:00:00. > :00:13.The NHS is under financial scrutiny like never before. Yet it seems
:00:14. > :00:18.billions of pounds are being lost to fraud and error every year. I think
:00:19. > :00:21.every citizen in this country wants to know the truth. Tonight, Panorama
:00:22. > :00:26.reveals the fraudsters who are stealing money and getting away with
:00:27. > :00:31.it. We had a notebook which appeared to be an order book for these stolen
:00:32. > :00:39.products. This is criminality at a professional level. It is
:00:40. > :00:43.astonishing. Mr Craig, I'm from BBC. Would you stop and talk to us for a
:00:44. > :00:44.moment? I've got some questions to ask. With exclusive evidence,
:00:45. > :00:57.Panorama examines the sheer scale no comment. Are our politicians
:00:58. > :01:00.telling us the truth? They are engaging in a very slick PR
:01:01. > :01:08.operation to minimise the potential picture of fraud in the NHS. And we
:01:09. > :01:11.also ask, with more private companies bidding for contracts, is
:01:12. > :01:14.the current NHS monitoring system robust enough to guard against
:01:15. > :01:16.mistakes? At the end, it's both the patient and the taxpayer who lose
:01:17. > :01:43.out. The National Health Service is under
:01:44. > :01:47.financial strain. NHS! Not for sale! Its resources are under pressure.
:01:48. > :01:52.The Royal College of Nursing says the NHS in England is in a desperate
:01:53. > :01:57.situation. And it's unlikely to ease. NHS England is warning it
:01:58. > :02:03.could face a ?30 billion funding gap by the end of the decade. We've
:02:04. > :02:07.grown used to being told about the NHS facing one crisis or another,
:02:08. > :02:14.but who's telling us about the vast sums being stolen from it every day?
:02:15. > :02:17.According to the government's own figures, hundreds of millions of
:02:18. > :02:23.pounds of NHS money is lost every year through fraud. Good morning
:02:24. > :02:26.folks. Thanks for sharing your time this morning. As you know this
:02:27. > :02:30.morning's meeting is about Operation Brass. We've been given access to
:02:31. > :02:38.NHS Scotland's Counter Fraud Services, or CFS.
:02:39. > :02:42.Often a CFS case starts with a tip-off, like from the medical
:02:43. > :02:48.supplier who'd spotted their products for sale on eBay. Products
:02:49. > :02:54.they'd already sold to a Glasgow children's hospital. They could see
:02:55. > :02:57.that those items had been sold previously to the Health Board by
:02:58. > :03:03.numbers that appeared on the actual items themselves. Fraser Paterson
:03:04. > :03:06.and his team traced the eBay account to this man, Douglas Stevenson, an
:03:07. > :03:11.NHS anaesthetic assistant and a trusted employee. The counter fraud
:03:12. > :03:21.team raided his home. We found a computer system which had
:03:22. > :03:27.some of the products that had been stolen sitting beside the computer,
:03:28. > :03:31.in effect ready to be sold. And we had a notebook which appeared to be
:03:32. > :03:36.an order book and envelopes with details of the next customer.
:03:37. > :03:43.Investigators found scalpels, drill bits, implants and sutures. CFS
:03:44. > :04:07.interviewed Douglas Stevenson under caution.
:04:08. > :04:15.Stevenson was simply going to the hospital stores, filling his bag and
:04:16. > :04:17.walking out. His eBay sideline, trading in stolen goods, was
:04:18. > :04:25.straightforward theft from his employers, the NHS, and the public
:04:26. > :04:28.purse, and it ran into thousands. I've found here one of Douglas
:04:29. > :04:35.Stevenson's eBay accounts, Stevenson136. I can see 188 people
:04:36. > :04:43.have left him feedback and they're saying brilliant eBayer, excellent
:04:44. > :04:49.service. Just the sheer volume of stuff here, it reads like a hospital
:04:50. > :04:56.inventory. At court, Douglas Stevenson pleaded guilty to
:04:57. > :05:01.defrauding the NHS out of ?23,000. He received a sentence of 20 months
:05:02. > :05:04.in prison and was struck off. He's a health care professional who has
:05:05. > :05:08.abused his position of trust and there are items that were intended
:05:09. > :05:14.for patient care that didn't go there. So that money has gone. CFS
:05:15. > :05:21.believe the total fraud added up to far more than the ?23,000 Stevenson
:05:22. > :05:25.admitted to in court. Over 850 items had been stolen and sold on eBay and
:05:26. > :05:33.this amounted to some ?75,000, give or take. And that's quite a
:05:34. > :05:37.Conservative estimate. We asked to speak to Douglas Stevenson. Through
:05:38. > :05:41.his lawyer he told us he disputes the figure, but did not want to
:05:42. > :05:43.comment. Stevenson's fraud might seem small-scale but it's believed
:05:44. > :05:51.there are thousands like him stealing from the NHS and the public
:05:52. > :05:56.purse. Individual cases can run to nearly ?1 million.
