Motion made, and Question proposed, That this House do now adjourn.—(Stephen Crabb.)
May I, through you, Madam Deputy Speaker, thank Mr Speaker for allowing me this evening’s debate. It is pleasure to see you in the Chair on what I think is your first day. I believe that this is the first time that I have addressed the Minister from the Opposition Benches, and I am very pleased to do so. I assure him that it will not be the last time that we will be engaged in these conversations.
From this Adjournment debate on alleged fraud in the Wirral hospital trust, I am looking for three things. First, I am sure that I am not exceptional in the number of constituent cases about alleged fraud that I refer to the relevant authority. In every case I have passed on, whether it be to the Department for Work and Pensions or to the Department of Health, I have never had a satisfactory reply that I could then refer to my constituent. I would not disclose the information, but if I had such a reply, I could say that I had been able to read the papers and assure constituents that they were mistaken in alleging fraud. I could say that a proper investigation had been carried out and we could leave the case there. As I say, however, that has never occurred. One thing I am looking for this evening, then, is for the Government to consider the particular role in which elected representatives sometimes find themselves in handing to the Government alleged cases of fraud, yet never being able satisfactorily to report back to their constituents.
Secondly, I have tried to use the Freedom of Information Act 2000 in order to gain the information that Wirral hospital trust denied me. I was refused on the basis that disclosure of the information would provide me with sensitive personal information such as the name of the person against whom the allegations of fraud were made. However, given that everybody involved in the case knows the name of the doctor, although I have never used it in public, it seems somewhat farcical to use the Freedom of Information Act in this way to prevent my gaining access to reports that have been commissioned.
Thirdly, this saga has been going on for a long time, and I have no intention of letting go of it, so I hope that the Minister might be able to advise me on the next best steps to take to resolve the issue. Through you, Madam Deputy Speaker, I would like to remind the House of what happened.
All too long ago, one of my constituents was sitting in the surgery at their doctor’s. The doctor was engaged in a telephone conversation with one of his patients, who turned out to be a private patient. During the conversation, for reasons that I cannot possibly explain, the doctor assured the person that they had been treated as an NHS patient although they were being charged as a private patient.
I started to look into the case. I asked both the primary care trust and the hospital trust—Wirral University Teaching Hospital NHS Foundation Trust—to investigate. I had a meeting with the hospital trust at which the chairman and the senior directors were present, as well as the locally based official who was in charge of countering fraud in the health service. At that stage the doctor admitted that, as a result of an error, he had put through as NHS patients about 180 patients whom he was charging as private patients, but who were being given tests as NHS patients.
I will give way in a moment to my good and hon. Friend from a neighbouring constituency.
The doctor admitted that that had been an error in all cases, and repaid money. I asked, through its chairman, whether the trust—on the basis of the core of cases of private patients being fed through the NHS—would examine other procedures in the hospital to establish whether any of those 180-odd patients had had scans or X-rays, and whether the doctor had again forgotten to declare that they were private patients when ticking the forms assuring the NHS that they were, in fact, NHS patients.
My right hon. Friend has raised an issue that affects all of us who represent constituents in the Wirral, which is served by the hospital concerned. Does he think that this individual case of fraud involving an individual doctor raises issues about conflicts of interest that may well resonate in other areas of the NHS, and does he agree, on the basis of his experience of this case, that there are general rules that all Members should consider applying more generally throughout the NHS to avoid such financial conflicts of interest?
I strongly agree, and I hope that at some stage the medical profession will give serious consideration to how the interface between the public and private sectors might be policed in the context of health.
As the fraud officer present said that it was quite reasonable to undertake the next stage of the inquiries, I left the meeting, only to find that later the chairman of the hospital trust and her senior executives had said that no such investigation would take place, and that I would not have access to their reports on this case of alleged fraud unless I was prepared to sign a document saying that after reading the information I would never use any of it in public debate. I was not prepared to sign such a gagging clause.
I appealed for access to the documents concerned under the Freedom of Information Act. Because the hospital trust is not known for its efficiency, it applied to block my appeal under the wrong section of the Act. When I appealed to the commissioner, he had to point out to the trust that if it wanted to block my original appeal it would have to use another part of the Act, which of course it then did.
