HSE Audit and Risk Committee meeting minutes 15 May 2026

Members Present

Anne Carrigy (Chair), Yvonne Traynor, Michael Cawley, Patrick Bailey, Éimear Fisher, John Moody and Peter Lynch

Apologies

Sharon Keogh

HSE Executive Attendance

Joseph Duggan (Chief Internal Auditor), Michael Lane (Acting Chief Financial Officer), Joe Ryan (ND Public Involvement, Culture and Risk Management / CRO), Kate Killeen White (REO Dublin Midlands), Mairead Dolan (Asst CFO), Dara Purcell (Corporate Secretary), Niamh Drew (Deputy Corporate Secretary), Patricia Perry (Office of the Board)

Joined the Meeting

Anne Marie Hoey (CPO), Fran Thompson (CIO), Brian O’Connell (ND, Head Strategic Health Infrastructure & Capital Delivery), Siobhan Dunphy (AND Procurement), Eileen Winnington (AND HR, HR Shared Services), Teresa Coss (General Manager - Pensions Quality & Standards), Sean Donoghue (National Pensions Management, HRSS), Dr Grant Jeffrey (Director Workplace Health & Wellbeing Unit), Hugh Brady (AND HR, Corporate Compliance & Resource Optimisation), David Langton (AND CCF), Elaine Kilroe (AND ERM)

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 Chair 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 17 April 2026.

2.3 Action Log and Follow Up Items

The Committee reviewed the action log, discussed progress on actions, and requested that all outstanding actions be reviewed with SLT members.

Items 3.1, 3.3 and 3.4 were deferred, and will be brought back to the next meeting with revised documentation.

3.1 Pension Abatement incl Letter of 29 April 2026 from INMO

Item was deferred to the June meeting.

The Committee held a discussion in relation to the potential impact of recently identified reductions in overpayments, the treatment of overpayments relating to deceased individuals, and the adequacy of governance and HR oversight in the write-off process. Management agreed to consider these matters further and reflect them in the revised documentation for the June meeting.

The Committee also considered correspondence received from the INMO regarding pension abatement. It was agreed that no further response from the Committee was required, noting that the correspondence had already been acknowledged and that any substantive engagement would be addressed directly by management through the appropriate channels.

3.2 Ill Health Retirements

The CPO provided an update on matters raised at the previous meeting, including long-term sick leave and ill-health retirement cases. It was noted that some long COVID-related cases may be included within the figures presented.

The Committee discussed the management of long-term absence cases, including a reported outlier of 3,382 absence days. Concerns were raised regarding oversight and safeguards in the management of extended absences. Management advised that there has been an increased focus on attendance management over the past year, including management training and enhanced monitoring of absence data on a monthly basis across staff categories. A slight reduction in absence levels in Q1 was noted.

It was confirmed that the data presented related to HSE statutory services only and did not include Section 38 and 39 agencies.

The Committee also discussed the ill-health retirement approval process. Management clarified that where applications do not meet the required criteria, retirement on ill-health grounds is not approved and staff remain on sick leave, subject to ongoing occupational health assessment and review, with frequency determined by individual circumstances and medical condition.

3.3 Pay Related Overpayments – Quarterly Report

Item was deferred to the June meeting.

3.4 Non SDR Doctors – Quarterly Report

Item was deferred to the June meeting.

3.5 HSE Management of Fraud

The Chief Internal Auditor (CIA) provided the Committee with an update on fraud management. The CIA noted that all actual or suspected fraud and irregularities must be reported to both the CIA and the CFO. The Committee was also advised of the process for determining the appropriate course of action and investigative approach, where required and were provided with additional context regarding matters reported to Internal Audit in 2025.

Members sought further detail on how frauds are identified and queried whether additional resources and a stronger fraud detection framework could generate significant savings. The CIA acknowledged the absence of an overarching anti-fraud framework and advised that work is underway by management on control measures for high risk areas including payroll fraud assurance. The CIA indicated that findings and observations from such work would be brought to the attention of senior management to inform future consideration of the HSE’s fraud risk management arrangements later in the year.

The Committee emphasised the importance of a strong deterrent effect, including visible follow-through where fraudulent activity is identified, and welcomed public reporting of enforcement actions as a means of discouraging further fraud.

4.1 Finance Update

The A/CFO provided a briefing to the Committee on the YTD Financial Position as at 31 March 2026, noting that the HSE is over the overall expenditure budget by €235.1m / 3.3%, (deficit of €249.5m Department of Health (DoH) and surplus of €14.3m Department of Children, Disability and Equality (DCDE)). It was noted that agency remains the most significant pressure with pay, with agency expenditure at €210.2m at the end of March against a YTD ceiling of €177.5m, resulting in a variance of €32.6m, and the impact of consultants converting to the Public Only Consultant Contract on income continues to be evident.

