Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceAppendix 4DESCRIPTION OF THE ESTIMATES AND ALLOCATIONSPROCESSINTRODUCTIONThis appendix describes the process whereby annual budgets are allocated and reported onwithin the health service. The description covers all the major stakeholders and, as such, dealswith all the main institutional players, viz. the Department of Finance, the Department of Healthand Children and the 10 health boards plus the Eastern Regional Health Authority. As far aspossible, the various stages are described chronologically in order to convey the step-by-stepprocess involved. This appendix simply describes the system; it provides neither a critiqueof the systems as described nor an assessment of the extent to which these arrangements areactually followed in practice. A full critique and recommendations for change are set out in thebody of the Report.The appendix is divided into seven sections, describing:I. The roles and responsibilities of relevant institutions;II. The national estimates process;III. The determination process (i.e. allocation of health board budgets);IV. Supplementary estimates;V. Health board reporting;VI. External reporting "up the line"; andVII. Capital expenditure.I. ROLES AND RESPONSIBILITIESBefore describing the existing process, it is important to be aware of the role and function ofthe main institutions involved, i.e. the Department of Finance, the Department of Health andChildren and the health boards.Department of Finance: The principal functions of the Department of Finance 1 , in terms ofits aggregate responsibilities for expenditure policy, are the allocation, co-ordination and overallmanagement of public expenditure within the context of the overall budgetary and economicparameters set by Government. The key functions of the Department of Finance as they relateto the Department of Health and Children and the health services are to ensure that publicexpenditure policy is managed in an effective and prudent manner by –● Negotiating the annual estimates;● Monitoring the evolution of spending against budget;● Sanctioning, where appropriate, alterations to schemes and programmes; and● Providing a second opinion to the Minister for Finance on policy proposals and prioritiesput forward by the Department of Health and Children in the light of factors such as theGovernment’s programme and commitments arising from national programmes such asthe Programme for Prosperity and Fairness (PPF).1Statement of Strategy 2001-2003160
Appendix 4Department of Health and Children: The Secretary General of the Department of Healthand Children is accountable for the overall spend and for the evaluation and review of policyimplementation. The Health (Amendment) (No.3) Act, 1996 devolves accountability forexpenditure to the health boards. While the Department of Health and Children is notdirectly involved in day-to-day spending at health board level, it can monitor expenditure and caninfluence the level of spending by setting operational criteria (e.g. the terms and conditions ofschemes and programmes).Health boards: Under the Health (Amendment) (No.3) Act, 1996, health board members areresponsible for adopting a service plan which must be consistent with the financial limitsdetermined by the Minister for Health and Children. The chief executive officer is responsiblefor the day-to-day management and control of expenditure within his/her region - under the1996 Act, s/he must implement the Service Plan on behalf of the health board so that it stayswithin approved budget. Any excess arising in any year is treated as a "first charge" on thefollowing year’s budget. The chief executive officer of each health board is accountable to thePublic Accounts Committee for his/her financial performance.II. THE NATIONAL ESTIMATES PROCESSThe Estimates for Public Services (Abridged Version), published in November of each year, setsout the primary allocations for each Department for the following year. The focus is generallyon the cost of maintaining existing services, but the allocations may include the cost of serviceimprovements for the next fiscal year. There may also be some announcements in that regardheld over until Budget day. In 1996 a partial system of multi-annual budgets was introduced toaccompany the estimates at national level. This involves a projection of spending for a threeyearperiod - i.e. the next fiscal year for which the estimate is being negotiated and theprojected cost for the following two years, completed on an "Existing Level of Service" basis(i.e. the cost in years two and three of maintaining services at the same level as pertains in yearone). This provides a more rounded, if limited, picture of the medium term costs of policyinitiatives proposed in the context of the estimates campaign as well as being a key mechanismin identifying trends as they are likely to affect the overall Government finances.The amount of tax revenue raised on the one hand, and the level of public expenditure on theother, essentially determines Government’s overall fiscal position. As such, the estimates processis a central element in Government fiscal policy. It is a prolonged process that necessitatesdetailed costings and, sometimes, difficult negotiations.Existing Level of ServiceIn April/May of each year, the Public Expenditure Division of the Department of Finance preparesan assessment of the costs of maintaining all public services, including health services, at theirexisting level. This is done in the context of the preparation, development and agreement of theGovernment’s budgetary and economic strategy for the next three years. The Governmentdecides, based on this assessment and all other relevant considerations (economic, taxation, debtservice, etc.), on the aggregate and departmental levels of spend for the forthcoming budget yearthat is consistent with sustainable economic and budgetary development. This is the basis forthe "Estimates Circular" that is then issued by the Department of Finance to all otherDepartments, including the Department of Health and Children, asking them to submit estimatesfor the coming years consistent with the Government decision.161
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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 IssuesIn 200
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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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Chapter 6 Accountability - General
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 113 and 114: Chapter 9 External Reporting Proced
Page 119 and 120: Chapter 10 Information SystemsStrat
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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: Appendix 3Name of AgencyWomen’s H
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
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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
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Brennan Report - Department of Health and Children

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