The Great NHS Robbery Panorama

The NHS is under financial scrutiny like never before. Yet it seems

billions of pounds are being lost to fraud and error every year. I think

every citizen in this country wants to know the truth. Tonight, Panorama

reveals the fraudsters who are stealing money and getting away with

it. We had a notebook which appeared to be an order book for these stolen

products. This is criminality at a professional level. It is

astonishing. Mr Craig, I'm from BBC. Would you stop and talk to us for a

moment? I've got some questions to ask. With exclusive evidence,

Panorama examines the sheer scale no comment. Are our politicians

telling us the truth? They are engaging in a very slick PR

operation to minimise the potential picture of fraud in the NHS. And we

also ask, with more private companies bidding for contracts, is

the current NHS monitoring system robust enough to guard against

mistakes? At the end, it's both the patient and the taxpayer who lose

out. The National Health Service is under

financial strain. NHS! Not for sale! Its resources are under pressure.

The Royal College of Nursing says the NHS in England is in a desperate

situation. And it's unlikely to ease. NHS England is warning it

could face a ?30 billion funding gap by the end of the decade. We've

grown used to being told about the NHS facing one crisis or another,

but who's telling us about the vast sums being stolen from it every day?

According to the government's own figures, hundreds of millions of

pounds of NHS money is lost every year through fraud. Good morning

folks. Thanks for sharing your time this morning. As you know this

morning's meeting is about Operation Brass. We've been given access to

NHS Scotland's Counter Fraud Services, or CFS.

Often a CFS case starts with a tip-off, like from the medical

supplier who'd spotted their products for sale on eBay. Products

they'd already sold to a Glasgow children's hospital. They could see

that those items had been sold previously to the Health Board by

numbers that appeared on the actual items themselves. Fraser Paterson

and his team traced the eBay account to this man, Douglas Stevenson, an

NHS anaesthetic assistant and a trusted employee. The counter fraud

team raided his home. We found a computer system which had

some of the products that had been stolen sitting beside the computer,

in effect ready to be sold. And we had a notebook which appeared to be

an order book and envelopes with details of the next customer.

Investigators found scalpels, drill bits, implants and sutures. CFS

interviewed Douglas Stevenson under caution.

Stevenson was simply going to the hospital stores, filling his bag and

walking out. His eBay sideline, trading in stolen goods, was

straightforward theft from his employers, the NHS, and the public

purse, and it ran into thousands. I've found here one of Douglas

Stevenson's eBay accounts, Stevenson136. I can see 188 people

have left him feedback and they're saying brilliant eBayer, excellent

service. Just the sheer volume of stuff here, it reads like a hospital

inventory. At court, Douglas Stevenson pleaded guilty to

defrauding the NHS out of ?23,000. He received a sentence of 20 months

in prison and was struck off. He's a health care professional who has

abused his position of trust and there are items that were intended

for patient care that didn't go there. So that money has gone. CFS

believe the total fraud added up to far more than the ?23,000 Stevenson

admitted to in court. Over 850 items had been stolen and sold on eBay and

this amounted to some ?75,000, give or take. And that's quite a

Conservative estimate. We asked to speak to Douglas Stevenson. Through

his lawyer he told us he disputes the figure, but did not want to

comment. Stevenson's fraud might seem small-scale but it's believed

there are thousands like him stealing from the NHS and the public

purse. Individual cases can run to nearly ?1 million.

Auchinleck in East Ayrshire where Stuart Craig ran his dental

practice. The village has just 12,000 residents, yet he was one of

the highest earners in the country. A random check of his patients'

