NHS Tayside Patients Private Funds Year ended 31 March 2012 Audit Findings Report
CONTENTS 1. Introduction 2 Page 2. Accounting and audit issues 3 3. Systems and controls issues 3 4. Matters from last year 9 5. Matters from last year which have been resolved 11 6. Reporting audit adjustments 13 1
1. Introduction We have pleasure in submitting our Audit Findings Report setting out the key matters identified and discussed with management during our audit of the financial statements of NHS Tayside Patients Private Funds for the year ended 31 March 2012. Audit procedures Our audit procedures, which are designed primarily to enable us to form an opinion on your financial statements, were carried out in accordance with International Standards on Auditing (UK and Ireland). Our work continues to combine substantive procedures involving direct verification of balances and transactions, including obtaining confirmations from third parties where we considered this to be necessary, with a review of certain of your financial systems and controls. All issues which came to our attention in relation to the operation of the relevant systems and controls are detailed later in this report, together with further follow-up of points raised at previous audits. We have included comments where we have identified potential improvements. We are aware that changes in personnel, restructuring of responsibilities and long-term sickness absence during the year have delayed the revision of Patients Fund Procedures and the Training Programme. However, we must emphasise the importance of an ongoing training programme, particularly since the majority of items raised in both 2010 and 2011 result from inconsistent operation of the procedures detailed in the manual. No restrictions were placed on our audit, and we have been able to undertake our work as set out in our engagement letter dated 30 April 2012 and our planning letter addressed to the Audit Committee. We have not identified any further issues with regard to our integrity, objectivity or independence since the date of our planning letter. Legal and Regulatory requirements In undertaking our audit work we considered compliance with the following legal and regulatory requirements, where relevant. Applicable accounting standards Adults with Incapacity (Scotland) Act 2000 We would like to express our appreciation for the assistance provided to us by the finance team during our audit. This report has been prepared for the private use of the Board of NHS Tayside and its contents should not be disclosed to third parties without our prior written consent. We assume no responsibility to any other person who has access to this report. 2
2. Accounting and audit issues Our audit processes include reviewing the accounting practices of NHS Tayside Patients Private Funds and the disclosures made in the Abstract of Receipts and Payments. Details of issues from this review and our related discussions with management have been recorded below. Issues and implications 2.1 Increase in cash float In September 2011, cash floats were increased from 4,025 to 5,025. This was erroneously recorded in SFR19 as Increase in cash float during year of 1,000 and included as expenditure within Payments to or on behalf of patients. These entries should be offset. Agreed SFR 19 amended. 3. Systems and control issues We have set out below certain potential improvements to processes and controls which we noted during our audit work and which we would like to bring to your attention. Our evaluation of the systems of control at NHS Tayside Patients Private Funds was carried out for the purposes of our audit and accordingly it is not intended to be a comprehensive review of your business processes. It would not necessarily reveal all weaknesses in accounting practice or internal controls which a special investigation might highlight, nor irregularities or errors not material in relation to the financial statements. Our systems work was designed to complement the work performed by internal audit, by performing additional testing on areas where control weaknesses had been identified to satisfy ourselves that these weaknesses do not significantly increase the risk of material misstatements occurring in the patients private funds accounts. During the course of the audit, visits were made to the cashiers offices at Stracathro Hospital, Dundee Royal Liff Hospital, Murray Royal Hospital, Ashludie Hospital and Ninewells Hospital. Ward visits were made to Willow Ward at Stracathro Hospital, Blair and Kinnoull Wards at Murray Royal Hospital and Wards 17 and 22 at Dundee Royal Liff Hospital. 3
Issues and recommendations 3.1 Letters of Authority One instance was identified at Liff where form PF28 was not held. For this patient, plus a further three at Liff, form PF28A had not yet been put in place for balances held in excess of 10,000. High balances are being held without current authority, in contravention of Procedures. Cashiers should be reminded of the importance of holding current Letters of Authority and Certificates of Authority in excess of the sums held. Agreed Action This location has already reviewed their documentation and is currently obtaining the necessary paperwork. Lead Cashier (Liff) Actioned. 3.2 Selection of forms PF5/PF7 At all locations visited except Ashludie, a number of instances were identified where ward staff completed form PF5 when the patient is depositing money only. Form PF7 is the appropriate documentation in this case. Board procedures are not being followed. Ward staff should be trained to use the appropriate documentation and cashiers advise them when the incorrect paperwork has been completed. i) This issue will be included in the elearning training package currently under development. Principal Corporate Accountant March 2013 ii) Memo to cashiers asking cashiers to advise ward staff when incorrect paperwork is completed, to ensure compliance with the Patients Funds procedures. Lead Cashiers July 2012 4
