Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceAs an important tool to facilitate the management of the health service, the Census has anumber of weaknesses:●●●●●●●●The Census for any one year is not usually available until well into the succeeding year.By that time significant changes in employment may have taken place. For example, the2001 data, only published in November 2002, is already one year out of date.The Census does not record staff employed in voluntary bodies/agencies that are grantfundedby health boards. Pay awards to health service personnel usually apply to staff atthese bodies/agencies, many of whom are paid at health service rates.The Census does not provide details of vacancies.The Census is taken at the year-end when employment patterns are atypical.The Census does not record the number of agency personnel employed. Agency nurses,for instance, are qualified nurses who, while they work on hospital wards alongside staffnurses, are not directly employed by the hospitals. They are used to fill vacancies inhospitals or temporarily substitute for absences.There is no method for validating the accuracy of the returns.The data contained in the Census is not consistent over time - i.e. ongoing refinementsto the data are not carried into returns for earlier years.It is not clear if uniform, accurate and relevant methods are being used throughout thehealth service, when carrying out the Census, for matters including the estimation ofwhole time equivalents.Because the health service is the biggest employer in the State, high quality information onemployment and pay is essential for effective management of the system.We have concluded that, once the appropriate information systems are in place (see Chapter10 recommendations), a formal annual Census coordinated by the Department of Health andChildren will no longer be necessary. Rather, such information should feed up from theemploying body based on existing records, such as payroll information etc. Responsibility for theprovision of employment information should reside with those organisations, principally thehealth boards, responsible for directly employing staff or funding their employment – as acondition of grant payment, voluntary bodies/agencies have a duty of accountability back to theState to provide the data necessary to manage national pay policy.Pending roll out of the necessary information technology systems, the Census will have toremain in place.94
Chapter 7 Accountability – Employment and PayRecommendations on Employment Information and ReportsResponsibilities for provision of Employment InformationR7.3 The CEO of each health board should be responsible for the provision of employment information both for theirown direct employees and for employees of all agencies funded by the health board.R7.4 Health boards should afford appropriate priority and resources to ensure the compilation of timely, accurate andverifiable employment data.Employment Information to be included in Monthly ReportsR7.5 Health board CEOs should report employee numbers and pay cost data to the Executive on a monthly basiswithin the revised Integrated Management Reporting structure recommended at R9.3.R7.6 The specific details of the pay and employment data to be provided in the health boards’ Monthly IntegratedManagement Reports should be determined by the working group referred to in recommendation R4.4. At aminimum, these should include:(i) Detailed information on gross pay costs, by grade code;(ii) Details on the elements comprising pay (i.e. basic pay, overtime, shift allowances etc.), by grade code;(iii) Details on costs of agency working;(iv) Identification of approved vacancies and progress in filling new posts to support service development asset out in the annual Service Plans;(v) Comprehensive listing of voluntary bodies/agencies funded by each health board; and(vi) Similar detail as at (i) to (iv) above in respect of these voluntary bodies/agencies.R7.7 National employment data should be reported by the Executive to the Department of Health and Childrenwithin the revised Consolidated Integrated Management Reporting structure referred to at recommendationsR9.4 and R9.5.7.5 CONTROLLING STAFFING LEVELSThe requirement to live within budgetary allocations is, and will remain, the primary means ofexpenditure management. However, Governments have traditionally chosen to underpinbudgetary allocations with an employee numbers control framework as an integral part of theoverall management structure for the public service.The most recent example of this came in the announcement by the Minister for Finance in hisBudget speech delivered on 4 December 2002 that "the Government has decided that numbersemployed across all sectors of the public service are to be capped at their present authorisedlevels with immediate effect. In addition, the Government has decided that there will be a reduction of5,000 in those numbers over the next three years" 6 .This announcement was made as part of widerefforts "to move our expenditure, pay and cost levels onto a lower growth trajectory" given thechanged economic and financial circumstances.We consider that there is, at least in the short to medium term, a place for an employeenumbers ceiling, consistent with the overall budgetary allocation, as an additional tool inbudgetary management. This is particularly the case within the health sector given the scale ofemployment engaged at a multitude of different levels and in a wide variety of working timearrangements. We also note the conclusion of the Independent Estimates Review Committeethat "centralised control of health service employment needs to be re-established by theDepartment of Health and Children as a matter of urgency" 7 .Under current arrangements, the Department of Finance authorises the overall staffing6Financial statement of the Minister for Finance, 4 December 2002.7Paragraph 9.3, Estimates for Public Services 2003 - Report of the Independent Estimates Review Committee to the Minister forFinance, December 2002.95
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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
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Chapter 3 Managing the Health Servi
Page 45 and 46: 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
Page 95: 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
Page 121 and 122: Chapter 10 Information SystemsRecom
Page 123 and 124: Chapter 11 ImplementationRecommenda
Page 125 and 126: Chapter 11 Implementationbeing brou
Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
Page 129 and 130: Appendix 1He has held this position
Page 131 and 132: Appendix 2SIPTU*South Eastern Healt
Page 133 and 134: Appendix 3Name of AgencyBord na Rad
Page 135 and 136: Appendix 3Name of AgencyIrish Blood
Page 137 and 138: Appendix 3Name of AgencyWomen’s H
Page 139 and 140: Appendix 4Department of Health and
Page 141 and 142: Appendix 4collated and assessed by
Page 143 and 144: Appendix 4The most detailed element
Page 145 and 146: 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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