The NHS is either excellent at preventing fraud or rather poor at estimating it.
Official figures put NHS fraud at £229 million – less than one-twentieth of the average level expected from looking at other healthcare systems worldwide. The UK Government's Annual Fraud Indicator, does concede that there may be £2.3 billion worth of procurement fraud affecting the entire UK public sector and £335 million in payroll fraud in England, Scotland and Wales.
If NHS fraud were to follow the global average, it would cost the service £5 billion a year, according to Jim Gee – who ran the NHS anti-fraud unit, NHS Protect, for ten years.
Most NHS fraud is likely to revolve around non-payment of prescription charges by patients, medical professionals claiming for work they have not done and overcharging by contractors. One of the key reasons for the low estimate is that the NHS only estimates losses due to the first category (prescription fraud) plus dentistry.
NHS Protect have not been resting on their laurels. Last year they oversaw nearly 150 successful criminal cases – including one in which a dentist was found guilty of stealing £1.4 million. There were also 435 civil or internal disciplinary actions. However, like the Crown Prosecution Service, NHS Protect does not proceed with cases it considers unlikely to win.
The operating budget for NHS Protect fell by 30% in the six years to 2013-14 – it now employs around 300 investigators. To put this into perspective, the Department for Work and Pensions employs six-times the number of staff to investigate fraud of an estimated £1.9 billion.
It is easy to see why many observers believe the burden of NHS fraud is far higher than previously revealed.
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