Brennan Report - Department of Health and Children

More documents

Recommendations

Info

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
Page 1 and 2: Commission onFinancial Managementan
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: 6.4 COMMUNITY DRUG SCHEMES 80Medica
Page 7 and 8: Executive SummaryEXECUTIVE SUMMARYT
Page 9: Executive SummaryWe do not underest
Page 13 and 14: Terms of ReferenceTERMS OF REFERENC
Page 15 and 16: GlossaryEstimates for Public Servic
Page 17 and 18: Chapter 1 Introduction and Backgrou
Page 19 and 20: Chapter 1 Introduction and Backgrou
Page 21 and 22: Chapter 2 Overview and Issues2.2 OR
Page 23 and 24: Chapter 2 Overview and IssuesAppend
Page 25 and 26: Chapter 2 Overview and IssuesFigure
Page 27 and 28: Chapter 2 Overview and Issuesother
Page 29 and 30: Chapter 2 Overview and IssuesTable
Page 31 and 32: Chapter 2 Overview and IssuesFigure
Page 33 and 34: Chapter 2 Overview and Issues●●
Page 35 and 36: Chapter 2 Overview and IssuesIn 200
Page 37 and 38: Chapter 2 Overview and IssuesThe an
Page 39 and 40: Chapter 2 Overview and IssuesTable
Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 61 and 62:
Chapter 4 Service Planning, Budgeti
Page 63 and 64:
Chapter 4 Service Planning, Budgeti
Page 65 and 66:
Chapter 5 Accountability - Hospital
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Chapter 6 Accountability - General
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Chapter 7 Accountability - Employme
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Chapter 8 Audit ReformCHAPTER 8AUDI
Page 103 and 104:
Chapter 8 Audit ReformRecommendatio
Page 105 and 106:
Chapter 8 Audit Reformoutsourcing)
Page 107 and 108:
Chapter 8 Audit Reformaudit reports
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 115 and 116:
Page 117 and 118:
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
Page 151 and 152:
Appendix 4Approvals Required in lin
Page 153 and 154:
Appendix 5Appendix 5DIAGNOSIS RELAT
Page 155 and 156:
Appendix 5Figure: Ax.1 Casemix Adju
Page 157 and 158:
Appendix 6Appendix 6AUDIT OF STRUCT
Page 159 and 160:
Appendix 7(vii)(viii)(ix)participat
Page 161 and 162:
Appendix 8Appendix 8 - Integrated M
Page 163 and 164:
ADDENDUMNumber Recommendation IT Ti
Page 165 and 166:
Number Recommendation IT TimeframeR
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
show all

Brennan Report - Department of Health and Children

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?