Monitoring of Patients Finances in Mental Health & Learning Disability Inpatient Facilities (Article 116 Mental Health (NI) Order 1986) South Eastern

Transcription

1 Monitoring of Patients Finances in Mental Health & Learning Disability Inpatient Facilities (Article 116 Mental Health (NI) Order 1986) South Eastern Health & Social Care Trust January

2 Table of Contents 1.1 Introduction Context for review of Article Inspection Process Wards Inspected Summary of Key Findings Conclusion

3 Section 1 Introduction 1.1 The Regulation and Quality Improvement Authority The Regulation and Quality Improvement Authority (RQIA) is a non- departmental public body established under the provision of the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order RQIA is responsible for providing independent assurance concerning the quality, safety and availability of health and social care services in Northern Ireland. Moreover RQIA endeavours to encourage improvements in the quality of services and to safeguard the rights of service users. RQIA undertakes a range of responsibilities for people with mental ill health and those with a learning disability. RQIA is required to monitor the arrangements put in place by Trusts to safeguard residents monies and gain an assurance that these are satisfactory. Under Article 116 of the Mental Health (NI) Order 1986 (MHO), RQIA is required to give consent to Trusts to hold balances of more than 20,000 for any single Mental Health and Learning Disability (MHLD) patient. To assist it in discharging this function RQIA in 2013/14 commissioned an external financial inspector to undertake financial inspections of MHLD patients monies in inpatient settings across the five Northern Ireland Heath and Social Care Trusts. 1.2 Context for the Review of Article 116 under the Mental Health (Northern Ireland) Order 1986 Article 116 of the Order outlines specific expectations in relation to the trusts handling of patients property as follows: (1) Subjects to paragraphs (4) and (5), where it appears to a trust that any patient in any hospital or in any accommodation administered by it under the Health and Social Services (Northern Ireland) Order 1972 is incapable, by reason of mental disorder, of managing and administering his property and affairs, the trust may receive and hold money and valuables on behalf of that patient. (2) A receipt or discharge given by a trust for any such money or valuables shall be treated as a valid receipt. (3) Where a trust holds money or valuables on behalf of a person in pursuance of paragraph (1), it may expend that money or dispose of those valuables for the benefit of that person and in the exercise of the powers conferred by this paragraph, the trust shall have regard to the sentimental value that any article may have for the patient, or would have but for his mental disorder. (4) A trust shall not receive or hold under paragraph (1) on behalf of any one patient without the consent of the RQIA money or valuables exceeding in the aggregate such sum as the Department may from time to time determine. (Currently sum of 20,000). 3

4 (5) Paragraph (1) shall not apply where a controller has been appointed in Northern Ireland in relation to the property and affairs of the patient. 1.3 Methodology used by RQIA to Monitor Compliance with Article 116 The financial inspector sought to obtain assurances that Trusts apply best practice in the management of patients property and monies through: Compliance with DHSSPS Circular 57/ Misappropriation of Residents Monies Implementation and Assurance of Controls in Statutory and Independent Homes. This applies to all Trust facilities including hospitals; Application of accounting policies as detailed in their Standing Financial Instructions (SFIs); Implementation of comprehensive local procedures; and, Application of Standard 15 of the Nursing Homes Minimum Standards (in so far as this can be applied to hospital patients). The inspector visited seven wards in the South Eastern Health and Social Care Trust (SEHSCT) as part of this review. The specific wards visited are detailed in 2.0. The inspection involved: Availability of appropriate written procedures for the Handling of Patients Private Property and Cash; Staff access to and awareness of the procedures; Staff training in the application of the procedures; Review of processes relating to withdrawal of patient s monies; Review of patient property books; Review of cash record books; and, Patients income and expenditure records. The inspector met with the ward manager, deputy ward manager or nurse in charge on each ward to discuss the processes in place to safeguard patients monies and property. 4

5 2.0 South Eastern Health & Social Care Trust Wards Inspected No Trust Hospital Ward Date of Visit 1 SEHSCT Ulster Hospital Ward 27 - Ulster 03/01/ Downshire SEHSCT Hospital Ward 27 - Downshire 03/01/ Downshire SEHSCT Hospital Ward 28 03/01/ SEHSCT Downe Hospital Dementia Ward 03/01/ SEHSCT Downe Hospital Downe Acute 03/01/ Lagan Valley SEHSCT Hospital Ward 11 03/01/ Lagan Valley SEHSCT Hospital Ward 12 03/01/2014 5

