Fraud must be top of NHS agenda

11 Feb 20

The government must get to grips with fraud within the NHS which is costing £1.27bn a year, argues Matthew Jordan-Boyd of the NHS Counter Fraud Authority.

Image credit | Alamy

You wait for an article about NHS fraud for ages, and then two come along at once. In her piece about NHS fraud prevention in November’s Public Finance, Laura Hough talked a good deal of sense. She praised NHS England’s economic crime strategy as “a strong example for the rest of the public sector”.

The NHS Counter Fraud Authority was proud to contribute to this strategy – not least with our fairly grim statistics about the scale of the NHS fraud problem; a total of £1.27bn a year by our latest estimates.

My honest opinion is that tackling fraud is still nowhere near high enough on the agendas of NHS chief executives and financial chiefs.

That’s not because they don’t care – far from it. It’s because, unfortunately, countering fraud is just one of hundreds of obligations on their collective shoulders.

If they have received paper assurances from internal and external auditors, and from local counter-fraud providers regarding the response taken to fraud risks, some boards and audit committees may be inclined to tell themselves “job done”, and move on to their next agenda item.

They may genuinely believe that if there is a significant problem of fraud in the NHS, it’s not in their organisation.

However, when NHS bodies – even the highest-performing ones – look deeper into activities with the intention of identifying fraud, they usually do find something.

Perhaps you are one of those leaders who puts fraud guidance from NHSCFA on the ‘later’ pile or forwards to their counter-fraud provider, saying “I think this is for you”.

Or, just maybe, you are one of those who says: “I am going to personally make sure this happens, and, while we are at it, let’s put in some extra resources.”

I would suggest that most people are somewhere in the middle. They want to do the right thing, but are concerned that there just aren’t enough hours in the day.

NHSCFA will shortly be providing all organisations with information to allow them to benchmark their fraud efforts against others of a similar size and type. Hopefully, this will allow for easier engagement in this area.

‘My suggestion is to look at counter-fraud effort and spend as something that could make your life – and that of your patients – easier in the long run.’

My suggestion is to look at counter-fraud effort and spend as something that could make your life – and that of your patients – easier in the long run.

Countering fraud is not only the ethically appropriate thing to do but an investment that will pay dividends in saved activity for most organisations.

We estimate that 1% of all pay and associated costs within the NHS is lost to fraud, so in a large trust this could be in excess of £8m a year.

Tackling fraud in this area could, in a fairly short timescale, pay much-needed dividends to be ploughed into delivering patient care.

The measures that guard against fraud also deliver more general results and efficiencies.

As Laura noted, preventative strategies, strong governance, long-term planning, clear accountability and strong ethics are important building blocks.

Looking back at the points I made in an article when I started this job two years ago, it’s clear they remain just as important.

  • Fraud is inherent in all business systems, including the NHS

  • We collectively need to do more to counter fraud: despite much good work across the NHS, in excess of £1.2bn is being lost to fraudsters – money that should be funding patient care

  • NHS leaders must prioritise countering fraud in their bodies.

Fraud within the NHS is continuing on a daily basis, with these attempts perpetually changing as criminals look at different methodologies. Those who manage the NHS must be even more agile and determined than the criminals. 

  • Matthew Jordan-Boyd

    is director of finance and corporate governance at the NHS Counter Fraud Authority

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