Brennan Report - Department of Health and Children

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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
Chapter 3 Managing the Health ServiceCHAPTER 3MANAGING THE HEALTH SERVICEIn this Chapter, we recommend the actions required to deal with a major structural weakness in the healthsystem – the fact that no single institution or person has overall responsibility for the day-to-day managementof the service as an integrated national service. We examine the corporate governance arrangements thatshould apply to a restructured health service.3.1 OVERVIEWThe primary role of the Department of Health and Children is the development of policy andservices. It acts as advisor to the Minister (for Health and Children) and the Government onthese issues. Actual management of the service has been devolved to health boards. They, inturn, liaise with the various agencies under their remit. But, at national level, no one hasexplicit responsibility for the effective executive management of the system as a nationalservice nor for ensuring the application of appropriate financial management and controlsystems.The estimates process is based on historical expenditure trends and is incremental in nature,although some allowance is made for demographic changes.At national level, there is no one inthe health service carrying out a systematic continuing evaluation of core service and funding.The management vacuum at the heart of the health service must be addressed urgently. Webelieve that national management of the health service would best be delivered outside thestructure of the Department of Health and Children and are recommending the establishmentof an Executive at national level (hereinafter called "the Executive") for this purpose. Thiswould allow the Department of Health and Children to focus more fully on health policy.The key function of the new Executive will be to provide the country’s health service withquality management, analysis and evaluation of existing resource allocation mechanisms builtaround evidence based needs assessment. The new Executive must reduce, not increase, thelevels of bureaucracy within the system and confront problems of fragmentation. Cutting thenumber of national executive agencies through consolidation and rationalisation will increaseaccountability for the performance of the health service and is also the key to beginning theprocess of reforming many of the management systems.If the Executive were given responsibility to manage the health service, the Department ofHealth and Children would then be able to concentrate on the development of national healthpolicy.This Chapter also deals with governance issues for the restructured health system. In very basicterms, clarity is required on a number of key questions including: who does what?; where doesthe responsibility lie?; and what are the lines and structures of management accountability?41
Page 1 and 2: Commission onFinancial Managementan
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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 9 External Reporting Proced
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Chapter 10 Information SystemsStrat
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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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