2025_26_InternalAudit_CareAssessment_FinalAuditReport
Argyll and Bute Council · 16 June 2026
Back to Argyll and Bute HSCP Audit and Risk Committee — 16 June 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Classification: OFFICIAL Argyll & Bute Health & Social Care Partnership Internal Audit Report April 2026 Final High Medium Low VFM Number of Findings 3 0 0 0 Care Assessment and Resources Allocation – Adult Care Audit Opinion: Limited
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2 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL Contents 1. Executive Summary ........................................................................................................................ 3 Introduction ............................................................................................................................................ 3 Background ............................................................................................................................................. 3 Scope ....................................................................................................................................................... 4 Key Dates ................................................................................................................................................ 4 Risks ........................................................................................................................................................ 4 Audit Opinion ......................................................................................................................................... 5 Recommendations ................................................................................................................................. 5 2. Objectives and Summary Assessment ........................................................................................... 5 3. Detailed Findings ............................................................................................................................ 6 Appendix 1 – Action Plan ..................................................................................................................... 10 Appendix 2 – Audit Opinion ................................................................................................................. 13 Contact Details Internal Auditor: Moira Weatherstone Telephone: 01546 604146 e-mail: moira.weathrstone@argyll-bute.gov.uk www.argyll-bute.gov.uk
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3 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL 1. Executive Summary Introduction 1. As part of the 2025/26 internal audit plan, approved by the Audit & Risk Committee in February 2025, we have undertaken an audit of Argyll & Bute Health & Social Care Partnership (HSCP) system of internal control and governance in relation to Care Assessment and Resources Allocation – Adult Care. 2. The audit was conducted in accordance with the Global Internal Audit Standards (GIAS) with our conclusions based on discussions with Health & Social Care Partnership officers and the information available at the time the fieldwork was performed. The findings outlined in this report are only those which have come to our attention during the course of our normal audit work and are not necessarily all the issues which may exist. Appendix 1 to this report includes agreed actions to strengthen internal control however it is the responsibility of management to determine the extent of the internal control system appropriate to the HSCP. 3. The contents of this report have been agreed with the appropriate Health & Social Care Partnership officers to confirm factual accuracy and appreciation is due for the cooperation and assistance received from all officers over the course of the audit. Background 4. Health and Social care provide services designed to support individuals in maintaining independence and quality of life, assisting with daily activities and personal care, helping to improve physical health, mental wellness and social wellbeing. 5. Providing effective support for people in ways that address their personal outcomes is a priority for the HSCP. However, with a shrinking population, recruitment and retention of health and social care staff and rurality of Argyll and Bute, this presents many challenges to the delivery of services. Whenever possible, the HSCP support people to live healthily and well within their local communities, with their families and friends. 6. Care Management is a term applied to an approach to intervention whereby a professionally qualified officer undertakes assessment, planning, monitoring and reviewing activity. The assessment process for services involves engaging and communicating with individuals to identify their strengths, needs, risks, capacity and aspirations with a view to determining how intervention could assist in meeting desired outcomes. Central to the process is the collation, analysis and interpretation of information. This approach has a strong focus on managing risk, the use of specific interventions and /or significant complexity will exist e.g. legal matters. 7. An assessment of need is carried out by a health or social work care manager appointed to the service user and this will fully include the person requiring support. Resources are allocated in line with the Council’s Prioritisation of Need Framework. The need for such a framework is a direct response to the increasing gap between assessed need and available resources. Details of the framework: • Priority 1: Critical risk where serious harm or loss of life may occur. • Priority 2: Significant risk where harm may occur now or in the near future.
