Counter fraud, bribery and corruption policy

Contents

1 Introduction

The aim of this policy is to set out Rotherham, Doncaster and South Humber NHS Foundation Trust’s policy on suspected and detected fraud, bribery and corruption, and to help individuals who may identify suspected fraud. It provides a framework for responding to suspicions of fraud.

Rotherham, Doncaster and South Humber NHS Foundation Trust adheres strictly to one of the basic principles of public sector organisations which is the proper use of public funds. It is, therefore, important that all those who work for Rotherham, Doncaster and South Humber NHS Foundation Trust are aware of the risk of, and means of enforcing the arrangements against fraud, bribery and corruption.

Our policies, procedures and staff training reflect our commitment to acting ethically in all our business relationships, and to implementing effective systems and controls to protect public funds and mitigate the risk of fraud.

The NHS counter fraud authority (NHSCFA) is accountable to the department for health anti-fraud unit and works collaboratively with key stakeholders, including NHS England, NHS improvement and the cabinet office. It has responsibility for overseeing counter fraud arrangements within the NHS and within those organisations funded to provide NHS care.

Rotherham, Doncaster and South Humber NHS Foundation Trust has appointed an accredited person, nominated to the NHSCFA, to undertake the full range of counter fraud, bribery and corruption work, including proactive work to prevent and deter fraud, bribery and corruption, and reactive work to hold those who commit fraud, bribery or corruption to account.

2 Purpose

The purpose of this document is to set out Rotherham, Doncaster and South Humber NHS Foundation Trust’s policy on suspected and detected fraud, bribery and corruption, and to help individuals who may identify suspected fraud. It provides a framework for responding to suspicions of fraud. Further guidance if you suspect fraud may be obtained by contacting our counter fraud specialist (CFS) or the director of finance (contact details can be found in appendix E).

3 Scope

3.1 Policy principles

Rotherham, Doncaster and South Humber NHS Foundation Trust strategic approach is that we have a zero tolerance to fraud, bribery and corruption within the organisation. The aim is to eliminate fraud, bribery and corruption as far as possible as they ultimately lead to a reduction in the resources available for patient care. Rotherham, Doncaster and South Humber NHS Foundation Trust is required to always act honestly and with integrity to safeguard public resources it is responsible for.

Rotherham, Doncaster and South Humber NHS Foundation Trust will not tolerate any acts of fraud, bribery or corruption perpetrated against it or involving its employees and will actively pursue all available criminal and civil actions, including the recovery of loss suffered as a result. The board of directors is committed to the elimination of fraud, bribery and corruption by ensuring that there is a strong anti-fraud, bribery and corruption culture, proactive prevention, detection and deterrence through widespread awareness, and by rigorously investigating any such cases, and where proven, to ensure wrong doers are appropriately dealt with, including taking steps to recover assets lost as a result of fraud, bribery and corruption.

The NHSCFA has released the government functional standard 013 counter fraud (‘the functional standard’) as a suite of requirements to countering fraud across the NHS. The functional standard will replace the old standards used by the NHSCFA and becomes effective from 1 April 2021. To meet Rotherham, Doncaster and South Humber NHS Foundation Trust’s objectives and to demonstrate its commitment to taking all necessary steps to counter fraud, bribery and corruption, the functional standard has been adopted by Rotherham, Doncaster and South Humber NHS Foundation Trust.

The purpose of the functional standard is to set the expectations for the management of fraud, bribery and corruption risk in government organisations and means that the whole counter fraud community in the public sector is working to a common counter fraud standard.

NHS funded services will be required to provide NHSCFA with details of their performance against the functional standard annually.

The term ‘NHS funded services’ above refers to any organisation with partial or full NHS funding. Currently this includes NHS trusts, foundation trusts, ambulance trusts, special health authorities, clinical commissioning groups, certain independent healthcare providers, health boards, NHS improvement and NHS England.

From April 2021, Rotherham, Doncaster and South Humber NHS Foundation Trust is expected to obtain organisational assurance against the functional standard. The functional standard provides guidance to organisations on the arrangements for undertaking assurance.