:05:57. > :06:04.Auchinleck in East Ayrshire where Stuart Craig ran his dental
:06:05. > :06:08.practice. The village has just 12,000 residents, yet he was one of
:06:09. > :06:14.the highest earners in the country. A random check of his patients'
:06:15. > :06:17.treatment records revealed why. There's certainly no evidence of
:06:18. > :06:22.these teeth needing to be filled in between them, so these are big
:06:23. > :06:26.fillings that he was doing. And of course the bigger the filling, the
:06:27. > :06:30.bigger the fee. It's John Cameron's job to catch dentists who aren't up
:06:31. > :06:37.to scratch or are fiddling the books. Stuart Craig's bills to the
:06:38. > :06:43.NHS for gold crowns caught his eye. I picked at random 40 cases. We got
:06:44. > :06:46.the laboratory bills in, we checked that he had actually claimed for
:06:47. > :06:54.precious metal, and the laboratory bills showed in 100% of them that he
:06:55. > :06:57.had provided non-precious metal. So Stuart Craig was netting a small
:06:58. > :07:03.fortune charging the NHS for gold crowns while giving his patients
:07:04. > :07:11.cheaper ones. His standard of work was also causing concern. This
:07:12. > :07:13.person's teeth have had...? Were being damaged by the dentist
:07:14. > :07:19.carrying out work that wasn't necessary. And then you have an
:07:20. > :07:25.onward spiral doing more and more treatment to the deterioration of
:07:26. > :07:28.the patient. Poor fillings led to root treatments the patient may
:07:29. > :07:32.never have needed. Bad root treatments led to crowns. Failed
:07:33. > :07:37.crowns would have to be repeated. All money in the bank for Stuart
:07:38. > :07:44.Craig. I'm ashamed as a dentist that any dentist could behave in this
:07:45. > :07:47.manner. Last summer, Stuart Craig was convicted and fined for
:07:48. > :07:55.defrauding the NHS of just under ?2,000, nowhere near his total
:07:56. > :08:04.theft. Is that the true scale of his fraud? Well, no. I went through and
:08:05. > :08:08.looked at the scale of mis-claims, and I estimate that the amount that
:08:09. > :08:16.he is due to repay, which is possibly an underestimate, is
:08:17. > :08:20.?782,896. In January 2012, the NHS sent Stuart Craig a bill for the
:08:21. > :08:26.three-quarters of a million pounds they say he owes but they've yet to
:08:27. > :08:33.receive a penny. And the man himself seems to have disappeared. But we
:08:34. > :08:37.found him living in the North of Glasgow and wanted to ask him a few
:08:38. > :08:39.questions. We approached him as he pulled up in his driveway. Mr Craig,
:08:40. > :08:58.I'm from BBC. Mr Craig, I'm from BBC Panorama.
:08:59. > :09:02.Would you stop and talk to us? I've got some questions to ask. Well, it
:09:03. > :09:05.seems Mr Craig cares as much about answering our questions as he does
:09:06. > :09:08.about his former patients. Hopefully the NHS will have more luck. We
:09:09. > :09:13.understand they'll be serving him with a writ.
