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• Today we hope to give you a whistle-stop tour about how we use and have

developed our systems, utilising existing IBM products, to help us to meet our

business objectives.

• Systems are a work in progress and today is a snapshot.

• Accessing our ‘live’ systems

NHS Protect is the body within the NHS that is focussed on the protection of NHS

resources from crime.

We exist to ensure that the money intended for patient care, and funded by the

taxpayer, doesn’t end up in the pockets of those that shouldn’t have it and is available

to be spent as is should be - on health services

People are often surprised that there is economic crime in the NHS. There is.

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These are a selection of our headlines have appeared in national papers over

the last year.

The NHS it is the biggest employer in Europe, it directly employs 1.2million

people and has a budget of £96bn

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NHS Protect achieve in relation to economic crime in the NHS……..

• The value of fraud, bribery and corruption identified following the

successful conclusion of investigations last year was £6.5 million.

• Over £2 million was restrained and over £2.4 million confiscated using

Proceeds of Crime Act

• As at the end of last year NHS Protect was investigating allegations of

fraud, bribery and corruption worth in excess of £25 million

Handouts available on headlines

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Two of the objectives this year have ended up having our collective

We hope to show you today is how we use and have developed our systems,

driven by these objectives and utilising existing IBM products, to help us to

meet these objectives now and into the future.

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Systems Overview:

The suite of products we utilise to undertake our function in the Intelligence

Unit are primarily IBM products.

Intelligence Database is built on iBase.

We also use Intellishare – which allows a web based interface to the database

And we used Analysts notebook to visualise the database information

The other system we will show you today is our own fraud and corruption

reporting online system.

Go to FCROL

https://www.reportnhsfraud.nhs.uk/

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This is our public facing on line system and we are going into it ‘live’. Anyone

can access it – just google ‘report NHS fraud’ or similar and it will be the top

hit.

System prior was designed and built outside the Intelligence unit which meant

the data collected did not fit seamlessly with our intelligence system, it was

clumsy to integrate and there was reliance on ‘freetext’ fields. When it became

clear it needed replacing – we were keen to get involved.

Processing information and integrating it into existing data can be one of the

most time consuming elements in an Intelligence Unit - we knew that we could

speed up processing and prioritise work better if we were involved in the build

of the new system.

‘in house’ small team effort led by intel.

The system has been built to feed directly into our iBase Intelligence

Database. Wherever we ask for information here – there is a corresponding

field in our intelligence database.

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The system talks the inputter through a series of questions that allow us to

classify the information they are providing easily.

So for instance if they have not chosen to be anonymous, we ascertain

specific information about them that helps us to determine the reliability of the

source later on.

In order to make sense of the information that comes into the intelligence unit

each report is classified into taxonomy of economic crime. This enables

robust classification of fraud in the NHS with categories and subcategories.

There are over 200 different classifications available.

In the old world somebody had to read each report and somehow classify it

into a type of fraud – we have introduced the taxonomy and using this system

– we make the public do it for us!

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Explain that this will impact on priority

Categorisations are useful from a statistical perspective but some issues are

have higher priority – impersonation v patient not paying the £8 for his

prescription!

So although we further enhance prioritisation via additional action when we

receive the report, this early classification plays a really important role to help

us to speedily identify issues that put staff or patients at risk.

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The other big factor that enables us to appropriate collate the information is

establishing specifically the link to the NHS – by asking the inputter a series of

questions that establish this link – whether the subject is employed by or a

patient of the NHS or linked in some other capacity – this is formally recorded

and transferred on import to our intelligence database.

We recently joined forces with Crimestoppers who have taken our ‘hotline’

calls since the beginning of October. This was another measure the

organisation took in order to increase the known under reporting in the NHS.

Crimestoppers utilise an ‘account’ version of this system for inputting details

taken by phone and transferring that information to NHS Protect.

There are many organisations both within the NHS and the wider public sector

that routinely get information that impacts on our business .

We need to ensure we offer robust and reliable routes to capture that

information but equally we need to minimise the impact this processing will

have on our resources.

By pushing this system out to such organisations this will help avoid

processing data which would otherwise reach us in an unstructured manner,

such as emails – that are time consuming to process.

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Database stats:

ENTITY RECORDS / LINKS

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Show how it differs from most intelligence databases - is our inclusion of the

structure of the NHS. So all NHS organisations exist in our database.

So this is a snapshot of some of the types of organisation that are held – so

for instance you can see that we have

DENTAL PRACTICES / GP PRACTICES

The NHS structure, represented by entities and links in the database, forms

the ‘foundation’ of our database and every item of work we receive is linked

in some manner to the NHS structure.

Our remit dictates that the NHS must be identified as the victim if we are to

pursue the issue – so if it can’t be linked to an NHS Organisation in some

manner, we would have to question why we are looking at it at all.

GO TO INTELLISHARE and view work queues from imported records

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Back to info processing:

So having been as clever as we can with the way we have collected the

information – with the help of our database specialist the data is imported into

our database overnight.

The next morning the officer goes into INTELLISHARE and goes this work

queue area

Work queues are just a queries written in iBase to pick up work at different

stages of processing and run from this structured search area in intellishare.