The functional standard removes the previous strategic areas of strategic governance, inform and involve, prevent and deter and hold to account and sets out a number of specific component requirements namely:

3.1.1 Component 1, accountable individual

Have an accountable individual at board level who is responsible for counter fraud, bribery and corruption. For Rotherham, Doncaster and South Humber NHS Foundation Trust this will be the director of finance.

3.1.2 Component 2, counter fraud bribery and corruption strategy

Have a counter fraud, bribery and corruption strategy. This is set out in this policy under section 2 policy principles.

3.1.3 Component 3, fraud bribery and corruption risk assessment

Have a fraud, bribery and corruption risk assessment.

3.1.4 Component 4, policy and response plan

Have a policy and response plan for dealing with potential instances of fraud, bribery and corruption. This is set out as at appendix A of this policy.

3.1.5 Component 5, annual action plan

Rotherham, Doncaster and South Humber NHS Foundation Trust maintains an annual work plan that is informed by national and local fraud, bribery and corruption risk assessments identifying activities to improve capability and resilience. This includes (but is not limited to) defined objectives, milestones for the delivery of each activity and measurable areas for improvement in line with strategic aims and objectives. The plan is agreed, and progress monitored by the audit committee.

3.1.6 Component 6, outcome-based metrics

Rotherham, Doncaster and South Humber NHS Foundation Trust has outcome-based metrics summarising what outcomes it is seeking to achieve that year.

3.1.7 Component 7, reporting routes for staff, contractors and members of the public

Rotherham, Doncaster and South Humber NHS Foundation Trust will have well established and documented reporting routes for staff, contractors and members of the public to report suspicions of fraud, bribery and corruption and a mechanism for recording these referrals and allegations.

3.1.8 Component 8, report identified loss

Rotherham, Doncaster and South Humber NHS Foundation Trust will report identified loss from fraud, bribery, corruption and error and associated recoveries, in line with the agreed government definitions.

3.1.9 Component 9, access to trained investigators

Rotherham, Doncaster and South Humber NHS Foundation Trust will have agreed access to trained investigators that meet the agreed public sector skill standard.

3.1.10 Component 10, undertake detection activity

Rotherham, Doncaster and South Humber NHS Foundation Trust will undertake activity to try and detect fraud in high-risk areas where little or nothing is known of fraud, bribery and corruption levels, including loss measurement activity where suitable.

3.1.11 Component 11m access to and completion of training

Rotherham, Doncaster and South Humber NHS Foundation Trust will ensure that all staff have access to and undertake fraud awareness, bribery and corruption training as appropriate to their role.

3.1.12 Component 12, policies and registers for gifts and hospitality and conflicts of interest

Rotherham, Doncaster and South Humber NHS Foundation Trust will have policies and registers for gifts and hospitality and conflicts of interest.

All staff have a duty to protect the assets of Rotherham, Doncaster and South Humber NHS Foundation Trust and also to cooperate with any investigation. The Board recommends anyone having suspicions of fraud, bribery or corruption to report those suspicions. All reasonably held suspicions will be taken seriously.

For concerns which relate to fraud, bribery or corruption these should be reported through the provisions within this policy, rather than through the freedom to speak up raising concerns (whistleblowing) policy.

3.2 Definitions

The following definitions apply for the purposes of this policy and the corresponding fraud response plan attached at appendix A.

3.2.1 Fraud

The Fraud Act 2006 came into force on the 15 January 2007 and introduced the general offence of fraud. It is no longer necessary to prove that a person has been deceived. The focus is now on dishonest behaviour and any intent to make gain or cause loss to another party. Put simply, fraud is a dishonest act intended for gain or to cause loss to another.

There are three main ways in which the offence of fraud can be committed:

• fraud by false representation (lying about something using any means, for instance words or actions)
• fraud by failure to disclose (not saying something when you have the legal duty to do so)
• fraud by abuse of position (abusing a position where there is an expectation to safeguard the financial interests of another person or organisation)

It should be noted that all offences under the Fraud Act (2006) occur where the act or omission is committed dishonestly and with intent to cause gain or loss. The gain or loss does not have to succeed so long as the intent is there.

