An on-call consultant paid more than €14,000 for one week’s work at Cork University Hospital, and a €25,000 monthly payment for radiology services at Bantry General Hospital where the contract was awarded with no tender process, are among the shortcomings highlighted in a series of HSE internal audit reports.
On-call consultant paid €14k for a week
An audit of agency medical services at CUH last September found the hospital was being billed an amount “150% greater” than specified in the contract with the agency in relation to one specific consultant.
CUH medical manpower management said the consultant was required for “a specific specialty” and due to the difficulty in obtaining the services of an agency consultant for this specialty, they had little choice.
The consultant was “essential to avoid having to close the facility from time to time” and CUH “had been obliged to pay more than the contract rate”.
The upshot was an overall charge of €14,080 compared to an expected charge of €5,633, for being continually on call for a period of one week, a variance of €8,447.
The consultant was also being reimbursed for hotel expenses while on-call off-site to CUH.
The audit team said the rates did not agree with the rates contracted with the agency and should not be charged. It recommended CUH tell the agency the rates specified in the contract are set “and cannot vary from nationally agreed rates”.
It said CUH should look at making a separate arrangement with the consultant to ensure service delivery.
CUH said it accepted the fees “are very costly” and that a new service level agreement due to take effect in 2017 meant the preferred locum agency could only charge the standard hourly rate.
At University Hospital Kerry (UHK), a recruitment fee in excess of €20,000 was paid to a recruitment company for the appointment of a consultant “but it was found the consultant was an employee at the time the fee was paid”.
The total charge from the recruitment company was €19,260 ex Vat.
The report said: “This amount was in essence paid to secure the services of an employee who was already directly employed by UHK at the time the service was engaged.” UHK said when the consultant was offered an extended contract of employment, this triggered a clause in the initial recruitment agreement “for which UHK was liable due to the continuation of employment past the initial period”.
At Bantry General Hospital (BGH), no procurement process was followed in awarding a contract to a third party medical services supplier, who charged a monthly amount of €25,000 for the provision of radiology services. The contract was in place since 2013.
The hospital said the service is required “in order that BGH retains it radiology service”.
Management confirmed its procurement process had not been completed prior to awarding the contract as required under EU law and HSE financial regulations.
Yesterday a spokesperson for the hospital said: “Requests for the provision of radiology services at BGH went to public tender in May of last year. The selected service provider commenced the delivery of services on the 1st of March this year.”
Youth group paid for transatlantic flights and hotel stays
An audit of a taxpayer-funded service provider for young people has raised concerns over its spending on transatlantic flights, hotel stays, restaurants, and gifts.
The HSE probe into Youth Advocate Programmes Ireland (YAP Ireland) queried the purchase of some products such as laptops and questioned whether all the expenditure on the company’s credit cards had a business purpose.
It also asked why YAP Ireland, which provides support services for young people and families referred by the Child and Family Agency Tusla, paid for travel and accommodation of two US-based board members.
The audit covered the period 2014-2016, during which time Tusla funded YAP Ireland by between €3.3m and €3.6m a year. The review found that expenses paid out by YAP Ireland exceeded €300,000 in each of the years audited.
In their 31-page report, auditors warned that:
- “There is a risk that YAP Ireland is not achieving value for money when paying €6,000 for two US resident board members to fly to Ireland to attend Board meetings and events.”
- A company credit card was used to pay a €125 clamping fine for a YAP advocate.
- A €6,084 payment was made for an overnight stay in Killashee House Hotel. The CEO said the payment was for an annual strategy away-day for management. Auditors warned there was a risk that expenditure “did not have a valid business purpose when proper records of business purpose of expenditure are not maintained”;
- There was no evidence of board approval for ex gratia payments made to departing staff;
- A “lack of robust HR procedures” resulted in litigation settlements and increased expenditure on insurance costs after two personal injury and unfair or constructive dismissal cases were taken against YAP Ireland. Insurance premium costs went from €15,239 in 2014 to €67,867 in 2016;
- YAP Ireland had seven separate expenses funds for staff, but no written guidelines in place for what could be claimed from these, or what amounts could be claimed;
- There was a lack of effective controls in place and a lack of backup of vouched expenses. One employee claimed €31,870 in expenses in one year;
- There was also a risk of “unauthorised expenditure” on credit cards identified, as spending on two of the three cards was authorised by the same people in possession of the cards.