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So ordinarily the processor would do the next stage in INTELLISHARE, but

for the purposes of this presentation we are going to visualise these in ANB

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IMB1 so these are the reports we are going to look at - expand them

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So most of you will be familiar with Analysts notebook – deliberately keeping

this small because it is live data and we don’t want you to be able to read it!

This newly imported data has structure to it.

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and you can see that the first time that anyone looks the data, it is already

interpreted into the appropriate entities and links, because the hard work has

been done in the definition and mechanics of the export / import process.

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If we have a closer at one report we can see that this information seems to

be about a doctor and it is something to do with prescriptions

Because the inputter has chosen Bradford City CCG as the place of

employment for the subject – this has been linked to the database entity

representing this health body.

This means that already we have some NHS context on which to draw. So for

example if we wanted to see what other reports we have had in respect of

Bradford City – we can do so by doing a controlled expand

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So for instance here – we know that our new information concerns a doctor

and prescriptions If we look at the linked reports it is easy to pick out that

there are 3 other reports with the title GP Prescribing issues – that it may be

prudent to examine these further. Just one of the ways that the information

has context as soon at it arrives in the database.

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The officer doing the initial processing reviews the information and ensures

that the visualisation is properly reflecting the information provided and

enhances it to enable us to contextualise the data by completing additional

fields.

Just to put that first stage into context – initial processing is usually done

every morning – first thing by one processor who has it all done and in work

queues for the IO’s by 10ish. So something that was added say at 11 o’clock

the night before – maybe the impersonating issue we were looking at earlier,

will processed and in the database with any existing context and ready for IO

action the following morning.

Now the work is ready to be picked up by an Intelligence Officer to develop in

another work queue.

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In iBase you can see the work queues better – they basically the same

queues we were looking at in intellishare….

The work that has been done by the original inputter (remember possibly just

a member of the public) and the initial processing enable the system to

categorise the work into queues based on some kind of criteria or

prioritisation.

Run through some of the queues….

High Priority

RUN THE HIGH PRIORITY QUERY

– I fully expect this queue to be empty as we don’t get many that fall into this

category and when they appear they are dealt with immediately…..This is

where amongst other high level issues – anything where there is a risk to the

health or wellbeing of NHS Staff or patients would be allocated. So if the

taxonomy type chosen at the outset was for instance ‘impersonating a

medical professional’ this would enter this queue and be dealt with on the

same day.

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Fast track queue identifies issues that we wish to push through the system

quickly.

This changes dependent on current issues – the taxonomy is currently playing

an active part in identifying ‘fast track issues’ these are the menu entries that

relate directly to the taxonomy choices like the ones we looked at earlier.

note Heathrow…

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So we aren’t going to go through every queue, they are all defined to pick up

specific work with varying priorities for the intelligence officers to utilise.

So if we now go to one of the new work queues and pick up some

reports…and show them in the same way as we did with the imported records

in ANB

You can already see that it looks far more colourful and interesting than it did

from the first

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And if we now just pick on an example from this work queue……

So similar to the last time – this time it is a dentist – JAMES HARRISON and

the report is about prescribing issues.

but additionally now, because of the work done in the first stage of processing

there are two pink entities, these are admin type entities linked to the that

enable us to track the progress of the work item and enable it to move forward

to the next stage of processing.

Subject comes under Greater Manchester Area Team / there are attachments

and the subject is a dentist so he is already represented in the database as an

NHS dentist - so the new subject nominal is linked to the existing foundation

data nominal

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And now if we expand out from him, the new information is represented in that

box but you can now see that a lot more information has come into the picture

linked via the entity that represents the subject as an NHS Dentist.

And if we follow that link down we can see that James Harrison already exists

in our database. So our next step would be to merge these two entities

and now we can clearly see that our subject is linked to another information

report and that information report has been tasked and became an

investigation case

And the case is still open.

So we would understand from that that the new information probably needs to

be disseminated to the investigation officer dealing with case.

And when the case is concluded we would be able to access the sanction

information on this entity.

So the point of showing you all this is to demonstrate the whole progression

from the receipt of the original information to its disposal can be robustly

tracked via our intelligence systems.

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So how is all that helping us to meet our objectives?

Our first objective was about increasing fraud reports. The new online system

is easier to find, it is more reliable, is available on multi platforms and is just

nicer to use! Since its introduction, which was a soft launch last year we have

seen a steady increase in reporting via this system.

And working in partnership with Crimestoppers – the social medial launch is

still underway and digital packs with the Crimestoppers message have

recently been issued to Health Bodies across the country for incorporation on

their websites. Using this joint approach of their telephone expertise and our

online system has resulted in a sharp increase of information taken over the

phone since the beginning of October. As the message gets out there we

have no reason to think that this increase won’t continue.

We know that fraud and corruption issues are under reported in the NHS, but

now the mechanisms that underpin reporting are robust and do nothing to

detract a potential reporter

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And the other objective we had was the acquisition and integration of data

sources

I said at the beginning this is a ‘work in progress’ and we have still do

undertake the next ‘phase’ which is making the online reporting account

holder area available to other stakeholders, making it an attractive option and

marketing the facility specifically to customers who know stuff we want to

know!

This will be the thing that makes the dramatic impact. And when it does we

will be ready and can meet this head on with systems built in such a way that

we will not be overwhelmed by quantity and our prioritisation methods can

effectively manage the workload.

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Questions

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