The Committee noted that following consideration by the CEO of the Quarter 1 2026 financial position under the Performance and Accountability Framework (PAF) 2026, three Regional Areas were placed into Tier 3 escalation and the remaining three into Tier 1 escalation with effect from 29 April 2026. The A/CFO outlined to the Committee the escalation requirements and the associated processes in cases where required improvements are not achieved.

4.2 Health Budget Oversight Group (HBOG) – minutes

The Committee noted the minutes of the Health Budget Oversight Group (HBOG) of 13 November 2025 and 11 December 2025. The Committee discussed data quality as IFMS is rolled out, and the CFO advised that work is underway to address data issues, with significant progress expected this year.

4.3 Annual Financial Statements (AFS) 2025 – progress update

The Asst CFO advised the Committee that there are no material adjustments to the Revenue Income and Expenditure (I&E) Statement, which was approved by the Board on 27 March 2026. However, a review of the Capital I&E Statement is ongoing, and an amendment may be required in relation to deferred capital funding.

The Committee noted that the Statement of Internal Control is being updated particularly in the areas advised by the Asst CFO. These are not deemed to be material and included updates to the areas of Non-compliant procurement; Duplicate Payments; Oversight of Grants to Outside Agencies; Fixed Assets; and High Earners.

The Committee discussed High Earners and issues including timing of arrears and requested that measures be taken to reduce arrears and improve visibility of real-time costs.

The Committee reviewed and noted the following documentation.

• Operating and Finance Review (OFR)
• Letter of Representation 2025
• Chair’s Comprehensive Report

4.4 Contract Approval Requests

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

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

5.1 Internal Audit Monthly Report - Activity Highlights - Q1 2026

The CIA presented a report to the Committee covering Audit Activity and Plan Status for Q1 2026; including audits issued, key control findings arising from audit reports; the implementation status of audit recommendations as at 31 March 2026, National Performance Indicator performance; and a summary of open recommendations by area.

The Committee noted that 21 audits were scheduled to commence in Q2 2026 and received an update in relation to the Internal Audit Plan Status at 31 March 2026. The Committee further noted that 10 audit reports issued in Q1 2026, resulting in 25 recommendations issued and 44 management actions. The Committee noted 72 management actions open overall with 29 (40%) overdue for implementation.

The CIA advised the Committee that the Audit of Governance and Equity in Patient Access and Waiting List Management at CHI is progressing to its final stage and the final report is expected in June and will be circulated to the Committee.

The Committee discussed the Ministerial request for an audit of the ARAS Addiction Service, delivered by the Peter McVerry Trust, within the South-Western Regional Drug & Alcohol Task Force (SURF) area, noting the concerns raised following a review undertaken by a SURF subgroup in relation to service delivery, value for money, governance and aspects of financial compliance. Separately, it was agreed that previous questions raised by Committee members would be forwarded to the CIA.

The Committee expressed concern regarding oversight of Section 38 and 39 agencies and sought assurance that available governance and monitoring mechanisms are being used effectively. Management confirmed that Service Arrangements contain audit and inspection provisions, including rights under Sections 12 and 14 to undertake reviews where concerns arise, and that these powers have been used where necessary. A copy of Service Arrangements is to be circulated to Committee members.

5.2 Internal Audit Internal Quality Assessment (IQA) – update on recommendations

The Committee noted the update from the CIA in relation to the progress on implementing recommendations and improvements from Internal Audit’s Internal Quality Assessment 2025. The CIA advised that the focus for 2026 is on embedding the revised methodology framework, completing documentation updates, and strengthening operational systems to support ongoing compliance with the Global IIA Standards.

The Committee noted the update and the number of recommendations that remain, the four categories of outstanding recommendations, recognising that many are interrelated and are being progressed through broader workstreams rather than as standalone actions.

6.1 Q1 2026 Corporate Risk Register Report

The Chief Risk Officer (CRO) presented to the Committee the Q1 2026 Corporate Risk Register (CRR) Report. The Committee noted the 11 Open risks and 7 Watched risks on the Register, of which 5 Open risks were rated High, 6 Open risks rated Medium. In relation to R011 Scheduled Care Services, the Committee noted the increase in risk rating, which arose from insights at a recent REO workshop, and the proposal that the Climate Change risk is closed this quarter and replaced by an Energy Targets risk, aligned to HSE deliverables.

The CRO advised the Committee of a workshop on geopolitical risks (including the Middle East conflict and potential fuel disruption) held in April 2026 with key stakeholders, which considered potential impacts, risk mitigations and response plans, with a further workshop to be held going forward. Further engagements are also planned to consider the potential inclusion on the CRR in relation to third party risk management and implications of Artificial Intelligence expansion within the HSE.

In discussing the CRR, the Committee suggested there may be value in identifying the root causes and key drivers behind the principal risks, noting a potential disconnect between some risks and controls. Using UEC services as an example, capacity was highlighted and joined-up planning as possible drivers and suggested actions could better reflect areas within the organisation’s control, such as agile planning. It was noted that further controls are included and agreed to review the detail and alignment between risks and controls.

