Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceIn response to the circular, the Department of Health and Children submits a "bid" for thefollowing year and forecasts of the costs of continuing the services proposed in the two yearsthereafter.A priority for the Department of Health and Children in this process is to obtain sufficientfunding to continue developments started in previous years.Health Board InputHealth boards do not generally make formal submissions to the Department of Health andChildren regarding the following years funding. However, they usually discuss needs with theappropriate line division in the Department of Health and Children.These discussions are, in the first instance, based around each health board’s estimate of thecosts of continuing to provide its existing level of services. However, the discussions also dealwith proposals for new service developments within their area, taking account of national andlocal strategies and analyses of needs.This process typically includes costings on those areas giving rise to additional spendingpressures such as:●●●●Full year costs of developments begun part way through the current year;Cost pressures impacting on core funding requirements (e.g. inflation, increasingdemand/activity);Potential costs - both pay and non pay - of proposed new service developments; andFuture revenue impacts of capital developments about to come on stream.The financial aspects of these discussions are usually prepared by the health board’s centralfinance department in conjunction with care group managers (e.g. community care, mentalhealth, etc.). In some health boards, dedicated finance staff have been recruited to supportmanagers in the financial analysis and costing aspects of planning.These submissions are sent to the appropriate "line division" in the Department of Health andChildren. From that point up until each health board receives formal notification of its finalallocation in its Letter of Determination (see Section III below), communication between theDepartment of Health and Children and health boards tends to be informal. Only limiteddiscussion takes place on the core funding issues and there is no advance indication of the finalallocation. However, within the current system of incremental budgeting, health boards wouldbe aware that the previous year’s level of funding forms the baseline for the coming year’sallocation. It is not possible for the Department of Health and Children to be specific on theamount available for the following year until the Estimates for Public Services (Abridged Version)is published in mid-November.Department of Health and Children InputFollowing consultation and review with health boards and other service providers, each linedivision within the Department of Health and Children prepares a "bid" for funding setting outthe associated service implications, the costs involved and any additional posts which may result.The costing process takes account of information provided by agencies, including health boards,and details prior experience of similar proposals. The bids from the various line divisions are162
Appendix 4collated and assessed by the Department’s Finance Unit who then formulate an aggregatedepartmental demand.The aggregate departmental demand contains detailed estimates of proposed servicedevelopments (i.e. new policy initiatives) for the following year and projections of the follow-oncosts in the subsequent two years of these new measures. These measures are ranked in orderof priority by line divisions and, as a general rule, focus on initiatives identified within theNational Health Strategy.The aggregate departmental demand is presented to the Department’s Management AdvisoryCommittee, comprising the Secretary General and other senior management. Followingapproval by the Management Advisory Committee and the Minister, the bid is submitted toDepartment of Finance.Negotiation of Abridged Estimates provisionThe Department of Finance reviews the aggregate departmental demand as submitted by theDepartment of Health and Children and compares its bid against the Department of Finance’sown prior assessment of the funding requirements. Typically, there is a preliminary meeting inearly September between officials from the two departments to identify the major areas ofvariation between the two sets of figures. This is followed by a series of meetings duringSeptember/October focusing on the detailed material provided by the Department of Healthand Children’s line divisions in their estimates bid. The objective from the Department ofFinance side is to match the aggregate level of funding demanded with the level previously agreedby the Government.Matters that cannot be resolved at official level are taken up during bilateral meetings betweenthe two Ministers. Ministers often become heavily involved in negotiations at this stage. Originalbids may be scaled down/prioritised in response to the outcome of these discussions. High-levelagreement is then reached between Ministers. An agreed "envelope" (i.e. overall allocation) isidentified as available to the Minister for Health and Children for the coming year. This figure isthen apportioned across the various subheads, in agreement with the Department of Finance,to produce the Estimates for Public Services (Abridged Version), which is presented to the Dáiland published in November.Budget Day AdjustmentsThe Budget announcement in the first week of December may include funding for additionalmeasures over and above those contained in the Estimates for Public Services (AbridgedVersion). The Minister for Finance normally determines the overall provision for Budget Daydevelopments, if any, in consultation with the various individual Ministers, including the Ministerfor Health and Children, in light of available resources. Prioritisation of any measures to befunded from the Budget day package is primarily a matter for the Minister for Health andChildren.The Revised Estimates for Public ServicesThe Revised Estimates for Public Services is published in March and contains all fundingprovided for public services, including health services, from:the Estimates for Public Services (Abridged Version)163
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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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Chapter 5 Accountability - Hospital
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Chapter 6 Accountability - General
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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 and 112: Chapter 8 Audit Reform●●Penalti
Page 113 and 114: Chapter 9 External Reporting Proced
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: Appendix 4Department of Health and
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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