A new report has slammed working practices, attitudes and system weaknesses in financial management in the health service.

The report, drawn up for the HSE, outlines a new financial system for the organisation, which, it says, will deliver more effective and efficient financial reporting and transaction processing, develop technical skills and expertise of finance staff and promote a culture of financial responsibility across the health system.

The report's publication coincides with growing concern over the CRC and top-up payments controversies, much of which has focused on poor financial controls and weak accountability and governance in the health system.

The report says finance staff have a low sense of 'belonging' to the HSE and there is a lack of trust pervading across the system.

The report, by PA consultants, also points to a low level of financial management qualifications among relevant staff working in the HSE.

The review found that only 16% of finance staff surveyed had accountancy qualifications, with 111 out of 702 respondents to a questionnaire being fully-qualified accountants. The report says the figure raised concerns for succession planning.

The PA review calls for improved training and continuing professional development for staff working in the finance area.

In examining culture and behaviour among HSE finance staff, the report points to defects such as financial management being more about reporting than control, and that budget holders in the health system are rarely accountable for success or failure in achieving budgets.

The report says a lack of trust pervades across the HSE system. This relates to the financial information available, the budget-holder's ability to deliver services within budget and in the wider system adhering to guidance, standard process and deadlines.

It says there is a low sense of 'belonging' to the HSE an organisation and too much time is spent on transaction processing, with not enough emphasis on areas such as compliance and decision support.

"There remains a strong allegiance to the 'regional jersey' and alignment to predecessor organisational structure (eg, the old health board structure) than the HSE.

The report also says the 'wrong people are in certain jobs'on hospitals.

It says hospital spend is outside the control of finance staff - finance is seen purely as a reporting function.

It adds that hospital policy of filing finance posts at most grades 'with a general administration person irrespective of  experience, knowledge or even interest perpetuates this problem'.

The report shows a wide variation among hospitals of the level of resources devoted to supporting financial management.

It says there is limited adherence to corporate standards and deadlines in the HSE's financial system.

"There is a real belief that variation is essential to meet local requirements. This sanctioned variation to the norm promotes inefficiency."

The PA review says the setting up of new hospital groups will provide a real opportunity to rationalise financial management across the sector, 'and bring consistency, transparency and improved effectiveness to operational
financial management practices'.

The report says the current system is characterised by:

* Financial management teams having no direct accountability to the HSE's Chief Finance Officer.

* Variation in processes, inconsistent data definition and multiple finance systems within the HSE inhibiting the ability of staff involved in decision support and compliance to make best use of their skills and expertise.

* Duplication and inconsistency in processes and a lack of integration.

* Under-investment in technology compromising the ability to improve current working practices.

* Weak accountability for actions among finance staff.

* Inconsistency in the level and standards of service provided to different customer groups.

It says the success of the planned new HSE financial system will depend heavily on having the 'right people in the right roles'.

The report says despite the current flaws in the health service managmeent system, there were many exmpkle sof good practice acyieved in spite of these flaws., which included 'limited engagement' between the HSE and the voluntary sector.

It calls for a workforce development plan and recommends the provision and completion of financial training courses by both finance and non-finance staff, and the training and supporting of budget holders and service managers in financial management.

The report is the third in a series of recent consultancy reviews drawn up for the HSE aimed at improving how it manages health service finances.

These were prompted by budget overspends by the HSE in 2012. The Troika has also insisted that better quality HSE financial management should be a priority.