Published: 16/10/2003, Volume II3, No. 5877 Page 23 24
Jim Gee is neither a fraud buster nor a moral crusader.As head of the NHS counter fraud service, he is committed to making practical improvements in the NHS by mobilising its honest majority
The NHS Counter Fraud and Security Management Service is coming soon to a workplace near you - if it hasn't already been.
As part of the NHS Fraud Awareness Month the service has planned 140 events across the country to spread its anti-fraud message to 100,000 staff.
CFSMS chief executive Jim Gee lets slip a brief 'Oh, joy' at the thought of all the travelling, setting up, presentations, packing up and moving on again involved, which shows he's human.
But the whole month has been planned with the relentlessness that is characteristic of the 'NHS fraud buster' and his approach to the job.
'I have a very positive view of the NHS, ' he says, when asked whether his view has changed since he became director of counter fraud services.
'However, I think one problem is that, although you often get good proposals, there is not always the same thought given to training people and to giving the NHS the powers to make sure they are applied properly.
'For example, in our area, we have 90 per cent compliance with procedures and very high attendance at meetings. Many people I meet are very impressed with that.
But I do not think 90 per cent compliance is high enough.'
Mr Gee earned his anti-fraud credentials just up the road from the service's peeling headquarters above south London's Elephant and Castle shopping centre.From 1996-98, he helped to clean up Lambeth council, once dubbed 'the most corrupt borough in the country'.
Appointed as the NHS's first director of counter fraud services in September 1998, Mr Gee instantly picked up the 'fraud buster'tag.He dislikes the label and it does seem incongruous when applied to someone who talks about the 'business process' of his work.
The counter fraud service set out to identify the scale of fraud and corruption accurately - to 'plus or minus 1 per cent'. It then drew up a strategy to deal with it and created a structure to implement the strategy.
The structure included the establishment of 400 local counter fraud services, all with professionally trained and accredited staff, working to clear legal directions.
But Mr Gee has never seen countering fraud as a job for the professionals alone.
As the CFSMS takes to the road, Mr Gee knows exactly what is ahead of him. From 1999-2002, the counter fraud service held more than 600 presentations covering 800,000 staff, including 500 finance directors and 200 human resources directors, all with the aim of developing an anti-fraud culture.
It also used the media to considerable effect.A 'key facts'briefing sent to HSJ after this interview notes that more than 650 articles or broadcasts have been written or made about the service.
Journalists may insist on comparing Mr Gee to The Sweeney or Sam Spade, but their work still has the effect of making people aware of his existence, thereby 'strengthening the deterrent effect', as the briefing notes.
The result of all this has been to deter, detect and prosecute fraud. The briefing says that in four full years of operation from 1999-2002, the counter fraud service reduced patient fraud by between 23 and 41 per cent and professional fraud by between 25 and 35 per cent.
It increased the amount of fraud detected from£2.7m a year to£12.8m a year and the amount of money recovered from£0.8m a year to£6m. It also boasted a 98 per cent successful prosecution rate, winning all but three of the 160 cases that went to criminal trial.
Mr Gee once advised Frank Field, the maverick Labour MP briefly asked to 'think the unthinkable'on reforming social security. He says a major obstacle to cracking social security fraud is that the money 'does not go on increasing benefits but back into the Treasury'.
When he took on his NHS job, he insisted that the money recovered should be seen to go back into patient care.
'We have just won a case against a Nottingham dentist for a£1.1m fraud, ' says Mr Gee. 'So far, he has paid back£700,000 and he is due to pay the rest to us today, at 5pm. I will be making recommendations to ministers about where that money should go.'
In April this year, the counter fraud service became part of a new NHS Counter Fraud and Security Management Service, with Mr Gee as chief executive. The new organisation, a special health authority, has a wider remit than its predecessor.
'For five years we have worked to manage the NHS's resources; now we want to protect its staff and property, too, ' he explains.'It is a big challenge, but one I am looking forward to.'
No doubt Mr Gee will apply the same grinding attention to detail - or, as he puts it, 'holistic approach'- to this challenge as he brought to his previous job.
There will be a 'rigorous exercise' to uncover staff experiences of violence, followed by new systems and training in conflict resolution for up to 800,000 frontline staff.
The CFSMS itself aims to train 100,000 people a year in these techniques, with accredited NHS and private trainers helping to reach the rest.
Mr Gee has already reached a memorandum of understanding with the Association of Chief Police Officers on how to deal with violent incidents. There will also be a new legal protection unit within the CFSMS, which will have the power to bring private criminal prosecutions and seek injunctions in cases where traditional legal routes are closed or inappropriate.
It is all very different from the current approach, within which trusts make their own arrangements with security firms or the police, while national poster campaigns operate more widespread crackdowns.
Mr Gee is careful to say the current 'zero tolerance zone' campaign - with its x-ray posters of weapons purportedly used against NHS staff - has not failed.
'It is about improving awareness and reporting, which is why the figures [for reported incidents] are going up, ' he says.
But there is only so much a 'moral crusade' can do.
The CFSMS's anti-violence strategy should be unveiled at the start of next month. Longer term, Mr Gee wants to see his new organisation target 'losses of property that are not fraud' (theft, for example), improve security on maternity units and improve methods for dealing with and securing hazardous substances.
Mr Gee says two things came together to help create the counter fraud service.
The first was investment in the NHS, which ministers did not want to see seeping out.
The second was the emergence of a cadre of counter fraud experts, which the NHS counter fraud service did its bit to develop by training 6,000 people, 250 of them to an advanced level.The first BSc in counter fraud studies is about to start at Portsmouth University and Mr Gee expects others to follow.
'For the first time, you had the desire to do something about it [NHS fraud] and the chance to do something professional, ' he says. 'We are not like people imagine.We are not The Sweeney or Sam Spade. That has got us support.'
The CFSMS grew out of similar impulses; a growing awareness of the issues it will tackle; a desire on the part of ministers, particularly former junior minister Lord Hunt, to see something done; and support from inside the Department of Health.
The service is now in a position to contribute to the professionalisation of security staff. Its first training course starts next April, with four modules covering a professional and ethical approach, the law, people and property.
'I want a professional approach, 'Mr Gee says.'There are some highly skilled people out there, but it has been patchy. I want to make sure it is not patchy.'
Meanwhile, Mr Gee is delighted that the CFSMS has been established as a special health authority.
'Prior to April, we had 10 host bodies for NHS staff and 30 staff in the DoH, which was very difficult to manage, ' he says.
'Strategically it is important for us - it means we are part of the NHS family.'
In the next year, Mr Gee would like to see the new body make more progress on fraud.
It recently started working with software vendor SAS on a system to predict where fraud is likely to occur. It should help the CFSMS spot 'outliers'and abnormalities that can be investigated to see if they represent fraud or error, reducing the time between a fraud being started and it being detected.
On the security front, Mr Gee wants the CFSMS to get its strategy out and its first local security strategists in place. And, of course, he will have met a lot more people who can also help to spread the message.
'If we can mobilise the honest majority we can help defeat the dishonest minority, 'he says.
'If we can improve security, people should be able to provide more care and better care.This is not a moral crusade. It is intensely practical.'
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