Brennan Report - Department of Health and Children
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Brennan Report - Department of Health and Children

Brennan Report - Department of Health and Children Brennan Report - Department of Health and Children

dohc.ie
13.07.2015 Views

Report of the Commission on Financial Management and Control Systems in the Health Servicesupplementary estimates are reintroduced. We recognise that, under current arrangements,there are certain categories of expenditure incurred, which are outside the control of budgetholders. Fluctuations in these categories of expenditure may place an unsustainable burden onthose agencies if they must be met from within their own resources in any given year. However,we are strongly of the opinion that every step should be taken to ensure that supplementaryestimates are never used to cover normal budgetary costs. As a matter of general principle, webelieve that automatic or easy access to supplementary estimates can undermine budgetarydiscipline. We consider that the tighter controls recommended below and adoption of the riskassessment procedures recommended in Chapter 8 should ensure that recourse tosupplementary estimates is greatly reduced in the future.Recommendation on Supplementary EstimatesR4.9 If, notwithstanding the statement of the Minister for Finance in his Budget speech delivered in December 2002that Ministers and their Management Committees will be required to manage strictly within the allocations givento them, there are to be supplementary estimates in the future, we recommend that the Department of Financeand the Department of Health and Children should:(i) Review the appropriateness and coverage of "allowable supplementaries";(ii)(iii)Make recommendations to the Minister for Finance in this regard; andThereafter conduct biennial reviews by reference to the volume and content of supplementary estimatesallowed in the intervening period.4.6 SUMMARYIn this Chapter we have looked at tightening the budgetary and planning processes, particularlyin relation to service planning.The changes recommended are necessary to support the national management function that wehave proposed in Chapter 3 be conducted by an Executive agency. The comprehensive useof standardised Service Plans at all levels throughout the system will also be essential tosupport the personal accountability framework which we adopted as one of our core principlesin Chapter 2 and which is addressed further in Chapters 5 and 6.A system of planning and then reporting on performance, financial and otherwise, against planwill help inculcate a culture of financial management through all levels, again consistent with ourcore principles identified in Chapter 2. External reporting is dealt with in more detail inChapter 9.62

Chapter 5 Accountability – Hospital and Non-Hospital ProgrammesCHAPTER 5ACCOUNTABILITY – HOSPITAL AND NON-HOSPITALPROGRAMMESIn this Chapter, we examine the changes most necessary to deal with the lack of clear accountabilitythroughout the health system for service planning, budgeting and expenditure control. The main focus is onthe Consultant-led specialist services.5.1 OVERVIEWIn Chapter 3, we recommended the establishment of an Executive to address the managementvacuum in the health service.The second major structural weakness of the system is the lackof clear accountability. In this Chapter, we will examine weaknesses in the structure ofaccountability within the hospital and non-hospital services for budgeting, costing, activityplanning and management and cost control. Our views on how to address these problems willbe guided by our core principles of reform, identified in Chapter 2, particularly as regardspersonal accountability – i.e. that accountability for resources expended should rest with thosewho have the authority to commit the expenditure.We believe that accountability for spending should be devolved to the lowest and mostappropriate decision-making level. There is a need to:(a)(b)(c)Identify where and by whom decisions affecting expenditure are made;Define the areas for which these individual decision makers have responsibility; andEngage the identified individuals fully in the planning, managing and control processes.Each year the general hospital sector accounts for almost 50% of national health expenditure.The role of clinical Consultants and their staff must be widened to include financialaccountability as well as clinical accountability so as to develop a more accountable, costeffectivehealth service. In the non-hospital areas of the health system, the individualresponsible for the budget, whether clinical or non-clinical personnel, should be held formallyaccountable for financial performance.The health system is financed by the taxpayer. We believe that full costs of treating privatepatients in public hospitals should be both transparent and publicly available, as part of theculture of improved accountability.5.2 GENERAL HOSPITALSIdentifying the Decision MakersA general hospital is a location where clinical (i.e. admitting) Consultants conduct theirmedical practices. It is for the individual clinical Consultant to decide whether his/her patientrequires admission and to decide and manage the patient’s investigation, treatment anddischarge.The work of other (non-admitting) Consultant colleagues (radiology, pathology, etc.)as well as the work of other hospital services (nursing, laboratories, therapy, administration)derives from the decisions of the clinical Consultant.63

<strong>Report</strong> <strong>of</strong> the Commission on Financial Management <strong>and</strong> Control Systems in the <strong>Health</strong> Servicesupplementary estimates are reintroduced. We recognise that, under current arrangements,there are certain categories <strong>of</strong> expenditure incurred, which are outside the control <strong>of</strong> budgetholders. Fluctuations in these categories <strong>of</strong> expenditure may place an unsustainable burden onthose agencies if they must be met from within their own resources in any given year. However,we are strongly <strong>of</strong> the opinion that every step should be taken to ensure that supplementaryestimates are never used to cover normal budgetary costs. As a matter <strong>of</strong> general principle, webelieve that automatic or easy access to supplementary estimates can undermine budgetarydiscipline. We consider that the tighter controls recommended below <strong>and</strong> adoption <strong>of</strong> the riskassessment procedures recommended in Chapter 8 should ensure that recourse tosupplementary estimates is greatly reduced in the future.Recommendation on Supplementary EstimatesR4.9 If, notwithst<strong>and</strong>ing the statement <strong>of</strong> the Minister for Finance in his Budget speech delivered in December 2002that Ministers <strong>and</strong> their Management Committees will be required to manage strictly within the allocations givento them, there are to be supplementary estimates in the future, we recommend that the <strong>Department</strong> <strong>of</strong> Finance<strong>and</strong> the <strong>Department</strong> <strong>of</strong> <strong>Health</strong> <strong>and</strong> <strong>Children</strong> should:(i) Review the appropriateness <strong>and</strong> coverage <strong>of</strong> "allowable supplementaries";(ii)(iii)Make recommendations to the Minister for Finance in this regard; <strong>and</strong>Thereafter conduct biennial reviews by reference to the volume <strong>and</strong> content <strong>of</strong> supplementary estimatesallowed in the intervening period.4.6 SUMMARYIn this Chapter we have looked at tightening the budgetary <strong>and</strong> planning processes, particularlyin relation to service planning.The changes recommended are necessary to support the national management function that wehave proposed in Chapter 3 be conducted by an Executive agency. The comprehensive use<strong>of</strong> st<strong>and</strong>ardised Service Plans at all levels throughout the system will also be essential tosupport the personal accountability framework which we adopted as one <strong>of</strong> our core principlesin Chapter 2 <strong>and</strong> which is addressed further in Chapters 5 <strong>and</strong> 6.A system <strong>of</strong> planning <strong>and</strong> then reporting on performance, financial <strong>and</strong> otherwise, against planwill help inculcate a culture <strong>of</strong> financial management through all levels, again consistent with ourcore principles identified in Chapter 2. External reporting is dealt with in more detail inChapter 9.62

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