Social Service. 32 (High)

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1 APPENDIX 2E AUDIT REPORT SERVICE EXTERNAL DAYCARE Social Service DATE ISSUED 21 January 2013 AUDIT RISK SCORE (pre-audit) KEY STATISTICS (pre-audit) 32 (High) The budget for externally provided daycare in 2012/13 is 577 thousand. In 2011/12, the budget was 568 thousand, with 607 thousand actually paid to suppliers. The daily charge to the Council ranged from 33 to 110 per day for a standard daycare package but could be more for specialised support. SUMMARY OPINION AUDIT RECOMMENDATIONS On the basis of our audit review and findings, we can provide limited assurance that the Council s controls in respect of external providers of care at home support are appropriate and are operating effectively. High Medium Low BACKGROUND Day Support Services provide community-based services for older people and adults who have a disability. This audit concentrated on the services available from external providers, which includes other Local Authority organisations. Services offered included daycare for social contact, activities and access to training and work opportunities. There are a number of daycare suppliers who provide specific services for service users with particular care needs such as dementia, mental health issues, autism and learning disabilities. There is no contract with the suppliers for these services, and the daycare placements are treated as 'spot' purchases with agreed daily rates. In some cases, where the level of support required is greater than the standard care provision, additional support may be provided or a different charge may be made, based on an assessment of support needs. A Care & Assessment Team care worker assesses each user s needs and determines a suitable placement with a daycare provider. The user s careplan should then be updated, and agreed with the Care Manager. A service request is passed to the Business Matching Unit (BMU) with the details of the placement, which has already been agreed by the care worker with the provider. The admin team then inputs the details onto SWIFT (the Social Services case management system). A daycare provision is set-up on SWIFT as a standard 5 hours per day. Care providers are sent a proforma invoice by the Finance & Admin Support team, according to a 4-weekly payment cycle. This contains the details of the planned care for the period. The proforma must then be updated to indicate the actual care provided, and returned within an agreed timescale for payment to be made.

2 Service Users are subject to financial assessment and, where appropriate, issued with a 4- weekly invoice for their contribution to the care costs, in line with the Council charging policy. AUDIT SCOPE & OBJECTIVES The scope of the review is to consider the arrangements for the provision of day support within centres operated by external providers. The specific objectives are: to identify the main providers and the number of clients in each of the day support centres; to consider the process for making assessments for clients who require day support services, how suitable placements are identified and are allocated in accordance with service criteria; to ensure that payments are made to service providers for the provision of support services in accordance with the terms and conditions of their contract / service level agreement; to ensure that only clients who have been allocated a place and have an individual service agreement attend, determine how attendance is recorded and whether nonattendance requires action to be taken; to ensure that any client contributions are received in a timely manner and appropriate action is taken for non-payments; to consider the adequacy of any management information with regard to the provision of this service; and, to consider whether different approaches, possibly using new technologies, can provide better value for money or efficiencies. This could consider issues such as method of payment of client contributions, transport arrangements and provision of activities. SUMMARY OF FINDINGS Good practice identified Our review identified a number of areas of good practice and effective controls, including: Payments timetable - the Admin Team issues a timetable in advance, which clearly sets out the deadlines for processing pro-forma invoices and issuing the related client invoices; Provider spreadsheet - a tracking spreadsheet is maintained in a shared drive, which details the progress made for each provider with the processing of the pro-formas for that payment period; Invoicing spreadsheet - a spreadsheet captures the actual hours provided and the client contribution, in order to inform the invoiced charge to the service user. Financial Information Statements for the invoice period are also generated and sent with the invoice to the client. These explain the client s contribution, the actual care delivered and the calculation of the charge, which should enable the client to review and query the invoice;

