Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceRecommendations on Monitoring Timeliness of Financial ReportsR8.5 The draft statutory accounts must be approved by the health board by I April following year end and theaudited statutory accounts must be completed by the C&AG and laid before the Houses of the Oireachtaswithin 9 months of year end in accordance with current statutory requirements. Where this requirement is notmet, the CEO should be required to provide a written explanation to the Secretary General, for inclusion in hisreport referred to at R8.6(v), setting out the reasons why these statutory deadlines have not been met.R8.6 The Department of Health and Children should publish on its website details of the performance of healthboards/agencies in terms of meeting their financial accounting responsibilities, including:(i) Year end date;(ii) Date financial accounts/statements are finalised/submitted;(iii) Date audit completed (including section 6(4) reports, if any, on the accounts);(iv) Details of organisations failing to meet their deadlines should be highlighted in an appropriate manner;and(v) Publish and widely circulate a report with commentary on performance annually by 1 January each yeari.e. 12 months after the period to which the report relates.We recognise that the Comptroller and Auditor General has complete constitutionalindependence and is accountable only to the Dáil for the performance of his functions.Nonetheless, we believe that the Comptroller and Auditor General fully supports efforts toimprove standards of accountability in the health services and the public sector generally. Inparticular, we believe the Comptroller and Auditor General would welcome any steps to dealwith persistent breaches of statutory accounting and auditing obligations. For these reasons,we believe that the Comptroller and Auditor General should be required to make an annualdeclaration by 1 January of each year to the Public Accounts Committee certifying (i) thebodies which he has audited / caused to be audited in accordance with statutory obligationsand (ii) the bodies which he has been unable to audit. His report should state the reasons forthe latter inability, distinguishing between (i) delays caused by the auditee and (ii) delays causedby lack of resources or other aspects of the operation of his own Office. In the latter case, theComptroller and Auditor General should indicate the steps required to remedy the problemsleading to such delays.Recommendation on a Declaration by the Comptroller and Auditor GeneralR8.7 The Comptroller and Auditor General should lay before the Public Accounts Committee a report (withcommentary) on performance in meeting accounting and auditing deadlines annually by 1 January each year i.e.12 months after the period to which the report relates.Audit by the Comptroller and Auditor GeneralThe Comptroller and Auditor General provides up to two possible outputs of his audit: a"section 6" report and a management letter.Section 6(4) reports: Where significant issues arise during an audit these are referred to inthe Comptroller and Auditor General’s section 6(4) reports. Such reports allow theComptroller and Auditor General to report on matters he deems appropriate to report,following his examination of the system of internal control operated by health boards. Suchreports are unsatisfactory. Section 6(4) reports that do not refer to any specific items are clean104
Chapter 8 Audit Reformaudit reports. A number of examples of section 6(4) reports are set out in Chapter 2.Management letters: This is a letter from the auditor setting out issues arising from the auditbut which were not of such significance as to merit mention in the audit report. The normalprocedure followed is for the auditor to draft the management letter and send it tomanagement (i.e. the CEO/chief financial officer) for their comment and responses to the itemsand issues raised. The final version of the letter contains management responses to theauditor’s points.The management letter refers to a small number of minor areas where some improvements canbe made. It would be unusual for there to be many items referred to in such letters or for theseitems to relate to fundamental issues. We examined the management letters from theComptroller and Auditor General to the health boards. A number of aspects of thesemanagement letters, though not significant enough to substantially affect the overall veracity ofthe audited financial statements, are worth drawing attention to:●●●●Firstly, the kind of items and issues being raised reflect basic errors and problems thatsuggest poor standards of accounting and weaknesses in administration procedures insome health boards.Secondly, we noted that, while all points raised by the Comptroller and Auditor Generalwere responded to, in some cases the Comptroller and Auditor General had to write oneor more reminders requesting the health board CEO/chief financial officer to respond tothe management letter points.Thirdly, we noted that in almost all cases, responses to the management letter were notprovided for at least six months.Lastly, we were surprised at some of the comments by management to what appeared tobe very valid points raised by the Comptroller and Auditor General. In some instances,points raised were not treated with the seriousness that they deserved.8.4 INTERNAL AUDITThe Comptroller and Auditor General reported 3 that all eight health boards (then existing) hadan internal audit unit. Three aspects of the internal audit function are of concern to us(i) resourcing of internal audit, (ii) powers and duties of internal audit and (iii) reporting lines.Resourcing Internal AuditA review of the role of internal audit in the health boards in 1995 found that internal audit wasat that time "underdeveloped and generally regarded as a backwater operation." 4 The Comptrollerand Auditor General reported 5 that the scope of internal audit varies in the eight health boardsexamined, depending on the remit given to it. In his 2000 report, he noted that"many Boardslack specialist personnel in these areas" and that "lack of resources is a problem in a number of unitswhich militates against the proper organisation of the unit". Since then, progress has been madewith many boards now having fully qualified internal audit teams, staffed to approved levels.However, we believe the internal audit function in the Department of Health and Children isunderresourced. The report Internal Audit Review prepared by the Department of Finance inSeptember 1999, indicates that only one member of staff (a Higher Executive Officer) wasassigned to the internal audit unit. We are aware that since then the unit has been increased to3Internal Audit in Health Boards, Comptroller and Auditor General,August 2000, p.4.4Internal Audit in Health Boards, Comptroller and Auditor General,August 2000, p.5.5Internal Audit in Health Boards, Comptroller and Auditor General,August 2000, p.4.105
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesAppend
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issuesother
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issues●●
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Chapter 2 Overview and IssuesIn 200
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Chapter 2 Overview and IssuesThe an
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesProble
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Chapter 3 Managing the Health Servi
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Page 55 and 56: Chapter 3 Managing the Health Servi
Page 57 and 58: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
Page 79 and 80: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
Page 103 and 104: Chapter 8 Audit ReformRecommendatio
Page 105: Chapter 8 Audit Reformoutsourcing)
Page 109 and 110: Chapter 8 Audit Reformas relating t
Page 111 and 112: Chapter 8 Audit Reform●●Penalti
Page 113 and 114: Chapter 9 External Reporting Proced
Page 119 and 120: Chapter 10 Information SystemsStrat
Page 121 and 122: Chapter 10 Information SystemsRecom
Page 123 and 124: Chapter 11 ImplementationRecommenda
Page 125 and 126: Chapter 11 Implementationbeing brou
Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130: Appendix 1He has held this position
Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
Page 133 and 134: Appendix 3Name of AgencyBord na Rad
Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
Page 139 and 140: Appendix 4Department of Health and
Page 141 and 142: Appendix 4collated and assessed by
Page 143 and 144: Appendix 4The most detailed element
Page 145 and 146: Appendix 4Ratifying and Submitting
Page 147 and 148: Appendix 4changes to the Service Pl
Page 149 and 150: Appendix 4advised of their existenc
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Page 153 and 154: Appendix 5Appendix 5DIAGNOSIS RELAT
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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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