Brennan Report - Department of Health and Children

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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
Chapter 2 Overview and IssuesFigure 2.6: Forecasted and Actual Numbers Eligible for over-70s Medical CardExtensionNumbers eligible in over 70s Medical Card extension (000)9080706050403020100Initial EstimateActual NumberThe extension had exposed serious weaknesses in the areas of advance costing. Otherproblems soon surfaced. The Department of Health and Children informed the C&AG that,when the introduction of the new scheme was being considered, it put down "a clear marker"about the potential dangers involved in announcing an extension without the prior agreementof the Irish Medical Organisation and the Irish Pharmaceutical Union.The warning proved prophetic: the Department of Health and Children eventually agreed acapitation rate with the Irish Medical Organisation for those covered by the new scheme.Therate for non-means tested medical card holders is a multiple of the fee paid for pre-existingmeans tested medical cardholders aged 70 and over. As of 31 December 2001, the annualcapitation fee for medical cardholders aged 70 and over varies from ¤ 95.43 to ¤ 160.58 formales and from ¤ 106.11 to ¤ 171.33 for females, depending on the distance between theservice user's home and the doctor's surgery.The capitation rate for newly eligible non-meanstested service users aged 70 years and over is ¤ 462.16 and ¤ 669.79 for those in a privatenursing home (Figure 2.7).29
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
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Page 21 and 22: Chapter 2 Overview and Issues2.2 OR
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Page 27 and 28: Chapter 2 Overview and Issuesother
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Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
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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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