Brennan Report - Department of Health and Children

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