3.2.2 Bribery

The Bribery Act (2010) came into force on 1 July 2011 and created three general offences of bribery:

• offering, promising or giving a bribe to induce someone to behave improperly, or to reward someone for having already done so
• requesting, agreeing or accepting a bribe either in exchange for acting improperly or where the request or acceptance is itself improper
• bribery of a foreign public official

A new corporate offence was also introduced:

• failure by a company to prevent a bribe being paid, or a business advantage

Bribing anyone is absolutely prohibited. Employees will not pay a bribe to anybody. This means you will not offer or promise reward in any way, or give financial or other advantage to any person, in order to induce that person to perform activities improperly. It does not matter whether the other person is a UK or foreign official, political candidate, party official, private individual, public sector employee or any other person.

Bribery does not have to involve cash or an actual payment exchanging. It can take many forms such as a gift, lavish treatment during a business trip or tickets to an event.

3.2.3 Corruption

Bribery is a form of corruption but corruption also includes many other dishonest practices such as fraud, nepotism, collusion and abuse of power or position. Corruption does not always result in a loss and the corrupt person may not always benefit directly from their deeds, however they may be unreasonably using their position to give some advantage to another.

This policy applies to all Rotherham, Doncaster and South Humber NHS Foundation Trust employees and contractors who are working for the organisation.

4 Responsibilities, accountabilities and duties

4.1 Chief executive

As Rotherham, Doncaster and South Humber NHS Foundation Trust’s accountable officer, the chief executive has overall responsibility for funds entrusted to Rotherham, Doncaster and South Humber NHS Foundation Trust. The chief executive must ensure that adequate policies and procedures are in place to protect the organisation and the funds it receives from fraud, bribery and corruption.

4.2 Director of finance

The director of finance accepts overall responsibility for all matters relating to fraud, bribery and corruption within Rotherham, Doncaster and South Humber NHS Foundation Trust.

4.3 The audit committee

The audit committee should satisfy itself that the organisation has adequate arrangements in place for counter fraud, bribery and corruption to comply with the functional Standard.

4.4 Human resources staff

Human resources staff provide advice, guidance and support to Rotherham, Doncaster and South Humber NHS Foundation Trust managers and officers investigating disciplinary matters. All disciplinary matters which involve suspected fraud, bribery or corruption offences will also be subject to parallel criminal investigation by the organisation’s CFS. A liaison protocol is in place which details arrangements for the conduct of parallel disciplinary and criminal investigations. Close liaison between the CFS and HR is essential to ensure that any parallel sanctions (for instance criminal, civil and disciplinary sanctions) are applied effectively and in a coordinated manner.

4.5 Counter fraud specialist

The CFS is responsible for conducting all anti-fraud work locally and ensuring that the organisation has appropriate anti-fraud, bribery and corruption arrangements in place.

The local counter fraud service will:

• ensure that the director of finance is informed about referrals or cases
• be responsible for the day to day local implementation of the functional standard and NHSCFA strategy
• investigate cases of fraud in consultation with the director of finance, report any cases to the police or NHSCFA in accordance with NHSCFA guidance
• adhere to the fraud response plan

4.6 Fraud champion

The role of a fraud champion is to support and challenge the organisation in relation to its commitment to fraud work. The champion will help promote a zero-tolerance approach to fraud within our own organisation. The role and duties of the fraud champion includes:

• promoting awareness of fraud, bribery and corruption within your organisation
• understanding the threat posed by fraud, bribery and corruption
• understanding best practice on counter fraud

4.7 Managers

Managers are responsible for implementing and maintaining the policy in their area of management, including ensuring that procedures are in place, individuals are adequately trained and controls are being complied with. The following examples (this list is not exhaustive) provide some areas of responsibility that managers have in the prevention of fraud, bribery and corruption:

• understanding financial decision making such as authorisation limits for purchases, ordering of stock or goods and the authorising of expenses and time sheets
• understanding responsibilities in relation to fraud awareness
• understanding the need to inform HR of any transactional changes to be made to electronic staff records. Managers are responsible for submitting these for any changes required; these include base changes, manager changes, incremental stage, change of working hours and many more. Incorrect or delayed submission of transactional changes could lead to financial implications for staff such as overpayments

Timesheet and expense claim checking to ensure that the details are accurate before submission to payroll.

