Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceExecutive FunctionsThe new Executive should subsume the statutory functions of many existing executive agencies andbe given any additional powers needed to manage the health service as a unified entity. Thesefunctions should include:●●●●●Planning and managing the organisation of specialist services/hospitals.Deciding on the number and type of Consultant posts in each specialist service/hospital.Planning and organising the provision of primary medical services.Coordinating the management of the various interdependent functions necessary to run thehealth service as a unified service e.g. manpower planning and recruitment, procurement,systems of funding and resource allocation.Ensuring that corporate governance meets the principles of best practice.Executive TasksThe following priority resource management issues should be addressed by the new Executive:●●●●●●●Putting in place the new budgetary and accountability systems.Managing the investment in information systems which is necessary.Negotiating the changes necessary for the effective management of the health service with keystakeholders.Putting in place performance management and management development programmes.Eliminating the inappropriate use of expensive acute hospital beds by providing alternatives forthe long stay patients who occupy them.Reorganising the Accident and Emergency services so as to keep more beds available forelective cases.Introducing more ambulatory day surgery to reduce waiting lists and increase throughput ofpatients.Department of Health and ChildrenThe creation and maintenance of the national policy framework within which the new Executiveperforms will place heavy demands on the Department of Health and Children. The work of theDepartment will require close interaction with the new Executive to ensure that the political and theexecutive systems for delivering the health service are kept closely aligned.Regional Health BoardsThe health board structure should be retained (although their number and functional areas should bereviewed) to safeguard the need for local democratic representation. The CEO of the Executiveshould be accountable for the performance of health board CEOs. The executive functions of healthboard CEOs should be expanded to include that of agreeing with the new Executive the Service Planfor the region, the implementation of national Service Plans/strategies within the region and thedevelopment of uniform financial planning, management and control systems for the health service.Service Planning, Budgeting and Supplementary EstimatesA single comprehensive and standardised template for Service Plans should be adopted. Plans andbudgets should derive from the individual plans of clinical Consultants and General Practitioners andfrom individual managers responsible for services not provided by clinically independent doctors. Athree-year rolling indicative financial and service planning system should be introduced. Changesshould be made in current arrangements for budgeting and for controlling expenditure on8
Executive Summary"demand-led" schemes.Accountability for Financial Management and Control in General HospitalsThe accountability for managing resources and for financial control should be devolved to thosepersons with the authority to commit or expend resources. Such persons should be accountable forhow those resources are used. Systems of clinical budgeting at the level of individual clinical practicesshould be developed. Budgets should focus on producing targeted outputs for patients in the mostcost effective way. These systems should identify the true economic cost of treating private patients.Existing arrangements, which enable medical Consultants to combine their public hospital commitmentwith private practice, are inherently unsatisfactory from a management and control perspective.To address this, we recommend that all new public consultant appointments be on the basis of acommitment to work exclusively in the public sector.Accountability for Resource Management in the GMS and Drug Refund SchemesThere should be a fundamental review of the General Medical Service with a view to agreeing withGeneral Practitioners how budgets can be established to deliver agreed levels of service andtreatment to patients which is in the interests of patients and of reducing unnecessary demands onexpensive hospital services. Arrangements under the Drug Payment Scheme should also be reviewed.Accountability for Controlling Pay CostsThere should be a detailed review of the drivers of pay costs including systems for control ofnumbers, for manpower planning and for work planning and scheduling which can control or reducepremium payments for non-emergency work outside core working hours.Financial Information SystemsThere needs to be an accelerated programme of investment in information systems to extend SAPand PPARS to all major spending agencies. This recommendation is contingent on the evidence of adetailed business case, parallel implementation of the organisational changes we recommend and therecruitment of certain key financial, human resource management and information technologypersonnel. Investment without the necessary other changes could be a waste of money.Other SystemsWe have also made recommendations on the development of governance structures such as internaland external audit, financial control, risk management and performance management.ImplementationWe do not underestimate the challenges that our recommendations pose. The scale of the changeswe envisage illustrates the size of the task.These include:●●●●●The creation, re-organisation and consolidation of agencies;Changing staff conditions;Engaging clinicians in resource management in a meaningful way;Addressing the issues in their contracts to enable this happen; andThe legislative programme.To ensure that the major changes we have recommended are implemented pending the establishmentof the new Executive, we recommend that a National Implementation Committee under an9
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Chapter 5 Accountability - Hospital
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Chapter 6 Accountability - General
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Chapter 8 Audit ReformCHAPTER 8AUDI
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Chapter 8 Audit ReformRecommendatio
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Chapter 8 Audit Reformoutsourcing)
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Chapter 8 Audit Reformaudit reports
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Chapter 8 Audit Reformas relating t
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Chapter 8 Audit Reform●●Penalti
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Chapter 9 External Reporting Proced
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Chapter 10 Information SystemsStrat
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Chapter 10 Information SystemsRecom
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Chapter 11 ImplementationRecommenda
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Chapter 11 Implementationbeing brou
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Appendix 1Appendix 1COMMISSION MEMB
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Appendix 1He has held this position
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Appendix 2SIPTU*South Eastern Healt
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Appendix 3Name of AgencyBord na Rad
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Appendix 3Name of AgencyIrish Blood
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Appendix 3Name of AgencyWomen’s H
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Appendix 4Department of Health and
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Appendix 4collated and assessed by
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Appendix 4The most detailed element
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Appendix 4Ratifying and Submitting
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Appendix 4changes to the Service Pl
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Appendix 4advised of their existenc
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Appendix 4Approvals Required in lin
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Appendix 5Appendix 5DIAGNOSIS RELAT
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Appendix 5Figure: Ax.1 Casemix Adju
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 7(vii)(viii)(ix)participat
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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