Brennan Report - Department of Health and Children
Brennan Report - Department of Health and Children Brennan Report - Department of Health and Children
Report of the Commission on Financial Management and Control Systems in the Health ServiceRecommendations on Risk Assessment and ManagementR8.12 A systematic assessment of all risks (including financial, operational and clinical risks) must be a central andintegral part of all policy development and ongoing operational activity.R8.13 A Risk Assessment Unit should be established with immediate effect by the Secretary General of the Departmentof Health and Children with the task of:(i) Supporting policy makers; and(ii) Driving the implementation of risk management policy and procedures down to local and agency levels.R8.14 In respect of R8.13(i) the role of the Risk Assessment Unit should be to:(i) Support in an integral and ongoing way national policy developments and negotiations;(ii) Provide technical support and advice to individual officers/sections on the identification and managementof risks at policy design stage;(iii) Advise on the design and execution of control measures to minimise risks; and(iv) Review the conduct of risk assessment procedures on new services/schemes within the Department ofHealth and Children.R8.15 In respect of R8.13(ii) the role of the Risk Assessment Unit should be to:(i) Develop, implement and communicate risk management strategy, policy and procedures across the healthservice;(ii) Develop and co-ordinate risk management information requirements, reporting thresholds andmechanisms for determining priorities;(iii) Develop, promote and maintain common methodologies for identifying and assessing risk anddetermining adequacy and cost effectiveness of controls;(iv) Identify and assess accumulations of risk across the health service and interdependencies; and(v) Co-ordinate risk management activity, training and technical support, across the health service.R8.16 A working group should be established to bring forward a report on best practice in terms of risk assessmentand risk management in the health sector.R8.17 The Risk Assessment Unit should make half-yearly reports to the Management Advisory Committee of theDepartment of Health and Children on the ongoing effectiveness of, and compliance with, national riskmanagement policy.R8.18 Internal audit units in all health service agencies should make half-yearly reports to the Chairman of their localaudit committees on the effectiveness of the risk management procedures in place in their organisation. Anylegislative amendments to facilitate this should be implemented.8.6 FRAUDIt is essential that all staff in the health services be aware of the possibility of fraud and beconscious of their individual duties and responsibilities in preventing fraud. The health serviceshave a budget of almost ¤ 9 billion in 2003. In view of the wide range of operations in the healthservices it is possible that fraud may occur. In order to give assurance to the Irish taxpayer, topatients and consumers and to staff, it is important to have a clear policy on fraud that shouldbe communicated and applied consistently throughout the health services.There are a number of elements that assist in preventing fraud. These include:●●●●Staff awareness of the potential for fraud;Strong internal controls built into all operations;Consideration of internal control and risk management in designing new developments,schemes etc;Strong internal and external audit functions;108
Chapter 8 Audit Reform●●Penalties for fraud, including policies for prosecuting fraud, for staff found to havecommitted fraud; andOpportunities for staff to report suspicions of fraud in confidence and without fear ofreprisals or other adverse consequences of carrying out their duties to their employerand the Irish taxpayer. On the contrary, such staff should be rewarded for taking stepsto reduce fraud in their organisation. Such reports should go to someone other thanmanagement (who may be implicated in or compromised by the finding of fraud) such asthe internal auditor.Recommendation on Fraud PolicyR8.19 The health board CEOs should submit, for approval by the Secretary General of the Department of Health andChildren, a written fraud policy statement covering all health boards and all organisations under their aegis.8.7 SUMMARYIn this Chapter, we have made recommendations to improve the timeliness and content offinancial reports and audits, problems with which were previously described in Chapter 2.We have also made recommendations to bring internal audit procedures into line with bestpractice generally and to introduce a comprehensive risk assessment and risk managementfunction. Progress in these areas would provide assurance that systems are operatingproperly and, thus, help ensure that the kind of problems described in Chapter 2 (for example,the over-70s medical card extension, the childcare workers pay deal, unauthorised expenditurebeing incurred and due charges not being imposed) are not repeated.109
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Chapter 8 Audit Reform●●Penalties for fraud, including policies for prosecuting fraud, for staff found to havecommitted fraud; <strong>and</strong>Opportunities for staff to report suspicions <strong>of</strong> fraud in confidence <strong>and</strong> without fear <strong>of</strong>reprisals or other adverse consequences <strong>of</strong> carrying out their duties to their employer<strong>and</strong> the Irish taxpayer. On the contrary, such staff should be rewarded for taking stepsto reduce fraud in their organisation. Such reports should go to someone other thanmanagement (who may be implicated in or compromised by the finding <strong>of</strong> fraud) such asthe internal auditor.Recommendation on Fraud PolicyR8.19 The health board CEOs should submit, for approval by the Secretary General <strong>of</strong> the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong><strong>Children</strong>, a written fraud policy statement covering all health boards <strong>and</strong> all organisations under their aegis.8.7 SUMMARYIn this Chapter, we have made recommendations to improve the timeliness <strong>and</strong> content <strong>of</strong>financial reports <strong>and</strong> audits, problems with which were previously described in Chapter 2.We have also made recommendations to bring internal audit procedures into line with bestpractice generally <strong>and</strong> to introduce a comprehensive risk assessment <strong>and</strong> risk managementfunction. Progress in these areas would provide assurance that systems are operatingproperly <strong>and</strong>, thus, help ensure that the kind <strong>of</strong> problems described in Chapter 2 (for example,the over-70s medical card extension, the childcare workers pay deal, unauthorised expenditurebeing incurred <strong>and</strong> due charges not being imposed) are not repeated.109
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