• 3 months ago
Panorama S2014E11 The Great NHS Robbery
Transcript
00:00The NHS is under financial scrutiny like never before, yet it seems billions of pounds are
00:09being lost to fraud and error every year.
00:12I think every citizen in this country wants to know the truth.
00:16Tonight, Panorama reveals the fraudsters who are stealing money and getting away with it.
00:22We had a notebook which appeared to be an order book for these stolen products.
00:27This is criminality at a professional level. It is astonishing.
00:31Mr Craig, I'm from BBC. Would you stop and talk to us for a moment? I've got some questions to ask.
00:36With exclusive evidence, Panorama examines the sheer scale of fraud.
00:41Can I ask, is that your signature?
00:43No comment.
00:46Are our politicians telling us the truth?
00:49They are engaging in a very slick PR operation to minimise the potential picture of fraud in the NHS.
00:58And we also ask, with more private companies bidding for contracts,
01:02is the current NHS monitoring system robust enough to guard against mistakes?
01:09At the end, it's both the patient and the taxpayer who result.
01:20The National Health Service is under financial strain.
01:24NHS! Stop falsehoods!
01:27It's resources under pressure.
01:30The Royal College of Nursing says the NHS in England is in a desperate situation.
01:35And it's unlikely that the NHS will be able to keep up.
01:38The NHS is under financial strain.
01:41NHS! Stop falsehoods!
01:44It's resources under pressure.
01:48And it's unlikely to ease.
01:50NHS England is warning it could face a £30 billion funding gap by the end of the decade.
01:59We've grown used to being told about the NHS facing one crisis or another.
02:04But who's telling us about the vast sums being stolen from it every day?
02:09According to the government's own figures,
02:12hundreds of millions of pounds are being lost to the NHS each year through fraud.
02:18Good morning, folks. Thanks for sharing your time this morning.
02:21As you know, this morning's meeting is about Operation Brass.
02:25We've been given access to NHS Scotland's Counter Fraud Services, or CFS.
02:36Often a CFS case starts with a tip-off.
02:39Like from the medical supplier who'd spotted their products for sale on eBay.
02:44Products they'd already sold to a Glasgow children's hospital.
02:48You could see that those items had been sold previously to the health board
02:52by numbers that appeared on the actual items themselves.
02:58Fraser Patterson and his team traced the eBay account to this man, Douglas Stevenson,
03:04an NHS anaesthetic assistant and a trusted employee.
03:08The Counter Fraud team raided his home.
03:16We found a computer system which had some of the products that had been stolen
03:20sitting beside the computer, in effect ready to be sold.
03:24And we had a notebook, which appeared to be an order book,
03:28and envelopes with details of the next customer.
03:33Investigators found scalpels, drill bits, implants and sutures.
03:38CFS interviewed Douglas Stevenson under caution.
03:42Tell me about that, how that came to be in your house.
03:45I acquired it from a hospital where I work.
03:48So you stole it? Yeah.
03:50Can you describe to me how you actually stole them?
03:55Basically, I put them in my rucksack at the end of my shift.
04:03Stevenson was simply going to the hospital stores,
04:06filling his bag and walking out.
04:11His eBay sideline, trading in stolen goods,
04:14was straightforward theft from his employers, the NHS,
04:18and the public purse, and it ran into thousands.
04:23I've found here one of Douglas Stevenson's eBay accounts,
04:27Stevenson136.
04:30I can see 188 people have left him feedback,
04:34and they're saying,
04:36brilliant eBayer, excellent service.
04:40Just the sheer volume of stuff here, it reads like a hospital inventory.
04:47At court, Douglas Stevenson pleaded guilty
04:50to defrauding the NHS out of £23,000.
04:54He received a sentence of 20 months in prison and was struck off.
04:58He's a healthcare professional who has abused his position of trust,
05:02and there are items that were intended for patient care
05:05that didn't go there, so that money has gone.
05:08CFS believe the total fraud added up to far more
05:13than the £23,000 Stevenson admitted to in court.
05:17Over 850 items had been stolen and sold on eBay,
05:22and that this amounted to some £75,000 or so, give or take,
05:26and that's quite a Conservative estimate.
05:29We asked to speak to Douglas Stevenson.
05:31Through his lawyer, he told us he disputes the figure,
05:34but he did not want to comment.
05:37Stevenson's fraud might seem small-scale,
05:40but it's believed there are thousands like him
05:43stealing from the NHS and the public purse.