I then appealed to the tribunal, which ruled that I should not have access to the document, or documents, because if I had such access I would gain sensitive personal information to which I was not entitled, such as the name of the person against whom the allegations were being made. As at every stage everyone who was in that room has known the name of the doctor concerned but none of us has made it public, it seems bizarre that it was on those grounds that I was denied access to the counter-fraud report which is alleged to have been undertaken.
Since the attempts to grapple with that individual case of fraud, the same hospital trust has had to repay more than £1 million to what was the primary care trust but is now Wirral Health, because it was found to be fiddling its accident and emergency figures. Quite how that came about and how it was decided that the fraud amounted to £1 million-plus I do not know, but that money has been repaid. I allege that there is a culture of fraud in that hospital trust, which is not being taken seriously by the chairman and the directors of the trust. I look forward to hearing what the Minister has to say.
One last point concerns the Freedom of Information Act. I am well aware that the Government have their own legislative programme, but I would be grateful if the Minister would take back the fact that there may be problems in two respects where MPs refer fraud cases to the administration for investigation. One is the one that I touched on at the beginning of my remarks. As elected representatives, we are never put in a position to report back fully to our constituents. Obviously, we deny them any sensitive personal information, but we cannot say that we have read the relevant papers and we would like to be able to assure them that their concerns about fraud are unfounded.
Secondly, I took up the case only because a constituent referred me to a case of alleged fraud. The doctor admits that somehow in 180-odd cases he happened to tick the wrong boxes, claiming the people concerned were NHS patients, rather than private patients. It seems wrong that I am denied access, as the elected representative of an area, to the counter-fraud allegations that have taken place.
There are two issues, and I would be grateful if the Minister reflected on them with his colleagues, although he may wish to comment on them in the debate. The case has dragged on for some time, but as I have said— I know the Minister is convinced of this—I am not going to let it go yet. I would be interested to hear how the Government think that we might take the case forward to a successful conclusion. I wait to hear what the Minister says.
I add my congratulations on your elevation, Madam Deputy Speaker. It is warmly welcomed by me and I imagine by many right hon. and hon. Members.
I congratulate the right hon. Member for Birkenhead (Mr Field) on securing the debate on detecting and dealing with fraud in Wirral NHS foundation trust. I know from the research that I have done that he has had a long-standing interest in the case. In certain areas I can appreciate his frustration as a constituency MP seeking to represent the interests of his constituents and to get to the bottom of a problem. Fraud in the NHS is totally unacceptable, but before I move to the specifics of the case that he has raised, I would like to explain the processes and institutions involved in the detection, investigation and prosecution of fraud in the NHS, although I promise to keep it brief.
Fraud and corruption in the NHS is dealt with by the NHS counter-fraud service. Since the NHS anti-fraud initiative began in 1998, counter-fraud service investigations have led to 551 successful prosecutions, with a 96% conviction rate, 773 civil and disciplinary sanctions and the recovery of more than £59 million in cash. Under “Secretary of State Directions”, all NHS bodies nominate a local counter-fraud specialist, who reports to their director of finance and works with counter-fraud service staff.
Because of their independent status, foundation trusts are not, however, bound by Secretary of State directions. Clause 43 and schedule 13 of the standard NHS commissioning contract, under which foundation trusts operate, regulate anti-fraud requirements and mirror those in Secretary of State directions. Local counter-fraud specialist staff investigate allegations or suspicion of fraud. Where fraud is suspected, all appropriate disciplinary, civil and criminal sanctions are sought.
Through a quality assurance programme, the counter-fraud service works to ensure that all NHS organisations apply the highest standards to their anti-fraud work. A self-assessment process, managed by the counter-fraud service, helps NHS organisations identify and improve any areas of weakness. The assessment rated trusts on a scale of 1 to 4, with level 1 indicating that adequate performance had not been met and level 4 demonstrating that the organisation was performing strongly. In 2009, Wirral University Teaching Hospital NHS Foundation Trust achieved a level 2 rating, indicating that its performance was “adequate”. The counter-fraud service is continuing to work with the trust to improve its performance and to ensure that it meets the highest possible standards.
I understand that the right hon. Gentleman has been concerned about this particular case of alleged fraud since 2007, when a constituent anonymously alleged that fraud was being committed by a general practitioner. The allegation was that the GP was using NHS blood service facilities at Arrowe Park hospital for his private patients but not declaring them as such. The case was first referred to the primary care trust by the pathology laboratory manager in January 2005. Following some initial inquiries, the PCT referred it to the trust local counter-fraud specialist in January 2006. The trust began its investigation in March 2006.
