HSE Audit and Risk Committee meeting minutes 11 July 2025

Members Present

Yvonne Traynor (Chair), Anne Carrigy, Michael Cawley, Éimear Fisher, John Moody and Sharon Keogh

HSE Executive Attendance

Joseph Duggan (Chief Internal Auditor), Stephen Mulvany (Chief Financial Officer), Mairead Dolan (Asst Chief Financial Officer), Brian O’Connell (ND, Head Strategic Health Infrastructure & Capital Delivery), Joe Ryan (ND Public Involvement, Culture and Risk Management/Chief Risk Officer), Kate Killeen White (REO Dublin & Midlands), Dara Purcell (Corporate Secretary), Patricia Perry (Office of the Board)

Joined the Meeting

Anne Marie Hoey (Chief People Officer)(Item 3.4), Martina Queally (REO Dublin & South East)(Item 3.4), Elaine Kilroe (AND Enterprise Risk Management)(Item 4), James Gorman (Unit Manager PPP Central Unit)(Item 5.6), Siobhan Dunphy (AND Procurement)(Item 5.7)

Minutes reflect the order in which items were considered and are numbered in accordance with the original agenda.  All performance/activity data used in this document refers to the latest information available at the time.

The Chairperson held a private session to consider the agenda, papers and the approach to conducting the meeting.

2.1 Conflicts of Interest

No conflicts of interest were declared.

2.2 Minutes

The Committee approved the minutes of the 13 June 2025 and Special meeting of 16 June 2025 subject to amendments. The Committee re-approved the minutes of the meeting of 09 May 2025.

2.3 Action Log and Follow Up Items

The Chair advised that she had reviewed the ARC Action Log with the Board Office and all actions were being progressed as per the Update Report. The Committee discussed some queries which had been raised around actions and it was noted that the action log would be updated accordingly.

3.1 Monthly Report

The Chief Internal Auditor (CIA) provided an update to the Committee in relation to the Internal Audit Function change programme, which was noted by the Committee.

The CIA advised the Committee that due to the significance of findings, two audit reports published in June were being presented to the Committee outside of the regular quarterly reporting schedule. The Committee held a discussion in relation to the following audit reports, noting that both reports focused on HSE processes and not on consultant actions.

Consultant Doctors not on the Irish Medical Council Specialist

The Committee expressed its concern on the high number of consultants not included in the Irish Medical Council Specialist Register and the slow reduction in this number over the past number of years, and noted the audit findings and risk implications, audit recommendations and implementation dates agreed by management. The Committee requested an update by year end.

HSE Employed Consultant Doctors - Pay Above €350k

The Committee highlighted its concern regarding possible Working Time Directive issues, the recruitment challenges, and noted that the CEO is to issue instructions to the REO’s to action recommendations in relation to the audit.

The Committee discussed the possibility of including a new criteria of unacceptable as an opinion in audit reports.

3.2 Mid-Year IA Plan Review

The Committee noted that the Internal Audit Plan 2025 was reviewed at the end of the Q2 2025, the changes that are being proposed, why they are necessary, and how they strengthen the plan’s alignment with the most significant risks facing the organisation in the second half of the year.

3.3 Review of the Audit Charter

The Committee noted that the Internal Audit Charter which was comprehensively reviewed and updated last year, and approved by the Committee on 04 October 2024, remains current and that no amendments are proposed at this time.

3.4 IA Reports outstanding recommendations

Anne Marie Hoey, Chief People Officer and Martina Queally REO Dublin & South East joined the meeting

At the request of the Committee at the June meeting, the Chief People Officer (CPO) and REO Dublin & South East (REO DSE) attended. The Committee outlined concerns around the delay in meeting the implementation date of the recommendations of the 2022 Audit reports relating to Ill health retirements and Waiting Lists – Speech & Language Therapy & Podiatry Services.

The CPO provided an update to the Committee in relation to the current status of the implementation of the recommendation and on the proposed solution and associated timeframe.

The Committee noted the update and asked for further information to be brought back to the Committee relating to a comparison of the number of Ill health retirement cases in the HSE with an external benchmark; stress related ill health retirements and the average age of employees retiring on the grounds of permanent illness.

