Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceManagement Remuneration: To ensure that the appropriate skills are attracted to the neworganisation it is necessary to set the level of remuneration to achieve this objective. Thisrequires different remuneration levels and conditions of service than in the civil service atpresent. In particular, the remuneration of the post of CEO should be determined by theprocess that currently applies to setting the salaries of CEOs in the non-commercial sector i.e.it should be determined by the Review Body on Higher Remuneration.Open and Competitive Recruitment: Posts should be filled by competition that is "open"in the very widest sense.This will allow recruitment of senior managers from both the publicand private sectors, domestically and internationally. This is fundamentally different to thearrangements that currently apply in the civil service.Following consideration of these issues we have concluded that national management of thehealth service would best be delivered outside the structure of the Department of Health andChildren. However, in reaching this conclusion we consider that there are a number ofessential pre-conditions to the establishment of an independent Executive.●●●Firstly, it is essential that a national Executive should not become an additional layer ofbureaucracy.Secondly, the creation of such an Executive must involve the consolidation of many ofthe existing agencies within its functions with the result that there is a very significantreduction of the number of agencies – not to do so would simply perpetuate theunsustainable fragmentation of accountability and financial control.Thirdly, accountability and authority for management of the health service as a nationalentity must be explicitly devolved to the CEO of the Executive.As regards the organisational consolidation, we believe that a major rationalisation of existingexecutive agencies in the health service is required if the establishment of the new Executive isto be recommended. We are aware that an audit of structures is already taking place (seeAppendix 6).While we do not wish to prejudge, we would not recommend a new agency:●●Unless the new Executive is made responsible for the functions now carried out by alarge number of existing statutory bodies.Unless the functions of some existing bodies are subsumed into the Executive (examplesinclude the Eastern Regional Health Authority, the Health Service Employers Agency andComhairle na nOspidéal). This avoids multi-layering in the health services which dilutesfinancial control.44
Chapter 3 Managing the Health ServiceRecommendations on the National Management of the Health ServiceR3.1 We recommend that the national management of the health service should be carried out by an "Executive"outside the Department of Health and Children.R3.2 Establishment of the Executive must involve the consolidation of many of the existing agencies within itsfunctions.R3.3 There should be no net increase in staffing levels within the health service to give effect to recommendationR3.1.R3.4 Staff of the Executive should be recruited by way of open competition and not restricted to the civil or publicservice.R3.5 Recruitment of the CEO of the Executive should be by means of an international search and selection process.Recommendations R3.1 and R3.2 will involve very substantial changes in the governancearrangements that apply to the health service.We recognise that the establishment of an Executive will take some time in terms of legislation,rationalisation of existing structures, staffing, etc. Throughout this report we makerecommendations to improve the health service that can be implemented immediately. Pendingthe establishment of the Executive, we take the view that these "quick-wins" should, in theshort-term, be addressed by the Department of Health and Children and the ImplementationCommittee recommended in Chapter 11.We would also emphasise that references to health boards and agencies elsewhere in the reportshould in no way be taken as an endorsement of existing structures or numbers of theseagencies. As indicated above, we would be strongly of the view that many of the statutoryagencies should be subsumed within the Executive.3.5 RESTRUCTURED ROLE OF THE DEPARTMENT OF HEALTH AND CHILDRENWithin a restructured health service the Department of Health and Children will continue tobe the chief advisor to the Minister for Health and Children and to the Government on healthpolicy and financing of the health service. It is imperative that the new structures we arerecommending do not diminish the quality of service available to the Minister and theGovernment. Indeed, it would be our wish that the proposed reorganisation should create anenvironment in which that service would be improved.Under our proposals, the Executive will be assuming significant functions now carried out by theDepartment. For instance, responsibility for industrial relations, for approving annual ServicePlans, for monitoring the spending of all health agencies and for overseeing the implementationof health policy will pass from the Department to the Executive.As a result, the Department will no longer have direct access to sources of information aboutthe services that currently comes from ongoing daily contact with the health boards.While, asindicated below, we envisage very close cooperation between the Department and theExecutive at all levels, the loss of immediate contact with those responsible for delivering the45
Page 1 and 2: Commission onFinancial Managementan
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
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Chapter 7 Accountability - Employme
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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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