The Committee noted that the External Review of the HSE Risk Management Framework by the Institute of Public Administration (IPA) is ongoing.

6.2 Protected Disclosures Update

The AND CCF provided a briefing to the Committee on Protected Disclosures as at 30 April 2026, noting the summary of activity; Open Cases prior to 2026; Protected Disclosures Process – Monitoring Performance and Outcomes; and the continuous Improvement Initiatives.

As requested at a previous meeting the AND CCF provided to the Committee an overview of allegations upheld/partially upheld from protected disclosures managed by the National

Office for Protected Disclosures (NOPD), and noted the number of disclosure reports handled by the NOPD since 1 January 2023; the Outcome Analysis; themes identified; and a summary of Protected Disclosures upheld or partially upheld 2023 to end Q1 2026.

The Committee discussed the number of upheld and partially upheld disclosures and emphasised the importance of monitoring implementation of recommendations arising from upheld disclosures to reduce the risk of repeat issues. It was noted that the establishment of appropriate ways of working/reporting relationships between the CCF and those responsible for compliance in the regions will be key to all compliance activities.

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

7.1 Regional analysis of distribution of projects

The National Director for Strategic Health Infrastructure and Capital Delivery (ND SHICD) provided the Committee with an update in relation to the capital investment over the past 6 years in both Health (approx. 6.14bn) and Disability (€90m) overarching care groups across Health Regions, which covers both major and minor capital funding categories and a full range of programmes with approximately 409 major capital projects completed in Health and approximately 77 major capital projects completed in Disabilities.

The Committee noted per region the number of major capital projects completed; health and disability expenditure; and the national expenditure between 2020 and 2025.

The Committee discussed with the ND SHICD reasoning why Public Private Partnership (PPP) expenditure is reported nationally rather than regionally, noting that PPP projects are funded through a centrally managed national contract and budget, although facilities are located across regions. And in relation to the disability capital investment in the context of regional disability needs, it was noted that work is underway to assess future service demand and inform investment planning.

7.2 Provision of community beds for older persons (in relation to closing out HIQA replacement programme)

The ND SHICD provided the Committee with an update in relation to the provision of community beds for older persons, noting that an infrastructure programme was established in 2016 to provide works to originally envisaged 90 Residential Care Centres,(currently 95 projects, as a result of phasing and sequencing) inclusive of 10 No. units originally planned to be delivered via a PPP (reduced to 7) The Committee noted the current programme status, with 78% at tender/construction stage or complete, a further 13% at design stage, and expenditure to date amounting to €622m with future expenditure estimated to be of a similar scale to complete the programme.

In response to the Committee’s query on completion, ND SHICD advised that the programme is expected to conclude but is unlikely to achieve 100% delivery, as some projects, are no longer expected to proceed. A paper will be brought forward outlining the final position, with delivery currently estimated at approximately 91% of the original programme and decisions on remaining projects to be finalised over the next 12–24 months.

7.3 Quarterly Report - final account for completed construction projects – verbal update

ND SHICD provided a verbal update confirming that there are no final accounts agreed for Q1 2026 for completed construction projects.

7.4 Update on Property Disposals

The ND SHICD provided an update to the Committee of the progress made under the accelerated disposal programme implemented in 2025 to streamline the release of surplus or underutilised properties during 2025 and Q1 2026, which included the current portfolio position. The Committee noted 142 buildings deemed surplus to HSE requirements as at end of Q1 2026; the composition of the current disposal pipeline; the ongoing prioritisation of complex and strategic campus site disposals; and the key risks to delivery, including legal, planning and title complexities.

The Committee discussed the need to ensure that value generated through Land Development Agency transfers is recognised and queried whether stronger alignment could be achieved with the ND SHICD and CFO to reflect savings delivered to the State, noting that capital and revenue budgets are treated separately but it was agreed that the ND SHICD would follow up with the CFO to explore any potential opportunities.

The Committee discussed the key focus for 2026 of the progression of the disposal of major campus sites, and discussed Residential Zoned Land Tax, and the possibility of retrospective recovery under the legislation, including following disposal of a site, and agreed that clarification would be sought.

7.5 Building Contracts & Properties

The Committee considered the details of the following proposed contracts which was presented by the ND SHICD.

The Committee agreed to recommend to the Board for approval the following contracts:

1. 1. 1. Contract Award for construction of a 3 Storey extension to the Corduff Primary Care Centre for the Enhanced Community Care Programme
      2. Proposed extension of lease of Primary Care Centre at Youghal, Co. Cork to provide a Permanent National Ambulance Service Training College

The Chair thanked the Committee and SLT members. The meeting ended at 12.53pm

Terms of Reference: Audit and Risk Committee