ITEM AS6(a)
ADULT SERVICES SCRUTINY COMMITTEE – 8 JULY 2009
THE MONEY MANAGEMENT SERVICE
Report by the Head of Shared Services
Background to Report
1. In December 2008, the
Social & Community Services Scrutiny Committee received a report on the
operation of the Money Management Service. A copy of that report is appended at
Annex 1 (download as .doc file) as background information. The Committee discussed the demands on the
service, which were likely to increase, and the implications of this, together
with the efficiency savings target to be met by the Service, on the waiting
list for the Service. The Committee asked for a further report to be brought
to its July meeting to enable members to review the operation of and the
waiting list for the Service. Brief Summary of the Money Management Service
2. The December report (Refer Annex 1) sets out in some detail the key aspects of the Money Management Service. In summary, the Service is responsible for the management of the financial affairs of Social Care clients deemed incapable of managing on their own. All referrals to the Service, which is part of the Council’s Shared Services, are made by Care Management, within Adult Social Care.
3. The service is provided through an Appointeeship or a Court of Protection Deputyship. Under an Appointeeship, we take on the administration of the client’s state benefits, with the agreement of the Department of Works and Pensions. An appointee has no powers over the wider financial affairs of an individual. Under a Deputyship, we take on the responsibility for the full management of the client’s financial affairs, under the direction of the Court of Protection.
4. In the case of both an Appointeeship, and Deputyship, the requirements of the service should be set out in the Money Management Plan for the individual client. Each Plan should be signed off by the referring Care Manager, and form part of the overall Care Plan for the individual.
5. The Money Management Service, in line with all care services, does have specific eligibility criteria. In particular, the Money Management Service will only get involved if there is no other suitable alternative individual to take on the role. Issues of mental incapacity have to be determined by an appropriate medical practitioner. Clients who meet the eligibility criteria are accepted into the service based on a priority of need assessment (Refer Annex 1), remaining on the waiting list in the meantime.
6. The team establishment is currently 13.9fte but this is targeted to reduce to 11.9fte as part of the overall Business Case for the establishment of Shared Services. The Service is looking to deliver efficiency savings to meet this target associated with the introduction of a specialist Money Management Database. At the time of writing the December report, the project was targeting a go live for the database in April 2009, but unfortunately, due to technical problems with the implementation (on the supplier side), the implementation has been delayed. At the time of writing this report, it is hoped that the basic database will be live in July, although the key automatic reconciliation functionality will not be available until a later date (not yet determined).
Current Service Issues
7. At the time of writing this report, the Money Management Service was working with 871 clients. A brief analysis of these clients is contained within the table below. The Service is directly managing £8.8m on behalf of these clients, which excludes any money lodged directly with the Court of Protection.
8. Since the December report, the number of clients receiving a service has remained fairly constant. Forty new clients have been allocated to a case officer, whereas 48 clients have died or left the service. There have been 40 new referrals, of which 10 require a Court of Protection Deputyship application.
9. The current waiting list for the service is 56, 14 of which require a Court of Protection Deputyship application. As explained in the December report, any urgent case involving suspected financial abuse is escalated straight into the service, and is not held on the waiting list (although it can take up to 12 weeks to get approval for an appointeeship, and up to 26 weeks to get approval for a deputyship.) In the interim, the Money Management Service support the client, and will provide basic financial support, to be re-imbursed once we have access to the individual’s own funds). The number of such financial abuse/safeguarding cases referred since December is 18.
10. Fifteen of the cases on the waiting list in December have now been allocated a Case Officer because their circumstances have changed, and urgent input has been required. Changes in circumstances include the threat or actual eviction from property, benefit issues, or the client having no access to money. Most of these clients will be suffering from some form of mental health problem, and be living in the community with no support network.
11. 26 cases on the waiting list in December are still on the waiting list today, with the longest wait now 9 months. Five cases brought forward by Care Management have been rejected by the Money Management Service, as either appropriate support mechanisms already exist, or the client has previously been in the service, and the service has been unable to meet the individual’s needs.
12. As explained in the December Committee report, the service operates a needs assessment system, which allocates a needs score to each client in line with the amount of work required in delivering their money management plan. Based on this internal assessment of the needs of our current clients, the service is working above capacity by some 729 points, which equates to just over 1 fte case officers, broadly in line with the position at the time of the December report.
13. There are a number of factors which lie behind the above analysis, some of which are hopefully short term, and others which are likely to have longer term implications. The main short term pressure remains the difficulty of managing the efficiency savings target given the delay in the implementation of the new database. As covered in the December report, two members of the Service resigned on moving to Shared Services or shortly afterwards. Given the 2fte efficiency savings target, it was not possible to replace these staff on a permanent basis, and it has not been possible to appoint suitably qualified staff on a temporary basis. The team are therefore working on the reduced numbers without the efficiency improvements the new database will bring (automatic reconciliation of all transactions, improved management information etc). The resulting pressures should reduce as the new database goes live. The pressures are further compounded at the current time, as the Team are running with a further vacancy, to which we are in the process of recruiting a replacement.