Issues and recommendations 3.3 Patients copies of form PF7 A number of instances were identified at Ninewells and one instance at Liff, where the cash office has retained the patient s white copy of form PF7 rather than the yellow copy for cash office files. Board procedures are not being followed. The patient or their representative does not have their record of the funds deposited. Ensure that these locations are adhering to the Procedures. To remind Liff and Ninewells cashiers to ensure that yellow copy is retained and not white copy of form PF7 in compliance with the Patients Funds procedures. Lead Cashiers July 2012 5
Issues and recommendations 3.4 Retention of cash and PF7 At Liff Ward 17 and Willow Ward, Stracathro, yellow (cash office) and green (ward) copies of form PF7 are being retained on the ward in all cases. None of the forms had been signed by the cash office. Balances in excess of 50 are being retained on the ward (see issue 4.3). It may be that patient s funds are being held at ward level instead of being passed to the cash office. Ensure that these locations are adhering to the Procedures. i) Ward 17 Liff Hospital: Memo to ward staff asking that the yellow copy of the PF7 form is passed to the cash office and signed by the cash office, in compliance with the Patients Funds procedures. Senior Charge Nurse, Ward 17 Liff Hospital July 2012 ii) Willow Ward Stracathro: Memo to ward staff asking that the yellow copy of the PF7 form is passed to the cash office and signed by the cash office, in compliance with the Patients Funds procedures. Senior Charge Nurse - Willow Ward, Stracathro Hospital July 2012 6
Issues and recommendations 3.5 Completion of forms PF5/PF7 At Liff and Murray Royal, ten occasions were identified where forms PF5/PF7 had not been signed by two members of staff when a cash deposit was made. Board procedures are not being followed at ward level. Ward staff should be reminded of the importance of the Procedures, being for their own protection as well as the security of patients funds. Memo to General Managers asking them to remind ward staff: i) Of the importance of the Patients Funds Procedures being for their own protection as well as the security of patients funds; ii) That forms PF5/PF7 require to be signed by two members of staff when a patient s cash deposit is made, in compliance with the Patients Funds procedures. Chief Operating Officer July 2012 3.6 Form PF2 - Liff Form PF2 was updated in 2011. However, staff at Liff continue to use the older version as they prefer it. Board procedures are not being followed. We were advised that the older version contains more information and that the Lead Cashier at Liff intends to ask management to review the revised form. If this practice is to be allowed to continue, the Procedures documentation must be reviewed or alternatively this location must be reminded to adhere to the Procedures. For consideration by working group with a view to updating the procedures as appropriate, taking into account the reason for the older version being used at Liff. Principal Corporate Accountant October 2012 7
Issues and recommendations 3.7 Form PF2 Ninewells Staff at Ninewells regularly omit completion of form PF2, obtaining information from PF5 if required. Patient s details may be incorrectly entered and their money or property risks being recorded against the wrong patient. We were advised that this practice is followed due to time pressures on ward staff. However, if this practice is to be allowed to continue, the Procedures documentation must be reviewed or, alternatively, this location must be reminded to adhere to the Procedures. 3.8 Form PF9 Liff The cash office is retaining all three copies of form PF9. Board procedures are not being followed. We were advised that patients who have been discharged into the community continue to attend the cash office to withdraw funds for a few months after their release. Procedures documentation should be reviewed to cover this circumstance. For consideration by working group with a view to updating the procedures as appropriate, taking into account the reason for the omission taking place in Acute setting. Principal Corporate Accountant October 2012 For consideration by working group with a view to updating the procedures as appropriate. Principal Corporate Accountant October 2012 8
Issues and recommendations 3.9 Recording of patient property At Murray Royal Hospital, one instance was identified where form PF5 recorded detail of a patient s bank card but no entry for this property was made within Harlequin. Board procedures are not being followed. There is a risk that property may not be returned to the patient. In accordance with Procedures, entries must always be made in the Harlequin system against a patient s record. Memo to cashiers asking cashiers to enter patient s property noted on form PF5 within Harlequin, in compliance with the patients Funds procedures. Lead Cashiers July 2012 4. Matters from last year not yet resolved We have set out below the systems and control issues which were reported to you after last year s together with an update based on our review. in 2011 Update 2012 4.1 Completeness of income Forms PF5/PF7 are sequentially numbered to ensure completeness of income. However, there were gaps in paperwork which could not be traced at either ward or cash office level. Since these forms are controlled documents, any spoiled copies should be retained. Revised training programme to cover this (31 March 2012). This is still a problem at Murray Royal with gaps in numbering of paperwork in three samples selected. However, some paperwork has been packed away in advance of move so it was suggested that the paperwork may still exist. Management comment: At local level, respective charge nurses to remind their ward staff of this requirement. In addition, this will be included in the elearning training package currently under development. 9