:09:14. > :09:18.Some fraud can undermine our faith in even the most trusted of health
:09:19. > :09:21.professionals. In the town of Greenock in Inverclyde, the local GP
:09:22. > :09:28.Susan McKinnon betrayed her patients using their medical records to hide
:09:29. > :09:31.her secret drug addiction. We received a call from the Health
:09:32. > :09:35.Board and they had had concerns reported to them by a pharmacist in
:09:36. > :09:38.the Greenock area. Dr McKinnon was at the pharmacy collecting a
:09:39. > :09:48.prescription she claimed was for a patient. Staff there felt something
:09:49. > :09:51.wasn't right. I just thought it was strange that a GP had come into a
:09:52. > :09:57.pharmacy to collect a prescription. How unusual is that? Very. The
:09:58. > :10:00.prescription was for diazepam and the opiate dihydrocodeine, both
:10:01. > :10:10.controlled drugs ? one a known substitute for heroin. When she'd
:10:11. > :10:14.left the building, Louise turned round and asked me, "Why is a GP
:10:15. > :10:17.picking a prescription up?" A few weeks later, in another of Eddie
:10:18. > :10:25.McAnerney's pharmacies, Dr McKinnon did the same thing. I'd actually
:10:26. > :10:29.bagged it up and tagged it, and I thought, "Wait a minute. That's
:10:30. > :10:38.diazepam and dihydrocodeine." Who's signed it? Dr McKinnon, for a
:10:39. > :10:41.patient's name that was obviously different to hers. I said, "So if
:10:42. > :10:45.that's you, what's your date of birth?" And she panicked. CFS were
:10:46. > :11:11.called in but in her interview, Dr McKinnon gave nothing away.
:11:12. > :11:19.Last June, Susan McKinnon was convicted of fraud. The official
:11:20. > :11:21.value? Just a few hundred pounds. But with hundreds of fraudulent
:11:22. > :11:27.prescriptions dating back four years, CFS say the true cost to the
:11:28. > :11:32.NHS was several thousand. Dr McKinnon declined to be interviewed.
:11:33. > :11:33.She's recently been reinstated as a GP after being suspended but only
:11:34. > :11:44.under strict supervision. Across Britain, NHS fraud
:11:45. > :11:50.investigators pursue around 3,000 cases a year. Officially, the
:11:51. > :12:00.Government's annual fraud indicator puts fraud against the NHS at ?229
:12:01. > :12:11.million a year. But is that the true scale of what's being stolen?
:12:12. > :12:16.For more than eight years, Jim Gee was the director of NHS Counter
:12:17. > :12:22.Fraud Services for the Department of Health. He's one of the world's
:12:23. > :12:25.foremost authorities on health care fraud and has studied 15 years of
:12:26. > :12:32.international fraud and error figures. This report is based only
:12:33. > :12:37.upon loss measurement exercises looking at the total cost of fraud.
:12:38. > :12:41.It's the most rigorous data that's available about health care fraud in
:12:42. > :12:44.the world. Tomorrow, with the University of Portsmouth, he'll
:12:45. > :12:50.publish a report on the scale of health care fraud and error
:12:51. > :12:56.globally. His findings for the NHS are staggering. How much money is
:12:57. > :13:00.lost to fraud in the NHS each year? Just under 7% on average lost, and
:13:01. > :13:07.in some cases ranging up to over 15% lost. In the UK the NHS Budget is
:13:08. > :13:13.around 100 billion, so that would equate to around seven billion lost.
:13:14. > :13:17.He puts more than five billion of that seven billion down to fraud
:13:18. > :13:20.rather than financial error. That's more than 20 times the amount
:13:21. > :13:26.recorded in the government's annual fraud indicator. Why would they say
:13:27. > :13:31.that there's only ?229 million of fraud? Well the figures quoted in
:13:32. > :13:33.the Government's annual fraud indicator are partial, just relating
:13:34. > :13:39.to pharmaceutical and dental services. They ignore the losses
:13:40. > :13:42.that might be taking place in payroll expenditure, one of the
:13:43. > :13:44.largest costs to the NHS, may be taking place in procurement
:13:45. > :13:49.expenditure, clearly areas where there's great potential for fraud.
:13:50. > :13:53.If Jim Gee's figures are correct, all of us as patients of the NHS are
:13:54. > :14:00.losing out to the tune of ?14 million every day. The amount stolen
:14:01. > :14:10.every year could pay for more than 68,000 new consultants or 244,000
:14:11. > :14:16.new nurses. It's the equivalent of the NHS's entire bill for cancer
:14:17. > :14:20.services. If the NHS was only losing ?229 million a year, it would be
:14:21. > :14:24.doing 30 times better than any other health care organisation in the
:14:25. > :14:31.world. Something I think is completely implausible. No minister
:14:32. > :14:35.would be interviewed but in a statement the Department of Health
:14:36. > :14:38.told us it did not recognise Jim Gee's figure or speculate on levels
:14:39. > :14:54.of losses, adding the department has not downplayed the cost of fraud.
