SCAN - Strengthening counter fraud across the NHS in England

Alex Rothwell
Alex Rothwell

CEO

Counter Fraud Authority, NHS

‘We recognise the value of academic study, which brings information and specialists from diverse disciplines and organisations together.  The counter fraud landscape is complicated and fresh perspectives and transparency is welcomed’.
Colin Edwards
Colin Edwards

Fraud and Security Management Services

NHS

"Recognising the presence of fraud, bribery, and corruption within the health sector is a vital first step toward meaningful change. By investing in research to understand these risks, we can identify the necessary resources and take informed, decisive action to mitigate them. There has never been a more critical time to confront these challenges and safeguard the integrity of the health sector. I am privileged and fully motivated to contribute to the SCAN initiative and endorse the project’s approach to uncover and strengthen the responses that combat fraud, bribery, corruption, and error across the NHS in England”.
Lisa McAlister
Lisa McAlister

Counter Fraud Manager (Finance and Commercial Directorate) NHS Business Services Authority 

NHS

"I welcome the efforts of the SCAN project to improve the national and local response to the threat of fraud against the NHS. This is a much-needed project at a time when NHS budgets are stretched more than ever. SCAN has great potential to bolster counter fraud efforts, and save public money lost to fraud and error." 
Terry Smith
Terry Smith

Managing Director

AuditOne 

"As one of the leading national providers of counter fraud services to the NHS, we are proud to support the SCAN project. SCAN promises to shed much-needed light on current fraud responses within the NHS, and significantly strengthen the counter fraud sector, ultimately saving the NHS money".
Sean McNabb
Sean McNabb

Director

Cartels, Competition and Markets Authority

"I fully support this important study. Tackling fraud in the NHS and in other parts of the public sector has never been more important and this vital research should help ensure that those responsible for spending public funds are more alert to the risk of fraud and better equipped to combat it".

Project Overview

SCAN: Strengthening Counter Fraud across the NHS in England, is a 32-month research project led by Northumbria University and is funded by the National Institute for Health and Care Research (NIHR). SCAN brings together researchers in law, medical sociology, criminology, and business studies from Northumbria University and the University of Manchester to answer the following core question:

How is counter fraud currently delivered within the NHS in England and how could this provision be reorganised and strengthened to reduce negative impacts on public trust, quality of care and losses within NHS budgets?

Why is SCAN needed?
Fraud in the NHS

Official estimates indicate fraud costs the NHS approximately £1.316bn per year, nearly 1% of the entire NHS budget (NHS Counter Fraud Authority, 2024). Fraud within the NHS can also have a substantial impact on public trust as well as on the quality and safety of health care.   

Since 2021 fraud has advanced significantly on the UK government’s policy agenda in line with the Government’s drive to find efficiency savings and reduce public expenditure (HM Treasury, 2024).  Several critical reports by parliamentary committees, official bodies, think tanks and other organisations (National Audit Office, 2022; House of Commons, 2022) highlight the escalating volume of fraud cases and the lack of a coherent counter fraud strategy.

In 2023 the government issued a Fraud Strategy which reported that ‘the volume of fraud, its capacity to undermine public confidence in the rule of law, and its potential negative effect on the UK’s financial reputation, means it should be considered a national security threat…[and that] the criminal justice system must ramp up the focus it gives to fraud’ (NHS Counter Fraud Authority, 2023: 9,14).

Fraud can significantly undermine public trust in the NHS, due to both the mishandling of public money, and impact on the quality and safety of health care (Searle, et al, 2017). In designing the project, we spoke to members of the public to hear their views on fraud against the NHS and these conversations reflected how the public are increasingly questioning the stewardship of public money, particularly around accountability and transparency in the context of NHS fraud.

What types of fraud are committed against the NHS? 

Frauds are committed by people from within and outside the NHS, and can include procurement fraud: procurement fraud (e.g. fraudulent contracts, over-pricing, or non-delivery of goods); patient fraud (e.g. patients unlawfully claiming treatment/exemptions); and , employee fraud (e.g. qualification fraud, expenses/timesheet fraud, recruitment fraud) (NHS Counter Fraud Authority, 2022).     

For more examples of frauds against the NHS see the Counter Fraud Authority’s website HERE.  

How is fraud responded to within the NHS? 

Current counter fraud provision is an extremely complex and fragmented patchwork of private and public providers, engaging in varied activities to fight fraud (Griffiths et al, 2023).   

NHS organisations must have measures in place to prevent and respond to fraud (NHS England and NHS Improvement, 2020), but what this involves in practice can vary considerably. How the NHS responds to fraud can be provided by directly employed NHS counter fraud staff, or by agencies or individuals outside the NHS. Consequently, practices to fight fraud are inconsistent across the NHS in England.   

Currently, the Public Sector Fraud Authority (PSFA) works with the sector fraud lead, the NHS Counter Fraud Authority (CFA), and a diverse range of policymakers to create national-level policies, regulations, and guidelines. These national bodies sit above a diffuse structure of counter fraud providers across primary and secondary health care. The connecting thread for NHS counter fraud provision is the Government Functional Standards (Cabinet Office, 2020).  

The result is a confused patchwork of public and private providers all following local action or work plans, rather than a coherent national approach (Griffiths, et al 2023). A lack of shared information, knowledge and evidence reduces the effectiveness of the counter fraud professionals in the health sector. 

Aims of the Project 

The key aims of the project are:  

  1. To identify where counter fraud measures across the NHS in England can be improved.
  2. To generate evidence, recommendations and resources that will (re)shape the provision of counter fraud. 
  3. To help reduce the reputational and financial loss for the NHS, and the negative impacts on quality and safety of healthcare, caused by fraudulently/dishonestly or illegally obtained employment, property or NHS funds.   

It will also provide a first essential step in addressing the silos and barriers which currently exist across the NHS counter fraud sector. The complexity of counter fraud provision across the NHS in England, the lack of coordination or an evidence base for policymaking and practice, and the lack of understanding of how current counter fraud structures and systems operate and work together, creates a clear need for research in this area.   

SCAN will map counter fraud policies, structures, networks and practices across the NHS in England, to gain a clear understanding of how national counter fraud policies and strategies are translated into implementation at regional level and on the ground, and the gaps and challenges in their implementation. 

What we’re seeking to do 

Conversations with our stakeholders indicate that policymakers, senior managers and counter fraud practitioners currently do not have enough information about the overall implementation of policies and strategies across the NHS, organisational and inter-organisational relationships, procedures and practices across the sector or in relation to third-party providers.  

Financial and reputational losses from fraud and impacts on the quality and safety of healthcare cannot be entirely stopped; where there is opportunity there will always be criminality (Wolf & Hermanson, 2004). However, we know that strategic, structural and operational responses to fraud can be adapted and strengthened. Greater understanding of the national counter fraud picture will support a more effective intelligence-led response (Levi & Doig, 2020).  

Outputs and Impact   

We are working closely with our professional, policy and public stakeholders to design innovative and effective outputs, tools, and strategies, which will be of use to stakeholders across the health sector and beyond.   

With policymakers, counter fraud specialists, and staff from across the NHS, SCAN will co-develop, pilot and evaluate recommendations and implementable resources for addressing competency, skills and joined up working to strengthen the counter fraud response, better protecting the NHS from frauds which have the potential to undermine the quality of care provided by, and the public trust in, the NHS and across the wider health sector.   

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