Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceBox 2: Programmes and Care GroupsProgrammes and Care Groups are essentially different ways of analysing health board activities.Traditionally, each health board is divided into three programmes:●●●Hospital Care (all Acute Hospitals),Special Hospitals (Elderly and Mental Health cost centres), andCommunity Care (Care Unit cost centres).The Care Group approach, which has become more common in recent years, looks at services from a clientperspective. For example, in the Midland Health Board, the following Care Groups are in place:●●●●●Episodic (Acute Hospitals and Primary Care),Older People (Services for Older People),Mental Health (Community & Residential),Disabilities (Intellectual & Physical), andChildren and Families (Child Protection & Family Health).At all stages of the process there are extensive consultations on how service delivery can bemaximised given the available resources. However, the extent to which this process is devolveddown as far as care or clinical service units varies significantly. Within the acute hospitalprogramme, the lowest cost centre for budgetary purposes is generally the hospital itself (insome cases it could be support functions, such as laboratory or radiography, or specialty).Clinicians will agree their activity levels with hospital management, which informs thehospital/health board Service Plan, but there is no link between that activity and a budget at thelevel of the Clinician. Within the other two programmes (special hospitals and community care),the budgets as they stand are in many cases already sufficiently devolved, as managers of careunits, who have budgets, make the resource consuming decisions.Performance indicators: The health board Service Plans include key performance indicatorsacross a number of headings as well as targets for delivery of service developments. Costsassociated with delivery of these targets are also set out in the plan. These indicators wereagreed between the Health Boards Executive (HeBE) and the Department of Health andChildren and relate primarily to health boards’ operational performance across a number ofheadings within all Care Groups. They are output-based indicators, moving towards anoutcome-based scenario. This is consistent with international experience, where outcomebasedindicators are difficult to achieve.Operational Plans: Within each health board, in addition to the formal health board-wideService Plan, each care group (e.g. community care, mental health, etc.), prepares its ownOperational Plan. This underpins the Service Plan, but at a greater level of detail, typicallysetting out (i) detailed targets, (ii) departments/individuals responsible for delivery,(iii) performance indicators to assess achievement, and (iv) potential bottlenecks. Full yearbudgets and the associated staffing complement, analysed by cost centre and cost element, arealso part of these Operational Plans.166
Appendix 4Ratifying and Submitting the Service Plan: The health board’s senior management teamagrees the overall Service Plan and presents it to the board’s Finance Sub-Committee. It is thenput before a health board meeting for adoption by the board.When adopted, it is forwarded tothe Department of Health and Children for Ministerial approval. The Service Plan is generallysubmitted by early/mid January.Once received by the Department of Health and Children, Service Plans are immediately puton the Department’s intranet and all line divisions (Secondary Care, Childcare, Services for OlderPeople, Community Health, Mental Health Division, Services for the Physically and IntellectuallyDisabled, Personnel, I.T., Hospital Planning Office etc.) are advised of their availability. The financialelement of the each health board’s Service Plan is examined by the finance unit to ensure thatit is within determination.The Minister may, within 21 days of receipt, direct the health board to make modifications tothe Service Plan.Health boards are required to submit a cash profile of their expected cash drawdown duringthe coming year. This profile, the requirement for which is set out in the Letter ofDetermination, must be submitted by the beginning of January. The individual health boardfigures are aggregated by the Department of Health and Children, supplemented by directspending by the Department, and submitted to the Department of Finance.IV. SUPPLEMENTARY ESTIMATESUnder government accounting rules, a Department which finds itself faced, during the course ofa year, with a prospective overrun on its aggregate spending or a shortfall in its income, may -subject to the prior approval of the Minister for Finance - apply to the Dáil for aSupplementary Estimate. The norm is that Departments must live within their allocated budgetand the Minister for Finance will only sanction a Supplementary Estimate in exceptionalcircumstances.A specific variant to this regime applies in the case of the Department of Health and Children.The Health (Amendment) (No.3) Act, 1996 placed a legal obligation on the chief executiveofficers of the health boards to live within the annual expenditure budgets determined for eachboard by the Minister for Health and Children; if they fail to do so, the excess is carried forwardto the following financial year as a first charge on that year’s expenditure. While the legislationallows for the Minister for Health and Children to vary a determination, it was agreed with theMinister for Finance in 1997 that increases in voted expenditure supported by SupplementaryEstimates would only be allowed in respect of specified areas deemed not to be amenable tomanagement/control by the Department of Health and Children or the health boards.In the context of the 2002 Estimates and Budgets, the Government approved a proposal fromthe Minister of Finance that, for the future and commencing in 2002, resources provided to theDepartment of Health and Children would be based on the annual cash allocation asdetermined in the Abridged Estimates Volume augmented by any subsequent Budget Dayprovision. In this context, it was further agreed that no requests for Supplementary Estimateswould be considered, save in the following specific areas that were considered not to beamenable to management by the Department of Health and Children.167
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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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Chapter 7 Accountability - Employme
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Chapter 7 Accountability - Employme
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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 and 140: Appendix 4Department of Health and
Page 141 and 142: Appendix 4collated and assessed by
Page 143: Appendix 4The most detailed element
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
Page 155 and 156: Appendix 5Figure: Ax.1 Casemix Adju
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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