“In summary, the grounds for reasonable suspicion againstthat the Claimant had carried out fraudulent activity against the NHS while running Harbottle surgery are: (1) The Claimant’s conduct in relation to her entry of QOF codes as alleged in paragraphs 12.14 to 12.24 above. (2) The fact that NHS Protect and the NHS England fraud team considered the Claimant’s alleged conduct required to be investigated as a suspected fraud matter and/or adjudged there was substantiated material in support of the allegation initially reported to the NHS by Ms Hooley. (3) The fact that the NHS investigation led to the emergence of further evidence supporting the initial suspicion of possible fraud, in particular the post-payment verification data of 40 QOF codes entered by the Claimant and the Claimant’s own admission that she had backdated QOF code entries when she had not in fact given advice and did not know that another practitioner had (such a failure to verify amounting to, as she must have known, a failure to comply with professional standards). (4) The fact that NHS Protect and NHS England fraud team considered the evidence against the Claimant strong enough to justify obtaining evidence from patients as to whether they had received the QOF-qualifying advice claimed by the Claimant and/or the decision to contact the patients strongly indicated that the Claimant’s response to the allegations under investigation had not satisfied NHS Protect and/or NHS England fraud team, otherwise they would not have called for the patients’ evidence. In particular, bearing in mind that the threshold for bringing a criminal prosecution under theFraud Act 2006 was that there was a realistic prospect of obtaining a conviction and it would be in the public interest, it is reasonably to be inferred that at the stage of directing that patient evidence should be obtained the NHS bodies considered the threshold potentially could be passed subject to assessment of the further evidence. (5) The investigation was closed for reasons unconnected to the merits or a full and/or proper evaluation of the evidence potentially available.”
“… evidence of this kind would be objectionable because it would introduce irrelevant considerations in purported proof of what the defendant has to establish. The defendant has to establish that there are objectively reasonable grounds to suspect the plaintiff. The evidence under consideration would be directed rather to an essentially subjective judgment of the honesty and credibility of third parties. In human terms, anyone is entitled to believe what third parties tell them. But such belief does not establish that what is reported is objectively credible.”
“There may be cases, of which this is unquestionably not one, in which, depending on the terms of its publication, a defendant may rely on matters which do not directly focus on some conduct on the plaintiff’s part giving rise to a relevant suspicion. A defendant may, for example, rely on strong circumstantial evidence implicating the claimant which might amount, objectively speaking, to the requisite grounds for reasonable suspicion. It is not, however, necessary to explore this possibility on the present appeal.”
“Circumstantial evidence cannot contribute to reasonable grounds for suspicion unless it gives rise to an available inference concerning the conduct of the plaintiff. The circumstantial evidence suggestion was first made by Brooke LJ himself in Chase [at paragraph 51] where he said that a defendant could “rely on strong circumstantial evidence implicating [the plaintiff]” as grounds for reasonable suspicion. The circumstantial evidence could hardly have any value unless it “implicated” the plaintiff by means of an available inference as to the plaintiff’s conduct. That is why we have said that our elaboration represents something which was already implicit in the sixth principle.”
“The fact that the NHS saw fit to instigate an investigation into the allegations against the Claimant self-evidently demonstrates there were grounds to investigate, not least given that NHS England would only carry out an enquiry if there was ‘substantiated material in support.’”