The healthmatters blog; commentary, observation and review
It’s been dubbed the most ambitious ever plan for efficiency savings in the NHS. There has been speculation that it is undeliverable.
The healthmatters blog; commentary, observation and review
Responding to the cancer waiting times statistics for December 2015 released today by NHS England[i], Dr Fran Woodard, Director of Policy and Impact at Macmillan Cancer Support, says:
“It is encouraging to see that cancer waiting times targets, which outline the time it should take for people with cancer to begin treatment following an urgent GP referral, have been met in December 2015, for the first time in 20 months. But this is not yet a cause for celebration. Analysis by Macmillan Cancer Support shows that more than 20,000[ii] cancer patients were hit by distressing delays during 2015.
“Keeping a person with cancer waiting for access to life saving treatment can leave them feeling anxious and alone at an extremely difficult time. It’s simply not right to leave people in the lurch like this.
“While we know that healthcare professionals are working hard to support people when they have been diagnosed with cancer, there is clearly a problem in people starting their treatment swiftly. It’s possible that the NHS is struggling to assess people with complex needs, such as the estimated 70%[iii] of people with cancer who also have another condition like heart disease or mental health problems; this can result in delays.
“While today’s figures are an improvement on previous months, targets were only just met – with more than 1 in 3 (36%) hospital trusts still missing the 62-day target[iv] and a quarter (25%) of people with lung cancer having to wait more than two months to start treatment. We need to see greater improvements consistently over the following months if the NHS has any hope of handling increasing pressures and giving people affected by cancer the best possible support.”
 NHS England. Provider based cancer waiting times. 11 February 2016. https://www.england.nhs.uk/statistics/provider-based-cancer-waiting-times-for-december-2015/
iiA wait of more than 62 days to begin their first definitive treatment following an urgent referral for suspected cancer from their GP.
iii An estimated 70% of people with cancer are living with at least one other LTC, compared to 55% of the general population of a similar age profile. Research undertaken by Monitor Deloitte, commissioned by Macmillan Cancer Support.
iv Based on provider organisations who gave first treatment to at least five people with cancer during December 2015.
Sir Michael Marmot in conversation with Professors Richard Wilkinson & Kate Pickett
Introduced by Christina McAnea (UNISON, Head of Health)
Tuesday 1 March, 6.15pm – 8pm
UNISON Centre, 130 Euston Road, London, NW1 2AY
In every country in the world, the higher you are on the social scale, the longer and healthier your life will be. In Britain, the average person would have eight extra years of healthy life if they had the same opportunities as the richest in our society. This social gradient is not inevitable, so what can governments do to address these dramatic and unjust health inequalities?
At this Equality Trust event, hosted by UNISON, Sir Michael Marmot will discuss the evidence from his latest book, The Health Gap: The Challenge of an Unequal World, with Spirit Level authors Professors Kate Pickett and Richard Wilkinson. Together they will explore the political and policy implications of the research, and take questions from the audience.
Please arrive to register at 6.15, for a prompt 6.30 start. The event is free, but Michael Marmot’s book will be on sale so do bring cash if you are considering a purchase. Please note this is not a catered event.
Getting to the venue
The UNISON Centre is situated on the north side of Euston Road between Euston and King’s Cross station. Euston tube station is on the Northern and Victoria lines, and King’s Cross station is on the Victoria, Piccadilly, Northern (City branch), Circle, Hammersmith & City and Metropolitan lines. Click here to check London travel, including bus routes. The event will be accessible, held on the ground floor.
The NHS has had an unhappy history in its relationships with information technologies. Undeterred, Health secretary Jeremy Hunt has announced a £4.2 billion investment in IT in the National Health Service (NHS), as part of the relaunched ‘digital transformation plan’.<
Examples of planned investments include:
Google, Apple and Microsoft will team up with the NHS to ensure the apps are fully supported across mobile platforms.
