Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceFigure 2.7: Capitation Rates for Existing and Newly Eligible Medical Card Holdersover 70 Years of AgeCapitation Rates (£ )800700600MaleFemale50040030020010000-3miles3-5miles5-7miles7-10milesOver 10milesNewover 70,GeneralNewover 70,NursingHomeSource: GMS (Payments) Board Annual Report 2001The extension of the medical card scheme gave all persons aged 70 years and over entitlementto free drugs and medicines as well as free medical services. Negotiations with the IrishPharmaceutical Union for the provision of services have not yet been concluded.Our view is that the over-70s medical card extension is a classic example of totally inadequateplanning and costing. The bill for the scheme is a multiple of the original costs envisaged and it continuesto rise.Childcare Workers 2001 Pay DealMany of the deficiencies found in the over-70s medical card extension also featured in a paydeal for childcare workers negotiated in 2001 (see Figure 2.8):● The original estimated cost of this pay deal was ¤ 4.7 million per annum.● The actual cost for childcare workers alone turned out to be ¤ 11.4 million per annum.● The knock-on costs for linked grades are expected to come to an additional ¤ 34million to ¤ 38 million per annum.30
Chapter 2 Overview and Issues●●The total eventual cost is therefore in the range ¤ 45 million to ¤ 50 million.Arrears of ¤ 30 million to ¤ 34 million are also due to be paid on this deal.Figure 2.8: Childcare Workers Pay Deal 2001Costs in £ millions50454035302520151050OriginalEstimateActualCostTotalcostsSource: Department of Health and ChildrenThis is an example of how the absence of a comprehensive risk assessment procedure, whichwould examine the full effects of such a change, can have enormous consequences. Weacknowledge that this problem is not unique to the health sector.Overruns in the General Medical ServicesThe estimated spending overshoot in 2002 for the General Medical Services (GMS) is ¤ 183million on a budget of ¤ 739 million – 25%. While we acknowledge that because this is ademand-led scheme it is difficult to forecast its costs, the extent and systematic nature of theunderestimation of costs have surprised us.An analysis of the period 1997 to 2002 (Figure 2.9and Table 2.4) shows an estimated annual average increase of around 6.8% in the annualEstimates. The actual annual average increases in costs were in excess of 21% for the sameperiod. Figure 2.9 shows the problem is getting worse.31
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 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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