NON CLINICAL POLICY - Halton and St Helens PCT

NON CLINICAL POLICY
For use in:
Target Audience:
Purpose
Document Author:
Approved by:
Ratified by:
Policy Indexed:
Controlled Document No:
Counter Fraud Policy and Response Plan
Version Number: 1.0
PCT - Wide
Effective From: April 2009
Review Date: April 2012
PCT Staff at all levels
The purpose of the policy is to ensure that
there is robust counter fraud and corruption
practices within NHS Halton and St Helens and
that staff are aware of their duties to report any
incidents.
Rick Marriot, Counter Fraud Officer, Mersey
Internal Audit Agency
Assistant Chief Executive
Governance Assurance Committee
Statutory and legal requirements
Implementation Lead
Implementation Process
The NHS Counter Fraud Strategy as set out in
HSC 1998/231. Secretary of State’s Directions
November 1999 (amended 09/2002 and
11/2004). HSC 1999/062 by nominating a
Local Counter Fraud Specialist (LCFS).
Rick Marriott
Circulated via The Trust Times, The Team
Brief and presentations at Staff Groups.
The Trust is committed to creating an environment that promotes equality and embraces
diversity, both within our workforce and in service delivery. This document should be
implemented with due regard to this commitment
This document seeks to uphold the duties and principles contained within the Human Rights
Act. All Staff within the PCT should be aware of its implications
This policy is due for review by April 2012. After this date, this policy and associated
process documents may become invalid. All users should ensure that they are consulting
the current version of this document.

Key individuals involved in developing the document
Name
Designation
Mike Treharne
Director of Financial Strategy
Debbie Fairclough
Assistant Chief Executive
Circulated to the following for comments
Committee
Committee
Members of the Policy Sub Committee
Members of the Clinical Guidelines Group
Audit Committee
Individual
Name
Designation
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Table of Contents
COUNTER FRAUD POLICY AND RESPONSE PLAN ................................................................4
INTRODUCTION .........................................................................................................................5
WHO THIS DOCUMENT APPLIES TO........................................................................................6
POLICY........................................................................................................................................6
LEGISLATION .............................................................................................................................7
PUBLIC SERVICE VALUES ........................................................................................................8
ROLES AND RESPONSIBILITIES ............................................................................................10
FRAUD RESPONSE PLAN .......................................................................................................12
REPORTING FRAUD ................................................................................................................12
APPENDIX A .............................................................................................................................17
APPENDIX B .............................................................................................................................18
APPENDIX C ...............................................................................................................................1
APPENDIX D ...............................................................................................................................4
APPENDIX E ...............................................................................................................................6
APPENDIX F................................................................................................................................1
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COUNTER FRAUD POLICY AND RESPONSE PLAN
This Policy document provides NHS Halton & St Helens with a policy and a response plan for
dealing with suspected incidents of Fraud and Corruption. The policy is designed to minimise
loss to the PCT by deterring, preventing and detecting fraud and providing effective action
against it. The policy provides clear procedures for reporting suspected fraud or corruption
for: employees, contractors, non executives, suppliers, patients, employees and committee
members of organisations we fund. The work to counter fraud within NHS Halton & St
Helens is extremely important. The vast majority of people who work in the NHS are honest
and professional and they find it unacceptable that fraud committed by a minority ultimately
leads to a reduction in resources available for patient care. The PCT is committed to
protecting the public money it looks after and this means preventing fraud so that more
money goes into health services.
We are all the victims of fraud in public services and therefore have a joint responsibility.
Money provided by taxpayers is stolen, and we are denied the proper level of service that we
are entitled to expect. Fraud is theft and is morally wrong in itself, but in the case of fraud
within public services, fraud deprives society of resources which could otherwise be used for
better systems and better services – an NHS for the future. Counter fraud work should
therefore be seen not as an end in itself, but as a means of making the best possible use of
NHS resources. (NHS Counter Fraud Strategy,1998)
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INTRODUCTION
One of the fundamental principles of public sector organisations is the proper use of public
funds. The size and nature of our services put us at risk to loss due to Fraud and Corruption
both from within NHS Halton & St Helens and outside it. This document sets out the PCT’s
policy for identifying suspected illegalities that may be occurring.
For simplicity, all such offences are referred to in the policy and response plan as “Fraud”,
except where the context indicates otherwise.
NHS Halton & St Helens is committed to ensuring that fraud and corruption is reduced to the
lowest level of risk. However, where fraud and corruption does occur the PCT will deal with it in
a firm and controlled manner by rigorous investigation of such cases. An important part of this
approach has been the introduction of a Counter Fraud Policy.