There is a sense that the government is pushing on an open door with its IT plans. A new Pricewaterhouse Cooper study of the UK’s healthcare market has found that almost four in 10 people would be willing to receive advice from their GP through their smartphones and tablets, while six in 10 would be happy to see a GP at a retail store during their shopping trips. Two thousand UK consumers, patients and clinicians were polled as part of PwC’s “Capture the Growth” study, which found that increasingly IT- savvy consumers are willing to have their care delivered in non-traditional settings, from non-traditional players.
The healthcare apps and wearables sectors are expected to be worth £460m and £375m respectively by 2020 ( vs £100m and £125m in 2015), PwC predicts. The wellness and fitness market, which includes gym memberships, studios, nutrition and sports drinks, alternative medicines, sports equipment, wearables and apps was estimated to be worth almost £20bn in 2015 and is predicted to grow to almost £23bn by 2020. Potential beneficiaries in the IT industry are enthusiastic but also cautious.
Gordon Morrison, Director of Government Relations at Intel Security said: “This investment sends a clear signal that the government is serious about transforming the NHS and making it fit for the digital age. However, the journey towards digitised records and services brings with it challenges around cyber security, privacy and protection of patient data.
That’s why it’s vital that the digital NHS plan is underpinned with a dedicated cyber strategy that can enable secure transformation that protects data from outsider threats. This approach will mean doctors, nurses and patients can enjoy world class digital health services and operate with genuine confidence in the increasingly connected online world.”
John Smith, principal solution architect at Veracode, added: “These proposals for a more connected, app-enabled NHS will certainly offer patients and health professionals more efficient digital services which are long overdue. But whilst patients will benefit from mobile access to records, data and online bookings, the sharp rise in healthcare apps could cause headaches for the government. That’s why it’s vital that all applications which access confidential data are fully tested and protected from vulnerabilities which could be an easy target for cyber criminals wishing to damage the NHS or profit from the wealth of sensitive data it holds.
Veracode’s research has shown that the healthcare industry has a poor track record in terms of creating secure code – with 69% of apps tested failing to meet basic security standards, and only 43% of identified flaws being fixed. Healthcare apps were also found to have a particularly high prevalence of Cryptographic Flaws which is rather worrying given that Encryption is one of the key technologies needed to protect sensitive data.”
Ensuring there are enough clinical staff with the right skills to meet the demand for high-quality, safe healthcare is essential to the operation of the NHS. However, the current arrangements for managing the supply of clinical staff are fragmented and do not represent value for money, according to a report from the National Audit Office published on February 5th. www.nao.org.uk/report/managing-the-supply-of-nhs-clinical-staff-in-england/
The arrangements for managing the supply of clinical staff involve the Department of Health, various arm’s-length bodies and healthcare commissioners and providers. Available data on vacancies are poor but, in 2014, there was a reported overall staffing shortfall of around 6% which equates to a gap of around 50,000 clinical staff. The extent of the shortfall varied between different staff groups and regions.
The creation of Health Education England means that, for the first time, there is a national body specifically tasked with making strategic decisions about planning the future workforce, working collaboratively with local healthcare providers. The national workforce plan is developed from plans prepared by local providers, which means it should be based on a detailed understanding of local circumstances. According to the NAO, however, the process for developing the national long-term workforce plan could be made more robust and Health Education England should be more proactive in addressing the variations in workforce pressures in different parts of the country.
Healthcare providers are responsible for employing clinical staff to deliver healthcare. Hospital trusts’ use of temporary staff has increased significantly, putting pressure on their financial position, and the NAO concludes that there is room for trusts to reduce spending on temporary staff. Temporary staffing gives trusts the flexibility to address short-term workforce pressures, but high levels of temporary staff are an inefficient use of resources. Spending on agency staff increased from £2.2 billion in 2009-10 to £3.3 billion in 2014-15. The Secretary of State for Health announced a cap in October 2015 on how much trusts can pay per shift to help control spending on agency staff; however, the NAO notes that these measures are unlikely to address fully the underlying causes of the increased demand for temporary staff.
