Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceConsultants’ average pay (¤ 151,694), as shown in Table 7.3, refers to remuneration in respectof their 33-hour public contract only. Consultants often work on-call and/or for lengthyperiods outside their core hours as part of their public contract commitment. Many Consultantsalso have income from private practice. The Department of Health and Children estimatespayments to Consultants from private insurers in respect of private practice in 2002 amountedto some ¤ 192.5 million. Averaging this over an estimated 1,515 Consultants with privateearnings, including those engaged solely in private practice, suggests an average gross feeincome (before practice and other expenses) from private practice in excess of ¤ 127,000 perConsultant per annum (this figure does not include fee income paid directly to the Consultantby the patient in the context of out-patient visits). Of course, some Consultants have little orno private practice while others will earn a multiple of this average.International comparisons of pay rates are fraught with difficulty due to a wide variety offactors such as differing job specifications and terms of contract. However, we consider that itis nonetheless instructive to give some indication of how the reward structure in Irelandcompares with, for example, the UK. Consultants in the UK earn a basic salary in the range of¤ 80,000 to ¤ 105,000 (Stg£52,640 - £68,505) 4 . A small proportion of Consultants in the UKcan earn in excess of this through a complex system of distinction/merit payments and awards.This can bring pay rates up to around ¤ 204,000 (Stg£133,585) based on an A+ distinctionaward. However, considerably less than 1% of Consultants employed in the UK’s National HealthService receive payment at the A+ distinctions level – in 2001, just 36 consultants. 5Having regard to the foregoing, we fully acknowledge the long and unsocial hours worked byhealth care staff in caring for patients. Patients have no control over the time at which theybecome ill and are entitled to expect treatment out of hours when they need it. Equally, staffare entitled to be recompensed for working unsocial hours.Nevertheless, we believe that the payment of overtime and other on-cost remuneration on thescale shown in the preceding tables is unsustainable. A significant proportion of the work of thehealth service is planned, non-emergency work. It should be possible to organise and managethis work within core hours. In addition, it has been suggested to us that a much greaterproportion of hospital work could be undertaken in day facilities, for example.We consider that a key task for the proposed Executive will be to examine the drivers of paycosts with a view to achieving more efficient working arrangements and cost savings throughstrategies to reschedule work within core hours and tighter control of basic pay costs throughthe introduction of improved systems of manpower deployment and control.7.3 NEGOTIATING AND IMPLEMENTING PAY AGREEMENTSThe Health Service Employers Agency (HSEA), on behalf of health employers, takes the lead rolein negotiations with trade unions and representative bodies on the pay and conditions ofemployment of health service personnel and in solving industrial relations problems in thehealth sector. The HSEA was established in 1996. It is a representative body for all publiclyfundedhealth service employers. Its membership includes the health boards, public voluntaryhospitals, intellectual disability agencies and such other corporate bodies in the health sector asare admitted to membership. The HSEA provides its services through a Board that isappointed by the Minister for Health and Children. The Board consists of nine persons drawn4Source: UK, Department of Health (April 2002). Euro/Sterling exchange rates as at 31 January 2003.5Source:Advisory Committee on Distinction Awards,Annual Report 2001, page 6.92
Chapter 7 Accountability – Employment and Payfrom the health boards, voluntary hospitals, the Department of Health and Children, jointboards hospitals and intellectual disability agencies. The HSEA has acquired particularexpertise by recruiting to its staff experts from outside the civil service.As indicated in Chapter 3, we would see the HSEA as one of the bodies whose functions wouldbe subsumed within the human resource function of the proposed Executive.There have been instances where the costs of special pay awards were underestimated, sometimes substantially so. Frequently, this is caused by the "spill-over" effects of pay agreementswith particular groups not being anticipated at the time negotiations are being finalised by theHSEA. The pay deal concluded with childcare workers, as detailed in Chapter 2, is such anexample. Originally estimated to cost ¤ 4.7 million, it turned out at ¤ 11.4 million in respect ofchildcare workers alone and is expected to cost some ¤ 45 million to ¤ 50 million per annumonce the knock-on effects have fed through to linked grades.Pending the establishment of the Executive, we consider that there should be some level ofresponsibility with the HSEA for the costing of awards negotiated by them while accepting thatultimate responsibility in this regard must rest with the Department of Health and Children.Our recommendations on risk assessment (see Chapter 8) are also relevant to this issue. Weare also aware that there have been past instances of differing interpretations of pay agreementsand, consequently, a lack of consistency between health boards in how agreements haveactually been implemented on the ground. In order to ensure clarity and coherence betweenthe various agencies involved, it is important that each party have a clear understanding of theirrole during the negotiation stage and, subsequently, during the implementation stage.Recommendations on Costing of Pay AwardsR7.1 Pending transfer of functions to the proposed Executive, the CEO of the Health Service Employers Agency(HSEA) should report to the Secretary General of the Department of Health and Children and be accountableto him for the financial consequences of pay negotiations and the interim costing of agreements conducted bythe HSEA.R7.2 Prior to any agreement being concluded, the final costing of pay agreements negotiated by the HSEA should beprepared by the Department of Health and Children, drawing on the comprehensive dataset proposed atrecommendation R7.6 below.7.4 COLLECTION AND VALIDATION OF BASIC INFORMATIONAt present, the principal data source on employment in the public health sector is the annualCensus of Health Service Employees. This is a snapshot of employment, conducted by all healthboards, on the instruction of the Department of Health and Children, over the last two weeksin each calendar year.The Census is a count of all health service personnel. It includes information on employmentcontracts, such as temporary, full-time, locum etc. Employee numbers are reported on by theabsolute number employed and are also expressed as whole time equivalents (WTEs) – i.e.converting the number of part time workers into an equivalent number of full time employees,by reference to the average length of the working week.93
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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
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Chapter 2 Overview and Issues2.2 OR
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Chapter 2 Overview and IssuesAppend
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issuesother
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesFigure
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Chapter 2 Overview and Issues●●
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Chapter 2 Overview and IssuesIn 200
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Chapter 2 Overview and IssuesThe an
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Chapter 2 Overview and IssuesTable
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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 79 and 80: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
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Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 123 and 124: Chapter 11 ImplementationRecommenda
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Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
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Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
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Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
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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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