In 1998, the Department of Health launched the NHS Counter Fraud Strategy. Over the last ten
years, success in tackling NHS fraud has meant that:
£811million has been spent on patient care.
There have been a total of 422 successful criminal prosecutions.
Recovery from fraud cases to the amount of £51,416,766.
Pharmaceutical fraud has been reduced by 60% to £47million.
Patient Fraud has been reduced by 55% from £171million to £76million
NHS Halton & St Helens endorses the NHS Counter Fraud Strategy as set out in HSC
1998/231. The PCT has complied with the Secretary of State’s Directions November 1999
(amended 09/2002 and 11/2004) and HSC 1999/062 by nominating a Local Counter Fraud
Specialist (LCFS).
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WHO THIS DOCUMENT APPLIES TO
This Policy applies to all employees and may also be used by Locum, Agency staff, contractors
or suppliers to report any concerns that they may have.
Upon implementing this policy, managers must ensure that all staff are treated fairly and within
the provisions of the PCT’s Equal Opportunities Policy. Attention should be paid to ensure the
Policy is understood by all staff. Where there are barriers to this, staff should be provided with
further training where an individual’s literacy or use of English is weak or where they have little
experience of working life.
POLICY
Those individuals who exploit the system are not only cheating the tax payers, but are depriving
patients of the care they require. Fraud against the PCT means there is less money to spend in
health services.
NHS Halton & St Helens needs every member of staff to report Fraud if they suspect it being
committed. If you suspect a Fraud it is your duty contact the nominated officers who are listed
within this document and give them the details. Every case is treated in the strictest of
confidence and you can provide information anonymously using the Confidential Fraud Hotline.
If you have any concerns regarding Fraud or Corruption occurring within the PCT then please
report it by contacting the:
- Director of Financial Strategy: Mike Treharne
Tel: 0151 495 5171
Email: mike.treharne@hsthpct.nhs.uk
- Local Counter Fraud Officer: Rick Marriott
Tel: 0151 285 4523 Mobile: 07825815018
Email: rick.marriott@miaa.nhs.uk
- Counter Fraud Team [MIAA] on 0151 285 4500
- Reporting your concerns using the on-line Intranet Referral Form
- Calling the national NHS Fraud and Corruption Reporting Line on:
0800 028 40 60
NHS Halton & St Helens wishes to encourage anyone having reasonable grounds of
suspecting Fraud being committed to report it. It is the PCT’s policy, which will be rigorously
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einforced that no employee will suffer in any way as a result of reporting reasonably held
suspicions.
All members of staff can therefore be confident that they will not suffer in any way as a result
of reporting reasonably held suspicions. For the purpose of this policy ‘reasonably held
suspicions’ shall mean any suspicions other than those which are totally groundless or rose
maliciously.
LEGISLATION
FRAUD is not a victimless crime; in fact defrauding the NHS organisations of money takes vital
resources away from patient care.
Fraudulent activity can be committed in many ways including deception, bribery, forgery and
counterfeiting. (See Appendix A) The Fraud Act 2006 came in to force in January 2007 which
created new offences relating to Fraud. (See Appendix B) Before this legislative act was
introduced there were no specific offences of ‘Fraud’. However legislation such as Theft Acts of
1968 and amended in 1978 and 1996, Forgery and Counterfeiting Act 1981, Criminal Attempts
Act 1981 was used. Subsequently, any fraudulent acts committed prior to January 2007 would
be tried under the previous fraud related acts.
Type of NHS Fraud - There is not one type of NHS Fraud that can be committed but a number.
There is an enormous variation of how Fraud is committed and this very much depends on the
individual’s intent and the opportunity that may exist. To assist in understanding the risk of
fraud in the NHS, the following is provided to example some familiar NHS related fraud.
Working at a secondary employer when absent through sickness from the primary employer.
Submission of Timesheets which have false representation.
Submission of false travel/mileage claims.
Patients claiming for exemption from payment when not entitled.
Falsely representing Quality Outcome Framework [QOF] achievements.
Securing employment by submitting false employment applications/CVs.
Corruption is an extremely serious offence which strikes at the heart of public confidence in
administrative affairs. The laws dealing with corrupt activity in the UK are to be found in the
common law offence of bribery and in three Acts of Parliament, namely the Public Bodies
Corrupt Practices Act 1889 and the Prevention of Corruption Acts of 1906 and 1916.
Generally, corruption can be defined as:
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“the receiving or offering of any undue reward by or to any person in public office in
order to influence that person to act contrary to the rules of honesty and integrity.”