At the same time as the use of temporary staff has increased, the NHS has made much less use of overseas recruitment and return-to-practice initiatives to address staffing shortfalls. The number of overseas nurses has fallen, particularly from outside the European Economic Area (EEA), where the number of entrants decreased from 11,359 in 2004-05 to just 699 in 2014-15. Some of the decline may have been due to tighter immigration rules for nurses between 2009 and 2015. The decrease was partly offset by a large rise in recruits from within the EEA. The NAO found that a more coordinated and proactive approach to managing the supply of staff could result in efficiencies for the NHS as a whole.
In response to the NAO report on managing clinical workforce supply, Danny Mortimer, Chief Executive, NHS Employers said: “The NAO report is a helpful analysis of the challenges that employers across the country are facing. Attracting and retaining the best staff is important for the NHS, and we need to get it right to build a sustainable workforce. Work is already happening with our recent survey showing that over 99 per cent of providers recognised the need to invest and retain their nursing workforce. We need to move away from a model of short-term fixes through agency staff to investing in attracting the best talent to work in the NHS – both from within and outside of the EU. Many NHS Trusts are currently facing a stifling shortage of nurses so we continue to lobby for nurses to be added to the shortage occupation list so that NHS Trusts can ensure safe staffing for patients.”
Homecare services are in a dire state according to the latest evaluation of reviews on Good Care Guide, the independent TripAdvisor style website for the care industry.
In an evaluation of over 7,000 reviews on the website, more than half (51%) of reviewers of homecare services slammed homecare agencies, describing them as providing a poor or bad quality service, contrasting sharply with 2012 when the equivalent figures was 23%. 42% were criticised for their poor or bad quality staff, while 47% were slated for their value for money, up from 23% in 2012.
The evaluation marks the four year anniversary of the launch of Good Care Guide, which went live in 2012 to give families a say about the care they have used – whether that’s care homes, homecare agencies or forms of childcare like nanny agencies or nurseries. The site has proved very popular with families looking for an impartial view on care in their area.
Stephen Burke, Director of Good Care Guide said: “Ever since we launched Good Care Guide in 2012, homecare has been getting poor reviews, much worse than those for care homes and childcare and this is largely down to bad value for money, the quality of care and poor staffing. The decline in homecare reviews has increased in the last year.
“I can’t emphasise enough the need to provide carers with better training, more time and higher pay to do their jobs well. Because of local spending cuts problems are exacerbated; there is poor communication by carers and their managers, lack of training, lack of knowledge of their clients and often missed or late appointments. As a result, individuals are left risking their lives each day, not knowing if their care provider is going to turn up, if they’re going to be given the correct medication, or experience rude or abrupt service as staff either don’t have time to spend caring for them or the training to do their job well.
“This is just not good enough and the impact on the individuals and their families is devastating, with the onus on families to look after their older relative, pay for care themselves or struggle without help. As a result, more people are needing hospital care and can’t be discharged – which of course pressures the NHS even further. The debate on the numbers is ongoing, but the much talked-about funding gap in social care is estimated to reach £3 billion by 2020. So, if people think they are getting poor service now, unless that gap is plugged, things are likely to get even worse.
“Improving homecare needs to be a priority for the government; it’s a positive way to support people out of hospital, but the deteriorating quality and availability is undermining these aims. The solution is more funding for councils beyond that already provided, joined up health and care budgets, better regulation of homecare by the Care Quality Commission and listening to the views of older people and their families.”
Common comments from reviewers on Good Care Guide website included staff who had failed to turn up either on time or at all, carers who had not given the correct medication or monitored an individual’s food and fluid intakes which is crucial for an individual’s condition, rudeness and neglect from staff and carers even falling asleep or stealing.
