Brennan Report points to managerial vacuum at the centre of health service
It agrees with the Prospectus Report that the unwieldy nature of the service with its myriad boards, agencies and committees is a large part of the problem.
There is a “managerial vacuum” at the centre of this network, it says, and the roles played by the Department of Health and Children are “not sufficiently defined” to address that vacuum.
Instead, it says, a new central command should be set up in the form of a national health executive, run by a board and headed by a chairman who would report directly to the minister.
Some of the multitude of health bodies would be amalgamated under the executive but, in contrast to Prospectus, it recommends that the health board structure be retained.
The Government has rejected this in favour of the Prospectus proposal.
However, putting in place a central control would merely keep an eye on the bottom lines, the budget allocations and the spending totals.
To keep tabs on expenditure day to day, the report recommends involving those who work in key areas of the health service such as hospital consultants and general practitioners.
It points out that consultants and GPs, by the very nature of their work, make the decisions and dispense the treatments that take up the bulk of the money in the health service yet they are not accountable for their expenditure.
By making them responsible for their own budgets, they would have to take into consideration issues like value for money and efficiency, with the knowledge that if they waste resources, it is their work and patients who will suffer.
“There is currently no incentive built into the system for clinical consultants to budget for their practices, to manage expenditure, to produce an agreed output, or to suggest ways of running their units or hospitals more cost effectively,” the report says.
The medical card system is similarly remiss, as it pays GPs according to the number of patients on their panel rather than the number they treat or treatments they dispense.
The report also identifies a major information deficit which it says makes it difficult to make cost effective decisions.
For example, there is no data available to show the difference in costs between treating a given medical condition at home, in a day-care unit or an acute hospital.
There is also a lack of information systems in hospitals and health boards tracking areas like payroll, staffing, attendance, rostering, stores and assets.
The report recommends substantial investment in information technology and says it would be necessary to recruit “certain key financial, human resource management and information technology personnel”.
One of the first tasks the report places before the new executive is reorganisation of hospital beds.
More facilities for long-stay patients and more day surgery would free expensive acute hospital beds and make better use of existing consultants before consideration is given to hiring more.