05:46Individual cases can run to nearly a million pounds.
05:51Auchinleck in East Ayrshire,
05:53where Stuart Craig ran his dental practice.
05:56The village has just 12,000 residents,
05:59yet he was one of the highest earners in the country.
06:02A random check of his patients' treatment records revealed why.
06:07There's certainly no evidence of these teeth
06:10needing to be filled in between them,
06:13so these are big fillings that he was doing.
06:18And, of course, the bigger the filling, the bigger the fee.
06:21It's John Cameron's job to catch dentists
06:24who aren't up to scratch or are fiddling the books.
06:27Stuart Craig's bills to the NHS for gold crowns caught his eye.
06:34I picked at random 40 cases.
06:36We got the laboratory bills in,
06:38we checked that he had actually claimed for precious metal,
06:41and the laboratory bills showed, in 100% of them,
06:44that he had provided non-precious metal.
06:50So Stuart Craig was netting a small fortune,
06:53charging the NHS for gold crowns
06:55while giving his patients cheaper ones.
06:58His standard of work was also causing concern.
07:02This person's teeth have had...
07:04Were being damaged.
07:05Were being damaged.
07:06By the dentists carrying out work that wasn't necessary,
07:09and then you have a number of cases
07:13and then you have an onward spiral,
07:15doing more and more treatment to the deterioration of the patient.
07:20Poorer fillings led to root treatments
07:22the patient may never have needed.
07:24Bad root treatments led to crowns.
07:27Failed crowns would have to be repeated.
07:30All money in the bank for Stuart Craig.
07:34I'm ashamed, as a dentist,
07:37that any dentist could behave in this manner.
07:41Last summer, Stuart Craig was convicted and fined
07:44for defrauding the NHS of just under £2,000.
07:48Nowhere near his total theft.
07:51Is that the true scale of his fraud?
07:54Well, no. I went through and looked at the scale of misclaims
08:00and I estimate that the amount that he is due to repay,
08:04which is possibly an underestimate,
08:07is £782,896.
08:12In January 2012, the NHS sent Stuart Craig a bill
08:17for the three quarters of a million pounds they say he owes.
08:21But they've yet to receive a penny.
08:24And the man himself seems to have disappeared.
08:27But we found him living in the north of Glasgow
08:30and wanted to ask him a few questions.
08:33We approached him as he pulled up in his driveway.
08:36Mr Craig, I'm from BBC.
08:46Mr Craig, I'm from BBC Pantomama.
08:48Would you stop and talk to us for a moment?
08:50I've got some questions to ask.
08:53Well, it seems Mr Craig cares as much for our questions
08:57as he does about his former patients.
09:00Hopefully, the NHS will have more luck.
09:03We understand they'll be serving him with a writ.
09:08Some fraud can undermine our faith
09:11in even the most trusted of health professionals.
09:14In the town of Greenock in Inverclyde,
09:16the local GP, Susan McKinnon, betrayed her patients
09:20using their medical records to hide her secret drug addiction.
09:25We received a call from the health board
09:27and they had had concerns reported to them
09:29by a pharmacist in the Greenock area.
09:32Dr McKinnon was at the pharmacy collecting a prescription
09:35she claimed was for a patient.
09:38Staff there felt something wasn't right.
09:42I just thought it was strange that a GP had come into a pharmacy
09:45to collect a prescription.
09:47How unusual is that?
09:49Very.
09:51The prescription was for diazepam and the opiate dihydrocodine,
09:56both controlled drugs, one a known substitute for heroin.
10:02When she'd left the building,
10:04Louise turned round and asked me,
10:07why is a GP picking a prescription up?
10:10A few weeks later, in another of Eddie McInerney's pharmacies,
10:14Dr McKinnon did the same thing.
10:17They actually bagged it up and tagged it,
10:21and I thought, wait a minute, that's diazepam and dihydrocodine.
10:24And Dr McKinnon, for a patient's name that was obviously different to hers,
10:31I said, so if that's you, what's your date of birth?
10:35And she panicked.
10:40CFS were called in,
10:42but in her interview, Dr McKinnon gave nothing away.
10:48This prescription, it prescribes dihydrocodine and diazepam
10:53and the doctor appears to have signed it on 18-10-2011.
10:58Do you recognise any of the handwriting on this form?
11:01No comment.
11:02Can I ask, is that your signature?
11:04No comment.
11:07Last June, Susan McKinnon was convicted of fraud.
