Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Serviceservices could impact adversely on the quality of the advice that will be available to theGovernment from the Department. There is also a risk that, when the Department isformulating advice on financing, policy and legislation, the Executive could dominate it.As a consequence of the changes we are recommending, the Department will also have to berestructured. The most important objective in this restructuring is to ensure that theDepartment has an increased capacity to carry out policy analysis and formulation. This rolemust go beyond simply promoting policy proposals put forward by the Executive. In carrying outits finance function, in particular, a key task will be to form its own view of the health services,based on ongoing critical analysis of service effectiveness and efficiency, so that the Governmentcan be satisfied that the maximum output is being achieved for the resources being madeavailable. It will also be vital that the working relationship that we outline in section 3.7 belowproves effective.The role, responsibilities and functions of the Department of Health and Children within arestructured health service will relate to the development of national health policy.The healthpolicy function covers all those areas that specifically relate to supporting the political processat national level (the Minister, Government and the Oireachtas) and includes the legislative,international representative and estimates functions.Recommendations on the Restructured Role of the Department of Health and ChildrenR3.6 The role of the Department of Health and Children should include:(i) Acting as advisor to the Minister and the Government;(ii) Developing and costing policy responses and strategies to achieve the necessary reform to addressidentified problems arising from existing policy;(iii) Developing and costing policies for future service developments;(iv) Dissemination and active sponsorship of best practice;(v) The Estimates process;(vi) Management of the legislative agenda as it relates to the health service;(vii) Acting as "regulator" in respect of national health care standards;(viii) International representation of the Irish health service (at the OECD,WHO etc.);(ix) Research and identification of ongoing developments in international best practice in the health areaand consideration of the extent to which they may be adapted for implementation in an Irish context;(x) Risk assessment/management; and(xi) Issues relating to public sector pay policy.3.6 THE ROLE OF THE EXECUTIVEThe role of the Executive should be focused on overall organisation and management of thehealth service as a national system – as indicated above, this is not currently being done within the existing structures.The work of the Executive must be to plan, organise and manage the total system in the sameway that a corporate HQ manages the context in which each business unit operates. Functionswould include:●Analysis of the changing patterns of need for different types of medical and socialservices.46
Chapter 3 Managing the Health Service●●●●Systematic review of the supply and provision of services to meet demand, includingevaluation of changes in medical and related technologies and their potential to improvethe range, quality and cost effectiveness of the services provided.Strategic planning and management of changes and improvements in the overall form,pattern and configuration of hospital and specialist services and balancing the provisionof national, regional and local services.Systematic planning of medical and other manpower needs and the ongoing negotiationof employment contracts and terms and conditions to match the changing pattern ofneed for human resources to the changing pattern of demand for services.Costing and funding of training of medical students in public hospitals, continuing medicaleducation and furthering medical research and development.To perform this work the Executive will be required to subsume the functions and authority ofa range of national executive agencies (e.g. Comhairle na nOspidéal, Health Services EmployersAgency etc.) as, specifically, it will require authority to perform the following functions:●●●●●To plan and manage the organisation of Consultant-led specialist services/hospitalsthroughout the State.To decide on the number and type of Consultant posts in each specialist service/hospital.To plan and organise the provision of primary medical services (General Practitionerservices) and to integrate primary medical services into the overall health system.To coordinate the management of the various interdependent support functionsnecessary to run the health service as a total unified health system e.g. manpowerplanning and recruitment, procurement, systems of funding and resource allocation, etc.To provide corporate governance of the total system in accordance with the principlesand practices of best forms of governance.Early tasks of the new Executive will include:●●●●●Putting in place the new budgetary and accountability systems which we haverecommended.Managing the investment in information systems which are necessary.Negotiating the changes necessary for the effective management of the health servicewith key stakeholders.Putting in place performance management and management development programmes.Reviewing resource allocation within the health service with a view to maximisingefficiencies (e.g. to eliminate inappropriate use of expensive acute hospital beds byproviding alternatives for the long stay patients who occupy them; and to reorganise theAccident and Emergency services so as to protect elective beds, thereby eliminatingwaste of Consultant time through cancellation of elective cases).Capita Consulting found that this last problem is especially difficult in a number of Dublinhospitals, where as many as 20% of acute care beds are occupied at all times by delayeddischarge of patients. They further found that over half of the large county hospitals andsmaller urban hospitals visited by them reported that 7% or more of beds were occupied bythese patients. 11National Review of Bed Management Function, 27 January 2003.47
Page 1 and 2: Commission onFinancial Managementan
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: 6.4 COMMUNITY DRUG SCHEMES 80Medica
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Page 9 and 10: Executive SummaryWe do not underest
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Page 13 and 14: Terms of ReferenceTERMS OF REFERENC
Page 15 and 16: GlossaryEstimates for Public Servic
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Page 21 and 22: Chapter 2 Overview and Issues2.2 OR
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Page 41 and 42: Chapter 2 Overview and IssuesProble
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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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