The Acts make corrupt activity in the public sector a criminal offence and the 1916 Act includes
reversal of the normal presumption of innocence so that where a payment is made to an
employee of a public body it is for the defence to prove that the payment was not illegal.
Main areas of activity which are susceptible to corruption include the awarding of contracts and
disposal of assets.
PUBLIC SERVICE VALUES
The highest standards of corporate and personal conduct, based around the recognition that
Patients come first has been a requirement of the NHS since its inception. The three
fundamental public service values are as follows:
Accountability
Everything done by those who work at NHS Halton & St
Helens must be able to stand the tests of Parliamentary
scrutiny, public judgments on property and professional
codes of conduct.
Probity
Absolute honesty and integrity should be exercised in
dealing with NHS patients, assets, employees, suppliers
and customers.
Openness
NHS Halton & St Helens actions should be sufficiently
public and transparent to promote confidence between the
PCT and its patients, our employees and the public.
In addition to the above, all those who work for or are in
contract with the PCT should adhere to the following
principals:
Professionalism
Employees should maintain the highest standards of
Professionalism, in the best tradition of the existing NHS
professions. Specifically, this should cover areas of
personal conduct, expertise and all work taken to counter
Fraud. Any information or evidence must be obtained in a
proper legal manner and recorded accordingly. The
reputation of the NHS must be paramount and officers must
not bring it into disrepute by any of their actions.
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Objectivity
Employees should undertake all work with an open mind
and ensure that any evidence or information obtained is
assessed without preconceptions. Consideration should be
given to all interpretations that may be placed on such
evidence or information.
Fairness Employees should act in a courteous, polite and
considerate manner and conduct all work applying proper
standards of fairness and without discrimination in
accordance with current Equal Opportunities Policy.
Expertise
Employees have a duty to maintain the highest level of
expertise and to ensure that this is applied thoroughly and
comprehensively in every aspect of counter Fraud work
that is undertaken.
Propriety
Employees have a duty to ensure that they meet the
highest standards of propriety. It must be ensured that in all
personal and financial areas, the integrity of those
undertaking counter Fraud work is never undermined.
Proper accurate records which meet the legislative
requirements must be kept on all aspects of work with
particular reference to issues of confidentiality so that
information is only passed to those who are entitled to
receive it.
Vision
Employees should ensure that the work undertaken is
understood in the context of all action taken to counter
Fraud and corruption and to develop an anti-fraud culture.
This should also include promoting Fraud awareness
generally, encouraging the active participation of other
relevant agencies and the implementation of a clear multiagency
approach.
NHS Halton & St Helens supports and promotes these principles.
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ROLES AND RESPONSIBILITIES
This section states the roles and responsibilities of NHS Halton and St Helens employees and
other relevant parties in reporting fraud or other irregularities.
Director of Financial Strategy
The Director of Financial Strategy has a legal responsibility to make sure that fraud and
corruption are prevented, detected and investigated. Combating Fraud and Corruption requires
an understanding of how and why it happens, the ways in which it can be minimized and how to
professionally investigate it; therefore the Director of Financial Strategy nominates a LCFS to
tackle fraud and corruption within NHS Halton & St Helens.
Director of Workforce Development
There is a protocol in place which sets out the agreed procedures between the LCFS, Director
of Financial Strategy and Director of Workforce Development where NHS Halton & St Helens
staff are involved. The Director of Workforce Development will advise those involved in any
investigation of requirements relating to matters of employment law and in other procedural
matters, such as disciplinary and complaints procedures.
Local Counter Fraud Specialist (LCFS)
The LCFS is an experienced and accredited (professionally qualified) counter fraud specialist.
In essence, the role of the LCFS is to respond to and proactively tackle risks and occurrences of
fraud and corruption at the PCT by providing a robust and effective prevention, detection and
Investigation function. The LCFS is responsible for ensuring that the PCT achieves the seven
specific objectives of the National Counter Fraud Strategy at NHS Halton & St Helens:
the creation of an anti-fraud culture;
maximum deterrence of fraud;
successful prevention of fraud which cannot be deterred;
prompt detection of fraud which cannot be prevented;
professional investigation of detected fraud;
effective sanctions, including appropriate legal action against people
committing fraud;
Effective methods for seeking redress in respect of money defrauded.
