Healthier options

Protecting each and every aspect of this huge organisation from those who would seek to abuse or attack it isn't a simple assignment. With this in mind, a new Special Health Authority – designated the Counter Fraud and Security Management Service (CFSMS) – has now been formed to assume responsibility for all policy and operational matters relating to the management of security and countering fraud in the NHS.

In announcing the CFSMS' creation last March, former health minister Lord Hunt commented: "As well as continuing to make progress against fraud, the main task of the new organisation will be to do as good a job when it comes to tightening security management procedures, in particular when it comes to protecting patients, staff and hospital supplies. This Government is determined to protect the NHS as best it can."

Combating the NHS fraudsters
What progress has been made to date, then? The CFSMS' predecessor, the National Health Service Counter Fraud Service (NHSCFS) contributed a financial benefit to the NHS of almost £300 million in the past four years. That included a reduction in patient fraud from £171 million down to £109 million (a 36% decrease), and a decline in fraud perpetrated by healthcare professionals by between 25% and 40% in key areas.

Since its inception back in 1999, the NHSCFS has also witnessed over 160 successful criminal prosecutions with a 98% success rate on convictions. Over 215 civil and disciplinary sanctions have been applied in that time.

Several cases have been handled, including that of a chief executive of an NHS Trust who was falsifying his mileage expense claim forms at a cost to the NHS of £40,000. He was sentenced to 18 months. Earlier this year, a Nottingham dentist was ordered to repay the NHS a total of £1.6 million. Over many years, he and his colleagues had made large numbers of false claims for recalled attendance fees. The case was one of the first examples in the public sector where civil, criminal and disciplinary sanctions have been pursued in parallel. In the past, such sanctions have been pursued separately – often over an extended period – with indifferent results.

As the NHS now moves into its 55th year, it has never been truly protected from those who wish to defraud its highly valuable resources. The major challenge that lays before the CFSMS, then, is not only to continue the successes of its forerunner, but also to raise the standards and professionalism of security management right across the organisation.

Our overall objective in security management is to deliver an environment for those who use or work within the NHS which is properly secure, such that the highest possible standard of clinical care may be made available.

Changes in security management
Every aspect of security management work in the NHS is important, of course, although the CFSMS will be looking at certain priorities aimed at harnessing the successful running of a secure NHS organisation. These include: violence against staff, the security of maternity units, the control of hazardous materials, the theft of medicines and other supplies and the confidentiality of records and data.

None of us within the CFSMS expects the delivery of these priorities to be easy, but nonetheless our expectations remain high. Due to the successes the NHS has seen in countering fraud since 1999, our strategy now will follow a similar business model of 'problem-strategy-structure-action'.

Working closely with the NHS, our first task is to gauge the current levels of security management arrangements in hospitals, and identify those areas where improvement is needed. Once this process is complete, the next step will be to publish our strategy (due later on this year) communicating a new vision for security management in the NHS.

Our aim is to build on the security management experience that presently exists within the NHS, and provide a new emphasis and degree of support for the work in a way that ultimately leads to lasting and tangible improvements.

In practice, the CFSMS will be defining roles within the NHS and then requiring locally-nominated individuals to complete an all-new training course in security management – the first of its type ever to be launched within the NHS – covering areas such as the protection of people, incident investigation, the protection of property and operating within an ethical framework. Individuals who eventually pass the course will then have to carry out their responsibilities accordingly.

The CFSMS Training Service is already set to deliver this new training, free of charge, to all nominated members of staff throughout 2004-2005 and 2005-2006. A bespoke NHS Security Management Manual will also be produced and provided to accredited staff on completion of their training.

Common skills and qualifications
We'll be doing all that we can to encourage high professional standards within a growing body of security management specialists operating to common skills, a common 'language' and common qualifications. What we really want to see is a trained and accredited security management specialist covering every NHS body in England.

In 2004-2005, the organisation is also going to recruit regionally-based CFSMS staff dedicated to the promotion and support of NHS security work, and the CFSMS quality assurance programme will be extended to include the inspection of security standards and professionalism in compliance with the legal framework covering this area that we intend to put in place.

NHS staff have a basic right to be able to care for people without the fear of them being attacked or abused. To ensure that such incidents of physical, verbal or mental abuse are properly dealt with, the CFSMS plans a new system for reporting incidents, specialist support for dealing with incidents and reports on the ground and a legal capacity to prosecute any cases not dealt with via the police.

The aim is to follow an inclusive approach in developing this work. This means that, as the work is taken forward, we'll seek to involve all relevant stakeholders – developing both regular and ad hoc discussion opportunities as and when appropriate.

A Strategy Development Group has already been established involving organisations such as the Royal College of Nursing, UNISON, the British Medical Association and those who have first-hand experience of security management within the NHS.

Back in July, the CFSMS announced one of the largest ever NHS training exercises. Starting early next year, all NHS frontline staff and professionals will receive conflict resolution training, designed to enable them to recognise the warning signs of a potentially violent incident while providing the skills for 'diffusing' the aggressor. It's currently estimated that the CFSMS will instruct around 100,000 members of staff each year, using 60 regionally-based trainers across the NHS.

Initial training will focus upon staff and professionals perceived to be at the greatest risk (ie nurses, ambulance crews, GPs and all those working in Accident and Emergency Departments). As the training develops, so specialist courses will in turn be designed for operatives deployed in areas focusing on mental health and learning disabilities.

The content of the conflict management course is now being developed in partnership with the main NHS professional and staff representative groups. In essence, it will allow skills to be improved so that attendees are able to recognise body language and the warning signs of a potential conflict, and then learn to diffuse the situation successfully.

Ramping up professionalism
The NHS CFSMS is introducing a new approach to security management that will seek to raise professionalism and standards in this vital arena. Tackling physical and non-physical assaults on staff is an essential element of the work, set against the background of the recent National Audit Office report 'A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression' and the development of the Improving Working Lives agenda. Here, tackling violence and aggression will become a Key Performance Indicator for health bodies.

Over the coming months, a good deal more information will be made available to the industry at large, outlining the finer detail of what the NHS' CFSMS will be doing to make the healthcare environment a safer one for all. It stands to reason that the better we protect the NHS, the better placed the service will be to achieve the highest standards of clinical care.