Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Service3.2 CURRENT ROLE OF THE DEPARTMENT OF HEALTH AND CHILDRENThe role of the Department of Health and Children is to advise the Minister on thedevelopment of health policy. In carrying out that role, it acts as a regulator and controller inrespect of service provision. It does not manage the health service nor does it have anyexecutive function in that regard. The management of the service is devolved to variousnational executive bodies, the health boards and other statutory and voluntary agencies. Anyorganisation which is multi-layered and fragmented has substantially weakened financialmanagement and control. As a result, there is no one carrying explicit responsibility for theexecutive management and evaluation of the health system as a national service.Despite the fact that accountability for the delivery of services is located at regional and locallevel, the Department of Health and Children frequently finds itself drawn into the details ofhealth service provision without having executive control over the service i.e. the Departmentof Health and Children is being held accountable (wrongly) for service delivery issues withouthaving the authority to directly address the management of the service at local level. TheDepartment of Health and Children is frequently drawn into "fire fighting" and is thereforeunable to create the space to carry out the necessary evaluation of core spending nationally.3.3 THE NEED TO EVALUATE CORE EXPENDITUREIn terms of spending on health services, the estimates process (see Appendix 4) is based onhistorical expenditure trends and is incremental in nature, although some allowance is made fordemographic changes. It has a disproportionate focus on the planning and implementation ofnew developments at the expense of ongoing systematic evaluation of baseline expenditure.Within the current structures, at national level there is no one in the health service carryingout this continual systematic evaluation of core service and funding.To get the best returns from the investment of taxpayers’ money in the health service, thereshould be a systematic process of monitoring and evaluating performance in terms of spendingand activity at regional/service delivery level.At present the system does not have the capacity,as a matter of routine, to accurately cost and explore options.An analysis of core funding would:●●●●Permit evidence-based decision-making;Provide more accurate estimates of the true cost of providing health services;Promote closer monitoring and evaluation of the returns achieved for the resourcesinvested; andShow where best value and best practice is to be found.As presently constituted, the Department of Health and Children is focused on policydevelopment. Its engagement in the estimates process is almost entirely aimed towardssecuring development monies for new initiatives at the margin of overall health spending. Simplyput, the main focus of the Department of Health and Children is on the 3%, or so, ofdevelopment funding without sufficient regard to how the 97% of core funding is being spent.The fact that the primary emphasis of the work of the Department of Health and Children ison the development of policy and services, rather than the executive management, analysis andevaluation of overall performance, is symptomatic of an inherent structural problem in thehealth service.42