6 3.0 Summary of Key Findings 3.1 Ulster Hospital Ward 27 The Trust policy is not to hold any money or valuables on behalf of patients. Money or valuables brought in on admission had been recorded in the inventory book and lodged in the cash office. If a trip to the shop or bank is planned ward staff/occupational therapist/social worker may accompany the patient and record this on their electronic system 3.2 Lagan Valley Hospital Ward 11 The majority of patients in Ward 11 had been deemed incapable of managing their own finances. There were two staff on duty on the day of the visit who were not fully aware of the protocol for managing patients money. The cash held at ward level was kept in a money box along with other valuables in a drawer at the nurses station. The nurse in charge held the key to the drawer, however all staff had access to the key. There were no records kept of who accessed the drawer or patient monies therein. An envelope is kept for each individual patient s money. On the day of the inspection, there were four envelopes in the drawer. The nurse in charge stated that two nurses sign if money is taken out of the cash box. However on the day of inspection one patient s record examined demonstrated that there was no record of where a 30 lodgement had come from or who had removed money from the envelope. A record of what is spent had been written on the front of the envelope. There were numerous receipts not reconciled to the expenditure and the envelope content were inconsistent with records held. Accurate records of monies received and any expenditure had not been maintained. Where withdrawals had been made from the cash office and given to a patient, signatures of receipt of the monies had not been kept. The Trust policy stated that on admission the patient property book should be signed by two staff where valuables are received by staff on behalf of patients and a white copy should be given to the patient. However on examination the patient property book was full of white copies, and had not been signed by two staff or by the patient. There was also no receipt by the cash office that they received the items. One patient record sampled recorded clothes and valuables but no record of where the items were currently. Recommendations manager ensures that there is a clear and transparent audit trail of patient s money received by the ward, purchases made and change appropriately accounted for and verified by another staff member. 6

7 manager ensures where patient money is withdrawn from the cash office and given directly to the patient an appropriate receipt is maintained. manager ensures that all items brought into the ward on admission are listed appropriately, the area of their storage or transferred recorded and appropriate receipting undertaken, particularly where relatives remove items from the ward. manager ensures that all staff attend relevant training in the management of patient finances. Ward 12 In line with Trust policy patients are required to keep their own money but on exception the ward will hold a maximum of 25 for patients in the safe in the nurses office. The safe is accessed with a code by all staff. On the day of visit the safe contained an envelope for one patient and a record of money withdrawn had been written on the front of the envelope along with two staff and patient signatures. The envelopes were kept in the safe with other items however there was no record of who accesses the keys to the safe. Records had been maintained of a weekly check of the safe contents by the nurse in charge. Recommendations manager ensures that a record is of the staff member who obtains the key to the patient s safe, and the reason for access is maintained. Downe Acute The Trust policy stated that all patients must keep their own money, or it can be lodged in the cash office. On occasions the ward had kept up to 20 on the ward for individual patients. The money had been kept in an envelope in a locked drawer in the nurses office and the key held by the nurse in charge. Other items were also kept in this drawer; there is no record of who accesses the drawer. Recommendations manager ensures that a record is of the staff member who obtains the key to the drawer where patients monies are kept, and the reason for access is maintained. Downe Dementia The ward manager and staff nurse did not make themselves available for interview but provided the policy and records maintained at ward level for managing patients monies. The policy in use by the ward was dated The majority of patients in Downe Dementia had been deemed incapable of managing their own finances. The ward operated a receipt book for cash received from the patient on admission, or from a relative. There were three copies, the white 7

8 copy should be given to the patient or relative, but on examination of the book there were a number of white copies still in the book. On further examination of one receipt (No: for 1000 cash) dated 26 September 2013, records demonstrated that 20 had been retained by patient and 980 handed over to staff. It was not noted on this receipt book where this money went to. In another lodgement book it appeared that the money had been given to the cash office. On 21 October 2013 there was a withdrawal slip (No 24006) for 980 signed by a member of staff but not signed by the patient and the white and blue copy were still in the book therefore there is no evidence the patient received the money. A withdrawal slip had been signed by the nurse manager to request the money from the cash office, however there is the nurse who obtained the money from the cash office was not identified. There was no separate book (withdrawal slip) for patients going to the cash office to collect their money, or to indicate if it is a staff member who goes to the cash office on their behalf. On occasions when staff had withdrawn money on behalf of behalf of patients, there was no record of receipt by the patients. Recommendations manager ensures that all items brought into the ward on admission are recorded, with appropriate completion of records and receipting. manager ensures that accurate records are maintained monies kept on the ward, received by patients or relatives or transferred to the cash office. manager ensures that clear & accurate records are kept at ward level of withdrawals made from the cash office by patients or staff. manager ensures that individual statements are received from the cash office in order to verify if the transactions are correct and facilitate reconciliation of reconciliation of expenditure and receipts. It is recommended that the Trust policy for management of patients finances is updated as a matter of urgency, and staff updated and trained accordingly. Downshire Hospital Wards 27 and 28 The Trust policy was not to keep valuables on the ward, therefore monies and valuables were lodged in the night safe or the general office in the Downe Hospital. Monies left for use by patients by relatives in Ward 27 had been kept in the nurses office in a cupboard along with other patient property e.g. cigarettes. The key was kept by the nurse in charge. Records of access to the cupboard had not been kept. There was no money in the cupboard on the day of visit.. The ward manager operated a separate record for each patient and a cash ledger was held separately from patients monies which were locked in a Bisley drawer in Ward 28. Appropriate records of deposits and withdrawals had been maintained, including associated receipts for all spends. However for larger items of spend, an 8