3 Transport provisions added to SWIFT - a specific provision for service user transport has been added to SWIFT from 2012/13. This integrates information that was previously held on a separate spreadsheet, and ensures that the transport elements of care packages are captured in SWIFT management reports; and, Careplan cost summary - a cost summary showing the weekly/annual cost for the care package has been added to the careplan from July Audit Issues Identified Our review highlighted 8 areas of risk, summarised as follows: 1 Careplans We found that there was no electronic careplan held on SWIFT for over 50% of service users sampled, and in most cases no paper careplan could be found to support the service being provided. There were a number of cases where no assessment of the 'Personal Outcomes' had been recorded. It was acknowledged that there was a backlog of assessments, which were being prioritised in July It is noted that the Service has planned a review of cases to ensure that packages are still appropriate. This is part of the plan to address the budget overspend. Risks There is a risk that, given the number of unavailable careplans, the Service is unable to demonstrate that the level of care being provided has been properly authorised, matched against the relevant eligibility criteria and reflects the service user s needs and outcomes. There is a risk that the monitoring of progress with the completion of careplans, assessments and reviews cannot be properly managed without adequate management information. 2 Careplan Management Due to the low level of careplans found, it could not be confirmed that the care provided to sampled daycare service users had been properly authorised. However, where careplans were found, those had been properly authorised. Additional management reports around the authorisation process and to highlight planned services not yet in place could assist management to ensure that all care needs are being met and that careplans are being properly authorised in a timely manner. Risks There is a risk that, given the number of unavailable careplans, the Service is unable to demonstrate that the level of care being provided has been properly authorised, matched against the relevant eligibility criteria and reflects the service user s needs and outcomes. There is a risk that careplan approvals may be in excess of the delegated authorities, and that this may not be identified without adequate management information on careplan costs and approvals.

4 3 Commisioning of Daycare Services There is no overarching framework contract for daycare services, and placements are negotiated by the Assessment & Care Management team, which does not necessarily possess the required procurement expertise.. Risk The charges for standard care packages are at annually agreed spot purchase rates. The arrangements for certain aspects of the service, such as nonattendance by service users and the escalation of disputes, are not clearly defined and may result in charges that would not apply if a framework contract was in place. We understand that the Service intends to address such issues through a tender exercise for daycare provision in 2013/14. There is a risk that, if contracts and other agreements are negotiated by officers with insufficient procurement skills and knowledge, the Council may not make the most appropriate procurement decisions, resulting in less beneficial terms and conditions and increased charges. 4 Contract Letters Risk The Council does not issue contract letters, and the Service cannot otherwise readily demonstrate that it meets National Care Standard requirements for advising clients of the level of care to be provided. While careplans may have been discussed with service users, they are not currently in a user-friendly format for issuing to clients or their carers. The issue of Financial Statements to service users provides this type of information, but this only supports the process and does not cover all clients. There is a risk that service users do not know the specific details of the approved level of care that should be provided to them and, therefore, would be unable to highlight instances where the care received does not meet the approved specification or the National Care Standards. 5 Payments & Variations We found that 3 invoices in our sample of 12 contained reflected variations to the planned level of care. Further investigation established that, during the 4- week sample period, 50% of invoices reflected a variation from planned hours. The three variations identified within our sample had not been properly updated on SWIFT some 6 months after the changes occurred. There are no management reports available that would highlight cases where there has been a change to the service provided and recurring variations worthy of further investigation. We identified one case where a provider had submitted their own invoice, rather than an amended or agreed Council proforma. As the original pro-forma had not been retained, the accuracy of the charge could not be confirmed.

