Patient being given an eye test by an optician

We're helping the NHS recover £1 million per year

By Maggie Ritchie

Did you know that every year NHS Scotland loses £10 million from patients wrongly claiming free dental or eye treatment?

A groundbreaking collaboration between the University of Glasgow and NHS Counter Fraud Services, using psychology to understand and adapt the economic decision-making processes of individuals, is helping the recovery of around £1 million each year, a five-fold increase in recovered funds.

Patients in Scotland benefit as funds can be diverted to frontline patient-care services.

Influencing behaviour

Professor Sayantan Ghosal and Dr Theodore Koutmeridis of Adam Smith Business School looked at applying “the framing effect”, how our choices are influenced by the way options are described and presented, to adapt the way the NHS communicates with patients about fraudulent and incorrect claims.

Historically, the NHS sent letters asking patients to pay for their treatment if they wrongly claimed for exemption. The letters included a statutory penalty charge for late payments, if they didn’t respond, but the amount of money recovered barely covered the costs of sending the letters.

Incorporating Glasgow’s research, the letters were reworded to “nudge” patients into repaying the cost of their treatment, without the threat of a penalty charge.

The campaign trialled three different approaches, or “frames”, and in March 2018 the letter was updated to include the Social Welfare frame: “Only a minority in your area wrongly claims exemption, diverting money away from patients like you who rely on NHS healthcare. Make sure you are not one of them.”

“By setting out the conditions under which frames have an impact on individual decision-making,” says Sayantan, “they can be used to influence behaviour in the absence of using an explicit monetary disincentive, such as a penalty charge or fine.”

Mr Iain MacMillan, NHS Senior Counter Fraud Specialist, agrees: “The data from the campaign, using different message frames, will provide the NHS with insights into how demographic groups are likely to respond to each frame, so we can adjust them.”

Tangible benefits

The campaign, along with other changes in the identification of incorrect claims, has increased the efficiency of debt recovery from £360,000 to around £1 million per annum, according to NHS Scotland, and the campaign has been a major success in recovering money from people without threatening a fine or penalties. “We are very happy to be recovering almost £100,000 a month,” says Iain, “using innovative approaches and trials to better understand and tackle problem issues.”

“This project has tangible benefits and demonstrates the economic and social impact of our research,” says Sayantan. “We collaborated with people outside academia to use our knowledge and expertise to support them in their activities and brought a fresh perspective to allow them to change their communications.”

The success of the collaboration in Scotland has led to the research team sharing their findings with NHS England, HM Revenue & Customs, local authorities in Scotland, and Swedish municipal officials.

Building on success

In September 2018, Sayantan started a new collaboration with the NHS to design a frame to be included in a letter sent to opticians to check patient eligibility when exemption claims are first made. Conservative estimates suggest that additional savings could be around £175,000 or £583 saved for every £1 spent.

A number of further collaborations have been agreed for 2019/20, which will generate additional income and free up valuable resources for NHS Scotland’s patients.

This article was first published June 2019.

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