The LCFS reports to the Director of Financial Strategy, but any member of the PCT staff can
speak to and ask for advice from the LCFS. The LCFS is authorised to receive reports of
suspected fraud from anyone, whether an employee of NHS Halton & St Helens, independent
contractors, patients and other third parties. Staff have a responsibility to the PCT to raise their
genuine concerns. Under Secretary of State Directions and NHS Halton & St Helens
Standing Financial Instructions [SFIs], the LCFS is responsible for investigating allegations of
Fraud and Corruption at the PCT. The LCFS employs a risk-based methodology to enable the
PCT to target resources at high risk areas and throughout the year undertakes proactive
reviews in these areas which can detect Fraud. Such reviews together with investigations
ensure the LCFS identifies and counters vulnerabilities within the PCT’s systems by
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implementing effective prevention, detection and corrective controls that reduce the likelihood of
Fraud.
Audit Committee
The Audit Committee’s primary role is to conclude upon the adequacy and effective
operation of the organisation’s overall internal control system. In performing that role the
Committee’s work will predominantly focus upon the framework of risks, controls and
related assurances that underpin the delivery of the organisation’s objectives. In
respect of fraud the Committee will review the adequacy of: the policies and procedures for
all work related to fraud and corruption as set out in Secretary of State Directions and as
required by the Counter Fraud and Security Management Service. In support of this role
the Committee will receive reports from the LCFS on progress regarding fraud
awareness/detection and updates regarding investigations.
Employees and Contractors
For the purposes of this policy, Employees includes NHS Halton and St Helens staff, Board,
Executive and Non-Executive Members (including co opted Members) and Honorary Members
to the board.
All employees and contractors of NHS Halton & St Helens are individually responsible for:
Securing the property of NHS Halton & St Helens
Avoiding loss
Confirming with the rules and the regulations contained in the PCT’s Policies and Procedures
NHS Halton & St Helens employees are required to follow any Code of Conduct related to their
personal professional qualifications.
All offers of gifts or hospitality, which are in any way related to the PCT’s duties, must be
declared by the employee to their line manager and acceptance of offers of gifts or hospitality is
required to be registered in line with NHS Halton & St Helens policy.
NHS Halton & St Helens employees must declare any possible conflicts of interest which they
may have in contracts entered into with the PCT and these must be noted in a register
maintained for that purpose. All non executives have to register potential conflicts between their
duties and personal or professional lives.
Please refer to the PCT’s ‘Standards of Business Conduct Policy’ for more guidance on the
standards of business conduct expected of all employees.
When an employee suspects that there has been fraud or corruption, they must report the
matter to the nominated LCFS. See Section 7.3 below.
Any employee in breach of these regulations may be liable to disciplinary action
including summary dismissal.
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FRAUD RESPONSE PLAN
NHS Halton & St Helens is committed to tackling Fraud and Corruption. When fraud is
discovered there is a need for clear, prompt and appropriate action. Therefore, having a Fraud
Response plan increases the likelihood that the crisis will be managed effectively. The
response will be effective and organised and will rely on the principles contained within this
section.
The PCT will be robust in dealing with any Fraud, and can be expected to deal timely and
thoroughly with any person who attempts to defraud the PCT or who engages in corrupt
practices, whether they are non executives, employees, suppliers, patients or unrelated third
parties. Appendix C is an overview of the fraud response process.
REPORTING FRAUD
What you should do if you suspect fraud
If you discover or suspect a colleague, patient or other person of committing fraud you must:
Immediately tell the ‘nominated officers’: Director of Financial Strategy or LCFS.
Secure records in your possession.
Record details of relevant events.
Await further advice (the nominated officers will decide on the next course of action and advise
you accordingly).
If the concern or query involves an executive director, the matter should be reported to the
Chair of the Audit Committee and passed to the LCFS to investigate.
Time may be of the utmost importance to prevent further loss to the PCT. Staff/contractors
should report their first suspicions and not undertake lengthy consideration of alternative
explanations – be assured that any subsequent investigation will be of the highest professional
standard. In addition, everything reported to the ‘nominated officers’ is treated in the strictest
confidence and an employee can request to remain anonymous. Well intentioned employees
making a referral will be protected from any unacceptable behaviour from the subject of the
referral or anyone else.
What not to do
Do not confront ‘suspect’
Do not assume only one person is involved
Do not talk amongst colleagues, friends about your suspicions, concerns or queries
Do not contact any external organisation (only the Director of Financial Strategy or the
LCFS are permitted to make such contact).
