Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceCHAPTER 9EXTERNAL REPORTING PROCEDURESIn this Chapter, we look at the information which financial and management reports "up-the-line" shouldcontain and the reporting deadlines that should apply.9.1 OVERVIEWMonitoring and management information is essential to the efficient functioning of any complexorganisation. In this regard, all budget, financial and non-financial reports must be (i) relevant,(ii) clear and concise, (iii) up to date and (iv) available as early as possible. Reporting systemsmust be geared to deliver these objectives.We conclude that some of the current arrangementsbetween service providers and the Department of Health and Children are not adequate.Theessence of our recommendations is that the reporting mechanisms should be designed toprovide regular updates (monthly, quarterly and annual) on performance against Service Plansat all the levels identified in Chapters 4 and 5.We have set out the changes that are necessaryto address these issues.9.2 MANAGEMENT REPORTINGEach health board is required to submit an Integrated Management Report to the Departmentof Health and Children on a monthly basis (see Appendix 4). Reports are to be submitted bythe 25th day of the month following the month under review. This report derives from theaggregation of internal reporting on activity and financial performance by each of themicro-units (hospital, community care areas etc.) and funded agencies that fall under the aegisof each health board. The Department of Health and Children in turn prepares aconsolidated report covering all the health service providers, which they then provide to theDepartment of Finance.The monthly Integrated Management Report sets out the health board’s current financialposition, identifying variances from budget.This numerical information is aggregate informationonly and variances are not analysed by programme or care group. A CEO commentary mustaccompany the monthly Integrated Management Report as this allows the board and the CEOto discharge their specific responsibility as required under the 1996 legislation.In Chapter 4, we highlighted the inadequacies as we see them of the existing service planningarrangements for the management of a modern health service. These inadequacies include (i)differing report formats between agencies, (ii) a concentration on plans for servicedevelopment money (i.e. an inadequate focus on core funding/activity) and (iii) weak linksbetween activity and funding.These inadequacies have direct consequences for the quality andcontent of reporting against Service Plan.In addition to this, we are aware of delays that have arisen in respect of the submission of theIntegrated Management Reports from the health boards to the Department of Health andChildren. In Appendix 8 it can be seen that some health boards may exceed the 25 dayreporting deadline by several weeks on some occasions. As a result the consolidated reports110
Chapter 9 External Reporting Proceduresfrom the Department of Health and Children to the Department of Finance, which aresupposed to be made monthly, are only submitted intermittently.We have concluded that existing reporting arrangements between the service providers and theDepartment of Health and Children fail to meet some or all of the criteria mentioned atsection 9.1 above. Reports are being submitted in a variety of formats, many of them late, andcontaining no links between activity and expenditure.It is not possible at the national level for the Minister for Health and Children and the Ministerfor Finance to plan or determine important and timely responses to emerging spending andservice pressures without comprehensive financial and activity data being provided each monthby health service providers.While the financial data in the Integrated Management Reports arelargely reported on time, there appears to be an acceptance that reporting on non-financialperformance to the national level is given lesser priority by health service providers whenconsidered against their own management requirements on the ground. Furthermore, the factthat late submission of reports has been allowed to persist by the Department of Health andChildren and the Department of Finance gives rise to some questions as to the usefulness anduse made of the management information gathered for the Departments. Elsewhere in thisreport (Chapter 10), we make recommendations in respect of the IT investment necessary tosupport financial management in the system. We believe that this investment must beaccompanied by fundamental change in the culture described above and that there be acommitment to produce timely and accurate financial and activity reports.We understand that, from the point of view of the health boards, their bottom line is thedelivery of their own regional/local Service Plan within budget. From their point of view, themonthly Integrated Management Report is simply a consolidated position of boards’ financial,human resource and activity performance used for reporting to the Department of Health andChildren. Its submission, late or otherwise, does not hinder the process of internal reporting inthe health board area or the taking of corrective action by health boards to deliver a balancedbudget.However, we take the view that the monthly Integrated Management Reports (appropriatelydeveloped) are cornerstones of the overall management of health expenditure at the nationallevel.They are an imperative and the health service providers should regard them as an integralpart of their own internal reporting and management structures. In this regard, mirroring therecommendations for service planning, reporting mechanisms must penetrate the internalsystems of the health boards right down to the level of those responsible for making decisionson expenditure. This is consistent with our second core principle articulated in Chapter 2.We believe that all routine reports should be built around the various Service Plans. Consistentwith our recommendations in Chapter 4 on standardising the format and content of ServicePlans throughout the system, we consider that monthly, quarterly and annual reports at alllevels should also, as far as possible, follow a standardised format (see recommendation R4.4 inthis regard).For each of the recommendations R9.1 to R9.5 below, the "reports" cover all routine reports(monthly Integrated Management Reports, quarterly Performance Indicator Reports and AnnualReports/CEO commentary).111
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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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Chapter 4 Service Planning, Budgeti
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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
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 111: Chapter 8 Audit Reform●●Penalti
Page 115 and 116: Chapter 9 External Reporting Proced
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Page 119 and 120: Chapter 10 Information SystemsStrat
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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Page 161 and 162: 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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