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It is estimated that the NHS loses £1.21 billion per year, or roughly £3.3 million per day, to fraud. This is taxpayers' money that is taken away from patient care and falls into the hands of criminals. This is enough money to pay for over 40,000 staff nurses, or to purchase over 5,000 emergency ambulances. When we say 'fraud', we refer to a range of economic crimes, such as fraud, bribery and corruption or any other illegal acts committed by an individual or group of individuals to obtain a financial or professional gain.
We now have a suite of animated videos covering main fraud risks in the NHS.
You can view them here or in the drop down box below.
AuditOne, the CCG’s counter fraud provider works closely with the CCG to combat fraud.
We have a team of experienced counter fraud specialists delivering a full range of counter fraud, bribery and corruption services including prevention, detection and investigation. Our professionally qualified counter fraud specialists work to identify potential fraud, bribery and corruption risks through policy and system reviews and suggest remedial action to reduce and mitigate these risks. We are experienced in carrying out timely criminal investigations, from referral to prosecution.
AuditOne is an NHS consortium providing counter fraud services to 23 NHS and independent health care provider organisations across the North of England. It is hosted by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and is a not-for-profit organisation.
Simon Clarkson is the CCG's Counter Fraud Specialist.
The CCG has a suite of policies that focus on staff and organisational behaviour. By following these policies, staff working in or associated with the CCG can help prevent fraud. These policies cover the following areas:
- Standards of business conduct
The NHS Counter Fraud Authority have produced some useful reference and prevention guidance documents for NHS organisations. There are several fraud reference guides available which cover the following areas:
- - This relates to a person working in, or for, the NHS in any capacity. This includes salaried employees, retired employees receiving an NHS pension, agency staff, trainees, contractors such as GPs, dentists, pharmacists, opticians and their organisations and any other contractors who work for the NHS in the same manner as an employee.
- - This relates to a patient, that is someone obtaining treatment, services or medication from the NHS. It may relate to someone using the NHS (either in the UK or abroad) to obtain medical, dental, optical or pharmacy services.
- - This relates to a person or organisation providing goods and/or services to the NHS. This can include contractors (individuals or companies), suppliers, or other organisations.
- - This relates to fraud in relation to financial accounting, performance, incentives or penalties or any other financial issue.
- - This relates to a person or organisation not linked to the NHS but trying to gain financially from it. This would include a third party making unsolicited requests for payment from the NHS or someone using an NHS facility to which they are not entitled.
There are also eight quick guides which covering different types of procurement frauds to aid prevention of these types of fraud:
If you suspect fraud is occurring, you can help by reporting your suspicions confidentially to the counter fraud specialist.
Follow these simple guidelines when reporting your suspicions:
- Do make an immediate note of your concerns
- Do deal with the matter promptly if you feel your concerns are warranted
- Don’t do nothing
- Don’t be afraid to raise your concerns
- Don’t approach or accuse individuals yourself
- Don’t try to investigate the matter yourself
The CCG’s counter fraud specialist can be contacted via the following:
Fraud Hotline: 0191 441 5936
Contact the National Fraud and Corruption reporting line
Alternatively, you can phone the National Fraud and Corruption reporting line: 0800 028 40 60
All calls are made in strictest confidence and no attempt will be made to persuade you to provide your personal details if you want to remain anonymous. You will be given a call reference number which you can quote if you phone again with additional information.
Finally, you can report allegations of fraud online directly to the NHS Counter Fraud Authority at
Each NHS organisation is required to nominate a fraud champion whose role is to support the counter fraud specialist in promoting awareness of fraud across the CCG.
The CCG’s fraud champion is Helen Walker the Head of Financial Reporting and Control. Staff should be aware that fraud champions are not authorised to investigate allegations of fraud. Therefore, staff should not report suspicions to fraud champions.
The Bribery Act 2010 came into force on 1 July 2011 with the aim of tackling bribery and corruption in both the private and public sectors. Bribery is defined as the giving or receiving of a financial or other advantage in exchange for improperly performing a relevant function or activity.
NHS North Cumbria Clinical Commissioning Group (CCG) is committed to applying the highest standards of ethical conduct, following good NHS business practice and having robust controls in place to prevent bribery. However, as an organisation we cannot afford to be complacent and under no circumstances is the giving, offering, receiving or soliciting of a bribe acceptable and the trust will not tolerate this in any form.
The CCG’s zero tolerance approach to bribery and corruption is set out across a range of CCG policies and procedural documentation. This applies to all staff and lay members, together with contractors and agents working or acting on behalf of the CCG.
All are responsible for gaining an understanding of the requirements, the standard of conduct expected of them and ensuring that they comply at all times with all of our policies and procedures. This includes those in relation to procurement, hospitality and the acceptance of gifts.
Bribery and corruption under the act are punishable for individuals as a criminal offence by up to 10 years imprisonment and if the CCG is found to have taken part in the corruption the CCG could face an unlimited fine and face incalculable damage to our reputation. The CCG therefore takes its legal responsibilities very seriously.
Any act of bribery undertaken by a member or an employee of the CCG will result in disciplinary action and will be treated with a similar level of importance by the CCG’s Governing Body. 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 contact a member of the CCG’s Governing Body or the Senior Information Risk Owner (SIRO), Charles Welbourn.
Dr David Rogers
Accountable Officer/Medical Director
NHS North Cumbria CCG is required to protect the public funds it administers. It may share information provided to it with other bodies responsible for auditing, or administering public funds, or where undertaking a public function in order to prevent and detect fraud.
The Cabinet Office is responsible for carrying out data matching exercises.
Data matching involves comparing sets of data such as the payroll records of a body against other records held by the same or another body to see how far they match. The data is usually personal information. The data matching allows potentially fraudulent claims and payments to be identified. Where a match is found it may indicate that there is an inconsistency which requires further investigation. No assumption can be made as to whether there is fraud, error or another explanation until an investigation is carried out.
We are a mandatory participant in the Cabinet Office’s National Fraud Initiative; a data matching exercise to assist in the prevention and detection of fraud. We are required to provide particular sets of data to the Minister for the Cabinet Office for matching each exercise, as detailed here on the www.gov.uk website.
The processing of data by the Cabinet Office in a data matching exercise is carried out with statutory authority under its powers in Part 6 of the Local Audit and Accountability Act 2014. It does not require the consent of the individuals concerned under data protection legislation or the GDPR (General Data Protection Regulation).
Data matching by the Cabinet Office is subject to a code of data matching practice, also available on the www.gov.uk website.
The Cabinet Office has published its Data Privacy notice, which sets out how the Cabinet Office will use your personal data and your rights. The notice is made under Article 14 of the General Data Protection Regulation (GDPR).
The legal basis for processing your personal data is that processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the data controller.
We want you to know that we take privacy very seriously. Please be assured that we will always manage your data securely and responsibly.
For further information on data matching at this organisation, please contact the Counter Fraud team on 0191 441 5936 or email firstname.lastname@example.org