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4 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL • Priority 3: moderate risk where harm may occur if action is not taken in the longer term. • Priority 4: Low risk where a person’s quality of life may be affected, if need not met. 8. The Council operate a charging policy and a financial assessment which is undertaken will determine the cost of services to be provided. Personal care is free. Scope 9. The scope of the audit was to assess whether there are policies and procedures in place for the assessment and allocation for resources for adult care packages. as outlined in the Terms of Reference agreed with the Head of Adults, Hospital & Community Services on 12 December 2025. Topical Requirements 10. Topical Requirements are a new, mandatory component of the updated International Professional Practices Framework for internal auditing, they must be followed when auditing subjects for which a Topical Requirement exists or when aspects of the Topical Requirement are identified within other audits. 11. With increased demand for services on limited resources there was a recent call for a Health & Social Care Emergency to be declared at the November Argyll & Bute Council meeting, including a motion that the ‘Council recognises that Argyll & Bute face distinct challenges in delivering sustainable health and social care due to its rural and island geography, demographic change and infrastructure limitations. The motion was amended but not upheld, however, has drawn attention within local press. Key Dates 12. The Terms of Reference provided provisional timescales for the review to take place, the actual dates are noted below. Exhibit 1 – Key Dates Stage Actual Date Terms of Reference agreed 12 December 2025 Fieldwork Commencement 22 December 2025 Draft Report issued 09 March 2026 Management Comments received 13 April 2026 Final Report issued 21 April 2026 Audit and Risk Committee 16 June 2026 Risks 13. The risks considered throughout the audit were: • SRR07: Failure of the HSCP to deliver on its Strategic Priorities results in deteriorating health and wellbeing outcomes for the population and / or reduced access to appropriate health and social care services. This could also result in financial and reputational risk to the Council
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5 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL • Audit Risk 1: Failure to meet our statutory requirements • Audit Risk 2: Failure to provide an effective assessment and review processes Audit Opinion 14. We provide an overall audit opinion for all the audits we conduct. This is based on our judgement on the level of assurance which we can take over the established internal controls, governance and management of risk as evidenced by our audit work. Full details of the five possible categories of audit opinion is provided in Appendix 2 to this report. 15. Our overall audit opinion for this audit is that we can take a limited level of assurance. This means that internal control, governance and the management of risk are displaying a general trend of unacceptable residual risk above an acceptable level and placing system objectives are at risk. Weakness must be addressed with a reasonable timescale with management allocating appropriate resources to the issues raised. Recommendations 16. We have highlighted 3 high priority recommendations where we believe there is scope to strengthen the control and governance environment. These are summarised below: • A comprehensive procedure and guidance document that outlines the process in relation to Care Assessment and Resources Allocation – Adult Care should be complied. This should document the various stages from referral, assessment, allocation of funding, commissioning of care packages and subsequent reviews of cases. It should also outline the process for the transferring of cases into and out of the Authority area. • Roles and responsibilities should be clearly outlined and agreed between the NHS and Social Work in relation to Care Assessment for adult care, particularly the referral process. • Once agreed, procedures should be circulated to all staff within the HSCP and should be included in a robust induction process to ensure consistency of practice across the HSCP. 17. Full details of the audit findings, recommendations and management responses can be found in Section 3 of this report and in the action plan at Appendix 1. 2. Objectives and Summary Assessment 18. Exhibit 1 sets out the control objectives identified during the planning phase of the audit and our assessment against each objective. Exhibit 2 – Summary Assessment of Control Objectives Control Objective Link to Risk Assessment Summary Conclusion 1 Care Assessment policies and procedures are in place SRR07 Audit Risk 1 Audit Risk 2 Limited Where various documents are in existence for the assessment and management of care packages, many are out of date or in draft and the 2008 procedure document which has limited circulation does not reflect current practice or are in draft. There is a comprehensive suite of procedures on Eclipse, however, these relate to tasks
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6 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL within Eclipse. There is no single document that provides comprehensive guidance through the various stages from referral, assessment, allocation of funding, commissioning of care package and subsequent reviews of cases. 2 Policies and procedures are being applied consistently across all the Council areas Audit Risk 2 Limited We met with staff from each area within Argyll & Bute; however, the lack of a comprehensive procedural documents made it challenging to assess whether procedures are being applied consistently in each of the Council areas. However, it was concluded, through discussions, that there were inconsistencies in practise with each area developing their own processes. This was particularly the case for clients transferring into the area from another Local Authority and requiring a package of care. 3 Resources are allocated in accordance with policies and procedures and reviewed on a regular basis SRR07 Audit Risk 1 Reasonable Resources are allocated in terms of the priority of needs framework with P1 and P2 cases receiving packages. It is noted that financial resources are limited in some areas, resulting in only high-risk cases being prioritised for a care package, whilst other areas have financial resources available, however care providers did not have the available hours to support a package of care. It was intimated that there were inefficiencies in the number of processes that had to be completed in some cases to reach agreement on financial resources being agreed for packages and also a lack of clarity of budget availability to the locality. 19. Further details of our conclusions against each control objective can be found in Section 3 of this report. 3. Detailed Findings Care Assessment policies and procedures are in place 20. Comprehensive, detailed procedures for the assessment and allocation of resources are not in place. Argyll and Bute Council Assessment and Care Planning Procedures was provided to audit during the 2023/2024 internal audit review of Learning & Physical Disabilities Audit. This document is dated 2008 and whilst reasonably comprehensive it is out of date and does not
