Midland Health Board Report Of The Comptroller And Auditor General

Midland Health Board Report of the Comptroller and Auditor General This report has been prepared pursuant to Section 6(4) of the Comptroller and Auditor General (Amendment) Act, 1993.

Fixed Assets - Buildings Buildings are reported in the accounts at a valuation of £159m at 31 December 1994. The valuation reflects their value as assessed by a quantity surveyor employed by the Board's insurers within the past ten years, adjusted to take account of additions and disposals which have occurred since the date of his valuation. It was noted in t he course of audit that no adjustment had been made to take account of the age and condition of buildings as is required by the Department of Health accounting standards. The Chief Executive Officer (CEO) informed me that the implementation of the requirement to take account of the age and condition of buildings and provide for depreciation would call for further clarification from the Department of Health. It is intended that following such clarification the annual financial statements for 1996 will comply fully with the accounting standards in this regard. I also inquired as to whether the Board had possession of all title documents for these assets. The CEO indicated that with the exception of documents for a small number of properties which were transferred by the local authorities to the Board when it was established under the Health Act, 1970 the title documents for the Board's properties were available. In regard to the properties for which title documents were not available the Board will undertake a legal process to establish title.

Fixed Assets - Equipment The total of equipment shown in the accounts (£389,683) comprises only the valtie of those assets purchased in 1994. The Board does not maintain an adequate record of equipment nor has its cumulative value at 1 January 1994 been incorporated into the financial statements. In response to my inquiries the CEO pointed out that die Board's Technical Services Department had developed and maintained an equipment and plant register over the past number of years in all the main cost centres in the Board which had facilitated the control of these assets and also their planned maintenance. He assured me that strong emphasis was placed on the physical safeguarding of all assets throughout the Board and especially on high value items and items which would have a market value. In addition, the recent acquisition of a computerised fixed asset register would enable the Board to comply with the accounting standards including a provision for depreciation in the 1996 financial statements.

Pharmacy Stocks Stock control records are not being maintained in any of the Board's pharmacies. The total expenditure on drugs and medicines purchased by the Board amounted to £1.9 million in 1994. The CEO informed me that a computerised pharmacy system is being implemented on a phased basis and that modules implemented to date enable drug costs to be allocated on the basis of issues to wards and provide cost control reports by ward and by drug classification. The system includes a stock control module which is targeted for implementation in 1996.

Call out payments and allowances Laboratory staff and radiographers receive an on-call allowance for being rostered for on-call duty and an additional fee for each patient in respect of each occasion they are called out. Twenty nine radiographers received a total of £206, 093 in respect of c allout payments and £14,572 in respect of on-call allowances. Thirty laboratory technicians received a total of £169,713 in respect of call-out payments and £14,064 in respect of on-call allowances. I asked the CEO if the Board is satisfied that the system of on-call allowances is the most economic way of addressing the needs of patients' care in the Board's hospitals. In reply the CEO stated that the agreements relating to on-call and call-out payments for laboratory staff and radiographers are negotiated nationally and the Board is not in a position to depart from these agreements. He also stated that the level of these payments is monitored on an ongoing basis at local level and that every effort is made to reduce the level of call-o ats to an absolute minimum consistent with providing an adequate service and that strict certification procedures are in place for such payments.

Patients' Private Property The Board acts as trustee of the funds held on behalf of the long stay patients in the Board's psychiatric and geriatric hospitals and, in common with the other health boards, it levies a charge based on time spent by its staff on administering these funds The private property accounts of patients are independently audited. It was noted from a review of these accounts that a deficit of £52,253 was reported in 1994. major contributing factor to the deficit was a £100,000 administration charge levied by the Board which was greater than the total interest earned on these funds for the year. In response to my inquiries the CEO stated that for the first time the amount of interest earned in the year was less than the administration charge because of the low interest rates prevailing in 1994. The annual charge for each of the years 1993inclusive was £100,000. However, as part of its triennial review of the charge, the CEO informed me that a survey of the workload was nearing completion and this would form the basis for the charge to be applied for the years 1996/98. The revised charge will be independently checked as part of the audit of private property accounts of patients.

Jotrn Purcell Comptroller and Auditor General I«+ February 1996

Treasury Building Dublin Castle