The reason for the above is twofold:
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To ensure evidence is secured against loss, destruction and
contamination
nothing is done that could give rise to an action for slander or libel
Whistle blowing/ Public Interests Disclosure Act 1998
Whistle blowing is when an employee blows the whistle by informing their employer, a
regulator, customers, the police or the media about suspected dangerous or illegal activity that
they are aware of through their work e.g. concerns about health and safety risks, potential
environmental problems, fraud, corruption, deficiencies in the care of vulnerable people, coverups
and many other problems. Often it is only through whistle blowing that this information
comes to light and can be addressed before real damage is done. Whistle blowing is a valuable
activity which can positively influence all of our lives. NHS Halton & St Helens fully endorses the
provisions of the Public Interest Disclosure Act 1998 and wishes to encourage anyone having
reasonable suspicions of fraud to report them. The PCT’s Whistle blowing Policy/Raising
Concerns at the Workplace, which will be rigorously enforced, is that no employee should suffer
because of reporting reasonably held suspicions under the provisions of the Act.
National Fraud and Corruption Hotline
If you are unable to talk to anyone within the PCT or the LCFS then staff/contractors can
contact the National Fraud and Corruption reporting line by telephoning
0800 028 40 60
Your call will be treated in confidence and you can remain anonymous.
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INVESTIGATION OF FRAUD
Where a referral concerning fraud or corruption has been made to the Director of Financial
Strategy, the Director shall inform the LCFS at the first opportunity. There is a protocol for the
referral, acknowledgement, investigation and reporting of allegations.
On receipt of a referral/ allegation of suspected fraud, the LCFS will assess the allegation to
determine a course of action. This may involve making preliminary enquiries such as obtaining
information from NHS Halton & St Helens systems.
Where appropriate, the LCFS will seek agreement from the Director of Financial Strategy to
carry out an investigation.
The LCFS is responsible for investigating all instances of fraud at NHS Halton & St Helens on
behalf of the Director of Financial Strategy.
The LCFS will regularly report to the Director of Financial Strategy on all fraud cases
investigated and at particular stages of individual investigations.
In addition, the LCFS will provide the Audit committee with quarterly updates as to the
progression of investigations.
Depending upon the nature of the investigation, the LCFS will normally work closely with
management and other agencies such as the Police, to ensure that all matters are properly
investigated and reported upon. Basically, the circumstances of each case will dictate who will
be involved and when.
The detailed arrangements for the investigations of any suspected fraud or corruption are
contained in the National Fraud and Corruption Manual and within NHS Halton & St Helens
policies
E.g. Disciplinary, Standing Financial Orders. The LCFS will record the progress of the
investigation and conduct the investigation in accordance with the legal codes of practices
(Police and Criminal Evidence Act 1994, Regulation of Investigatory Powers Act 2000, Criminal
Procedures and Investigation Act 1996. and other legislative requirements (e.g. Data Protection
Act 1998).
On the conclusion of the investigation the LCFS will report findings and recommendations to the
Director of Financial Strategy. The Director of Financial Strategy is the sole person who can
determine whether or not any formal action is justified and what form such action takes;
however, guidance can be sought from the Chief Executive and LCFS.
If the Director of Financial Strategy decides that formal action is to be taken against the
subject(s) of an investigation, the LCFS will comply with the CFSMS Applying Appropriate
Sanctions Consistently Policy. This will involve using an appropriate combination of the
sanctions described below:
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Disciplinary action - NHS Halton & St Helens and/or professional regulatory body
(warning, dismissal etc)
Civil remedy – recover money, interest and costs
Criminal prosecution – which may result in imprisonment, community penalty, a fine,
confiscation or compensation
The use of parallel sanctions or ‘triple-track’ approach helps to maximise the recovery of NHS
funds and assets while minimising duplication of work.
The NHS Halton & St Helens Disciplinary Procedures will be used where the outcome of the
investigation indicates improper behaviour on the part of employees. The LCFS shall liaise with
the Director of Workforce Development in providing evidence for Disciplinary Hearings.
Where financial loss has been suffered through fraudulent activity, NHS Halton & St Helens will
pursue the perpetrator for recovery, including taking appropriate legal action. The LCFS shall
liaise with legal representatives and attend court as required.
The LCFS will seek authorisation from the Director of Financial Strategy if a matter is to be
reported to the Police. The LCFS shall liaise with the police by providing a MG (Prosecution)
File and participate in interviews, searches etc. The LCFS shall attend court to give evidence
and liaise with the Crown Prosecution Service as required.
The LCFS acts on behalf of NHS Halton & St Helens in the event of any formal action and must
ensure there is co-ordination between the various parties involved such as where external legal
advisors are used.
When a fraud or corruption has occurred at the PCT, the LCFS will strengthen the control
environment in which the event occurred by identifying and addressing any system weaknesses
to reduce the risk of any such an event happening again.