treatment records revealed why. There's certainly no evidence of

these teeth needing to be filled in between them, so these are big

fillings that he was doing. And of course the bigger the filling, the

bigger the fee. It's John Cameron's job to catch dentists who aren't up

to scratch or are fiddling the books. Stuart Craig's bills to the

NHS for gold crowns caught his eye. I picked at random 40 cases. We got

the laboratory bills in, we checked that he had actually claimed for

precious metal, and the laboratory bills showed in 100% of them that he

had provided non-precious metal. So Stuart Craig was netting a small

fortune charging the NHS for gold crowns while giving his patients

cheaper ones. His standard of work was also causing concern. This

person's teeth have had...? Were being damaged by the dentist

carrying out work that wasn't necessary. And then you have an

onward spiral doing more and more treatment to the deterioration of

the patient. Poor fillings led to root treatments the patient may

never have needed. Bad root treatments led to crowns. Failed

crowns would have to be repeated. All money in the bank for Stuart

Craig. I'm ashamed as a dentist that any dentist could behave in this

manner. Last summer, Stuart Craig was convicted and fined for

defrauding the NHS of just under ?2,000, nowhere near his total

theft. Is that the true scale of his fraud? Well, no. I went through and

looked at the scale of mis-claims, and I estimate that the amount that

he is due to repay, which is possibly an underestimate, is

?782,896. In January 2012, the NHS sent Stuart Craig a bill for the

three-quarters of a million pounds they say he owes but they've yet to

receive a penny. And the man himself seems to have disappeared. But we

found him living in the North of Glasgow and wanted to ask him a few

questions. We approached him as he pulled up in his driveway. Mr Craig,

I'm from BBC. Mr Craig, I'm from BBC Panorama.

Would you stop and talk to us? I've got some questions to ask. Well, it

seems Mr Craig cares as much about answering our questions as he does

about his former patients. Hopefully the NHS will have more luck. We

understand they'll be serving him with a writ.

Some fraud can undermine our faith in even the most trusted of health

professionals. In the town of Greenock in Inverclyde, the local GP

Susan McKinnon betrayed her patients using their medical records to hide

her secret drug addiction. We received a call from the Health

Board and they had had concerns reported to them by a pharmacist in

the Greenock area. Dr McKinnon was at the pharmacy collecting a

prescription she claimed was for a patient. Staff there felt something

wasn't right. I just thought it was strange that a GP had come into a

pharmacy to collect a prescription. How unusual is that? Very. The

prescription was for diazepam and the opiate dihydrocodeine, both

controlled drugs ? one a known substitute for heroin. When she'd

left the building, Louise turned round and asked me, "Why is a GP

picking a prescription up?" A few weeks later, in another of Eddie

McAnerney's pharmacies, Dr McKinnon did the same thing. I'd actually

bagged it up and tagged it, and I thought, "Wait a minute. That's

diazepam and dihydrocodeine." Who's signed it? Dr McKinnon, for a

patient's name that was obviously different to hers. I said, "So if

that's you, what's your date of birth?" And she panicked. CFS were

called in but in her interview, Dr McKinnon gave nothing away.

Last June, Susan McKinnon was convicted of fraud. The official

value? Just a few hundred pounds. But with hundreds of fraudulent

prescriptions dating back four years, CFS say the true cost to the

NHS was several thousand. Dr McKinnon declined to be interviewed.

She's recently been reinstated as a GP after being suspended but only

under strict supervision. Across Britain, NHS fraud

investigators pursue around 3,000 cases a year. Officially, the

Government's annual fraud indicator puts fraud against the NHS at ?229

million a year. But is that the true scale of what's being stolen?

For more than eight years, Jim Gee was the director of NHS Counter

Fraud Services for the Department of Health. He's one of the world's

foremost authorities on health care fraud and has studied 15 years of

international fraud and error figures. This report is based only

upon loss measurement exercises looking at the total cost of fraud.

It's the most rigorous data that's available about health care fraud in

the world. Tomorrow, with the University of Portsmouth, he'll

publish a report on the scale of health care fraud and error

globally. His findings for the NHS are staggering. How much money is

lost to fraud in the NHS each year? Just under 7% on average lost, and

in some cases ranging up to over 15% lost. In the UK the NHS Budget is

around 100 billion, so that would equate to around seven billion lost.

He puts more than five billion of that seven billion down to fraud

rather than financial error. That's more than 20 times the amount

recorded in the government's annual fraud indicator. Why would they say

that there's only ?229 million of fraud? Well the figures quoted in

the Government's annual fraud indicator are partial, just relating

to pharmaceutical and dental services. They ignore the losses

that might be taking place in payroll expenditure, one of the

largest costs to the NHS, may be taking place in procurement

expenditure, clearly areas where there's great potential for fraud.

If Jim Gee's figures are correct, all of us as patients of the NHS are

losing out to the tune of ?14 million every day. The amount stolen

every year could pay for more than 68,000 new consultants or 244,000

new nurses. It's the equivalent of the NHS's entire bill for cancer

services. If the NHS was only losing ?229 million a year, it would be

doing 30 times better than any other health care organisation in the

world. Something I think is completely implausible. No minister

would be interviewed but in a statement the Department of Health

told us it did not recognise Jim Gee's figure or speculate on levels

of losses, adding the department has not downplayed the cost of fraud.

