Brennan Report - Department of Health and Children

Chapter 2 Overview and IssuesProblem 6: Inadequate Records/VouchingThe starkest example of the absence of control under this heading arises in the General MedicalService (GMS).The Comptroller and Auditor General reported significant numbers of duplicateregistrations for medical cards and also significant numbers of medical card holders without apharmacy claim for some time (suggesting that they may, for whatever reason, no longer be cardholders) but for whom capitation fees continued to be paid to General Practitioners.Table 2.11: Examples of Inadequate Records in the Health ServiceYear Agency Problem Identified1998 Eastern There were deficiencies in documentation supporting certain paymentsHealth Boardmade by the Eastern Health Board. These included:● Grants to Voluntary Bodies: The absence of completed applicationforms, evidence of grant approval, tax clearance certificates etc.● Home Help Vouching: In one location payment substantiation was notcountersigned, weekly hours not totalled and there was an absence ofhow actual payments were calculated (spend c. ¤ 612,000 in this area).● Inter Account Transfers: No supporting explanation for transfers.● Debtor Balance Substantiation: Documentation unavailable tosubstantiate a debtor of c. ¤ 464,000 and its related bad debt provisionof ¤ 348,000. (C&AG Annual Report 1998)2001 GMS The General Medical Service had advised that there were a potential 8,000duplicate medical card registrations and a further 28,000 people with no2.8 CONCLUSIONWe believe that the problems cited above show an inescapable need for fundamental reform inthe financial management and control systems within the health service. We are not in thebusiness of apportioning blame for what has happened in the past but we consider it ourfunction to make the case for change. What these examples show is that financial managementmust improve further to urgently address the issue of accountability within the system. It is notin the interests of anyone (service user, taxpayer, health professional, service provider orGovernment) to see this continue. We believe the case for reform is compelling.To do this, we must address, as a matter of priority, the two major structural weaknesses within the health service that give rise to these specific problems. Specifically, we have identifiedthese as:●●No single institution or person is responsible for the day-to-day management of theservice as an integrated national entity; management and control is too fragmented.The absence of clear accountability for relating clinical and other budgets to outputs.If these core structural weaknesses are not adequately addressed then the prospects ofsuccessfully putting in place practical and sustainable financial management systems aresubstantially reduced.39