4.8 Employees

All employees are expected to ensure that they are familiar with, and act in accordance with, this policy and attend all fraud training as required.

All employees are required to comply with Rotherham, Doncaster and South Humber NHS Foundation Trust’s policies and procedures and apply best practice in order to prevent fraud, bribery and corruption. All employees have a duty to ensure that public funds are safeguarded and where they have a suspicion that fraud exists they should report it to the counter fraud specialist or director of finance (contact details in appendix E). Alternatively you can report to the NHS fraud and corruption reporting line (0800 028 40 60), or through the online NHS fraud reporting tool found at Report fraud tool.

4.9 Fraud response plan

Rotherham, Doncaster and South Humber NHS Foundation Trust has developed a fraud response plan (appendix A) which should be used as a checklist of actions and a guide to follow in the event that fraud is suspected. It covers:

• notification of suspected fraud
• the investigation process
• sanctions and redress
• recovery action Roles and responsibilities
• monitoring and review.

5 Procedure and implementation

The organisation’s fraud response plan is attached at appendix A.

Furthermore, in accordance with the Functional Standard guidance, Rotherham, Doncaster and South Humber NHS Foundation Trust has undertaken a risk assessment to determine the extent to which bribery and corruption may affect the organisation. Proportionate procedures in place to mitigate the identified risk include the following requirements (the list is not exhaustive):

• the standard financial instructions (SFIs for short), which outline the decisions which Rotherham, Doncaster and South Humber NHS Foundation Trust’s board retains for itself and which it will delegate
• the scheme of delegation (SoD for short) outlines the minimum level allowed to make certain decisions. These include high value, mid value and low value
• management controls such as for the approval of overtime and expenses
• acting with propriety in the use of Rotherham, Doncaster and South Humber NHS Foundation Trust’s resources, including making accurate and honest expense claims and claims for sickness absence
• conducting oneself with integrity, accountability, openness and honesty
• all staff must disclose their business interests, prior to commencement of employment with Rotherham, Doncaster and South Humber NHS Foundation Trust
• all staff must declare hospitality (other than modest hospitality) received by or offered to them as Rotherham, Doncaster and South Humber NHS Foundation Trust employees
• all hospitality (other than extremely minor hospitality) provided by Rotherham, Doncaster and South Humber NHS Foundation Trust staff to third parties must be declared
• staff must not solicit personal gifts and must declare all gifts received (in excess of a minimum value set)

5.1 Government functional standard

NHSCFA requires Rotherham, Doncaster and South Humber NHS Foundation Trust to ensure appropriate anti-fraud, corruption and bribery arrangements are in place as set out in the NHS standard contract and as specified within the new government functional standard 013 for counter fraud.

It is the responsibility of the organisation to ensure that it complies with the functional standard. In order to demonstrate compliance, NHSCFA quality inspectors require the organisation to submit an annual return detailing compliance and anti-fraud, corruption and bribery activity undertaken within the organisation. Upon completion, the return provides a red, amber, or green (RAG) rating for the organisation. The RAG system is a management method of rating for issues or status reports, based on levels of compliance with the standards. As such, the colours are used in a traffic light rating system with red being non-compliant, amber being partially compliant and green being fully compliant.

The NHSCFA Quality and Compliance team (QCT) use the annual return as a basis for selecting organisations for detailed assessment and engagement.

5.2 Proactive prevention and detection

Rotherham, Doncaster and South Humber NHS Foundation Trust will ensure that its systems, policies and processes are sufficiently robust so that the risk of fraud, corruption and bribery is reduced to a minimum. Checks will be conducted in areas identified to be most at risk to fraud, corruption or bribery in order to proactively detect instances that might otherwise be unreported.

The CFS will review new and existing key policies and procedures to ensure that appropriate counter fraud measures are included. This includes (but is not limited to) policies and procedures in human resources, procurement, standing orders, standing financial instructions and other finance and operational policies.