5 Risks There is a risk that the process for handling payments to providers is inefficient due to the volume of monthly variations. Also the higher the volume of variations, the more chance that errors may be made by either the Council or the providers, leading to incorrect payments being made to providers and incorrect charging of clients. Given that some of these variations recur over more than 2 months there is also a risk that the current careplans do not reflect the actual ongoing care requirements. This creates inefficiencies in the payment process for both the Council and the provider. There is a risk that there is no evidence to support the hours recorded for the service delivered, where the original invoice documentation is not retained. 6 Daycare Charging & Bad Debtor Monitoring The process for raising and issuing invoices to service users, in line with their assessed financial contributions, is reasonably robust. Cases where there has been a change in circumstances are highlighted for checking. This process did not identify all the adjustments required resulting in a few invoicing errors. The process for monitoring and managing bad debts is operating satisfactorily. Risk There is a risk that invoices may be incorrect, or may not be created at all, if information on the invoicing spreadsheet becomes corrupted, or if manual adjustments are not properly checked. 7 Non-attendance - Charging Some aspects of the arrangements, including the process for reporting and charging for non-attendance by a service user, are not subject to a formally agreed process (there is no overarching framework contract for the provision of daycare services). Risks There is a risk that some payments will be made to providers where no service or a reduced service has been provided if no formal agreement is negotiated in relation non-attendance. There is a risk that service users may be overcharged for services where the actual hours recorded for provider payment purposes exceed the hours the user actually attended the daycare centre. 8 Client Confirmation of Services There is no independent checking of the care hours provided to service users. Service users are not required to advise the Council of any breaks in service or to confirm that the service requested has been provided. While in the longerterm the development of Webroster could enhance the process for recording breaks in service, additional checks should be implemented before then to identify hours charged but not delivered. Risk There is a risk that, where a variation in the usual pattern of a service occurs, this may not be identified and payment may be made for services that have not been delivered.

6 9 Service User Reviews Risk Exercises to ascertain service user views, in order to highlight and address areas of concern or to gather views on proposed changes, have been limited. There is a risk that, unless user surveys are undertaken for all groups of service users, not all service performance and delivery issues will be identified for action. 10 Future Developments There is scope to develop the extent to which service users can interact with the Council on certain aspects of their service: for example, client portals might be used to notify the Council of breaks in service, or to enable access to service delivery information and allow for changes to be updated. While a service redesign is being undertaken, future proposals have not yet been developed. Other Councils have changed service delivery methods away from centre-based models to providing services in the community, and this has highlighted the importance of service user choice and transport arrangements, which could also apply to Stirling Council. Risks There is a risk that potential improvements to the flow of information between clients, providers and the Council may not be achieved. There is a risk that improvements to the efficiency and effectiveness of service delivery are not maximised by considering the success or failure of developments elsewhere.

7 AUDIT OPINION On the basis of our audit review and findings, we can provide limited assurance Council s controls in respect of Housing External Contracts are appropriate and are operating effectively. Specifically, with regard to the agreed objectives of the audit, our conclusions are as set-out below: Objective To identify the main providers and the number of clients in each of the day support centres To consider the process for making assessments for clients who require day support services, how suitable placements are identified and are allocated in accordance with service criteria. Opinion There are a number of external providers who provide day support in community based centres. There is no formal contract for the provision of these services, and most providers supply specific care in specialist areas at rates agreed annually or on a case-by-case basis where required. We were unable to trace authorised careplans, either paper or electronic, for most service users in our sample, We also note that there was no recorded care assessment for a number of users, although there is a requirement for care packages to be (re-) assessed annually. The proposed review of social care cases within the plans to address the Service s overspend should help ensure that appropriate careplans are put in place in future. However, additional management reporting is required to manage this process effectively. To ensure that payments are made to service providers for the provision of support services in accordance with the terms and conditions of their contract / service level agreement. The payments made were in accordance with the payment timetable and at the agreed rates. The process relies on the provider to confirm the hours worked and highlight variances between the planned hours and the hours delivered. We consider that the Service does not properly demonstrate that all of these services have been provided.

