This article will be of value to those working across the National Health Service (NHS) and particularly to those engaged in counter fraud activities across the public sector. As well as having national value, this article will be of international relevance as it speaks to the responsible guardianship of public funds. This article evidences the ways in which counter fraud services across the NHS in England are disjointed and some of the causes for such disjointedness. Official reports estimate that at least £1.2 billion, approximately 1% of the NHS budget, is annually lost to fraud. At a time when the NHS is facing unprecedented demand on its resources due to austerity policies, Brexit and the global pandemic, and with no clear indication of significant additional investment, any loss of NHS funds could have significant impact on patient care and so a better understanding of counter fraud responses in the NHS is potentially pivotal to future responsible handling of public money.