Commission on Financial Management and Control Systems in the Health Service

The Commission carried out a detailed examination and review of the financial management and control systems in the Irish health service.

The Commission found problems in the existing systems, including:

• The absence of any organisation responsible for managing the health service as a unified national system.
• Systems are not designed to develop cost consciousness among those who make decisions to commit resources and provide no incentives to manage costs effectively.
• Insufficient evaluation and analysis of existing programmes and related expenditure.
• Inadequate investment in information systems and management development.

The Commission adopted four core principles in addressing the problems:

1. The health service should be managed as a national system.
2. Accountability should rest with those who have the authority to commit the expenditure.
3. All costs incurred should be capable of being allocated to individual patients.
4. Good financial management and control should not be seen solely as a finance function.

The Commission made 136 recommendations including:

• The establishment of an Executive to manage the Irish health service as a unitary national service.
• A range of reforms to governance and financial management, control and reporting systems to support the Executive in the management of the system.
• The designation of clinical Consultants and General Practitioners as the main units of financial accountability in the system.
• Substantial rationalisation of existing health agencies.
• All future Consultant appointments to be on the basis of contracting the Consultants to work exclusively in the public sector; more transparent arrangements for existing Consultants.
• Reform of the medical card scheme to include a Practice Budget for each GP, monitoring of activity and referral patterns etc.
• Strengthening the process of evaluation of clinical and cost effectiveness for publicly funded drug schemes.
• Pending the establishment of the Executive, the creation of a high level and well resourced Implementation Committee.