:14:55. > :14:58.# Oh, the good life... # If the risk of being caught is low
:14:59. > :15:07.compared to the rewards on offer, is the current policing system fit for
:15:08. > :15:09.purpose? Not if the activities of a former resident of this street,
:15:10. > :15:25.Birmingham's exclusive Millionaire's Row in Little Aston, are anything to
:15:26. > :15:28.go by. Living here was Joyce Trail. She ran a surprisingly modest dental
:15:29. > :15:33.practice seven miles up the road in Handsworth.
:15:34. > :15:36.# For you can't take the chance... # Joyce Trail enjoyed the high life -
:15:37. > :15:42.frequent Caribbean holidays and stays in ?1,000-a-night hotels. But
:15:43. > :15:47.the sums didn't add up. She was in fact one of the most prolific
:15:48. > :15:50.fraudsters in NHS history. Joyce Trail would visit care homes,
:15:51. > :15:54.offering to check the residents' teeth. She'd treat some patients on
:15:55. > :16:01.site but, as a trusted dentist, she now had access to residents'
:16:02. > :16:05.details. She used them to claim payment from the NHS for work she
:16:06. > :16:11.hadn't done, including dentures for patients who still had their own
:16:12. > :16:13.teeth. And, on 154 occasions, for work carried out on patients who had
:16:14. > :16:24.in fact died. I think what she has done is,
:16:25. > :16:31.frankly, disgraceful. Fellow dentist Vijay Sudra believes Trail became a
:16:32. > :16:37.full-time fraudster. She faked over 38,000 documents. This is
:16:38. > :16:43.criminality at a professional level. It is astonishing. Over a period of
:16:44. > :16:52.three years, some 75% of Joyce Trail's claims to the NHS were found
:16:53. > :16:55.to be bogus. She did not go to work and say, "I'm going to treat
:16:56. > :17:01.patients today." Three quarters of her dentistry was paper dentistry.
:17:02. > :17:07.Trail faked invoice statements from lab technicians claiming payment
:17:08. > :17:10.from the NHS. Reputable labs were dragged into the investigation and
:17:11. > :17:18.had to open their records to investigators. They came here to ask
:17:19. > :17:25.me if they were genuine statements or not. There was 12 months worth of
:17:26. > :17:29.statements and every one was false. Trail was stealing massive amounts
:17:30. > :17:35.of money to fund a lavish lifestyle. Yet it seems she didn't want to
:17:36. > :17:40.spend it paying her bills. We were owed just over ?3,000, which was
:17:41. > :17:41.never paid. It'd be three months wages for somebody that we couldn't
:17:42. > :17:49.pay. In court, it was revealed that Joyce
:17:50. > :17:57.Trail had defrauded the NHS out of ?1.4 million, the largest ever fraud
:17:58. > :18:03.by an individual against the NHS. She was jailed in 2012 for seven
:18:04. > :18:05.years. This wasn't the first time that Joyce Trail was found to have
:18:06. > :18:16.stolen from the NHS. She had form. Back in 2004, the NHS found she'd
:18:17. > :18:22.been making false claims too. She agreed to pay back ?320,000 and
:18:23. > :18:27.there was no further action. Remarkably, she was able to go on
:18:28. > :18:32.stealing. And there are worries that a fraud on the scale of Joyce
:18:33. > :18:36.Trail's could happen again. The problem here is monitoring. Going
:18:37. > :18:42.back to before 2006, there were regional dental officers who would
:18:43. > :18:45.randomly assess patients. As of two or three years ago they've disbanded
:18:46. > :18:54.that dental reference service, and that's a mistake.
:18:55. > :18:59.Not only have the specialist dental fraud teams been disbanded, but NHS
:19:00. > :19:02.Protect, the national body that investigates fraud for the
:19:03. > :19:11.Department of Health, has had its budget cut by around 30% since 2006.