The REO DSE provided an update to the Committee in relation to the current status of the implementation of the two recommendations of the audit.

The Committee noted the update and discussed the plan to address the vacancies identified in the services and asked for an update in relation to the engagement with the Department of Further and Higher Education on the expansion of training places for health and social care professionals (HSCP).

Chief People Officer and REO Dublin & South East left the meeting

Ms Elaine Kilroe, AND Enterprise Risk Management joined the meeting

4.1 Corporate Risk Update

The ND Public Involvement, Culture and Risk Management (ND PICRM) provided the Committee with the following updates as of June 2025.

Moody Review Recommendation Report – June 2025

The ND PICRM advised that 55 recommendations have been fully completed, three recommendations are underway and are actively being addressed and four recommendations have been superseded due to evolving practices or structural changes. The Committee noted the background, status and detail to each recommendation and the author of the Moody Review indicated their satisfaction in how the recommendations had been addressed.

Risk Framework Assessment Report – June 2025

The AND Enterprise Risk Management (AND ERM) advised that all components reported in 2024 as underdeveloped are now substantially addressed at the corporate level, and the Committee noted the overview of the assessment in 2025 and detail of the components as provided in the paper circulated.

Enterprise Risk Management Strategic Plan

The AND ERM advised the Committee the short-term deliverables under Strategic Goals and a majority of short-term goals under Strategic Objectives have been achieved. The Committee noted that a key element now is the focus on supporting and facilitating ERM risk management practices within the regional structures since their establishment and development.

The ND PICRM advised the Committee of an internal audit of the Corporate Risk Register and process, noting that the findings and recommendations will further inform the ERM’s programme of work.

The Committee discussed Clinical Risk and the reporting to the Committee and it was agreed that the CRO would discuss with the CCO.

The Committee welcomed and noted the good progress made in all areas relating to Corporate Risk.

AND Enterprise Risk Management left the meeting

5.1 YTD Expenditure

The CFO provided a briefing to the Committee on the YTD Financial Position as at 31 May 2025, noting that the HSE is over the overall expenditure budget by €246.1m / 2.2%, (€182.02m Department of Health (DoH) and €64.1m Department of Children, Disability and Equality (DCDE)). He advised that within that, the Health Regions are over their respective expenditure budgets by €341.5m / 4.8%, offset by a surplus at the centre of (€95.4m).

The CFO advised in relation to the cash position at the end of June which shows the HSE has drawdown €13.7bn which is €297.3m over profile. The Committee noted that in June the HSE requested €270m over profile for the month, DoH €237.3m and DCDEY €32.7m, and that a total of €159m of this request was to clear creditor balances in advance of IFMS IG3 go live, which is expected to reverse in July.

5.2 Thematic / Programmatic View of Initial 2025 Savings Plans (Pay and Non-Pay)

Further to the request from the Committee at the June meeting, the CFO presented a more detailed overview of the 1st draft 2025 savings plans, highlighting that there is a requirement for additional savings plans to be put in place along with full delivery against the initial plans already in place, noting the extent of overall savings to be delivered on a recurring basis as per NSP 2025.

The CFO advised the Committee that additional savings measures are required and are being pursued in order to deliver a breakeven position on a cash basis by end 2025 which includes the need to make up for any early under delivery in current savings as visible in April YTD reporting.

The Committee noted subject to various caveats, reporting plans in place with a total €138.6m of savings targeted delivery for 2025, the savings being delivered but noted that they remain short of target, and discussed the need for further reductions, without cutting services to achieve the savings target.

5.3 Levels of Authority

The Committee had recommended levels of authority proposed by the CFO to the Board. However, after a review and in the context of the urgent need to control costs the CEO had proposed stricter levels and these are now accepted by the Committee.

The Committee welcomed the changes to the Levels of Authority to improve the financial control environment and noted the new levels are mandatory and will become HSE policy from 01 October 2025 for two years, subject to review at that time. It was agreed that the Chair would respond to the CEO confirming the Committee’s support and that the changes to the Levels of Authority to improve the financial control environment were welcomed.

