Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceRecommendations on the Role of the ExecutiveR3.7 We recommend that the role of the Executive should include:(i) Strategic planning and management of change in the health system, including location of services, aimedat improved service delivery;(ii) Managing the delivery of health services within budget;(iii) Manpower planning and needs assessment;(iv) Managing staff relations;(v) The resource allocation process;(vi) Analysing health spending annually by:(a) Programme/care group (childcare, hospital services, disability services etc.),(b) Health board region;(vii) Under each of the headings at (vi)(a) and (vi)(b) above, the following actions should be undertaken:(a) A comparison of performance, productivity, quality of care and value for money,(b) Summary results of the comparative analysis undertaken at (vii)(a) above should be published, ina standardised format, within 6 months of the end of the relevant accounting period;(viii) Identifying the problems and issues highlighted by the comparative analysis undertaken at (vi) and (vii)above;(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;and(x) Risk assessment/management.R.3.8In regard to recommendation R3.7(vii)(a), we recommend that the existing National Performance IndicatorsProject Team define appropriate measurable definitions and indicators of "performance", "productivity" and"value for money".This group should submit its recommendations to the Secretary General and Minister forHealth and Children.3.7 RESTRUCTURED GOVERNANCE ARRANGEMENTS FOR THE HEALTHSERVICERelationship between Department and the ExecutiveIn order to effectively discharge its responsibilities – on drafting legislation, developing policyand as principal advisor to the Government on health issues – it will be essential that theDepartment of Health and Children be closely in touch with the on-the-ground reality ofpolicy implementation. This will require close contact between officials at all levels of theExecutive and the Department of Health and Children in order that Departmental officials willhave a clear understanding of the practical issues and challenges related to health servicedelivery.Furthermore, the aims and objectives of the Department and the Executive will both be focusedtoward the same end – maximising efficiency, effectiveness and output within the health service.These congruent interests make a close working relationship between the two organisationsessential. If the relationship between the two parties does not work properly, it couldsubstantially compromise the capacity of the health system to deliver on its objectives. One ofthe key tests of the practical success of the organisational structure we propose will be theability of both the Executive and the Department to forge an effective working relationship andbuild appropriate synergies.In this context, we see the relationship between the Secretary General of the Department ofHealth and Children and the CEO of the Executive working along the lines of that which existscurrently between CEOs of non-commercial State bodies and their respective Secretaries48
Chapter 3 Managing the Health ServiceGeneral. Neither party is accountable to the other, nor do they formally report to each other,but of necessity they must have a close working relationship to deliver the best health service.We envisage a "functional" relationship (rather than a formal reporting relationship) existingbetween the CEO of the Executive and the Secretary General of the Department. The CEO ofthe Executive will be responsible for providing the information necessary to support theSecretary General of the Department in his role as accounting officer for the health systemoverall. This information exchange will also be necessary to allow Government independentlymonitor the performance of the Executive against its objectives and to ensure that services arebeing delivered in line with Government policy.We are convinced that this functional relationship can work. Similar "functional reporting"models already operate successfully in the public service, for example between the RevenueCommissioners and the Department of Finance and between IDA Ireland and theDepartment of Enterprise,Trade and Employment.The ExecutiveWe have recommended the establishment of an Executive to manage the Irish health service asa unitary national service.The new Executive should have a corporate board with responsibilities and accountabilities thatare consistent with those of a normal corporate/commercial board. However, the Minister forHealth and Children will remain the ultimate accountable person, accountable to the Dáil andOireachtas for the performance of the health service. It is therefore vital that there is strongaccountability to the Minister by those responsible for the health service. For this reason, theChairman of the board of the Executive will have a direct personal reporting relationship to theMinister.The Minister for Health and Children will also appoint the Chairman and members ofthe board of the Executive.The CEO of the Executive should be accountable to the board of the Executive.Thus, the boardof the Executive should have the power of hiring and firing its CEO (the ultimate test ofaccountability). The CEO of the Executive should be an accounting officer in his/her own right.We have made recommendations earlier in this Chapter on the role and function of theExecutive. Complementing these recommendations, are recommendations below on the role ofthe corporate board and CEO of the Executive.These recommendations on the board of theExecutive cover accountability to the Minister, strategic and financial responsibilities, andresponsibility for the performance of the CEO of the Executive.49
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 43 and 44: Chapter 3 Managing the Health Servi
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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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