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When Controls Fail – Abuse of the Vulnerable February 16, 2014

Posted by Audit Monkey in The Joy & Pain of Internal Audit.
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I’m not quite sure what my conclusions will before writing this post as the subject matter doesn’t make for pleasant reading. This story broke before Christmas but it isn’t really what one would associate with Yuletide and goodwill to all men. Let me set the scene.

The Times ran a news story on the 23 December 2013 that staff at one of the UK’s biggest charities, the Royal Mencap Society, subjected vulnerable Care Home residents to years of systematic financial abuse. For those who are ignorant about Mencap’s activities, essentially they provide services to those with learning difficulties (this being the polite euphemism for those who are mentally incapacitated in one way or another). This includes the provision of residential services.

Long story short; a number of care home residents (read patients) at Dolphin Court, Havant, Hampshire, were overcharged for services and had to be reimbursed after a relative of a patient (Nicki Frampton) noted discrepancies and irregularities in the items being charged. This precipitated further investigation which resulted in other patients being recompensed. Examples of irregularities included patients being charged for a karaoke machine despite not being able to speak, the purchase of DVDs even though the patient was unable to comprehend television. Patient money was also spent on take-away meals.

So why am I blogging about it? Two fold, to shed some light on why this may occur and the problems the auditor has in conducting Care Home audits, having done them myself. Patients normally receive Social Security payments to cover the cost of accommodation, subsistence and other incidentals. The article in ‘The Times’ comments that even though residents were receiving £2,400 (sic) a week from the Local Authority (as well as Social Security payments), they were still being charged for incidentals. Was this appropriate?

In practice it is difficult to judge. Care staff are supposed to provide patients with some mental stimulation, be it visual or audio, as well as take them on visits outside of the Home so they have some exercise and to avoid a completely sterile existence. Yes, in some cases, providing CDs or DVDs to patients who smash them up or discard them is a waste but there has to be some compassion. Of course, the staff could misappropriate the CDs, etc, but it’s small beer in the grander scheme of things.

As for the meals, this is where it gets more tricky. The Care Home staff are supposed to cook meals for the residents (especially in the smaller Homes) but I can see how short cuts are taken and takeaways ordered. You can bet your bottom dollar that the majority of Care Home staff are not Gordon Ramsay in the kitchen department. What shouldn’t happen, as detailed in The Times article, is voyages on the QE2 (I kid you not). I can’t see the value in this.

I think the issues are as follows. Patients often have thousands of pounds in savings (as perversely they don’t spend it and are not charged full rent) and there is scope for misappropriation as controls are laxed. For example, I audited one Care Home and patient money (over several hundred pounds) had been spent on clothing but how could you tell who the recipient was? In hindsight, the only way around this is to prepare very strict and comprehensive guidelines on what constitutes patients expenditure and rigorous annual auditing, not only to protect the staff but patients as well. And of course, you can guess what was missing on my Care Home reviews…decent guidelines and decent auditors who had the wherewithal to highlight the relevant issues.

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