Brennan Report - Department of Health and Children

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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
Chapter 4 Service Planning, Budgeting and Supplementary EstimatesRecommendations on Service PlanningR4.1 A single, comprehensive and standardised template for Service Plans should be adopted. This should coverService Plans at all levels: clinical Consultants, hospitals and non-hospital General Managers at sub-health boardlevel, as well as regional health boards and the Executive. Higher level Service Plans should be derived from lowerlevel Service Plans (e.g. hospital from the aggregate of individual Consultants).R4.2 Pending establishment of the Executive, a working group, including representation from the the Department ofHealth and Children, Department of Finance and the regional health boards, should be established to devise anappropriate standard template and to make recommendations to the Secretary General and Minister for Healthand Children.R4.3 The terms of reference for the working group recommended at R4.2 above should, having regard to the dataimprovements afforded by the investment in information technology recommended in Chapter 10, includeconsideration of how best the Service Plans could be structured to provide:(i)(ii)(iii)Clear statements of projected service provision analysed by the main care groups (including eachspecialty in hospitals), linked to funding (both pay and non-pay elements);Integrated financial and non-financial data. Formal and clear inter-connections are needed between cost(approved determination) and activity (level of service being provided); andPay and employment data.R4.4 The working group at R4.2 above should also consider how existing reporting arrangements might berestructured to provide, again in a standardised format, an ongoing report on progress against targets andobjectives set out in the Service Plan (see also Chapter 9 recommendations in this regard). In particular:(i)(ii)(iii)Monthly Integrated Management Reports should be closely linked to the Service Plan.Quarterly Performance Indicator Reports should continue to be explicit on delivery of targets andshould also be linked to the Service Plan.Annual Reports and Financial Statements should specifically link back to financial and activity performanceenvisaged in the Service Plan. This would provide the final link between the Letter of Determination,Service Plan, Integrated Management Reports, Annual Financial Statement and Annual Report.Drafting Service PlansThe predominance of core service delivery means that the Service Plan is largely drafted beforethe Letter of Determination (which details new developments) is received by the health boards.Under current arrangements, as described in Appendix 4, letters of determination issuefollowing Budget day in early December and Service Plans are not finalised and approved untilthe middle of January each year (and, indeed, later than that in the case of those agencieswithin the Eastern Regional Health Authority area).However, to prepare high quality Service Plans, health service providers need more preparationtime. We believe that an effective planning and budgeting system requires activity andexpenditure profiles for the coming year to be in place before the year commences and thebudgetary timetable should be designed to accommodate this. A December Budget day is animpediment to achieving this objective. However, we accept that the Government must takeaccount of issues other than the efficient management of the health service in deciding onBudget day.While we consider that an earlier budget day is desirable we recognise that it maynot be a deliverable proposition.59
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
Page 9 and 10: Executive SummaryWe do not underest
Page 11 and 12: Executive Summary"demand-led" schem
Page 13 and 14: Terms of ReferenceTERMS OF REFERENC
Page 15 and 16: GlossaryEstimates for Public Servic
Page 17 and 18: Chapter 1 Introduction and Backgrou
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Page 21 and 22: Chapter 2 Overview and Issues2.2 OR
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Page 31 and 32: Chapter 2 Overview and IssuesFigure
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Page 35 and 36: Chapter 2 Overview and IssuesIn 200
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Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
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Page 65 and 66: Chapter 5 Accountability - Hospital
Page 79 and 80: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
Page 103 and 104: Chapter 8 Audit ReformRecommendatio
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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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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