The total credit card expenditure across 2014-2016 totalled €92,909, including €19,820 on hotel stays, €12,528 on restaurants, €9,590 on gifts and entertainment, and €23,411 on office supplies.
However, auditors cautioned that “some of the credit card expenditure, in particular the restaurant expenditure and gifts and entertainment, may not have a business purpose”.
The audit queried other purchases on the YAP Ireland credit cards — €1,669 on kitchen appliances, €1,000 on flatscreen TVs and accessories, €1,689 on laptops including a “gaming laptop”, and €1,220 on a digital camera and accessories. It found that there was no evidence of purchase orders, business cases, or authorisation for these purchases and that only some of the items bought could be found in the YAP Ireland Dublin office.
In all, the auditors noted 60 findings, 42 of which were identified as high priority, meaning they pose “a significant risk of substantial financial loss, and/or of accounting error, and/or of major non compliance with policies or regulations and requires immediate action”.
Central Mental Hospital warned over staff blood tests
The HSE investigated the Central Mental Hospital after it received allegations that the facility was providing medical services and medication to some staff free of charge.
The CMH has also been warned about its security measures after a probe found that the keys to three safes in the hospital were kept in a cabinet that had its own key left in the door, all in view of a window.
An audit reveals how an anonymous emailer claimed that staff members were having blood samples taken for testing, and were provided with antibiotics and painkillers for personal use.
Auditors contacted the accuser by email to seek further information, but the whistleblower then withdrew the allegations.
However the audit continued regardless, and management and primary care unit staff confirmed that “it was the practice to carry out tests for staff and that the hospital’s primary care unit did take bloods for staff members”.
Auditors were told staff would have their blood taken by their GPs and attend the unit with the samples, which were included with CMH patients’ samples sent to St Vincent’s Hospital.
The primary care unit staff also told auditors that “occasionally medication (antibiotics and painkillers) were provided to staff members for their personal use”.
The HSE auditors warned CMH management to immediately end both practices.
The unofficial practice of taking blood samples for staff members could lead to legal action being taken against the HSE in the event of something going wrong during the unauthorised process,” the report cautioned.
“Providing staff members with medication which was unprescribed for them could potentially lead to adverse reactions in the recipients and legal issues for the HSE and CMH.”
Meanwhile, auditors also noted security concerns regarding three safes in the CMH administration department.
They found that the three safes were “in view of a clear glass window”, and warned that the contents were at risk of theft.
“The keys to the safes were held in a locked key cabinet. The key to the key cabinet was left in the door of the key cabinet in view of the window.
Leaving the key inserted in the key cabinet increases the risk of theft,” the audit stated.
Staff were also unaware of the maximum amount of cash that could be kept in each safe for insurance purposes, and there was no register listing the contents of each safe.
The audit also questioned the distances claimed by some staff when submitting expenses claims, and in one case found that a consultant claimed €116 in mileage on days when they were on annual leave.
Staff payments ‘year after facility shut’
Staff working at a residential service run by the Child and Family Agency (CFA) continued to receive unsocial hours payments and sleepover rates more than a year after the home had closed.
Despite being reassigned to community placements such as working with fostering teams and delivering parental courses, the staff at the centre in Knocknamona, Letterkenny, Co Donegal, continued to be paid sleepover shifts and also for weekend and night duty.
An internal audit of the service by the HSE expressed concern that since the closure of the centre, staff time “has not been utilised in accordance with identified placements” and the budget “bears no resemblance to the cost of providing the service”.
This is borne out in the figures which show an underspend of €1.2m for the year to the end of December 2016 and of €558,000 in the year to May 31, 2017.
The purpose-built centre was the only remaining children’s home in the area, providing care for up to five children aged 12- 17.
The audit found:
- Staff were still receiving premium payments, unsocial hours payments and sleepover rates in September 2017, 16 months after the home was the subject of a temporary closure order, despite changed roles and responsibilities;
- Weekly time returns were not signed by employees, nor was a declaration on the form to state the hours specified were actually worked;
- Some returns gave a breakdown of duties performed, others gave no indication of the location of the community assignment or work carried out;
- Time returns were certified by social care leaders and not by a representative from the social work team where the staff member was temporarily reassigned into the community;
- Staff had eight active procurement cards, three of which had ATM withdrawal facilities even though Tusla policy is for a maximum of two cards with withdrawal capability per location.
One of the cards listed on the bank register had an active status even though the employee was on a career break.
