Part 1: Introduction
1.1
In this Part, we describe:
Purpose of our audit
1.2
We carried out a performance audit to assess the progress that the Ministry of Health (the Ministry) and district health boards (DHBs) have made since we published our December 2009 report, Effectiveness of arrangements to check the standard of services provided by rest homes.
1.3
In that report, we stated that, since arrangements for certifying rest homes1 had been introduced in October 2002, those arrangements had not provided adequate assurance that rest homes met the criteria in the Health and Disability Services Standards (the Standards).2 We considered that the Ministry had not responded quickly enough to address weaknesses and risks in the arrangements that it had known about since 2004.
1.4
We noted that the Ministry was actively trying to address the shortcomings in the effectiveness of auditing and certification arrangements but that more work was needed. At the time of our audit in 2009, it was too early to tell whether the efforts to make the arrangements work as intended would make a difference or whether certification was fundamentally unable to do what the legislation envisaged.
1.5
We made nine recommendations in our 2009 report. Six were for the Ministry and three for DHBs. The recommendations are included in the Appendix. We stated that we would follow up on our audit.
1.6
This report sets out the findings of our follow-up audit. We have assessed what progress the Ministry and DHBs have made in addressing our recommendations. We have also identified the differences between the auditing and certification arrangements that we saw in 2009 and the arrangements that we saw during this audit. Also, we have assessed whether the changes the Ministry was making at the time of our 2009 audit and the work it has done since then have improved the effectiveness of the overall auditing and certification arrangements.
How we carried out our audit
1.7
Since our 2009 audit, as part of our continuous engagement with the Ministry, we have regularly met with Ministry staff and received updates on the progress it is making in addressing our recommendations.
1.8
As part of the fieldwork for this follow-up audit, the Ministry provided us with updated details of the work that it has done with DHBs and other major stakeholders to address our recommendations. We saw evidence and verified that this work has actually been done.
1.9
As well as our verification work, we wanted to find out whether the main participants involved in certifying and monitoring rest home services thought that the auditing and certification regime had improved. To do this, we interviewed staff from the Ministry, DHBs, and the Health and Disability Commissioner's Office. We interviewed directors of the two accreditation bodies overseeing the work of the designated auditing agencies (DAAs). We also interviewed a range of staff from the rest homes, including chief executives and managers, including quality managers. We also spoke to directors and auditors from the DAAs and people working for organisations that provide advocacy services for older people.
1.10
After we published our 2009 report, the Auditor-General was approached by some members of the public who gave their views about the report and about rest homes. For this follow-up audit, the Auditor-General decided to seek the views of rest home residents and their families and friends during the audit fieldwork. We carried out an online survey of rest home residents, their families and friends, and caregivers and staff of rest homes. On request, we provided hard copies of the survey for respondents to complete.
1.11
During April 2012, our survey was available to the public on our website, and a link to the survey was provided on the websites of Age Concern New Zealand and the Health and Disability Commissioner.
1.12
Fifty-three people responded to our survey. Although this means that the responses are not statistically significant and do not necessarily reflect the views of rest home residents, their families and friends, and staff and caregivers as a whole, they raised important issues and contributed to our overall findings.
1.13
We surveyed the 20 DHBs to find out their views on whether the work that the Ministry has done on auditing and certifying rest homes since our 2009 report has led to improvements. We had 18 responses.
1.14
We also analysed complaints that the Health and Disability Commissioner had received about rest homes from 2006 to 2010.
The structure of this report
1.15
Part 2 outlines the changes that the Ministry has made since 2009 to the process for designating auditing agencies and for auditing and certifying rest homes.
1.16
Part 3 discusses the improvements that the Ministry has made to the auditing and certification arrangements since 2009.
1.17
Part 4 discusses how the Ministry assesses the quality of auditing and certification and whether the changes to the auditing and certification arrangements since 2009 have improved the quality of care for rest home residents.
1.18
Part 5 discusses the further work that the Ministry is doing to improve the quality of care for rest home residents and our views on how the Ministry might use its new systems to encourage continuous quality improvement.
1: Aged Residential Care Providers, which are referred to throughout this report simply as rest homes, are funded under two separate standard agreements with DHBs. The first is the Age Related Residential Care Services Agreement: Provision of Age Related Residential Care, which covers the provision of rest home services, dementia services, and hospital-level (geriatric) services. This agreement is also known as the Age Related Residential Care contract (ARRC). The second is the Age Related Residential Care Services Agreement: Provision of Aged Residential Hospital Specialised Services, which specifically covers the provision of psychogeriatric services.
2: The Health and Disability Services Standards (NZS 8134:2008) are approved by the Minister of Health and published by Standards New Zealand.
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