5.4 Health Budget Oversight Group (HBOG)

The Committee noted the minutes of HBOG meeting of 02 April 2025. The Committee requested that lessons learnt from the Estimates process, be brought back to the Committee at the September meeting.

5.5 Final Comptroller and Auditor General Audit Certificate

The Chair informed the Committee that the HSE Board re-approved the final draft Annual Financial Statements (AFS) 2024 and associated documentation at the Board meeting on 30 May 2025.

The Committee noted that the final C&AG audit certificate, with an unqualified audit opinion, was issued on 05 June 2025 and a combined Annual Report and AFS Submission was made to the Minister for Health and the Minister for Children, Disability and Equality on 03 July 2025.

The Committee reviewed and discussed the Audit Cert, noting the management issues raised relating to non-compliant procurement, and other specific issues. The Committee noted the update from the CFO in relation to the programme of work underway to address procurement compliance.

5.6 Draft Special Legislative Accounts 2024

James Gorman,Unit Manager PPP Central Unit joined the meeting

The Asst CFO advised the Committee that the HSE is required to prepare certain accounts under legislation, and presented the following Special Legislative Accounts 2024 to the Committee.

• Hepatitis C
• Long Stay Repayments
• Long Stay Donations
• Patient Private Property

The Committee noted the Special Legislative Accounts relating to Hepatitis C, Long Stay Repayments and Long Stay Donations and noted that the accounts had been submitted to the C&AG for audit on 25 June 2025.

The Committee reviewed and discussed the key figures in the 2024 National PPP Accounts and were advised that Crowleys DFK had completed their audit of the accounts and prepared the draft National Consolidated PPP Accounts and produced a Management Letter detailing their findings which was received by the HSE on 29 May 2025. The recommendations arising from the findings are being addressed.

Unit Manager PPP Central Unit left the meeting

5.7 Contract Approval Requests

Siobhan Dunphy AND Procurement joined the meeting

The CFO and AND Procurement presented to the Committee the following Contract Approval Requests (CARs).

1. CAR HSE 25387 Temperature Controlled Supply Chain
2. CAR HSE 12061 Mini Competition, Voice and Data Communications
3. CAR HSE 25431 Dynamic Purchasing System Mini Competition, Threat Detection and Response  
4. CAR HSE 24333 Dynamic Purchasing System Tender Competition Managed Extended Detection and Response
5. CAR HSE 26593 Authorisation Scheme for the provision of Assisted Human Reproduction (AHR) Medical Services (Extension)
6. CAR HSE 26435 Extension of the Authorisation Scheme for Provision of Home Support Services to Older People

The Committee considered the details of the proposed CARs and agreed to recommend to the Board for approval.

CFO and AND Procurement left the meeting

Brian O’Connell, ND, Head Strategic Health Infrastructure & Capital Delivery joined the meeting

6.1 Review of Capital Plan 2025 (NSP element)

The Committee noted the update from the ND, Head Strategic Health Infrastructure & Capital Delivery (ND SHICD) in relation to the Review of the Capital Plan 2025 – NSP element and endorsed the re-allocation process outlined.

6.2 Revision of HSE Capital Projects Manual & Approvals Protocol – update on progress

The Committee noted the update from the ND SHICD in relation to the significant progress made to date in relation to the Revision of HSE Capital Projects Manual & Approvals Protocol.

6.3 Building Contracts & Properties

The Committee considered the following contracts which were presented by the ND SHICD.

1. Property disposal – Disposal Errill Health Centre, Co. Laois, noted by Committee.
2. Property Disposal – Enniskerry Health Centre, agreed and recommended to the Board for approval.
3. Leasehold Acquisition – Site at Lisdaran Cavan, Co. Cavan, Committee agreed to approve.
4. Disposal of Knockanarrigan Health Centre, Knockanarrigan, Co. Wicklow, agreed and recommended to the Board for approval.
5. Proposed Lease of Primary Care Centre at Galway City West, Seamus Quirke Road, Galway, agreed and recommended to the Board for approval.

The Chair thanked the Committee and SLT members. The meeting ended at 12.16pm.

Terms of Reference: Audit and Risk Committee