FOI 2025/1274

Under the Freedom of Information Act 2000, I would like to request the following information relating to Personal Health Budgets (PHBs) issued or managed by your ICB.

Please provide this information broken down by individual financial year (e.g. 2020/21, 2021/22, 2022/23, 2023/24, 2024/25 to date), for each of the past five financial years or as many as you have data for:

1. The number of fraud concerns or cases involving Personal Health Budgets that were:

Alleged or reported

Under investigation

Proven or substantiated

Unfounded or dismissed

2. The financial value (£) associated with:

Proven or substantiated fraud cases

Any financial recoveries made by the ICB as a result

3. Where held, please indicate whether each case involved:

Direct payments to individuals

Third-party managed budgets

Notional budgets

4. If available, please include brief anonymised summaries of the types of fraud involved (e.g. falsified receipts, ineligible spending), while ensuring no personal or identifying information is disclosed.

NHS Greater Manchester (NHS GM) considers that a fraud concern or case has been raised at the point at which it has been referred to NHS GM Local Counter Fraud Specialist at Mersey Internal Audit Service (hosted by Liverpool University Hospitals NHS Foundation Trust). The below information represents NHS GM’s response in the context of the above definition.

Please note, the below excludes information in respect of active cases, which are considered exempt under section 31(1)(g) and 31(1)(h).

31(1) Law Enforcement

31.(1) Information which is not exempt information by virtue of section 30 is exempt information if its disclosure under this Act would, or would be likely to, prejudice –

(g) the exercise by any public authority of its functions for any of the purposes specified in subsection (2),

(h) any civil proceedings which are brought by or on behalf of a public authority and arise out of an investigation conducted, for any purposes specified in subsection (2).

Public Interest Test

There is an inherent public interest in ensuring that there is openness and transparency in the spending of public money.

However, revealing details of information of active cases would be seen to risk prejudicing current investigations, the apprehension of offenders, and reduce the ability to recover public monies.

After considering the arguments outlined above, we have decided to withhold this information in the interest of crime prevention.

Part of your request asks for information on a year-by-year basis. However, information is considered exempt under the Freedom of Information Act, section 40(2), where it would risk providing personal information which would identify individuals. In this instance, it is considered that where there are low numbers of cases in each year, there is a risk that personal information may be able to be identified about the individuals involved. As the annual values are below 5 cases, only a total volume of cases is disclosed.

1. Further to the above, NHS GM is only obliged to provide information it holds. NHS GM does not use the classification identified in the question. Instead, cases have been classified in line with existing information held by NHS GM below:

Please note, due to the low numbers involved (where data is 5 or less <5) we consider this to be exempt under section 40(2) of the Freedom of Information Act 2000 as the disclosure of this information may lead to the identification of individuals. This exemption is not subject to the public interest test.

2. As per the table above, as no cases have been classified as Proven, there are no financial values to report here

3. In respect of the 8 cases above, all related to Direct payments to individuals

4. Based on the information held, the majority of cases above related to either alleged false reporting of time worked, or allegations of other ineligible spending not in compliance with the individual’s PHB agreement.