Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health Servicenumbers. This sanctioned total, expressed in wholetime equivalents, is intended to relate to 31December of the year in question and, hence, is verifiable by reference to the annual Census ofHealth Service Employees, which the Department of Health and Children takes on that dateeach year.The Department of Finance indicated to us that it views the mechanism it uses for deriving theceiling for authorised staffing levels as crude. The authorised numbers are not analysed by eitheremploying source (e.g. health boards, hospitals etc.) or by grade. However, the underlyingweaknesses of the methodology are substantially compounded by the inadequacies of the basedata used to determine the sanctioned level of staffing (i.e. the annual Census of Health ServiceEmployees).While recognising the serious weaknesses in the methodology used to calculate theemployment numbers ceiling, we are, nonetheless, concerned at the significant breaches of thisofficially endorsed figure by the health service employers, as illustrated Chapter 2.Ultimately, however, an employee numbers ceiling is a crude tool that does not reflect thecomplex management decisions on use and substitution of resources, whether labour orotherwise, which influence output and value for money. In the longer term, we see activemanpower planning (including recruitment policies, rostering arrangements etc.) as part of theongoing function of the Executive proposed in Chapter 3. This should render crude, high-levelemployee numbers ceilings unnecessary.In the meantime, a numbers ceiling must recognise the reality of service delivery if it is to beuseful as a control tool – it is the number of hours worked, and when they are worked, thatdrive pay rather than the number of people that work them. There may, accordingly, beinstances where it can be cheaper to take on extra staff on a temporary basis rather thandeliver services through overtime etc. We accept, however, that until accurate data onmanpower hours is available, a numbers policy must act as a proxy.We consider that the following actions are essential to strengthen the employment controlfunction in the health service, consistent with the regulatory role of the Department of Healthand Children.Recommendations on Staffing LimitsR7.8 The Department of Health and Children, in consultation with the Department of Finance, should obtain from thehealth board CEOs accurate numbers and associated costs of employment (in respect of both their ownemployees and employees funded by the health boards) to inform the appropriate authorised limit.R7.9 The Department of Finance and the Department of Health and Children, with expert assistance as required,should fully review the existing methodology applied by the Department of Finance in calculating the numbersceiling. The methodology should be based on data from health boards and have regard to the lessons learnedfrom costings produced as part of the "benchmarking" process and to the potential future information flowsgenerated by investment in information technology (see Chapter 10 recommendations on PPARS).96