Tuesday, 16 December 2008
Dáil Eireann Debate
120. Deputy Ruairí Quinn asked the Minister for Health and Children her views on the recommendations in the third interim report on the 2006 report of the Comptroller and Auditor General of the Committee of Public Accounts in relation to the need for performance indicators and effective deployment of resources in the Health Service Executive; if she will ensure that the recommendations are implemented; and if she will make a statement on the matter. [45510/08]
Minister for Health and Children (Deputy Mary Harney): I welcome the ‘Third Interim Report on the 2006 Report of the Comptroller and Auditor General — Expenditure on Health Services’ which was recently published by the Public Accounts Committee. A number of the Report’s recommendations relating to matters such as the Hospital Consultants contract, the HSE’s utilisation of assets and its financial management systems are already the subject of action by my Department, the HSE or other relevant bodies.
With reference to the specific recommendations on effective deployment of resources and the need for performance indicators, I am committed to further developing the measurement of performance within the health system. Significant progress has been made in the HSE Service Plan 2009 in terms of incorporating more explicit links between funding, staffing and services and the development of an improved set of activity measures, performance indicators and deliverables in key service areas, which are matched with timescales. The HSE will report monthly to my Department on the performance of the health system against the agreed targets. The improvements in the National Service Plan will form a framework for achieving greater clarity at an individual service unit level within the HSE on performance expectations regarding service delivery, staffing levels and funding.
The first recommendation in the report refers to the need for the HSE to establish benchmarks to underpin decision making on the allocation of human resources. The HSE has operational responsibility to determine the number and type of staff required to deliver particular services. The financial constraints applying mean that there must be flexibility to deploy staff to areas of greatest service need. The HSE has already initiated discussions with health service unions to facilitate this approach during 2009.
The second recommendation refers to the need for decisions on resource allocation to be based primarily on activity levels, with incentives being put in place to improve performance.  Hospital funding is currently linked with performance through the National Casemix Programme which compares costs and activity between 37 hospitals that participate in the Casemix Budget Model, and reviews how over €4.5 billion in acute hospital funding is allocated. This Programme continues to be developed and rolled-out, both within hospitals already within the Programme, and to new hospitals. Internationally, performance based funding models are less well developed outside of the hospital sector. My Department and the HSE continue to keep opportunities in this area under review.
The third recommendation refers to the use of data collected through Healthstat to inform allocation decisions and to the need for it to be made more readily available to key stakeholders. Healthstat creates information at the level of hospital/hospital network and local Health Office. This information is provided to hospitals and local Health Offices in advance of the monthly HealthStat forum meeting chaired by the CEO of the HSE and these meetings demand accountability from hospitals and local Health Offices for their individual performances. The HSE intends to publish elements of HealthStat data on their website from March of next year. In addition, work is progressing under the auspices of the Joint HSE/Department Performance Information Group to incorporate relevant information from HealthStat into the performance management framework for the Health Services at national level.
The final recommendation relates to the need for major health development projects to be planned on the basis of whole life cost. Procedures currently in place require the HSE to identify the life cycle costs, including revenue and staffing costs, of proposed capital projects prior to their submission as part of the Executive’s proposed Capital Plan. These costs are a key criterion against which such proposals are evaluated. In conclusion, I welcome the Report of the Committee of Public Accounts. Progress is already being achieved on many of the recommendations and work will continue in both my Department and the HSE in relation to the Report’s findings.
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