11:11The official value, just a few hundred pounds.
11:14But with hundreds of fraudulent prescriptions dating back four years,
11:18CFS say the true cost to the NHS was several thousand.
11:24Dr McKinnon declined to be interviewed.
11:27She's recently been reinstated as a GP after being suspended,
11:31but only under strict supervision.
11:39Across Britain, NHS fraud investigators pursue around 3,000 cases a year.
11:46Officially, the government's annual fraud indicator
11:50puts fraud against the NHS at £229 million a year.
11:55But is that the true scale of what's being stolen?
12:08For more than eight years,
12:10Jim Gee was the director of NHS counterfraud services
12:14for the Department of Health.
12:16He's one of the world's foremost authorities on healthcare fraud
12:20and has studied 15 years of international fraud and error figures.
12:26This report is based only upon loss measurement exercises
12:30looking at the total cost of fraud.
12:32It's the most rigorous data that's available about healthcare fraud in the world.
12:37Tomorrow, with the University of Portsmouth,
12:40he'll publish a report on the scale of healthcare fraud and error globally.
12:45His findings for the NHS are staggering.
12:49How much money is lost to fraud in the NHS each year?
12:53Just under 7% on average lost,
12:56and in some cases, ranging up to over 15% lost.
13:00In the UK, the NHS budget is around £100 billion,
13:03so that would equate to around £7 billion lost.
13:07He puts more than £5 billion of that £7 billion down to fraud
13:11rather than financial error.
13:13That's more than 20 times the amount recorded
13:16in the government's annual fraud indicator.
13:20Why would they say that there's only £229 million of fraud?
13:24Well, the figures quoted in the government's annual fraud indicator are partial,
13:28just relating to pharmaceutical and dental services.
13:32They ignore the losses that might be taking place in payroll expenditure,
13:36one of the largest costs to the NHS,
13:38maybe taking place in procurement expenditure,
13:41clearly areas where there's great potential for fraud.
13:45If Jim G's figures are correct,
13:47all of us as patients of the NHS are losing out
13:51to the tune of £14 million every day.
13:55The amount stolen every year
13:58could pay for more than 68,000 new consultants
14:02or 244,000 new nurses.
14:05It's the equivalent of the NHS's entire bill for cancer services.
14:11If the NHS was only losing £229 million a year,
14:15it would be doing 30 times better
14:18than any other healthcare organisation in the world,
14:21something I think is completely implausible.
14:28No minister would be interviewed,
14:30but in a statement, the Department of Health told us
14:33it did not recognise Jim G's figure or speculate on levels of losses,
14:38adding the department has not downplayed the cost of fraud.
14:53If the risk of being caught is low compared to the rewards on offer,
14:57is the current policing system fit for purpose?
15:04Not if the activities of a former resident of this street,
15:07Birmingham's exclusive millionaires' row in Little Aston,
15:11are anything to go by.
15:16Living here was Joyce Trail.
15:18She ran a surprisingly modest dental practice
15:21seven miles up the road in Handsworth.
15:25Joyce Trail enjoyed the high life,
15:28frequent Caribbean holidays
15:30and stays in £1,000-a-night hotels,
15:34but the sums didn't add up.
15:37She was, in fact, one of the most prolific fraudsters in NHS history.
15:43Joyce Trail would visit care homes,
15:46offering to check the residents' teeth.
15:48She'd treat some patients on site,
15:51but as a trusted dentist, she now had access to residents' details.
15:56She used them to claim payment from the NHS for work she hadn't done,
16:02including dentures for patients who still had their own teeth,
16:06and on 154 occasions,
16:09for work carried out on patients who had, in fact, died.
16:15I think what she has done is frankly,
16:19disgraceful.
16:21Fellow dentist Vijay Sudra believes Trail became a full-time fraudster.
16:28She faked over 38,000 documents.
16:31This is criminality at a professional level.
16:35It is astonishing.
16:37Over a period of three years,
16:40some 75% of Joyce Trail's claims to the NHS were found to be bogus.
16:46She did not go to work and say,
16:48I'm going to treat patients today.
16:50Three-quarters of her dentistry was paper dentistry.
16:57Trail faked invoice statements from lab technicians
17:00claiming payment from the NHS.
17:03Reputable labs were dragged into the investigation
17:06and had to open their records to investigators.
17:10They came in to ask me if they were genuine statements or not,
17:14and there was 12 months' worth of statements that everyone was false.