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7 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL reflect current practice, this was mirrored in the 2023/2024 Audit. We met with staff from around the Council areas and there was very little knowledge of the existence of this document. 21. A Resource Allocation framework is in place based on a prioritisation of needs with supporting procedure documentation. The prioritisation of all referrals is based primarily on the information received at the time of referral including any relevant background information held on CareFirst/Eclipse (client data base) and is prioritised according to risk. 22. In addition, we were provided with a staff Induction policy: Social Work Team Manager. This is dated September 2024. This document is designed: “To assist in your new role, we have developed this induction pack which you should complete with the support of you line manager within the first 6 weeks of starting your post if full time, 12 weeks if part time. This induction covers both the requirement to complete the Council’s corporate induction process and the service specific induction process”. This document focusses very much on high level Council information and HSCP information, including the structures and does not cover care assessment and care planning procedures. The Induction policy refers to the 2008 Assessment and Care Planning Procedures document. However, during the process of meeting staff from around the area we were advised by new staff that their introduction to procedures had been to place reliance of experienced long-serving staff within the Council passing on their knowledge or they based their practice on previous experiences with other Councils. 23. A suite of procedures is available on Eclipse, the HSCP client management system, this includes guides for Eclipse and details of responsibilities at various access levels and tasks within Eclipse. The documents specifically relate to the management of client cases on Eclipse and do not outline the process for the assessment and allocation of resources or case management. 24. A Terms of reference for the Area Resource Group was reviewed. It also features a draft process map for Priority 1 and Priority 2 cases. The purpose of this document is to describe the role, function and remit of the Area Resources Group (ARG) as follows: • To oversee and manage Unmet Need lists, in line with principles of dynamic risk management. • To review all available efficiencies, across all areas, and realign according to budget pressures and organisational need. • To oversee and manage Adult Support Plan reviews and direct accordingly, in line with agreed priority and protocols. • To review and undertake quality assurance and scrutiny for all cases of 28.0 hrs or more, following an agreed checklist and process. • In cases of 28.0 hrs or more, where the specified conditions are met, forward the recommendation to the Escalations Panel for consideration resource approval. The Terms of Reference also included remits and functions for: • Care Referrals Meeting (CRM) meeting daily • Care Resources Group (CRG) meeting weekly • Area Resources Oversight Group (ARG) meeting weekly • Exceptions Panel
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8 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL 25. The overall assessment of whether policies and procedures are in place in relation to Care Assessment and Resources Allocation of Adult Care is that there are various documents in circulation, however, there is not an up-to-date document that outlines the whole process from referral to resource allocation and review of case. Action Plan 1 Policies and procedures are being applied consistently across all the Council areas 26. There is broad agreement across all areas on what the process is, however, these have been developed within the areas with slight differences. We met with staff from each area within Argyll & Bute; however, the lack of a comprehensive procedural documents made it challenging to assess whether procedures are being applied consistently in each of the Council areas and in line with agreed procedures. However, it was found that there were inconsistencies in practise with each area developing their own processes. 27. Helensburgh & Lomond have retrained the position of Information Worker. The Information Worker is the first point of contact with regards to referrals and are responsible for gathering information from the referrer and recording details on Eclipse. All other areas in Argyll & Bute do not benefit from this resource. Within the NHS, clerical staff can take details of referrals, including, at times assessment level detail. 28. There are inconsistencies in practice between Social Work and NHS staff within the HSCP in respect of the care and assessment processes, this includes suggested inefficiencies in practice. This was highlighted in one area where NHS staff will complete part of an adult care assessment following a referral, leaving Social Work staff to complete the assessment. 29. There were inconsistencies in practice where clients are transferring from one Local Authority into Argyll & Bute. There is government guidance available for this process and agreement should be reached that the out with area Authority should continue to pay care costs for a period of 12 weeks to allow Argyll & Bute HSCP to undertake a full assessment. However, this can create a situation whereby care is received ahead of those on the waiting list. Action Plan 2 30. The lack of comprehensive procedures and induction of new staff has led to new staff members, including at management level placing reliance of longer serving members of staff advising of processes or adapting best practice from the Local Authority they had previously worked for or developing their own area process maps. This further has the potential to lead to inconsistency of practice across all areas. Action Plan 3 Resources are allocated in accordance with policies and procedures and reviewed on a regular basis 31. Resources are allocated in terms of the priority of needs framework with P1 and P2 cases receiving packages. It is noted that financial resources are limited in some areas, resulting in only high-risk cases being prioritised for a care package, whilst other areas have financial
