SOMERSET PARTNERSHIP NHS FOUNDATION TRUST RATIFIED ?· somerset partnership nhs foundation trust ratified…

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<ul><li><p> V </p><p>Ratified minutes of the Audit Committee meetings held on 15 April 2015 and 27 May 2015 July 2015 Public Board - 1 </p><p>SOMERSET PARTNERSHIP NHS FOUNDATION TRUST </p><p>RATIFIED MINUTES OF THE AUDIT COMMITTEE MEETINGS HELD ON 15 APRIL 2015 AND 27 MAY 2015 </p><p> Report to the Trust Board 21 July 2015 </p><p>Sponsoring Director: Director of Finance and Business Development/Director of Governance and Corporate Development/Chairman of the Audit Committee. </p><p>Author: Secretary to the Trust. </p><p>Purpose of the report: The purpose of the report is to present the ratified minutes of the Audit Committee meetings held on 15 April 2015 and 27 May 2015 to the Board for information. </p><p>Key Issues and Recommendations: </p><p>The report set out the discussions held at the Audit Committee meeting held on 15 April 2015: </p><p> particular issues discussed were: </p><p> progress report from the Integrated Governance Committee, including areas on which further assurance was required; </p><p> Counter Fraud work plan for 2015/16 and progress </p><p>report; concluding counter fraud report relating to an </p><p>allegation of working for another organisation whilst in receipt of sick pay from the Trust this allegation was unfounded in relation to the Trust; </p><p> concluding reports on travel expenses actions </p><p>had been taken to clarify the deduction of home to base mileage, including the development of a new mileage claim form; </p><p> follow up review on pre-employment checks; progress report on the implementation of counter </p><p>fraud audit recommendations; CQUINS internal audit report, and in particular the </p><p>Friends and Family Test; main financial systems internal audit report; </p></li><li><p>V </p><p>Ratified minutes of the Audit Committee meetings held on 15 April 2015 and 27 May 2015 July 2015 Public Board - 2 </p><p> cost improvement programme internal audit report; Board Assurance Framework internal audit report; business development and contract management </p><p>internal audit report; internal audit 2014/15 annual report; progress report on the implementation of internal </p><p>audit recommendations; 2015/16 audit plan; 2014/15 Assurance Framework progress report; losses and special payments; hospitality/sponsorship register; the outcome of the external audit tender. </p><p>The Audit Committee discussed a risk in relation to culture and noted that this was a high priority area and a cultural thermometer and clear measures will be developed. The Audit Committee identified a risk in relation to staff and unintended consequences in relation to culture. </p><p> The main focus of the Audit Committee meeting held on 27 May 2015 related to the 2014/15 Annual Accounts, Annual Report, Quality Report and the Going Concern statement, which were subsequently approved at the Board meeting held on 27 May 2015. The Audit Committee also considered: the internal audit memorandum management and </p><p>service redesign service integration; </p><p> the IT Review Information Commissioners Office Action Plan internal audit report. </p><p>Actions required by the Board: </p><p>The Board is asked to note the ratified minutes of the Audit Committee meetings held on 15 April 2015 and 27 May 2015. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 1 </p><p>SOMERSET PARTNERSHIP NHS FOUNDATION TRUST </p><p>MINUTES OF THE AUDIT COMMITTEE MEETING HELD ON 15 APRIL 2015 IN THE BOARDROOM, FOUNDATION HOUSE, </p><p>TAUNTON </p><p>PRESENT: Judith Newman Non-Executive Director (Chair) Phil Dolan Non-Executive Director Roger Powell Non-Executive Director IN ATTENDANCE: Lynne Pamment Price Waterhouse Coopers Greg Rubins BDO Adam Spires BDO Andy Knight Dorset and Somerset Counter Fraud Service Phil Brice Director of Governance and Corporate Development Pippa Moger Director of Finance and Business Development Ria Zandvliet Secretary to the Trust 1. APOLOGIES </p><p> Apologies were received from Barbara Clift (Non-Executive Director). Judith Newman welcomed David Allen, Governor, to the meeting. </p><p>2. DECLARATION OF INTERESTS RELATING TO ITEMS ON THE AGENDA There were no declarations of interests relating to items on the agenda. </p><p>3. </p><p>MINUTES OF MEETING HELD ON 21 JANUARY 2015 The minutes of the meeting held on 21 January 2015 were approved as a true and accurate record with the following amendment: page two fourth paragraph to replace evident with </p><p>evidence. Pippa Moger proposed, Roger Powell seconded and the Audit Committee approved the minutes of the meeting held on 21 January 2015. