Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Servicebeen sought to address this issue and the Department does not intend to seek any additionalExchequer funding for this purpose. The Department has, however, due to the resulting cashdifficulty arising from this unauthorised spending, agreed to fund about ¤ 77 million of the abovefigure.Since February 2002, the Department of Health and Children has strengthened controls toensure no recurrence of the matter.Table 2.5: Example of Unauthorised Expenditure in the Health ServiceYear Agency Problem Identified2000/1 Health boards Health board management spent £115 million on capital projects that had notbeen authorised by the Department of Health and Children. [Dept. of Healthand Children, Dept. of Finance]Problem 3: Unauthorised Staff NumbersThe numbers to be employed in the entire health service is determined and authorised by theDepartment of Finance consistent with the Government’s overall employment policy. TheDepartment of Health and Children then authorise employment limits for each of the healthboards/agencies within that total.There is evidence that these ceilings on employment numbershave been breached on occasions in the past. We are also aware that for the years 2001 and2002, the process for controlling numbers in the health boards moved to one that linked postsdirectly to the resources available. For both those years, boards have stayed within theseavailable resources although the overall sanctioned employment limits were exceeded.Table 2.6: Examples of Unauthorised Staffing in the Health ServiceYear Agency Problem Identified1998 Eastern Health Board Eastern Health Board exceeded its authorised staffing levels throughout theyear. (C&AG Annual Report 1998)2000 All health service The annual Census of Health Service Employees, covering the entire healthservice, shows an excess of 500 over the approved employment ceiling.(Dept. of Health and Children, Dept. of Finance)2001 All health service The annual Census of Health Service Employees shows an excess of 3,800over the approved employment ceiling for the entire health service. (Dept. ofHealth and Children, Dept. of Finance)34
Chapter 2 Overview and IssuesThe annual employment census for the entire health service for 2001 shows an excess of 3,800 over theapproved employment ceiling while keeping within budget. However, we recognise the weakness of thecensus insofar as it does not take funded vacancies into account in calculating numbers.Problem 4: Non-Imposition of ChargesThe Comptroller and Auditor General has reported a number of instances where charges havenot been properly imposed or collected (Table 2.7). The most significant cases relate to thefailure to charge for tests relating to the private activity of Consultants in the public hospitalsystem (i.e. the taxpayer has met the costs which should have been charged to the privatepractice of certain Consultants). In addition, there was a case where a failure by Consultants toprovide information about their private patients to hospital management resulted in more than¤ 1 million not being billed to private health insurers.Table 2.7: Examples of Failure to Impose Due Charges in the Health ServiceYear Agency Problem Identified1998 Longford Westmeath While the hospital improved the situation over 1997 during Hospital the firstHospitalhalf of 1998 (collecting some ¤ 103,000 in outpatient charges), they onceagain ceased billing patients and no invoices were issued up to the end of theyear. (C&AG Annual Report 1998)1998 Waterford Regional In excess of ¤ 1 million in private patient charges (recoverable fromHospitalVHI/BUPA) could not be billed by Waterford Regional Hospital to theinsurers because hospital Consultants had not supplied the necessaryinformation in respect of their patients. The patients of three Consultantsaccounted for almost half of the outstanding monies. (C&AG Annual Report1998)2001 Virus Reference Charges for all laboratory services were levied against the public healthLaboratorysystem including those tests performed on behalf of private hospitals/clinics.Problem 5:Accounting DeficienciesIn reviewing the Comptroller and Auditor General’s reports on the audit of health boards’statutory accounts, a wide range of accounting failures feature.These include failure to:●●●Observe accounting standards;Record fixed assets; andMeet statutory accounts deadlines.It is unacceptable that the audited accounts of health boards (or any other public sectororganisation) are not available within the statutory auditing deadlines.The Minister for Health and Children laid down, effective from 1 January 1994, as amended from1 January 1998, accounting standards to be adhered to by the health boards. These include verymany prescriptive formats and directions for the recording of transactions in the books and35
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
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Page 9 and 10: Executive SummaryWe do not underest
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Page 13 and 14: Terms of ReferenceTERMS OF REFERENC
Page 15 and 16: GlossaryEstimates for Public Servic
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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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