The challenge

The importance of protecting the NHS from fraudulent activity.

Fraud, bribery and corruption are estimated to have cost the UK economy up to £81 billion in 2023-241 based on the Public Sector Fraud Authority’s (PSFA) methodology. Within health, the NHSCFA Strategic Intelligence Assessment (SIA) estimates that system-wide fraud risk and vulnerability stood at £1.346 billion in 2024-252, the equivalent to the annual running cost of one large Foundation Trust hospital3.

Losses at this scale can mean fewer staff such as doctors, nurses, healthcare assistants, porters and discharge staff working in our hospitals. It can also mean older equipment, fewer outpatient appointments and fewer operations as every pound lost to fraudsters is a pound lost from patient care4. Fraud, bribery and corruption can also mean unsafe care for patients.

The NHS is entering a significant period of transformation which creates new opportunities to tackle fraud more effectively. However, the process of change can mean that health budgets are more vulnerable to fraud risks as models of care are developed.

Whole system change is needed to ensure that NHS resources are not lost to fraud, bribery, corruption and error. Many opportunities exist to strengthen the health sector’s response to the risk of fraud, including:

NHSCFA’s response to strengthen the risk of fraud Circular infographic illustrating NHSCFA’s strategic response to strengthening the risk of fraud, including counter‑fraud culture, governance, data sharing, fraud‑proofed systems, priority risk targeting, awareness raising, and enforcement. NHSCFA’s response to strengthen the risk of fraud S t r e n g t h e n i n g a n d e m b e d di n g c o u n t e r f r a u d c u l t u r e , a c c o u n t a b il i t y a n d g o v e r n a n c e S t r e n g t h e n i n g a n d r e i n f o r c i n g r o l e s a n d r e s p o n s i b il i t i e s f o r h e a l t h - w i d e c o u n t e r f r a u d r ol e s E m b e d di n g c r o ss - e n t i t y d a t a s e t s t o i de n t i f y a n d r e s p o n d t o p o t e n t i a l f r a u d R a i s i n g t h e p r o f i l e o f f r a u d a n d i t s i mp a c t o n f r o n t l i n e s e r v i c e s E n su r i n g p r o c e s s e s a n d s y s t e m s a r e r ob u s t l y f r a u d- p r o o f e d f r o m i n c e p t i o n T a r g e t i n g c o u n t e r f r a u d r e s o u rc e s a t t h e h i g h e s t p r i o r i t y f r a u d r is k a r e a s T a k i n g r ob u s t e n f o r c eme n t a c t i o n w h e r e f r a u d i s d e t e c t e d

The diagram below provides an overview of these thematic areas, with procurement and commissioning fraud remaining one of the areas of highest fraud risk vulnerability

Recognising the changing health landscape, counter fraud priorities today may differ from those of tomorrow as vulnerabilities emerge. This business plan is therefore subject to re-prioritisation should new threats emerge and require a realignment of effort and resources across the sector. Any such changes will be subject to appropriate governance and assurance processes.

Fraud risk areas and estimated financial impact Diagram showing key fraud risk areas across the health sector, with estimated losses. Procurement and commissioning fraud is shown as the highest risk at £392.5 million, followed by patient exemption fraud at £230.2 million, data manipulation fraud at £189.1 million, community pharmaceutical contractor fraud at £135.2 million, and GP contractor fraud at £116.7 million. Procurementandcommissioning fraud£392.5m Patientexemption fraud£230.2m Communitypharmaceuticalcontractor fraud£135.2m GP contractorfraud£116.7m Data manipulationfraud£189.1m
Fraud risk areas and estimated financial impact Diagram showing key fraud risk areas across the health sector, with estimated losses. Procurement and commissioning fraud is shown as the highest risk at £392.5 million, followed by patient exemption fraud at £230.2 million, data manipulation fraud at £189.1 million, community pharmaceutical contractor fraud at £135.2 million, and GP contractor fraud at £116.7 million. Patientexemption fraud£230.2m GP contractorfraud£116.7m Procurementandcommissioningfraud£392.5m Datamanipulationfraud£189.1m Communitypharmaceuticalcontractor fraud£135.2m
  1. The impact of fraud and error on public funds 2023-24 - NAO overview
  2. Strategic Intelligence Assessment | Corporate publications | NHSCFA
  3. Finance and accounts - University Hospital Southampton
  4. DHSC counter-fraud strategy: 2023 to 2026 - GOV.UK

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