Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceDate Department Department of Health Healthof Finance and Children BoardApril/MayFigure 2.2: Summary of the Estimates and Allocations ProcessAssessment of funding neededto provide "Existing Level ofService" in coming year plustwo following yearsInformal contact withDepartment of FinancePresentation of Memorandumseeking Government decisionon broad budgetary strategyand prioritisation – overalllevels of spending, taxation etc.over three year periodMay/JuneEstimates Circular issuedEstimates Circular receivedEstimates Demand or "bid"preparedInformal contact withDepartment of Health andChildrenJuly/Aug Estimates Demand received Estimates Demand submittedNegotiation between DeptsNegotiation between DeptsOct/NovPresentation of Memorandumto Government for decision onpre-Budget allocations foreach Department. OngoingGovernment consideration ofEstimates, including MinisterialbilateralsAdvance drafting of local andhigh level Operational andService PlansNovAbridged Estimates for PublicServices publishedDecBudget Day announcements Letters of Determination issued Letters of DeterminationreceivedLocal and high level Operationaland Service Plans finalisedCorporate Service Plan draftedCorporate Service Planadopted by boardJan Corporate Service Planreceived from health boardsCorporate Service Plansubmitted to DepartmentFeb Revised Estimates for PublicAgreement of CorporateServices publishedService Plan with health boardsAgreement of CorporateService Plan with Department20
Chapter 2 Overview and IssuesAppendix 4 describes the process in greater detail and, as far as possible, the various stages aredescribed chronologically in order to convey the step-by-step process involved. Appendix 4simply describes the system. It provides neither a critique of the systems as described nor anassessment of the extent to which these arrangements are actually followed in practice. A fullcritique and recommendations for change are set out in the body of this report.The health service is an important issue for every citizen, both in terms of the quantity andquality of the service being provided, and the cost of that service to each of us. The share oftotal national public expenditure spent on health has increased from 19.2% in 1997 to 22.8%in 2002 while gross expenditure (i.e. before taking account of any receipts, forexample from the health levy) on Ireland's public health system more than doubled (increase of125%) between 1997 and 2002, from ¤ 3.6 billion to ¤ 8.2 1 billion (see Figure 2.3). For the year2002, this amounted to over ¤ 2,000 2 for every person in the country or a charge of over¤ 6,800 3 to each income tax payer.Figure 2.3: Evolution of Exchequer Allocations to Health 1997 - 20029 m9,0008,0007,0006,0005,0004,0003,0002,0001,00025%20%15%10%5%% Total Government Spending01997 1998 1999 2000 2001 2002 (est)0%Spendingas % total Govt spendSource: Revised Estimates for Public Services 1998 to 2002; Department of Finance1Source: Revised Estimates for Public Services 1998 and 2002. These figures are gross and include capital spending.2Source: Revised Estimates for Public Services 2002; Central Statistics Office.3Source: Revised Estimates for Public Services 2002; Department of Finance.21
Page 1 and 2: Commission onFinancial Managementan
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: 6.4 COMMUNITY DRUG SCHEMES 80Medica
Page 7 and 8: Executive SummaryEXECUTIVE SUMMARYT
Page 9 and 10: Executive SummaryWe do not underest
Page 11 and 12: Executive Summary"demand-led" schem
Page 13 and 14: Terms of ReferenceTERMS OF REFERENC
Page 15 and 16: GlossaryEstimates for Public Servic
Page 17 and 18: Chapter 1 Introduction and Backgrou
Page 19 and 20: Chapter 1 Introduction and Backgrou
Page 21: Chapter 2 Overview and Issues2.2 OR
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Page 27 and 28: Chapter 2 Overview and Issuesother
Page 29 and 30: Chapter 2 Overview and IssuesTable
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Page 33 and 34: Chapter 2 Overview and Issues●●
Page 35 and 36: Chapter 2 Overview and IssuesIn 200
Page 37 and 38: Chapter 2 Overview and IssuesThe an
Page 39 and 40: Chapter 2 Overview and IssuesTable
Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
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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 8 Audit ReformCHAPTER 8AUDI
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Chapter 8 Audit ReformRecommendatio
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Chapter 8 Audit Reformoutsourcing)
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Chapter 8 Audit Reformaudit reports
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Chapter 8 Audit Reformas relating t
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Chapter 8 Audit Reform●●Penalti
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Chapter 9 External Reporting Proced
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Chapter 10 Information SystemsStrat
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Chapter 10 Information SystemsRecom
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Chapter 11 ImplementationRecommenda
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Chapter 11 Implementationbeing brou
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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 4changes to the Service Pl
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Appendix 4advised of their existenc
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Appendix 4Approvals Required in lin
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Appendix 5Appendix 5DIAGNOSIS RELAT
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Appendix 5Figure: Ax.1 Casemix Adju
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 7(vii)(viii)(ix)participat
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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