Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Service2.9 CORE PRINCIPLESWe believe that there are a number of core principles that are fundamental to the design ofgood financial management and control. These principles form the basis for all therecommendations in this report.Principle 1:A Unitary Health ServiceThe health service should be organised and managed as a unitary national service that istightly controlled at the centre and is without the fragmentation of services and accountabilitythat typifies the existing arrangements.Principle 2: Personal AccountabilityAccountability for resources expended should rest with those who have the authority tocommit the expenditure. It follows that the structure of accountability in the Irish healthservice for containing expenditure within budget should be redesigned using this principle.Principle 3: Centred on the Service UserThe patient/service user should be at the centre of any system for managing and controlling theuse of resources. By creating awareness of the financial implications of decisions bothpatients/service users and service providers will be better informed of the most cost-effectiveclinical pathways in pursuit of the best clinical outcome. A system of patient costing wouldenable better decisions to be taken on the most cost-effective ways of achieving the sameclinical outcome for the patient.Principle 4: Financial ManagementGood financial management and control should not be seen solely as a finance function. All staffwith authority to spend money should have appropriate training to understand the basicprinciples of financial management.Observing these principles will create the opportunities for financial transparency, greateraccountability, increased value for the money invested in the service and, most importantly, helpidentify opportunities for treating more service users within the limits of available budgets.The implications of these principles for the organisation of the health service and for the roleof clinical Consultants, General Practitioners and other professional staff with authority tocommit expenditure will be examined in some detail in the following chapters.40