Rotherham, Doncaster and South Humber NHS Foundation Trust will carry out comprehensive local risk assessments to identify fraud, bribery and corruption risks. Risk analysis is undertaken and is recorded and managed in line with Rotherham, Doncaster and South Humber NHS Foundation Trust’s risk management policy and included on the appropriate risk registers. Measures to mitigate identified risks are included in Rotherham, Doncaster and South Humber NHS Foundation Trust’s annual work plan to counter fraud, bribery and corruption, progress is monitored at a senior level within the organisation and results are fed back to the audit committee.

Additional preventative activities may also be conducted. These activities will be targeted at those areas of the organisation considered to be at a higher risk of fraud, bribery or corruption. The purpose of these activities is to identify gaps in the organisation’s governance framework which could allow fraud to be perpetrated. These activities will be conducted in line with guidance issued by the NHSCFA where appropriate.

5.3 Effective sanctions

Where fraud, bribery or corruption offences are committed, criminal sanctions (including prosecution) will be considered and pursued where appropriate. Employees of Rotherham, Doncaster and South Humber NHS Foundation Trust found to have committed such offences will also be dealt with in accordance with internal disciplinary procedures and referred to professional bodies where appropriate.

5.4 Seeking redress

Rotherham, Doncaster and South Humber NHS Foundation Trust will consider initiating civil recovery action if this is cost-effective and desirable for deterrence purposes.

5.5 Reporting suspicions

All concerns or suspicions relating to fraud, bribery or corruption must be reported to Rotherham, Doncaster and South Humber NHS Foundation Trust’s counter fraud specialist or director of finance (contact details in appendix E). You can also use the fraud referral form attached at appendix B of this policy. Alternatively, fraud can be reported to NHSCFA via the NHS fraud and corruption reporting line on 08000 284060 or its online reporting tool (opens in new window).

5.6 Approval and ratification process

This policy will be approved by the audit committee and ratified by the board of directors.

5.7 Dissemination and implementation of this policy

This policy will be included on the intranet with other corporate governance documents.

6 Training implications

The CFS will promote fraud, bribery and corruption awareness through the delivery of face-to-face presentations, the provision of eLearning modules and or the distribution of newsletters and other materials. Should staff require any other assistance, or advice, they should contact the CFS (amanda.smith61@nhs.net).

6.1 All staff

• How often should this be undertaken: Annually.
• Delivery method: eLearning or face to face.
• Training delivered by whom: eLearning or CFS.
• Where are the records of attendance held: ESR.

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through a variety of means such as:

• all user emails for urgent messages
• one to one meetings and supervision
• continuous professional development sessions posters
• daily email (sent Monday to Friday) practice development days
• group supervision special meetings
• intranet team meetings
• local induction

7 Monitoring arrangements

7.1 Delivery of counter fraud, bribery and corruption plan

• How: CFS.
• Who by: Audit committee.
• Reported to: Audit committee.
• Frequency: Quarterly.

7.2 Staff questionnaire on fraud, bribery and corruption awareness

• How: CFS.
• Who by: Audit committee.
• Reported to: Audit committee.
• Frequency: Annually.

8 Equality impact assessment screening

The completed equality impact assessment for this policy has been published on this policy’s webpage on the trust policy library or archive website. Link to EIA.

8.1 Privacy, dignity and respect

The NHS constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High quality care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental capacity act 2005

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the mental capacity act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

Not applicable.

9 Links to any associated documents

• Listening and responding to concerns and complaints policy (formally complaints handling policy)
• Conflicts of interest policy
• Disciplinary policy
• Freedom to speak up: raising concerns (whistleblowing) policy
• Information governance policy and management framework (including Data Protection) policy
• Security policy
• Standing financial instructions

10 References

• Criminal procedure and investigations act 1996 (opens in new window).
• NHS counter fraud authority guidance (opens in new window).
• NHS counter fraud authority fraud strategy 2020 to 2023 (opens in new window).
• Government functional standard 013 NHS requirements (opens in new window).
• The Bribery Act 2010 (opens in new window).
• The Fraud Act 2006 (opens in new window).
• The Police and Criminal Evidence Act 1984 (opens in new window).
• The Proceeds of Crime Act 2002 (opens in new window).
• The Public Interest Disclosure Act 1998 (opens in new window).

