The Health Service Executive spent €14.7 billion on health and social care services in 2009. In addition, it spent €414 million on capital projects, of which €124 million was applied within agencies that provide services to the HSE. Its funding came from voted funds to the extent of €11.9 billion, €1.8 billion was raised by way of health contributions and the balance came from other income.
My annual report for 2009 includes eight chapters on health. I will mention some of the main findings briefly. On property management, the assets of the HSE have a historic cost value of €4.3 billion. A complete and accurate property database would be essential in managing assets because property is a key facilitator in the delivery of all services and the HSE's capacity to match property solutions to the objectives of component parts of the service is essential in the planning of its operations. The audit found that the content of the database that had been compiled remained invalidated and there were differences between the assets as recorded by the Property Registration Authority and HSE and as between the assets as recorded by the two different functions with responsibility for this area within the HSE, namely, its property and finance functions.
At the time of the report, there was limited information on building condition, maintenance costs, functional suitability and utilisation of property. The information system that had been created was not being used by most estate managers. We recommended that to obtain value from the investment that had been made in compiling the database, the HSE needed to validate the content, integrate it into the work of its staff, use it in service planning and ensure the database agreed with its financial records.
More generally, information is an essential resource in managing service delivery. It is important that this information be provided to managers in a timely and accessible form. In this regard, the HSE plans to improve information through projects designed to manage its accounting and procurement functions; improve radiology imaging processes; manage patient administration, including medical records management; and assist in managing laboratory test results. Progress in these areas has been slow. The chapter noted the need to manage the systems development through a structured process and ensure the associated business change that was to accompany the developments was fully taken into account. In this respect, our major concern was that the HSE did not have an overall information and communications technology, ICT, strategy and there was no functioning ICT steering committee at that point.
The HSE's cashflow is affected by delays in collecting income from private patients. Treatment of patients on a private basis in excess of the intended quota also has implications for equality of access. Chapter 44 reviewed the progress in implementing the limits on private practice by consultants that were agreed under the consultant contract 2008. The arrangements put in place by the HSE envisaged the payment by the consultant of excess fees for private practice into a research and study fund. The monitoring was very much in arrears at the point at which we examined the issue and no financial adjustments had been effected at the time of the report.
At the same time, the HSE is facilitating claims against insurers by consultants in respect of private work at public hospitals. These claims are processed in conjunction with its own claims for maintenance charges. In 2009, it was taking on average more than five months to collect maintenance charges for those persons who had been accommodated in designated private beds. Part of the delay is due to the requirement to have the entire claim signed off by a consultant. The report outlines a set of measures the HSE proposed to address the delays, including establishing targets for claim completion in each hospital; submitting claims more frequently - they were previously submitted monthly; movement to electronic processing; and centralisation of billing. The impact achieved to date has been low.
Chapter 42 outlines the progress in introducing cancer screening. It also notes some issues in regard to the funding and accounting for capital grants made available by the Department. The background to the accounting issues is that in 2007 the National Cancer Screening Service Board drew down funding in instances where the liability had not matured because the associated goods had not been delivered. It also charged a set of related invoices to its account and showed the liability under those invoices as having been discharged. This was achieved by moving the funds into an escrow account. The accounting for the matter was rectified in the 2008 financial statements. Overall, it must be said the funds were applied for the purposes intended. The chapter also reports that reasonable progress has been made on introducing the screening programmes.
Chapter 43 reviewed the comparative cost of agency staff, overtime and internal nurse banks which are managed internally by hospitals. At the point we reported, the cost of agency staff was higher than that of HSE staff and the cost of procurement of agency staff varied, due to the absence of a standard administration charge payable to agencies. There appears to be merit in evaluating options in light of relative costs as market conditions change, so as to enable the service to choose the optimum staffing solution.
Building on previous reports, chapter 45 explored the possibility of using service related information to inform decisions on the allocation of funding to voluntary bodies in the area of disabilities. The HSE had begun to seek additional information, but the audit found that the intensity of support needed by individuals with disabilities was not captured, either within the bodies themselves or by the HSE and the quality of the data currently being submitted needed to be validated in order to ensure its consistency across the system. In this respect, a review of the efficiency and effectiveness of disability services was being conducted at the time of reporting. I understand the HSE has updated the committee on developments in all of these areas since.
