Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Servicetwo staff headed by an Assistant Principal. The Department of Finance expressed the concernthat internal audit units should have the capacity to enable them to operate effectively and tobe well placed to bring to the accounting officer issues arising from inadequate or ineffectivesystems. The internal audit function in the Department of Health and Children concentratesonly on the ¤ 30 million or so administrative spending incurred directly by the Department.Pending the establishment of the Executive, we consider that internal audit systems should beput in place to cover the entire ¤ 9 billion of health service spending.Recommendations on Internal AuditR8.8 The Secretary General of the Department of Health and Children, the board of the Executive, boards of theregional health boards, boards of agencies and other bodies under the remit of health boards and boards of otherstatutory agencies should ensure that there is an adequately resourced internal audit function. Where it isconsidered inefficient, for reasons of scale, for an agency to have a dedicated internal audit unit, the regionalhealth boards should either provide the service centrally or have the function outsourced.R8.9 The internal audit unit should report directly to the non-executive Chairman of the audit committee.R8.10 The audit committee should determine powers and duties of the internal audit unit.R8.11 Internal audit reports should be made available to the external auditor.8.5 RISK ASSESSMENT AND MANAGEMENTDuring the course of our work, we encountered a number of examples where the assessmentof risk associated with policy decisions (and the management of those risks) was not adequatelyundertaken. For example, in Chapter 2, we highlighted the outcome of the negotiationsrelating to the extension of the medical card to all people over 70 years. In this case, the fullrisk, for a range of reasons, was not identified nor arrangements made for the management ofthe risk at the time the decisions were being taken.We believe that the Department of Health and Children must have a strong, proactive riskassessment role in relation to the development and monitoring of national policies. This wouldcover two broad areas; risk assessment at policy design stage and risk management atoperational/executive levels. We recommend that the Department of Health and Childrensubstantially enhance its capabilities in this area.Policy Risk AssessmentA professional assessment of the risks associated with national service development, building inthe necessary control measures in advance of the introduction/extension of new services, isessential. In this national policy context, risk assessment involves systematically (and at the veryearliest stages of policy development) analysing, evaluating, monitoring and communicating therisks associated with planned activities so that potential losses are minimised and opportunitiesare exploited in the best interests of the taxpayer.Risk ManagementIn this context, we refer to "risk management" as the ongoing monitoring and review of systemsand procedures in place in all bodies responsible for service delivery (the Executive, regionalhealth boards, hospitals, voluntary agencies etc.). As such, we see the risk management function106
Chapter 8 Audit Reformas relating to operational matters – the implementation, as opposed to the development, ofGovernment health policy. All agencies, at all levels, need to have effective risk managementprocedures in place.The Department of Health and Children should take the lead role in approving the overall riskpolicy and tolerance for the health service. They will have to satisfy themselves on theeffectiveness on the overall risk management framework and that the key risks are managed toan acceptable level. The risk management function in the Department of Health and Childrenshould implement and communicate risk management strategy, policy and procedures acrossthe health service. In terms of its development of risk management capabilities, the Departmentof Health and Children should adopt best practice standards.It would then be a matter for the internal audit function in the Executive and in each healthboard/agency at local and regional levels to ensure that effective risk management proceduresare in place. The internal audit function will be responsible for the ongoing review of theoverall effectiveness and suitability of the risk management framework at regional and agencylevel in the context of Departmental policy. The internal audit unit should report regularly tothe audit committee in that regard while the Department of Health and Children would havean oversight role at national level.107
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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 57 and 58: Chapter 3 Managing the Health Servi
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Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 107: Chapter 8 Audit Reformaudit reports
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Page 121 and 122: Chapter 10 Information SystemsRecom
Page 123 and 124: Chapter 11 ImplementationRecommenda
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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
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Page 153 and 154: Appendix 5Appendix 5DIAGNOSIS RELAT
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Page 157 and 158: 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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