:19:12. > :19:15.And yet over the same period, since the start of the recession, health
:19:16. > :19:22.care fraud has gone up, where it's been measured, by 25% What does that
:19:23. > :19:28.say to you? It says to me bad judgement. Through freedom of
:19:29. > :19:32.information requests we asked NHS Protect how many counter-fraud
:19:33. > :19:35.specialists it employs. The answer was 27, with a further 294
:19:36. > :19:43.investigators who work at a local level. So, that's just over 300
:19:44. > :19:50.investigators to police a potential ?5 billion of NHS fraud. Yet when it
:19:51. > :19:53.comes to benefits, the Department for Work and Pensions employs six
:19:54. > :20:01.times the number of investigators for less than half the amount of
:20:02. > :20:05.fraud. There are many good people in NHS Protect who want to do more to
:20:06. > :20:09.tackle fraud in the NHS but they don't have the resources to do the
:20:10. > :20:12.job that they are capable of doing. Cutting the budget of NHS Protect
:20:13. > :20:15.sends a message to fraudsters that there will be greater opportunities
:20:16. > :20:19.for them to gather their ill-gotten gains.
:20:20. > :20:24.The Department of Health said NHS Protect has a significant budget and
:20:25. > :20:33.protects and safeguards front line NHS services.
:20:34. > :20:40.In Dorset, Barry Hards is a local NHS fraud specialist. Until April
:20:41. > :20:47.last year, he had responsibility for investigating contractors to the NHS
:20:48. > :20:52.in his area, like opticians. That's now passed to a new body called NHS
:20:53. > :20:56.England. The question is, have they got the resource to deal with new
:20:57. > :21:02.cases, new referrals? And my suspicion, as of my colleagues, is
:21:03. > :21:05.the answer to that is no. Minutes of a meeting of NHS England's Audit
:21:06. > :21:11.Committee appears to reinforce Barry Hards' concerns. Under the title
:21:12. > :21:21.Budgets for Counter Fraud Work it says:
:21:22. > :21:25.How can you have confidence that there's a likelihood you'll be
:21:26. > :21:37.discovered, found out, when there's very few people looking at you? And
:21:38. > :21:40.I think it's a genuinely held concern that some people in senior
:21:41. > :21:45.positions have just taken their eye off the ball on this. So it's a good
:21:46. > :21:50.time to be getting away with it? In my view, yes. NHS England told us it
:21:51. > :22:01.was committed to detecting and preventing fraud. Health care in the
:22:02. > :22:05.21st century is changing. Professor Mark Button has watched as private
:22:06. > :22:11.companies have entered the NHS in increasing numbers. The Government
:22:12. > :22:17.argues it encourages competition and efficiency. But does it also bring
:22:18. > :22:23.new risks? These companies come in and they bid for work on a very
:22:24. > :22:27.tight budget. And if the service is not being delivered as it should,
:22:28. > :22:28.there may be a risk those types of individuals then manipulate or
:22:29. > :22:40.falsify data. So does a new, competitive, NHS need
:22:41. > :22:42.to do more to ensure that the data it uses to judge performance is
:22:43. > :22:55.subject to proper scrutiny? In 2006, here in Cornwall, one of
:22:56. > :23:03.the biggest private companies working in the NHS won a ?32 million
:23:04. > :23:08.contract. Serco was to provide the out of hours GP service. It meant
:23:09. > :23:13.anyone falling ill after hours would be treated by a doctor working for
:23:14. > :23:16.the company. In May 2012, Maggie Sloggett needed an out of hours
:23:17. > :23:22.doctor when her partner Darren became unwell. He deteriorated quite
:23:23. > :23:28.quickly, and in that time I felt I needed to phone for help. They then
:23:29. > :23:35.said, we'll get someone to ring you back. She says she never received a
:23:36. > :23:39.call and Darren was getting worse. He was unable to talk and I couldn't
:23:40. > :23:42.communicate with him to find out how he was feeling. I was shaking, I was
:23:43. > :23:50.quite frightened to be honest. She called an ambulance and
:23:51. > :23:56.paramedics gave Darren morphine and took him to hospital, where he
:23:57. > :24:02.recovered. Serco say their team did call back twice, but the calls went
:24:03. > :24:07.to voice mail. They say they took no further action once it was confirmed
:24:08. > :24:10.an ambulance was on its way. While Maggie and Darren's case may have
:24:11. > :24:15.simply been crossed wires, others were complaining about the time it
:24:16. > :24:19.took to see a doctor. It was then revealed that Serco's records were
:24:20. > :24:25.wrong. They said a few patients did see a GP on time when they hadn't.
