Brennan Report - Department of Health and Children

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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
Chapter 7 Accountability – Employment and Pay7.6 THE COMMON RECRUITMENT POOLA "Common Recruitment Pool" operates for administrative grades (Grades IV to VII) within thelocal authorities, health boards and certain other health bodies and vocational educationalcommittees 8 . Under this arrangement, any vacancies at the relevant administrative grades canonly be filled from within the Pool. The Common Recruitment Pool was an agreement made in1970 and was aimed at preserving the promotional outlets of certain employees within thePool.The operation of the Common Recruitment Pool means that staff in the private sector,voluntary hospitals, mental handicap agencies and the civil service are not eligible to competefor certain positions in health boards.We consider that these arrangements are not appropriate in a modern business environmentand are not conducive to achieving cost effectiveness and value for money. In particular, goodfinancial management and control systems require appropriately qualified personnel.The availability of skills in specific areas such as information technology, finance and humanresource management will be a prerequisite to the successful implementation of ourrecommendations. The Common Recruitment Pool arrangement does not provide sufficientflexibility to enable these specialist posts to be filled by appropriately qualified and experiencedpersonnel.We note that the public sector unions and employers have agreed during the recentpartnership negotiations to conduct a cross-sectoral review of pertinent recruitment issues inthe health sector 9 . We believe that this provides the opportunity to introduce the necessaryflexibility in recruiting the appropriate expertise.Furthermore, at present there is no dedicated formal career structure for the finance functionin health boards. This has militated against the creation of a professional finance team in healthboards and has been a factor in the accounting weaknesses identified in this report.The nature of the activities and the complex technology involved requires the finance functionto be resourced with specialist finance personnel. Such staff will not just contribute to aprofessional finance function but will facilitate the development of a financial ethos and cultureamongst operational management.Recommendations on the Common Recruitment PoolR7.10 The recruitment of certain key financial, human resource management and information technology personnel,necessary to the successful implementation of the recommendations of this report, should be by means of opencompetition i.e. from outside the Common Recruitment Pool.R7.11 In order to develop and retain suitably qualified personnel in the areas of finance, human resource managementand information technology it will be necessary to create appropriate career structures for these personnel.R7.12 The operation of the Common Recruitment Pool should be reviewed having regard to its appropriateness to amodern public service environment, the inflexibilities it engenders and the capacity of the system to attractgraduate, professional and other managers to the health service.8The “Pool” consists of the health boards, local authorities, vocational education committees, General Medical Services (Payments) Board,St. James’ Hospital, Beaumont Hospital,An Bord Altranais, and the Local Government Computer Services Board.9Sustaining Progress; Social Partnership Agreement 2003-2005, page 10197
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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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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 Issuesother
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Chapter 2 Overview and IssuesTable
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Chapter 2 Overview and IssuesIn 200
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Chapter 2 Overview and IssuesProble
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Chapter 3 Managing the Health Servi
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Chapter 3 Managing the Health Servi
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Page 127 and 128: Appendix 1Appendix 1COMMISSION MEMB
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Page 135 and 136: Appendix 3Name of AgencyIrish Blood
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Appendix 4advised of their existenc
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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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ADDENDUMNumber Recommendation IT Ti
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Brennan Report - Department of Health and Children

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