The NHSCFA estimates that £1.316 billion of NHS funding is vulnerable to loss through fraud, bribery, and corruption in England. This equates to 0.77% of the NHS budget for 2023 - 2024 and is therefore a percentage decrease when compared with the NHS budget for 2022 - 2023. Collaboration with stakeholders and counter fraud mechanisms such as the continued roll out of Real Time Exemption Checking (RTEC) appears to have resulted in a lesser portion of the NHS budget being vulnerable to loss.
When compared with the previous year, the allocated budget for the NHS in England has increased by almost 10% to £171.036a billion for 2023 - 2024. Although financial vulnerabilities are linked to budgets, the percentage of the budget vulnerable to fraud has remained static, which could in part demonstrate an effective counter fraud approach across the health sector.
Reports received by the NHSCFA have increased to 6,367 during 2023 - 2024. The following table breaks down the current reporting figures by thematic area and displays the financial vulnerability estimates for 2023 - 2024 compared with 2022 - 2023.
The impact of the NHS Supply Chain bringing more procurement responsibility in-house should leave fewer products managed by outside organisations on behalf of the NHS, and a reduced financial vulnerability from a fraud and error perspective.
The threat of payment diversion fraud, or mandate fraud, remains prominent with continued reporting of incidents. Proactive and collaborative work in this area has contributed to the prevention of NHS funds ending up in the hands of fraudsters.
Intelligence indicates evasion of NHS prescription charges where patients will deliberately avoid paying for services which usually require payment like prescription costs, dental treatment, and optical costs. The reduction in the financial vulnerability figure for patient exemption fraud demonstrates the impact from the rollout of RTEC.
An emerging trend has been identified in 2023 - 2024 where applicants from overseas have submitted forged and falsely obtained International English Language Testing System (IELTS), Occupational English Tests (OET) and Computer Based Test (CBT) certificates during the recruitment process to work for the NHS which highlights the need for continued due diligence in recruitment.
Intelligence suggests patients without exemptions will return to, or enter, the UK with the specific intent of accessing secondary care without charge, yet permanently reside abroad. This is frequently enabled through use of visitor visas and / or providing a false address.
Approximately 86% of reports this year relate to NHS staff fraud, patient exemption fraud, procurement and commissioning fraud, and Fraudulent access to NHS care from overseas visitors.
Reporting has increased by over 26% when compared with 2022 - 2023. This could be attributed to the reach of the television series Fraud Squad increasing public awareness around the NHSCFA, the relaxation in COVID-19 restrictions, along with the cost-of-living crisis.
The NHSCFA Strategy has four pillars which support counter fraud activity, with the Strategic Intelligence Assessment (SIA) providing the foundation for activity within these pillars.
For strategic priority and intelligence collection areas, the SIA highlights emerging and current modus operandi and presents the future landscape through horizon scanning.
Analysis was conducted on bribery and corruption reported within the NHS between 2021 and 2024 to develop our organisational understanding. This indicated that NHS staff fraud and GP contractor fraud were the most likely areas to see reports mentioning bribery or corruption.
This past year we have expanded our working relationships within the counter fraud community, collaborating with stakeholders to further combat fraud against the NHS.
| Strategic priority area | 2023 – 2024 financial vulnerability estimateb | 2022 – 2023 financial vulnerability estimate | Difference (£m) | 2023 - 2024 direct reports to NHSCFA |
|---|---|---|---|---|
| Procurement and commissioning fraud | £388.3m | £391.5m | - £3.2m | 723 |
| Patient exemption fraud | £240.2m | £271.8m | - £31.6m | 1,404 |
| Data manipulation fraud | £165.1m | £155.9m | + £9.2m | 8 |
| Community pharmaceutical contractor fraud | £130.2m | £123m | + £7.2m | 201 |
| GP contractor fraud | £110.1m | £101m | + £9.1m | 183 |
| Optical contractor fraud | £94m | £79.7m | + £14.3m | 28 |
| Dental contractor fraud | £58.6m | £57m | + £1.6m | 63 |
| NHS staff fraud | £31.9m | £31.5m | +0.4m | 2,963 |
| Intelligence collection | ||||
| Fraudulent access to NHS care from overseas visitors | £86.5m | £43.5m | + £43m | 405 |
| Reciprocal healthcare fraud | £0.4m | £0.467m | - £0.07m | 7 |
| Strategic oversight | ||||
| NHS Bursary fraud | £3.2m | £3.4m | - £0.2m | 54 |
| NHS Pension fraud | £7m | £6.1m | +0.9m | 28 |
| Total | £1.316bn | £1.264bn | £50.6m | 6,067c |
- Funding total includes Health Education England (HEE) and this is the first year this funding information has been available.
- Financial vulnerability estimates run a year in arrears to reporting data, therefore this assessment will include 2022 – 2023 financial data and 2023 – 2024 reporting data.
- There are an additional 300 reports which did not align to a thematic area, therefore the overall total is 6,367.