17:19Trail was stealing massive amounts of money to fund a lavish lifestyle,
17:24yet it seems she didn't want to spend it paying her bills.
17:28We were owed just over £3,000, which was never paid.
17:33We had three months' wages for six months.
17:37In court, it was revealed that Joyce Trail had defrauded the NHS
17:41out of £1.4 million,
17:44the largest ever fraud by an individual against the NHS.
17:49She was jailed in 2012 for seven years.
17:53This wasn't the first time that Joyce Trail was found
17:56to have stolen from the NHS.
17:58She was charged with embezzlement.
18:01This wasn't the first time that Joyce Trail was found
18:04to have stolen from the NHS.
18:06She had form.
18:10Back in 2004, the NHS found she'd been making false claims too.
18:16She agreed to pay back £320,000 and there was no further action.
18:22Remarkably, she was able to go on stealing,
18:25and there are worries that a fraud on the scale of Joyce Trail's
18:28could happen again.
18:31The problem here is monitoring.
18:33Going back to before 2006, there were regional dental officers
18:38who would randomly assess patients.
18:41As of two or three years ago,
18:44they've disbanded that dental reference service,
18:47and that's a mistake.
18:53Not only have the specialist dental fraud teams been disbanded,
18:57but NHS Protect, the national body that investigates fraud
19:01for the Department of Health,
19:03has had its budget cut by around 30% since 2006.
19:08And yet, over the same period, since the start of the recession,
19:12healthcare fraud has gone up, where it's been measured, by 25%.
19:16What does that say to you?
19:18It says to me, bad judgment.
19:22Through Freedom of Information requests,
19:24we asked NHS Protect how many counter-fraud specialists it employs.
19:29The answer was 27,
19:32with a further 294 investigators who work at a local level.
19:38So that's just over 300 investigators
19:41to police a potential £5 billion of NHS fraud.
19:46Yet when it comes to benefits,
19:48the Department for Work and Pensions
19:50employs six times the number of investigators
19:53for less than half the amount of fraud.
19:56There are many good people in NHS Protect
19:59who want to do more to tackle fraud in the NHS,
20:02but they don't have the resources
20:04to do the job that they are capable of doing.
20:07Cutting the budget of NHS Protect sends a message to fraudsters
20:10that there will be greater opportunities
20:12for them to gather their ill-gotten gains.
20:16The Department of Health said NHS Protect has a significant budget
20:22and protects and safeguards front-line NHS services.
20:31In Dorset, Barry Hards is a local NHS fraud specialist.
20:36Until April last year,
20:38he had responsibility for investigating contractors to the NHS in his area,
20:43like opticians.
20:45That's now passed to a new body called NHS England.
20:49The question is, have they got the resource to deal with new cases,
20:52new referrals?
20:54And my suspicion, as have my colleagues, is the answer to that is no.
20:59Minutes of a meeting of NHS England's audit committee
21:03appears to reinforce Barry Hards' concerns.
21:07Under the title Budgets for Counter-Fraud Work,
21:11it says management reported that no budgets were originally established
21:15for 2013-14.
21:18How can you have a confidence that there's a likelihood
21:21you'll be discovered, found out,
21:25when there's very few people looking at you?
21:29And I think it's a genuine health concern
21:32that some people in senior positions
21:34are just taking their eye off the ball on this.
21:37So it's a good time to be getting away with it?
21:39In my view, yes.
21:45NHS England told us it was committed to detecting and preventing fraud.
21:56Healthcare in the 21st century is changing.
22:00Professor Mark Button has watched as private companies
22:04have entered the NHS in increasing numbers.
22:08The government argues it encourages competition and efficiency,
22:12but does it also bring new risks?
22:15These companies come in and they bid for work
22:18on a very tight budget,
22:22and if the service has not been delivered as it should,
22:26there may be a risk those types of individuals
22:30then manipulate or falsify data.
22:35So does a new, competitive NHS need to do more
22:39to ensure that the data it uses to judge performance
22:43is subject to proper scrutiny?
22:51In 2006, here in Cornwall,
22:54one of the biggest private companies working in the NHS
22:57won a £32 million contract.
23:00Serco was to provide the out-of-hours GP service.
23:04It meant anyone falling ill after hours
23:07would be treated by a doctor working for the company.
23:10In May 2012, Maggie Sloggett needed an out-of-hours doctor
23:15when her partner Darren became unwell.
23:18He deteriorated quite quickly,
23:21and in that time I felt I needed to phone for help.
