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Central government staff costs
Results of staff reductions The British NAO found that departments had significantly reduced numbers of their civil servants and of course salary costs at the same time. But they reduced staff numbers mainly by minimising recruitment, and the age profile of the civil service has changed. NAO pays a lot attention to what effect this has had on the future pipeline of talent and skills. It reminds also that the departments need long-term operating models to work efficiently with the staff reduced.
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Results of staff reductions The British NAO found that departments had significantly reduced numbers of their civil servants and of course salary costs at the same time. But they reduced staff numbers mainly by minimising recruitment, and the age profile of the civil service has changed. NAO pays a lot attention to what effect this has had on the future pipeline of talent and skills. It reminds also that the departments need long-term operating models to work efficiently with the staff reduced.
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National Audit Office
, issued in 2015
Risk cases: 5
The protection of IT systems and health data in three Danish regions
Security to be improved in IT systems with health data It is Rigsrevisionen’s assessment that the three regions are not protecting the access to IT systems and health data in a satisfactory manner. As a consequence, unauthorised persons might gain access to sensitive and confidential personal data, which could affect there liability and availability of important health data used in the treatment of hospital patients. Based on the results of the study and the current threat scenario, Rigsrevisionen finds that basic security measures against cyber attacks and protection of access to IT systems and health data should be a top priority for Denmark’s five regions. Basic security measures in combination with management and control of user privileges can reduce the risk of compromising the regions’ IT systems and data considerably.
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Security to be improved in IT systems with health data It is Rigsrevisionen’s assessment that the three regions are not protecting the access to IT systems and health data in a satisfactory manner. As a consequence, unauthorised persons might gain access to sensitive and confidential personal data, which could affect there liability and availability of important health data used in the treatment of hospital patients. Based on the results of the study and the current threat scenario, Rigsrevisionen finds that basic security measures against cyber attacks and protection of access to IT systems and health data should be a top priority for Denmark’s five regions. Basic security measures in combination with management and control of user privileges can reduce the risk of compromising the regions’ IT systems and data considerably.
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National Audit Office of Denmark
, issued in 2018
Risk cases: 3
Identifying and meeting central government's skills requirements
Start with well managed responsibilities UK Departments have invested heavily in skills development. Government estimates that expenditure on formal training, including salary costs of departmental learning and development staff, was £275 million in 2009-10. NAO identified weaknesses of the system which start with devolved responsibilities, lead to: weak data, mis-profiled trainings, doubtful personal decisions, lack of well-targeted evaluation - and finish at more expensive buying-in and retaining key skills...
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Start with well managed responsibilities UK Departments have invested heavily in skills development. Government estimates that expenditure on formal training, including salary costs of departmental learning and development staff, was £275 million in 2009-10. NAO identified weaknesses of the system which start with devolved responsibilities, lead to: weak data, mis-profiled trainings, doubtful personal decisions, lack of well-targeted evaluation - and finish at more expensive buying-in and retaining key skills...
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National Audit Office
, issued in 2011
Risk cases: 6
VETERANS’ HEALTH CARE - Preliminary Observations on VHA’s Claims Processing Delays and Efforts to Improve the Timeliness of Payments to Community Providers
/> This statement, which is based on ongoing work, summarizes GAO’s preliminary observations about (1) VHA’s, Medicare’s, and TRICARE’s claims processing timeliness in fiscal year 2015; (2) factors that have impeded ... VHA’s timeliness in processing claims; (3) community providers’ experiences; and (4) VHA’s recent actions and plans to improve its claims processing and payment timeliness. To conduct its ongoing work ... , GAO obtained fiscal year 2015 data on the timeliness of VHA’s, Medicare’s, and TRICARE’s claims processing. GAO visited 4 of 95 VHA claims processing locations (selected on the basis of variation ... Data processing hold back by technology limitation, workload and administrative burden ... US GAO analyzed all factors of slower processing and user unfriendliness that occur sometimes to the veterans healthcare. The main focus is data processing - and it has been proved that it can ... be failing not only because of technology, but also because of work-process design, staff and organisation.