14. A more permanent pressure on the Team results from the changes introduced under the Mental Capacity Act of 2007. One of the main features of this Act is to give much greater powers back to the individual. This in turn means that in Deputyship cases, the Deputy must consult fully with the client on all significant issues/decisions, and can no longer act independently in the best interests of the client without reference back to them. These requirements have increased the workload of the Team, in terms of the time now required to consult with each client at each stage of a significant event e.g. selling of property, moving to new accommodation.
15. A third significant area of pressure is the increasing number of cases coming forward under the Safeguarding programme. As noted above, 18 clients have been referred to the service this year under safeguarding procedures. The current economic problems across the Country are also having an impact, both on the financial circumstances of the individual clients, and on the risks of financial abuse as others feel the financial pressure.
16. As covered in the December report and in much of the subsequent discussion, there are a number of implications of running the service with the pressures indicated above. Whilst the highest risk cases do get escalated straight into the service as noted above, the waiting list for others is growing, and individuals are spending longer waiting for a service. Whilst not deemed to be highly vulnerable, the absence of the service will be impacting on their quality of life.
17. For those within the Service, the pressure on the Team does mean that it is not possible to provide the level of service dictated by their needs assessment. In the absence of the improved management information and automatic reconciliation from the new database, this does create an element of risk. Financial errors to the detriment of the client will be corrected at additional cost to the Money Management Service. However in other cases, the issue will be a missed opportunity for the client which cannot be corrected.
18. Apart from the risks to the individual clients, the current pressures could ultimately lead to a risk to the service as a whole. The Service is audited annually by the Court of Protection, and the Court does retain the power to remove the office of Deputy from the Council’s nominated officer. To date, the Service has received positive feedback from the annual audit, but it has been noted that across the Country, the audit of the service has become more stringent, under the new guidelines associated with the Mental Health/Mental Capacity Acts.
Options Going Forward
19. The option of improving the efficiency of the service through the introduction of the new database is well advanced, and there is considerable pressure on the system supplier to deliver the outstanding elements of the system as a matter of urgency. At this stage it is not possible to be definitive about the impact of the database on the service figures.
20. It is likely that with the increasing numbers of safeguarding cases coming forward, and the increased workload associated with each individual Deputyship, pressure on the service will continue to grow. The Council therefore needs to look at options to reduce numbers in the system, or to increase the overall size of the Service.
21. Reducing numbers in the system can be approached from two angles. Firstly, eligibility criteria for the service can be further tightened so that only the highest levels of need are accepted. In respect of this option, it should be noted that historically Oxfordshire has had one of the highest number of clients receiving an in-house money management service, and significant greater numbers than many other authorities. However, since the inception of the Mental Capacity Act it has been reported through the Association of Public Authority Deputies (APAD) that case loads in other authorities have increased. No specific numbers are currently available, but APAD are in the process of undertaking a major benchmarking exercise across the Country.
22. The second approach to reducing numbers is to seek to minimise the time any individual spends in the service, with wherever possible, seeking to ensure that support is targeted to enable the individual to take back responsibility for their own financial affairs. To achieve this we need to ensure that all clients receive a regular review of their arrangements to ensure that the money management service is still required under their care plan, and no alternative sources of support have developed. A major challenge to this option is identifying the care management resource to undertake the regular review of the care plans. Many of the clients in the money management service have been closed by care management, and are currently not subject to a regular review.
23. To support this option, we are currently in the process of establishing a new joint panel, with representatives from Care Management and the Money Management Service. This Panel will be responsible for reviewing the waiting list and determining new allocations, and for proactively managing the review of clients currently using the service.
24. The alternative to reducing the numbers in the system is to increase the size of the team. Allowing for the recruitment to the current vacancy, it would take the recruitment of a further 1 fte to reduce the current excess workload in the team, and allow for the allocation of all those on the current waiting list.
Conclusion
25. It is clear from both the December report and this subsequent report that there is growing pressure on the Money Management Service. At this stage is unclear to what extent these pressures can be alleviated through the implementation of the new database.
26. The Scrutiny Committee is invited to continue to review the service as the benefits of the database begin to be felt, and to receive a further report on the service before the setting of the 2010/11 budget. This further report would be able to cover the results of the current benchmarking work being undertaken by APAD, and cover the impact the new panel arrangements will be having on both the waiting lists, and the numbers of clients supported to return to independent living in the Community.
RON SWEETMAN Head of Shared Services
Background Papers: Nil
Contact Officers : Sean Collins, Assistant Head of Shared Services Tel. (01865) 797190 Tarquin May, Money Management Team Leader Tel. (01865) 797189
June 2009
|