23:25They then said, we'll get someone to bring you back.
23:28She says she never received a call, and Darren was getting worse.
23:34He was unable to talk, and I couldn't communicate with him
23:37to find out how he was feeling.
23:40I was shaking. I was quite frightened, to be honest.
23:46She called an ambulance, and paramedics gave Darren morphine
23:50and took him to hospital, where he recovered.
23:54Serco say their team did call back twice,
23:58but the calls went to voicemail.
24:00They say they took no further action
24:02once it was confirmed an ambulance was on its way.
24:06While Maggie and Darren's case may have simply been crossed wires,
24:10others were complaining about the time it took to see a doctor.
24:14It was then revealed that Serco's records were wrong.
24:18They said a few patients did see a GP on time when they hadn't.
24:24Whistleblowers started to raise concerns.
24:27We've spoken to a number of informants,
24:29including a nurse who worked for Serco.
24:33I came in one morning and there had been one car doctor
24:36for the whole of Cornwall during the night.
24:39She went on to raise concerns about how data was manipulated.
24:44If Serco didn't meet their targets to see patients
24:47in the time I'd allocated for them, it was flagged up as a fail.
24:51There were times that I knew that targets weren't being met,
24:54and yet it was being recorded there had been no failures.
25:02Serco's audit uncovered 252 occasions over six months
25:07where patient response times were altered by two employees.
25:11That's just 0.2% of all calls,
25:14and some were only changed by a few seconds.
25:17But that sometimes meant that the company scored a pass rather than a fail.
25:23And some months, the NHS Trust thought
25:26all emergency patients were being seen within an hour,
25:29which wasn't true.
25:38Serco and the local primary care trust were summoned
25:41before the Public Accounts Committee at Westminster
25:44and cross-examined by the chair, Margaret Hodge.
25:47While at no time were they being accused of fraud,
25:50she wanted to get to the bottom of why two Serco supervisors,
25:53who've now left, had manipulated the data.
25:56What was the financial or other incentive for them to cheat?
26:01So there was no financial gain to them or the company
26:05for the changes that they made.
26:07It's something we've reflected on as to what their motives were,
26:11but I can only assume that they wished to portray
26:14a better view of the performance of the service.
26:18Because it seems to me very odd to want to manipulate data
26:23if there isn't an incentive there for you to do it.
26:27She then questioned the NHS Trust
26:30on why, despite the 252 errors, it hadn't penalised Serco.
26:36Why was that not enough for you to think,
26:39we should stop paying them?
26:41It was considered, because clearly we expect our providers
26:45to give us honest information.
26:47Say yes or no. 252 lies was not enough for you, in your judgement.
26:51One lie is too many.
26:53They never got a penny less.
26:55They lied 252 times. They never got a penny less.
26:58No, they didn't.
27:01It is deeply frustrating to my committee
27:04that time and time again, where there's been a failure,
27:08the terms of the contract are so poorly written
27:12that you can't actually find the private contractor
27:15for a failure to deliver.
27:17They're good at winning the contracts,
27:19they're less good at delivering the public services,
27:22and at the end, it's both the patient and the taxpayer who lose out.
27:27Serco voluntarily paid back £85,000 in performance-related bonuses.
27:33In a written response, they told Panorama
27:36that the data manipulation was wholly unacceptable.
27:40In relation to the claim of only one car doctor
27:43covering the whole of Cornwall,
27:45they say this only ever happened once.
27:48They went on to tell us that the last inspection
27:51by the Care Quality Commission found it fully compliant.
27:56That the NHS found it's currently providing a good service
28:00and feedback from patients is also very positive.
28:04From private company employees manipulating documents
28:08to dentists drilling for gold,
28:10we found worrying flaws in the ability of the NHS
28:14to ensure all its money is properly accounted for.
28:19We need to not be embarrassed or in denial.
28:23We need to get on with tackling the problem,
28:25minimising its cost,
28:27maximising resources available for proper patient care.
28:31With potentially billions in savings on offer,
28:34the cost of ensuring rigorous monitoring of NHS finances
28:38seems a small price to pay to safeguard our money.
28:46Panorama on the Mayor and our money next Monday.
28:49Drama next with Silk, then Hugh Edwards is here at 10.
28:53Coming up later, the bleak message for relatives of those on board
28:56the missing Malaysian airliner.
28:58The latest on the trial of Oscar Pistorius
29:00and the 70th anniversary of the Great Escape.
29:03Join us at 10.