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

•

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

PreventionKeeping 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

•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

•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