In what area of life would you try to provide a solution without knowing what the problem was’ Such a bizarre way of tackling fraud is common, however. Not so in the NHS – not any more. The government gave the task of fighting fraud in the National Health Service to Jim Gee.
Jim Gee, the man in charge of the NHS Counter Fraud Service, reels off a list of statistics. Recoveries of money: up five-fold. Fraud prevention: losses reduced by up to 40 per cent – losses involving contractors such as dentists and opticians, reduced by up to 30 per cent. For instance: dental patient fraud: down from £40m to £30m. Pharmaceutical patient fraud: down from £117m in 1998-9 to £69m in 1999-2000. Criminal prosecutions: 100, with only one case lost – ‘which has a deterrence effect’. Staff training: a training centre at Reading and 4,000 accredited counter-fraud specialists in the last two years, working with the Institute of Criminal Justice Studies at the University of Portsmouth. Jim Gee told Professional Security: ‘We have made a good start in the last three years.’ And the starting point of the start, as it were, has been to identify the problem: ‘We invest quite a considerable resource in measuring the extent and nature of the loss.’ Otherwise, how can you be sure you are going about the right solution’ he adds. (The document launching the counter fraud strategy in 1998 admitted: ‘We do not currently know the extent of NHS fraud.’ The same document did estimate losses through prescription fraud alone at £150m a year.) The National Audit Office has confirmed that the directorate’s methodology is accurate to within plus or minus one per cent – pretty accurate, statistically speaking; startling, when to do with fraud.
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How it began
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At the Department of Health, then Minister of State Alan Milburn (now Secretary of State) set up the NHS Counter Fraud Service in 1998. Its strategy: reduce fraud to an absolute minimum within 10 years; put in place arrangements to hold fraud at an absolute minimum, permanently; and free up resources for better patient care. Quite a task in the biggest organisation in Europe, with 1.2m employees. Setting up the new service – with a reporting line directly to the NHS Chief Executive – Jim Gee admits that he had the advantage of starting from scratch, more or less, so that he could set up his unit in a systematic manner, rather than adapting in a more ad hoc way to something already in place. ‘What we are trying to do in the NHS is something new. Historically, I have to say we have not been very successful in countering fraud. If you look at the losses to fraud in the public sector, you are looking at something up to £3b in social security. Large figures in local government. In the NHS, significant sums being lost. In the NHS, we have said that only people who are trained and accredited counter fraud specialists can work in that area, and that is in law, in secondary legislation. We are trying to attack the problem from all sides, not just reacting where there is a suspicion.’ The training does not only cover investigation, but how to develop a real anti-fraud culture; how to redesign policies and systems to prevent fraud; how to use information technology and other methods to detect fraud; how to apply various sanctions – the criminal and civil law, and internal discipline; and how to supply information so that the NHS can recover its losses. From the outset, then, the legal framework has meant that only accredited people can work in the area. There’s a network of more than 400 people across the NHS, covering every health body; backed by the Counter Fraud Operational Service, of eight regional teams (based in London, Surbiton, Harlow, Bristol, Walsall, Mansfield, St Helens and Jesmond); plus a national proactive team – an elite team, if you like, trained in finance and dealing with the most serious cases – plus two specialist teams in dental and pharmaceutical fraud. In the last three years, his service has run 580 awareness sessions, all over the UK, with doctors, dentists, pharmacists, opticians, and other healthcare professionals. Jim Gee has done 160 presentations in three years himself. ‘I have personally met almost every single finance director across the NHS,’ he adds, and that runs into the hundreds. He is a believer in publicising cases as a deterrent – ‘so potential fraudsters can read about what we do and be scared off’. As someone who has always been a counter fraud specialist, he is an example of the new profesion, without a first career in the police (say). He has worked in central and local government, including the London boroughs of Islington, Haringey and Lambeth – the last at least reviled by the press for its inefficiency and corruption. In Lambeth from 1996 to 1998, Jim Gee helped to dismiss 120 people.
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Jim Gee and the central unit are based at the Elephant and Castle in south London, where their tasks include revising policies with the aim of preventing fraud happening in the first place. Possible frauds, by staff and patients, are varied as you would expect in such a large organisation as the NHS – bogus prescriptions, falsifying timesheets and expense claims, accepting gifts in return for placing orders with suppliers, claiming for work done for dead or non-existent people, duplicate claims. As for whistle-blowing, the unit runs a fraud and corruption line. Jim Gee says: ‘There are several ways in which whistle-blowing can take place in the NHS.’ Each health trust, for example, is required to offer a way for staff to report concerns. Jim Gee worked with the charity Public Concern at Work (featured in April 2001 Professional Security) while he worked at Lambeth, as well as in his current role.
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Healthcare security managers might contrast the systematic, centre-led way that the government has gone about tackling NHS fraud with the lack of a nationwide effort to co-ordinate NHS security management, all too often leaving trust security managers to re-invent the wheel. Jim Gee does not know why this is. He says: ‘I would like to see the same impetus given to security work in the NHS as was already given to counter fraud work. I would like to see common training, a requirement for security managers to be professionally trained and accredited, some proper central back-up to people trying very hard to do a good job.’ Launching the counter fraud strategy in 1998 Alan Milburn pointed out: ‘Fraud in the health service takes many forms. Often it is low value and opportunistic. Sometimes it is high value and committed by skilled criminals. But in total it costs the health service a small fortune. Prescription fraud alone is estimated to rob the NHS of £150m a year.’
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What the counter fraud strategy said
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"What we can say with certainty is that the more we look for fraud in the NHS, the more we are finding … We will tackle all types of fraud, and we will always seek to strike a balance between addressing very common high volume but low value fraud and higher value, complex and sophisticated fraud … The most preferable way of minimising fraud is to ensure that fraudsters and potential fraudsters are deterred from even trying to perpetrate fraud. The most effective fraud deterrent would be peer group pressure, within a culture which rejects the idea of fraud as acceptable …. The pervasiveness of fraud in this country has helped to give it the appearance of acceptability in some cases. There are some who believe that fraud does not occur in the NHS, or that its extent has been greatly exaggerated. These ideas, together with perceived distinctions between so-called blue and white collar crime, and between ‘fiddling’ and real crime, are still held by some groups in society."
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For more about the Directorate of Counter Fraud Services at the site.
