Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Servicewithin the national policy framework so that the board can carry out its functions as outlinedabove. Under this model, the regional CEO would be accountable upwards to the CEO of theExecutive, and would report to his/her board at local level.This combination of accountabilityupwards, and reporting duties to a local board will, we believe, deliver maximum benefit in termsof accountability and corporate governance, in addition to greater efficiency and effectiveness.With the formation of the Executive, we recommend that Chairmen of the regional healthboards would report to the national level. We consider that the Chairman of each regionalhealth board should have access to the Chairman of the Executive to raise issues of localconcern and to comment on the performance of the regional CEO. This would allow theregional health boards to recommend changes in national policy to reflect local needs.Recommendations on Governance of Regional Health BoardsR3.17 Functions of the regional health boards should include:(i) Advising on local and regional health service requirements;(ii) Representing local community and professional interests in terms of regional service provision;(iii) Advising and providing input in respect of the regions annual Service Plan;(iv) Monitoring performance within the regional area against national health care objectives;(v) Establishment of an audit committee; and(vi) Approval of the regional Annual Report and Annual Financial Statements.R3.18 CEOs of the regional health boards should be accountable to the CEO of the Executive for the execution oftheir functions, including delivery of services within budget/determination, in respect of national serviceprovision.Accountability of Regional CEOs for Services Delivered in their Functional AreaThe CEO in each regional health board area will be accountable for the performance of the staffemployed by the regional health board, including the managers of health board hospitals.In the case of the eastern region, a specific issue will have to be addressed following theanticipated transfer of functions from the Eastern Regional Health Authority to the newExecutive. This relates to the accountability structure for those major teaching hospitalscharged with the provision of a range of national services. We are of the view that because theydeliver national services, the CEO of the new Executive (rather than the CEO of a regionalhealth board) should be accountable for the chief executives of these hospitals. Weacknowledge that specific and complex issues need to be addressed in the case of voluntaryhospitals that, while funded by the State, are owned and managed through arrangements thatreflect their history.We believe that the relationship of accountability we are recommending between the newExecutive and those hospitals delivering national services will greatly facilitate consideration,planning and implementation of the priority resource management tasks we have alreadyidentified for the Executive (e.g. the problems of "blocked" beds and of the Accident andEmergency services). We also believe that the role of these hospitals in providing nationalservices (e.g. organ transplant services) and major regional services (e.g. vascular surgery)positions them in a key role to assist in formulating proposals for rationalisation of the generalhospital service. In this regard, they can assist in balancing the national, regional and local52
Chapter 3 Managing the Health Serviceservices they provide as well as their role in providing medical education and training and inresearch and development.Recommendations on Accountability for Services Delivered in Regional Health Board Functional AreasR3.19 CEOs of regional health boards will be accountable to the CEO of the Executive for the performance of all staff,including the managers of health board hospitals, employed by their health board.R3.20 The CEOs of the major teaching hospitals providing national services would be accountable directly to the CEOof the Executive because of their role in the provision of national services and specialties.ImplementationSignificant changes will be required to existing legislation to give effect to the variousrecommendations above.Recommendations on ImplementationR3.21 The necessary changes to the Health Acts 1970 and 1996 and the Eastern Regional Health Authority Act 1999should be brought forward by the Department of Health and Children to give effect to the above changes.3.8 CODE OF GOVERNANCEIn our view, it is important to codify and clarify precisely what governance in a health careenvironment means and thus ensure boards of all agencies understand and fully observe theirresponsibilities in this regard. A written code would also encourage boards to implementappropriate systems and structures in their organisations to meet the (specified) standards ofgood governance.In this context, we would lay particular emphasis on the need to ensure that members are notplaced in a position where a systematic conflict of interest could impair their ability to actsolely in the best interests of the corporate entity.The Department of Health and Children and/or the Executive should also develop appropriatecorporate governance guidelines for hospitals. These guidelines should be mandatory forpublicly owned hospitals and health service organisations. We believe that adoption of theseguidelines should also be a condition for continued State funding of voluntary agencies/hospitals.Recommendations on a Code of GovernanceR3.22 The Department of Health and Children should produce a written Code of Governance for all agencies in thepublic health sector. This code should enshrine the principles contained in the Department of Finance Code ofPractice for the Governance of State Bodies.R3.23 All Executive board members should be independent and act solely in the interest of the board.53
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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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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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