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9 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL resources available, however care providers do not have the available hours to support a package of care. 32. Resource allocation and commissioning of care packages undergo several steps prior to being authorised and a package of care put in. Where it was understood that resources are limited and had to be managed carefully, there was a feeling that processes could be seen as over complicated. In addition, in one area there was not clarity on budget availability within their area. 33. There are inconsistencies across the Council areas in terms of the level of reviews that are being undertaken due to staffing shortages or the high number of referrals being received, resulting in reviews not being undertaken unless there was a change requested to the package. Action Plan 1
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Classification: OFFICIAL Appendix 1 – Action Plan No Finding Risk Agreed Action Responsibility / Due Date High 1 Procedures and Processes The overall assessment of whether policies and procedures are in place in relation to Care Assessment and Resources Allocation of Adult Care is that there are various documents in circulation, however, there is no comprehensive up-to-date document that outlines the whole process from referral to resource allocation and review of case. Inconsistency of practice across the Council area Establish a Short Life Working Group to review existing procedures and processes, identifying areas for improvement and updating documentation where appropriate. Agree standardisation of processes. Develop a comprehensive SharePoint directory to house all relevant processes, supported by a clear change control process to ensure accuracy, consistency, version control, and timely updates. Professional Lead Social Work/ Head of Adults – Hospital & Community Services 31 March 2027
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11 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL High 2 Roles and Responsibilities There are inconsistencies in practice between Social Work and NHS staff within the HSCP, this includes suggested inefficiencies in practice. This was highlighted in one area where NHS staff will complete part of an adult care assessment following a referral, leaving Social Work staff to complete the assessment. In addition, there is inconsistencies in the referral processes with Helensburgh & Lomond benefiting from an Information Worker resource to NHS clerical staff taking significant confidential details of referrals, including, at times assessment level detail. Lack of clarity in terms of roles and responsibilities leading to inefficiencies within the service A part of the Short Life Working Group will be to review and define key roles and responsibilities, ensuring these are clearly articulated and embedded within a standard operating process to support effective, consistent, and accountable practice. Professional Lead Social Work/ Head of Adults – Hospital & Community Services 31 March 2027 High 3 Distribution of Policies and Procedures The lack of comprehensive procedures and induction of new staff has led to new staff members, including at management level placing reliance of longer serving members of staff advising of processes, bringing in what was best practice from the Local Authority they had previously worked for or developing their own area process maps. This further has the potential to lead to inconsistency of practice across all areas. Policies and procedures not widely distributed leading to localised procedures being adopted A part of the Short Life Working Group will be to Implement a shared directory on SharePoint to host all approved and agreed policies and procedures. This will be supported by a clear change control process, including version control, ownership, approval pathways, and scheduled review dates to ensure documentation remains current and accurate. Professional Lead Social Work/ Head of Adults – Hospital & Community Services 31 March 2027
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12 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL In order to assist management in using our reports a system of grading audit findings has been adopted to allow the significance of findings to be ascertained. The definitions of each classification are as follows: Grading Definition High A major observation on high level controls and other important internal controls or a significant matter relating to the critical success of the objectives of the system. The weakness may therefore give rise to loss or error. Medium Observations on less significant internal controls and/or improvements to the efficiency and effectiveness of controls which will assist in meeting the objectives of the system. The weakness is not necessarily substantial however the risk of error would be significantly reduced if corrective action was taken. Low Minor recommendations to improve the efficiency and effectiveness of controls or an isolated issue subsequently corrected. The weakness does not appear to significantly affect the ability of the system to meet its objectives. VFM An observation which does not highlight an issue relating to internal controls but represents a possible opportunity for the HSCP to achieve better value for money (VFM).
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13 Argyll & Bute Health & Social Care Partnership – Internal Audit Report – Care Assessment and Resources Allocation – Adult Care, April 2026 Classification: OFFICIAL Appendix 2 – Audit Opinion Level of Assurance Definition High Internal control, governance and the management of risk are at a high standard. Only marginal elements of residual risk have been identified with these either being accepted or dealt with. A sound system of control designed to achieve the system objectives is in place and being applied consistently. Substantial Internal control, governance and the management of risk is sound. However, there are minor areas of weakness which put some system objectives at risk and specific elements of residual risk that are slightly above an acceptable level and need to be addressed within a reasonable timescale. Reasonable Internal control, governance and the management of risk are broadly reliable. However, whilst not displaying a general trend, there are areas of concern which have been identified where elements of residual risk or weakness may put some of the system objectives at risk. Limited Internal control, governance and the management of risk are displaying a general trend of unacceptable residual risk above an acceptable level and placing system objectives are at risk. Weakness must be addressed with a reasonable timescale with management allocating appropriate resources to the issues raised. No Assurance Internal control, governance and the management of risk is poor. Significant residual risk and/or significant non-compliance with basic controls exists leaving the system open to error, loss or abuse. Residual risk must be addressed immediately with management allocating appropriate resources to the issues.