Fraud cases being investigated in the NHS doubleBMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7305.128/d (Published 21 July 2001) Cite this as: BMJ 2001;323:128
The total debt for NHS health authorities in England has more than doubled over the past year, a report published last week by the National Audit Office has said.
The report showed that the net deficit of the NHS in England for 1999-2000 totalled £129m ($181m), compared with £61m in 1998-9. More than half (59/99) of the health authorities in England and Wales reported a deficit (only 48 out of 100 did so the previous year).
The report also showed an increase in the number of cases of fraud in the NHS being investigated. There were 484 cases of fraud, with an estimated total cost of £18m being investigated at the end of March 2000. This was more then double the number of cases in the previous year (239 fraud cases, totalling £14m).
The increase in fraud investigations was attributed to the setting up in 1998 of a central body to deal with fraud in the NHS—the Directorate of Counter Fraud Services. Pharmacists made up the largest group of fraud suspects currently under investigation, accounting for 128 cases, followed by GPs (118 cases) (see figure). Alleged frauds included claims for non-existent patients and items such as spectacles for people who are dead.
The total deficit is made up of debts accumulated by both the health authorities and trusts. The health authorities reported a deficit of £52m, compared with a deficit of £25m for 1998-9. West Surrey health authority had the highest accumulated deficit in 1999-2000 (9.1% of total income) followed by Redbridge and Waltham Forest (8.2%), Wakefield (7.3%), Barnet (6.8%), and West Hertfordshire (6.5%).
The 377 NHS trusts included in the report showed a similar doubling of deficit, increasing from £36m in 1998-9 to £77m in 1999-2000. On the basis of the figures, the Department of Health assessed 28 health authorities and 76 NHS trusts as being “in serious financial difficulties.”
The department's regional offices identified several factors contributing to these difficulties, including exceptional winter pressures, over-performance on service agreements with providers and financial pressures resulting from factors such as drug costs. However, the deficits had to be set in context—the 99 health authorities included in the report spent about £39bn in purchasing health care and related services from NHS trusts and other contractors to the health service.
On a more positive note, the report predicted that health authorities would have a surplus of £45m and that trusts would have a greatly reduced deficit of £8m in the next financial year.
The figures were taken from annual accounts prepared by individual health authorities, which were then audited by the Audit Commission.
Presenting the report to parliament, John Bourn, head of the National Audit Office, said: “I welcome improvements in financial control within the NHS and the initiatives taken to counter fraud. The way forward will be to continue to improve corporate and clinical governance and to ensure that accounting for these large sums presents fully and clearly the financial position of health authorities and trusts.”
The Report of the Comptroller and Auditor General. NHS (England) Summarised Accounts 1999-2000 is available at http://www.nao.gov.uk/ or can be obtained from the Stationery Office (tel 0845 702 3474).