in 2011 Update 2012 4.2 Review of cash balances in excess of 50 A number of instances were identified where cash balances in excess of 50 were held for several days on the ward, in breach of Procedures. This problem resulted from an extensive programme of resettlement of patients into the community, with sums required to fund personal purchases for patients new residences. 4.3 White copies of PF forms There was inconsistency in the treatment of the white copies of PF forms when it was deemed inappropriate to return to patient. Working party to review to determine whether it is appropriate to keep the PF form with the medical record, as stated in Procedures or on ward, as was happening in some cases. In Ward 17 at Liff, we identified a number of occasions where a patient s balance exceeded 50, with length of time exceeding the limit being between 2 and 42 days. On one occasion, funds of 473.63 were held, reducing over a six-week period to fall below 50. A review of cashbooks at Blair and Kinnoull wards at Murray Royal identified a significant number of patients exceeding the 50 limit, with ward 750 limits being breached on occasion. Management comment: This issue will be considered by the working group, with a view to updating the procedures if required. Both wards at Murray Royal continue to store white copies of PF forms on ward files, stating that patients are either not well enough or do not wish to retain their copy of the paperwork. Management comment: This issue will be considered by the working group, with a view to updating the procedures if required. 10
in 2011 Update 2012 4.4 All nursing staff should be aware of the Patients Fund Procedures and must have the relevant paperwork on each ward. Ongoing training programme to address this issue. Outdated versions of Patients Funds Procedures are held at Blair Ward (April 2009) and Kinnoull Ward (January 2010). Liff hold PF41 confirming that staff has read Procedures in summer 2011. Stracathro hold undated but signed PF41. No PF41 was available at Murray Royal. Management comment: Chief Operating Officer to ask General Managers to remind Nurse Managers to ensure that within their area of responsibility the most up-to-date version of the Patients Funds Procedure is being held by wards and that Nursing staff have read and understood the Procedures and confirmed this by completing form PF41, with Nurse Mangers retaining records for possible auditor scrutiny. 5. Matters from last year which have been resolved We have set out below the systems and control issues which were reported to you after last year s together with an update on our review this year. in 2011 Update 2012 5.1 Cash received on the ward At Ninewells and Ashludie, instances were identified where PF5/PF7 had been completed for deposit of funds by patients admitted but no entries were made in a client s account in the Harlequin system, due to short stays in hospital. Cashiers to be advised that this practice is not acceptable and all items receipted by them must be processed through Harlequin (Action by 31 December 2011). No such instances were identified during the current year. 11
in 2011 Update 2012 5.2 Cheques in excess of 25,000 It was observed that, if a sum in excess of 25,000 is required, two cheques are issued. Procedures to be updated to cover procedure required in this instance (Action by 31 December 11) 5.3 Release of funds on discharge At Ninewells and Perth Royal Infirmary, it was practice to pass property and monies to patients if they provided their copy of PF5 and signed it, rather than complete form PF9/PF12. Revised training to be developed (Action by 31 March 2012). 5.4 Release of funds on discharge At Ninewells, 2 instances were identified where patients had funds returned to them but there were no entries in an account in their name in Harlequin. Cashiers to be advised that this practice is not acceptable and all funds returned to patients must be processed through Harlequin (Action by 31 December 2011). 5.5 Authority to hold funds in excess of 10,000 Three instances of balances in excess of permitted sum on PF28A were identified. Each location had already reviewed their documentation and submitted changes as required to Tayside NHS Board. 5.6 Deceased patients funds Cashiers should pass on any deceased/discharged patient s valuables and/or cash to the QLTR after 6 months has passed if no contact has been made with the patient or next of kin. The problem resulted from two cases where it was difficult to trace next of kin. No such instances were identified since the Procedures were updated in December 2011. No such instances were identified during the current year. No such instances were identified during the year. No evidence of balances held in excess of permitted sum on PF28A Two new cases were identified where balances have been held for more than 6 months after date of death, but again, each were cases with exceptional circumstances and have been dealt in accordance with Procedures. 12
6. Reporting audit adjustments International Standard on Auditing (UK and Ireland) 260 (ISA 260) requires that we report to you all misstatements which we identified as a result of the audit process and which were not adjusted, unless those matters are clearly trivial in size or nature. We are pleased to report that there are no non-trivial items identified as a result of our audit work which have not been adjusted in the financial statements. 13