The latest analysis of Good Care Guide has revealed that while most homecare agencies have experienced a decline since 2012, care homes have actually improved in 2015 – potentially indicative of the CQC’s tougher inspection regime. Quality of care was reported as ‘good’ or ‘excellent’ in 68% of cases, up from 55% in 2014 showing a positive trend in care. However, 20% of care homes are still described as providing ‘bad’ quality care, 23% were rated ‘bad’ value for money and 17% were given the worst rating for their level of facilities and cleanliness according to the evaluation.
Yet again, results indicate that children are receiving better quality of care than their grandparents and great grandparents. Analysis found that 67% of nurseries and 62% of nanny and babysitting agencies were rated excellent for their quality of care. However, the biggest bugbear from reviewers was the high expense of childcare.
Good Care Guide provides parents and families with the platform to find, rate and review care providers local to them. The site works like TripAdvisor, and has proved popular with many parents and families as they embark on the difficult journey of finding the right care for their loved ones.
Good Care Guide recently launched a Caring Communities widget, enabling viewers to quickly see how care providers are performing in specific areas of the UK and compare with other areas.
It’s been dubbed the most ambitious ever plan for efficiency savings in the NHS. There has been speculation that it is undeliverable.
But amid all the debate about the planned £22bn of annual savings by 2020 in the NHS in England, one man has been rooting around the system working out how some of it might be achieved.
Now he has come up with a new set of proposals, some surprising, some controversial.
Lord Patrick Carter, a Labour peer as it happens, is advising Health Secretary Jeremy Hunt on how hospital budgets can be better spent.
In June he said up to £5bn a year could be saved annually by 2020. In his first report then he argued that some of it could be delivered by smarter procurement of hospital supplies and some by better management of staff rosters.
Now he has attempted to put more flesh on the bone, outlining other areas which could contribute to that £5bn figure.
He is a firm believer in good leadership leading to high-quality patient care and the most efficient use of resources.
If hospitals all adopted the best practice for different surgical procedures and treatments, he argues, then outcomes for patients would be better and money would be saved.
Homeless people benefit from resettlement programmes with many rebuilding their lives once they have their own accommodation, but individuals still need long term support, according to NIHR researchers at the Policy Institute at King’s College London.
Tracking a group of 297 homeless people for five years after they were rehoused, the Rebuilding Lives project examines their experiences and is the largest and only UK study of its kind. The researchers warn, however, that resettlement is not the sole answer, as many formerly homeless people are still vulnerable during the first few years after being rehoused and experience problems living independently, requiring ongoing support from housing, health and social care services – help many do not receive.
Dr Maureen Crane, from the Social Care Workforce Research Unit at the Policy Institute at King’s and the lead researcher, said: ‘Planned resettlement for homeless people does work and should be encouraged. However, although there have been cuts to tenancy support services, many people remain vulnerable and require long-term support to live independently and to prevent further homelessness.’
While 89% of individuals were housed at five years, many individuals were struggling financially and had difficulty meeting everyday living expenses:
Steady employment was another problem people faced with many only finding casual or ‘zero-hours’ contracts, despite a keen wish to work. Irregular working hours together with low weekly incomes, further contributed to financial struggles. The researchers highlight the problem such insecure hours pose for people who are trying to re-establish themselves and live independently after a period of homelessness. A growing shortage of social housing has meant that homeless people are now more likely to be resettled into the private rented sector. Yet the researchers found that young people, and those resettled into the private rented sector, had much poorer housing outcomes. They were more likely to have lost their accommodation and to have become homeless again. They were also the least likely to have received support from services after being resettled.
A third (35 per cent) of people in both the private rented sector and social housing were living in accommodation that had serious problems such as dampness and mould, faulty heating or electrical wiring faults, in some cases resulting in ill-health.
Peter Radage, Service Director at the charity Framework Housing Association, a collaborator in the study said: ‘This important research highlights the fact that homelessness is a complex and enduring issue for the individuals who experience it. Low income and an inability to access permanent full time employment threatens people’s housing and independence particularly at a time when access to social housing is diminishing. For a significant number of people in the study their support needs have not gone away. It is therefore vitally important that decision makers understand the importance of homeless prevention services and prioritise them in their thinking.’
