Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Servicerecommended by the Irish Hospital Consultants Association, are needed to satisfy currentdemand.The absence of this basic information on a systematic basis leads us to conclude that the health service isunder-managed despite the popular perception that it is over organised, over administered andbureaucratic.2.7 SPECIFIC PROBLEMS DERIVING FROM THE STRUCTURAL WEAKNESSESThe combination of these structural weaknesses has led to specific and ongoing problems overthe years that are symptomatic of the underlying organisational fragmentation of the system.These specific problems relate to failures in respect of planning, control and financialaccounting, delays in producing statutory accounts and reports for the Department of Healthand Children and unauthorised recruitment of staff. We recognise that the low levels ofinvestment in national modern enterprise-wide information systems and commensurateinvestment in financial expertise has been a factor in inhibiting best practice in financialmanagement. Some examples of these problems may be instructive.Problem 1: Inadequate Planning and CostingThree costly examples follow – the over-70s medical card extension, the 2001 childcareworkers pay agreement and the problems of over-runs in the General Medical Services (GMS).The over-70s medical card extensionThe extension of medical cards to all people over 70 years of age is a stark example of totallyinadequate planning and costing. The following sequence of events is drawn from the 2001annual report of the Comptroller and Auditor General (C&AG).In his 2001 Budget speech, the Minister for Finance announced the extension of the medicalcard scheme to cover all persons aged 70 and over, irrespective of means, to take effect from1 July 2001. The Secretary General of the Department of Health and Children informed theC&AG that his Department was made aware of the decision "a few days prior to Budget day."The Secretary General informed the C&AG that his Department provided "such data as wasreadily available to it in the extremely short time involved in order to assist the Department ofFinance in determining the likely cost of implementing the scheme in 2001". The initial estimatethat 39,000 people would become eligible was substantially incorrect. The Department ofHealth and Children have advised us that the actual number is now over 77,000. The cost ofthe scheme was projected to be ¤ 19 million and is now put at ¤ 55 million.28