BRIEFLY:
- The provision of technical aids to residents is not organised in the best possible way to receive them on time and as close to the place of residence as possible.
- Funding for the provision of the service increases every year but the queues do not decrease because the provision and delivery of the service is inefficient and does not correspond to modern work organization.
- At the end of 2023, almost 900 residents were on a waiting list although the necessary technical aids were available in warehouses.
- In recent years, the basket of technical aids has been improved significantly. In general, it provides residents with the opportunity to receive the necessary aids; however, they are constantly evolving so this mechanism should be made more flexible.
The State Audit Office of Latvia has concluded in the audit that the “basket” of technical aids provided by the state is generally sufficient and meets the needs of the population. However, the provision of technical aids to the population is not organised in a way that they are received in a timely manner and as close to the place of residence as possible. The problems are not in the financing of the service but in the process itself. The problems mainly concern the Vaivari Technical Aids Centre.
The population is provided with 266 state-funded types of technical aids, and approximately 20 thousand people receive them annually. Technical aids are provided by three contractual organizations of the Ministry of Welfare:
- The Latvian Society of the Blind (LNB) provides 29 types of technical aids (typhlotechnics);
- The Latvian Association of the Deaf (LNS) provides 12 types of technical aids (signing);
- The Vaivari TPC provides 225 types of technical aids by attending 69% of all recipients.
“Technical aids are an essential social service whose funding is increasing every year by reaching 17.1 million euros in 2023. However, complaints are still being heard in the public space about both the long queues and the state co-payment mechanism if a person wants to purchase the aid themselves. During the audit, we ascertained that increasing funding alone did not solve the problems if the administration of the service was not improved significantly. Processes must be reviewed and the capabilities of information systems should be used wherever possible, thereby reducing manual work significantly. We appreciate that with the change of management, the Vaivari TPC started to address several identified problems in a timely manner at the end of May this year,” emphasised Ms Maija Āboliņa, Council Member of the State Audit Office of Latvia.
Specialists who can provide an opinion for receiving a technical aid are not always available everywhere. To receive a technical aid, an opinion from a medical practitioner is required. The latter can be provided by a treating physician including a general practitioner and a physical rehabilitation and medical doctor, an occupational therapist and a physiotherapist, and a technical orthopaedist and audiologist for certain technical aids. The waiting time for a state-funded visit to these specialists varies significantly in different medical institutions, that is, 103 days on average and it can reach up to one year. For receiving a typhlotechnics and devices for the deaf, an opinion must be submitted only if this information is not already available at the LNB and LNS. In its turn, for receiving technical aids provided by the Vaivari TPC, an opinion must be submitted in all cases including when requesting a technical aid once again to replace a worn-out one with a new one.
Some residents must additionally undergo an in-depth functional assessment to receive a technical aid (for example, if a prosthesis or an electric wheelchair is needed). This is provided only at the Vaivari TPC and only in Riga. Therefore, people from all regions of Latvia have to travel to the capital, and the waiting time for an in-depth assessment is between 93 and 183 days depending on a type of technical aid the person needs.
The administration of the technical aids service is archaic, it does not use the capabilities of information systems. Waiting list and warehouse management is carried out manually that is inevitably due to the outdated information system. In its turn, the implementation of the new IT solution, which has begun in 2018, will not improve the situation because the Ministry of Welfare did not conduct a sufficient process analysis before starting the project but simply digitised the existing manual system. It does not allow one to find out whether the necessary aid is already available in a warehouse, and the waiting lists are reviewed less often than once a month or even only once a quarter. In almost 900 cases, customers continued to wait in line although the technical aids were available in the warehouse. The process is further hampered by slow communication with customers. It is done by mail and its preparation can take more than a month. The urgent procedure also does not solve the problem because customers wait until the manual review of waiting list. Under the urgent procedure, technical aids can be received after 72 days on average and after 110 days according to the regular procedure.
Even after sending the invitation, the issuance of technical aids to residents is disproportionately long and burdensome. All technical aids are issued only in person when a customer or their authorised representative arrives at the contracting organization including a branch/department or an on-site location which covers only part of local and regional governments. It affects the customers of the Vaivari TPC most significantly because visits are organised to some on-site locations every month but only a few times a year to other on-site locations. Therefore, from an invitation to receive a technical aid to the actual receipt, one has to wait 57 days on average and even more than 3 months in several cases. In addition, residents can receive bulky technical aids (functional beds, mobile lifts) only by arriving at the Vaivari TPC headquarters or a branch with their own transport. In the auditors’ opinion, the situation can be improved significantly by delivering simple and bulky technical aids to the place of residence of their recipients. By solving the delivery, the waiting time would be reduced by an average of 79 days or 11 weeks. Delivery costs would be around 60,000 euros per year. It should be added that the Vaivari TPC did not spend at least 3.14 million euros in 2023. The Ministry of Welfare redistributed a part of this funding then to solve other problems relevant to the welfare sector.
The state-provided “basket” of technical aids is adequate but it might not be flexible enough to respond to changes in the future. The state-provided “basket” of technical aids is generally sufficient and meets the needs of the population. It is supplemented by a co-payment mechanism when a person can purchase a necessary technical aid like a specific model, specially equipped, with increased functionality on their own while the contracting organisation compensates for the purchase costs. This mechanism is also a solution in cases where a model of the technical aid required by a person is included in the “basket” of technical aids but is not available at a specific moment.
However, the choice of people to purchase a technical aid with a co-payment is influenced by the amount of state compensation, which is not sufficient in all cases. In a fifth of cases examined during the audit, the cost of purchasing the technical aid was 51% higher than the amount of state compensation.
The State Audit Office of Latvia considers that the determination of state compensation needs to be improved and a solution must also be found for the purchase of specific technical aids if the person needs it impartially since technical aids are constantly developing.
Recommendations of the State Audit Office of Latvia #PēcRevīzijas
Six recommendations have been made to the Ministry of Welfare whose implementation no later than in 2028 (1) will improve the quality of opinions provided by medical practitioners and allow residents to receive them more conveniently and quickly, (2) technical aids available in a warehouse will be issued immediately by reducing the waiting list and waiting times, (3) simple technical aids will be available without having to come in person, (4) there will be more opportunities to purchase technical aids with a co-payment by updating the amounts of compensation systematically, (5) an individual mechanism will be introduced to ensure the possibility of receiving technical aids in cases where they are objectively necessary but not included in the standard “basket”, and (6) rational circulation and disposal of used technical aids will be ensured.
About the State Audit Office of Latvia
The State Audit Office of the Republic of Latvia is an independent, collegial supreme audit institution. The purpose of its activity is to find out whether the actions with the financial means and property of a public entity are legal, correct, useful and in line with public interests, as well as to provide recommendations for the elimination of discovered irregularities. The State Audit Office conducts audits in accordance with International Standards of Supreme Audit Institutions of the International Organization of Supreme Audit Institutions INTOSAI (ISSAI), whose recognition in Latvia is determined by the Auditor General. Upon discovering deficiencies, the State Audit Office of Latvia provides recommendations for their elimination, but it informs law enforcement authorities about potential infringements of the law.
Additional information
Ms Gunta Krevica
Head of PR and Internal Communication Division
Ph. 23282332 | E-mail: Gunta.Krevica@lrvk.gov.lv