Paul Noblet, Head of Public Affairs at the youth homelessness charity Centrepoint, another collaborator in the study said: ‘With the right support young people who have experienced homelessness can thrive when living independently, but their situation is incredibly precarious. Juggling a small budget too often leaves them just one unexpected bill away from finding themselves once again with nowhere to go. Times are tougher than ever for young people who have experienced homelessness. They must be given the support they need to find and keep a job and their own home.’
Rebuilding Lives, the report which outlines the research findings, makes a number of important recommendations about the services and support that are needed once homeless people are resettled. If addressed, they will help ensure that formerly homeless people are supported and their long term needs are met – so they can rebuild their lives.
Rebuilding Lives was funded by the National Institute for Health Research (NIHR) School for Social Care Research. The study was undertaken in collaboration with five leading homelessness organisations: Centrepoint, Framework Housing Association, St Anne’s Community Services, St Mungo’s and Thames Reach. Rebuilding Lives was a follow on to the ESRC-funded FOR-HOME study that took place in 2007-10 and investigated the outcomes of resettlement of 400 single, homeless people. Further details of the study can be found online.
NHS Employers is calling on staff in the NHS to share images of their first jobs in the NHS on Twitter as part of #NHSwhereIstarted, a new social media campaign.
In its first week, the campaign has seen more than 3,200 tweets and 1,480 participants share their stories, including senior leaders such as Suzanne Rastrick, Chief Allied Health Professions Officer, Jane Cummings, Chief Nursing Officer, Prem Singh, Chairman at Derbyshire Community Health Services NHS Trust and Danny Mortimer, Chief Executive of NHS Employers.
Danny Mortimer, Chief Executive of NHS Employers, said:
“I started when I was 18, and fell utterly for the NHS and its work. The #NHSwhereIstarted campaign is an engaging way for employers to highlight how the NHS has shaped their careers, and to demonstrate their support to keep doing this for the future generations. We want to commit and attract young talented people into the NHS who have so much to offer, both now and in the future. Increasing the number of young people working for the NHS will have a significant impact on the sustainability of the workforce and contribute towards better patient care.”
The campaign is part of NHS Employers ThinkFuture programme of work, and highlights the benefits of employing young people and the skills they can bring to the NHS. Many of today’s leading figures in healthcare have had long careers in the NHS and they recognise that young people in the NHS have the energy and commitment to make a real difference.
Get involved by following @ThinkFutureNHS on Twitter
Down here in Cornwall in the West Country our local and only general hospital group, Royal Cornwall Hospitals Trust, which is not a Foundation Trust, is on black alert for the second time this year. NHS Kernow, the Clinical Commissioning Group, has a £14-16m deficit and has been placed under a Legal Directive by NHS England. Earlier in 2015 the Chancellor indicated that he would like to devolve decision making powers for some part of Cornwall’s Health and Social Services.
In this context Cornwall Council and NHS Kernow are becoming concerned about public engagement. There is to be a ‘roadshow’ in March and they have launched an on-line survey. Responses are almost all in free-text and the questionnaire design makes it hard for members of the public to comment about the service as a whole. The focus is very much on the individual respondent’s health status. The introduction to the survey suggests its intention may be largely to prepare public opinion for inevitable cuts. It reads like this.
Have your say on health, care and wellbeing in Cornwall and the Isles of Scilly
Cornwall Council and NHS Kernow are seeking the views of people across Cornwall to help shape future health and social care provision and improve the wellbeing of our residents.
The way we commission and provide health and social care services was created more than 60 years ago and need redesigning. The Government has offered Cornwall more powers as part of the ‘Deal for Cornwall’, and as part of that we have been asked to put forward a new plan to meet the health and social care needs of Cornwall residents today and in the future.
Challenges facing us include rising costs because of increased demand for services as people live longer with more complex conditions. There are reducing levels of funding for some areas of health and social care. We also have some of the most disadvantaged neighbourhoods in the UK.
