Daily Insight: Solving the NHS's fraud mysteries

NHS gets tough (ish) on fraud

Making NHS counter-fraud services an independent special health authority has enthused senior management at the former NHS Protect – but it is not clear if it will change anything.

In the complicated picture of who investigates what in NHS fraud, having a standalone body might make things easier by making them simpler.

But critics of the system will point out that the new NHS Counter Fraud Authority, which took on its legal powers on Wednesday, has no more power than NHS Protect had to make improvements to local services.

Most cases are investigated and sent for prosecution by local counter fraud services, employed by trusts or CCGs.

It is fair to say their performance is mixed – with some organisations criticised for handing responsibility to contractors without the necessary investigatory skills.

Like NHS Protect, the CFA will have only an advisory role for these bodies, marking organisations’ own self-assessments. Its levers are limited to making comparisons and asking to speak to senior management at an organisation.

The CFA’s leadership is hoping a higher profile will see more local services referring cases up to it (the authority can take over investigating a case if a serious one is referred, but this happens less than the national body would like).

Currently there are gaps in reporting in some areas that seem… mysterious.

Alongside its three year plan, the CFA presented a breakdown of where unreported fraud may be.

Some of the estimates are more reliable than others but broadly the organisation sees big savings in pharmacy, “optical contractor” services and procurement if reporting is more consistent.

But with NHS finances tighter than they have been for a decade, trusts have no particular incentive to investigate too thoroughly.

Especially when a balance has to be struck between investigating and potentially shutting down a whole service line for a region.