9 up to date Trust protocol to guide and support practice in relation to approval and authorisation of expenditure was not available. The policy in use on the ward was dated Recommendations manager ensures that a record is of the staff member who obtains the key to the locked cupboard in Ward 27, and the reason for access is maintained. manager ensures that a record is of the staff member who obtains the key to the Bisley drawer in Ward 28, and the reason for access is maintained. It is recommended that a Trust policy for approval and authorisation of expenditure for larger items is developed and implemented. 9

10 4.0 Conclusion The management of patient finances in inpatient mental health and learning disability facilities was reviewed in seven wards in the South Eastern Health and Social Care Trust in January 2014 by a process of inspection. There were no concerns noted in relation to discrepancies of balances of monies in patients accounts. However, particular concerns were noted in relation to staff implementation of policies and procedures and accuracy of record keeping, across all hospital sites. This includes ward processes for keeping patients monies safe in terms where monies are kept by staff on each ward, receipting of transactions and the management of risk in access to patients monies. Other areas to be addressed include the updating of policies, procedures and training, including approval and authorisation of expenditure for larger items, to guide and support staff practice. The inspector would like to thank staff for their assistance during these inspections. 10

11 01 July 2014 A completed Quality Improvement Plan from the inspection of this service has not yet been returned. If you have any further enquiries regarding this report please contact RQIA through the address info@rqia.org.uk

12 Quality Improvement Plan South Eastern Health and Social Care Trust Finance Inspection January 2014 All recommendations are underpinned by the Mental Health (NI) Order 1986, Articles 86 (2) (c) (iv), & 116, and The Quality Standards for Health and Social Care 2006, Standard (c)

13 Quality Improvement Plan Ward Recommendations Details of action to be taken by trust Timescale Ward 11 manager ensures that there is a clear and transparent audit trail of patient s money received by the ward, purchases made and change appropriately accounted for and verified by another staff member. manager ensures where patient money is withdrawn from the cash office and given directly to the patient an appropriate receipt is maintained. manager ensures that all items brought into the ward on admission are listed appropriately, the area of their storage or transferred recorded and appropriate receipting undertaken, particularly where relatives remove items from the ward. manager ensures that all staff attend relevant training in the management of patient finances. 30 June 2014

14 Ward 12 Downe Acute Downe Dementia manager ensures that a record is of the staff member who obtains the key to the patient s safe, and the reason for access is maintained. manager ensures that a record is of the staff member who obtains the key to the drawer where patients monies are kept, and the reason for access is maintained. manager ensures that all items brought into the ward on admission are recorded, with appropriate completion of records and receipting. manager ensures that accurate records are maintained monies kept on the ward, received by patients or relatives or transferred to the cash office. manager ensures that clear & accurate records are kept at ward level of withdrawals made from the cash office by patients or staff. manager ensures that individual

15 Ward 27 Ward 28 statements are received from the cash office in order to verify if the transactions are correct and facilitate reconciliation of reconciliation of expenditure and receipts. It is recommended that the Trust policy for management of patients finances is updated as a matter of urgency, and staff updated and trained accordingly. manager ensures that a record is of the staff member who obtains the key to the locked cupboard, and the reason for access is maintained. It is recommended that a Trust policy for approval and authorisation of expenditure for larger items is developed and implemented. manager ensures that a record is of the staff member who obtains the key to the Bisley drawer, and the reason for access is maintained. It is recommended that a Trust policy for approval and authorisation of expenditure for larger items is developed and implemented. 31 May May May 2014

16 NAME OF CHIEF EXECUTIVE / IDENTIFIED RESPONSIBLE PERSON APPROVING QIP Inspector assessment of returned QIP Inspector Date Yes No A. Quality Improvement Plan response assessed by inspector as acceptable B. Further information requested from provider