# Oh, the good life... # If the risk of being caught is low

compared to the rewards on offer, is the current policing system fit for

purpose? Not if the activities of a former resident of this street,

Birmingham's exclusive Millionaire's Row in Little Aston, are anything to

go by. Living here was Joyce Trail. She ran a surprisingly modest dental

practice seven miles up the road in Handsworth.

# For you can't take the chance... # Joyce Trail enjoyed the high life -

frequent Caribbean holidays and stays in ?1,000-a-night hotels. But

the sums didn't add up. She was in fact one of the most prolific

fraudsters in NHS history. Joyce Trail would visit care homes,

offering to check the residents' teeth. She'd treat some patients on

site but, as a trusted dentist, she now had access to residents'

details. She used them to claim payment from the NHS for work she

hadn't done, including dentures for patients who still had their own

teeth. And, on 154 occasions, for work carried out on patients who had

in fact died. I think what she has done is,

frankly, disgraceful. Fellow dentist Vijay Sudra believes Trail became a

full-time fraudster. She faked over 38,000 documents. This is

criminality at a professional level. It is astonishing. Over a period of

three years, some 75% of Joyce Trail's claims to the NHS were found

to be bogus. She did not go to work and say, "I'm going to treat

patients today." Three quarters of her dentistry was paper dentistry.

Trail faked invoice statements from lab technicians claiming payment

from the NHS. Reputable labs were dragged into the investigation and

had to open their records to investigators. They came here to ask

me if they were genuine statements or not. There was 12 months worth of

statements and every one was false. Trail was stealing massive amounts

of money to fund a lavish lifestyle. Yet it seems she didn't want to

spend it paying her bills. We were owed just over ?3,000, which was

never paid. It'd be three months wages for somebody that we couldn't

pay. In court, it was revealed that Joyce

Trail had defrauded the NHS out of ?1.4 million, the largest ever fraud

by an individual against the NHS. She was jailed in 2012 for seven

years. This wasn't the first time that Joyce Trail was found to have

stolen from the NHS. She had form. Back in 2004, the NHS found she'd

been making false claims too. She agreed to pay back ?320,000 and

there was no further action. Remarkably, she was able to go on

stealing. And there are worries that a fraud on the scale of Joyce

Trail's could happen again. The problem here is monitoring. Going

back to before 2006, there were regional dental officers who would

randomly assess patients. As of two or three years ago they've disbanded

that dental reference service, and that's a mistake.

Not only have the specialist dental fraud teams been disbanded, but NHS

Protect, the national body that investigates fraud for the

Department of Health, has had its budget cut by around 30% since 2006.

And yet over the same period, since the start of the recession, health

care fraud has gone up, where it's been measured, by 25% What does that

say to you? It says to me bad judgement. Through freedom of

information requests we asked NHS Protect how many counter-fraud

specialists it employs. The answer was 27, with a further 294

investigators who work at a local level. So, that's just over 300

investigators to police a potential ?5 billion of NHS fraud. Yet when it

comes to benefits, the Department for Work and Pensions employs six

times the number of investigators for less than half the amount of

fraud. There are many good people in NHS Protect who want to do more to

tackle fraud in the NHS but they don't have the resources to do the

job that they are capable of doing. Cutting the budget of NHS Protect

sends a message to fraudsters that there will be greater opportunities

for them to gather their ill-gotten gains.

The Department of Health said NHS Protect has a significant budget and

protects and safeguards front line NHS services.

In Dorset, Barry Hards is a local NHS fraud specialist. Until April

last year, he had responsibility for investigating contractors to the NHS

in his area, like opticians. That's now passed to a new body called NHS

England. The question is, have they got the resource to deal with new

cases, new referrals? And my suspicion, as of my colleagues, is

the answer to that is no. Minutes of a meeting of NHS England's Audit

Committee appears to reinforce Barry Hards' concerns. Under the title

Budgets for Counter Fraud Work it says:

