1. 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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. Mental Health (Northern Ireland Order) 1986

9. 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

10. Protections People lacking capacity Those with funds - Office of Care and Protection appointment of controller Those on Social Security Benefits - Benefits Agency appointee

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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