Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health Service11 IMPLEMENTATION 12011.1 OVERVIEW 12011.2 DECISIONS BY GOVERNMENT 12011.3 MANAGING CHANGE 120Concentrate on Core Health ActivitiesImplementation CommitteeDelivering Change11.4 DETAILED GUIDANCE ON IMPLEMENTATION 123Timeframe for ImplementationIT Systems Implications of the Recommendations11.5 CONCLUSION 124ADDENDUM 125APPENDICESAppendix 1 - Commission Member Biographies 149Appendix 2 - Groups/Individuals Invited To Make Submissions 152Appendix 3 - Statutory Health Service Providers 154Appendix 4 - Description of the Estimates and Allocations Process 160Appendix 5 - Diagnosis Related Groups/Casemix 175Appendix 6 - Audit of Structures 179Appendix 7 - Extracts from the Consultants’ Common Contract 180Appendix 8 - Integrated Management Reports 183Appendix 9 - Investment in Information Technology in the Midland Health Board 184
Executive SummaryEXECUTIVE SUMMARYThe Commission carried out a detailed examination and review of the financial management andcontrol systems in the Irish health service.The Commission found problems in the existing systems, including:●●●●The absence of any organisation responsible for managing the health service as a unifiednational system.Systems are not designed to develop cost consciousness among those who make decisions tocommit resources and provide no incentives to manage costs effectively.Insufficient evaluation and analysis of existing programmes and related expenditure.Inadequate investment in information systems and management development.The Commission adopted four core principles in addressing the problems:●●●●The health service should be managed as a national system.Accountability should rest with those who have the authority to commit the expenditure.All costs incurred should be capable of being allocated to individual patients.Good financial management and control should not be seen solely as a finance function.The Commission made 136 recommendations including:●●●●●●●●The establishment of an Executive to manage the Irish health service as a unitary nationalservice.A range of reforms to governance and financial management, control and reporting systems tosupport the Executive in the management of the system.The designation of clinical Consultants and General Practitioners as the main units of financialaccountability in the system.Substantial rationalisation of existing health agencies.All future Consultant appointments to be on the basis of contracting the Consultants to workexclusively in the public sector; more transparent arrangements for existing Consultants.Reform of the medical card scheme to include a Practice Budget for each GP,monitoring of activity and referral patterns etc.Strengthening the process of evaluation of clinical and cost effectiveness for publicly fundeddrug schemes.Pending the establishment of the Executive, the creation of a high level and well resourcedImplementation Committee.5
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Chapter 3 Managing the Health Servi
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Chapter 5 Accountability - Hospital
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Chapter 6 Accountability - General
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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 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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