:24:26. > :24:30.Whistle-blowers started to raise concerns. We've spoken to a number
:24:31. > :24:33.of informants, including a nurse who worked for Serco.
:24:34. > :24:40.I came in one morning and there had been one car doctor for the whole of
:24:41. > :24:45.Cornwall during the night. She went on to raise concerns about how data
:24:46. > :24:49.was manipulated. If Serco didn't meet their targets to see patients
:24:50. > :24:54.in the time I'd allocated for them, it was flagged up as a fail. There
:24:55. > :24:58.were times that I knew that targets weren't being met, and yet it was
:24:59. > :25:03.being recorded there had been no failures.
:25:04. > :25:06.Serco's audit uncovered 252 occasions over six months where
:25:07. > :25:15.patient response times were altered by two employees. That's just 0.2%
:25:16. > :25:19.of all calls and some were only changed by a few seconds. But that
:25:20. > :25:26.sometimes meant the company scored a pass rather than a fail. And some
:25:27. > :25:27.months the NHS Trust thought all emergency patients were being seen
:25:28. > :25:41.within an hour, which wasn't true. Serco and the local Primary Care
:25:42. > :25:43.Trust were summoned before the Public Accounts Committee at
:25:44. > :25:50.Westminster and cross-examined by the chair, Margaret Hodge. While at
:25:51. > :25:53.no time were they being accused of fraud, she wanted to get to the
:25:54. > :25:59.bottom of why two Serco supervisors, who've now left, had manipulated the
:26:00. > :26:03.data. What was the financial or other incentive for them to cheat?
:26:04. > :26:08.There was no financial gain to them or the company for the changes that
:26:09. > :26:11.they made. It's something we've reflected on as to what their
:26:12. > :26:19.motives were and I can only assume that they wished to portray better
:26:20. > :26:23.view of performance of the service. Because it seems to me very odd to
:26:24. > :26:28.want to manipulate data, if there isn't an incentive there for you to
:26:29. > :26:36.do it. She then questioned the NHS Trust on why, despite the 252
:26:37. > :26:42.errors, it hadn't penalised Serco. Why was that not enough for you to
:26:43. > :26:45.think we should stop paying them? It was considered, because clearly we
:26:46. > :26:51.expect our providers to give us honest information. Say yes or no.
:26:52. > :26:55.252 lies was not enough, for you, in your judgement. One lie is too many.
:26:56. > :26:57.They never got a penny less. They'd lied 252 times and they never got a
:26:58. > :27:07.penny less. No they didn't. It is deeply frustrating to my
:27:08. > :27:11.committee that, time and time again, where there's been a failure, the
:27:12. > :27:14.terms of the contract are so poorly written that you can't actually fine
:27:15. > :27:22.the private contractor for failure to deliver. They're good at winning
:27:23. > :27:26.the contracts. They're less good at delivering the public services. And,
:27:27. > :27:31.at the end, it's both the patient and the taxpayer who lose out. Serco
:27:32. > :27:37.voluntarily paid back ?85,000 in performance-related bonuses. In a
:27:38. > :27:44.written response, they told Panorama that the data manipulation was
:27:45. > :27:47.wholly unacceptable. In relation to the claim of only one car doctor
:27:48. > :27:52.covering the whole of Cornwall, they say this only ever happened once.
:27:53. > :27:55.They went on to tell us that the last inspection by the Care Quality
:27:56. > :27:59.Commission found it fully compliant, that the NHS found it is currently
:28:00. > :28:07.providing a good service and feedback from patients is also very
:28:08. > :28:11.positive. From private company employees manipulating documents to
:28:12. > :28:14.dentists drilling for gold. We've uncovered worrying flaws in the
:28:15. > :28:23.ability of the NHS to ensure all its money is properly accounted for. We
:28:24. > :28:27.need to not be embarrassed, or in denial. We need to get on with
:28:28. > :28:32.tackling the problem, minimising its cost, maximising resources available
:28:33. > :28:35.for proper patient care. With potentially billions in savings on
:28:36. > :28:39.offer, the cost of ensuring rigorous monitoring of NHS finances seems a
:28:40. > :28:44.small price to pay to safeguard our money.