8 Objective To ensure that only clients who have been allocated a place and have an individual service agreement attend, determine how attendance is recorded and whether nonattendance requires action to be taken. Opinion There is no formal agreement issued to clients who have been allocated a care at home service. The information provided needs to be improved to support the National Care Standards. As the service is not part of a formal contract, the arrangements for handling non-attendance are not clear. There is no process that sets out the criteria where non-attendance should be highlighted, and what notice is required for periods of absence to ensure payments are only made where services are provided. To ensure that any client contributions are received in a timely manner and appropriate action is taken for nonpayments. A process is in place for raising and issuing invoices to clients for their contribution to the cost of their care. While there were some issues relating to clients whose financial assessment had changed during the period reviewed, the invoicing process was found to be reasonably robust. To consider the adequacy of any management information with regard to the provision of this service. The non-payment of invoices is reported on a regular basis, and appropriate action is taken to pursue these cases where required. Regular, adequate management reports are available. In addition, ad hoc reports can be requested from SWIFT. However, there are a number of reports that could be generated that would assist in the management of this service. In particular, there should be a mechanism for highlighting authorisations that exceed delegated approvals or agreed service limits; retrospective approvals; cases where there has been no annual care review; persistent and repeated variations or additional hours provided. To consider whether different approaches, possibly using new technologies, can provide better value for money or efficiencies. This could consider issues such as method of payment of client contributions, transport arrangements and provision of activities. The development of client portals could enable service users to advise the Council electronically of breaks in service. Other Councils that have moved from a central approach to a community-based model have carried out user consultations to inform this process. Consideration should be given to the key issues raised and how service users views may be taken into account.

9 The Action Plan to the report provides a summary of agreed actions to address the key issues identified by our review. We look forward to these being implemented. Progress against the Action Plan will be monitored through our Action Tracking process, which is reported to the Scrutiny & Audit Committee and includes verification of completed actions. It should be noted that the issues identified in this report are only those that have come to our attention during the course of our audit. An audit cannot be expected to detect all errors, control issues or opportunities for improvements in management arrangements that may exist.

10 RECOMMENDATIONS ( High priority only) RECOMMENDATION ACTION TAKEN TIMESCALE Service management should ensure that electronic careplans are put in place for all service users to identify and support the care being provided. These careplans should be properly authorised and include appropriate assessment information. Where necessary historic careplans could be added to SWIFT, if this information is not obtainable from other sources. Ensure all new provisions have an authorised Electronic Careplan. Time out for all ACM teams to update careplans to ensure that for all service users with ongoing provisions in 2013/14 all have an Electronic Careplan recorded. Jan 2013 July 2013 A programme of exception reports should be developed and circulated to managers for action on a regular basis. The reports should be available for the service overall with the ability to analyse by team or client category and detail the cases, for example: - where careplans are overdue for review; - where no care assessment is recorded on SWIFT; - where there are no details in the 'Needs, Services and Action required' part of the careplan; and - where there is a new provider. A programme of exception reports should be developed and circulated to managers for action on a regular basis. The reports should be available for the service overall with the ability to analyse by team or client category and detail the cases, for example: - where the authorisation is above the limit set; - where the authorisation is retrospective (eg for a period more than 1 month ago); - where the decision taken is more than 2 weeks after the need was Define service standards for applying review process. Liaise with BST to design and develop reports. Agree process for review of reports and escalation. Service Manager and team Manager 1:1 sessions will have these reports as a standing agenda item. Record review due dates on all clients with existing provisions. Explore best approach to develop exception report and consider process and action plan. Pilot this with the LD team. Roll out across remaining teams. Develop process for use of existing report for managing approval of needs. Service standards to be developed for responding and authorising needs. April 2013 April 2013 April 2013 July 2013 April 2013 July 2013

11 identified; and - where there is a planned service that has not been put in place more than 3 months after the date this was planned. The Service should develop a client version of the careplan that presents the care package in a way that is meaningful to service users. This should be issued to all clients. In the interim period before the client version of the careplan is implemented, clients who make a nil contribution should be provided with a copy of their Financial Statement as a means of confirming the service they should receive. Define paperwork to share with clients/carers. This work is being taken forward by the promoting outcomes group. Issue annual financial statement to clients to cover interim period but also as an annual housekeeping exercise. April 2013 January 2013