The NHSCFA estimates that £1.346 billion of NHS funding is vulnerable to loss through fraud, bribery, and corruption in Englanda . This equates to 0.72% of the NHS budget vulnerable to fraud for 2024 - 2025 and is therefore a percentage decrease when compared with the NHS budget for 2023 - 2024. Although the allocated budget for the NHS in England has increased by over 9% to £186.838b billion for 2024 – 2025.
Reports received by the NHSCFA have increased to 6,462 during 2024 – 2025. The table below breaks down the current reporting figures by thematic area and displays the financial vulnerability estimates for 2024 - 2025 compared with 2023 - 2024.
| Strategic priority area | 2024 – 2025 financial vulnerability estimatec | 2023 – 2024 financial vulnerability estimate | Difference (£m) | 2024 – 2025 reports received by the NHSCFA |
|---|---|---|---|---|
| Procurement and commissioning fraud | £392.5m | £388.3m | + £4.2m | 537 |
| Patient exemption fraud | £230.2m | £240.2m | - £10m | 1,238 |
| Data manipulation fraud | £189.1m | £165.1m | + £23m | 25 |
| Community pharmaceutical contractor fraud | £135.2m | £130.2m | + £5m | 238 |
| GP contractor fraud | £116.7m | £110.1m | + £6.6m | 233 |
| Optical contractor fraud | £90.7m | £94m | - £3.4m | 41 |
| Dental contractor fraud | £57.6m | £58.6m | - £1m | 74 |
| NHS staff fraud | £27.8m | £31.9m | - 4m | 3,211 |
| Fraudulent access to NHS care from overseas visitors | £98.1m | £86.5m | + £11.6m | 387 |
| Reciprocal healthcare fraud | £0.8m | £0.4m | + £0.4m | 6 |
| Strategic oversight area | ||||
| NHS Bursary fraud | £3.8m | £3.2m | + £0.6m | 23 |
| NHS Pension fraud | £4.1m | £7m | - £2.9m | 31 |
| Total | £1.346bn | £1.316bn | £30.9m | 6,044d |
Reporting received by the NHSCFA reporting has increased by 1.5% when compared with 2023 – 2024, which is in line with fraud in England and Wales increasing by 7% in December 2024 when compared to December 2023.
Approximately 83.2% 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.
The Procurement Act 2023 now allows all suppliers to compete for public contracts through a centralised application and tender process. These more flexible frameworks help suppliers and procurers work more collaboratively and reduce costs. This current reporting period has seen the first full year of the Provider Selection Regime (PSR). PSR is designed to introduce more flexibility, enable stable collaboration and remove levels of competitive tendering for the best interests of patient and service users. Yet, a vulnerability has arisen as PSR enables those in decision-makers to avoid competitive tendering by arguing that a change of current supplier is not required, or a supplier for a new contract has already been identified.
Following a proactive prevention exercise in 2022-2023 there has been reduced reporting and recorded financial loss relating to the threat of payment diversion fraud however this methodology remains prominent with instances of cyber enabled fraud by criminals to divert genuine payments or falsify payments observed. The reductions suggest that criminals are finding it harder to infiltrate NHS counter measures.
An emerging trend has been identified where individuals are impersonating NHS staff to perform NHS bank shifts. These shifts are reported to be carried out by another person using a genuine staff members ID, whilst they perform their substantive role.
A new modus operandi (MO) has arisen where the journey of accessing the NHS without charge when not entitled was reported to have been posted on a social media platform. Thus, publicising fraudulent access to the NHS for non-ordinary residents and potentially influencing those who aren’t eligible.
The NHS and other healthcare agencies are targets for cyber criminals with health data having the potential to be more valuable than banking data.
The NHSCFA is intelligence led and looks to the National Intelligence Model for strategic direction. This combined with the support of our four strategic pillars drives forward counter fraud activity to protect funds meant for patient care.
Over the past year we have continued to expand and improve our working relationships within the counter- fraud community, both newly established and continuous stakeholder relations have not only increased confidence in our analysis. Whilst maintaining its reliability and accuracy. Stakeholders should note the contents of this report and initiate action to develop appropriate counter-fraud measures, for example mitigating the detailed enablers.
- This is not a figure of actual financial loss from fraud, but an estimate of the amount of funding vulnerable to the risk of loss.
- Total NHS revenue department expenditure limit (RDEL) as per financial directions.
- Financial vulnerability estimates run a year in arrears to reporting data, therefore this assessment will include 2023 – 2024 financial data and 2024 – 2025 reporting data.
- There are an additional 418 reports which did not align to a thematic area; therefore, the overall total is 6,462.