Brennan Report - Department of Health and Children

Chapter 5 Accountability – Hospital and Non-Hospital ProgrammesWe believe that there is a need for practice, specialty and department-level Service Plans andbudgets within general hospitals. These should be subsets of the hospital Service Plans and, inturn, the health board Service Plans – aggregating the Service Plans from all the sub-units shouldgive the costs and activity set out in the health board Service Plan. All Service Plans, from theindividual clinical Consultant’s practice to the health board, should have a standardised formatand content. These Service Plans would replace the operational plans prepared, under theexisting arrangements, in support of health board’s Service Plans.Doctors are a valuable resource; the more time they devote to the treatment of patients thebetter. Involving Consultants in planning and management requires that hospital managementprovide appropriate support, through the provision of a business manager, to Consultants toassist them in preparing their annual budgets. This would create the space to ensure thatConsultants can continue to focus on medical services rather than spending an inordinateamount of time on administrative matters. The business manager would be responsible for thepreparation of cost and activity budgets, practice profiles, monthly expenditure reports, etc.Consultant budget holders must then be accountable for their actual expenditure and activityand how this compares against budget. We believe that such a system would createopportunities for improving value for money within the health service without compromisingclinical independence. We are of the view that business manager support can be found fromwithin the existing resources of the hospitals and from within different disciplines. It requires arefocusing of existing resources on to a different way of doing business i.e. by reformattingbudgeting systems and expenditure control reports around the patient and the clinicalConsultant.The introduction of hospital costing systems to patient level will require the development ofsophisticated activity based costing systems to fully integrate financial and activity data.Development of such systems should be undertaken within the IT investment programmeenvisaged in Chapter 10.69