11 Appendices

11.1 Appendix A fraud response plan

11.1.1 Introduction

This fraud response plan provides a checklist of actions and a guide to follow in the event that fraud is suspected. Its purpose is to define authority levels, responsibilities for action and reporting lines in the event of suspected fraud, theft or other irregularity, it covers:

• notification of suspected fraud
• the investigation process
• sanctions and redress
• recovery action
• roles and responsibilities
• monitoring and review

111.1.2 Notifying suspected fraud

It is important that all staff are able to report their concerns without fear of reprisal or victimisation and are aware of the means to do so. The Public Interest Disclosure Act (1998) commonly referred to as the “whistle-blowers act”, provides appropriate protection for those who voice genuine and legitimate concerns through the proper channels.

If an employee has any concerns or suspicions of fraud, they must inform the nominated counter fraud specialist (CFS). Alternatively, you can contact the organisation’s director of finance.

If the director of finance, CFS or chief executive officer (CEO) are implicated, then concerns should be reported to the NHS Counter Fraud Authority through their online reporting form or through their 24-hour reporting line on 08000 284060.

Appendix D of the fraud, bribery and corruption policy, provides a reminder and checklist of the key actions if fraud, corruption or bribery are suspected. staff are encouraged to familiarise themselves with this document.

11.1.3 The investigation process

The CFS will make sufficient enquiries to establish whether or not there is any foundation to the suspicion that has been raised.

Rotherham, Doncaster and South Humber NHS Trust wants all employees to feel confident that they can expose any wrongdoing without any risk to themselves. In accordance with the provisions of the ‘whistle-blowers act’, the organisation have implemented a freedom to speak up, raising concerns (whistleblowing) policy and freedom to speak up guardian who can provide an independent and impartial source of advice to staff at any stage of raising a concern.

A CFS investigation may identify conduct or performance that may be of concern to the organisation or to the employees professional body, whether related to fraud or otherwise. Where appropriate, relevant organisational policies and procedures, including disciplinary procedures, will be followed where such concerns arise. This may result in disciplinary action and notification to the relevant professional body where appropriate.

In accordance with the NHS counter fraud authority requirements the director of finance, in conjunction with the CFS, will decide whether or not a case should be referred to the police. Any referral to the police will not prohibit action being taken under any local disciplinary procedures of Rotherham, Doncaster and South Humber NHS Trust unless expressly stipulated by the police.

The CFS, in consultation with Rotherham, Doncaster and South Humber NHS Trust’s director of finance, will investigate allegations in accordance with procedures and documents referenced in the NHSCFA standards.

Rotherham, Doncaster and South Humber NHS Trust will follow their disciplinary procedure if there is evidence that an employee has committed any act of fraud, bribery or corruption. The CFS must be aware that staff under investigation which could lead to disciplinary action, have the right to procedural fairness and the CFS must seek advice from the organisation’s HR department during the investigation process where appropriate.

The CFS will take control of any physical evidence and record this in accordance with the procedures outlined in the NHSCFA Anti-fraud manual. For reasons of confidentiality access to this manual is restricted.

Interviews under caution will only be carried out by the CFS or, if appropriate, the police in accordance with the Police and Criminal Evidence Act (1984). The CFS will also take written statements where necessary.

If fraud, bribery or corruption is found to have occurred, the CFS will prepare a report for the director of finance, setting out the following:

The circumstances:

• the investigation process
• the estimated or actual loss
• the steps taken to prevent recurrence
• the steps taken to recover loss
• system control weaknesses that require correction.

Any recommendations as a result of an investigation will be reported in progress reports to the audit committee to consider any necessary improvements to controls.

11.1.4 Sanctions and redress

The seeking of financial redress or recovery of losses will always be considered in cases of fraud, bribery and corruption that are investigated by either the CFS or NHSCFA where a loss is identified.