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 2 </p><p>4. PROGRESS REPORT FROM THE INTEGRATED GOVERNANCE COMMITTEE Phil Brice presented the report on David Woods behalf and highlighted the work undertaken by the Committee since its last report to the Audit Committee including feedback on the detailed review of assurances in relation to the management and prevention of pressure ulcers within the Trust. Judith Newman commented that the progress report was helpful and provided the Audit Committee with assurance about the areas reported to and discussed by the Integrated Governance Committee. Roger Powell was also a member of the Integrated Governance Committee and highlighted the areas identified by the Committee as requiring further assurances: joint working with other organisations a further internal </p><p>audit was planned and it was expected that this audit will provide further assurance; </p><p> cultural barometer this was an area of high focus by the Trust and consideration will be given by the Committee on how to obtain assurance on the effectiveness of systems; </p><p> Care Quality Commission compliance (CQC) notification of a CQC inspection had now been received. The inspection will be carried out week commencing 7 September 2015 and the timing of the audit will be linked to the inspection date. </p><p>Judith Newman advised that when considering internal audit reports, the Audit Committee should also consider whether the Integrated Governance Committee should be requested to obtain further assurances. Previous requests for further assurances had related to pressure ulcers and medicines management. </p><p>5. COUNTER FRAUD UPDATE Workplan 2015/16 Andy Knight presented the 2015/16 workplan and advised that although the plan was ambitious, the number of days had remained at 85. Andy Knight advised that the work plan had been developed following discussions with the Director of Finance and Business Development and highlighted the areas of work in relation to strategic governance; inform and involve; prevent and deter; and hold to account. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 3 </p><p> Pippa Moger advised that the workplan was challenging but in view of the considerable work undertaken in 2014/15 in relation to raising fraud awareness generally and with specific teams, it was expected that there may not be a need to continue to put a high focus on this area of counter fraud during 2015/16. It was expected that the annual survey on fraud awareness will show improvements in fraud awareness amongst staff. The Committee discussed the workplan and noted that: standard 3.6 - a procurement audit of the Yeovil District </p><p>Hospital NHS Foundation Trusts procurement system had been carried out in 2014/15 and this audit will not be repeated in 2015/16 but assurance will be sought on the implementation of the recommendations; </p><p> standard 3.7 invoicing fraud and corruption risks details of the work to be carried out had not yet been agreed with the Director of Finance and Business Development. </p><p>The Audit Committee approved the 2015/16 workplan. Concluding Report Op Taru/Parri Andy Knight advised that this investigation related to an allegation that a member of staff may have been working for the Trust whilst in receipt of sick pay from another trust. The investigation concluded that criminal proceedings by the Trust were not warranted as the member of staff did not work for the Trust during periods whereby the member of staff would have been contracted to work at another trust. It was noted that the other trust was considering the findings of the investigation. Concluding Report Op Peka Andy Knight advised that during a pro active exercise on travel expenses, a sample of claims was investigated and it appeared that some of the claims examined had been incorrect as the appropriate home to base deductions had not been made. This investigation, and Op Peel and Patrin, was undertaken as a follow up to the pro active exercise. The investigation established that the guidance issued to staff had been confusing, sometimes inaccurate and contradictory and this had contributed to the incorrect home to base deductions. In view of this, the investigation concluded that there was insufficient evidence to pursue criminal sanctions in relation to this matter. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 4 </p><p>Pippa Moger advised that since the investigation has been undertaken revised guidance had been issued to staff and the expenses claim form had been revised to clearly indicate that, if appropriate, home to base deductions will need to be made. All staff will be expected to use this new form and from 1 July 2015 any old forms will be returned unpaid. The form now also included a self declaration in relation to a valid driving license, MOT and insurance Pippa Moger confirmed that the staff expenses handbook had been withdrawn and the Agenda for Change handbook was now the only reference handbook available to staff. Pippa Moger advised that as the overpayment came to light following the pro active exercise, the recommendation to recover overpayments will not be followed up. If it