NHS staff fraud encompasses staff manipulating income and hours, insider abuses, and false representation during application processes.
The financial vulnerability has decreased due to NHS services returning to pre-COVID-19 levels. Thus, reducing the need and reliance on expensive temporary agency staff, resilience for extra pay for working in high-cost areas, working unsocial hours, and band supplements.
£27.8m
vulnerable from an expenditure of £94.9 billion
Strategic intelligence picture
Working elsewhere whilst on sickness leave was highly likely within NHS Staff fraud. Staff could be falsifying sickness to receive both sick pay and extended leave while fit to work, with some potentially working for other employer(s) or their own private work or business during their sickness period. Dual employment is also likely with staff working simultaneously at other NHS Trusts whilst on short / long term sickness absence, including staff working bank shifts during their contracted hours in parallel with their substantive post.
There is a remote chance that Staff on long term sickness leave could present false or manipulated Med 3 certificates or private paid certificates to justify prolonged absence and mask genuine medical need when they are genuinely well.
There is also a remote chance of clinical staff falsifying sickness to be signed off on Tier 1 ill health grounds, despite not being genuinely unwell. Tier 1 is intended for those permanently incapable of performing their clinical duties, thus highlighting some staff misusing this clearance to avoid their responsibilities while working elsewhere.
Inflation of income and hours, including claiming for hours, shifts, overtime and patient care services which were not worked was also highly likely. Some staff may be abusing their position by manipulating their timesheets and e-rostering systems to inflate their income.
Furthermore, NHS staff retrospectively booking bank shifts on the e-rostering system with the intent to fraudulently claim for payments after not having worked or having any intention to is probable. Tampering and manipulation of e-rosters is possible, including through changes to shifts and pay bands to claim higher or enhanced pay. This likely occurs with bank shifts; some in collusion or means of nepotism with senior staff knowingly signing off or allocating bank shifts on a higher pay band. Senior staff could also be granting themselves a pay band uplift for certain shifts or services.
It is likely that some staff may work elsewhere during NHS contracted times, including staff working for their own private business, another NHS Trust, or an external organisation. Staff may have undeclared secondary employment including those with multiple employments, freelancing, or seeing private patients, thus leading to conflicts of interest and potential breach of contract. In addition, clinical staff could perform private paid practices / treatments, to private patients using NHS assets during their contracted times.
It is highly likely that an impersonator may use another person’s ID to carry out shifts. Bank shifts could be booked in advance via e-rostering however a pre-booked shift could be carried out by another person using the staff members ID, whilst the original shift booker is completing their substantive role.
Information reports received for NHS staff fraud
The change in the number of fraud reports received in relation to NHS Staff fraud from 2020 - 2021 to 2024 - 2025 is illustrated in the below chart:
| 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 | 2024 - 2025 |
|---|---|---|---|---|
| 2020 - 20211,828 | 2021 - 20222,375 | 2022 - 20232,537 | 2023 - 20242,963 | 2024 - 20253,211 |
Horizon scanning
The NHS in England is undergoing significant workforce reforms as part of the NHS Long Term Plan and the new NHS 10 Year Health Plan as set by the government. Including reducing reliance on agencies in the coming years by training more NHS staff domestically and retaining more existing staff. The NHS has struggled to recruit staff to meet demand and is therefore reported to have been hiring health staff from the World Health Organisation (WHO) work force support and Safeguard red list countries to meet demand. The Secretary of State for Health and Social Care is determined to reduce the NHS’s reliance on recruitment from red-list countries by investing in staff through their change plan.
Reforms include NHS England merging with the DHSC and Integrated Care Boards (ICBs) being required to halve their costs. However, this will likely impact on NHS employment figures.
The Nursing and Midwifery Council (NMC) has recently highlighted a case where it is alleged that a genuine NMC registrant’s identity was being used fraudulently by one or more non-registrants, for the purpose of gaining work in roles that are for registered nurses. This resulted in the NMC advising and providing guidance around the risk of identity fraud during recruitment. Similarly, Ofqual is setting out measures to strengthen steps to find, tackle and prevent qualification fraud.