Recovery of losses may involve action under the Proceeds of Crime Act (2002) but each decision will be taken in light of the particular circumstances of each case.

Redress allows for resources that are lost to fraud, bribery or corruption to be returned to the NHS for use as intended and for the provision of patient care and services.

The NHSCFA anti-fraud manual provides in depth detail of how sanctions can be applied and redress sought. Local action can also be taken to recover money using the administrative procedures of the organisation or civil law.

In cases of serious fraud, bribery and corruption, parallel sanctions can be applied, for example:

• disciplinary action
• use of civil law to recover lost funds
• use of criminal law to apply an appropriate criminal penalty, possible referral of information and evidence to a professional body if appropriate.

The NHSCFA can also apply to the courts to make a restraining order or confiscation order under the Proceeds of Crime Act (2002). This means that a person’s money can be taken away from them if it is believed that the person benefited from the crime. This can also include restraining assets during an investigation.

The range of available sanctions which may be pursued by the relevant decision makers includes:

• no further action, In some cases it may be that the organisation, under guidance from the CFS and with the approval of the director of finance, decides that no further action is taken
• criminal investigation, following an investigation it may be necessary to bring the matter to the attention of the criminal courts such as magistrates or crown court
• civil recovery, the civil recovery route is available to the organisation if this is cost effective and desirable. This could involve a number of options such as applying through the small claims court. Each case will be discussed with the director of finance to determine the most appropriate action
• disciplinary action, The appropriate person, in conjunction with the HR department, will be responsible for initiating any disciplinary action
• confiscation under the Proceeds of Crime Act, depending upon the extent of the loss and the proceedings in the case, it may be suitable for the recovery of losses to be considered under the Proceeds of Crime Act
• recovery from ongoing salary payment, arrangements can be made to recover losses via payroll if the subject is still employed by the organisation
• professional body disciplinary, during an investigation, if clear evidence exists of a healthcare professional’s involvement in fraud, bribery or corruption, the appropriate regulatory body will be informed so they can consider whether fitness to practice procedures should be invoked. Regulatory bodies have statutory powers to place conditions on, suspend or remove the registration of, professionals whose fitness to practice has been impaired

11.1.5 Roles and responsibilities

The codes of conduct for NHS boards and NHS managers set out the key public service values which Rotherham, Doncaster and South Humber NHS Trust adhere to. They state that high standards of corporate and personal conduct, based on the recognition that patients come first, have been a requirement throughout the NHS since its inception. All staff should be aware of and act in accordance with, these values. The values can be summarised as:

• accountability
• probity
• openness

Rotherham, Doncaster and South Humber NHS Trust will take all necessary steps to counter fraud, bribery and corruption in accordance with its fraud, bribery and corruption policy and the Government Functional Standard 013: Counter Fraud (the Functional Standard).

Rotherham, Doncaster and South Humber NHS Trust will appoint a CFS to undertake work as set out by the NHSCFA under the functional standard. (Rotherham Doncaster and South Humber NHS Trust) is committed to taking all steps necessary to counter fraud, bribery and corruption. To meet its objectives, Rotherham, Doncaster and South Humber NHS Trust has adopted the specific component principles of the functional standard.

All employees are required to comply with Rotherham, Doncaster and South Humber NHS Trust policies and procedures in order to prevent fraud, bribery and corruption.

All those who work within Rotherham, Doncaster and South Humber NHS Trust or are otherwise engaged with the Rotherham, Doncaster and South Humber NHS Trust should be aware of and act in accordance with the public service values and the Nolan Principles for standards in public life.

Employees are expected to act in accordance with the standards laid down by their professional institutes where applicable.

All employees have a responsibility to comply with all applicable laws and regulations relating to ethical business behaviour, procurement, personal expenses, conflicts of interest, confidentiality and the acceptance of gifts and hospitality.