I understand that the right hon. Gentleman wrote to the trust’s chief executive in March 2007, asking what actions had been taken to investigate such a serious allegation of fraud. The trust explained that an investigation had taken place. The trust’s local counter-fraud service was provided via a contract with Deloitte. This is common practice among NHS trusts.
In the report into the case, published in October 2007, the investigation found that while there had been inaccuracies in the documentation, there was insufficient evidence that the GP had intended to defraud the hospital. The GP accepted that he had made mistakes, but refuted any suggestion that he had intended to deceive or mislead the trust. The investigation report concluded that there was insufficient evidence on which to charge and prosecute the GP concerned. The investigation reached this decision partly because of a lack of clear instructions to GPs on how to complete referral forms, and partly because of the potential ambiguities on the forms themselves, such as a lack of a declaration on the form.
I understand that the GP repaid the money to the trust for the work done and that the trust chief executive wrote to the right hon. Gentleman to explain the outcome of the investigation. Separately, between December 2007 and February 2008, the Mersey internal audit agency investigated concerns over the use of NHS services on behalf of private patients. The review found no evidence of fraud.
I know that the right hon. Gentleman has met representatives of the trust and the counter-fraud service to discuss his concern that the investigation was not sufficiently robust. It is vital that hon. Members and the public have full confidence in the ability of the NHS to identify and root out any examples of fraud. So that I may satisfy myself and the right hon. Gentleman—I hope—that the original investigation was indeed sufficiently robust, I will ask the departmental sponsor at the Department of Health in Whitehall for the NHS counter-fraud service to work with the managing director of that service to review this case and report to me directly on their findings. I will then write to the right hon. Gentleman on the matter.
The second issue concerns the right hon. Gentleman’s requests for information on the investigation. I understand that on 30 November 2007 the trust offered him a copy of the investigation report subject to a confidentiality agreement, which he rejected. While accepting the good intentions of the trust, this offer was, to my mind, a mistake. While the trust’s intention was to be as helpful as possible, it was required to protect the GP under the provisions of the Data Protection Act 1998 and the Freedom of Information Act 2000.
I have noted the right hon. Gentleman’s observations about the workings of that legislation vis-à-vis the work of Members of this House in pursuing their constituency duties, and I will certainly give him a commitment that I will pass on his concerns to my relevant ministerial colleague, so that this can be looked at. I make no other promise or commitment on that, but I do give an assurance that it will be passed on to be considered, without any ties as to what the ultimate decision might be.
In January 2008, the right hon. Gentleman submitted a freedom of information request to the trust, asking for information on the investigation. Legal advice was sought by the trust. It was advised that it was legally required not to comply with the right hon. Gentleman’s request, as the release of the information in question would have been considered personal and in breach of the legislation that I have just mentioned. However, it was felt appropriate to disclose limited information from the investigation report that dealt with improving trust practices, such as the weaknesses in procedures that had been identified.
I understand that the right hon. Gentleman then sought the assistance of the Information Commissioner’s Office on this matter. The commissioner upheld the trust’s decision not to provide the GP’s sensitive personal data, and advised the trust that it should not take any further steps in relation to the request. Finally, the right hon. Gentleman appealed to the Information Tribunal, which also found that the trust had acted properly on the matter.
I understand that, at that point, the right hon. Gentleman agreed to the trust’s original proposal to sign a confidentiality agreement, so that he could see the original report. However, following the decision of the Information Commissioner’s Office, the trust was legally unable to disclose that information. As I said, I feel that it had been a mistake to make that offer to the right hon. Gentleman.
I wholeheartedly share the right hon. Gentleman’s concern about any possibility of fraud in the NHS. If there is ever any suspicion of fraud, it must not only be investigated thoroughly, but be seen to be investigated thoroughly. That is why I have asked the responsible Department of Health official, in conjunction with the NHS counter-fraud service, to review this case and the investigations that took place. I hope that that will clearly demonstrate to the right hon. Gentleman that the Government and I take issues of fraud in the NHS very seriously indeed. When it is committed, it must be rooted out. Equally, when an innocent party is accused, they must have every opportunity to clear their name. When the review is complete, I will write to the right hon. Gentleman with its findings. I hope that he will be satisfied with that approach to what has been a long, complex and sometimes perplexing problem.
Question put and agreed to.