Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Service5.3 OTHER (NON-HOSPITAL) PROGRAMMESApproximately 50% of health service expenditure occurs outside the general hospitalsprogramme. These expenditures relate to community care, mental health and a range of otherservices. Consistent with the principle that accountability for resources expended should bedevolved to those making the decisions which affect resource consumption, there is a need forthe health board CEO to assign formal responsibilities to personnel making financial decisions.Within the context of these services, we consider that the appropriate level within the systemto which accountability should be devolved is to that of the General Manager. The GeneralManager is the person in a health board responsible for managing and coordinating the deliveryof health and social services provided by a health board within a community care area, inaccordance with the board’s policy. 9We stress that the health board CEO should remain the accounting officer for all health boardexpenditure and that nothing in our recommendations is intended to change or undermine thisaccountability.Recommendations on Other (i.e. Non-Hospital) ProgrammesR5.27 In all other areas of the health service (i.e. non-hospital), the individual responsible for the budget (whetherclinical or non-clinical personnel) should be held formally accountable for financial performance.R5.28 The CEO of the Executive and the health board CEOs should analyse the totality of non-hospital related healthboard activities into clearly defined care groups (e.g. community care, mental health etc.) that are consistentthroughout the system.R5.29 The health board CEO should identify a General Manager with responsibility for each care group identified atR5.28 above.R5.30 Each General Manager should prepare an annual Service Plan and budget for their area of responsibility.R5.31 Each General Manager’s Service Plan should include:(i) Clear statements of projected service provision, linked to funding (both pay and non-pay elements); and(ii) Integrated financial and non-financial data. Formal and clear inter-connections are needed between costand activity.R5.32 General Managers should submit routine reports (monthly, quarterly, annual) to the CEO of their regional healthboard within the format and the timeframe envisaged in recommendation R9.2.ImplementationR5.33 The Health (Amendment) (No. 3) Act, 1996 should be amended, as necessary, to permit the health board CEOto formally assign duties to the General Managers making them accountable to the CEO/line management fortheir financial decisions. (The health board CEO should remain the accounting officer for all health board expenditureand nothing in our recommendations is intended to change or undermine this accountability.)5.4 SUMMARYIn line with our core principles on personal accountability and wider financial managementresponsibilities (see Chapter 2), in this Chapter, we have recommended devolving responsibilityand accountability for resource management and planning to those with the authority tocommit the expenditure – mainly Consultants in the case of the hospital system and General9They may also have responsibility for the management of health board owned hospitals – in this case they will be the Chairman ofthe proposed Executive Management Committee for the hospital (see recommendations R5.4 to R5.6 above).74