The CFS will:

• ensure that the director of finance is informed about all referrals and cases
• be responsible for the day to day implementation of the key standards of counter fraud, bribery and corruption activity as set out by the functional standard
• investigate cases of fraud
• in consultation with the director of finance, report any case to the police or NHSCFA as agreed and in accordance with the NHS government functional standard
• report any case and the outcome of the investigation through the NHSCFA national case management system
• ensure that other relevant parties are informed where necessary, for instance HR
• ensure that the appropriate organisation incident and losses reporting systems are followed
• ensure that any system weaknesses identified as part of any investigation are followed up with management and reported to internal audit
• ensure that cases are managed appropriately, taking into account appropriate legislation and regulation and the needs of procedural fairness in the employment relationship

NHSCFA will:

• provide leadership and expertise in counter fraud as a valued NHS partner
• collaborate nationally and locally with the NHS to understand threats, vulnerabilities and enablers
• deliver intelligence-led counter fraud services to find, respond to and to prevent fraud
• reduce the impact of fraud
• work in partnership to deliver financial savings that can be reinvested in patient care

11.1.6 Monitoring and review

The CFS will report regularly to the director of finance. The CFS will provide regular reports to the audit committee and provide an annual report containing details of reported and investigated cases of fraud. The NHSCFA monitors the work of the CFS.

The organisation is required to complete the government counter fraud functional standard return and submit these annually to the NHSCFA. The organisation must mark themselves against each standard as either compliant (green), partially compliant (amber) or non-compliant (red). A work plan is required to address all non-compliant standards which will be monitored by the audit committee.

An assessment process may be conducted by the NHSCFA. This is a means of evaluating the effectiveness of the organisation in dealing with the fraud, bribery and corruption risks it faces through one of four types of assessment: full, focussed, thematic or triggered.

The CFS raises fraud awareness by a number of means such as arranging road shows, giving presentations to staff teams and new starters on induction.

11.2 Appendix B referral form

• Appendix B referral form

11.3 Appendix C prevalent frauds in the NHS

Common examples of fraud, bribery and corruption offences occurring within the provision of healthcare services to the NHS (this is not an exhaustive list; for other types of fraud, bribery or corruption offences please contact the CFS for advice).

• Employment, presenting forged certificates of qualification to obtain employment; claiming for overtime or shifts not worked; taking sick leave and undertaking unauthorised work for another organisation whilst in receipt of sick pay; claiming expenses (such as travel) when it has not been incurred; falsification of references for a job application; claiming time for college or training but not actually attending; knowingly failing to report and retaining salary or other payments not entitled to; non declaration of criminal convictions.
• Patients monies, falsifying patients’ monies records to obtain cash and property.
• Pharmaceuticals, presentation of forged prescriptions; falsely presenting oneself as another to receive prescription items; receiving free prescriptions through fraudulently claiming entitlement to exemptions from a charge; Pharmacists substituting an expensive drug with a cheaper alternative and making claims for the more expensive one; writing prescriptions for own use.
• Procurement, price fixing or price hiking by suppliers; invoicing for products not supplied; over invoicing; supplying unsolicited goods or products.
• Equipment, obtaining or misuse of equipment or goods for private purposes, including theft or misuse of data, whether held electrically or in paper based form.
• Bribery, financial or other reward to staff responsible for procurement if they purchase from a particular supplier. Patients making informal payments to healthcare practitioners in order to receive treatment more quickly.
• Health tourism, a foreign national travelling to the UK with the intention of receiving free healthcare treatment to which they know they are not entitled.

11.4 Appendix D do’s and don’ts

11.5 Appendix E contacts

Counter Fraud Specialist, Amanda Smith

Telephone: 07920 138323

Email: amanda.smith61@nhs.net

Director of Finance, Ian Currell

Email: ian.currell@nhs.net

Counter Fraud Champion, Phil Gowland

Email: p.gowland@nhs.net

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Document control

• Version: 10.1
• Unique reference number: 197.
• Date approved: 28 December 2023.
• Approved by: Corporate policy approval group.
• Name of originator or author: Counter fraud specialist.
• Name of responsible individual: Finance sub committee.
• Date issued: 5 January 2024.
• Review date: October 2024.
• Target audience: All staff (including volunteers, agency workers and contractors) and whether employed directly or indirectly within any part of the trust.

Page last reviewed: April 15, 2024
Next review due: April 15, 2025

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