£31.5m
vulnerable from an expenditure of £78.9 billion
NHS staff fraud encompasses staff manipulating income and hours, insider abuses and false representation during application processes.
The increase in financial vulnerability can be attributed to increases in expenditure and staff numbers. This may have been the result of covering for NHS staff self-isolating or ill with COVID-19 and the additional hours worked during this period. This also likely explains the increase in agency staff expenditure as detailed within commissioning of services fraud.
Since July 2022, changes to COVID-19 workforce guidance have meant the withdrawal of full pay for NHS staff should they need to self-isolate or become ill with COVID-19. As such, those that may have exploited the pandemic, whether through presenting a false positive COVID-19 test or long term COVID-19 symptoms, may now be motivated to seek other opportunities for financial gain.
It is likely that some will work whilst sick or elsewhere during NHS contracted hours, such as performing bank shifts. Submission of falsified fitness to work certificates, management oversight, and the lack of collaboration between differing NHS staff management and rostering systems, are potential enablers for these frauds.
It is highly likely that inflation of income and hours will occur through staff manipulating timesheets and rostering systems. This includes staff falsely claiming for hours/shifts not worked, bank shifts, and overtime. This may extend to collusion with senior staff to sign off timesheets for unworked hours and changes of pay bands to inflate pay.
False representation by staff failing to declare information or supply false information during the recruitment process is also a realistic possibility. This is enabled by providing forged documents and difficulties in validating and identifying their authenticity.
Information reports received for NHS staff fraud
NHS staff fraud is the most significantly reported thematic area annually, inferring a persistent threat within the NHS. During this reporting period, the NHSCFA received a total of 2,660 reports, approximately the same as the 2021 – 2022 total of 2,632, but higher than at any point across the previous five years.
The highest reported staff fraud areas relate to income and hours manipulations including working whilst on sick leave and inflating income by falsely claiming for hours and services not worked. These are committed by those with knowledge of weaknesses within NHS systems and processes and abusing positions of trust.
It is assessed staff fraud reporting may continue an upward trend post-pandemic, in part at least, due to the impact of the cost-of-living crisis.
The change in the number of fraud reports received in relation to NHS staff from 2018 – 2019 to 2022 – 2023 is illustrated in the below chart:
| 2018 to 2019 | 2019 to 2020 | 2020 to 2021 | 2021 to 2022 | 2022 to 2023 |
|---|---|---|---|---|
| 2018 to 2019 2377 | 2019 to 2020 2531 | 2020 to 2021 1962 | 2021 to 2022 2632 | 2022 to 2023 2660 |