Given the financial challenges and the pressures on our health and social care system, we must better prepare our services for the future using the resources available in the best way possible.
Please let us know your health and social care priorities, which we will use to help assess the options to deliver improved services.
There seems to be a bit of an epidemic of consultation, nationally as well as locally, but it is not clear what, if any, notice will be taken of the response. Dr Peter Levine writes on http://bit.ly/1WMIlYE about a consultation Kernow Clinical Commissioning Group (KCCG) conducted on their procurement ,and the response of the group to the replies it received. West Cornwall’s response, which he helped to draft, was particularly robust in its criticism but none of the responses, however diplomatically worded, seem to have been considered by the Board when it made its decision.
It is also interesting that the lay Board Member with responsibility for Public and Patient engagement is the former Chief Executive of NHS Wiltshire & Gloucester Partnership NHS Trust and is the founder and director of a consultancy specialising in support to organisational leaders facing personal and organisational change. These are certainly skills that an organisation like KCCG needs but I am not sure that he can really be considered ‘lay’ or that his experience will make it easy for him to champion the views of the public.
He lists his achievements like this:
2006 – December 2011 (5 years 2 months) Led the turn round of a failing organisation post merger. Created a high perrforming leadership team. Led regional and national service improvement work programmes.
March 2002 – October 2006 (4 years 8 months) Created the first integrated health and social care mental health service organisation. Unified three separate organisations and led them to achieve highest performance band in England 3 years running
Local health campaigners in Redruth find themselves in the interesting situation of defending a commercial Primary Care centre against closure. Cardrew Primary Care Centre in Redruth serves 3,000 patient and also runs a walk-in facility. The private provider, Nestor Primecare, part of Allied Healthcare, owned by Charterhouse, seems to have decided at short notice not to renew the contract. Or possibly NHS England decided this. There is an assumption that local GP practices and Community Health services will be able to pick up the work. Since they are already overstretched this seems unlikely. Redruth is a post-industrial town with high levels of deprivation. So we have the local Labour Party in the interesting situation of needing to petition NHS England to keep a for-profit facility open.
The Guardian exposed new guidance about shrinking the NHS workforce on January 30th. NHS Hospitals are being told to shed staff to rescue the health service from an acute funding crisis, despite intense concern that reducing staff will hit quality of care, patient safety and staff morale, whilst also increasing waiting times. Monitor and the NHS Trust Development Authority (TDA) have issued the instruction to reduce staffing almost three years after ministers ordered hospitals to do the opposite, following the official report into the Mid Staffs care scandal. The move could lead to hospitals being forced to shed hundreds of staff in a bid to balance their books, with nurses and managers the most vulnerable to being axed.
Here come the bad boys:
The Health Services Journal has revealed that the very same Monitor has sounded out commercial management consultancies about putting up to 25 Hospital Trusts that are struggling financially into ‘turnaround’. The regulator confirmed to HSJ that it was considering “a programme of support” (i.e. cuts) for Trusts but had not decided how many organisations would be affected. If implemented across 25 trusts – about one-sixth of the acute hospital sector – the programme would be one of the biggest single interventions in the day-to-day running of providers since NHS England medical director Sir Bruce Keogh led a review of 14 trusts with persistently high mortality figures in 2013.
It’s not working:
The chief executive of NHS Improvement, Jim Mackey, has criticised the speed with which the “success regime” programme has made progress (HSJ January 29th). The “success regime” was launched by NHS England chief executive Simon Stevens in June last year and three areas were designated to be put through the programme: Devon, parts of Essex and Cumbria. The regime is supposed to address “deep rooted and systemic issues that previous interventions have not tackled across [a] whole health and care economy”. Clearly, it is not as easy as it seemed at the time.
Are you sleeping soundly?