How can you have confidence that there's a likelihood you'll be

discovered, found out, when there's very few people looking at you? And

I think it's a genuinely held concern that some people in senior

positions have just taken their eye off the ball on this. So it's a good

time to be getting away with it? In my view, yes. NHS England told us it

was committed to detecting and preventing fraud. Health care in the

21st century is changing. Professor Mark Button has watched as private

companies have entered the NHS in increasing numbers. The Government

argues it encourages competition and efficiency. But does it also bring

new risks? These companies come in and they bid for work on a very

tight budget. And if the service is not being delivered as it should,

there may be a risk those types of individuals then manipulate or

falsify data. So does a new, competitive, NHS need

to do more to ensure that the data it uses to judge performance is

subject to proper scrutiny? In 2006, here in Cornwall, one of

the biggest private companies working in the NHS won a ?32 million

contract. Serco was to provide the out of hours GP service. It meant

anyone falling ill after hours would be treated by a doctor working for

the company. In May 2012, Maggie Sloggett needed an out of hours

doctor when her partner Darren became unwell. He deteriorated quite

quickly, and in that time I felt I needed to phone for help. They then

said, we'll get someone to ring you back. She says she never received a

call and Darren was getting worse. He was unable to talk and I couldn't

communicate with him to find out how he was feeling. I was shaking, I was

quite frightened to be honest. She called an ambulance and

paramedics gave Darren morphine and took him to hospital, where he

recovered. Serco say their team did call back twice, but the calls went

to voice mail. They say they took no further action once it was confirmed

an ambulance was on its way. While Maggie and Darren's case may have

simply been crossed wires, others were complaining about the time it

took to see a doctor. It was then revealed that Serco's records were

wrong. They said a few patients did see a GP on time when they hadn't.

Whistle-blowers started to raise concerns. We've spoken to a number

of informants, including a nurse who worked for Serco.

I came in one morning and there had been one car doctor for the whole of

Cornwall during the night. She went on to raise concerns about how data

was manipulated. If Serco didn't meet their targets to see patients

in the time I'd allocated for them, it was flagged up as a fail. There

were times that I knew that targets weren't being met, and yet it was

being recorded there had been no failures.

Serco's audit uncovered 252 occasions over six months where

patient response times were altered by two employees. That's just 0.2%

of all calls and some were only changed by a few seconds. But that

sometimes meant the company scored a pass rather than a fail. And some

months the NHS Trust thought all emergency patients were being seen

within an hour, which wasn't true. Serco and the local Primary Care

Trust were summoned before the Public Accounts Committee at

Westminster and cross-examined by the chair, Margaret Hodge. While at

no time were they being accused of fraud, she wanted to get to the

bottom of why two Serco supervisors, who've now left, had manipulated the

data. What was the financial or other incentive for them to cheat?

There was no financial gain to them or the company for the changes that

they made. It's something we've reflected on as to what their

motives were and I can only assume that they wished to portray better

view of performance of the service. Because it seems to me very odd to

want to manipulate data, if there isn't an incentive there for you to

do it. She then questioned the NHS Trust on why, despite the 252

errors, it hadn't penalised Serco. Why was that not enough for you to

think we should stop paying them? It was considered, because clearly we

expect our providers to give us honest information. Say yes or no.

252 lies was not enough, for you, in your judgement. One lie is too many.

They never got a penny less. They'd lied 252 times and they never got a

penny less. No they didn't. It is deeply frustrating to my

committee that, time and time again, where there's been a failure, the

terms of the contract are so poorly written that you can't actually fine

the private contractor for failure to deliver. They're good at winning

the contracts. They're less good at delivering the public services. And,

at the end, it's both the patient and the taxpayer who lose out. Serco

voluntarily paid back ?85,000 in performance-related bonuses. In a

written response, they told Panorama that the data manipulation was

wholly unacceptable. In relation to the claim of only one car doctor

covering the whole of Cornwall, they say this only ever happened once.

They went on to tell us that the last inspection by the Care Quality

Commission found it fully compliant, that the NHS found it is currently

providing a good service and feedback from patients is also very

positive. From private company employees manipulating documents to

dentists drilling for gold. We've uncovered worrying flaws in the

ability of the NHS to ensure all its money is properly accounted for. We

need to not be embarrassed, or in denial. We need to get on with

tackling the problem, minimising its cost, maximising resources available

for proper patient care. With potentially billions in savings on

offer, the cost of ensuring rigorous monitoring of NHS finances seems a

small price to pay to safeguard our money.