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 ImplementationR11.2 A National Implementation Committee should be established with the role of:(i) Ensuring the implementation of the recommendations;(ii) Driving the implementation process;(iii) Overseeing the establishment of the Executive and the consequent governance changes in Chapter 3; and(iv) Providing progress reports every 3 months.R11.3 The Implementation Committee should, within 2 years of the publication of this report, be in a position to handover responsibility for implementation of any outstanding recommendations to the CEO of the Executive.R11.4 The Government should nominate an independent person to chair the Implementation Committee.R11.5 Membership should also include the Secretary General of the Department of Health and Children, a SecretaryGeneral in the Department of Finance, a health board CEO and three persons from the private sector withappropriate expertise and experience in change management and financial management/audit functions.R11.6 In the preparation of the reports referred to at R11.2(iv) above the Implementation Committee, andsubsequently the Executive, will:(i) Identify the person(s), by name and/or position, responsible for the delivery of each recommendation(and the elements therein where applicable);(ii) Contact and formally assign responsibility to each person identified at (i) above;(iii) Agree with the person(s) identified at (i) above appropriate deadlines for implementation of eachrecommendation;(iv) Draw up a schedule of implementation deadlines for all recommendations based on agreements at (iii)above;(v) Audit progress of the responsible person(s) in giving effect to recommendations against the statedobjectives; and(vi) Report progress with recommendations for corrective action as appropriate.R11.7 In reporting on progress to the Implementation Committee, and subsequently the Executive, each personidentified at R11.6(i) above should:(i) Identify the resources required to deliver the recommendations;(ii) Identify the critical success factors to deliver recommendations on time (and within budget); and(iii) Identify the barriers to success in delivering recommendations on time (and within budget).Delivering ChangeThe major challenge for the Implementation Committee will be to prepare a plan to implementand deliver the change programme. This will require investment in IT and some changes in workpractices.The investment recommended for information systems will involve very considerableexpenditure that can only be accommodated by either (a) once-off additional allocations,perhaps over a number of years, or (b) a reallocation of funding from other areas within theoverall system. However, we believe that full implementation of our recommendations will yieldsignificant cost efficiencies within the system.In relation to IT investment, we are aware that there is already a programme of investment inplace for the roll-out of SAP and PPARS systems on a national basis and that work in this areais ongoing. The State has already invested in the region of ¤ 60 million to date in these systemsand plans are well advanced for their further development across the health service.We are of the view that there are potentially significant benefits and efficiencies to be gainedfrom the already planned upgrading of systems that would justify the roll-out of the programme122
Chapter 11 Implementationbeing brought to completion as soon as possible. In this regard, we have noted the commentsof the Independent Estimates Review Committee 1 , set up by the Minister for Finance, whichstated in relation to the health service that "the strengthening of information systems shouldcommand a higher priority and implementation of improved personnel systems should be acceleratedso that value for money can be better assessed".Given the number of agencies in the system and the key recommendation that these should beconsolidated, there is scope for delivering many of the support services (payroll, accounting,information technology, systems development, procurement etc.) through a single sharedservices unit within the system or outsourced by way of public/private partnership. This wouldfree up considerable resources for core activity including supporting the reorganisation andchange programme.In terms of changing working practices, the implementation of our recommendations poses achallenge to all health service employees. However, we would stress that the changes wepropose are in the best interests of staff in the health service insofar as the reformed structureswill support them in their efforts to provide the best possible service to patients.We note that both unions and employers have already acknowledged, in the context of therecent partnership negotiations, that "reform of healthcare requires ongoing change anddevelopment of services and the skills that are required to deliver them". There is a sharedacceptance of "the requirement for system and structural change" 2 .We also note, as agreed between unions and employers, that the payment of the final twophases of the benchmarking increase and the general round increases is dependent onverification of cooperation with flexibility, ongoing change and satisfactory implementation ofthe agenda for modernisation. 3We see this common purpose between both health service management and staff as the idealenvironment within which to pursue the work practice changes proposed by ourrecommendations.I1.4 DETAILED GUIDANCE ON IMPLEMENTATIONIn putting forward recommendations on improvements to the health services, we are consciousof the need for our report to deliver maximum benefits in as short a timeframe as possible andat minimum cost to the Irish taxpayer. Accordingly we set out in the Addendum to this Chaptera list of our 136 recommendations, indicating in broad terms our view of the IT systemsimplications of the recommendations and the timeframe for implementation. It will be amatter for the Implementation Committee to develop a detailed project plan.Recommendation on Implementation (cont’d)R11.8 The Implementation Committee and the Executive should have regard to the attached Addendum thatsummarises the various recommendations throughout the report – cross-referenced to the relevant chapters –showing, where appropriate, a timeframe for their completion.1Paragraph 9.4(e), Estimates for Public Services 2003 - Report of the Independent Estimates Review Committee to the Minister forFinance, December 2002.2Sustaining Progress, Social Partnership Agreement 2003-2005.3Sustaining Progress, Social Partnership Agreement 2003-2005.123
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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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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 2 Overview and Issues2.2 OR
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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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Chapter 5 Accountability - Hospital
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Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
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Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
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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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Brennan Report - Department of Health and Children

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