Treatment of Ulcerative Colitis: Medical Management, Surgical Options
Primary treatment for ulcerative colitis involves medications like antidiarrhoeals, antibiotics, corticosteroids, diet management, vitamins, and general support. For mild to moderate attacks, prednisolone and sulfasalazine are commonly used, with adjustments for severe cases. Severe attacks may require IV fluids, blood transfusion, vitamins, and broad-spectrum antibiotics. Immunosuppressive drugs like azathioprine can also be beneficial. Surgical treatment is necessary in about 10% of cases, typically for emergencies like massive hemorrhage, toxic megacolon, or fulminating acute ulcerative colitis.
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CIPFA North West Audit Group Fraud Risks and Personal Budgets 4thMarch 2015 Jane Whyatt, Emma Parsons & Andrew Bloor
Agenda 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Further Assurance Required Overview of the Personal Budget scheme National Challenge The Risks: Syndicate Exercise Feedback from the Group Key Risks Break The Controls: Syndicate Exercise Feedback from the Group Oldham A Case Study 2
What are Personal Budgets? Personal Budgets (aka Direct Payments) are offered by your local authority to give more flexibility over how care and support is arranged and provided. Personal Budgets are designed to promote: Independence Choice Inclusion Personal Budgets enable people to purchase the assistance or services that the Council would otherwise provide. 3
Personal Budgets Your experience With colleagues on your table: discuss how PB operate at your organisation; and any challenges you may be facing? (10 mins) 4
How do they work Users are informed that : You have a needs assessment to establish which needs you have that can be supported ('eligible needs') You are allocated an indicative budget (estimated budget) You develop a 'support' or 'care' plan for using the indicative budget to meet your eligible needs. Once your plan is approved, you will be told the final amount of your Personal Budget and can make the necessary arrangements to get the support you have chosen. You will have your Personal Budget reviewed on a regular basis. Source: www.oldham.gov.uk 5
National Challenge Since 2007, government has consistently aimed to give people more choice and control over the social care they receive, and to enable them to live independently at home for as long as possible. The policy of more choice and local control has, however, changed the scale of the fraud risks faced by councils. Cases of detected social care fraud nationally increased from 131 in 2009-2010 to 438 in 2013-2014. In 2013-2014, however, a majority of all councils did not detect a single social care fraud 6
Detected Social Care Fraud/Misuse 2013-2014 Authorities Percentage Unitary Authorities 48% Metropolitan Districts 47% County Councils 48% London Boroughs 61% Source: Audit Commission Protecting the Public Purse 2014 7
National Challenge Councils face significant budget savings whilst continuing to provide vital social care services for its residents. Personal Budget Challenge: correctly assessed and paid spend appropriate to Support Plan ensuring most vulnerable are safeguarded 8
Cost of Personal Budget Fraud/Misuse Number of Cases ( m) Cases 2013/2014 2012/2013 Value Number of Value ( m) Number of Cases 2011/2012 Value ( m) 438 6.3 200 4.0 122 2.2 Number of cases since 2009-2010 of social care fraud has more than trebled to 438 Average value in 2013-2014 of 14,297 per case, this accounts for 6.3 million in losses Source: Audit Commission Protecting the Public Purse 2014 9
Greater Profile - Nationally Audit Commission: Protecting the Public Purse National Fraud Initiative Fighting Fraud Locally GMFIG NAFN CIPFA Counter Fraud Centre NW Chief Audit Executive Meeting 10
Key Internal Stakeholders Finance Health & Wellbeing Directorate Internal Audit 11
Personal Budgets - Risks Risk Financial Reputational Operational Support Plans are out of date X X Ineffective Brokerage Services X X Absence of payments approval leading to error X X Inappropriate spend by client to support plan X Lack of procedures and non compliance X X X Theft and Abuse by Family/PA X X Debts Recovered Lack of integrated systems and/or automated systems leading to error X X 13
Personal Budgets - Risks Risk Financial Reputational Operational Lack of governance arrangements Lack of collaboration between Directorates X X X X X X Client not making contribution in line with support plan X Funds allowed to accumulate without challenge X Care packages over generous in the first instance X X Lack of clear internal and financial controls X X X 14
Coffee Break 15
Case Study Oldham Council Response Internal Audit & Counter Fraud Team FFS Audit Assurance twice yearly and full reliance from Grant Thornton Continuous Audit process on the areas of high risk Full support for Adult Services system transformation and ongoing support and guidance Regular attendance at working groups to deliver change Professional collaboration between Brokers, Finance and Personal Budget Audit Team 17
Case Study Oldham Council Response Dedicated Personal Budget Audit Team Challenged and updated the audit process A risk based review of all client accounts Documentation Review Procedures - Whistleblowing Arrangements Revised Audit process Desk based approach Fit for purpose PB Agreement Introduction of PB Governance Policy Good Practice Guide highlighting process for Personal Budget including the Audit process Full collaboration with the Auditors and Health and Wellbeing Results speak for themselves 18
Case Study Oldham Council Results 1200 1000 800 Audits Recoveries ( ) 600 400 200 0 2012/2013 2013/2014 2014/2015 19
Case Study Oldham Council Response Health and Wellbeing Directorate Introduction of online panel process (Frameworki) Quick turnaround on decisions Audit trail Introduction of Prepayment Cards Allows for live audits and 1 day recovery of funds Terms and Conditions for External Brokers Internal In-house brokerage to go live 1st May 2015 20
What's next for Oldham Further Assurance Agreed Debt Management and Recovery Policies for direct payments, care and residential services funding. Joint working agreement and arrangements between the main investigatory bodies Fraud awareness session for Adult Services assessors and social workers Data sharing powers, legal gateways and legislation should be extended to include investigating social care assessments to protect the public purse Pre-financial and household member checks be made prior to the funding panel. 21
Wrap Up Risks around Personal Budgets are great They are here to stay National and local profile. Pro-active response required by all parties: External organisations Internal colleagues across the business Within Finance and Audit Results are real and affect the bottom line! Does everyone agree with this?......... 22
