1. Portfolio/Number/Name:H/C 11 Countering NHS Fraud - NEW |
2. Programme/Activity: The SEHD published a strategy to counter NHS fraud in September 2005, the main tenets of which were a proactive approach and a shared responsibility by everyone working within, for or using the NHS to tackle fraud. This was based on the joint experience of countering NHS fraud to date of SEHD and NHSScotland Counter Fraud Services ( CFS), a central specialist NHS counter fraud unit set up by SEHD within NHS National Services Scotland in July 2000. Initially the CFS's remit was to tackle fraud in family health services but this was extended in October 2004 to the whole of the NHS in Scotland. Deterrence is the key objective and all NHS bodies in Scotland are required to make use of the CFS in order to reduce losses from fraud to a minimum and maintain that position. |
3. Savings | 3.1 Current target; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | 1.0 | 3.2 |
Time | 0 | 0 | 0 |
3.2 Efficiencies delivered; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | - | - |
Time | 0 | - | - |
4. Accountable Officer for delivery | Kevin Woods |
5. Project Manager | Senga Robertson |
6. EGDD Portfolio Manager | Rowena Simpson |
7. Description of efficiency and actions to be taken | 7.1 What is the efficiency improvement? How will the saving be made? CFS working in partnership with NHSScotland will reduce fraud by staff, contractors and patients in the NHS to an absolute minimum thereby releasing more resources to provide better patient care. Savings to be made through a mixture of actual recoveries and deterrence, i.e. money which has not been paid out in false claims. |
7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? Changing the culture by education, publicity and training, in respect of fraud against the NHS so that it becomes unacceptable - this is the responsibility of the CFS in conjunction with the fraud liaison officers of NHS bodies. A proactive campaign of deterrence, prevention, detection and investigation carried out by CFS in conjunction with all NHS Bodies. The full involvement and commitment of NHS Chief Executives to working in partnership with CFS, referring all relevant cases to the CFS for investigation, taking all appropriate actions (prosecution, discipline and civil recoveries) in cases where prima facie fraud has been identified by the CFS and reporting the outcomes of disciplinary cases to the CFS. |
8. Associated costs | 8.1 Are there any development or redundancy costs associated with the delivery of this efficiency? There are no redundancy costs associated with this saving and the recurrent operational costs of the CFS have been deducted from the savings quoted. |
9. Measurement | 9.1 What are the inputs that will be measured? There is no input to measure |
9.2 What are the outputs that will be measured? Actual recoveries and monies not expended due to deterrence. |
9.3 What is the baseline for inputs and outputs? The baseline is the business plan to extend the role of the CFS to cover all the NHS in Scotland, approved by the SEHD in 2003 and which commenced in April 2004. |
10. Quality cross-check | 10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Not applicable - the activity concerned is countering fraud and not directly increasing quality of treatment |
11. Monitoring | 11.1 What are the arrangements for monitoring the delivery of efficiencies? CFS have an on-going programme of measuring and recording actual recoveries and deterrent savings. Savings can derive from either the deterrence of fraud, hard cash recoveries or annualised savings. The exact method for estimating the savings depends on a number of factors, including whether or not there was a historical trend, or if any reductions in the value of claims for a particular service were observed. |
12. Reporting | 12 What are the arrangements for reporting the delivery of efficiencies? The reporting of savings is by quarterly and annual reports to Health Bodies and the SEHD |
13. Dependencies | 13.1 Explain if your savings are dependent on legislation or other structural changes being achieved. One of the tasks of the CFS is to report to SEHD gaps or grey areas in Regulations or guidance which they have identified as allowing fraud or sharp practice to take place with a view to amending these where possible. This is a continuous exercise. |
14. Use of savings | 14.1 How are the efficiencies released from improvement activity being used to improve front-line services? The savings released are primarily from deterrence, i.e. fewer resources are being diverted into the pockets of fraudsters and can therefore be used for patient care |