The LCFS is required to advise the NHS Counter Fraud and Security Management (CFSMS) of
every investigation and refer appropriate matters to CFSMS.
The LCFS shall maintain and present to the Director of Financial Strategy and Audit Committee
a record:
Detailing of all reported suspicions;
Detailing of subsequent actions taken and conclusions reached.
This record will be reviewed by the Audit Committee at least once a year and any significant
matters will be reported to the NHS Halton & St Helens Board. The LCFS will have open access
to the record. The record will be a confidential document and accessible only by authorised
officers. The record is subject to the Data Protection Act 1998 particularly in relation to the
retention and destruction of personal data.
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The Director of Financial Strategy is responsible for the smooth running of this protocol and
where clarification is required his or her decision will be final.
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APPENDIX A
RELEVANT COUNTER FRAUD DEFINITIONS
1. The following ‘Definitions’ are provided as information to assist in the
understanding of fraud terminology:
1.1 Deception (also called beguilement or subterfuge) is the act of
convincing another to believe information that is not true, or not the whole truth as in
certain types of half truths.
Deception involves concepts like propaganda, distraction and/or concealment. Fiction,
while sometimes manipulative, is not a deception unless it is portrayed as the whole
truth. In many cases it is difficult to distinguish deception from providing unintentionally
wrong information. One of the reasons for this is that a person or an entire organization
may be self deceived.
1.2 Bribery, a form of pecuniary corruption, is an act usually implying money or gift given
that alters the behaviour of the recipient in ways not consistent with the duties of that
person or in breach of law. Bribery constitutes a crime and is defined by Blacks Law
dictionary as the offering, giving, receiving or soliciting of any item of value to influence
the actions of an official or other person in discharge of a public or legal duty.
The bribe is the gift bestowed to influence the recipient's conduct. It may be any money,
good, right in action, property, preferment, privilege emolument, object of value,
advantage, or merely a promise or undertaking to induce or influence the action, vote, or
influence of a person in an official or public capacity.
1.3 Forgery is the process of making, adapting, or imitating objects or documents, with the
intent to deceive. The similar crime of Fraud is the crime of deceiving another, including
through the use of objects obtained through forgery. Copies, studio replicas, and
reproductions are not considered forgeries, though they may later become forgeries
through knowing and wilful misrepresentations.
1.4 A counterfeit is an imitation that is made usually with the intent to
deceptively represent its content or origins. The word counterfeit most
frequently describes forged currency or documents, but can also describe
clothing, software, pharmaceuticals, watches, or more recently, cars and
motorcycles, especially when this results in patent or trademark
infringement.
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APPENDIX B
FRAUD RELATED CRIMINAL LEGISLATION
1. The following details elements of criminal legislation relevant to fraud. The detail is
provided for information solely and any further actions or understanding should be
requested from the LCFS.
FRAUD ACT 2006
2. A person is guilty of fraud if a person is in breach of any of the sections listed below
(which provide for different ways of committing the offence):
section 2 (fraud by false representation)
section 3 (fraud by failing to disclose information)
section 4 (fraud by abuse of position)
2.1 A person who is guilty of fraud is liable:
on summary conviction, to imprisonment for a term not exceeding 12
months or to a fine not exceeding the statutory maximum (or to both);
On conviction on indictment, to imprisonment for a term not exceeding 10
years or to a fine (or to both).
2.2 Section 2, Fraud Act 2006: Fraud by false representation - A person is
in breach of this section if a person:
(a) Dishonestly makes a false representation, and
(b) Intends, by making the representation:
(i) To make a gain for himself or another, or
(ii) To cause loss to another or to expose another to a risk of loss.
• A representation is false if:
(a) It is untrue or misleading, and
(b) The person making it knows that it is, or might be, untrue or misleading.
• Representation means any representation as to fact or law, including a
representation as to the state of mind of:
(a) The person making the representation, or
(b) Any other person.
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• A representation may be express or implied.
• For the purposes of this section a representation may be regarded as made if
it (or anything implying it) is submitted in any form to any system or device designed to
receive, convey or respond to communications (with or without human intervention).
2.3 Section 3, Fraud Act 2006: Fraud by failing to disclose information - A
person is in breach of this section if a person:
(a) Dishonestly fails to disclose to another person information which he
under a legal duty to disclose, and
is
(b) Intends, by failing to disclose the information:
(i) To make a gain for himself or another, or
(ii) To cause loss to another or to expose another to a risk of loss.
