Overcoming the Challenges of Fraud in the NHS - Alex Rothwell

Jessica Kimbell, GovNet
September 18, 2023

"We were banging pots for nurses three years ago, and now, the government has had to take the nurses' union to court over strike action." That's a statement Alex Rothwell, CEO of the NHS Counter Fraud Authority, made during his opening speech at the NHS Fraud 2023 conference to highlight some of the challenges the healthcare industry is facing today.

It perfectly demonstrates the stark contrast between how favourable things were in 2020 during the COVID pandemic vs. the challenging times the NHS finds itself in now.

But another issue under the microscope is fraud within the NHS. This blog will outline what Alex Rothwell discussed during his talk — touching on the key points you can't afford to miss.


The Statistics Are Unfavourable

Fraud within the NHS is a concern, especially when budgets are tight and statistics are unfavourable:

  • Record numbers of people are on elective waiting lists
  • We had the highest level of excess deaths for 50 years in 2022
  • In February 2023, 125,000 people waited more than 12 hours to be seen in A&E
  • There’s a 19-year gap in life expectancy between the most and least deprived areas of the country

During his talk, Rothwell highlighted that the gloomy statistics should be vital to the counter fraud practitioners in attendance. Why? Because the NHS is full of incredibly skilled people who dedicate their lives to making people better. It's our job to look after the money involved, as every penny saved goes back into the healthcare system.


Making a Case for Counter Fraud Activity

Rothwell explained that investing in this area is a good business decision. Fraud is a huge problem in the UK, not just in the health sector, and professionals must act on it, considering it wasn't even included in national crime statistics, and now it makes up 41% of all crime affecting people in the UK.

When talking about the relevancy of this subject, Rothwell stated: "Let's think about the public sector in particular. We know we're vulnerable to fraud; we know that it comes with a bit less moral baggage. To be quite frank, government departments in the past have not been robust enough in tackling fraud and that's emboldened a generation of fraudsters.

"I think we're very fortunate here in healthcare. We've got a 30-year history dealing with fraud; we're a relatively mature organisation when it comes to fraud. But like all mature organisations, we need to stay focused and we need to stay relevant.

"The last time the NAO produced a report like this, I think, was in 2016. What it said, I'll quote, was: "The government does not understand how fraud affects the public sector." Wind the clock forward eight years - we've got the PSFA, we've got a Government Counter Fraud Function, we have a Government Counter Fraud Profession — it's all very positive.

"But despite all of these great efforts being made to strengthen the response, the findings in this report were very clear."


A Corrupt Reputation

In the same talk, Rothwell revealed that the UK has dropped from eighth to 18th in the global corruption ranking index. People now think the UK is more corrupt. If people believe this, it becomes more acceptable. The challenge here is that trust has already been diminished, and rebuilding that reputation can take a long time.

He explained that there's a lack of capacity to deal with new threats, and questioned how often new initiatives are deployed in healthcare without appropriate consultation on fraud risks. These all link to the challenges we see in pharmacy issues and prescriptions, for example.

Many policy decisions are increasing fraud risks, and the collective mindset needs to change. The next part of the talk delved into the solutions and how to overcome these issues.


Data Is the Key

One of the solutions highlighted was simple - to get the basics right. But another way to mitigate fraud is the data sharing element.

Rothwell claimed: "I've made it a personal mission to convince officials here in the NHS that there's a use case for tackling flaws with our data. We want to get better access to data, but of course it goes beyond our own organisation. I know lots of you make good use of things like NFI data. We've got a really exciting partnership with the PSFA, but there's a lot more that we can do.

"So, my vision is for the NHS to be a leader in government for the use of data analytics. It's a significant part of our strategic contention — there's no reason why we can't lead the way with this. The NHS has huge amounts of data. We're really good at collecting data; that's how I knew all those gloomy statistics before. Lots of other countries wouldn't be able to tell you that."

He stated that we need to access data in real-time and go where it is rather than waiting for it to come to us. Rothwell also said showing the benefits is challenging, but the focus should be suppressing fraud, preventing further losses, and incentivising organisations to find fraud.

Regarding data, he also emphasises the importance of recording all activity. In the eyes of ministers, if it isn't recorded - it didn't happen. Capturing information is crucial and the time is now to set an anti-fraud and corruption culture, embedding it in every area.


What Else Was Discussed?

Rothwell also admitted he doesn't believe in the concept of zero tolerance. Fraud will always exist, but the industry needs to determine what the tolerance levels are and what the appetite is towards fraud.

Fraud is a complicated matter and he urged that everyone in this industry has had training and knowledge over the years to influence change and help the wider NHS leadership understand fraud better while positively impacting the space.

Rothwell closed out his talk by holding himself to account for three commitments he's going to make in his influential position:

  1. Educate and influence NHS leadership and argue why fraud is a good business decision
  2. Maintain strong relationships with the wider counter fraud community
  3. Listen and be available to the community

With commitments from both sides, Rothwell believes we can build the strongest counter fraud community in the government.


What's Next?

Alex Rothwell and other influential members of the NHS Counter Fraud Authority will be taking the stage again on 22nd February 2024 to discuss where we are a year on from the above presentation, and what lessons we've learnt in that time.

Take a look at what's on offer and book your free ticket to join them in London >> https://counterfraudconference.co.uk/agenda