The CFA/Tusla told the audit team that when the temporary closure was put in place on May 19, 2016, it was agreed 10 staff would continue to be based at the home and their eight-week rolling roster would continue to apply. It was also agreed, for the period of the temporary closure, staff would be reassigned to other duties.
The audit team said the agreement needed to be reviewed as the temporary closure “has now become long term”.
It said their findings “provide limited assurances that the residential service is operating as intended since the closure order”.
The team said negotiations should be held with staff on pay “that better reflects their work under the temporary closure”.
The audit team recommended Tusla make a decision on the future of the service.
Yesterday, a spokesperson for Tusla said discussions were continuing in relation to re-opening the service “under a new purpose and function”.
However, no definitive date has been agreed other than “it is hoped the service will reopen later this year”.
Financial records could not be found
Three years worth of financial records for a service for vulnerable children in Dublin could not be found when it was audited by the Health Service Executive.
A probe into Familiscope, which was wound up and merged with another facility in 2014, raised questions about ATM withdrawals from its bank accounts, some of which took place after it was wound up.
Familiscope provided a service for children, young people, and families in Dublin 10 who had experienced emotional and behavioural issues, and it was merged with Ballyfermot-based The Base in April 2014.
The merged entity was called Familibase, but an earlier audit of this new service did not include Familiscope’s final financial statements.
The latest audit was therefore conducted to seek assurances that Familiscope’s net assets at the time it was wound up were correctly included in Familibase’s 2014 records.
However, Familiscope’s financial records from 2012 to 2014 could not be located for the auditors, and a late filing of its audited financial statements resulted in a €2,500 fine from the Companies Registration Office.
When the auditors were eventually provided with bank statements, they showed that ATM withdrawals from one account totalled €19,800 — with €12,510 worth of transactions taking place after Familiscope was wound up in April 2014.
The maximum daily withdrawal limit of €700 was reached six times between 2013 and 2014.
While a sample audit of one month’s expenditure found that the amount spent in petty cash accounted for the ATM withdrawals in that month, “no documentation could be provided to reconciliation of the petty cash expenditure in the month to the amount withdrawn in that month”.
Auditors also looked at the Familiscope credit card, from which €4,751 was spent from January 2014 to June 2016.
It is not possible to provide assurance that any expenditure which may have been on this account during this period was appropriate and germane to the business,” said the auditors.
The investigation found board members had not reviewed or authorised the credit card expenditure, which auditors cautioned raises a risk “of unauthorised expenditure”.
Hospital external storage costs rose from €7,000 per annum to €800,000
When Galway University Hospitals entered a contract in 2008 for external storage of medical records, the cost was estimated at €7,000 per annum, but by 2016, the cost was €800,000, driven by the addition of services over the years which were not tendered for.
An internal audit conducted by the HSE found management at University Hospital Galway and Merlin Park had entered into “a number of other pricing arrangements with the service provider that were not tendered for”.
In 2008, the number of boxes in storage was 2,590; the figure as of December 31, 2016, was 32,027.
The audit found that the 2008 contract was for two years with an option for renewal but that it remained in place nine years later, along with a related agreement that has no termination date.
The audit team said where a contract is due to expire or where a new service is required in respect of records in external storage, the hospital should “ensure compliance with HSE guidelines”.
An audit that looked at use of external storage in the University of Limerick Hospitals group came across an invoice for €20,360 coded as storage of crockery, tableware, and utensils, between January and May 2017.
An audit team following up on findings from 2015 said management at Mayo University Hospital should pursue private health insurers on a monthly basis to chase outstanding claims.
As of June 30, 2017, there was €818,000 in claims submitted to insurance providers awaiting payment. During this audit, it was noted that in pre-admittance, oncology patients were not admitted or discharged through the system, so no invoices could be raised, estimated at €55,000 in lost revenue.
An audit looking at the use of non-emergency ambulance transport by Sligo University Hospital found it was paying an additional €700 per journey when the first- choice provider was used over the second-choice provider.
Four private providers are used, with LifeLine as first choice, Medicall as second, Beaumont as third, and Murray Ambulance Services as fourth choice.
However, LifeLine’s interpretation of the compulsory pricing schedule outlined in the National Framework Agreement covering the region differed to the interpretations of the other providers and “essentially as a result”, the hospital was paying an additional €700 per journey over the cost of travelling with Medicall for each return trip to Dublin.