2 .4 Section 4, Fraud Act 2006: Fraud by abuse of position
• A person is in breach of this section if a person:
(a) Occupies a position in which he is expected to safeguard, or not to act against,
the financial interests of another person,
(b) Dishonestly abuses that position, and
(C) Intends, by means of the abuse of that position:
(i) To make a gain for himself or another, or
(ii) To cause loss to another or to expose another to a risk of loss.
• A person may be regarded as having abused his position even though
conduct consisted of an omission rather than an act.
his
CRIMINAL ATTEMPTS ACT 1981
3. The following concerns attempted criminal offences:
(1) If, with intent to commit an offence to which this section applies, a person does an act
which is more than merely preparatory to the commission of the offence, he is guilty of'
attempting to commit the offence.
(2) A person may be guilty of attempting to commit an offence to which this section
applies even though the facts are such that the commission of the offence is impossible.
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(3) In any case where:
(a) Apart from this subsection a person's intention would not be
regarded as having amounted to an intent to commit an offence;
But
THEFT ACT 1968
(b) If the facts of the case had been as he believed them to be, his
intention would be so regarded, then, for the purposes of subsection
(1) above, he shall be regarded as having had an intent to commit
that offence.
(4) This section applies to any offence, which, if it were completed, would
be triable in England and Wales as an indictable offence, other than:
(a) Conspiracy (at common law or under section 1 of the Criminal
Law Act 1977 or any other enactment);
(b)aiding, abetting, counselling, procuring or suborning the
commission of an offence
(c) Offences under section 4(1) (assisting offenders) or 5(1)
(accepting or agreeing to accept consideration for not disclosing
information about an arrestable offence) of the Criminal Law Act
1967.
4 The following relates to the offence of ‘simple’ theft:
(1) A person is guilty of theft if he dishonestly appropriates property belonging to another
with the intention of permanently depriving the other of it; and ‘theft’ and ‘steal’ shall be
construed accordingly.
Page 20 of 26

APPENDIX C
FRAUD RESPONSE PLAN
Concerned about Fraud?
Fraud or corruption suspected
Fraud or corruption not
suspected
Inform the LCFS or Director of
Financial Strategy
NHS Fraud &corruption
hotline or Public Concern at
Discuss with your Head of
Department
LCFS will assess the referral and
commence investigation
No Fraud
Fraud
Criminal
Police/Court
Fraud
Civil Court
Fraud
Disciplinary
Hearing
LCFS
closes case
–
No action
Prison,
Community
Penalty, Fine,
Costs,
confiscation/
Compensation
Recovery of
monies,
interest &
costs
Professional
regulatory
body: struck
off, conditions
etc
Dismissal,
verbal or
written
warning
Feedback to the referrer on the
outcome of the allegation

APPENDIX D
FRAUD AND CORRUPTION
‘STAFF STATEMENT’
INTRODUCTION
NHS Halton & St Helens is committed to maintaining an honest, open and well intended
atmosphere, so as best to fulfil its objectives and that of the NHS. It is therefore also committed
to the elimination of Fraud and Fraudulent acts and to pursue a full and detailed investigation
and punishment of such cases. Where Fraud or illegality is proven, it ensures that those
responsible are appropriately punished. The PCT will also take appropriate steps to recover any
assets lost as a result of Fraud and other fraudulent acts.
NHS Halton & St Helens wishes to encourage anyone having reasonable suspicions of Fraud to
report them immediately. The PCT policy, which will be rigorously enforced, states that no
employee should suffer as a result of reporting reasonably held suspicions.
NHS Halton & St Helens has therefore set in place procedures in the form of Standing Orders,
Standing Financial Instructions, Scheme of Delegation and Procedure notes designed to
minimise the likelihood of it suffering wrongdoings and a response plan to be followed in the
event of a suspected Fraud and/or corruption being reported.
TACKLING FRAUD AND CORRUPTION IN THE NHS
The Counter Fraud and Security Management Service (CFSMS) became an organisation in
September 1998 with a remit to counter all Fraud and Corruption within the NHS, with a specific
priority for countering Fraud in the Family Health Services.
The CFSMS has recruited dedicated specialists to counter Fraud in the NHS and has specialist
teams working in each of the eight NHS regions, supported by a national proactive team and a
team working to investigate pharmaceutical and dental Fraud.
In addition to this, there are Local Counter Fraud Specialists (LCFS) situated in each PCT. Each
LCFS has received expert training in law and procedures and is accredited as a Counter Fraud
Specialist through the institute of Criminal Justice Studies. All staff are trained to conduct their
work in a professional, confidential and ethical manner.