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/> This statement, which is based on ongoing work, summarizes GAO’s preliminary observations about (1) VHA’s, Medicare’s, and TRICARE’s claims processing timeliness in fiscal year 2015; (2) factors that have impeded ... VHA’s timeliness in processing claims; (3) community providers’ experiences; and (4) VHA’s recent actions and plans to improve its claims processing and payment timeliness. To conduct its ongoing work ... , GAO obtained fiscal year 2015 data on the timeliness of VHA’s, Medicare’s, and TRICARE’s claims processing. GAO visited 4 of 95 VHA claims processing locations (selected on the basis of variation ... Data processing hold back by technology limitation, workload and administrative burden ... US GAO analyzed all factors of slower processing and user unfriendliness that occur sometimes to the veterans healthcare. The main focus is data processing - and it has been proved that it can ... be failing not only because of technology, but also because of work-process design, staff and organisation.
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General Accountability Office
, issued in 2016
Risk cases: 6
Conflicts of interest
First, recognise the conflicts of interest are a real risk the British NAO gathered a significant amount of intelligence on conflicts, particularly in the health and education sectors. These are areas of government where services are increasingly commissioned and delivered by parties at arm’s-length to departments. Conflicts of interest can occur naturally as a product of the way a system is designed and most often arise from operational situations.
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First, recognise the conflicts of interest are a real risk the British NAO gathered a significant amount of intelligence on conflicts, particularly in the health and education sectors. These are areas of government where services are increasingly commissioned and delivered by parties at arm’s-length to departments. Conflicts of interest can occur naturally as a product of the way a system is designed and most often arise from operational situations.
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National Audit Office
, issued in 2015
Risk cases: 8
Activities of the state in implementing the e-health system - Do the state, doctors and patients benefit from ehealth?
Estonia’s population is aging and the share of elderly people is increasing, as fewer children are being born and people are living longer. This creates a constantly growing need for health ... make the health system more efficient, improves people’s health via more effective prevention, raises the awareness of patients and also contributes to the more reasonable use of health resources ... and social services and patients are also becoming more and more demanding about the volume and quality of the services provided. The more extensive and systematic implementation of e-health solutions helps ... ... Why state, doctors and patients do not benefit from e-Health as much as they could? ... The report reviews whether the objectives set to the e-Health – ambitious multiyear program of Estonian Government - have been achieved. They are: higher quality of the health service and more ... efficient organisation of health care. As SAI Estonia found out, wide range problems started from two basic points: lack of strategic manager and unrealisitc schedule.
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Estonia’s population is aging and the share of elderly people is increasing, as fewer children are being born and people are living longer. This creates a constantly growing need for health ... make the health system more efficient, improves people’s health via more effective prevention, raises the awareness of patients and also contributes to the more reasonable use of health resources ... and social services and patients are also becoming more and more demanding about the volume and quality of the services provided. The more extensive and systematic implementation of e-health solutions helps ... ... Why state, doctors and patients do not benefit from e-Health as much as they could? ... The report reviews whether the objectives set to the e-Health – ambitious multiyear program of Estonian Government - have been achieved. They are: higher quality of the health service and more ... efficient organisation of health care. As SAI Estonia found out, wide range problems started from two basic points: lack of strategic manager and unrealisitc schedule.
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National Audit Office of Estonia
, issued in 2014
Risk cases: 3
The Shared Services Centre
The necessary environment for the efficient management of the Shared Service Center is lacking The department's administration of the Shared Services Centre (SSC) has been effective for sharing resources between the departments and delivering selected back-office services to a small client base. However, the governance arrangements established to oversight the SSC have not positioned it well for the future and the departments have not yet determined if the arrangement is efficient and resulting in savings. ANAO found instances where the advisory board of SSC was not consulted or involved in decisions relating to the strategic direction, financial arrangements and expenditure priorities. Information reported to the board did not focus on areas of strategic importance and the quality and completeness of this information could be improved. The mechanisms established for setting out responsibilities and obligations and ensuring transparency for services delivered by the SSC was weak. Service standards and levels were not fixed and can change. The delineation of responsibilities between the SSC and its clients was not clear and there was no commitment by the SSC to certify the quality of its control framework.
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The necessary environment for the efficient management of the Shared Service Center is lacking The department's administration of the Shared Services Centre (SSC) has been effective for sharing resources between the departments and delivering selected back-office services to a small client base. However, the governance arrangements established to oversight the SSC have not positioned it well for the future and the departments have not yet determined if the arrangement is efficient and resulting in savings. ANAO found instances where the advisory board of SSC was not consulted or involved in decisions relating to the strategic direction, financial arrangements and expenditure priorities. Information reported to the board did not focus on areas of strategic importance and the quality and completeness of this information could be improved. The mechanisms established for setting out responsibilities and obligations and ensuring transparency for services delivered by the SSC was weak. Service standards and levels were not fixed and can change. The delineation of responsibilities between the SSC and its clients was not clear and there was no commitment by the SSC to certify the quality of its control framework.
