Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceCHAPTER 2OVERVIEW AND ISSUESIn this Chapter, we look at the structures, strengths and weaknesses of the health service and recommend anumber of core principles to be followed in dealing with the problems we have identified.2.1 SUMMARYThe health service is the largest single employer in the State. Compared with other public orprivate enterprises, it presents a unique management challenge because of:●●●●●The range of services involved;The number and diversity of professional, technical and general staff employed;The implications of clinical autonomy in the relationship between doctors and patientsfor how accountability for outputs and budgetary control is structured;The ever increasing opportunities offered by new medical technologies and drugs formore expensive treatments; andThe expectations of service users, including patients.We recognise:● The dedicated and committed staff with a strong public service ethos throughout thesector, many of whom are working in difficult situations;● The improvements to budget controls since 1996;● That the health sector leads the public sector in service planning; and● The value of legislative accountability arrangements.However, we have identified two major structural weaknesses in the health service.These are:●●No single institution or person is responsible for the day-to-day management of theservice as an integrated national entity; management and control is too fragmented.The absence of clear accountability for relating clinical and other budgets to outputs.The following deficiencies are symptoms of these structural weaknesses:●●●●●●Inadequate planning/costing;Unapproved capital expenditure;Unauthorised staff numbers;Non-imposition of charges;Accounting deficiencies; andInadequate records/vouching.We have identified four core principles on which the recommendations of this report are based:●●●●The health service should be managed as a single national system.Accountability should rest with those who have the authority to commit the expenditure.All costs incurred should be capable of being allocated to individual patients.Good financial management and control should not be seen solely as a finance function.18
Chapter 2 Overview and Issues2.2 ORGANISATION OF THE HEALTH SERVICEThe health service is not a unitary service but a complex collection of services provided by avariety of authorities (see Appendix 3), agencies and service providers (see Figure 2.1).Figure 2.1: Organisation of the Health ServiceOireachtasGovernmentMinister for Health andChildrenEastern Regional HealthAuthorityAREA HEALTH BOARDSEast Coast Area BoardNorthern Area BoardSouth Western Area BoardDepartment of Healthand ChildrenREGIONAL HEALTHBOARDSMidland Health BoardMid Western Health BoardNorth Eastern Health BoardNorth Western Health BoardSouthern Health BoardSouth Eastern Health BoardWestern Health BoardSpecialist bodies andbodies establishedunder the Health(Corporate Bodies)Act with a range ofadvisory andservice functionsRegistration BodiesVoluntary Hospitals and Voluntary OrganisationsThe responsibilities and functions of the various stakeholders (health boards, Department of Healthand Children, Department of Finance etc.) are significantly different. However, they all requireinformation, on a timely basis, of a type and quality that allows, on the one hand, the professionalmanagement of the day-to-day activities of the service, and, on the other, the facilitation of betterevidence-based planning and coordination and improved support for policy making at Governmentlevel.2.3 ESTIMATES,ALLOCATIONS AND CONTROL OF THE SERVICEThe provision of money to provide public health services is made through the annualestimates and allocations process. This involves a complex set of interactions between theservice providers (e.g. health boards), the Department of Health and Children and theDepartment of Finance.This process is summarised in Figure 2.2 below.19
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Chapter 8 Audit ReformCHAPTER 8AUDI
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Chapter 11 ImplementationRecommenda
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Appendix 1Appendix 1COMMISSION MEMB
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Appendix 1He has held this position
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Appendix 2SIPTU*South Eastern Healt
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Appendix 3Name of AgencyBord na Rad
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Appendix 3Name of AgencyIrish Blood
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Appendix 3Name of AgencyWomen’s H
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Appendix 4Department of Health and
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Appendix 4collated and assessed by
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Appendix 4The most detailed element
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Appendix 4Ratifying and Submitting
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Brennan Report - Department of Health and Children

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