Brennan Report - Department of Health and Children
Brennan Report - Department of Health and Children Brennan Report - Department of Health and Children
Report of the Commission on Financial Management and Control Systems in the Health Serviceis reviewed by the health board’s senior management team and is signed off by the chiefexecutive officer.Each Integrated Management Report must be accompanied by a commentary from the chiefexecutive officer, detailing the causes of any variances and how the health board intends to dealwith such variances prior to the end of the year. The commentary is a central element of thereturn. Although the figures may appear satisfactory, the commentary may provide theDepartment of Health and Children with an early warning of emerging problems. Where thefigures are indicating a problem the commentary must set out both the cause of the problemand the steps the chief executive officer is taking to bring expenditure back withindetermination. Where the commentary shows excess in particular service areas, the IntegratedManagement Report is copied to the relevant line division in the Department of Health andChildren for observations. All line divisions have desktop access to the Integrated ManagementReports.Consolidated Monthly Integrated Management Reports: These are due from theDepartment of Health and Children to the Department of Finance (except in January). This isessentially an analysis of the various Integrated Management Reports as submitted to theDepartment of Health and Children, detailing the variances against budget to date beingexperienced in the system, and containing summary financial, activity and employment controlinformation at a national level. It also sets out problems and pressure points in the system.The Department of Finance requires that a separate report on the performance of thevoluntary hospitals should be appended to the monthly health board returns. Specific returnsare also presented for the General Medical Services (Payments) Board.Quarterly Performance Indicator Reports: In 2001, a set of performance indicators wasagreed between the health boards and the Department of Health and Children and these arebuilt into the Service Plan. Their purpose is to enable both the Department of Health andChildren and the health boards to reach a better shared understanding of the position inmonitoring and evaluating the attainment of Service Plan objectives by the health boards. TheQuarterly Performance Indicator Reports are used as an indicative picture of each healthboard’s position in relation to the delivery of the Service Plan goals. This process is still in itsvery early stages with joint Department and health board teams working to further enhancethese performance indicators.Working Capital: Under Section 8 of the Health (Amendment)(No.3) Act, 1996, each healthboard is required to manage within the level of indebtedness specified by the Minister for Healthand Children in the Letter of Determination. Health boards must submit details of theirworking capital levels to the Department of Health and Children on a quarterly basis. This isdesigned to ensure that excess debts, which would allow financing of current expenditurebeyond approved levels, cannot accumulate.Service Plan Reviews: Formal review meetings take place between senior staff at theDepartment of Health and Children and each health board on a regular basis over the courseof the year to assess progress on delivery of service plan objectives. Prior to the reviews, thehealth boards are required to report to the Department with regard to their performance todate against plan. These reports are placed on the Department’s Intranet and line divisions are170
Appendix 4advised of their existence. Service Plan Review Reports are more comprehensive than thehighly aggregated monthly Integrated Management Reports, and relate more closely toindividual service developments as set out in the Service Plan.Monthly Returns to the Department of Finance: Separate monthly returns for currentand capital cash issued, showing actual amounts issued from each subhead per month to dateand projected amounts to the year end, are submitted by the Department of Health andChildren to the Department of Finance by the 10th working day of the following month (fromJanuary 2003, this "lag" period is to be reduced to 5 working days). The cumulative varianceagainst budget is explained. These reports contain information about the cash drawn down bythe Department of Health and Children from the Exchequer and paid to the health boards andother providers in order to finance their activities. They provide no more than a broadindication of the volume of spending being undertaken by the health boards and other providers.Details of expenditure actually incurred, analysed by health board, are provided in separateexpenditure reports submitted by the Department of Health and Children to the Departmentof Finance.These monthly cash drawdown figures are assessed by the Department of Finance against themonthly profile prepared by the Department of Health and Children at the beginning of the yearand against the previous year’s expenditure for the same period. Any necessary explanationsare sought from the line divisions in the Department of Health and Children. This process istypically the key element in the monitoring of voted expenditure trends and the resultinganalysis, taken in conjunction with trends in the main revenue aggregates, are used to inform theGovernment of the emerging budgetary outturn and to highlight, where necessary, the needfor corrective action. Consolidated Integrated Management