As the global and economic landscapes evolve, the fraud landscape evolves alongside them and the NHSCFA has continued to produce the Strategic Intelligence Assessment (SIA) to capture these changes since 2016 - 2017. Fraudsters adapt to the current climate, recycling well established scams to fit a new narrative, or identifying loopholes to exploit new processes or policies.
The NHSCFA therefore produces the SIA to establish fraud threats and estimate the amount of funding for the NHS in England vulnerable to fraud, bribery and corruption annually on behalf of the Department of Health and Social Care (DHSC). This informs the NHSCFA and its stakeholders of the priorities for the year ahead by capturing established, emerging, and potential future threats. The SIA has, and will continue to ensure, a coordinated response to fraud and protect funding meant for patient care.
The NHSCFA has four strategic pillarsd which support counter fraud activity, with the ‘understand’ pillar supported by the SIA. The SIA helps strategic leads formulate direction, determine intelligence collection plans, and make strategic resourcing decisions based on priorities, areas of concern, or trends. Thus, ensuring an intelligencee led response to fraud in the NHS to drive forward counter fraud activity and protect money meant for patient care.
The NHSCFA estimates that £1.316 billion of NHS funding is vulnerable to loss through fraud, bribery, and corruption. This figure equates to 0.77% of the NHS budget for 2023 - 2024 which is a percentage decrease when compared to the 2022 - 2023 NHS budget. Although it is a financial increase of £50.6 million (4%) when compared with the previous SIA, it is a smaller increase in loss than experienced between 2021 - 2022 and 2022 - 2023.
When compared with the previous year the allocated budget for the NHS in England has increased by almost 10% to £171.036f billion for 2023 - 2024. Therefore, as fraud vulnerability percentages remained relatively static it is likely that there would be a correlation between the increase in budgets and an increase in the amount vulnerable to fraud. The legacy cost of the pandemic included NHS recovery funding, for example the government invested £3.3 billion with an aim of recovering emergency, elective and primary care to pre-pandemic levels of performance for 2023 - 2024, including reducing A&E waiting and ambulance response times.
Additionally, extra funding from the DHSC was provided to cover the increasing cost of the Agenda for Change pay awards, a 5.5% increase in staff numbers compared with the same period in January 2023 and an additional £200m of government funding as part of the NHS Dental recovery plan was announced in February 2024g, all of which is vulnerable to the risk of exploitation along with the rest of the NHS budget.
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. Reports received by the NHSCFA have increased by 1,319 reports raising the total to 6,367 during 2023 - 2024. This could be attributed to the first full financial year without any COVID-19 restrictions and the reach of the television series Fraud Squad increasing public awareness around the NHSCFA. Furthermore, the cost-of-living crisis can influence reporting patterns.
The NHSCFA continues to take a proactive strategic response to alert organisations tackling fraud to new and arising modus operandi. This is the first full year where both financial and reporting data do not separate COVID-19 as an impacting factor on the NHS, instead it has been incorporated under usual analysis. The NHS is now facing a multitude of other challenges with staff vacancies across the NHS at 8.4%, overall sickness and absence rates at 5.5%, a backlog of elective care due to COVID-19, as well as inflation and an increase in the cost of living with any one of these potentially increasing the inherent risk to fraud across the thematic areas. Additionally, within data manipulation the introduction of the Health and Care Act 2022 and the NHS Payment Scheme in 2023 consequently influenced various threats and areas of funding to evolve. Subsequently, the NHSCFA’s knowledge base has changed, areas in which we previously had a high confidence have seen new policies, contracts and processes introduced. However, we have expanded our knowledge within our strategic priority, intelligence collection, and strategic oversight areas, as well as having conducted focused analysis on the impact of bribery and corruption in the NHS.
Over the past year we have expanded our working relationships within the counter fraud community, collaborating with stakeholders to further combat fraud against the NHS. Advancements have been made towards improving the organisation’s knowledge base and financial vulnerability figures in some thematic areas. These improved stakeholder relations have not only increased confidence in our analysis, but also in the reliability and accuracy of the financial vulnerabilities. Sometimes collaboration can result in a reduction in the financial vulnerability for the area.
- Understand, Prevent, Respond and Assure.
- This assessment is based on intelligence from various sources, therefore the hypothesis and inferences drawn are from the most appropriate and accessible / available information at the time of writing.
- Funding total includes Health Education England (HEE).
- Which was announced in February 2024, did not commence until March 2024, and is therefore yet to have in depth analysis conducted.