Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceRecommendations on Service Planning in the General Hospitals ProgrammeR5.7 In the case of admitting Consultants who assume clinical care for a patient, the following steps should be taken:(i) Hospital/health board CEO, as appropriate, identify all individual clinical practices within each specialty;(ii) Hospital/health board CEO, as appropriate, identify a lead clinician as Head of Specialty;(iii) Hospital/health board CEO, as appropriate, should agree with the Head of Specialty the assignment of amember of staff as business manager to prepare cost and activity budgets, practice profiles and monthlyexpenditure reports for the specialty and each individual clinical Consultant’s practice within thespecialty.R5.8 In the case of non-admitting Consultants (e.g. radiology, pathology, etc.), the following steps should be taken:(i) Hospital/health board CEO, as appropriate, identify all non-admitting hospital departments;(ii) Hospital/health board CEO, as appropriate, identify for each department a Head of Department;(iii) Hospital/health board CEO, as appropriate, should agree with the Head of Department the assignmentof a member of staff as business manager to prepare cost and activity budgets, practice profiles andmonthly expenditure for the department.R5.9 All costs incurred by the non-admitting hospital departments identified at R5.8(i) above should be allocated backto the admitting specialties identified at R5.7(i) above in order to allow the calculation of full costs incurred byspecialty and patient.R5.10 A working group, under the aegis of the Department of Health and Children, should be set up to agree acommon national methodology to be applied to the allocation of the indirect costs referred to at R5.9 above.R5.11 The business managers recommended at R5.7(iii) and R5.8(iii) above:(i) May cover more than one specialty/department, depending on the particular needs and demands of thatspecialty/department; and(ii) Should be made available from within existing resources as part of a reorganisation by hospital/healthboard CEOs of existing duties and responsibilities.Format and Content of Service PlansConsistent with our conclusion from Chapter 4 that Service Plans at all levels should bestandardised, we consider it appropriate that sub-hospital level Service Plans should have aformat and content similar to standard health board Service Plans.Recommendations on Service Planning in the General Hospitals Programme (contd.)R5.12 The annual practice/specialty/department Service Plan should include:(i) Clear statements of projected activity, linked to funding (both pay and non-pay elements);(ii) Integrated financial and non-financial data. Formal and clear inter-connections are needed between costand activity; and(iii) A clear analysis between public and private patients in respect of (i) and (ii) above.R5.13 Clear reporting arrangements and responsibilities must be put in place such that:(i) Business managers are responsible for gathering and presenting management data on costs and activities;and(ii) Clinical Consultants/Heads of Department are responsible for providing explanations to thehospital/health board CEO of variances from budget and how such variances will be brought back intoline.R5.14 Routine reports (monthly, quarterly, annual) should be submitted in the format and within the timescalesenvisaged in recommendation R9.1.70
Chapter 5 Accountability – Hospital and Non-Hospital ProgrammesTraining NeedsIn addition to the information technology requirements necessary to give effect to the aboverecommendations (see Chapter 10), it will be necessary to provide a range of ongoing trainingand assistance to the main participants in the process to assist in the implementation of theabove recommendations.Recommendations on Implementation in the General Hospitals ProgrammeR5.15 Business managers should receive continuous relevant training to ensure they have the requisite skills, trainingand experience in medical and clinical work as well as finance and management to perform their duties.R5.16 The health board/hospital CEO should be responsible for determining the appropriate level and quantum oftraining and for putting in place the mechanisms necessary to ensure that training is delivered.R5.17 The Executive should liaise with educators to prepare/train clinical Consultants/Heads of Department on anongoing basis to understand and to work with new financial management information systems.R5.18 The Department of Health and Children should liaise with the Higher Education Authority to introduce arequirement for medical schools to develop programmes to ensure that every medical student receives at leastone module on health economics, technology assessment and financial management and control issues.R5.19 A working group under the aegis of the Executive, in consultation with the Department of Health and Children,should examine and make recommendations on appropriate incentives for those clinical Consultants/departments that successfully implement recommendations above.Public/Private Mix in Public HospitalsThe existing arrangements for mixing public and private treatments are inherentlyunsatisfactory from a management and control perspective.They result in a conflict of interestfor Consultants between meeting clinical obligations to public patients on the one hand and, onthe other, the prioritisation, treatment and the use of publicly provided infrastructure andresources in public hospitals for private patients. They also raise issues of fair competitionwith private hospitals in that the resources used are not charged for fully. They severely limitthe time the majority of clinicians have to pursue resource management. Ultimately, these issuescan only be resolved fully by completely separating public and private practices.Table 5.1 and Figure 5.1 give some indication of the levels of subsidy from the taxpayer towardsthe cost of treating private patients.71
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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
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
Page 21 and 22: Chapter 2 Overview and Issues2.2 OR
Page 23 and 24: Chapter 2 Overview and IssuesAppend
Page 25 and 26: Chapter 2 Overview and IssuesFigure
Page 27 and 28: Chapter 2 Overview and Issuesother
Page 29 and 30: Chapter 2 Overview and IssuesTable
Page 31 and 32: Chapter 2 Overview and IssuesFigure
Page 33 and 34: Chapter 2 Overview and Issues●●
Page 35 and 36: Chapter 2 Overview and IssuesIn 200
Page 37 and 38: Chapter 2 Overview and IssuesThe an
Page 39 and 40: Chapter 2 Overview and IssuesTable
Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
Page 71: 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
Page 105 and 106: Chapter 8 Audit Reformoutsourcing)
Page 107 and 108: Chapter 8 Audit Reformaudit reports
Page 109 and 110: Chapter 8 Audit Reformas relating t
Page 111 and 112: Chapter 8 Audit Reform●●Penalti
Page 113 and 114: Chapter 9 External Reporting Proced
Page 119 and 120: 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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