Reports, when received, are alsochecked for consistency with these monthly returns.VII. CAPITAL EXPENDITUREOf the total ¤ 8.2 3 billion allocated to the Department of Health and Children in 2002, justunder ¤ 500 million related to capital expenditure. This was allocated almost entirely to healthboards.Hospital Planning Office: The Hospital Planning Office has the lead role within theDepartment of Health and Children in assessing, planning and monitoring capital projectsthroughout the health service, including non-hospital projects. Its functions include:●●●●●●Assisting in the preparation of the Department of Health and Children's annual and longterm capital programmes;Providing investment, planning, programming and cost advice to line divisions within theDepartment of Health and Children and to health boards as contracting authorities;Advising and supporting health boards in the management of their programmes;Preparing design briefs, cost estimates, budgets and cashflow forecasts in relation tospecific projects;High level management and control of the approved capital expenditure allocation; andEnsuring compliance with EU directives, building regulations and national standards.National Development Plan: Published in 1999, the National Development Plan provided3Estimates for Public Services (Abridged Version) 2002.171
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Appendix 4advised <strong>of</strong> their existence. Service Plan Review <strong>Report</strong>s are more comprehensive than thehighly aggregated monthly Integrated Management <strong>Report</strong>s, <strong>and</strong> relate more closely toindividual service developments as set out in the Service Plan.Monthly Returns to the <strong>Department</strong> <strong>of</strong> Finance: Separate monthly returns for current<strong>and</strong> capital cash issued, showing actual amounts issued from each subhead per month to date<strong>and</strong> projected amounts to the year end, are submitted by the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong><strong>Children</strong> to the <strong>Department</strong> <strong>of</strong> Finance by the 10th working day <strong>of</strong> the following month (fromJanuary 2003, this "lag" period is to be reduced to 5 working days). The cumulative varianceagainst budget is explained. These reports contain information about the cash drawn down bythe <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> from the Exchequer <strong>and</strong> paid to the health boards <strong>and</strong>other providers in order to finance their activities. They provide no more than a broadindication <strong>of</strong> the volume <strong>of</strong> spending being undertaken by the health boards <strong>and</strong> other providers.Details <strong>of</strong> expenditure actually incurred, analysed by health board, are provided in separateexpenditure reports submitted by the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> to the <strong>Department</strong><strong>of</strong> Finance.These monthly cash drawdown figures are assessed by the <strong>Department</strong> <strong>of</strong> Finance against themonthly pr<strong>of</strong>ile prepared by the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> at the beginning <strong>of</strong> the year<strong>and</strong> against the previous year’s expenditure for the same period. Any necessary explanationsare sought from the line divisions in the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong>. This process istypically the key element in the monitoring <strong>of</strong> voted expenditure trends <strong>and</strong> the resultinganalysis, taken in conjunction with trends in the main revenue aggregates, are used to inform theGovernment <strong>of</strong> the emerging budgetary outturn <strong>and</strong> to highlight, where necessary, the needfor corrective action. Consolidated Integrated Management <strong>Report</strong>s, when received, are alsochecked for consistency with these monthly returns.VII. CAPITAL EXPENDITUREOf the total ¤ 8.2 3 billion allocated to the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> in 2002, justunder ¤ 500 million related to capital expenditure. This was allocated almost entirely to healthboards.Hospital Planning Office: The Hospital Planning Office has the lead role within the<strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> in assessing, planning <strong>and</strong> monitoring capital projectsthroughout the health service, including non-hospital projects. Its functions include:●●●●●●Assisting in the preparation <strong>of</strong> the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong>'s annual <strong>and</strong> longterm capital programmes;Providing investment, planning, programming <strong>and</strong> cost advice to line divisions within the<strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> <strong>and</strong> to health boards as contracting authorities;Advising <strong>and</strong> supporting health boards in the management <strong>of</strong> their programmes;Preparing design briefs, cost estimates, budgets <strong>and</strong> cashflow forecasts in relation tospecific projects;High level management <strong>and</strong> control <strong>of</strong> the approved capital expenditure allocation; <strong>and</strong>Ensuring compliance with EU directives, building regulations <strong>and</strong> national st<strong>and</strong>ards.National Development Plan: Published in 1999, the National Development Plan provided3Estimates for Public Services (Abridged Version) 2002.171
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