Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health ServiceAs such, they are inadequate to provide all the information necessary to underpin ourrecommendations on the structure and role of the Department of Health and Children and theExecutive. Furthermore, Service Plans, as currently constituted, do not adequately penetratethrough the system to those people making the spending decisions at the service delivery point.While there are examples of good practice in terms of involving staff at all levels in the serviceplanning process, Service Plans need to be further developed so that they are consistent withour core principle of accountability for resources expended being devolved to those making thedecisions that affect resource consumption and income generation.We have concluded that a fundamental reappraisal of the Service Plan and related reportingarrangements represents the best means of supporting a changed business focus within theDepartment of Health and Children and the Executive. The Service Plan should constitute aclear statement of the quantity and quality of health and social care provision to be provided byeach health board with reporting systems being focused on showing progress against thesestated objectives. It is imperative that standardised service planning should involve the staffdelivering care and treatment so as to bring those making the financial decisions on the groundinto the planning process. This reflects two of our core principles; firstly, that accountability forresources expended should rest with the decision maker and, secondly, that good financialmanagement and control should not be seen solely as a finance function. We are aware that ajoint health board and Department of Health and Children project team is currentlyundertaking significant work on the development of the service planning framework.Such a system would have benefits for both the providers (health boards) in terms of clarity asto their objectives and basis for accountability as well as for Government in terms of providinga more solid basis for measurement of output and value for money and an empirical frameworkwithin which to consider future policy development.The developments that we are recommending are significant initial steps towards activity-basedsystems (costing, management etc.). The international literature shows that activity-basedmanagement systems are evolving in countries around the world as examples of best practice.However, while the notion of providing cost and performance information to clinicians isgenerally seen as desirable, most jurisdictions are, as yet, in the early stages of producing thisinformation in terms of process and output measurement systems.58