A survey by Intel (NASDAQ: INTC), a world leader in computing innovation, shows that while the UK public understands the link between a good night’s sleep and their wellbeing, a huge percentage struggle to sleep and worry about the impact on their health. Working with a sleep expert and physiotherapist, Intel asked the British public questions about their sleeping habits and awareness of the links to wellbeing, with startling results:
You can find more information on the Reclaim your Sleep survey here.
The great and the good:
Twenty one Presidents of Medical Royal Colleges and Associations have written to both sides in the Junior Doctor dispute to encourage the negotiations and to support those seeking a deal on both sides. Insiders wonder if this would have been necessary if negotiations were not bogged down in detail or troubled by intransigence, possibly on both sides.
In January 2013 the The NHS Commissioning Board announced its intention to reshape England’s largest teaching and specialist hospitals in an attempt to control the “commanding heights” of the health economy. The Commissioning Board then directly commissioned specialist care worth £12bn., amounting to between a third and a half of the income of the country’s largest Hospital trusts. Chief Executive Sir David Nicholson argued that the large teaching, specialist and tertiary trusts had not paid enough attention to their commissioners. This would change, he said. It’s not going well, this struggle for the commanding heights. News in the HSJ (January 25th) has described how NHS England is troubled by the expansion of specialist services, now worth £14bn, and the difficulty in getting their costs under control. Even big commissioners can be avoided, it seems.
The real cost of healthcare fraud:
Fraud is a challenging problem no matter what sector it impacts on. News of its economic effects are clear – worse public services, less financially stable and profitable companies, diminished levels of disposable income for all of us, charities deprived of resources needed for charitable purposes. In every sector of every country, fraud has a pernicious impact. At present we have a fraudulent or corrupt minority who are prepared to divert the funds which are intended to keep us all well. That minority exists in all countries – and even in the UK’s National Health Service (NHS). Every penny lost to fraud and corruption weakens healthcare systems and undermines their capacity to provide essential treatment.
PKF Littlejohn and the Centre for Counter Fraud Studies at University of Portsmouth have published the latest global (and UK) research concerning the extent to which this happens – ‘The Financial Cost of Healthcare Fraud Report 2015’. (http://www.pkf-littlejohn.com/healthcare-fraud-report-2015.php)
The Report does not simply describe detected fraud or the individual cases which have come to light and been prosecuted. Because there is no crime which has a 100% detection rate, adding together detected fraud significantly underestimates the problem. Nor does the Report rely on survey-based information where those involved are asked for their opinions about the level of fraud. Instead it considers 107 statistically valid and highly accurate loss measurement exercises looking at the total cost of fraud (and error). The data considered covers 17 years and 14 different types of healthcare expenditure in different countries, with a total value of £2.9 trillion.
Across this massive global dataset it shows average losses of 6.2% with 88% of the loss measurement exercises showing losses of greater than 3% of total budget and an increase of almost 11% in this cost since 2007. In the UK’s NHS, the report identifies losses in 6 areas of expenditure and 3 of patient charge income, using the NHS’s own data where it has measured losses or global data where it has not. Total losses for the NHS (for fraud alone) are estimated to be between £3.73 and £5.74bn, depending on the assumptions made – either way an enormous sum which is not being devoted to patient care.
Fraud is a cost which the NHS needs to do more to manage and minimise. The report cites the period between 1998 and 2006 when the NHS did just this – reducing the cost of fraud by up to 60% and delivering £811m of financial benefits to fund better patient care.
It is the view of the authors of the Report that there are 3 first steps for the NHS to take to reduce the cost of fraud:
1) The NHS needs to re-adopt an approach which is focussed on reducing the cost of fraud not just investigating and prosecuting individual examples (although this is important too);
2) It therefore needs to re-commence loss measurement exercises across key expenditure streams. It is only with accurate knowledge about the nature and extent of fraud that proportionate, effective action can be taken to reduce its extent; and
3) It needs to re-create a powerful, well-resourced organisation to lead this work with a remit and authority across all parts of the NHS.
February 1st 2016