Brennan Report - Department of Health and Children

More documents

Recommendations

Info

Report of the Commission on Financial Management and Control Systems in the Health ServiceFigure 2.9: Estimated and Actual Cost of the Medical Card Scheme 1998 - 2002Spending (£ million)1000900800Estimated CostActual Cost70060050040030020010001998 1999 2000 2001 2002Source: Revised Estimates for Public Services 1998 – 2002; Department of Health and ChildrenTable 2.4: Estimated and Actual in Costs of the Medical Card Scheme 1998 - 2002 8Year Estimate Outturn Increase in Increase inEstimate over actual spendpreviousbased on¤ 000 ¤ 000 year’s outturn outturn1997 - 361 - -1998 380 400 5.3% 10.9%1999 422 543 5.4% 35.7%2000 517 551 -4.8% 1.4%2001 633 653 15% 18.4%2002 739 922 7 13.3% 41.3%Average 6.8% 21.5%Source: Revised Estimates for Public Services 1998 – 2002; Department of Health and Children7The “outrun” figure for 2002 is the sum of the original estimate for 2002 (£739m) and a supplementary estimate of £183m.8Rounding may affect totals32
Chapter 2 Overview and IssuesIn 2002, the estimated increase in expenditure on the GMS over 2001 was 13.3%. The actual increase inspend was 41.3% higher than the previous year – thus requiring a supplementary estimate of ¤ 183million. Each year since 1998 predictions about increases in spending have failed to anticipate how muchExchequer funding will be required. In 2003, the estimated increase in costs is 5.2%. We recognise thechallenge that this estimate poses for the Government in terms of its policy choices on the GMS. We dealwith these challenges in more detail in Chapter 6.Problem 2: Unapproved Capital ExpenditureEarly in 2002, the Department of Health and Children became aware that the capitalcontractual commitments of health boards included approximately ¤ 115 million not approvedby the Department of Health and Children. These related to a wide range of projects, some ofwhich had partial or limited Department of Health and Children approval and others which hadno approval from the Department. It would appear that all of these unapproved contractualcommitments relate to appropriate health service projects in different care programmes. Itmust be emphasised that on larger construction projects where Department of Health andChildren professional staff have had a direct involvement, budgetary difficulties have not arisen.Some health boards incorrectly took the view that the indicative funding which had beennotified at the commencement of the National Development Plan (NDP) for planningpurposes only could be regarded as a capital allocation and engaged in expenditure on capitalprojects without seeking approval from the Department of Health and Children.Also, circularsissued since the commencement of the NDP instructing health boards to comply with theestablished and normally rigorous procedures for the approval of individual projects were insome cases not adhered to (see Appendix 4).The unapproved commitments were generated in 2000/2001 at a time when health boards,supported by the Department of Health and Children, were striving to ensure theimplementation of the National Development Plan and were putting in place resources toproperly plan and to cost projects. Health boards were developing their NDP programmes inthe context of high local expectations and significant public pressure to meet the aspirationscreated by the launch of the NDP and the then buoyant economic climate.This was clearly adifficult developmental stage in the transition of the capital programme to a major multiannualinvestment plan. Before the NDP, the boards were relying on weak organisationalstructures and on older systems of planning, monitoring and control which had been in placefor many years to support a relatively modest annual capital programme.The management of the NDP programme within some boards, and the expectation associatedwith same, has certainly been problematic and has generated unapproved expenditure.This mustbe corrected and the NDP programme operated in line with requirements set down by theDepartment of Health and Children. We regard what occurred in relation to some healthboards in respect of unauthorised expenditure as unsatisfactory, particularly in the light of theclear instructions issued by the Department of Health and Children on the process of NDPmanagement at central and local level. We understand that the Comptroller and AuditorGeneral is examining this issue.The Department of Health and Children has emphasised that no additional capital funding has33
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 and 22: Chapter 2 Overview and Issues2.2 OR
Page 23 and 24: Chapter 2 Overview and IssuesAppend
Page 25 and 26: Chapter 2 Overview and IssuesFigure
Page 27 and 28: Chapter 2 Overview and Issuesother
Page 29 and 30: Chapter 2 Overview and IssuesTable
Page 31 and 32: Chapter 2 Overview and IssuesFigure
Page 33: Chapter 2 Overview and Issues●●
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
Page 79 and 80: Chapter 6 Accountability - General
Page 85 and 86:
Chapter 6 Accountability - General
Page 87 and 88:
Chapter 6 Accountability - General
Page 89 and 90:
Chapter 7 Accountability - Employme
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Chapter 8 Audit ReformCHAPTER 8AUDI
Page 103 and 104:
Chapter 8 Audit ReformRecommendatio
Page 105 and 106:
Chapter 8 Audit Reformoutsourcing)
Page 107 and 108:
Chapter 8 Audit Reformaudit reports
Page 109 and 110:
Chapter 8 Audit Reformas relating t
Page 111 and 112:
Chapter 8 Audit Reform●●Penalti
Page 113 and 114:
Chapter 9 External Reporting Proced
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Chapter 10 Information SystemsStrat
Page 121 and 122:
Chapter 10 Information SystemsRecom
Page 123 and 124:
Chapter 11 ImplementationRecommenda
Page 125 and 126:
Chapter 11 Implementationbeing brou
Page 127 and 128:
Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130:
Appendix 1He has held this position
Page 131 and 132:
Appendix 2SIPTU*South Eastern Healt
Page 133 and 134:
Appendix 3Name of AgencyBord na Rad
Page 135 and 136:
Appendix 3Name of AgencyIrish Blood
Page 137 and 138:
Appendix 3Name of AgencyWomen’s H
Page 139 and 140:
Appendix 4Department of Health and
Page 141 and 142:
Appendix 4collated and assessed by
Page 143 and 144:
Appendix 4The most detailed element
Page 145 and 146:
Appendix 4Ratifying and Submitting
Page 147 and 148:
Appendix 4changes to the Service Pl
Page 149 and 150:
Appendix 4advised of their existenc
Page 151 and 152:
Appendix 4Approvals Required in lin
Page 153 and 154:
Appendix 5Appendix 5DIAGNOSIS RELAT
Page 155 and 156:
Appendix 5Figure: Ax.1 Casemix Adju
Page 157 and 158:
Appendix 6Appendix 6AUDIT OF STRUCT
Page 159 and 160:
Appendix 7(vii)(viii)(ix)participat
Page 161 and 162:
Appendix 8Appendix 8 - Integrated M
Page 163 and 164:
ADDENDUMNumber Recommendation IT Ti
Page 165 and 166:
Number Recommendation IT TimeframeR
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
show all

Brennan Report - Department of Health and Children

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?