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The Australian National Audit Office
, issued in 2016
Risk cases: 2
Report on the problems connected with the development and implementation of the digitally based Shared Medication Record
The purpose of the examination was to assess whether the department of the Danish Ministry of Health, the Danish National eHealth Authority (NHA) and the five regions that are responsible ... for the hospitals have made an adequate effort to develop and implement the Shared Medication Record (SMR). With the SMR, data on the citizens’ medication can be shared across hospitals, general practitioners, etc ... . and relevant health staff and the patients have direct digital access to updated medical data round the clock. The report answers the following questions: 1) Has the Ministry of Health and the NHA provided ... ... Involvement of key participants necessary from the very beginning ... and processes leading to implementation problems, governance not involving key players, and IT security organisation. ... Digitally based Shared Medication Record is basis of the complex healthcare system. Rigsrevisionen analysed unsolved issues related to unclear business case, insufficient analysis of work flows
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The purpose of the examination was to assess whether the department of the Danish Ministry of Health, the Danish National eHealth Authority (NHA) and the five regions that are responsible ... for the hospitals have made an adequate effort to develop and implement the Shared Medication Record (SMR). With the SMR, data on the citizens’ medication can be shared across hospitals, general practitioners, etc ... . and relevant health staff and the patients have direct digital access to updated medical data round the clock. The report answers the following questions: 1) Has the Ministry of Health and the NHA provided ... ... Involvement of key participants necessary from the very beginning ... and processes leading to implementation problems, governance not involving key players, and IT security organisation. ... Digitally based Shared Medication Record is basis of the complex healthcare system. Rigsrevisionen analysed unsolved issues related to unclear business case, insufficient analysis of work flows
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National Audit Office of Denmark
, issued in 2014
Risk cases: 2
Effectiveness of the execution of the eHealth project
to the national public health system in the period between 1st of January 2004 and 26th of September 2013. The audit has focused on the effectiveness of the Ministry in achieving the project’s goals, time ... The Court of Audit of the Republic of Slovenia has audited how effectively the Ministry of Health had managed the project eHealth - the national plan for developing information system support ... management, management of the human resources and financial oversight. The goal of the Ministry was to implement a modern information system, which would support secure eHealth operations and effective ... ... Clear concept, good planning and financial control are indispensable conditions for a successful IT project ... The Court of Audit of the Republic of Slovenia analysed a Government eHealth project. Its goal was to implement a modern information system, which would support the health services and health related ... data. The Court has pointed at a long list of project management fundamentals to be corrected.
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to the national public health system in the period between 1st of January 2004 and 26th of September 2013. The audit has focused on the effectiveness of the Ministry in achieving the project’s goals, time ... The Court of Audit of the Republic of Slovenia has audited how effectively the Ministry of Health had managed the project eHealth - the national plan for developing information system support ... management, management of the human resources and financial oversight. The goal of the Ministry was to implement a modern information system, which would support secure eHealth operations and effective ... ... Clear concept, good planning and financial control are indispensable conditions for a successful IT project ... The Court of Audit of the Republic of Slovenia analysed a Government eHealth project. Its goal was to implement a modern information system, which would support the health services and health related ... data. The Court has pointed at a long list of project management fundamentals to be corrected.
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Court of Audit of the Republic of Slovenia
, issued in 2013
Risk cases: 5
Correct information at the right time in healthcare and nursing – collaboration without effect?
The Swedish National Audit Office has conducted an audit to determine whether Government initiatives have contributed to the objective that authorised healthcare staff shall have access to the right ... patient information at the right time by means of direct electronic access. ... ... Information share is crucial for competitive health care ... the Government and the municipalities must improve if the investments in better access to common patient information shall get impact in practice. ... Health and social care staff has very limited access to patient information from other care-giving institutions, which may lead to health damage and wrong-treatment. The cooperation between
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The Swedish National Audit Office has conducted an audit to determine whether Government initiatives have contributed to the objective that authorised healthcare staff shall have access to the right ... patient information at the right time by means of direct electronic access. ... ... Information share is crucial for competitive health care ... the Government and the municipalities must improve if the investments in better access to common patient information shall get impact in practice. ... Health and social care staff has very limited access to patient information from other care-giving institutions, which may lead to health damage and wrong-treatment. The cooperation between
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Riksrevisionen (Swedish National Audit Office)
, issued in 2011
Risk cases: 3