SUMMARY
You should be assured that there will be no re-criminations against staff or contractors who
report reasonably held suspicions. NHS Halton & St Helens employs a ‘Raising Concerns’ /
‘Whistle-blowing’ Policy which states that no-one should suffer for reporting reasonably held
suspicions. Any contravention of this policy should be immediately reported to the Chief
Executive or Chair of the Audit committee.
You may suspect a colleague, or other person of an irregularity involving the PCT or
infringement of its or NHS rules. If you do have a suspicion, please discuss it with your line
manager in the first instance unless you suspect your manager of being involved in the Fraud,
in which case you should report it to the Director of Financial Strategy.
Alternatively you may discuss the matter confidentially with the LCFS.
If it is acknowledged with you that there may be a Fraud then the manager or LCFS will report
to the Director of Financial Strategy and if deemed necessary a full investigation will be
undertaken. Under no circumstances should any members of staff speak to representatives
from the press, radio or TV or any other third party unless they have been instructed to do so by
the Chief Executive. Staff should be aware that if this is contravened, they may be in breach of
the PCT’s Standing Orders and Standing Financial Instructions which may result in disciplinary
proceedings being instigated against them.
Everyone has a part to play in the fight against Fraud and Corruption. We all have a
responsibility to protect our organisation and its resources. NHS Halton & St Helens is
committed to the elimination of any financial irregularity or fraud within the PCT by employees or
contractors and to the rigorous investigation and punishment in such cases.
Further information can be obtained from the following list of contacts:
- Director of Financial Strategy: Mike Treharne
Tel: 0151 495 5171
Em ail: m ike.treharne@ hsthpct.nhs.uk
- Local Counter Fraud Officer: Rick M arriott
Tel: 0151 285 4523 Mobile: 07825815018
Em ail: rick.m arriott@ m iaa.nhs.uk
- Counter Fraud Team [MIAA ] on 0151 285 4500
- Reporting your concerns using the on-line Intranet Referral Form
- Calling the national NHS Fraud and Corruption Reporting Line on:
0800 028 40 60

APPENDIX E
EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached to any corporate document when submitted to the appropriate
committee for consideration and approval.
1. Does the policy/guidance affect one group less or
more favourably than another on the basis of:
Yes/No
Comments
Race
Ethnic origins (including gypsies and travellers)
Nationality
Gender
Culture
Religion or belief
Sexual orientation including lesbian, gay and
bisexual people
Age
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
2. Is there any evidence that some groups are affected
differently?
3. If you have identified potential discrimination, are
there any exceptions valid, legal and/or justifiable?
4. Is the impact of the policy/guidance likely to be
negative?
5. If so can the impact be avoided?
6. What alternative are there to achieving the
policy/guidance without the impact?
7. Can we reduce the impact by taking different
action?
If you have identified a potential discriminatory impact of this corporate document, please refer it
to [insert name of appropriate person], together with any suggestions as to the action required
to avoid/reduce this impact.
For advice in respect of answering the above questions, please contact [insert name of
appropriate person and contact details].

APPENDIX F
DISSEMINATION AND TRAINING PLAN
This Dissemination and Training Plan must be submitted to the Policy Sub Committee upon request. The status column
must be given a Red, Amber or Green rating with evidence to demonstrate an action has been completed.
DISSEMINATION PLAN
Title of document: Counter Fraud Policy and Response Plan
Date finalised:
Dissemination Lead: (Print name and contact details)
Rick Marriott Mersey Internal Audit Authority
Previous document already being used? No
Proposed action to retrieve out-of-date copies of the document:
To be disseminated to: All existing and new staff of the PCT at all
levels
1. Presentations at Staff induction events
2. Through handouts and leaflets and NHS CFS forms distributed as part
of PCT’s induction process
3. Through awareness training to staff at all levels
4. Maintenance of CFS information site on the PCT intranet
Who will disseminate it
Timescale
(Date)
Email circulation to all Staff Debbie Fairclough W/C 6 th
July 2009
Status
Paper
or
Electronic
Comments
Article in The Brief Debbie Fairclough W/C 26 th
July 2009
Article in Trust Times Debbie Fairclough September
2009

TRAINING PLAN
Event (Please provide details of where and training dates available to educate staff about this policy) Timescale Owner Status
Programme of counter fraud awareness training to be delivered to staff at all levels with in PCT Minimum of 15
presentations to staff
groups
Rick Marriott
On
going
Training Plan Lead (Please provide details of staff who will be responsible for overseeing this training)
Rick Marriott
Additional information (Please provide details of any processes in place to support implementation)
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Denotes: Action partially implemented.
Denotes: Action complete.