Written answers

Wednesday, 17 December 2014

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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187. To ask the Minister for Health if he will provide in tabular form the recommendations contained in the 2012 reviews of financial management systems in the Irish health service; the progress made in implementing these recommendations; and if he will make a statement on the matter. [48733/14]

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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A Review of Financial Management Systems in the Irish Health Service, commonly known as the Ogden Report, was undertaken in 2012. The review was commissioned by the Secretary General of the Department of Health. Its overall intention was to review the state of the financial management system in place in the health sector in Ireland at the time in the context of the serious overruns projected to occur in 2012, the continuation of a challenging financial environment for the foreseeable future and the radical reforms envisioned in the Programme for Government.

The report made a number of recommendations to improve the financial management process within the HSE, with particular reference to managing the transition phase that the health sector was undergoing. The recommendations were grouped into 3 distinct areas: Improving Financial Performance; Policy Considerations; and Effective Transitioning (Managing the Change). These are set out in the following table.

As part of the process of further strengthening the financial management of the HSE, additional independent expertise was engaged to evaluate the financial performance management system and a Finance Reform Board has been established comprising the HSE Director General (Chair), senior HSE management and representatives from my Department and the Department of Public Expenditure and Reform.

The HSE commenced the Finance Reform Programme in Autumn 2012. One of the main outputs of Phase 1 of the programme was the development of a new finance operating model in health which was contained in the document entitled Defining Financial Management: A Finance Operating Model for Health in Ireland,available on the HSE website.This report encompasses a roadmap for the finance function to facilitate delivery of an efficient and effective financial service to meet the emerging requirements of the changing organisational face of the health system.

A critical enabler for the transformation of financial management is the introduction of a single Integrated Financial Management System (IFMS) which is considered to be the single most important non-clinical priority for the HSE this year. The initial key element of Phase 2 of the Finance Reform Programme was the preparation of a detailed business case for a new operating model in relation to securing the necessary approval to procure a new IFMS for the health service. The Business Case defines the case for change and scope as well as providing an estimate of the resources required to deliver the operating model and supporting technology. The HSE has submitted a business case to my Department and the Department of Public Expenditure and Reform which is receiving attention.

Phase 3 of the Finance Reform Programme is now progressing on a number of key workstreams. HSE has begun an industry engagement exercise on the Financial Operating Model and the strategic procurement approach it will be taking with suppliers. A key feature of the exercise is an assessment of the technology options available to underpin value for money and the best strategic fit given the current investment.

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A REVIEW OF FINANCIAL MANAGEMENT SYSTEMS IN THE IRISH HEALTH SERVICE
Main Recommendations
1.Improving Financial Performance
1.1Review and clarify the National financial accountability arrangements.
1.2





Enhance the core financial management capability of the system, through

-Building on the capacity and capability in the Department of Health;

-Developing a clear organisational strategy to prepare the financial system for hospital groups; and

-Designing a programme to upgrade financial capability.
1.3Provide immediate clarity to the system for 2012 on what will be funded nationally and what is a local responsibility for resolution.
1.4Agree financial control target ranges for each region for 2012 consistent with national agreements.
1.5Develop a strategy as a priority to establish the technical ICT infrastructure and management capacity required to support a single financial information system.
1.6Develop systems for measuring cost containment, avoidance, and reduction within the non-hospital sector.
1.7Review the process and transparency of forecasting, with best practice methodologies researched and adopted.
1.8Develop a supply chain excellence programme to underpin the full establishment of shared procurement services within the health system.
1.9Accelerate plans to develop a system wide procurement ICT system and shared service.
2.Policy Considerations
2.1Review the process of managing deficits and surpluses urgently and establish a new concordat between the centre, regions and organisations to enshrine the principle that deficits and surpluses will ‘lie where they fall’, with the appropriate consequences for local leaders in terms of autonomy and control.
2.2Review the allocations process and policy for 2013 – 2015
2.3Develop a strategy of stabilisation for hospitals
2.4Develop a suite of metrics to manage the financial and operational performance in community and primary care services.
3.Effective Transitioning (Managing the Change)
3.1The present period of transition is a period of maximum risk and clarity is required urgently on the leadership arrangements that will obtain through the transition period.
3.2Create a formal accountability framework based on the new incentives and governance arrangements at every level, and re-affirm accountability within the immediate system, through the transition phase into the future system.
3.3Create a single quality assurance process to ensure savings both now and in future are delivered safely, with full involvement of the clinical community.
3.4Model the impact of the clinical programmes in a more sophisticated way. This needs to be factored in to the service planning and budget allocation process for 2013 – 2015.

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