Transcript RQIA Inspection Model 2009-10

Presentation to EPSO, Porto, Portugal
RQIA Review of Patients/Service User Finance
and Property in Regulated and Statutory Adult
Care Settings
8 May 2014
14:35pm – 14:55pm
Theresa Nixon Director of Mental Health, Learning
Disability and Social Work
Safeguarding of Patients / Service Users
Finance
• RQIA inspections undertaken annually on a
legislative basis
• NI focus – Prevention and Protection
• Financial abuse – hard to define – intentional or
inadvertent
• New opportunities for financial exploitation due
to changes in delivery of community care
• RQIA recent findings and discussion
Financial Abuse - Complex and Diverse
Financial abuse can range from • Failure to access benefits
• Inadvertent mismanagement
• Opportunistic exploitation
• Deliberate and targeted abuse
• Threats and intimidation
Opportunities for financial exploitation
due to:
• people living more independent lives
• more direct payments / individual budgets
• more financial assessments for long-term care
involving property.
Financial Abuse
• misuse of cash, cheques, cards
• stealing of finances / high value items
• forged signatures for financial gain
• identity theft
• investment / benefit fraud
• abuse of power of attorney
• scams – targeting of older people
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Financial Abuse
Intentional or Inadvertent?
• Not providing the care/support but charging for it
• Double charging – for services already included
in the care placement
• Top up payments – in residential care settings
RQIA Focus
Prevention
Keeping adults safe e.g. safeguarding vulnerable
adults policy
Promotion of Good Governance and Care
• Effective care planning, engagement with
individuals / carers
• Development of standards, procedures and
guidance
• Registration and regulation – organisations and
individuals
Mental Health (Northern Ireland Order)
1986
Current protections
Departmental Guidance HSS (F) 57/2009
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Review of balances and expenditure
Authorisation of withdrawals
Supervision of funds
Assurances from regulated services that controls
are in place
• Spot checks by, or on behalf of, HSC trusts
Protections
People lacking capacity
• Those with funds - Office of Care and Protection
appointment of controller
• Those on Social Security Benefits - Benefits
Agency appointee
Control Issues Requiring Improvement
• Nursing staff not always recording cash, record
books withdrawals or receipts
• Former patients – went to nursing homes,
money paid over but no checks to see if patients
received monies
• Group expenditure occurred for toiletaries, other
items but no agreement by patients to these
• Cash lead for group activities not agreed
properly
Control Issues Requiring Improvement
• Records of valuables not matching with items
held
• Control of access keys to storage units where
money was held variable
• Transactions (mainly withdrawals) not signed by
two staff members on all wards
• No evidence monitoring of expenditure by
managers (19% of transactions were noted with
no receipts)
Case Study – Supported Living –
Regulated Setting
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Charges exclude benefits
Care hours provided less than those funded
Benefits used for staff meals or business costs
Charges against benefits contravening
departmental guidelines
• Charges for facilities used by wider groups
• Evidence of profit-making transport schemes
Gaps in Trust Protection Plans
The HSC Trust Care Manager at review
• was unaware of other contract expectations
• did not understand charging arrangements
• held infrequent reviews and was more focused
on care provision
• new service options have more complex funding
arrangements
RQIA Actions
• Enforcement meetings with provider
• Publicly available report setting out concerns
• Engagement of Counter Fraud and Probity
Team
• Adult Safeguarding processes
• Engagement with other funding bodies
• Consideration of individual referrals to
professional bodies
Conclusion
• Balance between autonomy of individual and
organisational / individual responsibilities
• Need awareness training of intentional /
inadvertent financial abuse / exploitation
• Multiagency working is key to success
• Action Plans – need conjoined ownership
Topic for Discussion
In the context of establishments/agencies /
services you regulate/ review, how do you
try to reduce the risk of intentional /
unintentional financial abuse