was decided to recover any overpayments, this would need to be based on a review of expenses claims of all staff. It was noted that the relevant member of staff (and the staff referred to in Op Peel and Patrin) had been informed of the errors in the travel expenses forms. The Audit Committee agreed not to recover any historic overpayments for this member of staff and the staff referred to in Op Peel and Patrin. Concluding Report Op Peel Discussed as part of the Op Peka concluding report. Concluding Report Op Patrin Discussed as part of the Op Peka concluding report. Local Proactive Exercise Travel Expenses Andy Knight presented the report and advised that the report had been presented to a previous Audit Committee meeting but the report had been updated to take account of management updates. The issue of home to base deductions and self declaration in relation to valid driving license, MOT and insurance had already been covered earlier on the agenda. A follow up audit, including a larger sample of claims, had been undertaken in February 2015 and this report will be presented to the July 2015 Audit Committee meeting. The audit had identified further overpayments but it had now been agreed not to recover historic overpayments. Future overpayments will however be recovered. The Audit Committee agreed that overall responsibility for checking claim forms rested with the line manager and not with payroll staff. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 5 </p><p>Pippa Moger advised that E-roster will enable electronic travel claims to be produced and the software will automatically deduct home to base mileage. This E-roster package will be introduced in 2015/16. There had been a delay in rolling this software out due to issues with the travel claims form and these were being addressed nationally. Local Proactive Exercise Follow-Up Review Pre-Employment Checks Andy Knight presented the follow up review of pre-employment checks and highlighted the conclusions of the report. Overall improvements had been made since the original review was undertaken but a small number of issues had been identified in relation to the marking of copies of original identity, right to work and qualification certificates. In view of the changes in HR leadership, it was queried how the recommendations will be implemented and Pippa Moger agreed to liaise with Sally Fox, Interim Director of Human Resources and Workforce Development. Counter Fraud Recommendation Tracker Andy Knight advised that the recommendation in relation to the travel expenses had been completed. The remaining two recommendations related to the Managing Absence policy and the Policy for the Use of Bank and Agency staff and Phil Brice advised that the approval of these policies will be followed up with Sally Fox. The Audit Committee agreed that the recommendation in relation to the commissioning of a follow up review had been completed. Counter Fraud Work Plan 2014/15 Progress Report Andy Knight provided an overview of the progress made against the 2014/15 Counter Fraud Workplan and highlighted progress in relation to the strategic governance, inform and involve, prevent and deter, and hold to account areas. The annual survey of fraud awareness had now closed and 210 staff had completed the survey which was a significant improvement from the previous year. 99% of staff who had responded indicated that they would report fraud. Andy Knight highlighted the investigation into excess mileage being claimed via the standard mileage claim form at full mileage rate and advised that the findings of the investigation will be presented to the July 2015 Audit Committee meeting. The Audit Committee agreed that the volume of overpayments showed the impact the change in mileage claim rules had on individual members of staff. </p></li><li><p>V </p><p>Ratified Minutes of the Audit Committee meeting held on 15 April 2015 July 2015 Public Board - 6 </p><p> Andy Knight commented that some managers did not want to challenge staff about incorrect travel claims and one manager asked Andy Knight to explain the changes to the team. The Audit Committee agreed that this was a cultural issue and, going forward, any overpayments will be recovered from staff. The Audit Committee acknowledged that the impact of the changes in mileage claims on community staff had not been anticipated. Phil Brice advised that the implementation of the Integration Phase 2 project and Agile working will address some of the issues as not all staff will be required to go to a work base. The Audit Committee recognised that there was a risk that staff may take other actions to compensate for a loss in travel expenses, i.e. productivity, and Pippa Moger was asked to raise this with Andy Heron. </p><p>6. BDO INTERNAL AUDIT REPORT CQUINS Audit Report Greg Rubins presented the report and advised that the report provided limited assurance for both design and effectiveness. The rep...</p></li></ul>