuring success

To assess the impact of our actions, outcomes and measures will include:

• Achieving an overall ‘Green’ rating for the annual Government Counter Fraud Functional Standards (GCFFS) return.
• Evidence showing year on year improvements in compliance with the CFFSR Standards.
• Enhancing counter fraud cost and benefit reporting within EEAST to help demonstrate that local investment counter fraud investment pays for itself.

 

Objective 2 – Building capability

We will engage a high performing and diverse counter fraud function, with great people in the right roles with the right skills.

Actions to achieve our objective

To achieve our objective, we will undertake the following actions:

1. Develop and monitor its counter fraud service using a set of agreed KPI’s that reflect local and any national NHSCFA requirements.
2. Ensuring that the Trust scores Component 9 of the CFFSR standards as ‘Green’ in its annual submission to the NHSCFA.

Measuring success

 To assess the impact of our actions, outcomes and measures will include:

• Periodic review of the counter fraud service using a set of key output KPI’s.
• Ensuring that counter fraud staff maintain their expertise by reviewing their CPD in the area of counter fraud.

 

Objective 3 – Insight

Increasingly, the counter fraud provider will measure the impact of activity to protect the Trust from economic crime at a local level.

Intelligence will be shared where appropriate. Increasingly, the counter fraud provider will be able to measure the impact of activity to protect the Trust from economic crime at a local level.

Intelligence will be increasingly shared across the Trust to enable us to understand and spot fraud threats earlier.

Actions to achieve our objective

To achieve our objective, we will undertake the following actions:

1. The counter fraud provider will lead intelligence sharing efforts of fraud related matters with specific Trust departments where there may be a risk of fraud.
2. The counter fraud provider will liaise with the Trust Communications and Education Departments to establish how to maximize staff awareness of counter fraud matters.
3. Counter Fraud will routinely use technology and data mining of Trust systems and information to consistently target key data and systems to detect and prevent fraud wherever possible.

Measuring Success

 To assess the impact of our actions, outcomes and measures will include:

• Successful targeted proactive measurement exercises.
• Increased levels and quality of fraud reporting.
• Completing a detailed fraud risk assessment using the fraud level methodology mandated by the NHSCFA.
• Increasing the number of fraud detection exercises especially in those areas identified in the fraud risk assessment as ‘low volume / high impact’ fraud risk areas.
• Increased use of data analytics to inform the picture of fraud risk across Trust operations and its wholly owned subsidiaries.

 

Objective 4 – Working together

We will increase collaboration and coordination of counter fraud responses across the Trust

Actions to achieve our objective

To achieve our objective, we will undertake the following actions:

1. Agree working protocols between counter fraud and Trust departments where such protocols add value to preventing and detecting fraud.
2. Advise on fraud prevention controls to be included within Trust policies.
3. Act on fraud prevention notices that are issued by the NHSCFA.
4. Participate in the National Fraud Initiative (NFI).
5. Comply with any mandated NHSCFA exercise.
6. Consider EEAST involvement in any non-mandated NHSCFA exercise on the basis of the cost and value to the Trust.

Measuring success

To assess the impact of our actions, outcomes and measures will include:

• Number of agreed working protocols in place.
• Number of Trust policies reviewed.
• Number of FPN’s issued and responded to.
• NFI exercise completion.
• Compliance with NHSCFA mandated data harvesting requests.
• Consideration of all non-mandated NHSCFA data harvesting requests.
• Number of employees undertaking mandatory and ad hoc training sessions.
• Employee responses on the annual counter fraud survey.

 

Objective 5 – Minimising loss

We will drive a strong culture of counter fraud planning, risk and performance management.

Actions to achieve our objective

To achieve our objective, we will undertake the following actions:

1. We will involve counter fraud on new system developments so as to fraud proof new systems and processes before they are implemented.
2. We will increase emphasis on fraud prevention activity and develop measures to ensure we can evidence the impact.
3. We will report on fraud prevention, fraud detection and fraud case costs and recoveries where possible and within any legal constraints. These will be used to inform exposure to fraud risks going forward and be reported to the NHSCFA on the annual CFFR return.

 Measuring success

To assess the impact of our actions, outcomes and measures will include:

• Number of fraud proofing exercises completed.
• Assessing the value of fraud prevention measures using the measurement metrics issued by the NHSCFA.
• Financial recoveries achieved in each accounting period/reported via CLUE.

 

Anti-Bribery Statement

Bribery is defined within the Bribery Act 2010 as the giving or receiving of a financial or other advantage in exchange for improperly performing a relevant function or activity.

Under no circumstances is the giving, offering, receiving, or soliciting of a bribe acceptable and we will not tolerate this in any form. This applies to all staff, volunteers, and non-executives, together with any external agents working or acting on our behalf.

Our zero-tolerance approach to bribery, and commitment to the Bribery Act 2010, is set out in further detail within the Counter Fraud and Anti-Bribery Policy, and across a range of other Trust policies and procedural documentation. All staff and volunteers, non-executives and other relevant parties are responsible for familiarising themselves with the requirements surrounding this and for complying with these at all times.

Any instances of non-compliance will be dealt with firmly and, in addition to possible internal disciplinary action, it is noted that a criminal offence under the Bribery Act 2010 could lead to up to 10 years imprisonment and/or an unlimited fine.

With regard to external parties, we will not do business with anyone who does not support our anti-bribery commitments, and we reserve the right to terminate any contracts where there is evidence of acts of bribery have been committed.

If you are in any doubt as to whether any conduct could amount to bribery, or if you have any concerns or suspicions regarding bribery being committed, please refer to the contact details within our Counter Fraud and Anti-Bribery policy, or the Whistleblowing policy. Such a response is critical to the success of our anti-bribery measures and we will support anyone raising an issue, provided that you are acting in good faith.