Audits Key to Improving Problem Gambling Services

Audits Key to Quality Improvement in Problem Gambling Services

A quality improvement programme for problem gambling services means they are well placed to manage additional demand likely from an awareness raising campaign planned to begin later this month.

The quality improvement programme, which operates on a three-year audit cycle, was timely for investigating concerns raised about the low level of client numbers being treated by some providers.

The programme included auditing, for the first time, all problem gambling services as the start in a series of improvements to services over time.

The audits covered contracts in the 2005/06 financial year with 28 providers nationwide and fed into a review resulting in the closure of three services from the end of this month; reduced funding for five providers; and closer monitoring of five others.

The Ministry is working with a number of other providers to address issues raised by the audits. A summary of the key findings from the audits is included below.

Deputy Director General, Mental Health Dr Janice Wilson says the changes represent approximately $750,000 per annum of ongoing savings based on the current service model.

Dr Wilson says the Ministry has considerable sympathy with those trying to help individuals with gambling problems. Problem gamblers are often difficult to identify; they often hide their problem from friends and family; they won't seek help until their gambling has taken a considerable toll; nor take treatment consistently when offered; and promises of better behaviour are frequently followed by relapses.

"All addictive behaviours are difficult to treat. It seems a bit obvious to say so, but these behaviours are hard to change precisely because they are addictive. Successful outcomes are dependent on the full involvement of the individual with the gambling problem and frequently the hardest step is getting an individual to recognise and accept they actually have a problem and agree to a course of treatment."

Dr Wilson says it is often for these or other reasons, including a number of relatively new providers facing difficulties getting themselves established, that problem gambling services have difficulties getting problem gamblers into treatment and then keeping them there.

"Over the past 18 months we have worked hard with providers to ensure good service coverage around the country for ease of access to treatment, and doing this cost effectively.

"In two cases we have also worked through issues of under-delivery where the providers have been funded for staffing services to a certain level, and then for one reason or another haven't been able to deliver to the level in their contract. In both cases the Ministry has reached agreement on either returning funds or providing services to make up the difference."

"Having completed the audits the Ministry has a process in place to ensure that it is continually improving the quality of its contract management for problem gambling service providers. We believe we are in a good position now for the launch of the campaign in the next few weeks to raise awareness of problem gambling".

Dr Wilson says "On one hand we appear to be in quite a good position because it’s clear that the number of people with gambling problems seeking treatment is lower than expected. But on the other hand we're concerned that the dip in treatment numbers disguises the many other problem gamblers yet to be identified and it may be the case that the numbers will go up again."

Early indications from providers is that in the last six months there has been an increase in service activity and we expect to be able to confirm this trend shortly.

Copies of the audit reports are available on request from the Ministry of Health.

Key Findings from the 2005/06 Problem Gambling Service Contract Audits undertaken for the Ministry of Health between August and December 2006

Between August and December 2006 the Ministry of Health undertook a routine audit of all problem gambling service providers (intervention and public health).
These audits are part of a programme of continuing improvement in a three-year cycle, as part of the Ministry’s overall contract management.
This was the first audit cycle for problem gambling service providers against their contracts to review governance, business and financial management, and service delivery and service quality. The audits found overall that providers complied with the majority of their contract requirements. There were a number of non-compliances in respect of infrastructure and general management practices that are being worked through with providers.
Specific issues identified were:
* data quality, and general understanding of the Ministry’s database reporting requirements and service definitions for database purposes. The Ministry has initiated a process to ensure that provider reporting, collection and accessibility of monitoring information and database definitions and requirements are consistent across providers, meet high quality contract practice, and are consistent with recognised contracting principles

* reported and actual low service volumes. The Ministry will closely support and monitor providers who have been under-reporting service volumes and those whose performance has been lower than the service user targets in their contracts by 30 June 2007

* issues of under delivery where two providers were funded for staffing services to a level that they have not been able to deliver on. In both cases the Ministry has reached agreement on the return of funds or providing services to make up the difference

* clearer outcome specification in contracts for intervention services to assist with outcome measurement and reporting. The Ministry will review outcome measures within problem gambling contracts as part of its programme of ongoing improvements for the next contracting round.

The Ministry has incorporated into its routine contract monitoring process workout plans to address the recommendations from the audits in relation to each problem gambling service provider. These plans will be fully implemented by 30 June 2007.

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