Auditor-General's overview
In December 2009, I published a report on the Effectiveness of arrangements to check the standard of services provided by rest homes. I found that, since its introduction in October 2002, certification of rest homes had not provided adequate assurance that rest homes had met the criteria in the Health and Disability Services Standards. I made six recommendations for the Ministry of Health (the Ministry) and three for district health boards (DHBs).
I noted in my 2009 report that the Ministry and the DHBs were making some progress in addressing the weaknesses and risks that I had identified. It was too early to say whether this progress would lead to long-term improvements. I also said that my Office would do more work in 2011 to look at whether the changes the Ministry was making had improved the effectiveness of the overall certification process.
Since my 2009 report, the Ministry has made good progress in strengthening how rest homes are certified and monitored. It has introduced an integrated audit approach, which combines audits previously done by DHBs and the designated auditing agencies (DAAs) that audit rest homes on behalf of the Ministry. It has introduced spot (unannounced) audits and requires more frequent audits when it assesses risks as higher. It has reintroduced third-party accreditation of the auditing agencies.
The consistency and quality of rest home audits have improved. Audits now provide better assurance that rest homes meet the criteria in the Health and Disability Services Standards.
The Ministry is shifting the focus of the auditing process towards ensuring that the documented policies and procedures deliver quality care to rest home residents, with the introduction of improvements such as a new tracer audit methodology. Overall, I consider that the recommendations I made in my 2009 report have been met.
However, there is still scope for certification and auditing to provide better assurance about the quality of care provided in rest homes, including better assurance to DHB planning and funding managers and rest home providers. My follow-up audit and the Ministry have identified further improvements that can be made. For example, the Ministry has identified that DAA auditors need further training in, and guidance in using, the tracer audit methodology.
In my view, new systems that the Ministry is introducing between now and 2015 provide an opportunity for the Ministry to consider how it might bring together and use clinical and audit information to continuously improve the quality of care provided in rest homes by:
- better assessing the quality of care being provided to rest home residents;
- making ongoing improvements to the Standards that rest homes must meet to provide residential care services for older people; and
- continuing to enhance the effectiveness and efficiency of auditing in providing assurance that the Standards are being met.
During the next 12 months, my Office will be working on the theme of Our future needs – is the public sector ready? As part of this work, I will look at the future needs of New Zealand's ageing population and how the public sector is planning to meet them. This will include further work with the Ministry, DHBs, and other government departments to explore the extent that older people's care and support services are integrated.
I would like to thank the staff of the Ministry, DHBs, and other organisations for their help and co-operation. I also extend particular thanks to the people who took time to complete my survey and share with my staff their experiences of rest home services.
Lyn Provost
Controller and Auditor-General
12 September 2012